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,ZhangSuzhanCancerinstitute,Zhejianguniversity,urbanarearuralareaorgan19912000increase(%)19912000increase(%)all123.92146.6118.31101.39112.5711.03lung32.5342.0829.3814.2921.1147.73liver19.3622.1913.0422.2526.0617.12stomach19.6919.941.2722.5520.94-7.14colon/rectum8.5311.1931.185.146.0417.51oesophagus8.949.061.3416.3215.24-6.62breast3.114.3238.911.512.1139.73leukemia3.603.826.113.313.18-3.93nasopharynx2.172.14-1.381.701.784.72cervix1.491.08-27.522.311.91-17.32baldder1.832.2623.500.891.1119.82,中国部分地区1991-2000癌症死亡率(1/100000),ChinaOncology2002;(11)5,DistributionofCRChighincidenceareainChina,Redrepresentshighincidencearea,Datain1970s,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,Questionnairesurvey,iFOBT,(+),(+),158926,106412,14034,8531,750(8.8%),763(8.9%),57(0.7%),35(0.4%),Age40-74,invitedtoscreen,CompletequestionnaireandFOBT,Questionnaire(+)orFOBT(+),Completecolonoscopy,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,ColorectalNeoplasm,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%),all763750921605,其它息肉,癌,all,61%adenomawerediscoveredbyQuestionnairebutmissedbyFOBT,中国城市和乡村的筛查顺应性,Screencomplianceincountiesismuchbetterthanthatinlargecities,Ruralarea,Urbanarea,Datain2008,0.00,0.10,0.20,0.30,0.40,0.50,0.60,0.70,0.80,0.90,1.00,0,1,2,3,4,5,6,7,screening,control,AccumulationmortalityforcoloncancerinJiashanCounty,years,Zhengs,zhangsz,Discolonrectum,2003,46：51-58,AccumulationmortalityforrectalcancerinJiashanCounty31.7%,Years,Zhengs,zhangsz,Discolonrectum,2003,46：51-58,Zhengs,Zhangsz,Discolonrectum,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,CRCScreeingPrograminChina2010,Redrepresentshighincidencearea,