陆军特色医学中心肿瘤科 陈滑维 近年来，随着医学影像检查设备的进步与环境污染等因素，肺结节检出率逐年上升。哪些人群需重点筛 查？又该如何科学看待辐射、漏诊与过度检查的顾虑？ 如何降低肺癌死亡率 据美国国家肺癌筛查试验（NLST）对5.3万名55~74岁高危吸烟者的研究显示，每年进行低剂量螺旋CT 筛查者，其肺癌死亡率比每年拍普通胸片的降低20%；在吸烟更重、烟龄更长的"极高危人群"中，降幅 可达60%。国内研究也显示，我国40岁以上高危人群每年进行1次低剂量螺旋CT筛查，可使早期肺癌检 出率提高3倍，晚期肺癌比例下降近半。 早期肺癌经微创手术切除后，患者5年生存率可达80%~90%，多能恢复正常生活。而晚期肺癌5年生存 率不足10%，治疗痛苦且费用高昂。因此，降低肺癌死亡率的关键在于早检查、早发现、早治疗。 哪些人需要重点筛查 《中国肺癌筛查与早诊早治指南（2021）》建议40岁以上且符合以下任一条件者，每年进行1次低剂量 螺旋CT筛查：吸烟或曾有吸烟史；长期接触粉尘、苯、甲醛等致癌物（含常处于二手烟环境中）；患 有慢阻肺、肺结核、肺纤维化等肺部基础病，或曾发现直径≥5mm的肺结节；有癌症家族史者。以上高 危 ...

Core Viewpoint - The article emphasizes the importance of prevention, early detection, and scientific treatment of lung cancer, highlighting the need for public awareness and proactive measures against the disease [1]. Group 1: Prevention - Smoking is identified as the primary risk factor for lung cancer, with a direct correlation between smoking quantity and the age of initiation to the likelihood of developing the disease. Early cessation and avoidance of secondhand smoke are crucial [2]. - Long-term exposure to dust and harmful chemicals, as well as poor air quality, should be avoided to reduce lung cancer risk [2]. Group 2: Screening - Four high-risk groups are identified for regular low-dose spiral CT screening: long-term smokers, individuals with a family history of malignancies (especially lung cancer), those with chronic lung diseases or occupational exposure, and elderly individuals around 70 years old. Early detection through screening can lead to a clinical cure rate of over 90% for early-stage lung cancer [3]. Group 3: Management of Nodules - The article provides guidance on managing lung nodules, emphasizing that most nodules are benign. For low-risk individuals, follow-up for nodules smaller than 5mm can be done every 2-3 years, while high-risk individuals may require more frequent monitoring [4][5]. Group 4: Treatment Strategies - Personalized treatment plans based on cancer staging can significantly enhance treatment efficacy. Early-stage lung cancer has a cure rate of 80%-90% post-surgery, while mid-stage patients can see survival rates increase from 30%-40% to over 65% with appropriate therapies [6]. - For late-stage patients, targeted therapies and immunotherapy offer new hope for long-term survival, with advancements in domestic drug efficacy and reduced economic burden for patients [7].

Core Viewpoint - The article discusses the ongoing controversy surrounding Aikang Guobin, highlighting the trust crisis in the health checkup industry and the implications for both consumers and companies involved in health screenings [2][5][6]. Group 1: Aikang Guobin Incident - Aikang Guobin has officially sued lawyer Zhang Xiaoling for defamation, seeking 10 million yuan in damages [2]. - Zhang Xiaoling, diagnosed with late-stage cancer, criticized Aikang Guobin for failing to alert her to cancer risks during her ten years of health checkups [4]. - The incident has escalated public discourse on the effectiveness and reliability of health checkups, particularly in light of Aikang Guobin's CEO's controversial remarks [4][5]. Group 2: Trust Crisis in Health Checkups - Many young individuals express skepticism towards routine health checkups, with 45.2% of surveyed youth fearing potential health issues being discovered [9]. - The majority of health checkup clients are corporate group checkups, which account for 70-80% of the business, leading to a focus on cost-effective services rather than comprehensive health assessments [11][12]. - Budget constraints often limit the scope of health checks, with most corporate budgets falling below 1,000 yuan, impacting the detection of serious health conditions [13][14]. Group 3: Limitations of Routine Health Checkups - Routine health checkups primarily identify common chronic diseases and early signs of certain tumors, but they are not designed to detect rare diseases [41][31]. - The detection capabilities of routine checkups are limited, often requiring further targeted testing for confirmation of any health issues identified [25][41]. - The industry faces challenges in addressing the needs of diverse populations, as many checkup programs lack specificity and fail to consider individual health risks [15][16]. Group 4: Future of the Health Checkup Industry - The health checkup market is projected to exceed 3 trillion yuan by 2028, with a compound annual growth rate of 12.5% from 2023 to 2028 [43]. - The aging population will drive demand for chronic disease management and early cancer screening, becoming a key growth factor for the industry [44]. - The industry is shifting towards more personalized and refined health checkup services, moving away from a one-size-fits-all approach [53][54].

Core Viewpoint - The article discusses the complexities and limitations of cancer screening, emphasizing that not all screening methods are effective and that many can lead to false positives and false negatives [1][2][3]. Group 1: Limitations of Current Screening Methods - Effective cancer screening should improve survival rates, but many existing methods do not meet this standard [2][4]. - False negatives (missed tumors) and false positives (incorrectly identified tumors) are significant issues in cancer screening, leading to unnecessary anxiety and financial burden [7][8]. - Many commonly used tumor markers are not recommended for healthy individuals due to high rates of false results [7][10]. Group 2: Recommended Screening Methods - Recommended screening methods include colonoscopy for colorectal cancer, gastroscopy for gastric cancer, low-dose spiral CT for high-risk lung cancer, mammography and ultrasound for breast cancer, and cytology and HPV testing for cervical cancer [8][11]. - The age at which screening should begin varies by cancer type, with guidelines suggesting starting at 45 for colorectal cancer and 40 for breast cancer [11][12]. Group 3: Future Directions in Cancer Screening - There is ongoing research into new screening methods, including liquid biopsies that detect cancer-related DNA in blood and the use of artificial intelligence for early tumor detection through imaging [12][13].

Core Viewpoint - The article emphasizes the importance of proper cancer screening methods, highlighting that routine health check-ups do not equate to effective cancer screening, which can lead to missed diagnoses of serious conditions like cancer [1]. Group 1: Cancer Incidence in China - In 2022, the estimated incidence of the top 10 malignant tumors in China included 1,060,600 cases of lung cancer, 517,100 cases of colorectal cancer, and 466,100 cases of thyroid cancer, among others [2]. Group 2: Cancer Screening Recommendations - The article discusses the release of the "Recommendations for Screening and Prevention of Common Malignant Tumors in Residents (2025 Edition)" during the National Cancer Prevention and Control Week, which outlines high-risk groups and the "gold standards" for screening for over 20 types of malignant tumors [3]. Group 3: Specific Cancer Screening Guidelines - For colorectal cancer, the gold standard for screening is colonoscopy, with recommendations for starting at age 45 and conducting annual fecal immunochemical tests or colonoscopies every 5-10 years until age 75 [6]. - For breast cancer, mammography is the gold standard, with screening starting at age 40 and recommended every 1-2 years [9]. - For lung cancer, low-dose spiral CT is the gold standard for high-risk populations, suggesting screening for those aged 40 and above with a significant smoking history [12]. - For liver cancer, serum alpha-fetoprotein (AFP) and liver ultrasound are the gold standards, with recommendations for screening men over 35 and women over 45 every 6 months [17]. - For esophageal cancer, the gold standard is endoscopy, with recommendations for high-risk groups to undergo screening every 2 years [26]. - For cervical cancer, the gold standard includes cytology and high-risk HPV testing, with specific age-based recommendations for screening [34]. - For prostate cancer, serum PSA testing is the gold standard, recommended for men over 40 with a good health status [44]. - For bladder cancer, urine tests and ultrasound are the gold standards, with annual screening starting at age 70 for general risk populations [47]. - For kidney cancer, ultrasound and urine tests are the gold standards, with annual screening recommended for those over 50 [51]. - For thyroid cancer, clinical neck examination and ultrasound are the gold standards, with annual checks starting at age 30 [54]. - For skin cancer, clinical skin examinations and biopsies are the gold standards, with recommendations for high-risk individuals to undergo regular checks [73].

Core Viewpoint - Lung cancer is the leading malignant tumor threatening the health of residents in China, accounting for 28% of all cancer-related deaths annually, highlighting the importance of early detection and treatment to improve survival rates [1]. Symptoms of Lung Cancer - Early identification of warning symptoms can significantly increase the chance of cure. Common symptoms include: - Persistent cough that does not improve with standard treatment [2]. - Blood in sputum, especially concerning for long-term smokers [2]. - Chest pain indicating possible tumor invasion [3]. - Difficulty in breathing due to airway obstruction [3]. - Hoarseness caused by tumor pressure on the recurrent laryngeal nerve [4]. - Unexplained fever that does not respond to antibiotics [5]. - Sudden weight loss without reason [6]. - Difficulty swallowing due to esophageal invasion [7]. - Superior vena cava syndrome presenting as swelling and congestion in the head and neck [8]. - Paraneoplastic syndromes such as clubbing of fingers, joint pain, muscle weakness, and endocrine disorders [9][10][11][12]. Prevention Methods - Early screening, diagnosis, and treatment are effective methods for lung cancer prevention. Low-dose spiral CT is recommended for high-risk groups, which can reduce lung cancer mortality by 20% [14]. Early detection can lead to a cure rate of up to 80% [15].