Xinhua News Agency, Beijing, April 21, 2019 Title: The 5-year survival rate is not less than 43.3%, how can cancer screening help?
Dong Ruifeng, a reporter from Xinhua News Agency's "Xinhua Viewpoint."
Can "talking about cancer" no longer be "discolored"?
The Healthy China Initiative (2019-2030) sets a target of no less than 43.3% and 46.6% of the overall cancer five-year survival rate by 2022 and 2030, respectively.
A number of senior experts in the industry interviewed by the "Xinhua Viewpoint" reporter said that at present, a variety of cancers can be "early detection and early treatment", and it is the key to do a good job in cancer screening and early diagnosis and treatment.
Most common cancers can be detected early, and the threshold of prevention should be pushed forward
According to the latest data from the National Cancer Center, there are about 4.06 million new cancer cases and about 2.41 million deaths in the country. In recent years, the 5-year survival rate of cancer has increased significantly, but there is still a big gap with developed countries.
"Some patients who are suffering from advanced cancer can be prevented by screening, early diagnosis and other means." Wang Guiqi, director of the Department of Endoscopy of the Cancer Hospital of the Chinese Academy of Medical Sciences, has insisted on promoting rural cancer screening and early diagnosis and treatment for many years, and he is deeply touched by this.
"The last thing we doctors who do cancer treatment wants to see is the word 'late', and the word 'early' that we want to tell everyone the most." Wang Guiqi said that the high incidence of esophageal cancer, gastric cancer, colorectal cancer, etc. in the mainland often takes 10 to 15 years to experience precancerous lesions, early cancer and then to intermediate and advanced tumors. Through screening and early diagnosis and early treatment, these precancerous lesions and early cancers can be found, diagnosed, treated and even cured, and long-term adherence can significantly reduce the incidence and mortality of these tumors.
The Healthy China Initiative (2019-2030) points out that current technical means can detect most common cancers at an early stage, such as gastrointestinal cancer can be found using gastrointestinal endoscopy, lung cancer can be found by low-dose spiral CT of the chest, and breast cancer can be detected by ultrasound combined with molybdenum target.
After the long-term clinical research and practice of several generations of medical workers in mainland China, key cancers such as stomach cancer, esophageal cancer, colorectal cancer, lung cancer, cervical cancer, breast cancer and other key cancers with high incidence and relatively mature screening methods and technical schemes have been formed.
According to the data released by the National Health Commission, after the cancer screening and early diagnosis and early treatment in rural areas and some cities, the early diagnosis rate of cancer in some project areas exceeded 80%, the treatment rate reached 90%, and the cancer mortality rate of the screened population was reduced by 46%.
"Whether it is an acute infectious disease or a chronic non-communicable disease, we should promote the prevention threshold to move forward and control the occurrence and development of major diseases from the source." Wang Guiqi said, "This is also the most economical and effective health strategy." ”
The coverage of early diagnosis of cancer screening is still limited, and a long-term mechanism needs to be established
The "Healthy China Action (2019-2030)" clearly states that the early diagnosis rate of key cancer species in high-incidence areas has reached 55% or more and continues to increase.
At present, the "two cancers" screening of cervical cancer and breast cancer in rural women has become the content of basic public health service projects in the mainland, and the scope of benefits has been expanding in recent years. With the support of major national public health projects, the rural cancer screening early diagnosis project has now covered 31 provinces and 782 counties (districts) across the country.
Industry experts pointed out that the current cancer screening and early diagnosis work is more through one project after another, the coverage is still limited, and the health effect of the whole population cannot be seen.
Li Zhaoshen, academician of the Chinese Academy of Engineering and director of the Department of Gastroenterology at Changhai Hospital affiliated to the Naval Military Medical University, said that the diagnosis rate of early gastric cancer in the country is still less than 20%, and the 5-year survival rate of gastric cancer patients is only 27.4%, which is largely due to the fact that the mainland has not yet carried out nationwide gastric cancer screening for people of the right age.
The results of the mainland digestive endoscopic technology census show that in 2019, more than 38 million cases of digestive endoscopic diagnosis and treatment were carried out nationwide, an increase of about 10 million cases over 2012. But there is still a considerable gap compared to the number of people at risk for gastrointestinal tumors in mainland China.
Yu Jinming, academician of the Chinese Academy of Engineering and president of Shandong Provincial Cancer Hospital, said that the overall 5-year survival rate of cancer in some developed countries is relatively high, in addition to the different tumor tumor spectrum, an important reason is to achieve a more common active prevention and screening of early diagnosis.
"Long-term mechanisms for cancer screening and early diagnosis and treatment need to be established." Wang Guiqi said.
Reduce screening costs and improve access to screening techniques
In 2020, the National Medical Security Bureau said in response to the suggestions of the Npc deputies that tumor screening should be solved through public health services and other channels, and the conditions for inclusion in the scope of medical insurance payment are not yet mature.
However, according to public information, some provinces have begun to study the selection of low-cost, high-efficiency cancer screening technologies to include in medical insurance.
In 2021, in response to the relevant proposals of local CPPCC members, the Guangdong Provincial Health Commission said that it will focus on considering some common malignant tumors in the province to be included in the scope of payment for physical examination medical insurance, and priority can be given to covering high-incidence age groups. At the same time, the technological maturity of cancer screening is also an important consideration.
"Reducing the cost of tumor screening and gradually increasing the accessibility and acceptance of tumor screening technology is the direction of our efforts." Wang Guiqi suggested that the construction of a long-term mechanism for promoting cancer screening and early diagnosis and treatment should be included in relevant policy documents to establish a sustainable cost-sharing mechanism. At the same time, through professional access, quality control, professional training, etc., improve the standardized screening and diagnosis and treatment level of medical and health personnel at all levels, especially grass-roots medical and health personnel.
Yu Jinming said that the conditions for including all tumor screenings into medical insurance are not yet available, but it is possible to consider the establishment of various forms of insurance and protection mechanisms for tumors with high incidence and easy to achieve screening, such as lung cancer, stomach cancer, breast cancer, cervical cancer, and thyroid cancer.