癌症筛查和早诊早治——实现全民健康助力全面小康

摘 要：癌症防治工作是“打赢脱贫攻坚战,助力小康社会全面建成”的重要环节。开展常见癌症筛查和早诊早治,对改善癌症患者生存率和降低死亡率有重要意义,可显著降低居民因病致贫、因病返贫的可能性,亦是实现全民健康的重要措施。     

中国癌症筛查的发展、现状与挑战

癌症是我国的重大公共卫生问题,严重威胁我国居民健康。为减轻癌症造成的疾病负担,在党和政府的有力领导下,我国在癌症筛查和早诊早治方面取得了显著的成就。现今我国癌症筛查体系日趋成熟,常见高发癌种的筛查与早诊早治项目逐渐推广和普及。但我国癌症筛查工作仍存在诸多不足,政府仍需根据目前癌症筛查现状制定和推行相应政策,多措并举以提高我国癌症筛查效果。     

推进农村地区癌症早诊早治 提高居民健康水平

对癌症高危人群实行筛查策略是降低癌症负担的重要方式。为降低农村地区消化道恶性肿瘤负担,我国于2007年启动了一项人群为基础的癌症筛查项目,针对项目地区符合纳入标准的高危人群开展消化道恶性肿瘤的筛查与早诊早治工作。在党中央和各级政府的领导下,农村地区癌症防治体系逐步完善,癌症筛查与早诊早治水平显著提升,居民生活质量也大幅度提升。     

黑龙江省2013—2014年度城市癌症筛查分析

目的 评价2013—2014年度黑龙江省城市癌症早诊早治项目筛查结果 的意义。方法 在黑龙江省哈尔滨市和大庆市常住人口中,通过危险因素问卷调查评估出高危人群,分别进行相应的临床筛查(肺癌、肝癌、乳腺癌、上消化道癌和结直肠癌),探讨黑龙江省癌症早诊早治的防治效果。结果 2013—2014年度黑龙江省城市癌症早诊早治项目工作,共邀请了15628人参加临床筛查,临床筛查高危人群10299人次,共筛查出66例疑似癌症病例。结论 黑龙江省顺利的完成了2013—2014年度城市癌症早诊早治项目,早诊早治项目可以做到早发现、早诊断和早治疗的目的,对于提高检出癌症患者的生存时间和生存质量具有重要的意义,此项目也为黑龙江省在癌症早诊早治方面的工作积累了经验。     

安徽省淮河流域癌症筛查的发展现状与展望

癌症作为我国居民主要死亡原因之一,严重影响居民健康。针对高危人群开展癌症筛查是降低癌症疾病负担的最有效途径。安徽省淮河流域癌症筛查与早诊早治项目在各级党委和政府的领导下取得了显著成就。全省癌症防治体系逐步形成,癌症筛查覆盖面逐年扩大。但癌症筛查工作还存在不足,需持续推进癌症筛查和早诊早治工作,完善规范化及长效化的癌症筛查工作机制,加大癌症宣传教育力度,提升居民生存质量。     

城市癌症筛查对象与社区居民的肿瘤相关行为对照分析

摘 要：［目的］ 评价“中国城市癌症早诊早治项目”中基于问卷评估的临床筛查推介机制对高危人群的区分能力大小。［方法］ 采用自行设计的癌症危险因素调查表,对合肥市社区居民和接受医院筛查的居民开展平行调查,并比较两个人群癌症相关因素的暴露水平。［结果］ 相对明确的肿瘤危险因素在两个人群中差异有统计学意义,且均为医院筛查人群高于社区人群;有近半数的肿瘤保护因素在两个人群中的分布不存在统计学显著性差异。［结论］ “中国城市癌症早诊早治项目”中的基于问卷评估的临床筛查推介机制对癌症危险因素的区分能力较强;对癌症保护因素的反向区分能力较弱。“中国城市癌症早诊早治项目”筛查问卷对癌症相关因素的识别具有一定的“外推”作用。     

2022年甘肃省武威市城市癌症早诊早治项目筛查结果分析

[目的]分析2022年甘肃省武威市城市癌症早诊早治项目筛查情况。[方法]选择在甘肃省武威市居住满3年,年龄在45～74岁之间的人群为筛查对象,分析2022年参与筛查居民的风险评估和筛查数据,计算比较不同性别、不同年龄段筛查人群在高危率、筛查率和阳性病变检出率之间的差异。[结果] 2022年甘肃省武威市共计4 123人完成风险评估问卷调查,人群总体高危率为80.06%。女性人群高危率高于男性人群,55～59岁年龄组人群高危率最高（84.32%）;2022年共完成4 998人次5种癌症筛查,各癌种临床筛查参与率从高到低分别为肺癌（91.16%）、乳腺癌（77.64%）、结直肠癌（75.60%）、肝癌（61.80%）、上消化道癌（56.27%）;检出阳性病变1 439例,总体检出率为34.90%,各部位阳性病变检出率分别为——肺：63.33%;乳腺：27.88%;肝：13.45%;结直肠：3.29%;上消化道：1.21%。[结论]通过筛查可以及早发现癌前病变和早癌患者,长远来看有利于降低恶性肿瘤的发病率和死亡率。但男性的筛查参与率不如女性,65岁及以上人群筛查参与率较低,提示在今后的工作中应...     

癌症筛查与早诊早治的研究进展

癌症是严重威胁人类生命健康的疾病之一,已经成为全球的公共卫生问题。目前癌症患者晚期较多,导致生存率较低,如果癌症能够早期发现,会大大提高生存率,降低癌症的疾病负担。目前肿瘤的筛查与早诊早治是肿瘤二级预防的主要手段,能够早发现、早诊断和早治疗,提高患者生活质量。本文从几大高发癌种对目前癌症筛查现状、成效以及筛查方法进行阐述,以期为科学、合理选择和推广适宜的癌症筛查策略提供参考。     

2014—2018年山西省城市癌症早诊早治项目筛查结果分析

摘 要：［目的］ 分析山西省2014—2018年城市癌症早诊早治项目的癌症筛查结果。［方法］ 采取整群随机抽样的方法,选取太原市、阳泉市、晋城市40～74岁常住居民进行患癌风险评估,评估出的高风险对象免费接受相应癌种的临床筛查,分析评估各癌种的高风险率、筛查顺应性和阳性病变检出率。［结果］ 研究人群整体患癌高风险率为41.37%,其中男性高风险率高于女性,55～59岁人群高风险率最高,各癌种高风险率从高到低依次为：上消化道癌22.46%,肺癌19.94%,乳腺癌17.38%,结直肠癌12.24%,肝癌9.42%;各癌种筛查顺应性从高到低为：乳腺癌（51.33%）、肝癌（43.74%）、肺癌（34.41%）、结直肠癌（21.71%）、上消化道癌（14.53%）;临床筛查结果显示,肺癌、上消化道癌和结直肠癌的阳性病变检出率随年龄的增加而增高,45～49岁女性乳腺癌阳性病变检出率较高,男性上消化道癌和结直肠癌的阳性病变检出率高于女性。［结论］ 人群患癌高风险比例分布与当地癌症发病分布基本一致,筛查顺应性和筛查方法相关,介入性检查顺应性较低。筛查人群高风险率、顺应性以及阳性病变检出率不同性别和不同年龄段存在一定的差异,有针对性地对城市高风险人群进行筛查,能够发现早期癌症患者,从长远来讲将有效降低癌症的发病率和死亡率。     

乌鲁木齐市2015~2016年度城市居民癌症高风险人群筛查分析

目的 了解乌鲁木齐市2015~2016年度城市癌症早诊早治筛查情况,为下年度开展癌症早诊早治项目工作提供依据.方法 选择乌鲁木齐市的高新区(新市区)、水磨沟区、米东区、经济技术开发区、乌鲁木齐县和达坂城区6个项目区作为筛查现场,选择整群抽样的方法,对40~69岁常住居民,开展肺癌、肝癌、乳腺癌、上消化道癌和结直肠癌5大类癌症的流行病学调查和高风险评估.对检出的高危人群进行免费的临床筛查,探讨新疆城市癌症早诊早治的防治效果.结果 共完成高危人群评估50711人,评估出高危人群52655人次,完成临床检查12420人次,其中肺癌3708人次,乳腺癌2649人次,肝癌2919人次,上消化道癌1920人次,结直肠癌1224人次,总任务完成率为124.2%.乳腺癌参与率最高(37.0%),结直肠癌参与率最低(11.8%).共筛查出阳性病例1010例,确诊癌症24例,癌症检出率为193/10万.癌症患者中早期病例19例(79.1%),23例接受治疗,治疗率为95.8%.结论 有针对性对城市高风险人群进行筛查,能够发现早期肿瘤患者.仍需加强癌症防治宣传力度,优化项目筛查流程,提高参与项目的积极性,提高项目筛查效果.     

浙江省温岭市2011～2016年大肠癌早诊早治筛查结果分析

摘 要：［目的］分析浙江省温岭市大肠癌筛查和早诊早治工作开展情况。［方法］根据《大肠癌早诊早治项目技术方案》,采用危险度评估问卷调查和免疫法大便隐血试验（FOBT）检查相结合的方法进行大肠癌初筛,对初筛结果阳性的高危人群采用电子肠镜作进一步检查。［结果］2011年12月1日～2016年6月30日对温岭市296个村进行筛查,完成初筛36 757人,初筛顺应性为46.34%（36757/79314） 。初筛阳性2673例,其中1039人接受肠镜检查,肠镜检查顺应性为38.87%（1039/2673）。共检出早期大肠癌14例（乙状结肠癌7例,直肠癌7例）,检出率为1.35%（14/1039）。肠道腺瘤287例,增生性息肉68例,结肠溃疡3例,检出率分别为27.62%（287/1039）、6.54%（68/1039）和0.29%（3/1039）。男性大肠肿瘤的检出率高于女性（P<0.01）。随着年龄增长,早期大肠癌的检出率明显增加（P<0.01）。［结论］ 开展大肠癌早诊早治筛查,有利于早期发现大肠癌及癌前病变。     

浙江省永康市大肠癌机会性筛查结果分析

[目的]了解机会性筛查在永康市大肠癌防治中的可行性.[方法]采用问卷调查及粪便隐血试验(FOBT)对40～74岁人群进行初筛,确定高危人群后,进行结直肠镜精筛,分析筛查对象的依从性、大肠的病变情况和大肠癌的早诊早治情况.[结果] 36 679人完成了初筛,其中FOBT的依从率为51.10％;评估高危人群5941人,进行肠镜检查5431人,检出各种大肠病变患者1006例,其中大肠癌患者163例,早期大肠癌患者54例,大肠癌的早诊率为59.48％,各种大肠病变的治疗率为98.51％.[结论]机会性筛查适合于永康市大肠癌的筛查,可检出更多大肠癌,特别是早期大肠癌及癌前病变.     

2013—2018年浙江省城市癌症早诊早治项目筛查结果初步分析

摘 要：［目的］ 分析2013—2018年浙江省城市癌症早诊早治项目筛查结果。［方法］ 汇总2013—2018年浙江省城市癌症早诊早治项目高危人群评估及临床筛查数据,开展数据匹配和整理,分别计算各癌症的高危率、筛查顺应性和阳性病变检出率。［结果］ 累计完成问卷调查166 293人,其中81 735人被评估为任一癌症高危,整体高危率为49.15%。不同癌种高危率从高到低分别是上消化道癌(26.48%)、肺癌(20.34%)、肝癌(14.29%)、结直肠癌(13.21%)和女性乳腺癌(12.56%)。累计完成五类癌症的临床检查51 504人次,其中分癌种筛查顺应性顺位分别是女性乳腺癌(56.03%)、肝癌(52.07%)、肺癌(48.21%)、上消化道癌(26.26%)和结直肠癌(19.97%)。共检出阳性病变16 397例,分部位阳性检出率顺位依次为女性乳腺癌(26.62%)、肺癌(15.78%)、结直肠癌(2.96%)、肝癌(2.40%)和上消化道癌(0.40%)。［结论］ 针对五类癌症高危人群联合筛查有助于发现癌症及其癌前病变,然而部分癌症筛查参与率相对较低,需加强人群组织动员,以进一步提升项目筛查效果。     

Health Promotion Lifestyle and Cancer Screening Behaviors: A Survey among Academician Women

Breast self examination (BSE), screening mammography and Pap smear screening can significantly reducemortality from breast and cervical cancer. In an effort to understand the factors that influence BSE,mammography, and Pap smear behavior of woman academicians, we here explored the relation between healthpromotion life-style and women’s cancer screening practice. A total of 750 woman academicians working in auniversity were enrolled, 350 of them responding to the survey. The study instruments used were the HealthPromotion Life-Style Profile (HPLP) scale and a questionnaire of demographic data. There was a significantrelationship between age-group, marital status, presence of cancer in the family, history of cervical erosion anddoing BSE, having mammography and a Pap smear. Additionally, both the general mean and nearly all domainsof HPLP were significantly related to BSE, mammography, and Pap smear behavior. This study demonstratedstrong relationships between breast and cervical cancer screening behavior and health promoting lifestyle inthis subgroup of women, making an important contribution to understanding the factors influencing women’shealth behavior.     

温岭市已婚妇女宫颈癌组织筛查分析

[目的]了解温岭市已婚妇女宫颈癌筛查情况,探讨其筛查价值。[方法]2010年4～10月参加宫颈病变筛查妇女21566例,以液基细胞学(TCT)、人乳头瘤病毒(HPV)和阴道镜为筛查方法,活检组织病理学为诊断金标准。[结果]21566例患者中检出细胞学阳性共1024例,988例行HPV-DNA检测HPV感染405例,病理诊断宫颈上皮内瘤样变(CIN)Ⅰ139例,CINⅡ～Ⅲ83例,鳞状细胞癌(SCC)1例。农村居民宫颈病变患病率明显高于城镇居民(χ2=16.65,P<0.05)。[结论]通过有组织地对已婚妇女行宫颈癌筛查,可早期发现宫颈病变。     

Breast and Ovarian Cancer Screening Practices in Healthy Women with a Strong Family History of Breast or Ovarian Cancer

Studies in women with a family history of cancer demonstrate a wide variability in the uptake of cancer screening measures. Little data exist regarding the breast and ovarian cancer screening practices of women who are members of hereditary breast cancer families. In order to address this issue, we examined the screening behaviors and the determinants of screening in a clinic based group of 216 women with a strong family history of breast or ovarian cancer who were participating in a free genetic counseling and testing research program. At baseline, prior to obtaining genetic counseling or testing, 50% of women ages 30–39, 83% of those age 40–49, 69% of those 50–64, and 53% of those 65 reported having a mammogram in the prior year. Adherence to mammography recommendations was correlated with age, number of relatives with breast cancer, and income. Twenty percent of participants had at least one CA-125 performed and 31% had ever obtained a screening ultrasound. Having at least one relative with ovarian cancer was very strongly associated with ovarian cancer screening [OR=12.3, 95% CI=4.6–33 for CA-125; OR=4.9, 95% CI=2.4,10.1 for ultrasound]. No association between cancer worries/distress and either breast or ovarian cancer screening was found. In conclusion, the breast and ovarian screening uptake in healthy women from hereditary breast cancer families is suboptimal, even for women over age 50, for whom annual mammography is clearly indicated. These findings indicate a need for better education about screening guidelines for high-risk women.     

Prostate Cancer Screening in a Healthy Population Cohort in Eastern Nepal: an Explanatory Trial Study

Background: Prostate cancer features a substantial incidence and mortality burden, similarly to breast cancer,and it ranks among the top ten specific causes of death in males. Objective: To explore the situation of prostatecancer in a healthy population cohort in Eastern Nepal. Materials and Methods: This study was conducted inthe Department of General Surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal from July 2010to June 2011. Males above 50 years visiting the Surgical Outpatient Department in BPKIHS were enrolled in thestudy and screening camps were organized in four Teaching District Hospitals of BPKIHS, all in Eastern Nepal.Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessmentof serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormalPSA/DRE findings. Results: A total of 1,521 males more than 50 years of age were assessed and screened aftermeeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ≤4.0 ng/ml. AbnormalPSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were bothabnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals weresubjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%)and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% anda positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostatewas 100% and the positive predictive value for serum PSA was 19.0% Conclusions: The overall cancer detectionrate in this study was 0.73% and those detected were locally advanced. Larger community-based studies arehighly warranted specially among high-risk groups.     

Effect of Comorbid Conditions on Adherence to Colorectal Cancer Screening

Potential barriers to colorectal cancer (CRC) screening include preexisting medical conditions (comorbidities), physician recommendation, psychosocial factors, and screening preparedness. This study's purpose was to investigate the impact of comorbid conditions on CRC screening among African Americans. A stage-matched randomized clinical trial was performed. Asymptomatic African Americans over age 50, with a primary care physician, and eligible for CRC screening were recruited at The Mount Sinai Hospital from 2005 to 2008. One hundred sixty-one patients were assessed for referral for, and completion of, CRC screening, comorbid conditions, "readiness to change," and number of physician visits within the observation period. Data was compared to a pretrial index to predict the likely effect of comorbid conditions on CRC screening. One hundred fifty-nine patients completed the study; 108 (68.9%) were referred for and 34 (21.2%) completed CRC screening. No demographic characteristics were associated with CRC screening completion. CRC screening referrals were similar for all patients, regardless of comorbidities or clinical visits. Comorbidities rated as having extreme influence on CRC screening showed a trend toward lower screening rates. There was a significant increase in screening rates among participants in advanced stages of readiness at enrollment. These data suggest that while comorbidities did not predict colonoscopy completion, they may play a role in concert with other factors. This is the only study to assess the effect of screening colonoscopy in an African American primary care setting. We must continue to explore interventions to narrow the disparate gap in screening and mortality rates.