2018-癌症早期诊断指南（英文版）-1mb

Summary of "Guide to Cancer Early Diagnosis"

Core Content

This document, Guide to Cancer Early Diagnosis, published by the World Health Organization (WHO) in 2017, provides a comprehensive overview of the principles and practices of early diagnosis in the context of cancer control. It emphasizes the importance of early diagnosis in improving cancer outcomes and reducing the burden of noncommunicable diseases (NCDs) globally.

Main Viewpoints

• Early diagnosis is the identification of cancer in individuals who already have symptoms, whereas screening aims to detect cancer or pre-cancerous lesions in asymptomatic populations.
• Early diagnosis and screening are both essential components of comprehensive cancer control, but they differ in terms of target population, resource requirements, impact, and cost.
• Early diagnosis is more cost-effective in settings with limited resources and is a core component of health services to improve timely diagnosis.
• Screening is effective in reducing incidence and mortality for certain cancers, such as cervical and breast cancer, but requires significant infrastructure and resources.
• Comprehensive cancer control involves a range of strategies including prevention, early diagnosis, screening, treatment, palliative care, and survivorship care.

Key Information

Importance of Early Diagnosis

• Early diagnosis significantly improves survival rates and quality of life.
• It reduces the stage of cancer at diagnosis, leading to less complex and more affordable treatment.
• Early diagnosis is particularly important in low- and middle-income countries (LMICs), where late-stage diagnosis is common due to limited access to healthcare services.

Components of Early Diagnosis

1. Awareness and accessing care

   • Patients must recognize cancer symptoms and seek timely medical evaluation.
   • Health systems must ensure accessible, affordable, and culturally appropriate care.

2. Clinical evaluation, diagnosis, and staging

   • Involves accurate clinical diagnosis, diagnostic testing, and referral for treatment.
   • Diagnostic interval is the time between symptom recognition and confirmation of cancer.
   • Pathological confirmation is essential before initiating treatment.

3. Access to treatment

   • Requires timely, high-quality, and affordable treatment.
   • Treatment should be multi-disciplinary and well-coordinated through established referral systems.

Delays and Barriers

• Common barriers include limited access to diagnostic tests, poor follow-up, inaccessible treatment, and financial constraints.
• Delays in care lead to higher mortality and morbidity.
• Public awareness is critical to reduce delays and promote early health-seeking behavior.

Strategies for Strengthening Early Diagnosis

• Policy-makers and programme managers must understand the difference between early diagnosis and screening to develop effective interventions.
• Monitoring and evaluation frameworks are necessary to assess the impact of early diagnosis and screening programmes.
• Community engagement, health literacy, and integration of services are essential to improve early diagnosis capacity.
• Adaptation to local contexts is necessary due to the variability in health system capabilities and resource availability.

Scope and Application

• The guide is intended for policy-makers and programme managers to help them plan and implement early diagnosis programmes.
• It highlights the importance of context-specific adaptations and the need for multisectoral action to address risk factors and improve early diagnosis capacity.
• It also notes that screening should be introduced only after ensuring adequate early diagnosis capacity, especially in LMICs.

Conclusion

• Early diagnosis is a cornerstone of cancer control, offering better outcomes and more efficient use of resources.
• Comprehensive cancer control must integrate early diagnosis with other components such as prevention and treatment.
• The guide encourages strategic investments in early diagnosis to meet global targets related to NCDs and the Sustainable Development Goals (SDGs).
• Screen-and-treat approaches are recommended for certain cancers, such as pre-invasive cervical cancer, to reduce the need for additional diagnostic steps.

Key Messages

• Early diagnosis is more cost-effective than screening in LMICs.
• Public awareness and health literacy are vital to reduce delays in seeking care.
• Integrated health systems are essential to ensure timely and effective diagnosis and treatment.
• Screening programmes require significant resources and should not be implemented without sufficient early diagnosis capacity.
• Comprehensive cancer control must be people-centred, equitable, and sustainable.

References

• The guide is informed by WHO publications and peer-reviewed literature.
• It references the Global Action Plan for the Prevention and Control of NCDs 2013–2020 and the UN Sustainable Development Goals.
• Specific studies and data from the United Kingdom, the United States, and other countries are used to illustrate the impact of early diagnosis and screening.