SCREENING FOR CANCER OF THE AERODIGESTIVE TRACT
SCREENING FOR CANCER OF THE AERODIGESTIVE TRACT
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DOI：
10.1002/1097-0142(19930801)72:3
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发表时间：
1993-08-01
期刊：
影响因子：
6.2
通讯作者：
SMART, CR
中科院分区：
文献类型：
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作者：
SMART, CR
在美国，口腔癌是呼吸消化道中唯一适合于对50岁以上无症状人群进行常规筛查的部位。虽然口腔癌的发病率和死亡率几乎是宫颈癌的两倍（分别为30，300对13，500和7，950对4，400），但进行盆腔检查和巴氏涂片检查似乎比口腔检查更容易接受。口腔检查应该是牙医或医生办公室每次体检的一部分，特别是对于50岁以上的重度吸烟者和酒精使用者。90%的鳞状细胞癌发生于口底、舌腹外侧和软腭复合体。检出率从50岁以上无症状个体的约1/1000增加到高风险吸烟者和饮酒者的1/200，以及曾接受口腔癌治疗的个体的1/7。筛查可检测早期癌症，治疗可提高存活率。虽然没有进行（或可能）具有死亡终点的随机筛选试验，但有证据表明，在早期口腔癌治疗的种族中，基于人群的病死率较低。当大多数患者在出现症状时被诊断为晚期疾病，而不是在无症状时通过早期筛查时，这一证据几乎没有安慰作用。在一项研究中，94%的口腔癌患者在前一年内看过医生。口腔癌患者在诊断后3年内平均有10.7次医生就诊。在美国，喉癌和食道癌的早期发现应该基于早期症状而不是筛查。例行口腔筛查应是医生或牙医每次体检的一部分。它将检测早期癌症并挽救生命。
In the United States, cancer of the oral cavity is the only region of the aerodigestive tract that lends itself to routine screening of the asymptomatic population older than 50 years. Although the incidence and mortality rate for oral cancer is nearly double that of cancer of the cervix (30,300 versus 13,500 and 7950 versus 4400, respectively), conducting a pelvic examination and Pap smear appears more acceptable than looking in the mouth. The inspection of the oral cavity should be part of every physical examination in the dentist's or the physician's office, particularly in patients older than 50 years who are heavy users of tobacco and alcohol. Ninety percent of all squamous cell cancers arise from the floor of the mouth, the ventrolateral aspect of the tongue, and the soft palate complex. The detection rate is increased from approximately 1 per 1000 in asymptomatic individuals older than 50 years to 1 per 200 in high-risk smokers and drinkers and to 1 in 7 for individuals once treated for oral cancer. Screening detects earlier stage cancers, for which treatment results in higher survival rates. While no randomized screening trials with a mortality end-point have been conducted (or are likely), there is evidence that population-based case-fatality rates are lower in races treated with earlier stages of oral cancer. This evidence is of little solace when the majority of patients are diagnosed with advanced disease when symptoms appear, rather than through screening at an earlier stage when asymptomatic. In one study, 94% of patients with oral cancer were seen by a doctor within the previous year. The average oral cancer patient had 10.7 physician encounters within 3 years of the diagnosis. In the United States, the early detection of cancers of the larynx and esophagus should be based upon early symptoms rather than on screening. A routine oral screening examination should he a part of every physical examination by a doctor or a dentist. It will detect earlier cancers and save lives.