年纪大了，有些叔叔阿姨、甚至同龄人发现了癌症。因此，请教了业内人士，在这里贴了权威的癌症早筛方法。

其实有些家人朋友并没有按时体检，特别是「讳疾忌医」的长辈。一定要提醒他们，做 体 检。早发现，早治疗，有更高的生存率。现在并没有「神奇」的癌症早期筛查手段。（媒体上说的「滴血测癌」是夸张的说法。）

其实癌症在健康人群中的早筛从理论上还不是非常完备，液体（主要是血液）检测作为癌症诊断手段仍有很长的路要走。目前成熟的基因检测都是针对患者的，比如用于肺癌靶向药物的选择。

但「液体活检」技术是趋势，以非侵入性的方式将患者的血液作为肿瘤活检的样本，检测出与肿瘤相关的遗传突变，以此找到肿瘤的迹象。通过循环肿瘤细胞（CTC）检测和循环肿瘤DNA（ctDNA）检测可能实现癌症早筛。针对健康人群来说，主要是做好定期体检，一般一年一次。同时如果觉得自己身体有不适，要及时就医，有不明因素的话定期按时随访，都可以及时发现癌症。针对有癌症家族史的健康人群（不是所有癌症，而是由遗传风险的癌症），更要保证常规体检，并参考下文中的手段针对性进行筛查。关于筛查方法，推荐参考。附件1：上海市抗癌协会2018年4月发布的《居民常见恶性肿瘤筛查和预防推荐》。附件2：美国癌症协会官网上的筛查指南cancer.org/（我没有翻译中文，也担心有的网站上在翻译中做文章，直接贴英文了）上海市抗癌协会《居民常见恶性肿瘤筛查和预防推荐》

肺癌

高危对象年龄40岁以上；至少合并以下一项危险因素：1、吸烟≥20包/年，其中包括戒烟时间不足15年者；2、被动吸烟者；3、有职业暴露史(石棉、铍、铀、氡等接触者)；4、有恶性肿瘤病史或肺癌家族史；5、有慢性阻塞性肺疾病或弥漫性肺纤维化病史。怎样早发现？1、对于肺癌高危人群，建议行LDCT筛查（即低剂量螺旋CT）。建议尽可能使用32层或以上多层螺旋CT进行肺癌筛查。扫描范围为肺尖至肋膈角尖端水平。基线CT扫描以后，每年进行1次LDCT肺癌筛查。

2、 若检出肺内结节需至少在12个月内进行LDCT复查；

3、 肺内结节根据国情和效能以及我国人群特征，不推荐将PET/CT作为人群肺癌筛查的方法。预防建议1、 不吸烟或戒烟；2、 对于有职业暴露危险的应做好防护措施；3、 保护环境，改善空气条件；4、 有呼吸系统疾病者要及时规范地进行治疗；5、 加强对肺癌科普知识的宣传。大肠癌高危对象

1、40岁以上有两周肛肠症状（即：大便习惯改变，如慢性便秘、慢性腹泻等；大便形状改变，如大便变细；大便性质改变，如黏液血便等；腹部固定部位疼痛）的人群；

2、有大肠癌家族史的直系亲属；3、大肠腺瘤治疗后的人群；4、长期患有溃疡性结肠炎的患者；5、大肠癌手术后的人群；6、有家族性腺瘤性息肉病(FAP)和遗传性非息肉病性结直肠癌(HNPCC)家族史的20岁以上直系亲属；7、50岁以上无症状人群。

怎样早发现？

1、40岁以上有症状高危对象，经两周对症治疗症状没有缓解者，应及时作肛门直肠指检、大便隐血试验(FOBT)检查，任一指标阳性应进行钡剂灌肠检查或肠镜检查。FOBT阳性者亦可直接进行肠镜检查以明确诊断，如FOBT阳性者经肠镜检查仍未示有异常，建议作胃镜检查，以排除上消化道出血。

2、40岁以上无症状高危对象，每年接受1次FOBT检查，如隐血试验阳性，则加钡剂灌肠检查或肠镜检查以进一步明确诊断。如FOBT检查连续3次阴性者可适当延长筛查间隔，但不应超过3年。3、年龄大于20岁的FAP和HNPCC家族成员，当家族中先发病例基因突变明确时，建议行基因突变检测，阳性者每1~2年进行1次肠镜检查。如基因突变检测阴性，则按照40岁以上个体进行筛查。4、50岁以上无症状筛检对象，每年接受1次FOBT检查，每5年接受1次大肠镜检查。预防建议1、运动可有效减少肿瘤发生，坚持体育锻炼，避免肥胖；2、健康膳食，增加粗纤维、新鲜水果摄入，避免高脂高蛋白饮食；3、适当膳食补充剂，如ω-3，钙剂；4、非甾体类消炎镇痛药可能对预防肠癌有效，老年人可尝试服用低剂量阿司匹林，既预防心脑血管疾病又预防肠癌发生，具体使用须咨询医生；5、戒烟戒酒，避免烟酒对消化道的长期毒性和炎性刺激。

乳腺癌

高危对象1、未育或≥35岁初产妇；2、月经初潮≤12岁，或行经≥42年的妇女；3、一级亲属在50岁前患乳腺癌者；4、两个以上一级或二级亲属在50岁以后患乳腺癌或卵巢癌者；5、对侧乳腺癌史或经乳腺活检证实为重度非典型增生或乳管内乳头状瘤病者；6、胸部放射治疗史（≥10年）者。上述情况均为乳腺癌高危因素，伴多条因素时，应考虑为高危乳腺癌对象。怎样早发现？

1、一般妇女

乳腺自查：20岁以后每月检查1次；临床体检：20~29岁每3年1次，30岁以后每年1次；X线检查：35岁，摄基础乳腺片；隔年1次乳腺X线摄片；>40岁，每1~2年1次乳腺X线检查：60岁以后可隔2~3年拍片检查1次。超声检查：30岁以后每年1次乳腺超声检查。2、乳腺癌高危人群鼓励乳腺自查；20岁以后每年做临床体检1次，30岁以后建议乳腺磁共振（MRI）检查。预防建议1、 健康生活方式，远离烟酒，合理营养，保持健康体重，坚持锻炼；2、 适时生育，母乳喂养；

3、 参加乳腺筛查，定期体检。

宫颈癌高危对象已婚或有性生活史3年的女性。怎样早发现？1、21~29岁采用宫颈细胞学检查，每2~3年1次；2、 30~65岁采用宫颈细胞学检查，每3年1次；或者HPV与宫颈细胞学联合筛查，每5年1次；3、 筛查结束时间：大于65岁且既往多次检查均示阴性，则不需筛查；若曾诊断为高度鳞状上皮内病变（HSIL）病史者，再持续筛查20年，筛查频率视病情定；4、接受过子宫全切术的女性（无宫颈），且过去20年里未曾有CIN2、CIN3、原位癌或癌症的女性，不需要检查；5、接种过HPV疫苗的女性，遵循特定年龄的建议（与未接种疫苗的女性一样）。

预防建议

1、 接种HPV疫苗；2、 不吸烟或戒烟；3、 安全与健康性行为；4、 及时治疗生殖道感染疾病；5、 增强体质。肝癌高危对象年龄男性35岁以上、女性45岁以上的以下人群：1、有乙型肝炎病毒（HBV）或丙型肝炎病毒(HCV)感染的血清学证据；2、有肝癌家族史；3、血吸虫、酒精性肝硬化等任何原因引起的肝硬化患者；4、药物性肝损患者。

怎样早发现？1、男性35岁以上、女性45岁以上的肝癌高危人群应进行筛查；2、联合血清甲胎蛋白(AFP)和肝脏B超检查，每6个月筛查一次。预防建议1、慢性肝炎患者尽早接受抗病毒治疗以控制肝炎病毒的复制；2、减少饮酒；食物尽量清淡，减少油腻食物摄入；3、防止发霉食物的摄入。胃癌高危对象（凡有下述情况之一者，均系高危对象。）1、60岁以上人群；2、中重度萎缩性胃炎；3、慢性胃溃疡；4、胃息肉；5、良性疾病术后残胃（术后10年）；6、胃癌术后残胃（术后6~12月）；7、异型增生（轻、中、重）；8、中、重度肠化生；9、明确家族史；10、胃黏膜巨大皱褶征。怎样早发现？年龄大于40岁有腹痛、腹胀等上腹部不适症状，并有慢性胃炎、胃黏膜肠上皮化生、胃息肉、残胃、胃巨大皱褶征、慢性胃溃疡和胃上皮异型增生等病变以及有肿瘤家族史的对象，应根据医师建议定期做胃镜检查。预防建议1、健康的饮食习惯和饮食结构，尤其是避免腌渍食物和霉变食物摄入，减少亚硝酸盐的摄入；2、积极防控幽门螺旋杆菌感染；3、定期体检，发现癌前病变并及时处理；4、戒烟戒酒，不暴饮暴食和进食过烫的食物；5、少喝或不喝烈性酒。前列腺癌高危对象1、年龄大于50岁的男性；2、年龄大于45岁且具有前列腺癌家族史的男性；3、年龄大于40岁且基线PSA>1μg/L的男性；具有以上前列腺癌高危因素的男性，需提高警惕，必要时进行有针对性的检查，对异常结果进行合理随访。怎样早发现？1、建议对身体状况良好，且预期寿命在10年以上的男性开展基于PSA检测的前列腺癌筛查，且在筛查前应详细说明前列腺癌筛查的风险和获益；2、血清PSA检测每2年进行1次，根据患者的年龄和身体状况决定PSA检测的终止时间；3、对于前列腺癌高危人群应尽早开展基于血清PSA检测的筛查；4、不建议针对40岁以下男性进行人群筛查。预防建议1、避免吸烟、饮酒等不良生活习惯；2、减少高动物脂肪的食物摄入，因为这些食物中含有较多的饱和脂肪酸；增加蔬菜水果摄入；3、避免过于辛辣的食物，因为这些食物会造成前列腺的过度充血；4、日常生活中多饮水，勤解尿。避免憋尿，久坐不动；5、建议适度体育运动。在中国人群当中，约有45%的癌症是由生活方式或者微生物感染因素所导致。通过疫苗接种以及改善生活方式，有将近一半的癌症是可以避免的。而另一半的癌症或许在所难免，但仍可以通过癌症筛查等方式早发现，从而提高治疗效果，增加治愈机会。部分早期癌症病人经过正规治疗后能活到5年以上的（5年生存率）可达到90%以上，而晚期癌症病人经治疗后的5年生存率约10%。American Cancer Society Guidelines for the Early Detection of Cancer原文链接在这里：cancer.org/healthy/findThe American Cancer Society recommends these cancer screening guidelines for most adults. Screening tests are used to find cancer before a person has any symptoms.Breast cancer
  • Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
  • Women age 45 to 54 should get mammograms every year.
  • Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
  • Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
  • All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening.

Women should also know how their breasts normally look and feel and report any breast changes to a health care provider right away.

Some women – because of their family history, a genetic tendency, or certain other factors – should be screened with MRIs along with mammograms. (The number of women who fall into this category is very small.) Talk with a health care provider about your risk for breast cancer and the best screening plan for you.Colon and rectal cancer and polypsFor people at average risk for colorectal cancer, the American Cancer Society recommends starting regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person』s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). Talk to your health care provider about which tests might be good options for you, and to your insurance provider about your coverage. No matter which test you choose, the most important thing is to get screened.If you』re in good health, you should continue regular screening through age 75.For people ages 76 through 85, talk with your health care provider about whether continuing to get screened is right for you. When deciding, take into account your own preferences, overall health, and past screening history.People over 85 should no longer get colorectal cancer screening.If you choose to be screened with a test other than colonoscopy, any abnormal test result needs to be followed up with a colonoscopy.Cervical cancer
  • Cervical cancer testing should start at age 21. Women under age 21 should not be tested.
  • Women between the ages of 21 and 29 should have a Pap test done every 3 years. HPV testing should not be used in this age group unless it』s needed after an abnormal Pap test result.
  • Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called 「co-testing」) done every 5 years. This is the preferred approach, but it』s OK to have a Pap test alone every 3 years.
  • Women over age 65 who have had regular cervical cancer testing in the past 10 years with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing goes past age 65.
  • A woman who has had her uterus and cervix removed (a total hysterectomy) for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested.
  • All women who have been vaccinated against HPV should still follow the screening recommendations for their age groups.

Some women – because of their health history (HIV infection, organ transplant, DES exposure, etc.) – may need a different screening schedule for cervical cancer. Talk to a health care provider about your history.

Endometrial cancerThe American Cancer Society recommends that at the time of menopause, all women should be told about the risks and symptoms of endometrial cancer. Women should report any unexpected vaginal bleeding or spotting to their doctors.Some women – because of their history – may need to consider having a yearly endometrial biopsy. Please talk with a health care provider about your history.Lung cancerThe American Cancer Society recommends yearly lung cancer screening with a low-dose CT scan (LDCT) for certain people at higher risk for lung cancer who meet the following conditions:Are aged 55 to 74 years and in fairly good health
  • and

Currently smoke or have quit smoking in the past 15 years

  • and
  • Have at least a 30 pack-year smoking history. (A pack-year is 1 pack of cigarettes per day per year. One pack per day for 30 years or 2 packs per day for 15 years would both be 30 pack-years.)

Before getting screened, you should talk to your health care provider about:

  • Your risk for lung cancer
  • How you can quit smoking, if you still smoke
  • The possible benefits, limits, and harms of lung cancer screening
  • Where you can get screened

You should also talk with your insurance provider about your coverage.

Prostate cancerThe American Cancer Society recommends that men make an informed decision with a health care provider about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. We believe that men should not be tested without first learning about what we know and don』t know about the risks and possible benefits of testing and treatment.Starting at age 50, men should talk to a health care provider about the pros and cons of testing so they can decide if testing is the right choice for them.If you are African American or have a father or brother who had prostate cancer before age 65, you should have this talk with a health care provider starting at age 45.If you decide to be tested, you should get a PSA blood test with or without a rectal exam. How often you』re tested will depend on your PSA level.Take control of your health, and help reduce your cancer risk.
  • Stay away from all forms of tobacco.
  • Get to and stay at a healthy weight.
  • Get moving with regular physical activity.
  • Eat healthy with plenty of fruits and vegetables.
  • Limit how much alcohol you drink (if you drink at all).
  • Protect your skin.
  • Know yourself, your family history, and your risks.
  • Get regular check-ups and cancer screening tests.

推荐阅读：

相关文章