Iingxabano kunye nokuchasana nomhlaza weLung Cancer
Ukuba ubukele iindaba kwiimbalwa ezimbalwa zeminyaka edlulileyo, mhlawumbi uvile ezinye zeengxoxo malunga nomhlaza wesifo somhlaza. Ingxoxo ekuqaleni yayikuthi okanye ingekho i-Medicare kufuneka ifake umhlaza womphunga we-CT ukuhlola abo badibanisa imigaqo ecacileyo. Ngomhla kaFebruwari ka-2015, eso sigqibo sagqitywa njengokuba i-Medicare ngoku ihlanganisa olu vavanyo. Isizathu sokuba iingxoxo zifunyenwe-kwiziko lophando olutsha olubizwa ngokuba yi-National Lung Cancer Screening Trial - ukuba ukuhlolwa kwe-CT (LDCT) ephantsi kakhulu kunokunciphisa ukufa komdlavuza wamaphaphu ngama-20 ekhulwini, okanye abantu abayi-18 000 base-US ngonyaka.
Kuya kubonakala konke kulungile, kodwa uvavanyo lwango-2016 lufumene ukuba ngaphantsi kwengxenye yamagqirha entsapho avuma ukuba ukuhlolwa komdlavuza wamaphaphu kwakuyinkcazelo entle kwaye abaninzi babengazi iziphakamiso ezithile. Ukongezelela, abaninzi bala ma gqirha bayaqhubeka nokuyalela i-x-rays njengesifuba sokuvavanya umhlaza wemiphunga. Oku, kuye kwaphumela kumbuzo oqhelekileyo:
"Kutheni na ugqirha wam angayilanga uvavanyo oluza kusindisa ubomi bam?"
Ziziphi iingxoxo kunye nokuchaswa komhlaza wemiphunga, kwaye yiyiphi imibutho exhasa ezi ngxabano? Makhe sijonge kulezi zikhundla kwaye uqhathanise umhlaza wompompo ukuhlolwa kwezinye iimvavanyo zokuhlola umhlaza okwangoku.
* I-Medicare ngoku ibandakanya umhlaza womphunga wamaphesenti kulabo abaneminyaka engama-55 no-77, abaqhubeka beshiya okanye bayeka kwiminyaka eyi-15 eyadlulayo, kwaye baye bavutha ubuncinane iminyaka engama-30 epakethe. Ukuhlola kuyimfuneko yesiginesha (okanye ungenaye ugqirha ofanelekileyo) kwaye ufuna ukuba umntu oza kuhlolwayo adibane nodokotela wabo ngokucebisa ukuba athathe inxaxheba kwisabelo sokubanjwa kwesigqibo ngaphambi kokuba umyalelo ubhaliwe.
Ubani Abazuzwa Ngomhlaza Wengwenya?
Emva kweminyaka emininzi ngaphandle kokuvavanya ukuhlolwa kwe-cancer yomphunga, i-National Lung Cancer Screening Trial (NLST) yafumanisa ukuba ukuhlolwa kwe-CT ephantsi (i-LDCT) kungasindisa ubomi phakathi kwabantu abahlangabezana nemigangatho ethile. Kubantu abadibana nale miqobo, ukuhlolwa kwe-LDCT yonyaka kunokunciphisa ukufa komdlavuza wamaphaphu ngama- 20 ekhulwini -inani eliguqulela kumawaka angamawaka aseMerika ngamnye ngonyaka.
Ngokusekelwe kwiziphumo zophando iUnited States Preventive Task Force (USPSTF) isincome ukuhlolisisa:
- Abantu abadala abaneminyaka engama-55 no-80 abanomlando we-pack of year- 30 wokutshaya, kunye
- Qhubeka ukutshaya okanye ukuyeka ukutshaya kwiminyaka eyi-15 edluleyo
Ukuhlolwa kwesicelo kungabhekisela kwabanye abantu, njengabo baveleleke kwi-asbestos, kwimbali yesifo sofuba, ukuhlaselwa kwe-radon , i- BRCA2 , kunye nezinye iimeko.
Izizathu zokuvuyela malunga neLDCT yeLung Cancer Screening
- Okwangoku, okungenani ama-40 ekhulwini labantu abanomdlavuza wamaphaphu bafumaneka xa isifo sele siphumelele kwisigaba 4 somhlaza wamaphaphu .
- Umyinge weminyaka emi-5 yomdlavuza wamaphaphu uwonke ungaphezu kwama-17 ekhulwini.
- Xa umdlavuza wamaphaphu ufunyanwa kumanyathelo okuqala, ukusinda kuphezulu.
- Ezinye iifom zokuhlola eziye zavanywa ukuza kuthi, njengesihlunu se-x ray kunye ne- sputum cytology , azifumaneki ukunciphisa ukufa.
- Umdlavuza womlenze yiyona nto ibangela ukuba ukufa komhlaza kubasetyhini kunye nabasetyhini e-United States. Ibulala abafazi ababini njengomdlavuza webele.
- Kungekudala kuye kwafunyanwa ukuba abanye ababhemayo abanokwenza ukuhlolwa kwe-LDCT banokuthi bayeke ngaphezu kokuba bengenalo vavanyo. Nangona kusekuqaleni ukuthetha, ulwazi lwezinye izifo ezibangelwa ukutshaya lubonisa ukuba, njengokwenziwa kwe-perk, ukuhlolwa komdlavuza wamaphaphu kunokunciphisa ingozi yesifo senhliziyo, i-COPD, kunye nokunye.
- Phakathi kwabaxhamli be-Medicare, kucatshangelwa ukuba ukuhlolwa kwe-LDCT ngonyaka kungaphaya kabini ipesenti zesigaba sokuqala somhlaza wesifo somhlaza wamaphaphu (njengendlela yokuthelekisa ngokukhawuleza, isilinganiso seminyaka emihlanu yokusinda kwisigaba soku-1 esincinci somhlaza wamaphaphu singama-60 ukuya kuma-80 ekhulwini. Kwinqanaba lesi-2 40 ukuya kuma-50 ekhulwini. Kwinqanaba lesi-4 lingaphantsi kweepesenti ezi-5.) Kucingelwa ukuba oku kuhlola kuza kuchonga ama-cancer angama-54,000 eyongezelelweyo ngemiphunga ngonyaka (32,000 kwinqanaba lokuqala).
- Ukuba izikhokelo zesikhokelo ziphunyeziwe ngokukhawuleza, kwaye ukuba wonke umntu ohlangabezana neendlela zokujonga i-screening, uya kubalwa , abantu abayi-18,000 bangagcinwa ngonyaka.
Iingxaki ezinxulumene noConfishing
Naluphina uvavanyo lokuhlola luza neengxaki ezithile. Abaninzi benu banokwazi ngomntu owayesabisayo kwi-mammogram - kuphela ukuva ukuba kwakusongela. Ezinye zeengxaki zokuhlolwa kwimihlaza yomphunga zingabandakanya:
- Iimpawu ezibuxoki
- Amanqaku amanga
- I-Overdiagnosis
- Ukunyuka kwamayeza
Uphi Ukuhlolwa Kwengqungqungqomane Yengqumbo?
I-United States I-Preventive Task Force (USPSTF) isincomele ukuhlolwa komhlaza wamaphaphu njengenkqubo yeBakala B. Ngaphantsi koNgcaciso lwe-Career Affordable Act (ACA) abucala kufuneka bafake iinkqubo zokuhlola iBanga B okanye ngaphezulu (jonga ngezantsi). Oku kuphumelela ngoJanuwari 2015. Ukuhlolwa ngumbutho kuhlanganiswe liSebe lezeMandla, iSebe leMfuyo yePhondo (ngokubonga, njengabalandeli abanomdla wokuphakamisa umhlaza wamaphaphu,) nabanye.
Kuthiwani Ngamayeza?
Ngo-Ephreli, iKomiti yeCandelo loPhuhliso loBonelelo kunye neNgcaciso yeCommunity Advisory Committee (MEDCAC) ivotelwe ngokuchasene ne-LDCT yomhlaza wesifo somhlaza wamaphesenti kubaxhamli-ngamanye amazwi, ayifakwe "njengenzuzo engundoqo yempilo" ngaphandle kweendleko. Isizathu kukuba abaqinisekanga ukuba iintlawulo ziza kuba zigqithise izibungozi kule ndawo. Ngokuchasene nabanini-mshishino baso-inshorensi, ii-Medicare iintlawulo azihlanganiswa phantsi koMthetho wokuNakekelwa ongenakuncedo . Isigqibo sokugqibela asisenziwa kuze kube ngoFebruwari 2015.
Ngubani oseNkxaso yeCung Cancer Screening?
Ukuhlaziywa okukhawulezayo kweWeb kufumana le mibutho elandelayo ukuxhasa ukuhlolwa komdlavuza wamaphaphu (isichasene nesigqibo sikaMagare)
- I-American Medical Association (AMA)
- I-American College of Radiology (ACR)
- I-Lung Cancer Alliance (LCA) - I-LCA ifake isicelo esifanelekileyo sokuQinisekisa koMgaqo-kaZwelonke wokuhlola umhlaza wemiphunga.
- I-United States ye-Preventional Services Task Force (USPSTF)
- I-American Society of Clinical Oncology
- I-American Cancer Society (ACS)
- I-Society of Thoracic Surgeons (STS)
- Abaninzi bamaSenethi kunye nabameli bakaRhulumente
Ongaxhasayo i-Lung Cancer Screening
Ukususela ngo-Oktobha ka-2016, i-American Academy ye-Family Practice ithi akukho ubungqina obufanelekileyo bokulawula okanye ukuchasa ukuhlola.
Iziphakamiso / iingcebiso kwiNkxaso ye-Lung Cancer Screening - Ukuthelekisa ii-apula kuma-apulo
- Iyeza-based Ukuhlolwa kwesifo somhlaza kuboniswe nge isicatshulwa esisekelwe kumqondiso ukusindisa ubomi. Uphando olutshanje luchaza ukuba ukuhlolwa kwesifo somhlaza wesifuba akusi. Ukuphononongwa kwakhona kwe- PLos One kwandifumene ukuba ukujonga izilwanyana kunomphumo othobekileyo ekufeni kwabasetyhini abaneminyaka engama-50 ukuya kuma-69, kunye nemiphumo engabonakaliyo kwabasetyhini abangaphezu kweminyaka engama-70. Ukuhlolwa kwesifo somdlavuza kulindeleke ukuba kubekho ukufa komhlaza wamaphaphu kulabo Ibanga le minyaka. Nangona kunjalo, i-Medicare ihlawulela i-mammograms kodwa ayihlawulelanga ukuhlolwa komhlaza wamaphaphu.
- Iingxaki zeendleko - Iindleko zokubhengeza umdlavuza wamaphaphu ekufunyanwe yiMedareya zikhulu, kodwa ziguqulela kwi-$ 3 ngenyanga ngenyanga ngamnye ngomxhamli. Iindleko zesifo somhlaza webele we-Medicare abafumana inzuzo ziguqulela malunga ne-2.50 ngeenyanga. Qaphela ukuba i-$ 3 ngenyanga malunga nokuhlolwa komdlavuza wamaphaphu kufaka ukulandelelana (umzekelo ukukhangela ama-positi amanga,) kodwa i-$ 2.50 nganye ngenyanga malunga nokuhlolwa komhlaza wesifuba akubandakanyi iimvavanyo zokulandelelana kunye neenkqubo. Ukujonga ezinye iinombolo kwezinye izifundo, kwacatshulwa ukuba kubize i-Medicare $ 2 yezigidigidi ngonyaka ukuze unikeze umhlaza womphunga wamaphaphu kunye ne-1.08 ukuya kwi-1.36 yezigidigidi zamammogram. Cinga ukuba bobabini abaxhamli kunye nabesilisa baya kuzuza kwimilinganiselo yeemiphunga, kodwa uninzi lwabafazi kuphela abafumana amamigrams. Andiyi kungena kwiindleko zonyango. Ukuqaphela, okwenene, kuya kukwandisa inani lomhlaza womphunga ngenxa yokunyuka kwinqanaba lokuxilongwa kwexesha lokuqala, kwaye ke, kubiza kakhulu ukugubungela iindleko zomdlavuza kunye nokulandelelana kunokufa. Sinokulinganisela iindleko zolu unyango lwe-cancer yesifo samaphaphu kunye neendleko zokulawulwa komdlavuza wamaphaphu kunye nokupheliswa kobomi, kodwa ndingakuthandi ukuya khona. Ukususela kumgca wokulala, akukho nto ithelekiswayo. Ewe, ndibone intlungu njengoko abantu beyifumana ukuhlinzwa, kodwa kubonakala xa kuqhathaniswa nentlungu yokuphela komntu kunye neethambo zesifo kunye ne-short breath-breath.
- Ukuphikisa ukugxila ekupheleni kokutshaya . Ewe, oku kubalulekile, nangona kunjalo, akuyi kunceda abo baviwa ukuba bahlolwe abaye bayeka kwiminyaka eyi-15 edlulileyo. Kuyathakazelisa kwakhona ukuphawula ukuba njengoko kuphawuliwe ngasentla, ukuhlola ukuphucula izinga lokuyeka ukutshaya kwabanye abantu (kwaye ngokubhekiselele ngokusekelwe kumanani kuneenkqubo kunye neenkxaso esikhoyo.) Kodwa kubaluleke kakhulu - ukuba sibaphathe abo basengozini yomdlavuza wamaphaphu ngokulinganayo kwabo basengozini yezinye iintlobo zomhlaza esifanele senze enye yezinto ezimbini. Ingaba i-Medicare ifanele ikhusele i-LDCT yokuhlola umdlavuza wamaphaphu, okanye usebenzise uhlobo olufanayo lokucalula kubantu abasemngciphekweni kwezinye iifom ze-screen screening. Ngokomzekelo, ukuba i-Medicare ikhetha ukuhlawula ukuyeka ukutshaya endaweni yokuhlolwa kwimihlaza yomphunga, kulandela ngokufanelekileyo ukuba kufuneka ihlawule ukufundisa abesetyhini ukuba bancelise abantwana babo, kunokuba bahlawulele imimmogram. Kwakhona kuya kulandela ukuba i-Medicare kufuneka igxininise ekukhuthazeni umsebenzi kunokubambisa i-colonoscopies njengomdlavuza wekolon inxulumene nokuphila kwimizimba kwezinye iimeko. (Ewe, ndiyabhekana, kodwa kubalulekile ukuqhubeka nokuqhathanisa ii-apples kwiipulo, kwaye le sigqibo ndixhalabisa ukuba umdlavuza womdlavuza ungadlala indima kwisigqibo.) Kwinqanaba lomlando wehlabathi kulo nyaka omnye wam Abantwana babuzwa lo mbuzo. "Yayiyiphi indawo ebaluleke kakhulu ukuba ibe khoboka?" Impendulo yayise-Caribbean, kuba esikhundleni sokutya nokunyamekela inceku, kwakungabizi ukuba "uyisebenzise" kwaye uthenge enye. Ngesizathu esithile, loo ngcamango yayilokhu ifika engqondweni njengoko ndayifumene nale ngxabano.
- Iimpawu ezibuxoki - Ewe, ukuhlolwa komdlavuza wamaphaphu kubangelwa yimiphumo emibi. Kwakhona isifo somhlaza webele. Iimpawu ezingamanga ziye zaphawulwa kwi-25% yabantu abajongene nokuhlolwa kwesifo somdlavuza wamaphaphu, badinga ukufundwa kwamanye amaxesha kunye neenkqubo ezithile ezingenayo. Iigulane zilandelwa ngeminyaka eyi-10 ubudala, iziganeko zobuxoki bobukhulu ziyi-50 ukuya ku-60%. Ukongezelela, izigulane ezingama-90,000 zilandelwa iminyaka engama-25 kunye nokuhlolwa kwe-mammogram, i-22% ayifumanekanga okanye iphathwe ngonyango olungadingekile. Kodwa i-mammography yinzuzo ephantsi kwenkqubo ye-Medicare, kodwa ukuhlolwa komdlavuza wemiphunga akukona njengokuba kucatshulwa (iziphuzo ezingamanga, ukugqithisa i-overdagnosis) zingaphezulu kweenzuzo (i-20% ephakamileyo izinga lokusinda.) Ngaba i-MEDCAC ilindele ukuba ibambane ne-stampede Ubomnyama xa befanele baphathe iipulo njengeipulo kwaye banqabile ukugubungela imimmigrams ngenxa yengozi yeempembelelo zobuxoki?
- Ukuchasana kweemvula - Siye safunda ukuba ukunyuka kwimizila yonyango kungekho ngaphandle kweengozi.
- I-USPSTF iBakala B - I-United States ye-Preventive Task Force "iibakala" ezijongene nenzuzo ekunikezeni inkonzo kwizigulane. IBakala B kuthetha ukuba i-USPSTF icebisa inkonzo kuba kukho ukuqinisekiseka okuphezulu ukuba inzuzo yomnatha iyimodareyitha okanye ukuba kukho ukuqinisekiswa okuthe ngqo ukuba inzuzo enemodareyitha iyimodareyitha. Ukuhlolwa komdlavuza wamaphaphu, ukuhlolwa kwe-LDCT kufakwe kwiBakala B kwizigulane ezifanelekileyo njengoko kuxoxwe ngentla. Ukuhlola umhlaza wesifuba nge-mammography ikwaqwalaselwa neBanga B kubafazi bonke emva kweminyaka eyi-1 ukuya kwimi-2 emva kweminyaka engama-40.
- Ingxabano malunga noko sifunde kwi-screen cancer - Ukunye ukuphikisana kwiWebhu kukuba sifanele silumke ngomhlaza wesifo samaphaphu kwaye sisebenzise umzekelo wesifo somhlaza wesibeletho njengomzekelo. Kwiminyaka, amadoda akhuthazwa ukuba ahlolwe umhlaza wesibeletho, kwaye iimvavanyo ze-PSA ziye zaba yintsapho. Ukuphononongwa kweCochrane kweengxowa -maninzi ngoku sele kufumene ukuba ukuhlolwa kwesifo somhlaza wesifo seprotate akunciphisi ukufa kwesifo somhlaza wesifo se-prostate (ukufa) okanye ukufa kwabantu bonke. Ukongeza, ukulimala (ukusuka kwi-overdagnosis kunye nokugqithisa ngokugqithiseleyo) kuye kwavunywa njengento eqhelekileyo kwaye ifanelana. Umlinganiselo weminyaka emihlanu wokusinda komdlavuza wesibeletho ngowama-99%. Ngaba oku kuthelekisa iipulo kwiipulo?
- Izigulane ziyaziwa . Xa besithi abaqinisekanga ukuba izibonelelo ziphezulu kakhulu kubungozi balo bantu, i-Medicare ikhankanya izigulane ilungelo lokwenza izigqibo eziziwayo ngokwazo - izigqibo ezenziwa rhoqo ngoncedo lugqirha onokunika uncedo izigulane ezinomdla wokuqalisa ukuhlola ukulinganisela ingozi kunye neenzuzo zempilo yabo kunye nemeko. Abantu bafuneka ukuba benze ezi zigqibo imihla ngemihla - ezinye zazo ezinokubaluleka ebomini obunempilo, njengokuba kunamavili amnandi kwimoto yakho.
- Amahlwempu aya kuhlwempuzeka (okanye afe) kwaye izityebi ziya kuzuza (okanye ziphile). Iindleko zokuphonononga i-CT scans ziyahluka, kodwa ngokubanzi zibubanzi be-$ 350. Abanye abantu kwi-Medicare banako ukukwazi ukuhlawula loo mali, ngoxa abanye abakwazi. Izifundo ziye zafumanisa ukuba abantu abanakukwazi ukuqhuba iimvavanyo zokuhlola ukufumana izifo xa befuneka ukuba bahlawule kwi-pocket, kwaye ngokukodwa xa iindleko zifuna ukuba bathathe into ethile, umzekelo, ukutya.
- Lungisa. Kubonakala kungabikho kokungabi nabulungisa okusekelwe kumanqaku apha ngentla, ukuba abo basengozini yomdlavuza wamaphaphu abaphethwe ngokulinganayo. Njengoko uMartin Luther King wambi wathi, " Ukungabi nabulungisa naphina isongelo kwimicimbi yonke indawo ." Ziziphi ezinye izinto ezisongelayo ekunyamekelweni kwempilo yabemi bethu?
Ukuyifumanisa ngokuPhakamisa kunye neeNyulo ezilandelayo
Ukuba wena okanye othandekayo uhlangabezana nemilinganiselo yokuhlolwa komhlaza wamaphaphu, kukho ithemba. I-Medicare ayisenzi isigqibo sokugqibela kwi-coverage. Ukuba unesishurensi yabucala yangasese (okanye i-veteran, phakathi kwamanye ama-inshorensi) unenhlanhla. Njengoko kuphawuliwe ngaphaya kwe-Care Affordable Care Act kufuna ukuba ezi zihlolwe zikhutshwe. Izinketho xa ungenayo isongezelelo zibandakanya ukuzihlawulela ukuzihlawula. Nangona i-Medicare ingabonakali ngokukhenkcelwa komhlaza wamaphaphu, unelungelo lokuvavanywa kwaye uhlawule yona. Ukuba umhlaza womphunga ufumaniswa xa uzihlawula ukuhlola, u-Medicare uya kufuneka uhlawule ngokunyamekela.
> Imithombo
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IIic, D., Neuberger, M., Diulbegovic, M., noP. Dahm. Ukuhlola i-prostate cancer. I-Cochrane Database yeeNkqubo eziPhezulu . 2013 Jan 31.
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Tammemagi, M. et al. Impembelelo yemiphumo yomhlaza wemiphunga emiphumo yokuphelisa ukutshaya. Umbhalo weNational Cancer Institute . 2014. 106 (6): uDju084.