Effect Assessment For Early Detection And Early Intervention Of Esophageal Cancer In Feicheng,China

Esophageal cancer is the eighth common cancer and the sixth leading cause of cancer-related deaths in the world.The tumor stage when diagnosed is a determinant of esophageal cancer prognosis.The prognosis of advanced esophageal remains dismal,for most cases had progressed into the advanced stage when diagnosed;while the esophageal cancer in an early clinical stage always has a better prognosis,with a five year survival rate higher than 90%.What is more,the exact cause of esophageal cancer is still not very clear,and it is difficult to establish an effective primary prevention measures;therefore,early discovery,early diagnosis,early treatment is the key to reduce the crowd esophageal cancer mortality.China is the high-risk area of esophageal cancer--nearly half of the morbidity and mortality occurs in China.Esophageal cancer has a significant regional distribution characteristic,and distribution of esophageal cancer in China has a clear regional gradient,presented as irregular concentric circles,the ratio between the highest incidence and minimum area is 100 times.Therefore,early screening in the high risk areas of esophageal cancer is the premise and foundation of early detection,early diagnosis and early treatment,and could also be an effective approach to reduce esophageal cancer mortality in China,as well as to reduce the financial burden of esophageal cancer in local communities.Feicheng,Shandong locates in a high risk region of esophageal cancer.Esophageal cancer is an important reason for local farmers' poverty.In 2006,Feicheng County is identified as a national cancer early detection and early treatment pilot region.Since 2006,under the support of the central fiscal subsidies to local special public health funds,using "endoscopic biopsy with iodine stains",Feicheng County has developed esophageal cancer early detection and treatment program.Through this project,we were about to screen out precancerous lesions and early-stage esophageal cancer patients,to give them corresponding early treatment and interventions,and follow-up those persons closely,and ultimately to reduce the esophageal cancer mortality and disease burden.The purpose of this paper is to evaluate the effect of this early detection and treatment project.In this paper,we described the implementation of this project,compared the pathological type,clinical stage,survival time between screening detected cases and the clinical patients discovered by symptoms,compared the esophageal cancer mortality between the screening and control groups,and compared the esophageal cancer burden between screening and contrast village.Through these comparisons,we got a comprehensive effect evaluation of the early detection and treatment program for esophageal cancer in Feicheng County.Methods:Since 2006,Feicheng city has screened 63 countries;in this study,we matched 1-2 countries to every screened country in those which have not been screened.The match condition were:had some buffer areas with the screened countries,and the total population,population in 40?69 age group,baseline incidence were similar to those of screened countries.Describe the baseline population age,the gender ratio,and the incidence to compare the balance of important characteristics between screened countries and control countries.Calculate the compliance rate of the screening program.Describe the demographic and other characteristics of people who have received the intervention,including the gender,age,and so forth.Describe the pathological types of positive cases and calculate the early diagnostic rate.Compare the pathological types and the clinical TNM stages between screening cases and clinical cases.Based on the chi-square test adjusted for intraclass correlation,we compared the mortality rate of people elder than 40 years old between intervention and control group,as well as between screening cohort and control cohort.Compare the survival curve between the screening with all of the clinical esophageal cancer cases,as well as with the clinical esophageal cancer in control group and with those in intervention group using Kaplan-Meier.Construct the extension of cox proportional hazard model to evaluate the effect of intervention.We assessed the effect of intervention on decreasing esophageal cancer disease burden using DALY.Results:1.Since the implement of esophageal cancer early detection and intervention program,the Feicheng City screened 63 countries in total.The target population was 43005,the actual participants were 25089,and the covered population was 102092.The total compliance rate was 58.3%.We discovered 1686 mild hyperplasia,402 moderate hyperplasia,160 severe hyperplasia,46 in situ cancer,and 111 squamous carcinoma,the early diagnose rate is 75.1%.2.Through comparison of clinical stages between patients discovered by screening and those diagnosed by active outpatient because of clinical symptoms,patients discovered by screening had an earlier clinical stage of esophageal cancer.Most of the patients discovered by screening were precursor and early stage of esophageal cancer,while most of those diagnosed by active outpatient had an advanced clinical stage later than II.3.In the esophageal cancer mortality comparison of the total population,we only observed a significant decrease 50-69 age group in male.We observed non-significant decreases in esophageal cancer mortality in total population and in male.In the esophageal cancer mortality comparison of the cohort population,we did not observed any significant decrease in any age and gender groups.We observed non-significant decreases in esophageal cancer mortality total,male,and female.4.Through comparison of survival curves between patients discovered by screening in the intervention group and those diagnosed by active outpatient because of relevant symptoms in the control group,patients discovered by screening had a much longer survival time and rate.In the COX regression,after adjusting the effect of age,gender and clinical stage,the effect of intervention on individual survival time was significant,the HR is 4.543.5.Through follow-up observation,the intervention group had lower esophageal cancer disease burden(DALY/thousand)of esophageal cancer than that of control group after completion of screening for three years.In the age-group comparison,we only discovered a decrease in disease burden in 5 5?69 years group.Conclusions:1.Based on "endoscopic biopsy with iodine stains",the population screening could effectively discover the precursor and early stage of esophageal cancer,and could successfully discover,diagnose and treat esophageal cancer at an early stage.2.We have not observed the decrease of esophageal cancer mortality.It could be observed for longer time.3.The early detection and intervention of esophageal cancer program could effectively increase the survival rate,and elongate the survival time of esophageal cancer patients.4.The early detection and intervention of esophageal cancer program could effectively decrease the disease burden of esophageal cancer in the high prevalence areas of esophageal cancer.