optimizedscreeningprogramforcolorectal.pptVIP

中国结直肠癌筛查实践方案 Zhang Suzhan Cancer institute, Zhejiang university 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 QS FOBT贡献 中国城市和乡村的筛查顺应性 现行方案 40－74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: ① 慢性腹泻；② 粘液血便；③ 慢性便秘；④ 慢性阑 尾炎； ⑤ 精神刺激史；⑥ 慢性胆道疾病史。 大便潜血　　　２ iFOBT, 1 周间隔 全结肠镜 问卷或ＦＯＢＴ阳性推荐全结肠镜检查y 谢谢您 * * 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 Questionnaire survey iFOBT + + 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% 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 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 13.3% 34.8% 45.6% Hz,Hb,Sh 12.6% 78.0% 88.9% Jiashan 16.5% 79.6% 89.8% Haining High risk individuals Compliance for colonoscopy Compliance for first screen 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 Zheng