上海市宝山地区社区居民大肠癌筛查结果分析

目的:分析上海市宝山地区社区居民大肠癌筛查结果,探究国内大肠癌筛查模式在大肠癌诊断中的临床意义.方法:选取2017年06月至2019年06月上海市宝山地区按照社区大肠癌筛查流程完成筛查且评定为初筛阳性,并至我院完成全结肠镜诊断性检查且获取检查结果的人群作为研究对象,共769例.根据肠镜结果,分成病变组和正常组,分析两组...     

居民电子健康档案在社区大肠癌筛查中的应用

健康档案可以通过健康教育、门诊因症就诊及体检,对人群完成危险度问卷来确定高危人群,对高危人群进行个体化医学干预和监测,同时建立以社区卫生服务中心为基础的实时交互信息化监测网络.由此建立依托社区卫生服务全科团队,融入健康教育、筛查、高危人群管理,以及转诊的多元化监测体系,突破了单纯以临床技术为基础的肿瘤早发现模式.     

上海市奉贤区2014—2016年社区居民大肠癌筛查结果分析

摘 要：［目的］ 分析上海市奉贤区第二轮社区居民大肠癌筛查项目的效果。［方法］ 对2014—2016年上海市奉贤区常住居民进行第二轮大肠癌筛查,采用危险度评估问卷调查结合大便隐血试验（FOBT）的筛查模式,初筛阳性者建议全结肠镜检查,并对结果进行分析。［结果］ 3年内共计完成初筛63 156人,初筛阳性率31.58%,男性和女性 60~岁组和70~岁组人群初筛阳性率均为最高;肠镜检查依从率为45.25%,男性肠镜检查依从率显著高于女性（χ2=7.44,P＜0.05）,且80~岁年龄组的肠镜检查依从率最低;总病变检出率19.40%,总病变检出率随着年龄增长呈上升的趋势（χ2=32.86,P＜0.05）,且男性显著高于女性,差异有统计学意义（χ2=152.94,P＜0.05）;单一评估阳性组的肠镜检查依从率、总病变检出率、癌及癌前病变检出率分别为39.55%、16.58%和7.48%,均低于单一大便隐血试验（FOBT）阳性组（分别为46.26%、20.80%和10.46%）,差异均有统计学意义（χ2分别为132.00、15.97和14.34,P均＜0.05）;9025例肠镜检查共检出大肠癌147例,早期比例为39.25%。［结论］大肠癌筛查项目通过初筛和全结肠镜检查,显著提高大肠癌早期及癌前病变的检出率,对于降低大肠癌的死亡率和延长生存时间具有重要意义。由于奉贤区组织发动工作到位,肠镜检查依从率高于其他城区。     

广州市社区人群大肠癌筛查实践研究

大肠癌是我国严重危害居民健康的重要癌症之一,发病率和死亡率均呈明显上升趋势.而大肠癌筛查能够显著降低人群的死亡率,是降低大肠癌疾病负担的重要措施.广州市于2015年将社区人群大肠癌筛查纳入重大公共卫生项目,在全市范围内进行筛查实践.全文就筛查实践过程所涉及的技术要点和可能问题进行介绍和讨论,为项目实施提供可靠依据.     

2015~2018年广州市海珠区大肠癌筛查效果分析

目的∶通过对 2015 ~2018 年广州市海珠区大肠癌初筛和肠镜检查结果的分析,评价其筛查效果,为基于人群的大肠癌筛查工作提供依据。方法∶采用危险因素评估问卷和两次粪便隐血检测（FOBT）进行初筛,初筛阳性者转介至定点医疗机构参与全结肠镜检查,所有初筛和肠镜检查数据录入广州市大肠癌筛查信息系统。结果∶2015～ 2018 年共63 922 人参与大肠癌筛查,初筛阳性人数 13 459 人,初筛阳性率21.05% ,女性两次参与筛查的积极性均明显高于男性（P<0.001）,但男性两次 FOBT 阳性率均高于女性（P<0.001）,且整体初筛阳性率也是男性高于女性（P<0.001）。FOBT阳性率和整体初筛阳性率随着年龄增长而增加（P<0.001）。初筛阳性者中2 977 人参与肠镜检查,肠镜检查顺应性22.12%。检出进展期腺瘤250 例,大肠癌97例。男性大肠癌检出率是女性的2.24 倍。随着年龄增长,大肠癌检出率有所升高（P<0.001）,70～74 岁组检出率是50～54 岁的5.74 倍。早诊率85.71%（300/ 350）。结论∶大肠癌筛查能有效提高癌前病变和早期癌检出率,降低大肠癌发病率和死亡率,对于大肠癌的早诊早治有重要意义。     

乌鲁木齐市社区居民癌症筛查依从性及影响因素分析

[目的]了解社区肿瘤高危人群参加筛查的依从性及影响因素,为提高癌症筛查效果提供依据.[方法]采用随机抽样的方法选取研究对象,并按照是否参加筛查分为筛查组(n=439)和非筛查组(n=529),采用问卷调查的方法对依从性影响因素进行分析.[结果]筛查人群总体依从性为30.04％(10297/34282).多因素Logistic回归分析显示受教育程度、肿瘤家族史、筛查部位疾病史、了解本次筛查目的和周围有认识人参加筛查是影响筛查依从性的主要因素.[结论]乌鲁木齐市社区患癌高危人群筛查依从性较低,应加强癌症筛查的健康宣教工作,尤其是受教育程度低、无肿瘤家族史和疾病史的人群,提高认知程度,进一步提高依从性.     

大肠癌危险度评估问卷在社区筛查阳性居民次年复筛中的有效性分析

摘 要：［目的］ 描述上海市50～74岁社区大肠癌筛查阳性对象复筛时危险度评估问卷阳性条目前后两年应答的一致性,评价大肠癌危险度评估问卷的有效性。［方法］ 分析2015～2016年上海市松江佘山与新桥社区大肠癌筛查人群信息,描述初筛阳性居民次年再次筛查时大肠癌危险度评估问卷各条目阳性率变化情况,并利用Logistic回归分析危险度评估条目两年阳性应答一致性的影响因素。［结果］ 2015年,两社区共计18 051人参与大肠癌筛查项目,6205人（34.4%）初筛阳性,其中4093人（66.0%）再次参与次年筛查。首年报告阳性,次年报告阴性的情况在生活负性事件史（84.4%）及黏液血便史（81.3%）条目中发生率最高;个人癌症史（36.5%）、个人息肉史（44.3%）与一级亲属肠癌史（47.2%）阳性对象亦有次年报告不一致情况。2015年经肠镜检出的肠癌患者中,2/6次年未报告个人癌症史;息肉或腺瘤检出者中,35.8%（58/162）次年未报告肠息肉史。多因素Logistic回归提示,婚姻状况、是否吸烟、首年粪便隐血试验（FOBT）结果、蔬菜水果摄入量与运动情况是阳性条目两年报告不一致的主要影响因素。［结论］ 大肠癌筛查项目初筛阳性居民次年危险度再评估时,问卷原阳性条目存在误报,可探索建立大肠癌筛查数据信息平台,充分利用历年筛查信息,提高问卷评估的有效性。     

隐血筛查空腔脏器癌症实践及思路分析

全文介绍秦德兴教授研制的“防癌隐血筛查试剂”在全国的实践应用，并与肿瘤标志物检测的临床意义进行比较，探讨空腔脏器癌症筛查思路。     

上海地区人群大肠癌筛查的研究和实践

以人群为基础的筛查可以降低大肠癌的死亡率,是控制我国大肠癌疾病负担的有效措施,制定和实施人群筛查策略应列入区域性癌症控制规划之中.上海于2011年在全国率先将“社区大肠癌筛查”列入重大公共卫生项目.全文就大肠癌筛查列入公共卫生项目后如何实施人群筛查所涉及的技术性和实施性问题进行介绍和讨论,为大肠癌筛查的政策制定和实施提供依据,也为其他癌症防治项目提供借鉴.     

痰隐血与胸片筛查肺癌比较研究

目的比较痰隐血与X线胸片筛查肺癌效果。方法2007年1至7月在云南省宣威市来宾镇对35—70岁近3万居民（来宾镇共有人口近9万人）作肺癌首次筛查,第一阶段先作胸部X线拍片,发现肺部阴影可疑者437例,再经CT精查,175例肺内有可疑占位病变,疑诊肺癌,其中30例有手术适应证,自愿接受手术治疗;术后27例病理确诊肺癌,另3例未见癌。4个月后除X线已确诊者外,进入第二阶段痰隐血筛查共25010例,每人发给痰盒一个,早晨深咳痰,做痰隐血检测,不变色为阴性（一）。变蓝色者为阳性,当即在痰变蓝色处用竹签挑痰,涂玻璃片一张,滴纯酒精2～3滴固定标本,送细胞学检查找癌细胞。结果痰隐血阳性共2429例,列为肺癌一级高风险人群,占筛查人群的9．71％（2429／25010）,其中弱阳性（＋）占66．73％（1621／2429）,涂片发现癌细胞9例,癌检出率0．56％（9／1621例）;阳性（＋＋）615例,检出癌7例,癌检出率1．14％（7／615）。强阳性（＋＋＋）194例,检出癌6例,癌检出率3．09％（6／194）。痰隐血量越高肺癌检出率越高;细胞学报告上皮细胞有中度或重度不典型增生者281例,可疑癌或癌者22例,经薄层CT确诊早期肺癌者7例,这些患者先前X线片未见异常。另15例痰癌细胞阳性患者,CT未找到原发病灶,待观察。结论痰隐血与X线胸片筛查肺癌相比的优点：（1）痰隐血比X线胸片可省90％资源;（2）痰检出的肺癌多数是早中期,在胸片上看不到;（3）痰细胞不典型增生率为11．6％,提前5—10年预报癌前病变,警示肺癌高风险,X线胸片无法做到。     

To scope or not - the challenges of managing patients with positive fecal occult blood test after recent colonoscopy

BACKGROUNDColorectal cancer (CRC) is a major health problem. There is minimal consensus of the appropriate approach to manage patients with positive immunochemical fecal occult blood test (iFOBT), following a recent colonoscopy.AIMTo determine the prevalence of advanced neoplasia in patients with a positive iFOBT after a recent colonoscopy, and clinical and endoscopic predictors for advanced neoplasia.METHODSThe study recruited iFOBT positive patients who underwent colonoscopy between July 2015 to March 2020. Data collected included demographics, clinical characteristics, previous and current colonoscopy findings. Primary outcome was the prevalence of CRC and advanced neoplasia in a patient with positive iFOBT and previous colonoscopy. Secondary outcomes included identifying any clinical and endoscopic predictors for advanced neoplasia.RESULTSThe study included 1051 patients (male 53.6%; median age 63). Forty-two (4.0%) patients were diagnosed with CRC, 513 (48.8%) with adenoma/sessile serrated lesion (A-SSL) and 257 (24.5%) with advanced A-SSL (AA-SSL). A previous colonoscopy had been performed in 319 (30.3%). In this cohort, four (1.3%) were diagnosed with CRC, 146 (45.8%) with A-SSL and 56 (17.6%) with AA-SSL. Among those who had a colonoscopy within 4 years, none had CRC and 7 had AA-SSL. Of the 732 patients with no prior colonoscopy, there were 38 CRCs (5.2%). Independent predictors for advanced neoplasia were male [odds ratio (OR) = 1.80; 95% confidence interval (CI): 1.35-2.40; P < 0.001), age (OR = 1.04; 95%CI: 1.02-1.06; P < 0.001) and no previous colonoscopy (OR = 2.07; 95%CI: 1.49-2.87; P < 0.001).CONCLUSIONA previous colonoscopy, irrespective of its result, was associated with low prevalence of advanced neoplasia, and if performed within four years of a positive iFOBT result, was protective against CRC.     

厦门市海沧区结直肠癌筛查结果分析

目的通过分析厦门市海沧区结直肠癌的筛查结果,探索筛查的结直肠癌最佳方案,以期达到对结直肠肿瘤的早发现、早诊断和早治疗。方法 自2008年12月—2010年10月,采用中国癌症基金会推荐的结直肠癌筛查方案,对海沧区4个行政村40~74岁常住居民结合问卷调查和连续粪便隐血试验(Fecal occult blood test,FOBT)进行初筛,共8179人,实际接受筛查6380人。高危人群接受全结肠镜检查。结果 经问卷调查和FOBT检测,获得结直肠癌高危人群1035例。81.06%的高危者接受全结肠镜检查,结直肠癌和腺瘤息肉及其他病变检出率分别为1.67%和23.96%。问卷调查及FOBT均阳性者结直肠癌检出率显著高于单纯问卷调查阳性者或单纯FOBT阳性者(P＜0.05);FOBT两次阳性者结直肠癌检出率显著高于FOBT阴性和FOBT单次阳性检出率(P＜0.05)。FOBT检测阳性次数与结直肠癌检出率和腺瘤息肉及其他病变检出率呈线性关系(P＜0.05)。结论 调查问卷和连续粪便隐血试验筛查可明显缩小高危人群,大大降低筛查的工作量。     

Academic hospital staff compliance with a fecal immunochemical test-based colorectal cancer screening program

AIM: To measure the compliance of an Academic Hospital staff with a colorectal cancer (CRC) screening program using fecal immunochemical test (FIT). METHODS: All employees of “Attikon” University General Hospital aged over 50 years were thoroughly informed by a team of physicians and medical students about the study aims and they were invited to undergo CRC screening using two rounds of FIT (DyoniFOB^® Combo H, DyonMed SA, Athens, Greece). The tests were provided for free and subjects tested positive were subsequently referred for colonoscopy. One year after completing the two rounds, participants were asked to be re-screened by means of the same test. RESULTS: Among our target population consisted of 211 employees, 59 (27.9%) consented to participate, but only 41 (19.4%) and 24 (11.4%) completed the first and the second FIT round, respectively. Female gender was significantly associated with higher initial participation (P = 0.005) and test completion - first and second round - (P = 0.004 and P = 0.05) rates, respectively. Phy sician’s (13.5% vs 70.2%, P < 0.0001) participation and test completion rates (7.5% vs 57.6%, P < 0.0001 for the first and 2.3% vs 34%, P < 0.0001 for the second round) were significantly lower compared to those of the administrative/technical staff. Similarly, nurses participated (25.8% vs 70.2%, P = 0.0002) and completed the first test round (19.3% vs 57.6%, P = 0.004) in a significant lower rate than the administrative/technical staff. One test proved false positive. No participant repeated the test one year later. CONCLUSION: Despite the well-organized, guided and supervised provision of the service, the compliance of the Academic Hospital personnel with a FIT-based CRC screening program was suboptimal, especially among physicians.     

Diagnostic yield of a one sample immunochemical test at different cut-off values in an organised screening programme for colorectal cancer

BackgroundQuantitative immunochemical faecal occult blood tests have become the recommended tests for colorectal cancer screening. The aim of this study was to complete our knowledge on the performance of one of the quantitative immunochemical tests available, FOB-Gold, and to propose a possible strategy for an organised screening programme.Patients and methodsWithin the French organised screening programme, 23,231 average-risk individuals, aged 50–74 performed both a 3-day Hemoccult test and a 1-day FOB-Gold test. Performances of the immunochemical test were evaluated at different cut-off levels.ResultsThe positivity rate for the Hemoccult was 2.1% and for the FOB-Gold varied between 4.6% (cut-off value of 100 ng/mL, the lowest studied cut-off) and 2.1% (cut-off value of 352 ng/mL). The number of colonoscopies decreased with increasing cut-off values by 21.5% (150 ng/mL), 35.4% (200 ng/mL) and 53.3% (352 ng/mL). The corresponding miss rate for CRC was respectively 6.4%, 11.1% and 22.2%, and for advanced adenoma respectively 16.3%, 29.2% and 43.6%. Compared with the reference cut-off for the FOB-Gold (100 ng/mL) the miss rate for Hemoccult was 53% for CRC and 77% for advanced adenoma.ConclusionThe study suggests that in countries with colonoscopy facilities compatible with a screening test positivity rate of up to 5%, use of a 1-day test with a cut-off value between 100 and 150 ng/mL could be the recommended strategy. Further increasing the cut-off value up to the same positivity rate as Hemoccult could be used in areas with limited access to colonoscopy.     

Cutoff value determines the performance of a semi-quantitative immunochemical faecal occult blood test in a colorectal cancer screening programme

Background:

The cutoff of semi-quantitative immunochemical faecal occult blood tests (iFOBTs) influences colonoscopy referrals and detection rates. We studied the performance of an iFOBT (OC-Sensor) in colorectal cancer (CRC) screening at different cutoffs.

Methods:

Dutch screening participants, 50–75 years of age, with average CRC risk and an iFOBT value ⩾50 ng ml⁻¹ were offered colonoscopy. The detection rate was the percentage of participants with CRC or advanced adenomas (⩾10 mm, ⩾20% villous, high-grade dysplasia). The number needed to scope (NNTScope) was the number of colonoscopies to be carried out to find one person with CRC or advanced adenomas.

Results:

iFOBT values ⩾50 ng ml⁻¹ were detected in 526 of 6157 participants (8.5%) and 428 (81%) underwent colonoscopy. The detection rate for advanced lesions (28 CRC and 161 with advanced adenomas) was 3.1% (95% confidence interval: 2.6–3.5%) and the NNTScope was 2.3. At 75 ng ml⁻¹, the detection rate was 2.7%, the NNTScope was 2.0 and the CRC miss rate compared with 50 ng ml⁻¹ was <5% (N=1). At 100 ng ml⁻¹, the detection rate was 2.4% and the NNTScope was <2. Compared with 50 ng ml⁻¹, up to 200 ng ml⁻¹ CRC miss rates remained at 16% (N=4).

Conclusions:

Cutoffs below the standard 100 ng ml⁻¹ resulted in not only higher detection rates of advanced lesions but also more colonoscopies. With sufficient capacity, 75 ng ml⁻¹ might be advised; if not, up to 200 ng ml⁻¹ CRC miss rates are acceptable compared with the decrease in performed colonoscopies.     

New immunochemical fecal occult blood test with two-consecutive stool sample testing is a cost-effective approach for colon cancer screening: results of a prospective multicenter study in Chinese patients

The purpose of the study is to evaluate a new immunochemical fecal occult blood test method (Hemosure IFOBT), and compare it to the Guaiac-based chemical method (CFOBT) for colorectal cancer detection. A hypothetical sequential method (SFOBT), in which IFOBT was used only as a confirmatory test for CFOBT, was also evaluated. A total of 324 patients were recruited from 5 major hospitals in Beijing, China. For each patient, 3 consecutive stool samples were collected for simultaneous CFOBT and IFOBT tests, followed by colonoscopic examination. We compared the sensitivity and specificity of the 3 methods (CFOBT, IFOBT and SFOBT) in two settings, with the first 2 consecutive samples versus all 3 samples. Although the sensitivity for the detection of cancer and large (>20 mm) or multiple adenoma was similar for all 3 methods in the three-sample setting, in the two-sample setting IFOBT had higher sensitivity than SFOBT for detecting cancer (87.8% vs. 75.5%, respectively, p < 0.05) and large (>20 mm) or multiple adenomas (65.4% vs. 42.3%, respectively, p < 0.05). The IFOBT also had a higher specificity than the CFOBT (89.2% vs. 75.5%, respectively, p < 0.01) in "normal" individuals defined by colonoscopy in the three-sample setting. Comparing two-sample setting to the three-sample setting, both CFOBT and SFOBT showed significant loss of sensitivity for the detection of cancer as well as adenoma, whereas the sensitivity for IFOBT did not change significantly. Overall, IFOBT with two-sample testing showed compatible sensitivity and specificity to the three-sample testing, and had a lower relative cost per cancer detected than the three-sample testing. In conclusion, the new Hemosure IFOBT with two consecutive stool samples appears to be the most cost-effective approach for colon cancer screening.     

Quantitative fecal immunochemical tests for colorectal cancer screening

Fecal immunochemical tests (FITs) for hemoglobin (Hb) are increasingly used for colorectal cancer (CRC) screening. We aimed to review, summarize and compare reported diagnostic performance of various FITs. PubMed and Web of Science were searched from inception to July 24, 2017. Data on diagnostic performance of quantitative FITs, conducted in colonoscopy‐controlled average‐risk screening populations, were extracted. Summary receiver operating characteristic (ROC) curves were plotted and correlations between thresholds, positivity rates (PRs), sensitivities and specificities were assessed. Seven test brands were investigated across 22 studies. Although reported sensitivities for CRC, advanced adenoma (AA) and any advanced neoplasm (AN) varied widely (ranges: 25–100%, 6–44% and 9–60%, respectively), with specificities for AN ranging from 82% to 99%, the estimates were very close to the respective summary ROC curves whose areas under the curve (95% CI) were 0.905 (0.88–0.94), 0.683 (0.67–0.70) and 0.710 (0.70–0.72) for CRC, AA and AN, respectively. The seemingly large heterogeneity essentially reflected variations in test thresholds (range: 2–82 µg Hb/g feces) and showed moderate correlations with sensitivity (r = ?0.49) and specificity (r = 0.60) for AN. By contrast, observed PRs (range: 1–21%) almost perfectly correlated with sensitivity (r = 0.84) and specificity (r = ?0.94) for AN. The apparent large heterogeneity in diagnostic performance between various FITs can be almost completely overcome by appropriate threshold adjustments. Instead of simply applying the threshold recommended by the manufacturer, screening programs should adjust the threshold to yield a desired PR which is a very good proxy indicator for the specificity and the subsequent colonoscopy workload.     

Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy

There is increasing evidence that faecal immunochemical tests (FITs) for haemoglobin offer a number of advantages over traditional guaiac based faecal occult blood tests (gFOBTs). However, evidence on diagnostic performance from direct comparisons with colonoscopy findings in all participants in the average risk population is still sparse. We aimed for a head-to-head comparison of three quantitative FITs with a gFOBT among participants of the German screening colonoscopy programme. Pre-colonoscopy stool samples and colonoscopy reports were obtained from 2235 participants of screening colonoscopy in 2005–2009. To enhance comparability of diagnostic performance of the various tests, we assessed sensitivity, specificity, predictive values and likelihood ratios of FITs after adjusting the FIT cut-off haemoglobin (Hb) concentrations in such a way that FIT positivity rates equalled the positivity rate of the gFOBT. Colorectal cancer, advanced adenomas and other adenomas were found in 15 (0.7%), 207 (9.3%) and 398 (17.8%) participants. The gFOBT was positive in 111 (5.0%) participants, with sensitivities (specificities) for detecting colorectal cancer, any advanced neoplasm or any neoplasm of 33.3% (95.2%), 8.6% (95.4%) and 5.5% (95.2%). At the same positivity rate, all three FITs outperformed the gFOBT in all indicators. In particular, all sensitivities of FITs were approximately two to three times higher at increased levels of specificity. All differences were statistically significant, except for some of the performance indicators for colorectal cancer. In conclusion, FITs can detect much larger proportions of colorectal neoplasms even if their cut-offs are set to levels that ensure equally low positivity rates as gFOBT.     

Prevention of advanced colorectal cancer by screening using the immunochemical faecal occult blood test: a case-control study

To evaluate colorectal cancer screening with faecal occult blood testing (FOBT) in terms of prevention of advanced cancers, we conducted a case-control study in the areas where an annual screening programme with immunochemical FOBT has been offered to all inhabitants aged 40 years or over. Cases were 357 consecutive patients in the study areas clinically diagnosed as having advanced colorectal cancer or a tumour invading the muscularis propriae or deeper, that is, T(2)-T(4) in TNM classification. Three controls were selected for each case matched by gender, age, residential area and exposure status to screening within 1 year before case diagnosis. The odds ratios (ORs) of developing advanced cancer were calculated using conditional logistic regression analyses. The OR for those screened within 3 years before the diagnosis vs those not screened was 0.54 (95% confidence interval (CI) 0.29-0.99). The ORs were lower for rectum than for colon (0.32-0.73 and 0.84-1.18 for rectum and colon, respectively). For those screened within the past 3 years, OR of developing advanced cancer in the rectum was 0.32 ( 95%CI: 0.12-0.84). A screening programme with immunochemical FOBT can be effective for prevention of advanced colorectal cancer. Risk reduction appears to be larger for rectal than for colon cancer.British Journal of Cancer (2003) 89, 23-28. doi:10.1038/sj.bjc.6601002 www.bjcancer.com