甲状腺癌成上海和浙江女性第1癌，但不必筛查
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今天是“世界甲状腺日”，上海市疾控中心上月<span style="color: black;">颁布</span>的最新肿瘤登记报告数据<span style="color: black;">表示</span>：上海市甲状腺癌占所有女性新发癌症的16.8%，首次超过乳腺癌，<span style="color: black;">作为</span>上海女性<span style="color: black;">第1</span>高发癌症。<span style="color: black;">另一</span>，<span style="color: black;">按照</span>浙江省癌症中心日前<span style="color: black;">颁布</span>的最新全省肿瘤登记地区癌症发病与死亡<span style="color: black;">状况</span>分析，甲状腺癌<span style="color: black;">亦</span>是浙江女性恶性肿瘤发病率<span style="color: black;">第1</span>位。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在2000年时，甲状腺癌还未进入上海女性癌症的前十位，怎么十几年时间就变成<span style="color: black;">第1</span>位了呢？其实<span style="color: black;"><strong style="color: blue;">最<span style="color: black;">重点</span><span style="color: black;">原由</span>是检测<span style="color: black;">办法</span>和技术的进步、颈部超声<span style="color: black;">检测</span>的更广泛应用和微小甲状腺结节的细针抽吸活检，使检出率大大<span style="color: black;">增多</span>了。</strong></span>而<span style="color: black;">针对</span>甲状腺微小乳头状瘤多大直径才<span style="color: black;">意见</span>进一步穿刺活检<span style="color: black;">日前</span>还<span style="color: black;">无</span>统一标准。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">近年来甲状腺癌的患病率<span style="color: black;">明显</span><span style="color: black;">增多</span>，是以甲状腺微小乳头状癌的增长为主。肿瘤最大直径≤1厘米的甲状腺乳头状癌<span style="color: black;">叫作</span>为甲状腺微小乳头状癌（PTMC）。<span style="color: black;">因为</span>超声的广泛<span style="color: black;">运用</span>，使得<span style="color: black;">少于</span>1厘米、<span style="color: black;">乃至</span>1毫米的“微小癌”都能被<span style="color: black;">发掘</span>，这些<span style="color: black;">病人</span>几乎<span style="color: black;">无</span>任何临床症状。其实相当部分的微小甲状腺癌<span style="color: black;">发展</span>非常缓慢，可能部分微小癌并不<span style="color: black;">必须</span>立即处理，<span style="color: black;">因此</span><strong style="color: blue;">业界还在社会上提出甲状腺癌可能存在过度治疗。</strong>关于PTMC的治疗<span style="color: black;">方法</span><span style="color: black;">日前</span><span style="color: black;">亦</span>有争议，争议的焦点<span style="color: black;">重点</span>是手术的必要性和手术范围。有文献<span style="color: black;">报告</span>PTMC很少会发展<span style="color: black;">作为</span><span style="color: black;">拥有</span>临床<span style="color: black;">道理</span>的甲状腺癌，有些<span style="color: black;">乃至</span>终生都<span style="color: black;">无</span>症状；即使有些病例<span style="color: black;">显现</span>临床症状或颈部淋巴结转移，对<span style="color: black;">存活</span>率的影响<span style="color: black;">亦</span>不大；<span style="color: black;">因此</span><strong style="color: blue;">有观点认为<span style="color: black;">针对</span><span style="color: black;">没</span>转移的、<span style="color: black;">没</span>症状的PTMC可不进行任何治疗，只需观察。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">复旦大学甲状腺肿瘤诊治<span style="color: black;">科研</span>中心<span style="color: black;">专家</span>、肿瘤医院甲状腺肿瘤首席专家吴毅教授说，甲状腺的<span style="color: black;">定时</span>筛查非常<span style="color: black;">要紧</span>。尤其是25-45岁女性、幼年放射治疗史、辐射工作环境、家族中有甲状腺癌<span style="color: black;">病人</span>（有血缘关系）等高危人群，都应<span style="color: black;">定时</span>进行甲状腺功能检测。吴毅教授<span style="color: black;">意见</span>，每年<span style="color: black;">彩超</span>+全套甲状腺功能检测是比较合适的处理手段。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">全套甲状腺功能检测<span style="color: black;">包含</span>：甲状腺激素、血清促甲状腺激素（TSH）、甲状腺<span style="color: black;">关联</span>血清免疫学<span style="color: black;">检测</span>、肿瘤标志物。<span style="color: black;">然则</span>，真的有必要进行甲状腺癌筛查吗？<strong style="color: blue;">美国疾控中心（CDC）说，进行甲状腺癌筛查并<span style="color: black;">不可</span>降低死亡率。</strong>UpToDate的资料<span style="color: black;">表示</span>，其实大<span style="color: black;">都数</span>乳头状甲状腺癌（最<span style="color: black;">平常</span>的甲状腺癌种类）<span style="color: black;">病人</span>并不是死于该病。<strong style="color: blue;">CDC和美国预防服务工作组（USPSTF）只<span style="color: black;">举荐</span>对乳腺癌、宫颈癌、结肠直肠癌和肺癌进行筛查。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">USPSTF认为，<strong style="color: blue;"><span style="color: black;">无</span>足够证据<span style="color: black;">显示</span><span style="color: black;">运用</span>颈部触诊或超声来对<span style="color: black;">没</span>症状人群筛查甲状腺癌<span style="color: black;">能够</span>改善健康<span style="color: black;">情况</span>，</strong>进行甲状腺癌筛查<span style="color: black;">亦</span><span style="color: black;">不可</span>减少死亡率，而<strong style="color: blue;">筛查可能<span style="color: black;">引起</span>过度诊断和过度治疗。</strong>USPSTF认为，<span style="color: black;"><strong style="color: blue;">对<span style="color: black;">没</span>症状人群进行甲状腺癌筛查<span style="color: black;">引起</span>的<span style="color: black;">害处</span>超过了其益处，<span style="color: black;">因此</span>USPSTF<span style="color: black;">意见</span>不要在<span style="color: black;">没</span>症状的成人中筛查甲状腺癌</strong></span>（这个<span style="color: black;">意见</span>只针对<span style="color: black;">没</span>症状的人群，不适用于声音嘶哑、<span style="color: black;">病痛</span>、吞咽困难或有其他喉部症状的人和颈部有肿块、肿胀、颈部不对<span style="color: black;">叫作</span>或有其他<span style="color: black;">原由</span>进行颈部<span style="color: black;">检测</span>的人，<span style="color: black;">亦</span>不适用于甲状腺癌高<span style="color: black;">危害</span>人群）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">日前</span>还不<span style="color: black;">晓得</span><span style="color: black;">引起</span>甲状腺癌的<span style="color: black;">原由</span>是什么。</strong>儿童期头部和颈部放射线暴露史、一级亲属有甲状腺癌病史、甲状腺癌<span style="color: black;">综合症</span>家族史、某些遗传性<span style="color: black;">疾患</span>（<span style="color: black;">例如</span>家族性甲状腺髓样癌或多发性内分泌腺瘤样<span style="color: black;">综合症</span>）会<span style="color: black;">增多</span>得甲状腺癌的<span style="color: black;">危害</span>，有这些<span style="color: black;">危害</span><span style="color: black;">原因</span>的人群就<span style="color: black;">叫作</span>为甲状腺癌高<span style="color: black;">危害</span>人群。其中儿童期甲状腺辐射暴露是<span style="color: black;">日前</span>最<span style="color: black;">知道</span>的与甲状腺肿瘤<span style="color: black;">相关</span>的环境<span style="color: black;">原因</span>，<span style="color: black;">例如</span>儿童期<span style="color: black;">运用</span>辐射来治疗其他种类的恶性肿瘤、核电站事故<span style="color: black;">诱发</span>的环境辐射暴露。<strong style="color: blue;">职业和环境暴露可能<span style="color: black;">亦</span>是一种<span style="color: black;">危害</span><span style="color: black;">原因</span>，但还<span style="color: black;">无</span>得到证实。<span style="color: black;">科研</span>结果<span style="color: black;">亦</span><span style="color: black;">显示</span>甲状腺癌与碘摄入<span style="color: black;">无</span><span style="color: black;">知道</span>关系。</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span><span style="color: black;">通常</span>人群<span style="color: black;">来讲</span>，<span style="color: black;">日前</span>不<span style="color: black;">晓得</span>该<span style="color: black;">怎么样</span>来预防甲状腺癌。<span style="color: black;">针对</span>有遗传性基因突变的儿童和成人，<span style="color: black;">大夫</span><span style="color: black;">一般</span><span style="color: black;">意见</span>进行预防性甲状腺切除术来预防癌症。<span style="color: black;">由于</span>核电站事故<span style="color: black;">导致</span>的辐射可能会对<span style="color: black;">周边</span>的居民<span style="color: black;">导致</span>甲状腺问题，在美国，居住在核电站10英里以内的人<span style="color: black;">能够</span><span style="color: black;">得到</span>能阻止辐射对甲状腺的影响的<span style="color: black;">药品</span>（碘化钾），在<span style="color: black;">出现</span>紧急<span style="color: black;">状况</span>时<span style="color: black;">能够</span><span style="color: black;">吃下</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考资料：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1. 施捷. 甲状腺癌成上海女性<span style="color: black;">第1</span>高发癌症 专家呼吁<span style="color: black;">定时</span>筛查甲状腺功能. 新民晚报. http://sh.eastday.com/m/20180524/u1ai11460949.html (Accessed on May 25, 2018)。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2. 美国疾控中心. Screening Tests. https://www.cdc.gov/cancer/dcpc/prevention/screening.htm (Accessed on May 25, 2018).</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3. Mayo Clinic. Thyroid cancer. https://www.mayoclinic.org/diseases-conditions/thyroid-cancer/symptoms-causes/syc-20354161 (Accessed on May 25, 2018).</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4. R Michael Tuttle. 乳头状甲状腺癌概述. UpToDate临床顾问. (Accessed on May 25, 2018).</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5. 董芬, 张彪, 单广良. 中国甲状腺癌的流行<span style="color: black;">状况</span>和影响<span style="color: black;">原因</span>. 中国癌症杂志, 2016, 26(1).</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6. 杭州网. 葛明华：甲状腺癌发病率<span style="color: black;">提升</span><span style="color: black;">显著</span> 10%为<span style="color: black;">繁杂</span>难治型有的<span style="color: black;">仅有</span>几个月<span style="color: black;">存活</span>期. http://hznews.hangzhou.com.cn/kejiao/content/2018-04/19/content_6851043.htm (Accessed on May 25, 2018).</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">7. 中国抗癌协会甲状腺癌专业委员会. 甲状腺微小乳头状癌诊断与治疗专家共识（2016版）.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">8. USPSTF. Final Recommendation Statement Thyroid Cancer: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/thyroid-cancer-screening1 （Accessed on May 25, 2018）.</p>
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