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BACKGROUND: Esophageal cancer is a common human digestive tract cancer, the mortality rate ranks fourth in malignant tumors. The Shexian Hebei Province, located in the southern foot of the Taihang Mountains, is one of the high incidence of esophageal cancer in China in recent years to study the presence of esophageal and gastric cardia high incidence found in the area. Nutritional deficiencies, the lives of poor eating habits, family history of esophageal cancer, as well as smoking, alcohol consumption and other factors is a major risk factor for the high incidence of esophageal and gastric cardia. Prevention and control work year round in areas of high, esophageal cancer incidence and mortality decline, but the result is still not satisfactory, and most of them have not yet establish prevention team high incidence of esophageal cancer morbidity and mortality still remain at a high level. Based primary prevention in order to eliminate or reduce the carcinogenic factors difficult to implement due to esophageal exact pathogenic factors and pathogenesis is unclear, but also by the impact of the high incidence of the level of economic development. Secondary prevention so in recent years more and more attention and assistance of the Cancer Foundation, endoscopic screening in high incidence has generally commenced, the purpose of this project is to study the relevant factors affecting the detection rate observed esophageal cardia precancerous lesions of the natural history, explore the appropriate endoscopic screening interval, reduce the interval cancer, and to provide a basis to improve screening efficiency. Objective: the implementation of the first round of Hebei Province Shexian 40-69 years old crowd and repeated endoscopic screening, observed detection rate of esophageal lesions at all levels, in accordance with the level of detection rate study of the risk factors of the esophagus and cardia. Comparing the pathological results before and after the repeat screening observe the natural history of esophageal and gastric cardia precancerous lesions, to find the appropriate screening interval. Analysis of different age, gender, upper gastrointestinal cancer family history, smoking, alcohol consumption, and the presence or absence of iodine solution not stained with precancerous lesions progress relative risk high incidence populations, and to explore the relationship between esophageal lesions with malignant family history method : March 2001 to December 2008, in the 10 villages of the the Shexian solid new god head Township residents to register and record the 40-69 years old, to mobilize accept electronic endoscopy screening, screening rates in 70 % or more. Fill epidemiological questionnaire before screening, and signed informed consent, and by the fourth Hospital of Hebei Medical University, MD, endoscopy room with Olympusgif2XQ230 and 240 electronic gastroscopy, check the range of application iodine staining method including the esophagus, cardia, stomach until twelve the ball portion of the duodenum, biopsy and, if found positive lesions in the esophagus 25cm and cardia ridge roots at the boundary line between biopsy to check the results of a detailed record of iodine is not stained or light stained area. The biopsy specimens rapid neutral formalin-fixed, conventional dehydrated, embedded in paraffin, sliced, HE staining, and reading the diagnosis by pathologists. Stage treatment program recommended on the diagnosis of advanced cancer, screening out carcinoma in situ, intramucosal cancer and severe dysplasia in patients will be endoscopic mucosal resection or argon plasma coagulation (APC) therapy. In the short term after the first endoscopic screening for 40-69 year-olds in the repeat screening. Receive repeat screening, compared to the pathology results before and after the repeat screening, determined by pathology diagnostics development cases, recorded its first round of screening and repeat screening intervals, to infer the appropriate screening interval. Application of case-control studies analyzed different age, gender, family history of cancer, upper gastrointestinal, the relative risk of the point of origin as well as factors such as smoking, drinking and precancerous lesions of the esophagus and cardia progress. All census information entered into the computer, to establish a database of census data, using SPSS13.0 software for statistical analysis. Results: The first round of screening results 1.1 Total 4124 people to accept the first round of screening, males accounted for 51.8% (2135/4124), more than 50 years of age accounted for 60.1% (2475/4124), upper gastrointestinal cancer family history accounted for 34.3% (1414/4124), the presence of iodine solution is not stained by 5.2% (213/4124), a history of smoking accounted for 35.3% (1457/4124), a history of alcohol consumption accounted for 15.2% (628/4124 ). 1.2 the first round of screening in mild dysplasia (mild dysplasia, mD), the detection rate was 15.4% (634/4124), the detection rate of moderate dysplasia (moderate dysplasia, MD), 3.7% (153 detection rate of 1.5% (63/4124), carcinoma in situ or intramucosal cancer detection rate was 2.8% (117/4124) / 4124), severe dysplasia (severe dysplasia SD), invasive carcinoma of the seized a rate of 0.9% (37/4124). 2 factors affect the detection rate of 2.1 parts mD occur in the esophagus, MD, SD, carcinoma in situ and intramucosal carcinoma and invasive cancer detection rate of 7.10%, 2.52%, 0.95%, 1.04% and 0.34%, respectively; mD cardia, MD, SD, carcinoma in situ and intramucosal carcinoma and invasive cancer detection rate were 6.01%, 0.99%, 0.51%, 1.43% and 0.44%; occurs in the distal stomach mD, MD SD, carcinoma in situ and intramucosal cancer and invasive cancer detection rate of 2.26%, 0.19%, 0.07%, 0.36% and 0.12%, respectively. 2.2 Gender men and women esophageal dysplasia detection rates were 11.9% (255/2135) and 9.1% (181/1989), the difference was statistically significant (χ ~~ 2 = 8.808, P = 0.002); esophagus The cancer detection rate was 1.97% (42/2135) and 0.75% (15/1989), between the two statistical difference (χ ~~ 2 = 11.117, P = 0.001); men and women cardia dysplasia seized out rates were 9.2% (196/2135) and 5.7% (114/1989), the differences between men and women was statistically significant (χ ~ 2 = 17.618, P lt; 0.0005); cardia cancer detection rates were 3.04% (65/2135) and 0.60% (12/1989), the difference was statistically significant (χ ~ 2 = 33.497, P lt; 0.0005); men and women gastric atypical hyperplasia detection rate was 2.86% (61 / 2135) and 2.16% (43/1989), and the difference was not statistically significant (χ ~ 2 = 2.025, P = 0.093); men and women of gastric cancer detection rates were 0.80% (17/2135) and 0.15% ( 3/1989), the difference was statistically significant (χ ~~ 2 = 8.888, P = 0.002). 2.3 lt of age; 50 years of age and ≥ 50 years age group esophageal dysplasia detection rate of 6.00% (99/1649) and 13.6% (337/2475), the difference was statistically significant (χ ~ 2 = 60.659, P lt; 0.0005); lt; 50 years and ≥ 50 years age group of esophageal cancer detection rate was 0.67% (11/1649) and 1.89% (46/2429), the difference was between significance (χ ~~ 2 = 10.308, P = 0.001); lt; 50 years of age and ≥ 50 age group cardia dysplasia detection rate of 5.52% (91/1649) and 8.85% (219/2475), the two by difference between statistical significance (χ ~ 2 = 15.785, P lt; 0.0005); lt; 50 years and ≥ 50 years age group cardia cancer detection rate of 0.61% (10/1649) and 2.71% (67 / 2475), the difference between statistical significance (χ to 2 = 23.834, P lt; 0.0005); lt; 50 years and ≥ 50 years age group gastric dysplasia detection rates were 2.67% (44/1649 ) and 2.42% (60/2475), the difference between the two was not statistically significant (χ ~~ 2 = 0.240, P = 0.347); lt; 50 years and ≥ 50 years age group, gastric cancer detection rate of 0.12% ( 2/1649) and 0.73% (18/2475), and the difference was statistically significant (χ ~~ 2 = 7.526, P = 0.004). 2.4 family history family history positive people esophageal mild, moderate and severe dysplasia detection rate was significantly higher than the negative population (P lt; 0.05), family history positive and negative populations carcinoma in situ or intramucosal carcinoma and invasive carcinoma seized out rate differences, but there was no statistical significance (P gt; 0.05); detection rate for all levels of cardiac lesions family history positive population and negative population there was no significant difference (P gt; 0.05). Family history positive people at all levels of lesions of the esophagus detection age, in addition to moderate dysplasia were significantly ahead of the negative population (P lt; 0.05); cardia, family history positive people only mild atypical hyperplasia detected significantly older below the negative population (P lt; 0.05). Over 2.5 is not stained seized 210 cases of esophageal iodine staining found many shallow stained or not stained stove, how not dyed and not dyed differences in the detection rate of esophageal dysplasia was statistically significant (P lt ; 0.0005), esophageal cancer detection rate difference was statistically significant (P lt; 0.0005). 3 repeat screening results of 310 475 cases accepted repeat screening found 92 cases in the original site progress by comparing the results of repeated screening before and after the pathological lesions mucosal resection, 15 patients with primary site in progress in other parts of the (iso bit progress). 3.2 by repeat screening newly discovered 13 cases of severe atypical hyperplasia: the first prosecution normal two cases, respectively, 13, 22 months apart detection; cases of basal cell hyperplasia detection interval of 19 months; 4 cases mD interval of 3 4,4,10.5 months detection; six cases of MD interval 6,9,12,12.5,17,44 month checkout. 3.3 through repeated screening newly discovered 15 cases of carcinoma in situ and intramucosal carcinoma: five cases of first seizure normal interval 12.5,13,24,25 and 61 months, respectively detected; cases of basal cell hyperplasia interval 52 months detection; 2 cases of mild dysplasia detection interval of 16,48 months; 4 cases of moderate dysplasia detected three cases of severe atypical hyperplasia interval 3.5 4,6,13,13 months apart , 9,17.5 months detected. 3.4 by repeat screening new found four cases of invasive cervical cancer: one cases of moderate dysplasia 50 months interval detection, detection of three cases of severe atypical hyperplasia, respectively, 14, 17, 19 months apart. 4 Repeat screening results show that the first seizure, the shortest BCH and mD 12.5 months progress to cancer, the first seizure MD and SD shortest by 3.5 months of progression to cancer to avoid during the screening interval occurred between Phase cancer of the large crowd, the first seizure of normal, BCH and mD crowd should line screening once a year, the crowd six months of the first seizure MD screening time. 5 factors that affect the progression of precancerous lesions male, age greater than 50, upper gastrointestinal not stained positive family history of cancer and esophageal mucosa before the crowd of esophageal cancer, the risk of disease progression than women younger than 50 years old, the family history negative and no more than dyed crowd, OR (95% CI) and P values ??were 2.102 (1.325-3.336), 0.001; 2.001 (1.246-3.214), 0.004; 1.562 (1.010-2.416), 0.044; 3.062 (1.824-5.142), 0.000. Conclusion: 1 male, age greater than 50 years old, upper gastrointestinal positive family history of cancer, esophageal mucosa not dye a higher risk of suffering from esophageal cancer and a history of smoking crowd; men, age greater than 50 years of age and a history of smoking higher risk of the population suffering from gastric cardia. 2 men, age greater than 50, the risk of upper gastrointestinal cancer family history positive and esophageal mucosa is not stained by its esophageal precancerous lesions progress than women younger than 50, family history negative and no more than not stained by . 3 for the rapid progress of the individual, should be appropriately shorten endoscopic screening interval to reduce the rate of misdiagnosis of early cancer. 4 family history can significantly increase the rate of detection of esophageal cancer and precancerous lesions and the number of primary foci, and the early age of onset.
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