Early screening knowledge of high-risk groups of common malignant tumors in residents (1)

Do you know? More than 10,000 people on the mainland develop cancer every day, and 1 person is diagnosed with cancer every 8 seconds. Chinese lifetime risk of cancer is as high as 25%. The World Health Organization proposes that nearly 50% of cancers can be prevented, and 1/3 of cancers can be detected early through screening, thus obtaining a chance of cure. The top 10 cancers in the world in 2020 are breast cancer, lung cancer, colorectal cancer, prostate cancer, stomach cancer, liver cancer, cervical cancer, esophageal cancer, thyroid cancer, and bladder cancer. Therefore, scientific screening is extremely important for early detection, early diagnosis and early treatment of common malignant tumors. Now I would like to introduce the screening methods for people at high risk of common malignancies.

01

breast cancer

Women who meet any of the following criteria (A), (B), and (C) are at high risk for breast cancer

A Has a genetic family history, i.e. any of the following:

(1) First-degree relatives have a history of breast cancer or ovarian cancer;

(2) Second-degree relatives have 2 or more breast cancers before the age of 50;

(3) Before the age of 50, the second-degree relatives have 2 or more people with ovarian cancer;

(4) At least 1 first-degree relative carries a known pathogenic genetic mutation of brCA1/2 gene; or carries a pathogenic genetic mutation of BRCA1/2 gene.

B. Any of the following:

(1) Age of menarche≤12 years;

(2) Menopausal age≥55 years;

(3) History of breast biopsy or surgery of benign breast disease, or history of atypical hyperplasia of the breast (lobular or catheter) confirmed by the disease;

(4) Hormone replacement therapy using "estrogen-progesterone combination" for not less than half a year;

(5) Breast x-ray examination after age 45 indicates that the mammary parenchyma (or breast density) type is uneven and dense or dense.

C Has any two of the following:

(1) No history of breastfeeding or breastfeeding time < 4 months;

(2) No history of live birth (including never had a child, miscarriage, stillbirth) or the age of the first live birth ≥ 30 years;

(3) Hormone replacement therapy with only "estrogen" is not less than half a year; miscarriage (including spontaneous abortion and induced abortion) ≥ 2 times.

(Note: First-degree relatives refer to mothers, daughters and sisters; second-degree relatives refer to aunts, aunts, grandmothers and maternal grandmothers)

Screening Recommendations:

1. Breast X-ray combined with breast ultrasound once a year.

2. If necessary, combined with breast MRI once a year (need to be confirmed by a specialist).

02

lung cancer

1. High-risk groups

(1) Smoking: The number of years of smoking packs ≥ 30 pack years, including 30 packs of years ≥ have smoked, but less than 15 years of smoking cessation.

(2) Passive smoking: living with or working in the same room with smokers for ≥ 20 years.

(3) Have chronic obstructive pulmonary disease (COPD).

(4) Have a history of occupational exposure (asbestos, radon, beryllium, chromium, cadmium, nickel, silicon, soot and soot) for at least 1 year.

(5) There are first-degree relatives diagnosed with lung cancer.

(Note: Note 1: Number of years of smoking packs = number of packs smoked per day (20 sticks per pack) × years of smoking; Note 2: First-degree relatives refer to parents, children and siblings).

2. Screening recommendations for high-risk groups:

(1) For people at high risk of lung cancer, it is recommended to perform low-dose spiral CT screening. Lung cancer screening is recommended using 64 rows or more of spiral CT whenever possible.

(2) If nodules in the lungs are detected, according to the different characteristics of the nodules: ground glass, sub-solid, solid nodules or the specific situation of multiple nodules Low-dose spiral CT review (the specific situation needs to be determined by a specialist).

(3) PET/CT screening is not recommended.

03

Colorectal cancer

1. High-risk groups

(1) Asymptomatic people over 45 years old.

(2) People over 40 years old with 2-week anorectal symptoms [2-week anorectal symptoms refer to those who have any of the following symptoms for more than 2 weeks: changes in stool habits (constipation and diarrhea, etc.); changes in the shape of stools (thinning of stools); changes in the nature of stools (blood in the stool and mucus stools, etc.) and pain in fixed parts of the abdomen].

(3) My fecal occult blood (OB) test is positive.

(4) I have inflammatory bowel disease that has not healed for 8 to 10 years.

(5) People after colorectal cancer surgery.

(6) People after colorectal adenoma treatment.

(7) Immediate family members with a "family history of colorectal cancer".

(8) Immediate family members diagnosed with "hereditary colorectal cancer", over the age of 20 years.

2. Screening recommendations:

"General Population" Screening for High-Risk Persons In Accordance with Items 1 to 5:

(1) Colorectal cancer screening begins at the age of 45, regardless of men and women, once a year fecal occult blood (OB) test, every 10 years colonoscopy, until the age of 75;

(2) 76 to 85 years old, physical fitness, life expectancy of more than 10 years, can continue to maintain screening;

(3) For those over 85 years old, it is not recommended to continue screening.

(4) Colon CT: suitable for cases where colonoscopy cannot be completed.

Complies with The Screening Recommendations for Immediate Family Members with a Family History of Colorectal Cancer in High-Risk Recipients Section 6:

(1) 1 first-degree relative with a clear high-grade adenoma or cancer (age of onset < 60 years old), 2 or more first-degree relatives with a clear high-grade adenoma or cancer (any age of onset), screening begins at the age of 40 (or starts at 10 years younger than the age of onset of the smallest family), and stool OB is examined once a year, and colonoscopy is performed every 5 years;

(2) High-risk subjects with family history of first-degree relatives (only 1 person, and the age of onset ≥ 60 years). Screening begins at age 40, with an annual stool OB exam and a colonoscopy every 10 years.

Complies with The Screening Recommendations for Immediate Family Members of High-Risk Subjects under Article 7 "Hereditary Colorectal Cancer":

(1) Genetic counseling;

(2) risk assessment and genetic testing;

(3) Screening begins at age 20 (or 10 years younger than the youngest patient in the immediate family) and colonoscopy is performed every 1 to 2 years.

04

prostate cancer

1. High-risk objects

Men with a life expectancy of more than 10 years who meet one of the following criteria may decide whether to screen for prostate cancer in conjunction with specialist recommendations, after fully aware of the benefits and harms of screening.

(1) Age ≥ 60 years old

(2) Age ≥ 45 years old and has a family history of prostate cancer

(3) Carry brCA2 gene mutation and ≥ 40 years old.

2. Screening recommendations:

(1) It is recommended to carry out PSA-based prostate cancer screening for men with good physical condition and > life expectancy of 10 years.

(2) Serum PSA testing is carried out once every 2 years, and the termination time of PSA testing is determined according to the age and physical condition of the patient (specifically confirmed by a specialist).

(3) It is not recommended to use positron emission computed tomography (PET-CT), ultrasound or magnetic resonance imaging alone for prostate cancer screening.

(4) It is not recommended to use digital rectal examination (DRE) alone for prostate cancer screening.

(5) For high-risk groups of prostate cancer, screening based on serum PSA testing should be carried out as soon as possible.

(6) Population screening for men under 40 years of age is not recommended.

bibliography:

National Health Commission. Guidelines for breast cancer diagnosis and treatment (2022).

National Health Commission. Guidelines for the Diagnosis and Treatment of Prostate Cancer (2022).

National Health Commission. Guidelines for the Diagnosis and Treatment of Primary Lung Cancer (2022).

He Jie, Chen Wanqing, et al. Guidelines for Breast Cancer Screening and Early Diagnosis and Early Treatment in Chinese Women (2021). Beijing.2021,30(03):161-191.

[5] He Jie, Li Ni, et al. Guidelines for Screening and Early Diagnosis and Early Treatment of Lung Cancer in China (2021). Beijing2021.30(02):81-111.

Chen Wanqing et al. Guidelines for Screening and Early Diagnosis and Early Treatment of Colorectal Cancer in China (2020).China Oncology,Beijing.2021.30(01):1-28.

[7] Hejie et al. Guidelines for Prostate Cancer Screening and Early Diagnosis and Early Treatment in China (2022, Beijing). Beijing.2022,31(01):1-30.

Cai Sanjun et al. Recommendations for screening and prevention of common malignant tumors in residents (2021 edition).Shanghai:2021.41(04):296-308.

Cao Maomao,Chen Wanqing. GLOBOCAN 2020 Global Cancer Statistics Interpretation. Chinese Journal of Frontiers in Medicine[J/OL].2021, 13(03):63-69.

Author: Wang Jiangtao

Review: Hu Yuandong

Trial: Huang Yan

END