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.     

粪便隐血试验在大肠癌筛查中的意义

大肠癌是常见的消化道恶性肿瘤之一,近年来我国大肠癌发病率呈上升趋势,通过筛查可以诊断出腺瘤、癌前病变和早期癌症,从而降低其发病率和死亡率,因此筛查对于大肠癌显得尤为重要。目前大肠癌检查主要分为粪便检查和结肠结构性检查,其中粪便检查包括粪便隐血试验、粪便脱落细胞检查及粪便基因学检查等,结肠结构性检查包括钡灌肠、结肠镜检查及计算机断层扫描结肠造影等。结肠镜检查被认为是大肠癌诊断的金标准,具有精准度高、可于发现癌前病变同时将其切除的优点,但因其为侵入性检查、需要肠道准备、检查时多引起被检查者明显不适和诊疗费用较高,其在筛查应用中受到了很大限制。相对而言,粪便隐血试验简单、易行、无创、节省人力物力,适合大规模人群筛查。我国部分学者已经开始重视大肠癌筛查,而粪便隐血试验在这些筛查中已被广泛应用。     

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.     

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。     

An Evaluation of Mass Screening Using Fecal Occult Blood Test for Colorectal Cancer in Japan: A Case-Control Study

There is as yet no firm evidence showing that mass screening for colorectal cancer using fecal occult blood tests (FOBTs) reduces the mortality from this cancer. Therefore we evaluated the effectiveness of the screening by a case-control study in Miyagi Prefecture, Japan. The study included as case subjects 28 individuals who had died from colorectal cancer and had had an opportunity to participate in the mass screening before the date of diagnosis as colorectal cancer, and 3 controls for each case subject randomly selected from residents who were alive on the date of death of case subjects and matched by sex, age (within 3 years) and living area using residential files. For each set, i.e., a case subject and 3 controls, screening histories before the date of the diagnosis of the case as colorectal cancer were examined. Both the case subjects and the controls who had participated in the screening at least once within 3 years before the date of diagnosis of the case were classified as "screened." The 28 case subjects consisted of 12 males and 16 females (average age: 60.8 years). The odds ratio of death from colorectal cancer for the screened versus the non-screened persons was 0.24 (95% confidence interval = 0.08–0.76) by the Mantel-Haenszel method. The present study suggests that mass screening using FOBTs for colorectal cancer significantly reduces the mortality from this cancer epidemiologically.     

多轮次免疫法粪便潜血试验用于中国人群结直肠癌筛查的参与率与病变检出情况分析

目的 评价连续3轮次年度粪便免疫化学试验(FIT)在中国人群结直肠癌筛查中的参与率和结直肠病变检出情况。 方法 基于2018年5月至2021年5月在全国6个中心开展的一项人群结直肠癌筛查研究,共纳入了7 793例50~74岁符合研究条件的受试者,为其提供免费的FIT检测和结肠镜检查(仅针对FIT初筛阳性者)。在基线时,所有受试者均受邀接受FIT筛查。在后续轮次筛查中,仅邀请FIT阳性但未接受结肠镜检查者或FIT阴性者进行重复FIT筛查。FIT阳性者推荐接受结肠镜和病理检查(如结肠镜下有异常发现)。研究共计开展了3轮次每年1次的FIT筛查,主要研究结局为FIT参与率、FIT阳性者的结肠镜检查参与率以及结直肠肿瘤的检出率。 结果 7 793例受试者中男3 310人(42.5%),年龄为(60.50±6.49)岁。第1轮、第2轮和第3轮FIT筛查的参与率分别为94.0%(7 327/7 793)、86.8%(6 048/6 968)和91.3%(6 113/6 693)。在7 793例参与者中,99.3%(7 742/7 793)参加了至少1轮筛查,66.3%(5 163/7 793)参加了全部3轮筛查。第1轮筛查人群的FIT阳性率(14.6%,1 071/7 327)高于第2轮(5.6%,341/6 048)和第3轮(5.5%,339/6 113)筛查(均 P<0.001)。FIT阳性受试者结肠镜检查依从率在3轮筛查中均达到70%以上,分别为76.3%(817/1 071)、75.7%(258/341)和71.7%(243/339)。logistic多因素回归分析显示,性别和吸烟状态是影响FIT筛查参与率的影响因素,男性和不吸烟者的FIT筛查参与率较高。此外,年龄与FIT阳性者的结肠镜检查依从率呈负相关。经过3轮筛查,进展期肿瘤(结直肠癌+进展期腺瘤)的检出率逐轮下降[第1轮：1.15%(90/7 793);第2轮：0.57%(40/6 968);第3轮：0.58%(39/6 693)],但进展期肿瘤的阳性预测值逐轮增加,分别为11.02%、15.50%和16.05%。在各轮次筛查中,男性病变检出率均高于女性,且检出率均随着年龄增长而增加。 结论 每年1次的重复FIT筛查在中国人群中具有较好的接受度以及较高的病变检出率。为了优化和提升人群结直肠癌筛查效果,应在保证人群筛查参与率的条件下推行多轮次重复FIT筛检。     

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.     

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.     

Diagnostic Validity of Fecal Occult Blood Tests for Detecting Gastroenterological Cancers

In order to estimate the diagnostic validity of chemical fecal occult blood tests, i.e. orthotolidine (Shionogi A) and guajac (Shionogi B) slides for detecting cancers of the esophagus, stomach and colorectum, the authors followed up all the examinees (n=3,449) of comprehensive medical check-ups at the Center for Adult Diseases, Osaka, by means of record linkage to the Osaka Cancer Registry's files. Then, diagnostic validity was calculated based on the results of two years' follow-up. Sensitivity for the respective cancers was 20.0%, 11.8% and 62.5% for Shionogi A, and 20.0%, 5.9% and 43.8% for Shionogi B slides. Likelihood ratio for the respective cancers was 1.4, 0.8 and 4.5 for Shionogi A, and 3.3, 1.0 and 7.5 for Shionogi B. Specificity was analogous among the three cancer sites, being 86% for Shionogi A and 94% for Shionogi B. These results suggest that the diagnostic validity of chemical occult blood tests for detecting cancers of the esophagus and the stomach is very poor, and therefore imply that close examinations of these sites for screening positives is unnecessary in mass screenings for colorectal cancer.     

Estimating key parameters in FOBT screening for colorectal cancer

Objectives  The association between screening sensitivity, transition probability, and individual’s age in FOBT for colorectal cancer are explored, for both males and females. Methods  We apply the statistical method developed by Wu et al. [1] using the Minnesota colorectal cancer study group data, to make Bayesian inference for the age-dependent screening test sensitivity, the age-dependent transition probability from disease-free to preclinical state, and the sojourn time distribution, for both male and female participants in a periodic screening program. This gives us more information on the effectiveness of the fecal occult blood test in colorectal cancer detection. Results  The sensitivity appears to increase with age for both genders. However, the posterior mean sensitivity is not monotonic with age for males; it has a peak around age 74. The standard errors of the sensitivity are not monotone either; there is a minimum at age 69 for males and at age 78 for females. The age-dependent transition probability is not a monotone function of age; it has a single maximum at age 72 for males and a single maximum at age 75 for females. The age dependency seems more dramatic for females than for males. The posterior mean sojourn time is 4.08 years for males and 2.41 years for females, with a posterior median of 1.66 years for males and 1.88 years for females. The 95% highest posterior density (HPD) interval is (0.97, 20.28) for males and (1.15, 5.96) for females, which are very large ranges, especially for males. The reason might be that there were fewer men than women in the annual screening program. Conclusion  Reliable estimates of age-dependent sensitivity and transition probability are of great value to policy-makers regarding the initial age for colorectal cancer screening exams. We found that the mean sojourn time for males is much longer than that for females, which may imply that FOBT screening for colorectal cancer may be more effective for males than for females.     

Colonoscopy with and without Occult Blood Test Pre-Screening:Which is more Cost Effective for Implementation for Screeningfor Colon Cancer?

Colon cancer is an important gastrointestinal cancer that has increasing prevalence in the present day.Screening for colon cancer is accepted as a method for colon cancer prevention. There are many methods forscreening for colon cancer. However, the best method is colonoscopy. Nevertheless, the simple classical methodas occult blood test is still widely used in clinical practice. Here, the author appraises on colonoscopy with andwithout occult blood test pre-screening. The aim is to compare the cost effectiveness and cost utility betweenthese two approaches. Based on the present appraisal, the colonoscopy without pre-screening occult blood testprovides more cost effectiveness than colonoscopy with such pre-screening.