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In order to truly and efficiently detect malignant tumors early, scientists from various countries around the world have conducted a large number of follow-up observations, comparative studies and health economic analysis. At present, relatively reliable physical examination methods have been identified in some high-frequency tumors: p>

For example, low-dose chest CT is used to screen for lung cancer;

Gastroscope is used to screen gastric cancer and esophageal cancer;

Use of fecal occult blood, digital anal examination, and colonoscopy to screen for colon cancer;

Screening for breast cancer with B-ultrasound or molybdenum target;

Cervical exfoliation cytology combined with HPV detection for screening cervical cancer;

Hepatitis B carriers screen for liver cancer with B-ultrasound and blood alpha-fetoprotein testing;

PSA screening for prostate cancer …

Each of the suggestions listed here is followed up by tens of thousands of people for several years or even decades of follow-up observations, and finally condenses into the wisdom of all human beings.

Next I will show readers how low-dose chest CT can be used to screen for lung cancer.

Why isn’t an ordinary chest radiograph recommended for a lung cancer checkup?

Lung cancer is the malignant tumor with the highest morbidity and death rate in the world. Early lung cancer can be without symptoms, and blood tests can be completely normal. Early screening of lung cancer. As of now, a large probability depends on imaging Learning, the most commonly used are: chest X-ray (referred to as chest radiograph) , chest CT.

But a cancer early screening technology that can be widely promoted and successfully implemented must meet a series of indicators: simple, cheap, as small as possible for healthy people, as small as possible, not missing cancer patients, As much as possibleJudgment etc.

In addition, there is a decisive indicator, is whether it can effectively reduce the probability of dying of this cancer because of healthy people participating in medical examinations, and greatly extend the overall life expectancy of healthy people.

Anti-cancer physical examination has found more patients with early-stage malignant tumors. The 5-year survival rate of this group of patients must be much higher than that of patients with advanced malignancies as a whole. However, there is a major “hidden danger”: if you do not take a physical examination, these 10 people will find lung cancer at the age of 60 on average, and they will survive an average of 2 years after the discovery of lung cancer. The implication is that these 10 people died at the age of 62; actively participate On physical examination, the 10 people found lung cancer at the age of 55 on average, and lived an average of 7 years after the discovery of lung cancer. These 10 people still died at the age of 62.

If this is the case, anti-cancer physical examination only discovered lung cancer earlier, but did not really extend the average life expectancy of this group of patients; then, instead, this group of people lived in the shadow of lung cancer earlier. , Spent more money, suffered more side effects of treatment, wouldn’t it be fatal!

From November 1993 to July 2001, 10 large medical centers in the United States conducted randomized controlled trials on 154,901 people at high risk of lung cancer between the ages of 55 and 74. One group underwent regular chest radiography and one group No special arrangements were made, and these 150,000 people were followed up and observed for up to 13 years. The final data was published in the Journal of the American Medical Association in 2011: regular chest radiographs can indeed find more early and middle stages Lung cancer patients, but failed to reduce the probability of dying of lung cancer in this population, that is, failed to extend the life expectancy of this population.

Past and present life of low-dose chest CT for anti-cancer medical examinations

There is no benefit from a chest radiograph, so try another way.

From August 2002 to April 2004,The center funded and led the participation of 33 US medical centers, recruiting 53,454 55-74-year-old lung cancer high-risk groups-mainly the number of cigarettes smoked per day and the number of years of smoking multiplied by more than 30 years of old chimneys, such as smoking every day One pack has been smoked for more than 30 years, or two packs have been smoked daily for more than 15 years.

These people are divided into two groups, one group undergoes low-dose chest CT examinations, and one group undergoes regular chest X-ray examinations, with annual physical examinations and three consecutive physical examinations. If abnormalities are found during this process, arrangements are made Follow-up examinations, if lung cancer is confirmed, of course, active treatment, follow-up observation December 31, 2009, and then a summary analysis of the data.

Data show that low-dose chest CT can find more lung cancer patients, most of which are stage I lung cancer patients. Most of these patients were cured after undergoing comprehensive treatment such as surgery, so the overall lung cancer mortality rate dropped by 20%.

The picture below is valuable. The red line represents the growth curve of the number of people who died of lung cancer over time in the group receiving ordinary chest radiography; the black line below it represents the number of people who died of lung cancer in the group receiving low-dose chest CT examination over time. Growth curve; in the first year or two, there is no difference between the two curves. The gap before the black and red lines represents a reduction in deaths from low-dose chest CT examinations.

Calculate an economic account for low-dose chest CT examinations

Low-dose chest CT physical examination can effectively reduce the probability of dying of lung cancer in high-risk populations, thereby extending the life expectancy of this population; this physical examination method is very sensitive, and more than 95% of lung cancer patients can be discovered by this technology . Then, the next question is to calculate the economic account.

After all, In developed countries such as Europe and the United States, a chest CT is not cheap. In 2014, the New England Journal of Medicine officially announced the results of the economic cost-benefit analysis of low-dose chest CT for lung cancer physical examination. Let us look at how Americans calculate their accounts. After all, how human lives are converted into US dollars, is one Men Xuanzhi and Xuan Xue.

First, health economists calculated the annual cost of low-dose chest CT, the cost of additional laboratory tests performed by a small percentage of healthy people because they were judged to have abnormal breasts, and other calculable and low-dose chests. CT-related additional medical expenses. They eventually found that the average annual expenditure per capita is US $ 1631, which is equivalent to more than 10,000 yuan RMB—going to a hospital or physical examination institution for a low-dose chest CT every year, and after getting the report, you may need to register for a doctor to see it. A simple thing will cost 10,000 yuan; a domestic chest CT is about seven or eight hundred yuan.

Next, medical scientists calculated the increase in life expectancy caused by low-dose chest CT. Since the vast majority of people were healthy, they were also healthy and did not benefit directly. The real benefit is that only a very small number of lung cancer patients who would not be discovered until the middle and late stages have lost their chance of cure. Some of them have just developed lung cancer due to low-dose chest CT examinations. It was discovered in stage I and was completely cured after receiving active treatment such as surgery.

The prolonged life expectancy obtained by this group of patients is evenly distributed to the total population participating in the physical examination, which is about 0.0316 years, which is equivalent to 11.5 days—a low-dose chest CT physical examination will increase the average life expectancy of this group of people at high risk for lung cancer. 11 and a half days.

Finally, benevolent sees benevolence, wise see wisdom, readers and policy makers are asked to make their own judgments and judgments: In the current domestic medical service pricing system, about 1,000 yuan is spent each year, and the average lifespan is extended by 11 and a half days; Is this money worth it?

This article comes from WeChat public account: CC Weekly (ID:gh_d30ff03bdc88) , Author: Smart Fish (Shanghai Tumor Hospital, a physician)