云南省127960名城市居民癌症风险评估及筛查结果分析

Analysis of Cancer Risk Assessment and Screening Results Among Urban Residents in Kunming City

[目的]分析2014-2017年云南省昆明市城市癌症早诊早治项目中癌症筛查情况。[方法 ]项目实施范围为昆明市西山区共18个街道,针对40-74岁年龄组人群,自愿参加并签署知情同意书的居民。接受有关癌症的流行病学问卷调查和高危因素评估,评估出高危人群并免费接受肺癌、上消化道癌（食管癌和胃癌）、肝癌、结直肠癌和女性乳腺癌的临床筛查,分析6种癌症的高风险率、筛查参与率、检出率。[结果]共完成127 960人的高危因素问卷调查和风险评估,女性参与人数明显高于男性。评估出高风险人群43 068人,高风险率为33.66%（43068/127960）。肺癌、食管癌、胃癌、肝癌、结直肠癌和女性乳腺癌高风险率分别为18.63%（23843/127960）、10.85%（13885/127960）、14.50%（18554/127960）、9.06%（11595/127960）、11.70%（14971/127960）、16.93%（11547/68212）。肺癌高风险率男性高于女性,食管癌、胃癌、肝癌、结直肠癌高风险率均为女性高于男性。单癌种、两癌种、三癌种、四癌种、五癌种和六癌种高风险人数分别占总体高危人数的50.73%（21849/43068）、17.46%（7518/43068）、11.56%（4978/43068）、7.45%（3209/43068）、7.76%（3344/43068）、5.04%（2170/43068）。肝癌、女性乳腺癌、肺癌、结直肠癌、上消化道癌的筛查参与率依次为40.82%（4733/11595）、40.08%（4628/11547）、30.50%（7271/23843）、23.27%（3484/14971）、14.52%（4710/32439）。肺部阳性病例共502例,检出率6.90%（502/7271）。上消化道阳性病例209例,检出率4.44%（209/4710）。肝脏AFP升高15例,肝脏阳性病例7例,检出率分别为0.32%（15/4733）和0.15%（7/4733）。结直肠阳性病例275例,检出率7.89%（275/3484）。乳腺阳性病例45例,检出率0.97%（45/4628）。[结论 ]云南地区居民的防癌意识淡薄、知识欠缺。癌症筛查参与率不高,各癌种参与率低于50%,上消化道癌与结直肠癌筛查参与率低于30%。阳性病变检出率不高,需进一步完善城市癌症早诊早治策略,提高早诊早治效果。

[Purpose] To analyze the results of cancer risk assessment and screening among urban residents in Kunming. [Methods] A cancer screening program was conducted among urban residents aged 40-74 years from 18 communities of Kunming Xishan district during 2014 -2017. The risk for cancer was assessed with a questionnaires and the high-risk subjects received screening tests for lung cancer,esophageal cancer,gastric cancer,liver cancer,colorectal cancer and female breast cancer. The high-risk rate,screening rate and detection rate were analyzed. [Results] A total of 127 960 questionnaires for risk assessments were completed,and 43 068 subjects（33.66%）were identified as high risk. The high-risk rates of lung cancer,esophageal cancer,gastric cancer,liver cancer,colorectal cancer and female breast cancer were 18.63%（23843/127960）,10.85%（13885/127960）,14.50%（18554/127960）,9.06%（11595/127960）,11.70%（14971/127960）and16.93%（11547/68212）,respectively. The high-risk rate of lung cancer in males was higher than that in females,while the high-risk rates of esophageal cancer,gastric cancer,liver cancer,colorectal cancer were higher in females than those in males. The proportions of subjects with single cancer risk,or two,three,four,five and six cancer risks were 50.73%（21849/43068）,17.46%（7518/43068）,11.56%（4978/43068）,7.45%（3209/43068）,7.76%（3344/43068） and 5.04%（2170/43068） in the high-risk subjects. The screening rate of liver cancer,female breast cancer,lung cancer,colorectal cancer and upper gastrointestinal cancer were 40.82%（4733/11595）,40.08%（4628/11547）,30.50%（7271/23843）,23.27%（3484/14971）and 14.52%（4710/32439）,respectively. The detection rates with screening tests for lung cancer,upper gastrointestinal cancer,colorectal cancer and female breast cancer was 6.90%（502/7271）,4.44%（209/4710）,7.89%（275/3484） and 0.97%（45/4628）,respectively. Among 4733 subjects undergoing liver cancer tests,there were 15 cases of elevated AFP（0.32%）,and 7 cases of liver cancer（0.15%）. [Conclusion ] The cancer screening program performed in Kunming city has been less effective with a relatively low participation rate and low detection rate,particularly for upper gastrointestinal cancer and colorectal cancer. The health education and preventive strategies of cancer control need to be further strengthened among urban residents in Kunming city.