张苏展 教授：中国结直肠癌筛查实践方案

null中国结直肠癌筛查实践中国结直肠癌筛查实践方案Zhang Suzhan Cancer institute, Zhejiang universitynull 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)5nullDistribution of CRC high incidence area in ChinaRed represents high incidence areaData in 1970s 中国结直肠癌筛查项目 中国结直肠癌筛查项目国家“十一五科技支撑”(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中国结直肠癌筛查流程图Questionnaire surveyiFOBT(+)(+)null158926106412140348531750(8.8%)763(8.9%)57(0.7%)35(0.4%)Age 40-74, invited to screenComplete questionnaire and FOBTQuestionnaire(+) 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 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all61% adenoma were discovered by Questionnaire but missed by FOBT中国城市和乡村的筛查顺应性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 areaUrban areaData in 2008null0.000.100.200.300.400.500.600.700.800.901.0001234567screeningcontrol Accumulation mortality for colon cancer in Jiashan CountyyearsZhengs,zhangsz, Dis colon rectum,2003, 46：51-58 nullAccumulation mortality for rectal cancer in Jiashan County 31.7% YearsZhengs,zhangsz, Dis colon rectum,2003, 46：51-58 Zhengs,Zhangsz, Dis colon rectum,2003, 46：51-58现行方案 现行方案 40－74岁个体, ： (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 nullCRC Screeing Program in China 2010Red represents high incidence areaHubei 2Yunnan 1 Sichuan 1Shanghai 1 Zhejiang 2Guangdong 1Beijing 1 Tianjin 1Sanxi 1Sandong 1 Ninxia 1null谢谢您