张苏展教授中国结直肠癌筛查实践方案.ppt

中国结直肠癌筛查实践方案,Zhang Suzhan Cancer institute, Zhejiang university,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 CRC high incidence area in China,Red represents high incidence area,Data in 1970s,中国结直肠癌筛查项目,国家“十一五科技支撑计划”(2006-2009) 国家科学技术部 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 survey,iFOBT,(+),(+),158926,106412,14034,750(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%,1605,Colorectal 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,Screen compliance in counties is much better than that in large cities,Rural area,Urban area,Data in 2008,0.00,0.10,0.20,0.30,0.40,0.50,0.60,0.70,0.80,0.90,1.00,0,1,2,3,4,5,6,7,screening,control,Accumulation mortality for colon cancer in Jiashan County,years,Zhengs,zhangsz, Dis colon rectum,2003, 46：51-58,Accumulation mortality for rectal cancer in Jiashan County 31.7%,Years,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 全结肠镜 问卷或阳性推荐全结肠镜检查y,CRC Screeing Program in China 2010,Red represents high incidence area,Hu