作者：Norra MacReady
出處：WebMD醫學新聞
October 30, 2008(加州聖地牙哥) — 根據發表於美國公共衛生學會第136屆年會中的研究，於馬里蘭地區普及大腸鏡篩檢的計畫，發現早期大腸直腸癌(colorectal cancer，CRC)案例的數量增加，該州的局部CRC病例減少。
這是屬於Healthy People 2010活動所推動的一部份，該計畫的目標之一是，增加50%的50歲以上美國人接受大腸鏡或者乙狀結腸鏡檢查。
主要作者、馬里蘭州健康與心智保健部門、馬里蘭癌症登記中心的Jennifer Hayes小姐在發表海報資料時表示，這是初步結果，但是個很好的指標，希望未來可以成真。
Hayes小姐等人使用該州的健保給付資料，研究1999至2004年間在該州進行的大腸鏡和乙狀結腸鏡紀錄，她們也從馬里蘭癌症登記中心獲得CRC案例的就醫資料；從這些資料中，她們發現，於研究期間在馬里蘭進行的大腸鏡檢查數量，從64,069增加到149,749 件，乙狀結腸鏡檢查從23,553減少到3929件；整體而言，50歲以上者接受大腸鏡或者乙狀結腸鏡檢查的比率從50%增加到69%。
雖然篩檢數增加，但全部的侵犯性CRC案例略降，而早期病例百分比從37%增加到42% (P= .04) ，局部案例從45%減少到36% (P= .02)；有趣的是，遠端轉移疾病從17%增加到20%；但是此一變化並不顯著。
Hayes小姐向Medscape Public Health & Prevention表示，我們的目標是早期發現癌症，我們發現局部CRC呈現一個有趣的比率，但還未能下定論；她歸因於該州的公共衛生人員致力增加大腸鏡檢查，以及醫師共同鼓勵病患接受篩檢，這讓大眾對CRC和大腸鏡檢查有比較普及的警覺。
美國癌症學會大腸直腸癌主任Durado Brooks醫師表示，末期疾病略增可能部份是因為發現案例增加的結果，當把新的篩檢方式推廣到大眾，在趨勢圖中要加上註記，因為你開始篩檢多年來未曾檢查的部份；在這些篩檢的最初幾年中，你會發現早期和晚期案例都大幅增加。
未參與此研究的Brooks醫師表示，另外要記住的是，在研究期間，有一大部份馬里蘭人民從未篩檢過CRC，有一部份人民只有接受乙狀結腸鏡篩檢，這種檢查只會看到部份大腸；我們不知道研究中案例的篩檢史或者癌症案例的臨床病史，可能有一大部份末期案例是那些未曾篩檢過的人。
Brooks醫師結論表示，無論發生哪種情況，當篩檢計畫成熟時，我們將期望重症比例下降，希望有更多人接受篩檢。
本研究未接受商業資助。Hayes小姐和 Brooks醫師都宣稱沒有相關資金上的往來。
美國公共衛生學會(American Public Health Association (APHA))第136屆年會：摘要186296、發表於2008年10月28日。
Colorectal Cancer Screening Program Yields Promising Early Results
By Norra MacReady
Medscape Medical News
October 30, 2008 (San Diego, California) — An effort in Maryland to perform more screening colonoscopies has resulted in an increase in the number of early-stage colorectal cancer (CRC) cases and a decrease in regional CRC disease detected in the state, according to findings presented here at the American Public Health Association 136th Annual Meeting.
The push is part of the Healthy People 2010 campaign. One of the goals of that program is to increase to 50% the proportion of Americans 50 years or older who have ever undergone a colonoscopy or sigmoidoscopy.
This is an early finding, but "it's a good indication, if it's in fact true," said lead author Jennifer Hayes, MEd, MPH, from the Maryland Cancer Registry, State of Maryland Department of Health and Mental Hygiene, in Baltimore, who presented the data in a poster session.
Using claims data maintained by the state, Ms. Hayes and colleagues determined the number of colonoscopies and sigmoidoscopies performed between 1999 and 2004. They also obtained hospital reports on CRC cases from the Maryland Cancer Registry. From these records, they found that the number of colonoscopies performed on Marylanders increased from 64,069 to 149,749 during the study period. The number of sigmoidoscopies declined from 23,553 to 3929. All in all, the percentage of people 50 years or older who had ever undergone a colonoscopy or sigmoidoscopy increased from 50% to 69%.
Despite the increase in screening, the total number of invasive CRC cases decreased only slightly and insignificantly. But the percentage of early-stage cases increased from 37% to 42% (P?= .04) of cases, and regional disease decreased from 45% to 36% (P?= .02). Interestingly, distant disease increased from 17% to 20%, although the change was not significant.
"Our goal is to find cancer earlier, and we are finding localized CRC at an increasing rate, although it's too early to tell if this is convincing," Ms. Hayes told Medscape Public Health & Prevention. She attributed the increase in colonoscopies to the efforts of state public-health personnel, who worked with physicians and patients to encourage people to undergo the tests. There is also more general awareness about CRC and colonoscopy among the public, she said.
The slight rise in advanced-stage disease "could be, in part, a result of case-finding: whenever a new screening test is introduced into a population, you will have a 'blip' in the trend graph because you start detecting cases that have lain dormant for years in the absence of testing," said Durado Brooks, MD, MPH, director of colorectal cancer for the American Cancer Society. "During these early years of screening, you will find larger numbers of both early- and late-stage cases.
"It is also important to keep in mind that, during the study period, there was a significant proportion of the Maryland population that had never been screened for CRC, as well as a number of people who had been screened only with sigmoidoscopy, which only views a portion of the colon," said Dr. Brooks, who was not involved in the study. "We have no idea about the screening history or the clinical history of the cancer cases documented in this study. It may be that a significant proportion of the advanced cases come from that unscreened population.
"In either case, we would expect the proportion of advanced cases to fall as the screening program matures and more individuals are up to date with screening," Dr. Brooks concluded.
The study did not receive commercial support. Neither Ms. Hayes nor Dr. Brooks disclosed any relevant financial relationships.
American Public Health Association (APHA) 136th Annual Meeting: Abstract 186296. Presented October 28, 2008.
[ 本帖最後由 goodcat1111 於 2008-11-10 13:38 編輯 ] |
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