Lancet Public Health:五种癌症一发现就是晚期 早筛早诊绝非空话!

2021-12-23 生物探索 生物探索

我国主要的五大癌症,包括肺癌、胃癌、食管癌、结直肠癌及女性乳腺癌,52.8%的患者一确诊就已经处于晚期阶段,中国迫切需要提高防癌意识,实行癌症早筛。

白天“珍珠奶茶方便面,火锅自助小烧烤”,夜晚则是“一时熬夜一时爽,一直熬夜一直爽”,许多人是不是直呼“你报我身份证得了呗”。看似很潇洒的日常生活,但长期以往可能就会导致药物、医院、医生相伴,甚至最后的归宿就是那四四方方的小盒子。饮食方式、生活习惯和周围环境中的许多因素,都可能会增加患癌风险。

癌症已成为影响人类健康和国家经济社会发展的重大公共卫生问题。据《2020全球癌症报告》,2020年全球新发癌症病例1929万,死亡病例数996万例,中国均居世界首位。癌症生存率与癌症分期息息相关,提高癌症早期筛查、早期诊断是当务之急。

2020全球各国癌症新发病例数

2020年全球癌症死亡病例数 来源:https://www.iarc.who.int/

中国国家癌症登记中心联合中国医学科学院与北京协和医学院肿瘤医院,分析了2016年1月-2017年12月中国12个省份、23个地区医院登记的癌症病人电子医疗记录以及癌症登记中心记录,研究结果发表在The Lancet Public Health。该研究发现我国主要的五大癌症,包括肺癌、胃癌、食管癌、结直肠癌及女性乳腺癌,52.8%(22009/41671)的患者一确诊就已经处于晚期阶段(III-IV期),进一步研究确定了癌症诊断时的分期分布和相关因素,包括癌种、性别、地区、年龄、生活习惯等,研究提示中国迫切需要提高防癌意识,实行癌症早筛。

中美对比研究

在中美对比研究中,I期乳腺癌确诊(美国51.2% vs.中国27.6%),I期结直肠癌确诊(美国24.1% vs.中国15.2%),I期肺癌确诊(美国25.3% vs.中国17.3%)。但我国在食管癌的早期诊断优于美国,I期食管癌确诊(中国18.7% vs.美国13.8%)。

中美各癌种确诊时癌症分期的分布差异(未包括分期不明患者)

中美各癌种确诊时癌症分期的分布差异(所有患者)

研究人员进一步研究发现,癌症诊断的影响因素包括癌种、性别、地区、年龄、生活习惯等,其中性别差异与地区差异比较显着。在五大癌症中,乳腺癌患者确诊时处于晚期的比例最少(21.6%),肺癌占比最高,高达67.7%的肺癌患者在确诊时已经处于晚期阶段。75岁以上的胃癌患者比55岁以下的患者确诊为晚期的风险高,但是在结直肠癌中,越是年轻的患者,诊断出晚期的概率就越大。有吸烟习惯的患者确诊为晚期肺癌的概率比不吸烟人群高30%;饮酒的患者确诊为食管癌晚期的概率是不饮酒人群的1.3倍;有癌症家族史的患者,晚期诊断率较低。

就性别而言,男性/男孩比女性/女孩更有可能确诊为癌症晚期(64.1% vs. 40.2%), 这种性别差异在晚期肺癌中尤为突出。在肺癌和食管癌中,男性确诊为癌症晚期的概率分别是女性的1.7倍(调整后OR=1.7)和1.4倍(调整后OR=1.4)。在胃癌和结直肠癌中,男女晚期确诊则无明显差异。

各癌种确诊时癌症分期的男女差异

就所有癌症而言,农村地区患者的晚期诊断比例高于城市地区。农村和城市人口在肺癌、胃癌和乳腺癌的诊断上存在很大的差异。城市居民一般在医疗保健方面有社会经济优势(更高收入和更优质的医疗资源),加之更好的癌症意识,促使他们追求癌症筛查和早期治疗。另一个重要解释可能是城市和农村地区医疗保险计划的差异,大多数城市保险类型提供了比全国医疗保险更优惠的福利和更高的报销比例。值得注意的是,中国城市和农村地区的结直肠癌分期没有明显差异,这意味着癌症风险不止与地区差异有关,还可能与一系列个人卫生习惯和疾病的特定因素有关。

各癌种确诊时癌症分期的地区差异

这一结果与中国卫生健康统计年鉴(2020)结果一致,2019年中国恶性肿瘤诊断与治疗与地区、性别显着相关;中国肿瘤死亡率发病率前五位的癌症中,除了肺癌其他都是消化道相关癌症,这与中国人的饮食习惯有关。如果能在癌前病变时就发现、干预,就能够避免其发展成为癌症。

近年来,在国家政策助力下,我国癌症患者治疗负担显着降低,5年生存率和生存质量显着提高,部分实施项目较早的地区实现发病率和死亡率的双下降。尽管如此,我国的筛查率仍远低于发达国家。接下来,我国要建立癌症早期筛查制度,加大癌症防治科普宣传力度,提升全民防癌抗癌意识,建立完善癌症筛查与早诊早治长效机制,促进癌症早预防、早筛查、早诊断、早治疗,切实遏制癌症危害。

原始出处:

Hongmei Zeng, et al. Disparities in stage at diagnosis for five common cancers in China: a multicentre, hospital-based, observational study. The Lancet Public Health, 2021.

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    2022-06-18 howi
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    2022-03-10 医者仁者

    #肺癌##胃癌#、食管癌、#结直肠癌#及女性乳腺癌,早诊早筛的价值是巨大的

    0

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    2022-09-11 shizhenshan
  4. [GetPortalCommentsPageByObjectIdResponse(id=1831422, encodeId=4adf1831422bf, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Jun 18 01:39:28 CST 2022, time=2022-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1201335, encodeId=4413120133550, content=<a href='/topic/show?id=384b8220449' target=_blank style='color:#2F92EE;'>#肺癌#</a>、<a href='/topic/show?id=f9e2832202f' target=_blank style='color:#2F92EE;'>#胃癌#</a>、食管癌、<a href='/topic/show?id=493ae869206' target=_blank style='color:#2F92EE;'>#结直肠癌#</a>及女性乳腺癌,早诊早筛的价值是巨大的, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82204, encryptionId=384b8220449, topicName=肺癌), TopicDto(id=83220, encryptionId=f9e2832202f, topicName=胃癌), TopicDto(id=78692, encryptionId=493ae869206, topicName=结直肠癌)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=医者仁者, createdTime=Thu Mar 10 14:46:09 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1861484, encodeId=76ec1861484ec, content=<a href='/topic/show?id=401a23e102' target=_blank style='color:#2F92EE;'>#ALT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2371, encryptionId=401a23e102, topicName=ALT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Sun Sep 11 06:39:28 CST 2022, time=2022-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1183137, encodeId=55f5118313e6e, content=学习了,很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210920/cc1287d895a346908d9358058cdb61ff/5ef3f7950426411ea0c9966d76a74064.jpg, createdBy=1d315559103, createdName=ms6000000225486324, createdTime=Tue Jan 11 11:00:08 CST 2022, time=2022-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1420916, encodeId=a43d14209166e, content=<a href='/topic/show?id=9fc65949978' target=_blank style='color:#2F92EE;'>#早筛早诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59499, encryptionId=9fc65949978, topicName=早筛早诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2dc43627972, createdName=yulin2007, createdTime=Sat Dec 25 04:39:28 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456928, encodeId=40ee1456928d0, content=<a href='/topic/show?id=7de159498d1' target=_blank style='color:#2F92EE;'>#早筛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59498, encryptionId=7de159498d1, topicName=早筛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a10e5815774, createdName=nakerunner, createdTime=Sat Dec 25 04:39:28 CST 2021, time=2021-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1621937, encodeId=a22a162193eb4, content=<a href='/topic/show?id=5f1386329e' target=_blank style='color:#2F92EE;'>#Health#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8632, encryptionId=5f1386329e, topicName=Health)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8d2020283215, createdName=yyanpro@28cn.c, createdTime=Sat Dec 25 04:39:28 CST 2021, time=2021-12-25, status=1, ipAttribution=)]
    2022-01-11 ms6000000225486324

    学习了,很好

    0

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    2021-12-25 nakerunner
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