构建我国肿瘤筛查的循证评价方法学体系及运用

Malignant tumors, particularly cancer, represent the first cause of death in China. They lead to serious social and economic burdens which account for more than 1/4 of the global burden of cancer. The prevention and control of cancer relies on early detection, diagnosis, and treatment. Cancer screening is one of critical interventions to achieve effective cancer prevention and control, and has become a national strategy. The cancer incidence rate in China is similar to that in developed countries, such as the U.S. and those in Europe, but the mortality due to cancer doubles. The underlying important reason is due to the fact that a methodological system is lacking to reliably, setting-specific, and evidence-based assessment and selection of cancer strategies. The proposed project aims to develop – and preliminarily validate through empirical research – a methodological support system to evidence-based assessment of cancer screening strategies that are applicable to the Chinese setting. We anticipate that the proposed system, if successful, would improve the selection of cancer screening strategies in China, consequently, enhancing the prevention and control of cancer. In the project, we will achieve the following goals. First, we will develop a conceptual framework for evidence-based assessment of cancer screening strategies, applicable to the Chinese setting. Second, on the basis of the framework, we will develop methodological/technical guidance and reporting guidance for reliably assessing effectiveness and safety of cancer screening strategies. Third, we will tailor the GRADE system to develop a model for assessing the quality of cancer screening evidence so as to support the policy making. Last, we will apply the developed guidance and methods to the assessment and selection of screening strategies for liver cancer so as to prove the applicability and reliability.

恶性肿瘤尤其癌症是我国第一死因的重大疾病，社会经济负担严重，占全球癌症总负担1/4以上。癌症防控关键在于早发现、早诊早治。筛查是癌症防控的关键措施，已成为我国癌症防控国家策略。与美欧等国相比，我国肿瘤发病率相当，但死亡率是其两倍。关键原因是我国肿瘤筛查水平较落后，尚未建立客观科学、以证据为基础、适应国情的肿瘤筛查评价方法体系，以甄别遴选高效安全的肿瘤筛查项目。针对该科学问题，本课题旨在开展研究建立适应我国国情的肿瘤筛查循证评价方法体系，通过实证运用确立其实际价值，以期用于我国肿瘤筛查项目的评价与遴选，提高我国癌症防控水平。具体目标包括：1）建立适应我国国情的肿瘤筛查循证评价理论框架，形成基本框架；2）开发肿瘤筛查循证评价技术指南报告指南，确保研究技术的科学性；3）基于GRADE体系，开发肿瘤筛查证据的质量评价模型，促进循证决策；4）开展肝癌筛查循证评价研究，确立该方法体系的科学性和适用性。

恶性肿瘤尤其癌症是我国第一死因的重大疾病，社会经济负担严重，占全球癌症总负担1/4以上。癌症防控关键在于早发现、早诊、早治。筛查是癌症防控的关键措施，已成为我国癌症防控国家策略。关键原因是我国肿瘤筛查水平较落后，一直尚未建立客观科学、以证据为基础、适应国情的肿瘤筛查评价方法体系，以甄别遴选高效安全的肿瘤筛查项目。针对该科学问题，本课题首先通过文献综述开展研究建立了适应我国国情的肿瘤筛查循证评价方法体系，并进一步通过实证运用确立了其实际价值，制定了癌症筛查措施的遴选标准和推荐策略，结合国情建立了适应我国国情的肿瘤筛查循证评价方法体系，已完成了两个案例（结直肠癌、肝癌），通过结直肠癌和肝癌的实证运用确立了本课题构建的方法学体系的实际应用价值，结果显示该体系可用于指导我国肿瘤筛查项目的评价与遴选，为癌症筛查策略的循证评价提供了科学思路和方法学借鉴，希望为提高癌症防控水平提供参考。