海门市肝癌早诊早治的主要经验与成效分析

目的通过海门市肝癌早诊早治项目的筛查和随访复查,总结经验与成效。方法根据《中国癌症预防与控制规划纲要》和《中国癌症筛查及早诊早治技术方案》,筛查高危地区人群的乙肝表面抗原(HBsAg),建立HBsAg(+)队列人群,每年2次进行甲胎蛋白(AFP)联合B型超声检查,可疑患者再经医院进一步确认是否为肝癌。结果 2010—2012年2 123例乙肝病毒感染者建立HBsAg阳性队列,2010—2018年共随访21 093人次,发现肝癌71人,检出率0.34%。其中早期肝癌41人,早诊率57.75%;治疗68人,治疗率95.77%。肝癌早诊早治项目队列人群的肝癌早诊率(57.75%)明显高于2015年日常系统报告组(4.45%),差异有统计学意义(χ2=114.51,P0.01)。结论对HBsAg(+)队列人群进行定期随访复查,是早期发现肝癌,提高治疗效果的有效措施。     

中国4省农村地区肝癌预防知信行变化情况

目的 了解我国4省农村地区肝癌预防知信行的变化情况，为农村地区的癌症健康教育与综合防控工作提供科学依据。方法 2013、2016、2019年在我国4省(河南、安徽、山东和江苏)14个农村县区采用多阶段整群随机抽样方法抽取18岁及以上常住居民进行面对面问卷调查。采用Pearsonχ²检验比较不同特征人群的肝癌预防知识知晓情况差异，采用Cochran-Armitage趋势检验和Cochran-Mantel-Haenszel检验分析肝癌预防知信行变化情况。结果 共纳入调查对象44 777人。2013—2019年，肝癌预防知识知晓率从20.31%升至31.23%。在肝癌预防知识中，调查人群对“吸烟”和“饮酒”是癌症的危险因素知晓率在50%以上，对“肥胖”和“遗传因素”的知晓率低于30%;在肝癌预防态度中，愿意接种乙肝疫苗者占80%以上；在肝癌预防行为中，有了解癌症知识途径者占90%以上，而癌症筛查率在20%以下。在2013—2019年，所有知识条目知晓率、积极态度持有率、健康体检、癌症筛查、有了解癌症知识的途径、不吸烟、不饮酒的行为持有率均呈上升趋势(P<0.05)...     

五河县20282人肝癌筛查结果分析

目的分析肝癌筛查效果,了解人群肝癌患病影响因素。方法采取整群抽样方法,共筛查20 282名当地居民,年龄在35～64岁之间,开展癌症相关危险因素和健康知识问卷调查,并按高危人群判定标准,筛选出符合筛查条件的高危人群,经知情同意后,进行血清AFP检测和B超检查。结果检出肝癌7例（其中早期肝癌5例）,肝硬化29例（占1.43%）,AFP≥20μg/L9例（占0.44%）,检出其他肝脏异常736例（占36.2%）。肝癌和肝硬化病例中HBs Ag阳性比例较高,分别为71.4%和65.5%。一般筛查对象和高危人群不同种类膳食摄入差异无统计学意义（χ^2=0.307,P〉0.05）,心理因素中环境适应能力和精神创伤在一般筛查对象与高危人群比较,差异有统计学意义（P〈0.05）。结论开展肝癌筛查工作,对早期发现肝癌具有重要作用。     

宁波市江北区2013—2017年度居民癌症高风险评估及临床筛查结果分析

目的评估浙江省宁波市江北区2013—2017年度居民癌症高风险并分析临床筛查结果,为癌症患者的早诊早治和管理提供参考依据。方法采用整群随机抽样方法于2013年12月—2017年7月在宁波市江北区抽取5个街道22 700名40～74周岁常住居民,采用国家癌症中心开发的防癌高风险评估问卷和软件系统评估肺癌、上消化道癌、肝癌、结直肠癌和乳腺癌的高风险人群并进行临床筛查,分析此5种癌症的高风险率、筛查率和检出率。结果宁波市江北区2013—2017年度完成癌症高风险评估的22 700名40～74周岁居民中,进行临床筛查者6 550人次,共检出660例癌症或疑似癌症和癌前病变;肺癌、上消化道癌、肝癌、结直肠癌和乳腺癌的高风险率分别为19.82%、39.01%、13.29%、12.21%和4.69%,筛查率分别为45.73%、16.33%、61.25%、18.11%和65.35%;肺癌或疑似肺癌、上消化道癌、肝癌或疑似肝癌、大肠癌和乳腺影像报告和数据系统(BI-RADS)4～5级检出率分别为1.55%、0.69%、0.11%、0.40%和2.87%。结论宁波市江北区2013—2017年度居民肺癌、上消化道癌、肝癌和结直肠癌患病风险较高,开展癌症早诊早治工作有利于早期发现癌症,提高患者的早期诊治率、生存率和生存质量。     

哈尔滨市癌症风险评估系统的构建与应用

目的分析癌症风险评估系统在哈尔滨市癌症早诊早治工作的运行现状,评价其应用效果,为探索完善癌症防治模式,制定科学、可行的癌症早诊早治策略提供依据。方法应用国家癌症中心开发的癌症风险评估系统,对哈尔滨市区居民进行流行病学问卷调查和5种高发癌症(肺癌、大肠癌、肝癌、乳腺癌、上消化道癌)的风险评估工作,对评估出的高危个体进行专项临床筛查。结果运用高危评估系统对16 460名居民进行了癌症风险评估,共评估出癌症高危个体8 848人;进行临床相关检查6009人次,筛查出癌症及癌前病变509例,总阳性率为8.47%。结论通过癌症高危评估系统,对高危人群开展高发癌症的早期筛查,可极大提高肿瘤筛查和早诊早治的有效性和性价比,有利于早期发现癌症及癌前病变,提高癌症的早诊率、治愈率、生存率。     

四川省盐亭县居民对癌症和食管癌防治知识的认知调查

[目的]了解四川省盐亭县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措施提供依据。[方法]采取整群抽样的方法,抽取盐亭县发病率较高的乡镇高灯作为调查现场,以当地2007年参加食管癌筛查的2012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2003份,有效率99.55%。调查对象癌症综合知识和食管癌防治知识平均得分(58.22±15.11)分,其中60分以上(及格)共1244人,及格率62.1%。[结论]盐亭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,促进相关知识在当地的普及,树立和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健康水平与生存质量的相关策略措施的实施提供群众基础。     

南通市通州区居民癌症潜在筛查服务接受度及支付意愿分析

目的了解南通市通州区开展癌症筛查服务的潜在需求及接受度,为研究癌症筛查项目的可持续性和扩大筛查范围的可及性提供依据。方法以2014-2015年南通市通州区尚未参加过"城市癌症早诊早治"项目的 500名居民为调查对象,针对癌症筛查服务接受度及支付意愿进行问卷调查。用SPSS 20.0统计软件进行χ~2检验及筛查需求和支付意愿影响因素的多因素logistic回归分析。结果在不考虑费用等因素的情况下,58.00%的居民对癌症筛查服务有需求,37.20%的居民对癌症筛查服务没有需求。多因素分析显示,事业单位人员及公务员(OR=0.25,95%CI:0.14~0.44)、教育程度为初中及以上者(初中OR=0.51,95%CI:0.29~0.88;高中或中专OR=0.49,95%CI:0.28~0.86;大学及以上OR=0.24,95%CI:0.12~0.46)、家庭人均年收入≥2.0万元(OR=0.76,95%CI:0.47~0.99)的人群对癌症筛查的需求较高,医疗保险状态为新型农村合作医疗(OR=2.78,95%CI:1.31~5.93)的人群对癌症筛查的需求较低;对筛查服务的支付意愿方面,仅有20.20%的居民愿意支付一定费用,而71.80%的居民不愿意支付任何费用。多因素分析显示,事业单位人员及公务员(OR=0.26,95%CI:0.15~0.46)、教育程度为初中及以上者(初中OR=0.28,95%CI:0.09~0.83;高中或中专OR=0.15,95%CI:0.05~0.45;大学及以上OR=0.08,95%CI:0.03~0.23)、家庭人均年收入≥2.0万元(OR=0.55,95%CI:0.28~0.70)的人群对癌症筛查的支付意愿较高,医疗保险状态为城镇居民医疗保险(OR=2.76,95%CI:1.60~4.74)、新型农村合作医疗(OR=6.42,95%CI:1.50~27.52)以及对癌症筛查没有需求(OR=1.94,95%CI:1.20~3.15)的人群对癌症筛查的支付意愿较低;对于癌症筛查打包支付的意愿和额度范围,39.20%的居民不愿意支付检查费用,41.20%的居民愿意支付10%以内的筛查费用。结论南通市通州区居民对于癌症筛查服务有潜在需求但对于癌症筛查费用的支付意愿和额度有限。     

2015—2017年中国城市居民肿瘤早治疗意识现况及相关因素分析

目的分析中国城市居民肿瘤早治疗意识及其人口学、社会学等影响因素。方法采用横断面调查的方法,于2015—2017年以2015年度"城市癌症早诊早治项目"覆盖的16个项目省份为研究现场,采用整群及方便抽样的方法,将年龄≥18岁、能够理解调查程序的居民纳入研究。共纳入32257名研究对象,其中社区居民、癌症风险评估/筛查干预人群、现患癌症患者及职业人群分别有15524、8016、2289、6428名。调查问卷收集个人信息、肿瘤早治疗态度及影响其态度的原因等信息。比较不同组别早治疗态度构成比的差异;采用多因素logistic回归模型分析肿瘤早治疗态度的影响因素。结果假设本人被确诊为癌前病变/癌症,社区居民、癌症风险评估/筛查干预人群、现患癌症患者和职业人群选择积极治疗者分别占89.97%、91.84%、93.00%和91.52%(P<0.001);假设直系亲属被确诊为癌前病变/癌症,4组人群选择鼓励亲属早期治疗者分别占91.96%、91.94%、92.44%、91.55%(P<0.001)。公司职员、家庭年收入4万元及以上者、其他3个亚组人群选择积极治疗意愿相对较高(P<0.05);男性、丧偶、无业人员、中西部地区的受访者积极治疗的意愿较低(P<0.05)。结论2015—2017年中国城市居民肿瘤早治疗意识较高;婚姻状况、职业、家庭年收入、区域是居民肿瘤早治疗意识的影响因素。     

农村地区高危人群胃癌肝癌筛查效果评估

目的评估农村地区高危人群胃癌、肝癌筛查效果,为相关疾病防治提供依据。方法对适宜年龄段人群（胃癌40~69岁,肝癌35~64岁）开展癌症相关危险因素问卷调查,并按高危人群判定标准,筛选出符合筛查条件的高危人群,经知情同意后,进入临床筛查（胃癌：腔镜＋病理,肝癌：AFP＋B超）。结果检出胃癌4例（0.16%）（其中早期胃癌3例）、癌前病变（异型增生）55例（2.26%）;检出肝癌7例（占0.25%）（其中早期肝癌2例）,肝硬化23例（占0.83%）,AFP异常（≥10μg/L）126例（占9.6%）;检出其他肝脏异常者369人（占12.2%）。肝癌和肝硬化病例中HBsAg阳性比例较高,分别为85.7%（6/7）和82.6%（19/23）。结论定点、定人群、定期开展两癌筛查是发现早期病例的重要手段,同时,应普及防癌知识和提高基层医务人员对早期癌症的识别能力,以提高机会性发现早期癌症的比例。     

闵行区社区居民癌症筛查态度干预效果的调查

[目的]评价闵行区社区居民大肠癌、胃癌、肝癌、肺癌早期筛查行为干预效果。[方法]通过体检、门诊、社区途径对12家社区126634名40岁以上人群进行肿瘤早发现知识教育(每次教育只针对1种癌种),对接受教育对象进行危险因素问卷、动员其进行早发现筛查。随机抽取758人分别对四癌知识行为进行干预前后评估调查。[结果]四癌教育覆盖全区40岁人口26.63%。干预前人群对四癌高危对象的知晓率均低于45%,在干预后对四癌的高危对象知晓率均有提高,在接受肠镜、胃镜、CT检查态度上干预后也较干预前有明显提高,差异有统计学意义。接受健康教育的126649人中完成有效问卷达93.01%。其中问卷有一项危险因素人群接受筛查率65.70%,确诊病例中有91.17%是初筛阳性后进行复查后确诊。[结论]开展40岁以上人群的OB、X线胸片筛查和AFP+B超筛查的宣传教育,形成社区人群早发现意识和行为,对提高社区肿瘤早发现水平会有较大帮助。     

Mathematical Models for the Early Detection and Treatment of Colorectal Cancer

Colorectal cancer is a major cause of death for men and women in the Western world. When the cancer is detected through an awareness of the symptoms by a patient, typically it is at an advanced stage. It is possible to detect cancer at an early stage through screening and the marked differences in survival for early and late stages provide the incentive for the primary prevention or early detection of colorectal cancer. This paper considers mathematical models for colorectal cancer screening together with models for the treatment of patients. Illustrative results demonstrate that detailed attention to the processes involved in diseases, interventions and treatment enable us to combine data and expert knowledge from various sources. Thus a detailed operational model is a very useful tool in helping to make decisions about screening at national and local levels.     

Knowledge,Attitudes and Practices of Breast Cancer Screening Among Women in Jordan

Enhancing breast cancer screening in developing countries is pivotal in improving women's health. We aimed at describing knowledge of and perceived reasons for performing breast cancer screening. We interviewed 1,549 population-based randomly selected women. We found that women share limited knowledge about breast cancer screening. Few women performed screening for early detection purposes. The influence of physicians was the main reason for performing mammography. Prevalence of breast cancer screening might be enhanced by integrating screening into other medical services. Health agencies need to invite women for screening and educate them regarding the importance of screening in the absence of symptoms.     

肺癌高危人群癌症防治核心知识认知情况调查

目的 探讨肺癌高危人群对癌症防治核心知识认知情况并对其影响因素进行分析。方法 以2017年3月至2019年12月在上海市某医院胸外科完成肺癌高危人群筛查并判断为肺癌高危人群的居民为研究对象,开展癌症防治核心知识知晓情况调查,采用描述流行病学分析方法对癌症防治核心知识掌握情况进行分析,并采用单、多因素分析方法对知识掌握影响因素进行分析。结果 共纳入肺癌高危人群416例,年龄40~72岁,男性269例,女性147例,分别占64.66%、35.34%。癌症防治核心知识知晓326例,知晓率为78.4%。知晓率最高的为“体检或癌症筛查有利于早期发现癌症”、“癌症无传染性;癌症早期可无明显症状;癌症检查价格并非越高效果越好”、“戒烟有利于预防肺癌”,知晓率分别为92.79%、92.31%、90.38%。知晓率最低的为“适龄生育、母乳喂养、多进行身体活动、保持合适体重、少饮酒和定期体检有利于预防乳腺癌”、“肺癌早期筛查的有效方法”、“导致癌症发病的高风险因素”,知晓率分别为50.24%、37.98%、34.86%。二分类Logistic回归分析结果显示,年龄60~72岁（OR=0.418）、文化程度为大专及以上（OR=2.309）、职业类型为医疗卫生行业（OR=4.121）是肺癌高危人群癌症防治核心知识知晓的影响因素。结论 肺癌高危人群防癌认知的总体知晓情况较好,但还应针对年龄较大、文化程度较低及非医疗卫生行业人群进一步加强癌症防治宣传,不断提高广大居民群众的防癌知识认知水平。     

Knowledge of Breast Cancer and Screening Practices Among Iranian Immigrant Women in Toronto

Breast cancer is a leading cause of mortality and morbidity in Canada. Secondary prevention through screening may enable early identification and treatment, but this is suboptimal among all Canadian women, particularly minority immigrant women. This cross-sectional exploratory study assessed breast health knowledge and practices among Iranian immigrant women residing in Toronto. Our sample included 50 adult women with no history of breast cancer. Results showed that, overall, participants had limited knowledge of breast cancer and screening practices. More than two-thirds had low knowledge scores; 22% did not know that the risk of breast cancer increases with age; about 50% did not know the recommended time interval for screening mammography; 72% did not know how frequently to undergo a clinical breast examination. Length of stay in Canada was associated with self-reported breast health practices. These findings highlight the need to educate Iranian immigrants about the role of screening to promote early identification of breast cancer in the absence of symptoms. Culturally sensitive educational materials should be developed to address their specific needs. Healthcare providers should also be educated about how to communicate breast health information effectively to immigrant women. Opportunistic teaching during each health encounter should be encouraged and reinforced.     

Cancer knowledge and misconceptions among immigrant Salvadorean men in the Washington, D.C. area

Although Salvadoreans are the fourth largest group of Hispanics in the United States, little is known about their cancer knowledge, attitudes, and practices. There are no publications assessing cancer knowledge among Salvadorean men. In this cross-sectional survey, information was gathered from 706 immigrant Salvadorean men in Washington, D.C. The majority of these men knew that smoking causes cancer and that some cancers can be cured if detected early. However, the men in this survey had inadequate knowledge about symptoms of cancer and early detection methods. The most important predictor of cancer screening among older participants was enrollment in health insurance plans. Our study suggests that Salvadorean men would participate in cancer screening efforts if they had access to medical care. Educational programs to increase awareness of cancer and availability of preventive services may help prevent cancer in this population.     

Differences between African American and Caucasian Men Participating in a Community-Based Prostate Cancer Screening Program

Prostate cancer is a major contributor to morbidity and mortality in the male population, but public awareness of the cancer has been reported as minimal. We evaluated the effectiveness of an educational prostate cancer screening program on 944 men in a midwest urban community. Digital rectal examinations and PSA blood tests were provided at no charge to participants with a grant from the Michigan Department of Community Health. An educational intervention that stressed the importance of prostate cancer early detection and treatment was conducted before screenings. A brief questionnaire administered before and after the videotape and screenings, targeted both knowledge and attitudes concerning prostate cancer. Pre-test results revealed that African American men were significantly (t = 3.7, P = .00) less likely then white men to correctly identify early symptoms of prostate cancer and the basic components of a prostate checkup. Following program involvement, scores significantly improved in all areas and differences were no longer significant between the races. Racial differences were also found for screening preferences and modes of reaching men to participate in screening. African American men were twice as likely as white men to choose private appointments over mass screening (OR = 2.2, P = .00). Radio reached the most African Americans (25%) while newspaper reached the most Caucasians (34%). The decreased level of knowledge among African Americans regarding prostate etiology and clinical factors highlights the need for educational programs to target minority populations. The need for discretion also applies by providing minority-favored access with screening through private appointments.     

对宫颈癌早期筛查患者实施护理干预的效果观察

目的探讨对接受宫颈癌早期筛查后的宫颈炎患者实施护理干预的效果。方法选取2013年6月至9月294例在我院妇产科门诊首次接受宫颈液基细胞学检查(thinprep cytologic test,TCT)+人乳头瘤样病毒(HPV)检查、年龄<50岁的宫颈炎患者。采用自制问卷对患者接受干预措施前后对宫颈癌早期筛查的认知进行对比。结果患者接受干预措施前后对宫颈癌早期筛查的认知的差异有统计学意义(P<0.01或P<0.05)。结论护士以健康信念模式为指导的个性化健康教育,利用各种宣传方式和途径做好患者宫颈癌防治知识普及和指引,能有效提高患者对宫颈癌早期筛查的认知程度,使患者树立健康的信念并改善患者参与宫颈癌早期筛查行为,最终达到及时发现、及时诊断、及时治疗的宫颈癌防治目的。     

西宁市居民的肿瘤防治健康素养现况调查

目的 了解西宁市居民肿瘤防治健康素养现况,为当地制定肿瘤防控策略及措施提供科学依据。方法 2021年6至8月,通过整群方便抽样在西宁市5个社区对1 036名居民进行肿瘤防治健康素养问卷调查,采用χ²、Fisher精确检验比较不同特征的居民肿瘤防治健康素养水平差异。结果 西宁市居民肿瘤防治健康素养水平为63.3%。各维度分析显示,肿瘤预防意识相关问题的正确回答率范围为43.0%～94.0%,其中,饮食及锻炼因素等问题的正确回答率最高,超88%,女性针对雌激素会增加患乳腺癌风险的预防意识最低,仅43.0%; 早发现意识中,34%的居民自评有患癌风险,有风险人群考虑肿瘤筛查者占83.8%,近五年参加体检者占79.3%,但体检项目包含肿瘤筛查的比例为46.2%; 早诊断意识中,90.7%的居民发现异常结果后会选择进一步检查; 早治疗意识中,88.4%的居民若被确诊为癌前病变或癌症时会选择积极治疗; 居民对肿瘤防治知识的需求度为79.0%。不同年龄、性别、文化程度、职业及自评患癌风险者的健康素养水平有差异。结论 西宁市居民肿瘤防治健康素养达到一定水平,但仍有较大提升空间。居民肿瘤预防意识、早发现意识有待提升,早诊早治意识水平较高,对肿瘤防治知识、筛查的需求度大,需加大肿瘤防治知识普及及相关防控措施落实的力度。     

Beliefs about bowel cancer among the target group for the National Bowel Cancer Screening Program in Australia

Objective: To assess awareness of and intentions and self‐reported participation in the National Bowel Cancer Screening Program (NBCSP) in Australia and the program's impact on knowledge of and beliefs about bowel cancer. Method: Cross‐sectional, computer‐assisted telephone surveys of Western Australians aged 55–74 years conducted in April 2007 (n = 505) and June 2008 (n = 500) measured beliefs about the prevalence of bowel cancer, its preventability, impact of early detection on life expectancy, knowledge of the symptoms and tests for bowel cancer, and awareness of and participation in the NBCSP. Results: In 2008, awareness of the Program was 58%. Seventy‐seven per cent of those invited to participate in the program agreed to do so. The vast majority believed bowel cancer to be preventable (83%), with early treatment making ‘a great deal of difference’ to life expectancy (85%). Awareness of blood in faeces as a sign of bowel cancer increased from 64% in 2007 to 75% in 2008 (p<0.01). Awareness of FOBT as a test for bowel cancer increased from 54% in 2007 to 70% in 2008 (p<0.01). Conclusions: The NBCSP appears to have increased knowledge of bowel cancer. Implications: Education and screening campaigns are required to further increase perceived prevalence of bowel cancer and to increase knowledge of symptoms and risk factors.     

全球肝癌筛查指南制订现状的系统综述

目的 使用系统综述的方法对全球范围内肝癌筛查指南进行系统梳理,并根据权威机构的癌症筛查指南制订框架,对肝癌筛查制订现状进行总结和评价,从而为后续制订肝癌筛查的循证指南提供重要参考。方法 系统检索多个中英文数据库和相关网站,2019年1月3日前发布的肝癌筛查指南。根据预先制订的纳入排除标准双人独立筛选文献、提取信息。对肝癌筛查指南基本信息、筛查推荐意见、证据来源等情况进行汇总描述和总结。结果 目前国内外均无独立的肝癌筛查指南,只有17部肝癌临床实践指南（Clinical practice guidelines,CPG）中简要提到肝癌筛查推荐意见。各国肝癌CPG仅推荐对乙肝、丙肝、肝硬化等肝癌高危人群进行筛查;大部分肝癌CPG推荐筛查间隔为6个月;欧美最新指南均推荐使用超声进行筛查,而亚洲则推荐使用US和甲胎蛋白联合使用。目前肝癌CPG主要基于筛查人群患肝癌风险、筛查工具准确性、筛查成本等要素推荐相应筛查策略,尚未综合考虑筛查有效性、安全性等关键要素。结论 目前尚无独立的肝癌筛查指南,仅在肝癌CPG中描述了筛查推荐意见。目前指南仅推荐对肝癌高危人群进行筛查,筛查间隔为6个月;欧美和亚洲指南推荐的肝癌筛查措施有所差异。建议相关机构参考国际公认的其他癌症筛查指南制订的理论框架,考虑肝癌筛查的各个环节和关键要素的特殊性,制订专用的肝癌筛查循证指南。