四川盐亭县食管癌筛查和早诊早治的绩效评价

[目的]评价盐亭县2006~2011年食管癌筛查和早诊早治项目的开展情况及其其效果。[方法]收集2006~2011年盐亭当地人口情况、食管癌发病死亡登记资料以及2006~2011年间食管癌筛查和早诊早治的相关资料,比较筛查人群与当地非筛查人群的早诊早治情况以及患者的预后情况,并对项目组工作人员进行定性访谈。[结果]2006~2011年共计筛查40~69岁年龄段人群15065人,发现阳性病例1186例。除2006年,其余各年食管癌筛查的早诊率均超过了70%,总的早治率为96.58%。筛查人群中食管癌患者的1年、2年及5年生存率均明显高于非筛查人群(P<0.001)。[结论]食管癌筛查及早诊早治项目确可做到癌症早发现、早诊断及早治疗。在食管癌高发区开展筛查及早诊早治,对于提高当地人群的生存率和生命质量,减少患者的医疗费用以及节省当地卫生资源都具有重要意义。     

农村上消化道癌早诊早治随访筛查顺应性影响因素分析

摘 要：［目的］ 分析农村上消化道癌早诊早治随访筛查顺应性的影响因素,探讨提高随访率的实现途径。［方法］ 选取2015年7月至2016年6月需要接受随访筛查的随访对象312例,应用随访筛查一般医学知识知晓调查问卷和基本信息调查表进行调查。采用χ2检验比较随访组与失访组基本信息的差异,独立样本t检验比较随访筛查一般医学知识知晓得分上的差异。应用Spearman相关分析研究基本信息和随访筛查一般医学知识知晓得分与实现随访的相关性,多元线性回归分析研究随访筛查顺应性影响因素。 ［结果］ 回收有效问卷312份,出自随访组199例、失访组113例。检验分析结果表明,随访筛查一般医学知识知晓得分、对上消化道癌早诊早治认知程度、文化程度、就业方式、居住状态、健康状况、家庭结构、有无癌症家族史、子女对上消化道癌早诊早治认知程度,是随访筛查顺应性的影响因素（P<0.01）。 ［结论］ 改进、创新随访筛查宣传发动的方式和方法,提高随访筛查一般医学知识知晓率,减少制约随访筛查顺应性的主、客观因素,是解决早诊早治随访率不达标的关键。     

2009—2019年贵州省农村上消化道癌早诊早治筛查结果分析

摘 要：［目的］分析2009—2019年贵州省农村地区上消化道癌早诊早治筛查项目筛查结果。［方法］ 2009年7月1日—2019年6月30日,在贵州省的福泉市、榕江县、从江县、黄平县、玉屏县、仁怀市、西秀区、赤水市8个项目点,以乡/村为单位整群抽取40～69岁、符合纳入项目标准的村民作为初筛人群,经消化道的内镜检查,对发现的可疑病变辅以碘染色,然后进行病理学检查,按照不同年份、不同项目点对筛查情况进行比较。［结果］ 开展项目10年间,完成初次筛查17 666人次,检出癌症共计29例,检出率为0.16%,早期癌症13例,早诊率为 44.83%。卡方检验显示各年度病变检出率差异有统计学意义（χ2=36.360,P<0.001）,癌症检出率差异无统计学意义（χ2=13.638,P=0.136）。各项目点病变检出率差异有统计学意义（χ2=82.881,P<0.001）,癌症检出率差异无统计学意义（χ2=10.684,P=0.153）。［结论］ 贵州省农村上消化道癌早诊早治项目中,各项目点均可发现各级病变和早期癌症患者,但癌症检出率、早诊率、治疗率均未达到技术方案要求,无随访发现病例,故在以后项目工作中,需进一步提高筛查质量和随访水平。     

食管癌筛查和早诊早治研究进展

概述食管癌筛查方案、内镜辅以碘染色诊断早期食管癌和外科手术、内镜黏膜切除术、激光治疗、光动力学治疗及氩离子束凝固术治疗早期食管癌的研究进展。     

食管癌筛查和早诊早治的实践与经验

[目的]报告在高发区居民中食管癌筛查和早诊早治的效果和经验。[方法]分析2006—2008年在6个省中的8个县（市）居民中,开展食管癌筛查和早诊早治的资料。总结工作中的效果和经验。[结果]3年内镜检查共39221人,发现食管癌600例,检出率为1．53％。其中早期食管癌515例,早诊率85．83％。同时,发现胃贲门癌413例,检出率为1．05％。其中,早期贲门癌336例,贲门癌的早诊率81.36％。[结论]食管癌内镜筛查可发现大批早期癌和癌前病变,现阶段作为食管癌防治措施是可行的和有效的。     

2015—2018年重庆市农村上消化道癌早诊早治项目内镜筛查结果分析

摘 要：［目的］ 分析总结2015—2018年重庆市农村地区上消化道癌（食管癌、贲门癌及胃癌）早诊早治项目内镜筛查结果。［方法］ 选择上消化道癌发病率较高的区县,采取整群抽样的方法,对8236例40~69岁的无症状的人群进行上消化道癌筛查。［结果］ 2015—2018年完成胃镜筛查8236例,活检2810例,共检出重度异型增生、高级别上皮内瘤变及癌71例,检出率为0.86%,其中食管重度异型增生及癌检出率为0.40%（33例）,贲门高级别上皮内瘤变及癌检出率为0.15%（12例）,胃高级别上皮内瘤变及癌检出率为0.32%（26例）;其中早期病例59例,早诊率为83.10%;治疗病例62例,治疗率87.32%。对未治疗的癌前病变以上患者共348例进行随访,成功随访228例,随访率为65.52%,其中随访中新发现病例5例,全为早期病例,并已全部接受治疗。［结论］ 开展上消化道癌筛查,不仅普及了当地群众的肿瘤防治知识,还能及时发现癌前病变及早期癌,并通过适宜的干预手段从而阻断疾病的进行性发展,降低癌症的发病率和死亡率,同时,提高了基层医疗单位及工作人员的癌症防控水平。     

中国食管癌筛查与早诊早治指南(2022,北京)北大核心CSCD

食管癌是我国常见的消化道恶性肿瘤之一,严重威胁我国居民生命健康。食管癌高风险人群接受筛查和早诊早治能够有效降低食管癌的发病率和死亡率。制定符合中国国情的食管癌筛查与早诊早治指南,将促进中国食管癌筛查的同质性和规范性,提高食管癌筛查的效果。中国食管癌筛查与早诊早治指南受国家卫生健康委员会疾病预防控制局的委托与指导,由国家癌症中心发起,联合多学科专家,整合食管癌筛查与早诊早治领域的国内外研究进展,同时考虑中国国情和食管癌筛查的实际经验,根据世界卫生组织推荐的指南制定原则和方法,针对食管癌筛查过程中的筛查人群、技术、流程等给出了基于证据的推荐,旨在保证食管癌筛查与早诊早治效果,为中国的食管癌防控提供科学依据。     

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。     

结直肠癌人群筛查研究进展

 陈坤,医学博士,教授,博士研究生导师。现任浙江大学公共卫生学院流行病学与卫生统计学系主任,享受国务院特殊津贴。兼任高等学校预防医学专业教学指导委员会委员,全国临床流行病学和循证医学分会副主任委员,浙江省人民政府突发公共事件应急管理专家组成员,浙江省卫生经济学会副会长,浙江省人口与健康学会副会长,浙江省医师协会社区医师分会副会长等。长期从事肿瘤流行病学研究。先后主持国家自然科学基金会、科技部、卫生部以及重大国际合作等各类科研项目30余项;获各级各类荣誉奖励数十项,其中国家科技进步二等奖1项、三等奖1项,省部级奖12项;主编专著教材8部,参编教材著作10余部;以第一或通信作者发表论文200余篇,其中SCI论文近70篇。     

Advances in lung cancer screening and early detection

Lung cancer is associated with a heavy cancer-related burden in terms of patients’ physical and mental health worldwide. Two randomized controlled trials, the US-National Lung Screening Trial (NLST) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON), indicated that low-dose CT (LDCT) screening results in a statistically significant decrease in mortality in patients with lung cancer, LDCT has become the standard approach for lung cancer screening. However, many issues in lung cancer screening remain unresolved, such as the screening criteria, high false-positive rate, and radiation exposure. This review first summarizes recent studies on lung cancer screening from the US, Europe, and Asia, and discusses risk-based selection for screening and the related issues. Second, an overview of novel techniques for the differential diagnosis of pulmonary nodules, including artificial intelligence and molecular biomarker-based screening, is presented. Third, current explorations of strategies for suspected malignancy are summarized. Overall, this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.     

Computed tomography screening for the early detection of lung cancer

Although lung cancer is the leading cause of cancer-related death in the world and has an increased chance of cure if detected at an earlier stage, routine lung cancer screening is currently not recommended in the United States. Unfortunately, most patients with lung cancer present only after the onset of symptoms and have advanced disease that cannot be surgically resected. The overall 5-year survival rate for all patients with lung cancer is only 15%. When the cancer is detected at its earliest stage (pathologic stage IA), however, the 5-year survival rate is more than 70%. Although past randomized screening trials evaluating the use of standard chest radiography or sputum cytology have not resulted in lower mortality, recent studies suggest that computed tomography (CT) may have promise as a screening tool. This article summarizes experience over the past decade of using low-dose spiral CT imaging as a screening tool to detect early lung cancers in asymptomatic, high-risk individuals.     

Challenges related to developing serum-based biomarkers for early ovarian cancer detection

In this issue of the journal, Cramer and colleagues and Zhu and colleagues report carefully designed phase 3 assessments of candidate ovarian cancer screening biomarkers. The main conclusion is that CA-125 remains the "best of a bad lot"; the new candidates have fallen short of expectations. We review factors impeding the development of an effective ovarian cancer screening strategy, highlight the requirements related to validating proposed screening biomarkers, and emphasize the risks from premature clinical applications of unvalidated tests, all underscoring the need for new research strategies.     

Mass screening for the early detection of colon cancer in patients with endometrial cancer

A mass screening has been performed for the early detection of colon cancer by evaluating Hemocult II slides of blood relatives of patients with endometrial cancer. Though the defect of this screening is that the subject of the investigation, which was undertaken in all parts of Japan, is restricted, one case of colon cancer, two cases of colon polyposis, two cases of hemorrhoids, and one case of colon diverticulum have been uncovered by this screening. The rate of discovery of colon cancer proved to be 0.45%, a rate that is higher than seen in usual screening method. It has been concluded that blood relatives of patients with endometrial cancer should be screened, since they represent a high risk group for developing colon cancer.     

The current status of early detection and screening for colorectal cancer

There are several approaches to the early detection of colorectal cancer that currently are in use in various segments of the health care system. Herein, the status of cancer control research regarding symptom and risk factor assessment, sigmoidoscopy and colonoscopy, double contrast barium enema, and fecal occult blood testing is reviewed. In addition to the different technologies of early cancer detection, there are different models of disease control intervention. These include the routine clinical activities of primary care providers as well as programmatic screening of mass populations. The currently available techniques for early colorectal cancer detection appear better suited for existing patient care settings than for programs outside the direct supervision and follow-up of the health professional.     

Trial of early detection for breast cancer by itinerant mass screening

Since 1977 mass screening for breast cancer has been conducted in Miyagi Prefecture, Japan. The main activities involve itinerant screening in the communities and group screening at the workplaces. In addition to the above two screenings, examinations were also carried out at a Detection Center. The total number of examinees was 94,593. Breast cancer was detected in 116 subjects (0.12%) during mass screening. In contrast, the rate was 3.1% at the Center examination. Early cancer was more frequently detected during mass screening. The cytologic studies of nipple discharge was performed in 14,314 subjects (15.3%). Positive findings were seen in five (0.005%). In the high risk group, the detection rate (0.35%) was higher than that (0.12%) among general examinees. The higher detection rate in the high risk group may have been due to both the high frequency of breast cancer and the detection of nonpalpable breast cancer by mammography.     

Trial of early detection of breast cancer by mass screening

Since 1977, mass screening for breast cancer has been conducted in Miyagi Prefecture, Japan. The main activities consist of itinerant screening in the communities and group screening at the workplace. In addition, examinations were also carried out at a detection center. The total number of subjects examined was 90,076 in mass screening, with 4172 (4.6%) of them requiring a second examination. The overall breast cancer detection rate was 0.12% in the mass screening. In contrast, it was 3.1% at the center examination. Cytologic studies of nipple discharge were performed on 31,833 subjects. Positive findings were seen in 4 (0.004%). The incidence of smaller tumors was higher and that of nodal metastasis was lower in subsequent examinations than in the initial screening. In the high-risk group, who also underwent mammography at first screening, the detection rate was higher than that among general subjects examined.