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*The professional part involved in this article is only for medical professionals to read.
The reference guide says that it is different.
What should I do? Recently, the United States Preventive Services Task Force (USPSTF) and the American College of Gastroenterology (ACG) have successively released the latest editions of lung and colorectal cancer screening guidelines.
What they have in common is that the initial age of screening is advanced.
There are two major changes in the latest version of the USPSTF lung cancer screening guidelines.
Compared with the 2013 version, the latest version of the USPSTF lung cancer screening guidelines quoted new data, indicating that lung cancer screening in younger age groups and relatively short smoking history is obvious.
benefit.
Based on this, the latest version of the guide has two major changes.
First, it is recommended that the initial age for lung cancer screening should be advanced from 55 to 50.
Routinely receive low-dose CT screening once a year until the age of 80.
Second, expand the initial scope of lung cancer screening.
The 2021 version of the guideline update believes that regardless of whether the individual quit smoking or not, people who smoked ≥20 pack years (pack year = number of cigarette packs consumed per day × number of smoking years) are considered high-risk groups.
This is 10 pack years less than the 2013 guide.
Professor Jacob Sands, a thoracic oncologist at the Dana-Farber Cancer Institute in Boston, USA and a member of the Early Screening Committee of the International Association for the Study of Lung Cancer, pointed out that according to the new guidelines, the number of eligible for screening will double.
Moreover, those lung cancer patients who are easily "missed" may be screened out.
For example, epidemiological studies have shown that compared to white men, women smoke significantly less, but the incidence of lung cancer is not low.
A joint study by the Canadian, French and American Cancer Society shows that under the same smoking conditions, women aged 30-49 have a higher rate of lung cancer than men.
At the same time, the United Kingdom analyzed the lung cancer patients who underwent surgery from 2008 to 2014 and found that 67% of female patients had never smoked.
The risk of colorectal cancer at the age of 45 = 50 years ago was earlier than 10 years ago.
It is also the update point of the American College of Gastroenterology (ACG) "Colorectal Cancer Screening Guidelines".
In March 2021, the American Journal of Gastroenterology published an article stating that compared with the 2009 version of the ACG guidelines, the initial screening age of the 2021 version of the guidelines is 5 years earlier.
It is recommended that the general risk population of 45-49 should undergo routine screening.
To reduce the incidence of advanced adenoma and colorectal cancer, and reduce related mortality.
Routine screening should continue until the age of 75, after which decision-making is based on individual conditions.
The risk of colorectal cancer for a 45-year-old person today is equivalent to that of a 50-year-old person 10 years ago.
Kimmie Ng, director of the Youth Colorectal Cancer Center at the Dana-Farber Cancer Institute in Boston, United States, said that before this, the American Cancer Society had advanced the initial age for colorectal cancer screening from 50 to 45.
This is because the incidence of colorectal cancer among people over the age of 50 is declining in many countries, but the incidence of young people has increased significantly.
"A study published in the Journal of the American Medical Association-Surgery in 2015 shows that by 2030, the incidence of colorectal cancer in people aged 20-34 will increase by 90%, and the incidence of people aged 35-49 will increase by 28%.
"It has changed abroad, but it may also be changed in China.
"Western developed countries revise guidelines based on new evidence, which will have a certain impact on China.
" Director of Cancer Prevention Department of Fudan University Affiliated Tumor Hospital, Shanghai Anti-Cancer Association Cancer Prevention and Screening Committee Chairman Zheng Ying told the "medical community" that the guidelines for screening for malignant tumors are supported by peer-reviewed randomized controlled studies.
These studies are time-consuming and costly, and our country lacks such data.
Therefore, my country's development of screening guidelines refers to the data and experience of Western countries.
This is also an international practice.
Some experts in China also regard 45 as the "starting point" for routine cancer screening.
On March 10, Song Zhangjun, representative of the National People's Congress and president of the Shaanxi Cancer Hospital, accepted the media interview, saying that it is recommended to include the annual cancer special physical examination for people over 45 years old and at high risk of cancer into the medical insurance reimbursement, and establish a health management file.
This may be an effective response to the problem of young cancer incidence in China.
The “Global Burden of Disease (IHME)” data shows that China’s cancer presents the characteristics of “two modernizations”: both “aging” and “younger”, the proportion of people aged 15-49 with cancer has increased from 0.
35% to 0.
89% .
"Different tumors have different risks at different ages.
" Zheng Ying said, such as cervical cancer in situ cancer is high in the age of 30-35 years old, it is too late to start screening at 45 years old.
The high incidence of prostate cancer in my country is 65-80 years old, and it is too early to start the investigation at the age of 45.
Rigidly delineate the starting age of cancer screening, the benefits may improve people's awareness and early diagnosis rate, and enhance the benefits.
However, if it involves expanding the screening population, in addition to scientific evidence, it is also necessary to consider whether the benefits and costs match.
"Low-dose spiral CT screening is widely used and many nodules have been detected.
What follows is how to deal with false negatives and false positives, whether medical insurance can afford it, and whether medical resources are adequate.
" Zheng Ying said frankly.
, The implementation of cancer screening guidelines requires consideration of all aspects, and there are difficulties.
The overall quality of China's cancer screening guidelines is not high.
my country has attached great importance to cancer screening in recent years.
The "Healthy China 2030" Plan outlines early cancer screening as a public health service project and the main means of "preventing major diseases", saying that "by 2030, the overall 5-year cancer survival rate will increase by 15%.
" .
Zhang Kai, deputy director of the Cancer Prevention Department of the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences, told the media that, first of all, regular screenings for major cancers, including lung cancer, breast cancer, colorectal cancer, stomach cancer, liver cancer, esophageal cancer, and cervical cancer, should be carried out.
But cancer screening needs to be standardized.
In February 2021, the "Chinese Journal of Epidemiology" published a joint study by the National Cancer Center and the National Cancer Center for Clinical Medicine.
There were 3 articles, including "Cancer Screening Guidelines and Consensus Quality Evaluation Research Progress", "Global Lung Cancer Screening Guidelines and Consensus Quality Evaluation and "Global Colorectal Cancer Screening Guidelines and Consensus Quality Evaluation".
It pointed out that there are multiple screening guidelines/consensus for different cancers, and the quality of my country's guidelines is lower than that of developed countries, and the overall quality is not high.
Zheng Ying said that the same cancer and multiple guidelines/consensus are common in various countries, which are academic behaviors based on different stages and positions.
"This is a good thing, which shows that everyone attaches great importance to it.
Moreover, sometimes as soon as the guidelines are made, there is insufficient evidence to carry out more research.
" Regarding the low quality of the guidelines, the "Cancer Screening Guidelines and Consensus Quality Evaluation Research Progress" believes that, This aspect stems from the lack of epidemiological investigations of related cancers in China.
At the same time, it also reflects the lack of rigorous systematic evaluation of relevant guidelines/consensus.
Including whether to follow the guideline development standards and procedures, whether it is transparent, whether it can ensure the quality of the guideline, provide the public with effective screening in compliance with the regulations, whether the development process is strict, standardized, and transparent, whether the composition of experts is comprehensive and reasonable, as well as funding and benefits Whether the conflict is declared or managed.
It should also be noted that different guidelines/consensus have inconsistent recommendations.
Taking colorectal cancer as an example, the 2019 "Quality Evaluation of Global Colorectal Cancer Screening Guidelines" pointed out that some guidelines in China recommend screening ages of 50-74 years (or 75 years), and 40-74 years old.
Regarding the recommendation of screening tools, some guidelines recommend colorectoscope once every 3 years, some recommend once every 5-10 years, and some do not specify the screening interval.
"Only high-quality guidelines can give effective guidance on screening, and avoid the potential risks, harms and waste of medical resources of screening to the greatest extent.
" "Cancer Screening Guidelines and Consensus Quality Evaluation Research Progress" wrote.
1671-167X.
2019.
03.
026 Source: medical Author: Yan Primary Six Reviewer: Tian Dongliang proofread: Zangheng Jia Editor: Pan Ying to the wonderful review of cancer screening, in addition to colonoscopy, there is no other way? Gastroscopy, colonoscopy, cervical cancer screening.
.
.
How often is the cancer prevention checkup done? More than half of the people in the country are infected with Helicobacter pylori! Adults are infected, do children need to be screened?
The reference guide says that it is different.
What should I do? Recently, the United States Preventive Services Task Force (USPSTF) and the American College of Gastroenterology (ACG) have successively released the latest editions of lung and colorectal cancer screening guidelines.
What they have in common is that the initial age of screening is advanced.
There are two major changes in the latest version of the USPSTF lung cancer screening guidelines.
Compared with the 2013 version, the latest version of the USPSTF lung cancer screening guidelines quoted new data, indicating that lung cancer screening in younger age groups and relatively short smoking history is obvious.
benefit.
Based on this, the latest version of the guide has two major changes.
First, it is recommended that the initial age for lung cancer screening should be advanced from 55 to 50.
Routinely receive low-dose CT screening once a year until the age of 80.
Second, expand the initial scope of lung cancer screening.
The 2021 version of the guideline update believes that regardless of whether the individual quit smoking or not, people who smoked ≥20 pack years (pack year = number of cigarette packs consumed per day × number of smoking years) are considered high-risk groups.
This is 10 pack years less than the 2013 guide.
Professor Jacob Sands, a thoracic oncologist at the Dana-Farber Cancer Institute in Boston, USA and a member of the Early Screening Committee of the International Association for the Study of Lung Cancer, pointed out that according to the new guidelines, the number of eligible for screening will double.
Moreover, those lung cancer patients who are easily "missed" may be screened out.
For example, epidemiological studies have shown that compared to white men, women smoke significantly less, but the incidence of lung cancer is not low.
A joint study by the Canadian, French and American Cancer Society shows that under the same smoking conditions, women aged 30-49 have a higher rate of lung cancer than men.
At the same time, the United Kingdom analyzed the lung cancer patients who underwent surgery from 2008 to 2014 and found that 67% of female patients had never smoked.
The risk of colorectal cancer at the age of 45 = 50 years ago was earlier than 10 years ago.
It is also the update point of the American College of Gastroenterology (ACG) "Colorectal Cancer Screening Guidelines".
In March 2021, the American Journal of Gastroenterology published an article stating that compared with the 2009 version of the ACG guidelines, the initial screening age of the 2021 version of the guidelines is 5 years earlier.
It is recommended that the general risk population of 45-49 should undergo routine screening.
To reduce the incidence of advanced adenoma and colorectal cancer, and reduce related mortality.
Routine screening should continue until the age of 75, after which decision-making is based on individual conditions.
The risk of colorectal cancer for a 45-year-old person today is equivalent to that of a 50-year-old person 10 years ago.
Kimmie Ng, director of the Youth Colorectal Cancer Center at the Dana-Farber Cancer Institute in Boston, United States, said that before this, the American Cancer Society had advanced the initial age for colorectal cancer screening from 50 to 45.
This is because the incidence of colorectal cancer among people over the age of 50 is declining in many countries, but the incidence of young people has increased significantly.
"A study published in the Journal of the American Medical Association-Surgery in 2015 shows that by 2030, the incidence of colorectal cancer in people aged 20-34 will increase by 90%, and the incidence of people aged 35-49 will increase by 28%.
"It has changed abroad, but it may also be changed in China.
"Western developed countries revise guidelines based on new evidence, which will have a certain impact on China.
" Director of Cancer Prevention Department of Fudan University Affiliated Tumor Hospital, Shanghai Anti-Cancer Association Cancer Prevention and Screening Committee Chairman Zheng Ying told the "medical community" that the guidelines for screening for malignant tumors are supported by peer-reviewed randomized controlled studies.
These studies are time-consuming and costly, and our country lacks such data.
Therefore, my country's development of screening guidelines refers to the data and experience of Western countries.
This is also an international practice.
Some experts in China also regard 45 as the "starting point" for routine cancer screening.
On March 10, Song Zhangjun, representative of the National People's Congress and president of the Shaanxi Cancer Hospital, accepted the media interview, saying that it is recommended to include the annual cancer special physical examination for people over 45 years old and at high risk of cancer into the medical insurance reimbursement, and establish a health management file.
This may be an effective response to the problem of young cancer incidence in China.
The “Global Burden of Disease (IHME)” data shows that China’s cancer presents the characteristics of “two modernizations”: both “aging” and “younger”, the proportion of people aged 15-49 with cancer has increased from 0.
35% to 0.
89% .
"Different tumors have different risks at different ages.
" Zheng Ying said, such as cervical cancer in situ cancer is high in the age of 30-35 years old, it is too late to start screening at 45 years old.
The high incidence of prostate cancer in my country is 65-80 years old, and it is too early to start the investigation at the age of 45.
Rigidly delineate the starting age of cancer screening, the benefits may improve people's awareness and early diagnosis rate, and enhance the benefits.
However, if it involves expanding the screening population, in addition to scientific evidence, it is also necessary to consider whether the benefits and costs match.
"Low-dose spiral CT screening is widely used and many nodules have been detected.
What follows is how to deal with false negatives and false positives, whether medical insurance can afford it, and whether medical resources are adequate.
" Zheng Ying said frankly.
, The implementation of cancer screening guidelines requires consideration of all aspects, and there are difficulties.
The overall quality of China's cancer screening guidelines is not high.
my country has attached great importance to cancer screening in recent years.
The "Healthy China 2030" Plan outlines early cancer screening as a public health service project and the main means of "preventing major diseases", saying that "by 2030, the overall 5-year cancer survival rate will increase by 15%.
" .
Zhang Kai, deputy director of the Cancer Prevention Department of the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences, told the media that, first of all, regular screenings for major cancers, including lung cancer, breast cancer, colorectal cancer, stomach cancer, liver cancer, esophageal cancer, and cervical cancer, should be carried out.
But cancer screening needs to be standardized.
In February 2021, the "Chinese Journal of Epidemiology" published a joint study by the National Cancer Center and the National Cancer Center for Clinical Medicine.
There were 3 articles, including "Cancer Screening Guidelines and Consensus Quality Evaluation Research Progress", "Global Lung Cancer Screening Guidelines and Consensus Quality Evaluation and "Global Colorectal Cancer Screening Guidelines and Consensus Quality Evaluation".
It pointed out that there are multiple screening guidelines/consensus for different cancers, and the quality of my country's guidelines is lower than that of developed countries, and the overall quality is not high.
Zheng Ying said that the same cancer and multiple guidelines/consensus are common in various countries, which are academic behaviors based on different stages and positions.
"This is a good thing, which shows that everyone attaches great importance to it.
Moreover, sometimes as soon as the guidelines are made, there is insufficient evidence to carry out more research.
" Regarding the low quality of the guidelines, the "Cancer Screening Guidelines and Consensus Quality Evaluation Research Progress" believes that, This aspect stems from the lack of epidemiological investigations of related cancers in China.
At the same time, it also reflects the lack of rigorous systematic evaluation of relevant guidelines/consensus.
Including whether to follow the guideline development standards and procedures, whether it is transparent, whether it can ensure the quality of the guideline, provide the public with effective screening in compliance with the regulations, whether the development process is strict, standardized, and transparent, whether the composition of experts is comprehensive and reasonable, as well as funding and benefits Whether the conflict is declared or managed.
It should also be noted that different guidelines/consensus have inconsistent recommendations.
Taking colorectal cancer as an example, the 2019 "Quality Evaluation of Global Colorectal Cancer Screening Guidelines" pointed out that some guidelines in China recommend screening ages of 50-74 years (or 75 years), and 40-74 years old.
Regarding the recommendation of screening tools, some guidelines recommend colorectoscope once every 3 years, some recommend once every 5-10 years, and some do not specify the screening interval.
"Only high-quality guidelines can give effective guidance on screening, and avoid the potential risks, harms and waste of medical resources of screening to the greatest extent.
" "Cancer Screening Guidelines and Consensus Quality Evaluation Research Progress" wrote.
1671-167X.
2019.
03.
026 Source: medical Author: Yan Primary Six Reviewer: Tian Dongliang proofread: Zangheng Jia Editor: Pan Ying to the wonderful review of cancer screening, in addition to colonoscopy, there is no other way? Gastroscopy, colonoscopy, cervical cancer screening.
.
.
How often is the cancer prevention checkup done? More than half of the people in the country are infected with Helicobacter pylori! Adults are infected, do children need to be screened?
