Májek O, Danes J, Zavoral M, Dvorák V, Suchánek S, Seifert B, Kozený P, Pánová S, Dusek L
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Klin Onkol. 2010;23(5):343-53.
All three cancer screening programmes recommended by the Council of the EU are available to defined target age groups in the Czech Republic. Organized programmes for screening of breast, colorectal and cervical cancer have been initiated in the last decade.
A system for information support, as an essential component of organized screening programmes, has been implemented in all screening programmes. It comprises the Czech National Cancer Registry to monitor the cancer burden and population impact of the programmes, the National Reference Centre as a provider of nationwide insurance claims data, and the specialised databases of all three programmes, which collect information on screening, diagnostics and final diagnoses.
Early diagnostics of malignant neoplasms and progress in therapy have helped to stabilize mortality, even in diagnoses with increasing incidence. The coverage of the Czech screening programmes has constantly been rising; however, it is still insufficient: 51.2%, 17.9% and 48.4% of the target population was covered at the end of 2008 in breast, colorectal and cervical screening programmes, respectively. In 2008, a total of 468,419 women underwent screening mammography and 2,128 tumours were detected (4.5 per 1,000 screened). According to the screening colonoscopy registry, more than 13,000 men and women underwent preventive colonoscopy in 2009, 4,085 patients were diagnosed with adenoma and 619 with colorectal cancer, mostly in the early stages. The information system for cervical screening was implemented in 2009 and has been running in pilot mode; the first results are expected at the end of 2010.
The system for information support within organised cancer screening programmes enables monitoring of the performance of screening and diagnostic centres and thus helps to maintain continuous quality improvements, which are a necessary presumption for replicating the promising results of clinical trials. To achieve a substantial impact on population incidence and mortality, a large increase in test coverage in target populations will be necessary. The programmes should be transformed to a population-based form, which involves inviting all people in the target population to be screened.
欧盟理事会推荐的所有三项癌症筛查项目在捷克共和国均适用于特定目标年龄组。在过去十年中启动了乳腺癌、结直肠癌和宫颈癌的有组织筛查项目。
作为有组织筛查项目的重要组成部分，信息支持系统已在所有筛查项目中实施。它包括用于监测项目的癌症负担和人群影响的捷克国家癌症登记处、作为全国保险理赔数据提供者的国家参考中心以及所有三个项目的专门数据库，这些数据库收集有关筛查、诊断和最终诊断的信息。
恶性肿瘤的早期诊断和治疗进展有助于稳定死亡率，即使在发病率上升的诊断中也是如此。捷克筛查项目的覆盖率一直在上升；然而，仍然不足：2008年底，乳腺癌、结直肠癌和宫颈癌筛查项目分别覆盖了目标人群的51.2%、17.9%和48.4%。2008年，共有468419名女性接受了乳腺钼靶筛查，检测出2128例肿瘤（每1000名筛查者中有4.5例）。根据筛查结肠镜登记处的数据，2009年有超过13000名男性和女性接受了预防性结肠镜检查，4085例患者被诊断为腺瘤，619例被诊断为结直肠癌，大多数处于早期阶段。宫颈癌筛查信息系统于2009年实施，目前处于试点运行模式；预计2010年底会有首批结果。
有组织的癌症筛查项目中的信息支持系统能够监测筛查和诊断中心的表现，从而有助于持续保持质量改进，这是复制临床试验中令人鼓舞的结果的必要前提。为了对人群发病率和死亡率产生重大影响，有必要大幅提高目标人群的检测覆盖率。这些项目应转变为基于人群的形式，即邀请目标人群中的所有人进行筛查。
