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Lancet Oncol：乳腺癌筛查可改善早期诊断

2013-02-05 Lancet Oncol： Dxy

筛查早期乳腺癌
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 　　在低收入和中等收入国家中，患者通常是到疾病的晚期才前往医院就诊，此时肿瘤已转移至其他器官，所以在上述国家乳腺癌的治愈率很低。本研究旨在调查，在非洲撒哈拉以南的农村地区通过培训当地的女性志愿者，通过提高当地人对肿瘤的认识和对乳腺检查项目重视来发现早期乳腺癌。来自苏丹Gezira大学的Dafalla Omer Abuidris等参加了以上研究，研究结果发表在Lancet 1月最新的在线

 　　在低收入和中等收入国家中，患者通常是到疾病的晚期才前往医院就诊，此时肿瘤已转移至其他器官，所以在上述国家乳腺癌的治愈率很低。本研究旨在调查，在非洲撒哈拉以南的农村地区通过培训当地的女性志愿者，通过提高当地人对肿瘤的认识和对乳腺检查项目重视来发现早期乳腺癌。来自苏丹Gezira大学的Dafalla Omer Abuidris等参加了以上研究，研究结果发表在Lancet 1月最新的在线期刊上。

　　本研究为队列研究，在苏丹Gezira州的两个县中进行。研究者将包含56个村庄的Keremet县作为研究组，而将包含79个村庄的Abugota县作为对照组。来自Keremet县的女性志愿者接受培训以期能及时发现乳腺异常。在被培训时，志愿者们访视她们村庄的家庭，对年龄在18岁以上的女性进行乳腺异常的筛查，对疑似乳腺癌的女性推荐前往当地医院接受诊断，如果需要的话还建议她们在地区医院接受治疗。在进行研究的村庄内，研究者同时进行了一个男性和女性对肿瘤的认识项目。对照组村庄的人群不接受任何干预。本研究还在进行之中。

　　在2010年1月1日至2012年10月10日间，在Keremet县中，14788名女性中有10309人接受了筛查。有138名女性被确认存在乳腺异常，并被建议去地区医院接受进一步的诊断和治疗。其中20人没有去医院进一步接受诊断治疗。在去医院的108名女性中，101人确诊为良性病变，8人确诊为原位癌，另外9人为恶性病变。在治疗后，17名确诊为原位癌或恶性病变中的12人（4人为早期乳腺癌，8人为导管原位癌）预后良好。在对照组中，仅有4名女性去医院就诊，1人为良性病变，另3人为肿瘤晚期。

　　本研究结果提示，在偏远地区中，通过当地志愿者进行乳腺癌筛查能增加早期发现不典型的乳腺肿瘤患者。这些发现能帮助政策制定者在苏丹和其他撒哈拉以南地区做出制定肿瘤控制项目的决定。


Background
Breast cancer has a low cure rate in low-income and middle-income countries because patients often present with late-stage disease that has metastasised to other organs. We assessed whether the implementation of a cancer awareness and breast examination programme that uses local, volunteer women could increase the early detection of breast cancer in a rural area of sub-Saharan Africa.
Methods
We did this pilot study in two counties in Gezira State, Sudan. We chose Keremet (56 villages) as the experimental county and Abugota (79 villages) as the control county. Female volunteers from villages in Keremet were trained in the detection of breast abnormalities. When trained, volunteers visited households in their village and screened women aged 18 years or older for breast abnormalities, referring women with suspected breast cancer for medical diagnosis and, if necessary, treatment at the district hospital. We also ran a cancer awareness programme for both men and women in study villages. Villages in the control population received no intervention. This study is ongoing.
Findings
Between Jan 1, 2010, and Oct 10, 2012, 10 309 (70%) of 14 788 women in Keremet were screened. 138 women were identified as having breast abnormalities and were referred to the district hospital for diagnosis and treatment. 20 of these women did not report to the hospital. Of the 118 women who did report, 101 were diagnosed with benign lesions, eight with carcinoma in situ, and nine had malignant disease. After treatment, 12 of the 17 women with either carcinoma in situ or malignant disease (four had early breast cancer and eight had ductal carcinoma in situ) were disease-free and had a good prognosis. In the control villages, only four women reported to the centre: one was found to have a benign lesion while three were diagnosed with advanced disease.
Interpretation
Our findings show that a screening programme using local volunteers can increase the detection of breast cancer in asymptomatic women in low-income rural communities. These findings can inform policy-makers' decisions in the design of cancer control programmes in Sudan and other similar areas in sub-Saharan Africa.

    

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    2013-12-05 minlingfeng

    #Oncol#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1864415, encodeId=d2ff186441511, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Thu Dec 05 02:13:00 CST 2013, time=2013-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1827514, encodeId=9efa182e514f0, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Jun 13 01:13:00 CST 2013, time=2013-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1382607, encodeId=6b8f138260e37, content=<a href='/topic/show?id=1f4e5946422' target=_blank style='color:#2F92EE;'>#早期诊断#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59464, encryptionId=1f4e5946422, topicName=早期诊断)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Thu Feb 07 08:13:00 CST 2013, time=2013-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1455943, encodeId=02f81455943a3, content=<a href='/topic/show?id=d1fc23e69b7' target=_blank style='color:#2F92EE;'>#乳腺癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23769, encryptionId=d1fc23e69b7, topicName=乳腺癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Thu Feb 07 08:13:00 CST 2013, time=2013-02-07, status=1, ipAttribution=)]
    2013-06-13 howi

    #Lancet#

    0

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    2013-02-07 一叶知秋

    #早期诊断#

    0

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    2013-02-07 智智灵药

    #乳腺癌筛查#

    0

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