He Zhonghu, Ke Yang
State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Chin J Cancer Res. 2023 Dec 30;35(6):584-594. doi: 10.21147/j.issn.1000-9604.2023.06.03.
Cancer stands as a prominent public health concern in China, with elusive intervention targets due to unidentified high-risk causal factors for most cancers. Consequently, emphasis has shifted towards screening, diagnosing, and treating early cancer cases within the general population. However, China faces considerable obstacles in its cancer prevention and control efforts, attributing to the complexity and heterogeneity of the occurrence, progression, and prognosis of malignant tumors across populations, time, and regions. Taking esophageal cancer screening practices as an example, this review outlines the importance and assessment of cancer screening, delineating major challenges in China's cancer prevention and control: 1) limited comprehension of cancer's natural history; 2) lack of "China Evidence" supporting screening effectiveness and value; 3) compromised efficiency and accuracy in current screening modality; and 4) insufficient sustainability of the current screening practices and translation of relevant scientific research achievements. To address these challenges, we propose potential coping strategies: 1) establishing tailored technologies and pathways for cancer prevention and control based on population-based and clinical epidemiological studies using high-quality designs; 2) breaking conventional constraints to establish a novel cancer screening strategy aligned with real-world needs; and 3) establishing enhanced communication platforms among scientific research teams, policymakers, and industrial institutions to foster collaboration and innovation.
癌症是中国一个突出的公共卫生问题，由于大多数癌症的高危致病因素尚不明确，干预目标难以确定。因此，重点已转向在普通人群中筛查、诊断和治疗早期癌症病例。然而，中国在癌症防治方面面临诸多障碍，这归因于恶性肿瘤在人群、时间和地区上发生、发展及预后的复杂性和异质性。以食管癌筛查实践为例，本综述概述了癌症筛查的重要性和评估，阐述了中国癌症防治中的主要挑战：1）对癌症自然史的理解有限；2）缺乏支持筛查有效性和价值的“中国证据”；3）当前筛查方式的效率和准确性不足；4）当前筛查实践的可持续性以及相关科研成果转化不够。为应对这些挑战，我们提出了潜在的应对策略：1）基于高质量设计的人群和临床流行病学研究，建立针对癌症防治的定制技术和途径；2）突破传统限制，建立符合实际需求的新型癌症筛查策略；3）在科研团队、政策制定者和产业机构之间建立强化的沟通平台，以促进合作与创新。
