Vanhu Vanofanira Kubhabhatidzwa Vanofanira Kuongorora Kurapa Kwekenza Here?

by Lynne Eldridge, MD

Nharo Nekurwisana neLung Cancer Screening

Kana wakatarisa nyaya pamusoro pemakore mashomanana apfuura, zvimwe wakanzwa zvimwe zvekukakavadzana nezvekenza yemapapu ekuongorora. Kukurukurirana pakutanga kwaive kana kuti Medicare inofanirwa kuvhara mutsa wemapapu CT kugadziriswa kune avo vakasangana nemitemo yakananga. MunaFebruary ra2015, chisarudzo ichocho chakanga chakaiswa seMedarere ikozvino inosanganisira iyi kuedzwa. Chikonzero chekukakavadzana kwaiva kuwanikwa - mune chirwere chikuru chekurapa chinonzi National Lung Cancer Screening Trial - kuongorora kwakaitwa CT (LDCT) kuongorora kunogona kuderedza kufa kwekenza yemapapu ne 20 muzana, kana 18 000 veUnited States gore negore.

Zvingaita sezvose zvakanaka, asi chidzidzo che 2016 chakawana kuti pasi pehafu yevamwe vanachiremba vemhuri vakabvuma kuti kuongorora kwekenza yemapapu yaiva pfungwa yakanaka uye vazhinji vakanga vasinganzwisisi zvakananga. Mukuwedzera, vazhinji vezviremba ava vanoenderera mberi kuronga chifuti-maziso sekuongorora kuongorora kwemukenza wemapapu. Izvi, zvakare, zvakaguma nemubvunzo wakafanana:

"Nei chiremba wangu asingakwanisi kuudza muedzo unogona kuponesa hupenyu hwangu?"

Ndezvipi zvinopikisa uye kupikiswa kwekenza yemapapu, uye ndeapi masangano anotsigira izvi nharo? Ngatitarisei pane zvitubu uye tienzanise nekenza yemapapu kuongorora kune dzimwe mimwe mutsva yekuongorora kuongororwa.

* Medicare ikozvino inotakura chirwere chemapapu emapapu kune avo vari pakati pemakore 55 ne77, vanoramba vachitsvaira kana kuti vakasiya mumakore gumi apfuura, uye vakatsvaira makore makumi matatu emakore. Kuongorora kunoda chiremba wechiremba (kana kuti asiri chiremba anofanirwa) uye zvinoda kuti munhu anozoongororwa anosangana nachiremba wavo pakupa mazano kuti atore chikamu mukushanya kwekuita sarudzo musati warongeka.

Ndivanaani Vanobatsirwa neLung Cancer Screening?

Mushure memazana mazhinji emakore pasina ruzivo rwekuongorora maitiro emukenza yemapapu, National Lung Cancer Screening Trial (NLST) yakaona kuti kuderedzwa kwechiremba CT (LDCT) kunogona kuponesa hupenyu pakati pevanhu vanopindirana nemimwe mitemo. Muvanhu vanosangana nemitemo iyi, gore negore kuongorora kweLDCT kunogona kuderedza kufa kwekenza yemapapu ne20 muzana - nhamba inoshandura kuva makumi ezviuru zveAmerica gore negore.

Kubva pamigumisiro yekudzidza United States Preventive Task Force (USPSTF) yakakurudzira kuongorora:

Vakuru pakati pemakore makumi mashanu nemakumi matanhatu vane makore makumi matatu emakore emakore ekutsvaira, uye
Ramba uchisvuta kana kurega kusvuta mumakore gumi apfuura

Kuongorora kunogonawo kukodzera kune vamwe vanhu, vakadai seavo vakambororwa neAsbestos, nhoroondo yechifukidzo, radon inowanikwa , BRCA2 kuchinja kwemashoko , nezvimwe zvinhu.

Zvikonzero Zvokufadzwa Pamusoro peLDCT Lung Cancer Screening

Iye zvino, vanenge makumi mana kubva muzana yevanhu vane chirwere chemapapu vanorwara apo chirwere ichi chave chafambira mberi kusvika kumusasa wekenza yemapapu 4 .
Mvura yemakore mashanu yemapapu ekupona kwemapapu inongopfuura 17 muzana.
Kana mutanho wemapapu unowanikwa mumatanho ekutanga, kupona kwakakwirira.
Mamwe maitiro ekuongororwa akave akaongororwa kusvika nhasi, akadai sebhokisi x-rays uye sputum cytology , haana kuwanikwa kuti aderedze kufa.
Kanza yemaperembudzi ndiyo inokonzera rufu rwekenza kune varume nevakadzi muUnited States. Inouraya pedyo nevakadzi vakawanda sekenza yemvere.
Munguva pfupi yapfuura yakawanikwawo kuti vamwe vanoputa vane LDCT kuongorora vanogona kuregera kupfuura kana vasina kuedza kuitwa. Kunyangwe ichinge ichangotanga kutaura, ruzivo rwezvimwe zvirwere zvinokonzerwa nekuputa rinoratidza kuti, sekuwedzerwa kweperiki, kuongorora kenza yemapapu kunogona kuderedza ngozi yepfungwa yemwoyo, COPD, nezvimwewo.

Pakati peMederal vanobhadhara, inofungidzirwa kuti gore negore LDCT kuongorora kunogona kudarika kaviri peresenti yematanho epakutanga emapapu emapapu ekuongorora. (Sekuenzanisa nokukurumidza, makore mashanu ekupona kwechikwata chetachiona chechina chekenza yemapapu emapapu ari 60 kusvika ku80 muzana. Panzvimbo 2 ndeyo 40 kusvika ku50 muzana. Kune chikamu chechina chiri pasi pe5 kubva muzana.) Zvinofungidzirwa kuti kuongorora uku kwaizoratidza makumi mashanu emakirini emapapu emapapiro pagore (32,000 panguva yekutanga.)
Kana kuongororwa kwekutsvaga kwakagadziriswa pakarepo, uye kana munhu wese anogarisana nemitemo yekuongorora aizoongororwa, vanhu vane zviuru zvine gumi nezviviri vanogona kuchengetedzwa gore negore.

Zvimwe Zvinetso Zvinosanganiswa neChechi

Chero chero upiedzo wokuongorora unouya nemamwe matambudziko. Vazhinji venyu vanogona kunge muchiziva nezveumwe munhu aive nekutya pamusana pemhuka - kungonzwa kuti zvaingova zvinotyisa. Zvimwe zvematambudziko ane chirwere chekenza yemapapu zvinogona kusanganisira:

Nhema dzenhema
Nhema dzisina kururama
Overdiagnosis
Kupisa mazaisai kunowedzera

Ndivanaani Rinovhenekera Kuongorora Kurapa Kufukidzwa?

IUnited States Preventive Task Force (USPSTF) yakurudzira chirwere chemapapu chemapapu senzira yeBanga B. Pasi pe Affordable Care Act (ACA) vadziviriri vega vega vanodikanwa kuvhara maitiro ekuongorora maitiro neBanga B kana kupfuura (ona pasi apa). Izvi zvinobudirira munaJanuary 2015. Kuongorora kunovharwa neDhipatimendi reMagetsi, Dhipatimendi reVeteran Affairs (tichionga, seveterans vane ngozi yakakwirira yekenza yemapapu,) nevamwe.

Ko Zvakadini Nemishonga?

MunaMuvhuro, Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) yakasarudza kupikisa kuvhara kwekenza yemapapu yeLDCT yevashandi - mune mamwe mashoko, haina kuvharwa se "zvinodiwa mune zvehutano" pasina mari. Chikonzero ndechekuti ivo havasi kuvimba kuti zvikomborero zvichapfuura zvinotambudza munharaunda ino. Kusiyana nevatsigiri vega vega, Medicare zvakabatsiri hazvifukidzwi pasi peCountable Care Act . Chisarudzo chokupedzisira hachizoitwa kusvikira munaFebruary 2015.

Ndiani ari Mukutsigira Lung Cancer Screening?

Kuongorora kwakakurumidza kweWebhu kunoona masangano anotevera kutsigira kenza yemapapu yekuongorora (inopesana neChirwere chekuita :)

IAmerican Medical Association (AMA)
The American College of Radiology (ACR)
The Lung Cancer Alliance (LCA) - LCA yakatumira chikumbiro cheNational Coverage Determination for lung cancer screening.
IUnited States Preventive Services Task Force (USPSTF)
The American Society of Clinical Oncology
IAmerican Cancer Society (ACS)
The Society of Thoracic Surgeons (STS)
VaSeneteri vazhinji neVamiririri vehurumende

Ndiani Asingatsigiri Lung Cancer Screening

Kubva munaOctober 2016, American Academy of Family Practice inotaura kuti kune uchapupu hunokwana hwekutonga kana kurwisana nekuongorora.

Arguments / Counterarguments inotsigira Kurapa Kanza Kuongorora - Kuenzanisa Maapulo kuAples

Zviratidzo-zvakagadzirwa nemishonga . Kuongorora kenza yemaronda kwakaratidzwa kuburikidza mishonga inopupurirwa neuchapupu kuponesa upenyu. Kuongorora kwemazuva ano kunotaura kuti kuongorora kenza yebonde hakuiti. Imwe ipurojekiti yePlastic One yakagadziriswa yakawana kuti kuongorora mammogram kunokonzerwa nekufa kwevakadzi vane makore makumi mashanu kusvika ku69, uye zvisingabatsiri zvinokonzerwa nevakadzi vanopfuura makore makumi manomwe. Kuongorora kenza yemaronda kunotarisirwa kuve nechepamusoro kwepabonde rekenza yemapapu kune avo vari mu Medicare age group. Pasinei neizvi, Medicare inobhadhara mammograms asi haibhadhara mutero wekenza yemapapu.
Nhaurirano dzeMari - Mari yekuvhara muchengeti wemapapu kuongororwa kweVagari veMedare inokosha, asi inoshandura kusvika inenge $ 3 pamwedzi kune mumwe munhu anowana rubatsiro. Mari inoshandiswa nekenza yepachifu yevashandi veMedare inotsanangurira kusvika madhora 2.50 pamwedzi. Cherechedza kuti $ 3 pamwedzi wekenza yemapapu emapapu inosanganisira kuitevera (somuenzaniso kutsvaga zviratidzo zvenhema,) asi $ 2.50 pamwedzi nokuda kwekuongororwa kwekenza yemazamu haisanganisi kuedza kutevera uye nzira. Kutarisa kune dzimwe nhamba mune zvimwe zvidzidzo, zvaifungidzirwa kuti zvinodhura Medicare $ 2 bhiriyoni pagore kupa chirwere chemapapu emapapu ne 1.08 kusvika 1.36 mabhiriyoni kumammograms. Funga kuti vose vakadzi nevakadzi vanogona kubatsirwa kubva pamapapu emapapu, asi nguva yakawanda nguva chete vakadzi vanogamuchira mammograms. Handizopindi mune mari yekurapa. Kuongorora, zvechokwadi, kwaizowedzera kuwanda kwemapapu emapapu emapapu nekuda kwekuwedzera kwekutanga-gadziriro yekuongororwa, uye zvechokwadi, zvinodhura kuvhara mari yekuchengetedza kenza uye kutevera kupfuura rufu. Tinogona kuverenga mari yekurapa uku kwemapapu emapapu ekutanga mapepa nematambudziko ekupedzisira-epakati yemapapu emapapu emapapu uye kuguma kwehupenyu, asi ndinoda kuenda kwete ikoko. Kubva pamubhedha wechipfuva, hapana kuenzanisa. Hongu, ndakaona kurwadziwa sokunge vanhu vanorapwa kubva pakuberekwa, asi inofananidzwa nekuenzanisa nekuguma kwehupenyu nemapfupa emapfupa uye kupfupika-kwe-kufema.
Nharo yekufunga nezvekusvuta kusvuta . Hongu, izvi zvinokosha, zvisinei, hazvingabatsiri avo vanofanirwa kuongorora avo vakasiya mumakore gumi apfuura. Zvinonakidza zvakare kutarisa, kuti sezvakataurwa pamusoro apa, kuongorora kunovandudza kuwandisa kwekusvuta kusvuta kune vamwe vanhu (uye zvakanyatsogadziriswa maererano nenhamba pane zvirongwa uye rubatsiro isu tiripo.) Asi zvakakosha - kana tichizobata avo vari pangozi yemukenza yemapapu zvakaenzana kune avo vari pangozi yeimwe mhando dzekenza tinoda kuita chimwe chezvinhu zviviri. Chero Medicare inofanira kuvhara LDCT kuongorora kwekenza yemapapu, kana kushandisa nzira imwechete yekusarura kune vanhu vari pangozi yeimwe nzira dzekenza kuongorora. Somuenzaniso, kana Medicare inofarira kubhadhara kusvuta kusvuta panzvimbo yekuongorora mishonga yemapapu, zvinonzwisisika zvinotevera kuti inofanira kubhadhara kudzidzisa vakadzi kusamwisa vana vavo, panzvimbo yekubhadhara mammograms. Inogonawo kutevera kuti Medicare inofanira kuisa pfungwa pakukurudzira maitiro pane kuvhara colonoscopies sekenza yemaronda inobatanidza nehupenyu hwekugara mune dzimwe nguva. (Hungu, ndiri kutarisana, asi zvakakosha kuramba ndichienzanisa maapuro nemaapuro, uye chisarudzo ichi chinondifungira kuti kunyadziswa kwemapapu emapapu kunogona kuita basa mukusarudza.) Munyika yake nhoroondo yegore rino rimwe remari yangu vana vakabvunzwa mubvunzo uyu. "Ndeipi nzvimbo yakaipisisa yokuva muranda?" Mhinduro yacho yaiva muCaribbean, nokuti pachinzvimbo chokudyisa nekutarisira muranda, zvakanga zvisingadhuri "kumushandisa" uye kutenga imwe. Nechimwe chikonzero, pfungwa iyi yakaramba ichiuya mupfungwa pandakavhura nharo iyi.
Mafungiro enhema - Hungu, kuongorora kwekenza yemapapu kunokonzera zviratidzo zvenhema. Saizvozvowo kuongorora kenza yepazamu. Mafungiro enhema ave akaonekwa muvanhu vanosvika makumi maviri ne25 kubva muzana vari kutarisana nekenza yemapapu ekuongorora, vachida zvimwe zvikwangwani uye dzimwe nguva zvinopesana nemitemo. Pamakirwere akatevera nemammograms gore negore kwemakore gumi, chiitiko chezvipo zvenhema chaive 50 kusvika ku60%. Uyezve, vevane 90 000 vakatevera makore 25 vane mammogram kuongorora, 22% vakanga vasingagoni kuonekwa kana kurapwa nehutano husingadikanwi. Asi mammography inobatsira yakavharidzirwa pasi peMedare, asi chirwere chemupapu kuongorora hakusi sezvinofungidzirwa kuti zvinokuvadza (nhema dzenhema, kuongororwa kwepamusoro) zvinogona kupfuura zvakakosha (20% inowedzera huwandu hwekupona.) MedCAC inofungidzira kuti inofanira kurwisana nekumanikidzwa yepiniki kana vaizobata maapuro seapuro uye vachiramba kuvhara mammograms nekuda kwehutano hwemapenzi echokwadi?
Kupisa mazaisai emhepo - Takadzidza kuti kusvibiswa kwehutano hwemishonga hakusi pasina njodzi.
USPSTF Bhuku B - United States Preventive Task Force nyaya "makirasi" anotarisa kubatsirwa nekupa rubatsiro kuvarwere. Bhuku B rinoreva kuti USPSTF inokurudzira basa nokuti kune chokwadi chakasimba chokuti mari yekubhadhara mari inonyorera kana kuti kune kuvimbika kwakakwana kwekuti mari inobatsira inowedzera kuwedzera. Nekenza yekenza yemapapu, kuongorora kweLDCT kunowanikwa seBanga B yevarwere vakakodzera sekukurukurwa pamusoro apa. Chirwere chepabonde kuongorora kuburikidza nemammography chinonziwo Bhuku B revakadzi vose makore 1 kusvika 2 mushure memakore makumi mana.
Kupopotedzana pamusoro pezvatakadzidza kubva pakuongorora kwekenza yeprostate - Imwe nharo paWebhu ndeyokuti tinofanira kungwarira nezvekenza yemapapu ekuongorora uye kushandisa muenzaniso wekenza yekenza yeprotate semuenzaniso. Kwemakore, varume vave vakakurudzirwa kuva nekenza yeprostate kuongorora, uye kuongorora kwePSA kwakava shoko remhuri. Kubvunzurudzwa kweCochrane kweongororo dzakawanda kwave kuwana kuti kenza yekenza yeprotate haisi kuderedza kenza yeprotate-inofanirwa kufa (kufa) kana kufanana kwevanhu vose. Mukuwedzera, kukuvadza (kubva pakuziva zvakanyanya uye kunyanya kuwedzerwa) kwakarongwa sechinhu chakajairika uye chakanaka. Makore mashanu ekupukunyuka kwekenza yeprostate ndeye 99%. Iko kuenzanisa maapuro nemaapuro here?
Varwere vane savvy . Mukutaura kuti havasi nechokwadi chokuti zvikomborero zvinowedzera njodzi muhuwandu huno, Medicare iri kuramba varwere kodzero yekuita zvisarudzo zvakadzika ivo pachavo - zvisarudzo zvinowanzoitwa nekubatsirwa nachiremba anogonawo kubatsira varwere vane chido chekutanga kuongorora kuyera kuisa njodzi uye kubatsirwa kwehutano hwavo uye mamiriro ezvinhu. Vanhu vanofanirwa kuita izvi zvisarudzo zuva rega-zvimwe zvingakosha zvikuru kune hupenyu hwakanaka, zvakadai sekuva nematairi akanaka emotokari yako.
Varombo vachawana varombo (kana kufa) uye vapfumi vachawana vapfumi (kana kurarama). Mutengo wekuongorora screen CT unosiyana, asi kazhinji uri mu $ 350. Vamwe vanhu paMedare vanogona kukwanisa kubhadhara mari iyi, asi vamwe vasingagoni. Zvidzidzo zvakawana kuti vanhu havakwanisi kutsvaga kuongororwa kuongororwa kwekurumidza kuziva chirwere apo pavanofanira kuribhadhara kubva muhomwe, uye kunyanya kana mari inoda kuti vatarise chimwe chinhu, somuenzaniso, zvokudya.
Kururamisira. Zvingaita sekusaruramisira kwakavakirwa pamashoko akataurwa pamusoro apa, kuti avo vari panjodzi yekenza yemapapu havasi kurapwa zvakaenzana. Sezvo Martin Luther King akamboti, " Kusaruramisira kupi zvako kunotyisa kururamisiro kwose kwose ." Ndezvipi zvimwe zvinotyisa zvinowedzera mukuchengetedza utano hwevagari vedu?

Kuinyorera Iyo Kumusoro uye Maitiro Anotevera

Kana iwe kana munhu waunoda akawana mvumo yekuenzaniswa kwekenza yemapapu, kune tariro. Medicare haisati yaita chisarudzo chokupedzisira pamusoro pekugovera. Kana iwe uine pfufisi yekuwedzera yunivhesiti (kana uri mhare, pakati pevamwe bhizimisi) iwe uri muhombe. Sezvakataurwa pamusoro peNotengeswa Care Care Act inoda kuti izvi zvinyorwa zvifukidzwe. Zvisarudzo kana iwe usina pfuti yekuwedzera inosanganisira kuzvipira kwechiyero. Kunyange zvazvo Medicare haisi ikozvino kuongorora kanzera yemapapu, iwe une kodzero yekuti muedzo uite uye iwe uripe iwe pachako. Kana kenza yemapapu inowanikwa apo iwe uchizvibhadhara kuti uongorore kuongorora, Medicare ichazodiwa kubhadhara kutarisira kwako.

> Sources

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