中国结直肠癌筛查实践方案课件

中国结直肠癌筛查实践 方案 urban area rural area organ 1991 2000 increase(%) 1991 2000 increase(%) all 123.92 146.61 18.31 101.39 112.57 11.03 lung 32.53 42.08 29.38 14.29 21.11 47.73 liver 19.36 22.19 13.04 22.25 26.06 17.12 stomach 19.69 19.94 1.27 22.55 20.94 -7.14 colon/rectum 8.53 11.19 31.18 5.14 6.04 17.51 oesophagus 8.94 9.06 1.34 16.32 15.24 -6.62 breast 3.11 4.32 38.91 1.51 2.11 39.73 leukemia 3.60 3.82 6.11 3.31 3.18 -3.93 nasopharynx 2.17 2.14 -1.38 1.70 1.78 4.72 cervix 1.49 1.08 -27.52 2.31 1.91 -17.32 baldder 1.83 2.26 23.50 0.89 1.11 19.82 中国部分地区1991-2000 癌症死亡率(1/100 000) China Oncology 2002;(11)5 Distribution of CRCDistribution of CRC high incidence area in Chinahigh incidence area in China Red represents high incidence area Data in 1970s 中国结直肠癌筛查项目 n国家“十一五科技支撑计划”(2006-2009) 国家科学技术部 n癌症早诊早治项目(2006-2013) 国家卫生部癌症基金会 中国结直肠癌筛查流程图 Questionnaire surveyiFOBT (+)(+) 158926 106412 14034 8531 750(8.8%)763(8.9%)57(0.7%)35(0.4%) Age 40-74, invited to screen Complete questionnaire and FOBT Questionnaire(+) or FOBT(+) Complete colonoscopy 腺瘤 其它息肉早期癌 进展期癌 初筛顺应性 67% 结肠镜顺应性 61% 阳性率 13.2% 1605Colorectal Neoplasm 阳性率 18.8% 都市: 上海，哈尔滨，杭州 乡村：海宁县，嘉善县 QS & FOBT贡献 腺瘤 Ques(+) 465(61%) 457(61%) 19(21%) 941(59%) FOBT(+) 245(32%) 225(30%) 50(54%) 520(32%) Both(+) 53(7%) 68(9%) 23(25%) 144(9%) all 763 750 92 1605 其它息肉 癌 all 61% adenoma were discovered by Questionnaire but missed by FOBT 中国城市和乡村的筛查顺应性 Compliance for first screen Compliance for colonoscopy High risk individuals Haining89.8%79.6%16.5% Jiashan88.9%78.0%12.6% Hz,Hb,Sh45.6%34.8%13.3% Screen compliance in counties is much better than that in large cities Rural area Urban area Data in 2008 0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00 01234567 screening controlcontrol Accumulation mortality for colon cancer in Accumulation mortality for colon cancer in Jiashan CountyJiashan County yearsyears Zhengs,zhangsz, Dis colon rectum,2003, 46：51-58 Accumulation mortality for rectal cancer in Accumulation mortality for rectal cancer in JiashanJiashan County County 31.7%31.7% YearsYears Zhengs,zhangsz, Dis colon rectum,2003, 46：51-58 Zhengs,Zhangsz, Dis colon rectum,2003, 46：51-58 现行方案 4074岁个体, 问卷： (1)一级亲属大肠癌史 (2)本人有癌症史 (3) 本人肠息肉史 (4) 具有以下二项及二项以上者: 慢性腹泻； 粘液血便； 慢性便秘； 慢性阑 尾炎； 精神刺激史； 慢性胆道疾病史。 大便潜血 iFOBT, 1 周间隔 n全结肠镜 问卷或阳性推荐全结肠镜检查y CRC CRC ScreeingScreeing Program in China 2010 Program in China 2010 Red represents high i