Ngoma Twalib, Mandeli John, Holland James F
Ocean Road Cancer Institute, Dar es Salaam, Tanzania.
Int J Cancer. 2015 Jun 15;136(12):2875-9. doi: 10.1002/ijc.29348. Epub 2014 Dec 3.
Cancer is usually diagnosed late in rural Africa leading to incurability and abbreviated survival. Many curable cancers present on the body surface, often recognizable early by laymen as suspicious, justifying professional referral. Cancer diagnoses in two randomly chosen Tanzanian villages were compared after conventional dispensary self-referral vs. proactive visits in the home. Village navigators organized trips for professional consultation. In the control village 21% were self-referred, 20% of them were sent on as suspicious, 78% had cancer (8% in men) 0.9% of the village population. In the intervention village 99% were screened, 14% were referred for professional opinion, 93% had cancer (32% in men) 1.6% (p < 0.01 compared with control village). In the second and third years similar activity yielded 0.5% cancer annually in the control village for a 3 year total of 1.86% whereas interventional villagers had 1.4% and 0.6% cancer for a 3 year total of 3.56% (p < 0.001). Downstaging was recognized in the second and third years of intervention from 23 to 51 to 74% Stages I and II (p < 0.001) but in the control village Stages I and II changed from 11% to 22% to 37% (p = NS). The greatest downstaging occurred in breast and cervix cancers.
在非洲农村地区，癌症通常在晚期才被诊断出来，导致无法治愈且生存期缩短。许多可治愈的癌症出现在身体表面，外行人通常能早期识别出可疑症状，从而促使患者寻求专业转诊。在坦桑尼亚两个随机选择的村庄，对传统药房自我转诊与主动上门访视后的癌症诊断情况进行了比较。村庄导航员组织了专业咨询就诊。在对照村庄，21%的患者是自我转诊的，其中20%因可疑症状被转诊，78%患有癌症（男性占8%），占村庄人口的0.9%。在干预村庄，99%的人接受了筛查，14%被转诊以征求专业意见，93%患有癌症（男性占32%），占1.6%（与对照村庄相比，p<0.01）。在第二年和第三年，类似的活动使对照村庄每年的癌症发病率为0.5%，三年总计为1.86%，而干预村庄的癌症发病率分别为1.4%和0.6%，三年总计为3.56%（p<0.001）。在干预的第二年和第三年，分期降低的情况得到确认，I期和II期从23%降至51%再降至74%（p<0.001），而在对照村庄，I期和II期从11%变为22%再变为37%（p=无显著性差异）。分期降低最明显的是乳腺癌和宫颈癌。
