中国肺癌筛查与早诊早治指南(2021,北京)

肺癌是中国发病率和死亡率最高的恶性肿瘤。筛查与早诊早治是降低人群肺癌死亡率的有效措施。制定符合中国国情的肺癌筛查与早诊早治指南,将极大推进中国肺癌筛查的同质性和优质性,提高肺癌筛查的效果。指南受国家卫生健康委员会疾病预防控制局委托与指导,由国家癌症中心发起,联合多学科专家共同制定。指南整合近年来国内外在肺癌筛查与早诊早...     

我国城市癌症早诊早治项目研究现状

对国内外癌症早诊早治工作开展情况、我国城市癌症早诊早治项目的优势、不足及其优化策略进行综述，提出我国城市癌症早诊早治项目的发展前景与展望，以期为我国城市癌症早诊早治的优化、完善提供参考。     

数字

癌症高危人群肺癌占比四成2013年3月广州正式启动的"城市癌症早诊早治项目"已基本完成高危人群筛查调查问卷。共完成问卷调查13 828份,录入10 447份,评估8459份,其中肺癌1756人,食管癌155人,胃癌843人,肝癌520人,大肠癌340人,乳腺癌534人,肺癌高危人群占比超过40%。(来源:南方日报)http://t.cn/z8IU0Ql     

北京5年内将为25万人免费查“五癌”

自2012年起,北京将连续5年开展城市癌症早诊早治项目,每年为5万名高危人群免费筛查肺癌、乳腺癌、大肠癌、上消化道癌、肝癌。目前,北京市卫生局正在针对这5种癌症,制定高危人群界定标准、癌症自我检查指南、高危人群筛查检查目录和体检套餐。统计数据显示,目前,恶性肿瘤已成北京居民首位死因,其中肺癌、乳腺癌、大肠癌、上消化道癌、肝癌发病率和死亡率均较高。2012年北京市卫生局发起防控慢性病的＂阳光长城计划＂,将肿瘤防治行动列为四大慢性病防治行动之一。     

100例妇女乳腺普查结果分析

乳腺癌的发病率在全球范围内呈现上升趋势，我国乳腺癌发病率明显低于欧美国家，但是死亡率却明显升高，我国乳腺癌死亡率高的主要原因是乳腺癌早诊率明显偏低，广泛应用的乳腺癌人群普查与合理化的治疗是其死亡率下降的主要原因，而普查是乳腺癌早诊和早治的基础。超声又作为一种安全易行、无创性、无痛苦、方便实用的诊断工具在普查中发挥了作用。     

早孕期唐氏综合征产前筛查结果的回顾性分析

目的:分析并评价早孕期唐氏综合征筛查系统在我院开展情况,为提高实验室产前筛查质量及产前筛查诊断准确率提供指导依据.方法:选择2017年1月~2019年3月在我院产科门诊接受早孕期唐氏综合征筛查的7547例单胎妊娠孕妇作为研究对象,在对孕妇进行充分知情告知后进行超声NT检测,同时抽取孕妇外周血,检测相生化关标记物,使用风险评估软件评估胎儿罹患21-三体、18-三体综合征的概率.对筛查结果高风险的孕妇即刻进行电话召回进行产前诊断.结果:在7547例接受早孕期唐氏综合征筛查的孕妇中,筛查结果高风险共计121例(阳性率1.60%),自愿接受羊水或脐血穿刺产前诊断检查70例,发现染色体核型异常6例;未接受产前诊断检查的51例孕妇中发现其他异常4例.结论:早孕期唐氏综合征筛查有利于早期诊断胎儿染色体异常,可使产前诊断时机推前,对防止出生缺陷,提高人口素质具有重要临床意义.     

乳腺癌高风险人群定期筛查的依从性及其影响因素研究

目的调查影响乳腺癌高风险人群对乳腺癌定期筛查的依从性和行为因素,提高乳腺癌定期筛查率。方法对201例乳腺癌高风险人群定期筛查情况进行调查,并分析其筛查依从性的影响因素。结果乳腺癌高风险人群定期筛查率为51.24%,年龄、月收入、乳腺癌危险因素、筛查报告解读为影响乳腺癌高风险人群定期筛查的独立危险因素。结论乳腺癌高危人群定期筛查率较低,建议制订相应的干预措施提高筛查率,达到乳腺癌早期防治的目的。     

淮南市潘集区居民对癌症和食管癌防治知识的认知情况调查

目的了解安徽省淮南市潘集区居民对癌症综合知识和食管癌防治知识的认知现状,为进一步的健康干预提供依据。方法采取整群抽样的方法,抽取潘集区发病率较高的乡镇平圩镇作为调查现场,以当地2014年参加食管癌筛查的1075名居民作为调查对象进行问卷调查,对调查结果评分后进行相应统计分析。结果本次调查中,有效问卷共1075份,有效率100%。调查对象癌症综合知识和食管癌防治知识平均得分(52.15±8.35)分,其中60分以上(及格)共647人,及格率60.2%。结论潘集地区居民对于癌症和食管癌防治知识的综合认知水平还较低,有待开展进一步的健康教育工作,以促进相关知识在当地的普及,增加当地居民参加食管癌筛查和早诊早治的信心和积极性,从而为提高当地食管癌筛查与早诊早治率以及居民键康水平与生存质量的相关策略措施的实施提供群众基础。     

胃镜前口服用药的研究进展*

胃癌在我国高发,早诊早治是关键。高危人群胃镜筛查是发现早期胃癌的重要举措,胃镜前服用去泡剂及去黏液剂能改善胃镜清晰度、缩短内镜操作时间、减少早癌的漏诊。联合用药优于单一用药,但患者于胃镜前何时服药及服药后采取何种体位效果最佳仍未达成共识。该文就去泡剂及去黏液剂应用的进展情况作一综述。     

应用内镜普查武宁县早期食管癌的发病情况

食管癌是我国常见的恶性肿瘤之一,近几十年来,虽然对食管癌进行了较为深入的研究,但是食管癌的死亡率仍居高不下[1].肿瘤专家公认,降低恶性肿瘤病死率和提高生存率的关键在于"三早"(早期发现、早期诊断及早期治疗)和近几年提出的"三前"(癌前发现、癌前诊断及癌前治疗) .早期食管癌的5 年生存率可达90 %以上[2].2005 年卫生部将食管癌筛查和早诊早治项目纳入中央补助地方公共卫生专项资金,并于2006年实施,武宁县是目前江西省唯一的一个项目点,2010年8-9月武宁县人民医院对武宁县罗坪镇1 000例目标人群实行内镜普查,探讨武宁县食管癌的发病情况,以及为今后进一步开展此项目积累经验.现将普查结果报告如下.     

乳腺癌患者一级亲属对乳腺癌早期筛查认知情况调查

目的了解乳腺癌患者一级亲属对乳腺癌早期筛查认知情况及探讨其影响因素,为临床针对性开展护理干预和健康教育提供理论依据和指导。方法选取2013年8月至2014年1月本院乳腺治疗中心乳腺癌患者一级亲属213例作为研究对象,采用问卷调查的形式分析乳腺癌患者一级亲属对乳腺癌早期筛查认知情况及其影响因素。结果乳腺癌患者一级亲属对乳腺癌疾病相关知识获取途径主要来源于亲属住院期间的健康教育(29.11%)和医护人员(24.41%);在乳腺癌高危因素认知上主要有认为其发病与乳腺良性疾病史(65.73%)、长期服用激素(64.32%)和家族史(61.03%)有关,在临床表现上,主要认为乳腺癌的临床表现为乳房肿块(88.26%);在早期筛查方法上,主要通过乳房临床检查(52.11%);乳腺癌相关知识认知程度与乳腺癌患者一级亲属居住地、有无职业和文化程度有关(P0.05),与年龄和婚姻状况无关(P0.05);乳腺癌患者一级亲属主要希望通过邮寄资料获取相关健康教育知识。结论乳腺癌患者一级亲属对乳腺癌早期筛查认知不足,应加大预防乳腺癌相关知识的健康教育,并注意不同居住地、职业和文化程度的宣传教育方式,努力提高防癌意识。     

Treatment considerations for the elderly person with cancer

In an aging population, the number of patients with cancer continues to rise. Little research has focused on the treatment of cancer in the elderly. Therefore, the treatment for various cancers differs across the healthcare system. A uniform approach in assessing the elderly person with cancer is lacking. This article describes two case studies in the elderly population, focusing on two common cancers: acute myelogenous leukemia and breast cancer. Common side effects of treatment and determinants of treatment options are discussed. It is important that the elderly receive appropriate screening, early detection, treatment, and management of comorbidities.     

乳腺磁共振背景实质强化的研究进展

乳腺癌作为女性最常见的恶性肿瘤,其发病率及死亡率都较高,且不同分子亚型乳腺癌生物学表现及临床治疗、预后各不相同,寻找乳腺癌针对性和个性化诊断及治疗的影像学标记物是目前研究的热点。乳腺背景实质强化(background parenchymal enhancement,BPE)是正常纤维腺体组织的生理性强化,受多种因素的影响,并在乳腺疾病的诊断及治疗预后方面有着重要的诊断价值,BPE水平升高与乳腺癌发病风险相关,并可能评估乳腺癌新辅助化疗的疗效。作者就BPE的影响因素及在乳腺癌筛查、诊断及治疗评估中的作用加以综述。     

乳腺超声在乳腺癌筛查中的研究进展

乳腺癌已成为全球发病率最高的恶性肿瘤,筛查可提高其早期诊断率,对乳腺癌的治疗及预后具有重要意义。乳腺超声是乳腺癌筛查的常用方法,不仅可作为乳腺X线的补充筛查手段提高检出率,且可单独用于乳腺癌筛查。近年来,剪切波弹性成像、超声造影等超声新技术在乳腺癌筛查中的应用正迅速发展。本文将对乳腺超声在乳腺癌早期筛查中的临床应用进展进行综述,以期为临床医生提供借鉴和参考。     

短期规范化培训教育模式对社区医师乳腺癌筛查知识水平的影响

目的 评估短期规范化培训对社区医师乳腺癌相关筛查知识的影响,为社区医师培训教育模式的优化提供依据.方法 在为期8学时的关于乳腺癌筛查规范化培训教育的课程前后,对127位社区医师进行乳腺癌筛查、诊治与预防知识的两次问卷调查;将收集到的资料录入计算机,对比短期规范化培训前后对问卷所涉及的22个问题的回答准确率.结果 问卷调查结果显示：培训课程后社区医师对于乳腺癌的好发年龄、症状与体征、早期诊断与治疗、以及靶与内分泌治疗方面,知晓率明显提高（P〈0.05）;在乳腺癌的筛查与预防方面,社区医师培训结束后对于肿瘤家族史、个人生育史、生活习惯、精神压力等乳腺癌高危因素的知晓率也获得显著改善（P〈0.05）.结论 短期规范化培训教育模式对社区医师乳腺癌筛查知识的影响是显著的,应成为未来培训社区医生的一个常规的继续教育模式.     

Cancer screening in Singapore, with particular reference to breast, cervical and colorectal cancer screening

Cancer is the leading cause of mortality in Singapore, accounting for 27.1% of deaths in 2004. The most common cancers are those of the lung, colon and rectum, liver, stomach, and prostate in men; and breast, colon and rectum, lung, ovary and cervix in women. Singapore has the highest age-adjusted breast cancer incidence in Asia. National population screening programmes have been implemented for breast and cervical cancer. BreastScreen Singapore (BSS), the first population-based nationwide mammographic breast-screening programme in Asia, was launched in 2002, incorporating international standards and practice guidelines. For improved quality assurance, two-view screening mammography is carried out. From January 2002 until March 2004, BSS conducted over 84,000 screens, with an overall recall rate of 9.5%, and an overall invasive cancer detection rate of 4.48 per 1000 screened. Close to 30% of the cancers diagnosed was ductal carcinoma in situ. Papanicolaou (Pap) smear screening for cervical cancer has been available opportunistically since 1964. The national CervicalScreen Singapore programme was launched in 2004, aiming to achieve coverage of 80% of targeted women by 2010. Colorectal cancer currently has the highest incidence of all cancers in Singapore. The health authorities advocate colorectal cancer screening for the average risk population, starting from age 50 years, but in the absence of a national screening programme, the reliance is on opportunistic screening.     

Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care

Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in early identification and treatment of breast cancer-related lymphedema (BCRL). Early intervention may reduce the need for intensive rehabilitation and may be cost saving. This perspective article compares a prospective surveillance model with a traditional model of impairment-based care and examines direct treatment costs associated with each program. Intervention and supply costs were estimated based on the Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast cancer who were receiving interval prospective surveillance, assuming that one third would develop early-stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the paradigm of physical therapy toward a prospective surveillance model is warranted.     

乳腺癌筛查工作中妇幼保健院的角色和任务

乳腺癌是威胁女性健康和生命的最常见的恶性肿瘤。目前，乳腺癌诊疗领域具有规范的诊疗标准，通过筛查而早期发现并尽早治疗是乳腺癌防控工作的有效措施。国家非常重视慢性病防控工作，“健康中国2030”规划纲要提出到2030年，总体癌症5年生存率提高15%，其中乳腺癌生存率的提高至关重要。我国妇幼保健系统在长期实践中形成了“县、乡、村”三级妇幼卫生服务网络以及群防群控和临床诊疗相结合的有效模式，在开展乳腺癌筛查方面具有独特优势。北京市乳腺癌筛查工作开展10余年来，形成了妇幼保健院为主导的组织构架和筛查体系，在乳腺专科的引领下，筛查的技术水平不断提升。在卫生行政部门的支持下，妇幼保健院应利用管理和体系优势开展乳腺癌筛查相关研究，探索适合中国人群的乳腺癌筛查模式。     

Impact of breast cancer patients' awareness on attendance at screening

SHIEH S.-H., CHEN H.-C., TSAI W.-C., KUO S.-Y., TSAI Y.-F. & LU C.-H. (2012) Impact of breast cancer patients' awareness on attendance at screening. International Nursing Review59, 353-361 Aim: The purpose of this study is to investigate the impact of breast cancer awareness on the attendance for screening among women with breast cancer prior to diagnoses of breast cancer. Background: Breast cancer is the most commonly diagnosed cancer for women in Taiwan and its incidence rate continues to increase. However, screening for breast cancer is still not common even if the incidence rate has topped the list from 2003 to 2010. Methods: A cross-sectional study was conducted among women diagnosed with breast cancer. Subjects (535 women) were recruited from two medical centres in central Taiwan. Information on attendance for breast cancer screening was collected by self-report. Chi-square test and logistic regression were utilized to analyse the relationships between awareness of breast cancer and attendance at screening. Findings: The results indicated that pre-diagnostic awareness of 'the concept of early treatment relating to higher cure rate'[odds ratio (OR): 4.09; 95% confidence interval (CI): 1.12-14.9], 'various breast cancer screening methods' (OR:3.00; 95% CI: 1.23-7.30), 'the coverage of breast cancer screening programme in the National Health Insurance' (OR:1.76; 95% CI: 1.03-3.02) and 'breast self-examination after each menstrual cycle' (OR:3.42; 95% CI: 1.99-5.87) were all significantly associated with the screening procedures performed. Conclusions: Findings of this study indicated that particular attention should be paid towards enhancement of women's knowledge for prevention and early detection of breast cancer through educational efforts by nurse professionals, medical institutions and/or civil organizations.     

钼靶X线下触诊阴性乳腺病灶132例的诊治分析

目的探讨钼靶X线下触诊阴性乳腺病灶的定位切除活检在乳腺癌早期诊断与治疗中的价值。方法132例女性患者146个由钼靶X线发现的触诊阴性乳腺病灶,采用钼靶定位进行切除活检。结果全组146个临床触诊阴性乳腺病灶中,乳腺癌39个（39例患者）占26.7%,乳腺癌分期：0期10个（25.6%）,Ⅰ期19个（48.8%）,Ⅱ期7个（17.9%）,Ⅲ期3个（7.7%）。随访29个月,仅1例Ⅲ期患者出现肝脏转移,其余患者均无癌生存。结论钼靶X线发现的临床触诊阴性乳腺癌大多数为早期癌,预后良好,对于此类病灶应当积极进行定位切除活检,以利于临床触诊阴性乳腺癌的早期诊断与治疗。