台灣南部某醫院常見癌症篩檢推動策略及成效分析

Common Cancers Strategic Screening and its Outcomes Analysis in a Southern Hospital

王建楠(Jian-Nan Wang) ； 李璧伊(Pi-I Li)

《中華職業醫學雜誌》 22卷4期 (2015/10) Pp. 263-272

摘要

自民國71年起，癌症（惡性腫瘤）便高居國人十大死因之首，直到現在每年約奪走4萬多人的生命，一旦罹患癌症，不但影響病人及其家人的日常生活品質，也導致龐大的健保醫療費用支出和工作人年之損失，對整體社會經濟與民生帶來重大衝擊。每一個人終其一生均可能罹癌，隨著國人平均餘命延長，罹癌的機率亦隨著年齡增長而上升。一個人是否罹癌，和個人體質（遺傳）、環境暴露與生活型態有關，乃先天遺傳與後天環境交互作之結果，真正遺傳性癌症僅占約10%。三段五級預防策略同樣可應用於癌症防治，可經由篩檢早期發現與早期治療，例如30歲以上婦女定期子宮頸抹片檢查，一旦發現子宮頸原位癌，經即時完整治療後可達100%治癒率，真可說是六分鐘護一生。民國92年「癌症防治法」實施後，國民健康署於民國94年至98年推動「國家癌症五年防治計畫」，執行成效良好獲得行政院頒發績優獎，緊接著政府為降低癌症死亡率，於民國99年推動「第二期國家癌症防治計畫－癌症篩檢（99-102年）」，強化民眾對於癌症防治方法之認知，避免癌症危險因子（如吸菸、嚼檳榔、飲酒、肥胖等），整合各縣市衛生局及全國醫療院所資源，提供民眾主要癌症（子宮頸癌、乳癌、大腸癌及口腔癌）篩檢服務。若以民國102年十大癌症死因死亡率和民國92年作比較，則發現子宮頸癌下降幅度最大，從每10萬人口數8.4人降至每10萬人口數6.0人。女性乳癌經由乳房攝影檢查，可早期發現群聚微細鈣化病灶，進一步追蹤治療，四年（99-102年）篩檢追蹤統計結果，發現台灣婦女乳癌罹病年齡較歐美國家約提早10年，於是自民國103年起乳癌篩檢年齡，從50歲下降至45歲，若二等親有乳癌家族病史，則40歲便可開始參加乳攝篩檢。常見癌症篩檢服務可分為社區與醫療院所，各衛生局可和當地醫療院所合作，利用健康講座、義診、複合式健檢等社區活動時，同時對符合條件之民眾提供四癌篩檢，符合條件且未檢名單可事先由電腦資料中取得，以電話或明信片通知。民眾及其家人至醫療院所就醫時，除了提供醫療服務外，應設置可近性癌症篩檢站，鼓勵符合篩檢條件民眾加入即時預防保健行列，尤其是口腔癌與子宮頸癌，只須花一、二十分鐘當場便可完成。至於大腸糞便潛血檢查，可先索取管子，回家後取得檢體再送至醫院；乳房攝影檢查若當天無法完成，可另約適當時間排檢。

關鍵字

癌症 ； 乳癌 ； 子宮頸癌 ； 大腸癌 ； 口腔癌 ； 原位癌 ； 侵襲癌

並列摘要

Cancer was the first leading cause of death in Taiwan since 1982.Until now every year, cancer brought about more than 40,000 deaths, the cancer not only affected patients and their families daily life qualities, but also caused large amount medical costs and work-year loss. Everyone could get cancer in his life, cancer morbidity risks increased with longer life expectancy, it depended on each hereditary genes, environmental exposures, and lifestyles, namely the outcomes of genetic and environmental interactions. The cancer is preventable, via screening in communities, local clinics and hospitals, early detection and treatment of cancer is possible and with better prognosis. For example, Pap's smear for screening of cervical cancer, once detected carcinoma in situ, after immediate proper treatment, it could be cured completely. In 2003, the law of cancer prevention was announced and started motivation, the National health promotion bureau moved the national 5-year cancer prevention program from 2005 to 2009.To reduce the cancer mortality rate, proposed the cancer screening program from 2010 to 2013, enhanced the recognition of cancer prevention methods, how to avoid cancer risk factors (i.e. smoking, betal nuts chewing, alcoholism, obesity, etc.), integrated the resources of each local city health bureau and hospitals or clinics in islands, provided the common cancer screening, such as cervical cance, oral cancer, female breast cancer, and colorectal cancer.For the most 10 cancer mortality rate, compared 2003 with 2013, we found cervical cancer mortality rate dropped dramatically, from 8.4 person every 100 thousand to 6.0 person per 100 thousand. By means of mammography screening study, we could detect cluster microcalcification lesion earlily and further in-vestigation and management. Oral cavity inspection by doctors are convenient and fast test for adults with smoking and/or betal nuts chewing habits.

並列關鍵字

cancer ； breast cancer ； cervical cancer ； colorectal cancer ； oral cancer ； carcinoma in situ ； invasive cancer