重复实施结直肠癌筛查服务的效率分析

Effectiveness of Repeated Screening for Colorectal Cancer

[目的]了解重复开展结直肠癌筛查的成效。[方法]以2015—2017年上海市松江区参加结直肠癌筛查的居民为研究对象,比较不同筛查服务次数发现癌前病变和结直肠癌的情况。[结果]2015—2017年上海市松江区共完成结直肠癌筛查199456人次,涉及居民137715人,发现癌前期病变4147人,结直肠癌201人。34.16%的调查对象3年中参与了多次筛查。一次筛查完成初筛137715人次,实施肠镜检查10022人次,癌前病变初筛检出率为2070.94/10万,肠镜检出率为28.46%,结直肠癌初筛检出率为94.40/10万,肠镜检出率为1.30%;二次筛查完成初筛47045人次,实施肠镜检查4142人次,癌前病变初筛检出率为2442.34/10万,肠镜检出率为27.74%,结直肠癌初筛检出率为108.41/10万,肠镜检出率为1.23%;三次筛查完成初筛14696人次,实施肠镜检查2141人次,癌前病变初筛检出率为4191.62/10万,肠镜检出率为28.77%,结直肠癌初筛检出率为149.70/10万,肠镜检出率为1.03%。二次、三次筛查的癌前病变初筛检出率高于一次筛查,癌前病变及结直肠癌的肠镜检出率差异无统计学意义。[结论]3年内多次实施结直肠癌筛查的效率与一次筛查相近,应提高居民肠镜检查依从性,可对60岁以上男性居民提供多次筛查服务从而提高筛查效益。

[Purpose]To assess the effectiveness of repeated screening for colorectal cancer(CRC).[Methods]Residents participating in CRC screening in Songjiang district of Shanghai from 2015 to 2017 were recruited.The positive detection rates of adenomas and CRC in participants undergoing screening with different frequency were calculated and compared.[Results]Total 199456 times of screening were completed among 133715 residents in Songjiang during the period.And 4147 cases of adenomas and 201 cases of CRC were detected;and 34.16%of participants completed more than once of screening.Total 137715 participants completed the initial screening in the first screening and 10022 subjects underwent colonoscopy(CSPY).The detection rate of adenomas was 2070.94/10~5 in initial screening and 28.46%in CSPY,while detection rate of CRC was 94.40/10~5 in initial screening and 1.30%in CSPY.Total 47045 participants completed initial screening and 4142 subjects underwent CSPYs in the second screening.The detection rate of adenomas was 2442.34/10~5 in initial screening and 27.74%in CSPY,while the detection rate of CRC was 108.41/10~5 in initial screening and 1.23%in CSPY.Total 14696 participants completed initial screenings and 2141 subjects underwent CSPYs in the third screening.The detection rate of adenomas was 4191.62/10~5 in initial screening and 28.77/%in CSPY,and the detection rate of CRC was 149.70/10~5 in initial screening and 1.03%in CSPY,respectively.The detection rate of adenomas by initial screening of second and third screening was significantly higher than that of first screening,but there was no significant difference in the detection rate of adenomas and CRC by CSPY among screenings with different frequency.[Conclusion]The effectiveness of repeated screenings is likely to be close to that of one-time screening in three years,while the adherence of CSPY is much more important.Repeated screenings may be provided to male residents over 60 years in order to improve screening effectiveness.