Assessment of the Effectiveness of Radon Screening Programs in Reducing Lung Cancer Mortality

The present study was aimed at assessing the health consequences of the presence of radon in Quebec homes and the possible impact of various screening programs on lung cancer mortality. Lung cancer risk due to this radioactive gas was estimated according to the cancer risk model developed by the Sixth Committee on Biological Effects of Ionizing Radiations. Objective data on residential radon exposure, population mobility, and tobacco use in the study population were integrated into a Monte‐Carlo‐type model. Participation rates to radon screening programs were estimated from published data. According to the model used, approximately 10% of deaths due to lung cancer are attributable to residential radon exposure on a yearly basis in Quebec. In the long term, the promotion of a universal screening program would prevent less than one death/year on a province‐wide scale (0.8 case; IC 99%: –3.6 to 5.2 cases/year), for an overall reduction of 0.19% in radon‐related mortality. Reductions in mortality due to radon by (1) the implementation of a targeted screening program in the region with the highest concentrations, (2) the promotion of screening on a local basis with financial support, or (3) the realization of systematic investigations in primary and secondary schools would increase to 1%, 14%, and 16.4%, respectively, in the each of the populations targeted by these scenarios. Other than the battle against tobacco use, radon screening in public buildings thus currently appears as the most promising screening policy for reducing radon‐related lung cancer.     

癌症如何被呈现？——基于优酷网肺癌视频的内容分析

网络视频已成为重要的内容传播方式,但现有研究少有关注其对疾病的呈现方式与呈现特征。通过确定入选标准和内容编码,对优酷网跨度10年的220个肺癌视频进行分析。研究表明,视频普遍存在信息不权威、不科学与不充分现象。自媒体和非专业的个体是视频发布主体,科学的筛查建议、社会支持、患者实际生存状态等内容极少出现,不同发布来源在健康信念模式要素呈现上存在显著差异。为此,建议加强对媒介平台的融合使用,强化信息呈现形态与内容设计,加强网络平台的内容审核等。     

进展期胃癌术后三维适形放疗同步替吉奥化疗的临床观察

目的：探讨进展期胃癌术后三维适形放疗同步替吉奥化疗的不良反应及近期疗效。方法对32例进展期胃癌术后患者行同步放化疗：采用三维适形放疗（3DCRT）技术,靶区包括瘤床和区域淋巴引流区,放疗总剂量（ DT）46Gy/23Fx;同期口服替吉奥胶囊,60mg/次,2次/日,28天。观察毒性反应、肿瘤局部复发情况和1年生存率。结果32例患者随访率100％,1＋2、3级白细胞减少发生率分别为78．13％,15．63％;1＋2、3级恶心、呕吐发生率分别为62．50％、3．13％。1年总生存率、无复发生存率和局部控制率分别为87．50％,81．25％和90．63％。3例3级骨髓移制,1例3级恶心、呕吐,其余均为1～2级不良反应。结论进展期胃癌术后采用3DCRT联合替吉奥同步放化疗,患者不良反应可耐受,近期疗效较好。     

Effects of Disease Type and Latency on the Value of Mortality Risk

We evaluate the effects of disease type and latency on willingness to pay (WTP) to reduce environmental risks of chronic, degenerative disease. Using contingent-valuation data collected from approximately 1,200 respondents in Taiwan, we find that WTP declines with latency between exposure to environmental contaminants and manifestation of any resulting disease, at a 1.5 percent annual rate for a 20 year latency period. WTP to reduce the risk of cancer is estimated to be about one-third larger than WTP to reduce risk of a similar chronic, degenerative disease. The value of risk reduction also depends on the affected organ, environmental pathway, or payment mechanism: estimated WTP to reduce the risk of lung disease due to industrial air pollution is twice as large as WTP to reduce the risk of liver disease due to contaminated drinking water.     

亚砷酸对肺癌细胞凋亡及LRP基因表达影响的体外研究

目的观察亚砷酸(As2O3)对人肺腺癌的诱导凋亡作用及对LRP基因表达的影响及可能机制.方法选用人肺腺癌A549细胞系,应用体外细胞培养法,流式细胞术检测As2O3对人肺腺癌的诱导凋亡作用;用逆转录-聚合酶链反应(RT-PCR)方法检测LRPmRNA的表达.结果不同浓度的As2O3均可诱导A549细胞凋亡.1.0μmol/L、2.0μmol/L的As2O3可下调LRPmRNA的表达.结论As2O3诱导肿瘤细胞凋亡作用主要是通过下调LRPmRNA表达有密切关系.     

Effects of Risk and Time Preference and Expected Longevity on Demand for Medical Tests

Despite their conceptual importance, the effects of time preference, expected longevity, uncertainty, and risk aversion on behavior have not been analyzed empirically. We use data from the Health and Retirement Study (HRS) to assess the role of risk and time preference, expected longevity, and education on demand for three measures used for early detection of breast and cervical cancer—regular breast self-exams, mammograms, and Pap smears. We find that individuals with a higher life expectancy and lower time preference are more likely to undergo cancer screening. Less risk averse individuals tend to be more likely to undergo testing.     

Tobacco—the importance of relevant information on risk

Summary. Although it has been widely accepted since the 1960s that smoking cigarettes carries a substantial health risk, worldwide mortality from tobacco-related diseases is increasing rapidly at the beginning of the 21st century. To provide the motivation to control this epidemic there is a continuing and pressing need for information on the risks of tobacco consumption that is accurate, up to date, locally relevant and imaginatively presented.     

Quantifying Potential Health Impacts of Cadmium in Cigarettes on Smoker Risk of Lung Cancer: A Portfolio-of-Mechanisms Approach

This article introduces an approach to estimating the uncertain potential effects on lung cancer risk of removing a particular constituent, cadmium (Cd), from cigarette smoke, given the useful but incomplete scientific information available about its modes of action. The approach considers normal cell proliferation; DNA repair inhibition in normal cells affected by initiating events; proliferation, promotion, and progression of initiated cells; and death or sparing of initiated and malignant cells as they are further transformed to become fully tumorigenic. Rather than estimating unmeasured model parameters by curve fitting to epidemiological or animal experimental tumor data, we attempt rough estimates of parameters based on their biological interpretations and comparison to corresponding genetic polymorphism data. The resulting parameter estimates are admittedly uncertain and approximate, but they suggest a portfolio approach to estimating impacts of removing Cd that gives usefully robust conclusions. This approach views Cd as creating a portfolio of uncertain health impacts that can be expressed as biologically independent relative risk factors having clear mechanistic interpretations. Because Cd can act through many distinct biological mechanisms, it appears likely (subjective probability greater than 40%) that removing Cd from cigarette smoke would reduce smoker risks of lung cancer by at least 10%, although it is possible (consistent with what is known) that the true effect could be much larger or smaller. Conservative estimates and assumptions made in this calculation suggest that the true impact could be greater for some smokers. This conclusion appears to be robust to many scientific uncertainties about Cd and smoking effects.     

Uncertainty and Sensitivity Analysis in Assessment of the Thyroid Cancer Risk Related to Chernobyl Fallout in Eastern France

The increase in the thyroid cancer incidence in France observed over the last 20 years has raised public concern about its association with the 1986 nuclear power plant accident at Chernobyl. At the request of French authorities, a first study sought to quantify the possible risk of thyroid cancer associated with the Chernobyl fallout in France. This study suffered from two limitations. The first involved the lack of knowledge of spontaneous thyroid cancer incidence rates (in the absence of exposure), which was especially necessary to take their trends into account for projections over time; the second was the failure to consider the uncertainties. The aim of this article is to enhance the initial thyroid cancer risk assessment for the period 1991-2007 in the area of France most exposed to the fallout (i.e., eastern France) and thereby mitigate these limitations. We consider the changes over time in the incidence of spontaneous thyroid cancer and conduct both uncertainty and sensitivity analyses. The number of spontaneous thyroid cancers was estimated from French cancer registries on the basis of two scenarios: one with a constant incidence, the other using the trend observed. Thyroid doses were estimated from all available data about contamination in France from Chernobyl fallout. Results from a 1995 pooled analysis published by Ron et al. were used to determine the dose-response relation. Depending on the scenario, the number of spontaneous thyroid cancer cases ranges from 894 (90% CI: 869-920) to 1,716 (90% CI: 1,691-1,741). The number of excess thyroid cancer cases predicted ranges from 5 (90% UI: 1-15) to 63 (90% UI: 12-180). All of the assumptions underlying the thyroid cancer risk assessment are discussed.     

个体身份与生命意义：肺癌网络社区的疾病叙事

文章通过对国内"医享网"癌症社区"肺癌圈"中33篇精华帖的叙事分析,探究其中生命故事的主体对自我身份的建构路径及其对生命价值的意义探寻,并尝试性地提出一些反思。研究发现,在自述和他述生命故事中,叙事者在信息寻求过程中改善自我印象,并运用"写作疗法""阅读疗法"和叙事隐喻理解疾病,帮助患者重塑自身角色。通过社群互动,患者形塑了对自身的身份认同,并形成了集体层面的生命价值观。从本研究的结论看,疾病叙事是癌症网络社区患者建构个体身份、形成身份认同的重要途径,叙事或可成为未来增进社会对癌症乃至其他疾病的理解、推进治疗与康复的可行之路。