长沙市2012～2013年城市居民癌症筛查分析

Early cancer screening and treatment in Changsha,China: assessment for 2012-2013

目的 通过在城市人群中开展肺癌、乳腺癌、大肠癌、上消化道癌和肝癌等常见癌症高危人群的评估、筛查和早诊早治工作,探索早诊早治适宜技术,努力遏制城市癌症高发的势头。方法 按照国家癌症中心统一制定的高危人群评估问卷对长沙市5个辖区的40～69岁常住居民开展问卷调查,并录入高危评估软件进行癌症高危评估,对评估为癌症的高危人群采用低剂量螺旋CT、乳腺超声、乳腺钼靶,腔镜（胃镜、肠镜）、指示性病例活检、AFP及肝脏超声检查等技术开展相应的癌症筛查。结果 实施癌症高危人群评估50 000人,共开展高危人群癌症筛查10 136人次,其中肺部、肝脏、乳腺、上消化道（食管和胃）、大肠分别筛查3 220人次、3 109人次、2 057人次、1 018人次、732人次。筛查出癌前病变1 279例,癌前病变阳性率为12.62%;检出可疑癌症患者47例,癌症筛查阳性率为0.46%。其中肺部癌前病变902例,阳性率为28.01%,癌变15例,阳性率为0.47%;肝脏癌前病变4例,阳性率为0.13%,癌变9例,阳性率为0.29%;乳腺癌癌前病变244例,阳性率为11.86%,癌变16例,阳性率为0.78%;上消化道癌癌前病变23例,阳性率为2.26%,癌变2例,阳性率为0.20%;大肠癌癌前病变106例,阳性率为14.48%,癌变5例,阳性率为0.68%。结论 开展癌症早诊早治工作,能有效探索癌症防控新技术、新机制,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,降低癌症发病率。

Objective To examine whether early cancer diagnosis and treatment can help reduce the increasing incidence of cancer in cities,we evaluated the results of a survey in Changsha,China concerning the detection and treatment of common cancers of the lung,breast,colon,upper gastrointestinal tract and liver. Methods A survey of residents aged 40-69 years in five districts of Changsha was conducted in 2012-2013 to identify high-risk cancer populations,and individuals assessed to be at high risk of one or more cancers were screened using low-dose spiral CT,breast and liver ultrasound,mammary molybdenum target,or endoscopy as appropriate. Results The implementation of high-risk assessment included 50 000 people and the cancer screening included 10 136 person-time;this investment varied by target organ as follows： lung,3 220 person-time;liver,3 109 person-time;breast,2 057 person-time;esophagus and stomach,1 018 person-time;large intestine,732 person-time.Precancerosis was detected in 1 279 cases,and the positive rate was 12.62%. A total of 47 suspected cancer patients were screened,and the positive rate was 0.46%. Precancerosis and cancer showed different prevalences by tissue type：precancerous lung lesions were found in 902 individuals,and the positive rate was 28.01%;lung cancer was found in 15 cases,and the positive rate was 0.47%;precancerous liver lesions were found in 4 cases,and the positive rate was 0.13%;liver cancer was found in 9 cases,and the positive rate was 0.29%;precancerous large intestine lesions were found in 106 cases,and the positive rate was 14.48%;colorectal cancer was found in 5 cases,and the positive rate was 0.68%;precancerous upper gastrointestinal tract lesions were found in 23 cases,and the positive rate was 2.26%;upper gastrointestinal tract cancer was found in 2 cases,and the positive rate was 0.20%;precancerous breast lesions were found in 244 cases,and the positive rate was 11.86%;and breast cancer was found in 16 cases,and the positive rate was 0.78%. Conclusions Targeted efforts to screen for and diagnose cancer early in cities can be an effective way to increase the rate of early treatment,survival and quality of life.