| BackgroundColorectal cancer (CRC) is a serious threat to human health of common digestive tract malignant tumor, as the digestive system morphology, function, immunological diagnosis new technology constantly emerging, colorectal cancer accurate diagnosis has been improved significantly. But the Chinese crowd colorectal cancer incidence and mortality remains high, ensuring that colorectal cancer early detection, early diagnosis and early treatment is the key measures in patients with colorectal cancer and precancerous lesions in the crowd to implement effective screening. Asymptomatic population screening and symptoms and signs of the natural population driven at higher risk of opportunistic screening, are the most popular at home and abroad and each have its advantages and disadvantages of the colorectal cancer screening model, in domestic, it is less aims to improve the colorectal cancer screening modes of exploration.AimBy participating in the national projects and 1187 cases of colorectal cancer census colonoscopic data and analysis of relevant factors, to explore and practise colorectal cancer screening model. To explore Chinese colorectal cancer epidemiological situation, evaluate the value of two kinds of screening models, which will provide a scientific basis for improving the colorectal cancer screening strategy.MethodWith reference to the 2011’China colorectal cancer screening, early detection treated early and comprehensive prevention consensus opinions’, makes natural population screening and opportunistic screening process and judging standard of colorectal cancer high risk groups. Opportunistic screening:continuous in December 2013-May 2014, patients including a hospital outpatient and the inpatient physician are introduced to the digestive endoscopy room, combining questionnaire and faecal occult blood test (FOBT) at the beginning and screening 1085 cases of colorectal cancer high risk individuals.Informing the clients related issues and obtaining the consent of the signature according to the standard method to complete the whole colonoscopy surgery of accurate screening for colorectal cancer. Finding lesions and excluding contraindications, obtaining biopsy specimen to inspection, as far as possible removal of lesions. Natural population screening:Some communities of Anning of Yunnan province are selected, multipoint random sampling method is adopted in 102 cases of the subjects, matters related to inform a colonoscopy and sign informed consent, exclude colonoscopy contraindications and complete colon endoscopy, finding lesions and excluding contraindications, sending the microscopic living tissue to inspection, implement the microscopic resection for the microscopic pathological changes when necessary. Adopt SPSS 17.0 statistical software package to analysis subjects gender, age, colon lesions detected condition, pathological type, check out the site data, contrast the pros and cons of two kinds of colorectal cancer screening. With P< 0.05 sentence to difference is statistically significant.Result1.Opportunistic screening resultsIn December 2013-May 2014, patients which include a hospital outpatient and the inpatient medical physician, is introduced to the digestive endoscopy room for further examination, through questionnaire and faecal occult blood test (FOBT) at the beginning and screening 1085 cases of colorectal cancer high risk individuals,487 cases of male, female 598 cases, the youngest is 15 years old, the eldest is 89 years old, an average of 51+ 24 years old. Standard methods have been agreed to and accepted by the electronic colon endoscopy (acceptance rate 100%) and questionnaire survey, prompting symptoms driven or faecal occult blood positive recommended acceptance of opportunistic screening for colorectal cancer high-risk groups have a high compliance.283 cases with colon polyps and colorectal cancer detection rate (26.08%), the male detection rate 32.85% is higher than that of female detection rate 20.56%(P< 0.05);Rate of colorectal cancer in 34 cases (3.13%), the male of the 21 cases 62% detection rate higher than women 38% detection rate of 13 cases (P< 0.044), the youngest age 28, the eldest is 84 years old, an average age is 58, on. Advanced adenomas,22 cases (2.03%), ordinary adenomas,147 cases (13.55%), the adenomatous polyps 80 cases (7.37%).lesions colonoscopy detection rate of 12.56% for people under age 40,60-69-year-old crowd detection rate of up to 34.8%, more than 70 people aged colonoscopy detection rate is as high as 30.3%.Distal colon cancer accounts for 73.5% of 34 cases of colorectal cancer, the proximal 17.65%, mixed 8.82%.169 cases of colorectal adenomas in the proximal (38.46%), distal 39.65%, mixed 20.89%, benign and malignant lesions are found in the colon is far more segments (P< 0.05).487 cases of colorectal cancer in male subjects 21 cases (4.31%), polyps in 139 cases (28.54%),598 cases of colorectal cancer in female subjects in 13 (2.17%), polyps in 110 cases (18.39%), regardless of the detection rate of colorectal cancer or polyps are males more than females (P< 0.05).2. Natural population screening resultsRandomly select 102 cases agree with the individuals, and complete colonoscopy, and questionnaire survey as the standard method. Total detection rate (31.37%),32 cases are colon tumors,17 the detection rate of 53.13% of males than females in 15 the detection rate of 21.43%(P< 0.05).Including advanced adenoma,4 cases (3.92%),14 cases of ordinary adenoma (13.73%),14 cases (13.73%) than adenomatous polyp, do not detect colorectal cancer (0%).People under the age of 50 detected polyps 14 cases (31.82%),50-70 people aged 17 cases (29.82%) detected polyps, over 70 people detected polyps in 1 case (100%), the detection rate to grouping children by age, there was significant difference (P< 0.05).Proximal intestinal segments in 32 cases of colon tumor detection,7 cases (6.86%), the distal bowel check out 20 cases (19.61%), mixed in 5 cases (4.90%), distal intestinal segments detection rate is close to 3 times of proximal intestinal segments, the distal intestinal segments is tendency location of colorectal polyps and colorectal cancer.3. Comparison of opportunistic screening and natural population screeningThere is no significant difference of the total detection rate (26.08% and 31.37%, P> 0.05)of opportunistic screening and natural population screening in the colorectal disease, but opportunistic screening for colorectal cancer is much higher than that of natural population screening (3.13% and 0%).Regardless of opportunistic screening or natural population screening, males surpass the age of 60 colon lesions especially malignant lesion detection rate on the high side. Two methods of detection of pathological changes on the site distribution there is no significant difference (P> 0.05), with hints of opportunistic screening of natural population screening results are in good correlation.Conclusions1.There is high adherence and malignant lesions of detection rate with recommended for suspected symptoms or fecal occult blood positive line of opportunistic screening for colorectal cancer. Still it is our country at present the most efficient, convenient, safe and economic patterns of main screening for colorectal cancer.2.60 years old or elder, male, the digestive system symptoms and fecal occult blood positive are especially susceptible factors of malignant lesions.In case of limited resources to carry out the opportunistic screening or natural population screening, colorectal cancer screening should be preferred to have the above characteristics of the crowd.3. Colorectal cancer opportunistic screening and natural population screening for two models have their own advantages and disadvantages, the distal intestinal segments should be observed as the key area in endoscopic examination.In view of the current national conditions and the health care system, the natural population screening implementation is difficult.4. In view of the high risk groups to carry out the opportunistic screening is simple, economic and feasible, good adherence, is conducive to early detection of colorectal cancer and early treatment, which can improve prognosis rate and the quality of life.5. Under our current health care system and public health awareness, opportunistic screening is the most compliant with the goal of the colorectal cancer early detection, early treatment and feasible, but it exists in diagnosis of asymptomatic patients with high risk groups, and it is difficult to deal with a lot of the risk of screening value needs to be promoted.6. In the face of higher incidence of colorectal cancer and early detection rate is not the ideal situation, establishing and implementing more accordance with Chinese national conditions of colorectal cancer screening model is necessary and urgent. |
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