Izimpikiswano Nokubhekisisa Ukuqapha I-Cancer Lung
Uma ubukele izindaba kule minyaka embalwa edlule, cishe uke wazizwa ezinye zempikiswano mayelana nokuhlolwa komdlavuza wamaphaphu. Ingxoxo ekuqaleni yayiwukuthi uM Medicare kufanele yini ibheke umdlavuza wamaphaphu CT ukuhlola kulabo abahlangabezane nezinqubo ezicacisiwe. NgoFebhuwari ka-2015, leso sinqumo sabekwa ukuphumula njengoba i-Medicare manje ihlanganisa lokhu kuhlolwa. Isizathu sezimpikiswano kwakuwukutholwa - ocwaningweni olukhulu lwezokwelapha okuthiwa i-National Lung Cancer Screening Trial - ukuthi ukuhlolwa kwe-CT (LDCT) ephansi kakhulu kunganciphisa ukubulawa komdlavuza wamaphaphu ngamaphesenti angu-20, noma izakhamuzi zase-US ezingu-18 000 unyaka ngamunye.
Kubonakala sengathi konke kuhle, nokho isifundo se-2016 sathola ukuthi abangaphansi kwengxenye yamagciwane omndeni avumile ukuthi ukuhlolwa komdlavuza wamaphaphu kwakuwumqondo omuhle futhi abaningi babengazi izincomo ezithile. Ngaphezu kwalokho, abaningi balaba odokotela baqhubeka beyala umkhuhlane we-x-ray njengesivivinyo sokuhlola umdlavuza wamaphaphu. Lokhu, futhi, kuye kwaba nombuzo ovamile:
"Kungani udokotela wami engalawule ukuhlolwa okungasindisa impilo yami?"
Yiziphi izimpikiswano zokuphikisana nomdlavuza wamaphaphu, futhi yiziphi izinhlangano ezisekela lezi zimpikiswano? Ake sibuke lezi zikhundla bese siqhathanisa ukuhlolwa komdlavuza wamaphaphu nakwezinye izivivinyo zokuhlola umdlavuza okwamanje.
* I-Medicare manje ihlanganisa ukuhlolwa komdlavuza wamaphaphu kulabo abaneminyaka engama-55 no-77 ubudala, abaqhubeka bebhema noma beyeka eminyakeni engu-15 eyedlule, futhi baye bathe okungenani iminyaka engu-30 yepakethe. Isikrini sidinga isignesha kadokotela (noma ongewona odokotela oqeqeshiwe) futhi kudinga ukuba umuntu ozohlolwa ahlangane nodokotela wabo ngokululekwa ukuze ahlanganyele ekuvakasheni okwabelwana ngokuthatha isinqumo ngaphambi kokuba kulandelwe umyalelo.
Ubani Abazuzwa Ukuhlolwa Kwegciwane Lungula?
Ngemuva kweminyaka eminingi kakhulu ngaphandle kokuhlolwa okuphumelelayo kokuhlolwa komdlavuza wamaphaphu, i-National Lung Cancer Screening Trial (NLST) ithole ukuthi ukuhlola okuphansi kwe-CT (LDCT) kungagcina izimpilo phakathi kwabantu abahlangabezana nemigomo ethile. Kubantu abahlangabezana nalezi zindlela, ukuhlolwa kwe-LDCT yonyaka kunganciphisa ukubulawa komdlavuza wamapayipi ngamaphesenti angu-20 - inombolo eguqulela kuba amashumi ezinkulungwane zamaMelika ngonyaka ngamunye.
Ngokusekelwe emiphumeleni yokutadisha i-United States Preventive Task Force (USPSTF) inconywe ukuhlola uku:
- Abantu abadala abaneminyaka engama-55 no-80 abanomlando wepakethe engu- 30 wokubhema, futhi
- Qhubeka ukubhema noma ukuyeka ukubhema eminyakeni engu-15 edlule
Ukuhlolwa kungase kulungele nabanye abantu, njengalabo abaye babhekwa ne-asbestos, umlando wesifo sofuba, ukukhishwa kwe- radon , ukuguqulwa kwegciwane le-BRCA2 , nezinye izimo.
Izizathu Zokujabula Ngokwe-LDCT Lung Cancer Screening
- Njengamanje, okungenani amaphesenti angu-40 abantu abanomdlavuza wamaphaphu atholakala lapho lesi sifo sesivele sithuthukile kuya esigabeni 4 somdlavuza wamaphaphu .
- Isilinganiso sokusinda komdlavuza weminyaka emi-5 jikelele siphelele ngaphezu kwamaphesenti angu-17.
- Lapho umdlavuza wamaphaphu utholakala ezinyathelweni zangaphambili, ukusinda kuphakeme.
- Ezinye izinhlobo zokuhlola eziye zahlolwa kuze kube yimanje, njenge-x-ray kanye ne- sputum cytology , azitholakalanga ukunciphisa ukufa.
- Umdlavuza we-Lung iyimbangela ehamba phambili yokufa komdlavuza kokubili amadoda nabesifazane e-United States. Ibulala abesifazane abaningana kabili njengomdlavuza webele.
- Muva nje kutholakala ukuthi abanye ababhemayo abanokuhlola i-LDCT banamathuba amaningi okuyeka ngaphandle uma bengenayo ukuhlolwa okwenziwe. Yize kusencane kakhulu ukushiwo, ulwazi lwezinye izifo ezibangelwa ukubhema lukhombisa ukuthi, njengokwengeziwe kwe-perk, ukuhlolwa komdlavuza wamaphaphu kunganciphisa ingozi yesifo senhliziyo, i-COPD, nokuningi.
- Phakathi kwalabo abahlomula ku-Medicare, kucatshangwa ukuthi ukuhlolwa kwe-LDCT yonyaka kungaphezu kokuphindwe kabili amaphesenti okuqala komdlavuza wamaphaphu emaphaphu (njengokuqhathaniswa okusheshayo, isilinganiso seminyaka emihlanu sokusinda emdlalweni wesiguli samangqamuzana angama-amancane angama-60 kuya kuma-80. Esikhathini sesigaba sesibili Amaphesenti angu-40 kuya kwangu-50. Esikhathini sesigaba 4 singaphansi kwamaphesenti amahlanu.) Kucatshangwa ukuthi lokhu kuhlolisisa kwakuzokhomba amakhemikhali angamaphesenti angama-54,000 emaphaphu ngonyaka (32,000 ekuqaleni kwesigaba.)
- Uma imihlahlandlela yokuhlola iqaliswa ngokushesha, futhi uma wonke umuntu ohlangabezana nemigomo yokuhlola eyohlolwa, izimpilo ezingu-18 000 zingagcinwa unyaka ngamunye.
Izinkinga ezinokwenzeka ezihambisana nokuhlolwa
Noma yikuphi ukuhlolwa kokuhlola kuvela nezinkinga ezithile. Abaningi benu kungenzeka bazi omunye umuntu owayesabeka emlonyeni - ukuzwa nje ukuthi kwakusabisa nje. Ezinye zezinkinga zokuhlolwa komdlavuza wamaphaphu zingabandakanya:
- Amaphutha amanga
- Amanga amanga
- I-Overdiagnosis
- Ukuvezwa kwemisebe
Ngabe Ukuhlolwa Kwegciwane Lesifo Sengculaza Kuphekwe?
I-United States Preventive Task Force (USPSTF) inconywe ukuhlolwa komdlavuza wamaphaphu njengendlela yeBanga B. Ngaphansi kwe-Insurance Affordable Care Act (ACA) abathintekayo abathintekayo kumele bahlanganise izinqubo zokuhlola ngeBanga B noma ngaphezulu (bona ngezansi). Lokhu kuphumelela ngoJanuwari 2015. Ukuhlolwa kuhlanganiswa uMnyango Wezamandla, uMnyango Wezempi Yezilwane (ngokubonga, njengabaqaphi abanomdlavuza omkhulu wamaphaphu emaphaphu,) nabanye.
Kuthiwani Ngomuthi?
Ngo-Ephreli, iKomiti Yezokugqugquzela I-Medicare Eyesibindi Nokuthuthukiswa Kwezokuphepha (i-MEDCAC) ivotelwe ngokumelene nokuhlolisisa umdlavuza we-LDCT wamaphaphu kubantu abazuzayo - ngamanye amazwi, awuhlanganiswa " njengenzuzo " ebalulekile yezempilo " ngaphandle kwezindleko. Isizathu siwukuthi abaqiniseki ukuthi izinzuzo zizobe zidlula ukulimala kule ndawo. Ngokungafani nabanomshwalense bangezimele, izinzuzo zeMeditare azihlanganiswa ngaphansi koMthetho Wokunakekelwa Onganakekelwayo . Isinqumo sokugcina ngeke senziwe kuze kube nguFebhuwari 2015.
Ubani Osekela Ukuhlolwa Kwegciwane Lungane?
Ukubuyekezwa okusheshayo kweWeb kuthola izinhlangano ezilandelayo ukusekela ukuhlolwa komdlavuza wamaphaphu (ziphikisana nesinqumo sikaMedare)
- I-American Medical Association (AMA)
- I-American College of Radiology (ACR)
- I-Lung Cancer Alliance (LCA) - I-LCA ithumele isicelo esisemthethweni seNational Protection Determination for screen cancer.
- I-United States Preventive Services Task Force (USPSTF)
- I-American Society of Clinical Oncology
- I-American Cancer Society (ACS)
- I-Society of Thoracic Surgeons (STS)
- AmaSenenja amaningi kanye nabaMemezeli boMbuso
Ubani Ongasekeli Ukuhlolwa Kwengculaza Lung
Kusukela ngo-Okthoba ka-2016, i-American Academy of Family Practice ithi kukhona ubufakazi obufanele bokulawula noma ukulwa nokuhlola.
Iziphakamiso / Iziphakamiso Ngokusekela Ukuhlolwa Kwegciwane Lungula - Ukuqhathanisa ama-apula kuma-apula
- Imithi esekelwe ebufakazini . Ukuhlolwa kwesifo somdlavuza kukhonjisiwe nge- imithi esekelwe ebufakazini ukusindisa izimpilo. Ucwaningo lwamuva luthi ukuhlolwa komdlavuza webele akusho. Ukubuyekezwa kwamuva kwe- PLos One kutholile ukuthi ukuhlola ama-mammograms kunomthelela omncane ekufeni kwabantu besifazane abaneminyaka engama-50 kuya ku-69, kanye nemiphumela engeyona emqoka yabesifazane abangaphezu kweminyaka engama-70. Ukuhlolwa kwesifo somdlavuza kulindeleke ukuthi kufinyeleleke kakhulu ekubulaweni komdlavuza wamaphaphu kulabo abakuleli Iqembu le-Medicare yobudala. Naphezu kwalokhu, i-Medicare ikhokhela ama-mammograms kodwa ayikhokheli ukuhlolwa komdlavuza wamaphaphu.
- Izinkinga Zezindleko - Izindleko zokumboza ukuhlolwa komdlavuza wamapayipi kulabo abatholwa yiMedricare zikhulu, kodwa zihumusha cishe u-$ 3 ngenyanga ngenzuzo yomuntu ngamunye. Izindleko zokuhlolwa komdlavuza webele weMedricare abahlomulayo zihumusha cishe ku-$ 2.50 ngenyanga. Qaphela ukuthi i-$ 3 ngenyanga ngomhlolovuza womdlavuza wamaphaphu kufaka ukulandelwa (isibonelo sokubheka amaphutha amanga,) kodwa u-$ 2.50 ngenyanga ngenyanga yokuhlola ukuhlolwa komdlavuza wesifuba akubandakanyi ukuhlolwa nokulandela izinqubo zokulandela. Ukubheka ezinye izinombolo kwezinye izifundo, kwakucatshangwa ukuthi kubize u-Medicare $ 2 billion ngonyaka ukuze unikele ngomdlavuza we-lungs vs 1.08 kuya ku-1.36 billion ukuze uthole amamograms. Cabanga ukuthi bobabili abazuzi besifazane nabesilisa bazozuza emaphakathini amaphaphu, kodwa iningi labesifazane kuphela abathola amamograms. Ngeke ngiye ezindlebeni zokwelashwa. Ukuhlola, kuzokwandisa inani lokuhlinzekwa komdlavuza wamaphaphu ngenxa yokwanda kwezibalo zokuqala, kanti futhi, kuyabiza kakhulu ukumboza izindleko zokwelashwa komdlavuza nokulandelelana kunokufa. Singazilinganisa izindleko zokwelashwa kwamagciwane amaphaphu emapulazini okuqala ngezindleko zokuphathwa komdlavuza wamapayipi wamaphesenti nokuphela kokukhathazeka kokuphila, kepha ngithanda ukungahambi khona. Kusukela embhedeni, akukho ukufaniswa. Yebo, ngibone ubuhlungu njengoba abantu bephuluka ekuhlinzekeni, kepha kubonakala uma kuqhathaniswa nobuhlungu bokuphela kokuphila nge-metastases namathambo nokuphefumula.
- Ukuphikisa ukugxila kokuyeka ukubhema . Yebo, lokhu kubalulekile, noma kunjalo, ngeke kusize labo abazohlolwa ukuhlolwa lapho beyeka eminyakeni engu-15 edlule. Kuyathakazelisa ukuphinde uqaphele ukuthi njengoba kuphawuliwe ngenhla, ukuhlolwa kuthuthukisa izinga lokuyeka ukubhema kwabanye abantu (futhi ngokuphumelelayo ngokusekelwe ezinombolweni kunezinhlelo kanye nezinsiza esizitholayo.) Kodwa kubaluleke kakhulu - uma sifuna ukuphatha labo abasengozini yomdlavuza wamaphaphu ngokulinganayo kulabo abasengozini yezinye izinhlobo zomdlavuza kudingeka senze enye yezinto ezimbili. Noma i-Medicare kufanele ihlanganise ukuhlolwa kwe-LDCT yomdlavuza wamaphaphu, noma ukusebenzisa uhlobo olufanayo lokubandlulula kubantu abasengozini yezinye izinhlobo zokuhlolwa komdlavuza. Isibonelo, uma i-Medicare ikhetha ukukhokha ukuyeka ukubhema esikhundleni sokuhlolwa kwesifo somdlavuza wamaphaphu, kulandela ngokufanele ukuthi kufanele ikhokhele ukufundisa abesifazane ukuba bancelise izingane zabo, kunokuba bakhokhele amammogram. Kuzophinde kulandele ukuthi i-Medicare kufanele igxile ekukhuthazeni umsebenzi wokuzivocavoca kunokuba ihlanganise amakolonoscopies njengemdlavuza wekoloni ihlotshaniswa nokuphila komzimba kwezinye izimo. (Yebo, ngibhekene nobunzima, kodwa kubalulekile ukuqhubeka nokuqhathanisa ama-apples nama-apula, futhi lesi sinqumo sithinta ukuthi ukucwasa komdlavuza wamaphaphu kungadlala indima esinqumweni.) Emkhakheni wakhe womlando womhlaba kulo nyaka owodwa izingane zabuzwa lo mbuzo. "Yayiyini indawo engcono kunazo zonke yokuba yisigqila?" Impendulo yayiseCaribbean, ngoba esikhundleni sokudla nokukhathalela isigqila, kwakungabizi ukuthi "ngimsebenzise" futhi ngithenge enye. Ngesizathu esithile, lo mcabango wawulokhu ufika engqondweni njengoba ngifunda le ngxabano.
- Amaphutha amanga - Yebo, ukuhlolwa komdlavuza wamaphaphu kubangelwa ama-positi amanga. Kanjalo ukuhlolwa komdlavuza webele. Amaphutha amanga aqaphele kubantu abangaba ngu-25% ababhekene nokuhlolwa kwesifo somdlavuza wamaphaphu, okudinga ama-scans okuqhubekayo kanye nezinqubo ezithile ezingavamile. Kulezi ziguli zilandelwa ngeminyaka eyi-10 ubudala, izibalo zamaphutha amanga zaziyi-50 kuya ku-60%. Ngaphezu kwalokho, iziguli ezingu-90,000 zalandelwa iminyaka engu-25 ngokuhlolwa kwamammogram, ama-22% ayengaphathwa kabi noma aphathwa ngelashwa olungadingekile. Kodwa i-mammography yinzuzo ehlanganisiwe ngaphansi kwe-Medicare, kodwa ukuhlolwa komdlavuza wamaphaphu akukona njengoba kucatshangwa ukuthi ukulimaza (amaphutha amanga, ukubhekwa ngokweqile) kungase kube ngaphezu kwezinzuzo (isilinganiso se-20% esithuthukisiwe sokusinda.) Ingabe i-MEDCAC ilindele ukuthi izobhekana nokunciphisa of pink uma kufanele aphathe apula njenge apula futhi wenqaba ukumboza mammograms ngenxa engozini amanga amanga?
- Ukwehliswa kwemitha - Siye safunda ukuthi ukuvezwa kwemisebe yezokwelapha akuyona ingozi.
- I-USPSTF Ibanga B - I-United States Preventive Task Force nezindaba "amamaki" abheka inzuzo ngokuhlinzeka isevisi ezigulini. IBanga B lisho ukuthi i-USPSTF itusa insizakalo ngoba kukhona ukuqiniseka okuphezulu ukuthi inzuzo enembile ingezingeni elincane noma ukuthi kunesiqiniseko esilinganiselwe sokuthi inzuzo enembile ihambisana nokulinganisela. Ukuhlolwa komdlavuza wamaphaphu, ukuhlolwa kwe-LDCT kufakwe eBangeni B iziguli ezifanele njengoba kuxoxwe ngenhla. Ukuhlolwa komdlavuza wesibeletho nge-mammography kubuye kubhekwe iBanga B labesifazane njalo eminyakeni engu-1 kuya kwemibili emva kweminyaka engama-40.
- Ukuphikisana ngalokho esikufundile ekuhloleni komdlavuza we-prostate - Okunye ukuphikisana kwiWebhu ukuthi kufanele siqaphele ukuhlolwa kwesifo somdlavuza wamaphaphu futhi sisebenzise isibonelo sokuhlolwa komdlavuza we-prostate njengesibonelo. Sekuyiminyaka, amadoda akhuthazwa ukuba abe nomdlavuza we-prostate, kanti ukuhlolwa kwe-PSA sekube igama lomndeni. Ukubuyekezwa kwe- Cochrane yezifundo eziningi manje sekutholile ukuthi ukuhlolwa komdlavuza we-prostate akunciphisi ukubulawa komdlavuza we-prostate (ukufa) noma ukufa kwabantu bonke. Ukwengeza, ukulimala (kusuka ekunakekeleni ngokweqile nokweqa ngokweqile) kwalinganiswa njengokujwayelekile futhi okulinganisiwe. Isilinganiso sokusinda iminyaka emihlanu yesifo somdlavuza wesifo sofuba singama-99%. Ingabe lokhu kuqhathanisa ama-apula kuma-apula?
- Iziguli ziyi-savvy . Lapho bethi abaqiniseki ukuthi izinzuzo zidlula izingozi kulokhu, uMedare uphika iziguli ilungelo lokwenza izinqumo ezifundisiwe ngokwazo - izinqumo ezivame ukwenziwa ngosizo lodokotela ongasiza iziguli ezithintekayo ekuqaleni ukuhlolwa kulinganisa izingozi nezinzuzo zempilo yabo kanye nesimo. Kubalulekile ukuthi abantu benze lezi zinqumo nsuku zonke - ezinye zazo zingabaluleke kakhulu empilweni enempilo, njengokungathi unamathayi amahle emotweni yakho.
- Abampofu bayothola abampofu (noma bafe) kanti abacebile bazozuza (noma baphile). Izindleko zokuhlola ucwaningo lwe-CT ziyahlukahluka, kodwa ngokujwayelekile zisebangeni lika-$ 350. Abanye abantu aseMedare bangakwazi ukukhokhela le mali, kanti abanye abakwazi. Ucwaningo luye lwabona ukuthi abantu abancinci ukuphishekela izivivinyo zokuhlola ukutholakala kwezifo ngokushesha uma kufanele bakhokhele ephaketheni, futhi ikakhulukazi uma izindleko zifuna ukuba zenzeke ezinye izinto, isibonelo, ukudla.
- Ubulungisa. Kungabonakala ukungabi nabulungisa okusekelwe kumanothi angenhla, ukuthi labo abasengozini yomdlavuza wamaphaphu abaphathiswa ngokulinganayo. Njengoba uMartin Luther King eshilo, " Ukungabi nabulungisa noma yikuphi okusongela ubulungisa kuyo yonke indawo ." Yiziphi ezinye izinsongo ezithintekayo ekunakekeleni impilo yezakhamuzi zethu?
Ukuyifinyelela phezulu kanye nezinyathelo ezilandelayo
Uma wena noma othandekayo uhlangabezana nemigomo yokuhlolwa kwesifo somdlavuza wamaphaphu, kunethemba. U-Medicare akakaze enze isinqumo sokugcina ekuhambeni. Uma unomshuwalense wangasese wenkampani yangasese (noma ingumdala, phakathi kwamanye ama-inshuwalense) unenhlanhla. Njengoba kuphawulwe ngenhla kwe-Care Affordable Act kudinga ukuba lezi zibuko zihlanganiswe. Izinketho uma ungenayo isengezo kufaka phakathi ukuzikhokhela ukuhlolwa. Ngisho noma i-Medicare ayitholi ukuhlolwa kwesifo somdlavuza wamaphaphu okwamanje, unelungelo lokuba nokuhlolwa kwenziwe futhi ukhokhele ngokwakho. Uma umdlavuza wemaphaphu utholakala uma uzikhokhela ukuhlolwa kokuhlolwa, uMareare uzobe edingeka akhokhele ukunakekelwa kwakho.
> Imithombo
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Ersek, J., Eberth, J., McDonnell, K., Strayer, S., uSercy, E., Cartmell, K., noD. Friedman. Ulwazi mayelana, Ukucabanga, nokusetshenziswa kwe-Tomography ehlanganisiwe ebizwa nge-Lose Cancer Ukuhlolwa Kwegciwane Lungwane Phakathi Kwezazi Zomndeni. I-Cancer . 2016. 122 (15): 2324-31.
Gross, G. et al. Izindleko zokuhlolwa komdlavuza webele esifundeni seMedare. I-JAMA Imithi Yangaphakathi . 2013. 173 (3): 220-6.
IIic, D., Neuberger, M., Diulbegovic, M., noP. Dahm. Ukuhlolwa kwesifo somdlavuza we-prostate. I-Cochrane Database yezibuyekezo ezihleliwe . 2013 Jan 31.
U-Irvin, u-V., no-R. Kaplan. Ukuhlolwa kwesifo somdlavuza we-mammography nesifo sebele: ukuhlolwa kwe-meta-analysis of quasi-experimental studies. PLoS One . 2014 Jun 2.
UTammemagi, M. et al. Umthelela wokuhlolwa komdlavuza wamaphaphu imiphumela yokuyeka ukubhema. Journal of the National Cancer Institute . 2014. 106 (6): dju084.