| BackgroundGastric cancer is one of the most common malignant tumors in the world.Each year a round 1 million people suffer from the disease,and nearly 700,000 people die of it.China is amon g the countries with the highest incidence rate of gastric cancer.The incidence rate and mortality r ate are 2-3 times above the world average level,each year there are around 360000 newly added c ases,accounting for 20 percent of the new cases of malignant tumor,which is about a half of th e patients of gastric cancer around the world.Gansu is an area with high incidence rate of gastric c ancer.In Wuwei,100.38 people of 100000 have gastric cancer.Every 90.71 of 100000 die of it.T he incidence rate and morality rate are the top of the list in China.From 2009 to 2013 the incidenc e-rate and mortality rate in this area remained high,while the patients were young.Gastric cance r has become a major regional disease to threaten the life or the health of the masses and to obstr uct the social and economic development.At present,research regarding the elements leading to t he high-incidence rate in this area is still at a preliminary stage.The researches are scattered and si ngular in form.Most of them are retrospective studies with low reliability of the data.The reason s are rather unclear and there is no obvious progress.Meanwhile this area is in the underdevelope d Western area.The people here have low living standards,their health consciousness is rather we ak.The medical preventive and control level lags relatively behind,there is a lack of integrated an d systematic mode and strategies preventing and controlling gastric cancer.Therefore,it’s impo rtant to reduce the incidence rate and morality rate of gastric cancer by adjusting measures to loc al conditions,to be supported by the data and fruit of the research of the prospective gastric canc er cohort.At the same time,the use of gastric cancer cohort is taken as an implementation platform to carry out technical demonstration and the building and improvement of preve ntion and control capacity.It is therefore imperative to improve the life quality of the patients a nd increase the early-stage diagnosis rate of gastric cancer,reduce the burden of the country and th e society,and promote the local economic development.ObjectiveIn view of a major disease problem with distinct regional characteristics that the hig h incidence of gastric cancer in Wuwei seriously affects the health of the local people and r estricts social and economic development,as well as the current situation of the backwardn ess of research on preventive and control measures,In this area,the research group constructe d the prevention and control model and strategy system which was guided by the govern ment,provided technical support by the provincial medical institutions,with advanced tech nology as the carrier,and the primary hospital as the implementation platform.Then,the model of gastric cancer prevention and control was applied in Wuwei,a high incidence ar ea of gastric cancer.Under this framework,a prospective cohort study of gastric cancer b ased on crowed was established.After long-term follow-up,the investigation and study of related risk factors of gastric cancer were carried out to provide reliable theoretical suppor t for tumor prevention and control in this region and even throughout the country;At the same time,as the implementation and evaluation platform,gastric cancer screening,demon stration and application of treatment and other key techniques were carried out to construc t and improve the local gastric cancer prevention and control ability for the evaluation an d improvement of prevention and control mode and strategy system.The threelevel screenin g and graded intervening strategies were put forward,so as to provide scientific reference for th e drawing guidance or common ground idea of preventing and controlling gastric cancer.MethodsThe project group was supported by the science and technology program for public wellb eing plan from 2012 to 2015.Seven towns and villages in Liangzhou,Wuwei were chosen as th e site of research.First of all,the government led five-level prevention and control organiz ation system of gastric cancer was constructed,including province,city,county,township a nd village,so as to verify the “three in one” gastric cancer preventive and control mode and str ategy which was guided by the government,implemented by the medical institutions,and partic ipated by the crowed.Secondly,after signing the informed consent,baseline research,epidemic i nvestigation,screening of illness,retaining of biological samples,follow-up visits,statistic analysi s and cohort maintenance,prospective research cohort was set up,and initial screening and resear ch on relevant dangerous elements were carried out.Based on the large crowd of gastric cance r patient cohort,conduct crowd health intervention,appropriate technical training and cohort cul tivation through screening were conducted,and the mode of preventing and controling gastric ca ncer was systematically evaluated.ResultsThis project had constructed a government led five-level malignant tumor prevention a nd control organization system,including province,city,county(district),township,village(community).A cohort of 17643 patients with gastric cancer was established in 7 townshi ps of Liangzhou District of Wuwei city,which was named as “Wuwei Cohort” of the pro spective study of gastric cancer.The omni directional,multi channel and wide covered hea lth education and intervention were carried out for the whole population by issuing educati onal manuals,health education videos,on-site education and so on.At the same time,the training courses were organized for 12 times,which has trained education personnel for m ore than 1000 people,and a government led propaganda force for cancer prevention and c ontrol was eatablished.The knowledge awareness rate of prevention and control of gastric cancer increased from 27.41% to 81.36% after the implementation;The "one to one" tech nical support model of provincial medical institutions and primiary medical institutions was constructed,which has completed a cohort of gastrointestinal cancer screening and techno logy demonstration in 17643 cases.A total of 248 cases of upper digestive tract cancer w as discovered and confirmed.Among them,178 cases were early cancer,accounting for 71% of the total,which significantly improved the diagnostic rate of local early gastric can cer.A total of 3500 patients diagnosed with precancerous lesions were followed up for a long term;The advanced and effective prevention and control of diagnosis and treatment t echnology was integrated to set up 4 demonstration bases.The primary management,publi city and technical personnel were trained,including 18 professional technical teams and 44 business cadremen.The related risk factors of gastric cancer were investigated preliminari ly and it was found that there were significant differences in gender,age,occupation,edu cation level,diet,smoking,daily exercise,sleep and medical history among cancer,precan cerous diseases and other digestive tract diseases.The“Wuwei Mode”of preventing and con trolling malignant tumors in regions with high-incidence was explored and set up,forming an efficient preventive and controlling mechanism and strategic system,which has produce d a marked effect.ConclusionThe preventive and control mode as well as the strategic system in regions with high incidenc e rate of gastric cancer formed by the project,effectly breaks the condition without leading and ass istance.Advantageous resources are integrated in a reasonable way,greatly enhancing the healt h cognition and participating consciousness of the masses,and greatly improving the ability an d effectiveness of prevention and control of gastric cancer,which is currently running smo othly,and has achieved remarkable results.Through setting up large-scale prospective cohort a mong crowds on gastric cancer,long-term followup visit,data collection and recording of the endpoint event was carried out,greatly increasing the efficiency and accuracy of research on relevan t dangerous elements to gastric cancer,allied research on multiple layers,regions,centers and inter sections can be carried out.It has provided scientific basis and theoretical support for the i mprovement of prevention and control mode,screening of population gastric cancer,and f ormulation of prevention and control strategy.The study cohort for the implementation of platform,and the one-for-one technology supporting mode,can be used to carry out effect ive health intervention,gastric cancer screening,demonstration and application of diagnosis and treatment and other key techniques,which can significantly improve the control abilit y of gastric cancer;With the incessant expansion and promotion of the fruit of the project and th e preventive and control mode,scientific basis and practical guidance will be provided to the draw ing and implementation of tumor and chronic illness prevention and controlling strategies. |
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