Background: The incidence and mortality rate of colorectal cancer (CRC) have increased dramatically over the past 3 decades in China due to changes in lifestyle factors. Early detection and treatment guidelines for asymptomatic cases have shown to improve CRC control in developed countries. In response to these challenges, the Shanghai Municipal Government launched a community-based CRC screening program in 2012.
Materials and methods: Free initial screening, inclusive of immunochemical fecal occult blood and risk assessment (questionnaire), was provided by community health centers in Shanghai. Participants with positive results were referred to a specialist for a colonoscopy.
Results: In 2013, 828,302 Shanghai residents were registered; 97.7% (809,528) of the registrants completed initial screening. Among 180,094 initial screening-positive participants, 71,733 underwent colonoscopy. The proportion of compliance to colonoscopy was 39.8%; the proportion decreased with age and educational level. A total of 6,668 adenomas were detected, and 1,630 CRC cases were diagnosed. The CRC detection rate of the program was 201.35/100,000; among the detected CRCs, 51.6% were in stage 0-I.
Conclusion: The screening program achieved great progress, especially on initial screening completion and CRC early stage rate, although particular intervention is still needed to improve the compliance of colonoscopy.
Implications for practice: Due to socioeconomic transitions and lifestyle changes, colorectal cancer is now becoming one of the most common cancers in developing countries, as it is in developed countries. While most developed countries have now initiated national colorectal cancer screening programs based on recommended country-specific colorectal cancer screening guidelines, colonoscopy has become the most commonly used screening method. This is a challenge in developing countries due to limited resources. Based on the analysis of the Shanghai colorectal cancer screening program, with immunological fecal occult blood test and risk assessment as initial screening, followed by a diagnostic testing of colonoscopy for individuals with positive results, this article provides the basis and suggestion for similar program in other regions of China and other developing countries.
摘要
背景.中国由于生活方式改变,过去30年结直肠癌(CRC)的发生率和死亡率显著升高。在发达国家,无症状病例的早期检测和治疗已被证明可改善CRC控制。为应对这些挑战,2012年上海市政府发起了一项社区性CRC筛查计划。
材料和方法.上海社区卫生服务中心提供免费初步筛查,包括免疫化学粪便潜血检测和风险评估(问卷)。将结果为阳性的受试者转诊给专科医生行结肠镜检查。
结果.2013年,有828 302名上海居民进行注册;97.7%(809 528)的居民完成了初步筛查。在180 094名初步筛查结果为阳性的参与者中,71 733名进行了结肠镜检查。结肠镜检查依从性比例为39.8%;该比例随年龄和教育水平降低而降低。共计检出6 668例腺瘤,诊断出1 630例CRC。此计划的CRC检出率为201.35/100 000;在检出的CRC中,51.6%为0–I期。
结论.筛查计划取得了巨大进展,特别是在初步筛查完成度和CRC早期诊断率方面,不过仍然需要采取特别干预措施以提高结肠镜检查依从率。
对临床实践的提示:由于社会经济变革和生活方式发生变化,结直肠癌现已成为发展中国家最常见的癌症之一,此情况与发达国家一致。多数发达国家现在已根据推荐的国家特定结直肠癌筛查指南启动了全国性结直肠癌筛查计划,结肠镜检查已成为最常使用的筛查方法。由于资源有限,此检查在发展中国家是一项挑战。基于上海结直肠癌筛查计划的分析,使用免疫学粪便潜血检测和风险评估作为初步筛查,随后对阳性结果个体进行结肠镜检查诊断性检测,本文为中国其他地区以及其他发展中国家的类似计划提供了基础和建议。
Keywords: Cancer screening; Colorectal cancer; Public health.
© AlphaMed Press 2018.