J Cancer 2019; 10(8):1909-1914. doi:10.7150/jca.27676 This issue
1. Cancer Research Institute of Zhongshan City, Zhongshan City People's Hospital, Zhongshan, Guangdong Province, China;
2. Department of Cancer Prevention Research, Cancer Prevention Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
Background: Nasopharyngeal carcinoma (NPC) and hepatocellular carcinoma (HCC) have remained a major burden of public health in Southern China. The screening for early disease in asymptomatic individuals has potentially been the most promising tool to improve cancer treatment outcomes. The present study aims to evaluate the compliance rates and characteristics of cancer incidence in the population of NPC and HCC screening.
Methods: Enzyme-linked immunsorbent assay (ELISA) for Epstein-Barr virus (EBV) antibodies and Hepatitis B surface antigen (HBsAg) was performed in this population. NPC high/medium risk and HCC high risk individuals were followed-up for a number of years. The compliance rate, cancer incidence and early diagnosis rate of the screened population were statistically analyzed.
Results: (1) In the preliminary screening, the compliance rate for NPC screening was significantly higher than that for HCC screening (29.3% vs. 26.2%; P<0.05). The compliance rates for screening were positively associated with age in these two screenings (P<0.01). (2) In the NPC screening, the compliance rates for the first year follow-up among NPC high/medium risk individuals were 74.9%, which was higher than that (60.2%) for the second year follow-up (P<0.05). The compliance rates for fiberoptic endoscopy among high risk individuals decreased along with the frequency of screening (P<0.016). The rates of missed diagnosis by non-compliance and the poor diagnostic accuracy of indicators were 3.3% and 3.3%, respectively. The average annual incidence and early diagnosis rate of the compliers were higher than those of the non-compliers (94.3 per 100,000 vs. 29.0 per 100,000; P<0.05 and 77.8% vs. 18.5%; P<0.05). (3) In the preliminary HCC screening, the compliance rate for ultrasonography among high risk individuals was 61.8%. The compliance rates for the follow-up were unsatisfactory. The rates of missed diagnosis by non-compliance and the poor diagnostic accuracy of indicators were 12.3% and 24.6%, respectively. There was no significant differences in average annual incidence and the rate of early diagnosis between compliers and non-compliers (79.4 per 100,000 vs. 54.6 per 100,000, P>0.05; 49.1% vs. 38.5%, P>0.05).
Conclusion: The compliance rates for NPC and HCC screening needs to be improved. In particular, public health policies for HCC should be implemented. The present NPC screening could be the preferred strategy. However, the efficiency of HCC screening remains substantially unsatisfactory and needs to be further discussed.
Keywords: nasopharyngeal carcinoma, hepatocellular carcinoma, screening, compliance