Zokambirana ndi Kuletsa Kuyezetsa Khansa Kwambiri
Ngati mwakhala mukuyang'ana nkhaniyi zaka zingapo zapitazo, mwinamwake munamvapo zokambirana za khansara zamapapo. Mutuwu poyamba unali ngati Medicare iyenera kuyang'ana kufotokoza khansa ya mapapu ya m'mapapo mwa iwo omwe anakumana ndi ndondomeko yoyenera. Mu February wa 2015, chigamulochi chinasinthidwa monga Medicare tsopano ikukhudzana ndi kuyesedwa. Chifukwa cha zifukwazo chinali kupeza - mufukufuku waukulu wa zachipatala wotchedwa National Lung Cancer Screening Trial - kuyeza kochepa kwa CT (LDCT) kungathe kuchepetsa kufala kwa khansa ya mapapo ndi 20 peresenti, kapena nzika 18,000 za US chaka chilichonse.
Zingawoneke bwino, komabe kafukufuku wa 2016 anapeza kuti osachepera theka la madokotala a m'banja adavomereza kuti kuyesa kansa ya m'mapapo ndi nzeru yabwino ndipo ambiri sadziwa zoyenera. Kuonjezera apo, ambiri mwa madokotalawa akupitiriza kulamulira chifuwa-mazira ngati kuyesa kansa ya m'mapapo. Izi, zowonjezera, zachititsa funso lodziwika:
"Chifukwa chiyani dokotala wanga sadzalandire mayeso omwe angapulumutse moyo wanga?"
Kodi ndi zifukwa zotani zowunikira khansa yamapapo, ndi mabungwe ati omwe amachirikiza mfundozi? Tiyeni tiyang'ane pa malo awa ndi kuyerekeza kansa ya mapapo m'mapapo kuyesera koyezetsa khansa pakali pano.
* Medicare tsopano ili ndi kansa ya m'mapapo yowononga mapapo kwa anthu a zaka zapakati pa 55 ndi 77, omwe akupitiriza kusuta kapena kusiya zaka 15 zapitazi, ndipo akusuta kwa zaka zosachepera 30. Kuwunika kumafuna siginecha ya dokotala (kapena osakhala dokotala yemwe akuyenerera) ndipo amafuna kuti munthu yemwe adzayang'anidwe akukumana ndi dokotala kuti apereke uphungu kuti atenge nawo mbali yoyendera kupanga chisankho asanayambe kulembedwa.
Kodi Ndani Amapindula ndi Kuyezetsa Khansa Kwambiri?
Pambuyo pa zaka zambiri popanda kuyesa kuyesa kansalu yamapapo, kanema ya National Lung Cancer Screening (NLST) inapeza kuti kuyesa kwa CT (LDCT) kochepa kungapulumutse miyoyo pakati pa anthu omwe amakwaniritsa zofunikira zina. Kwa anthu omwe amakumana ndi izi, kuwonetseratu kwa chaka cha LDCT kungachepetse imfa ya khansa ya mapapo ndi 20 peresenti - nambala yomwe imamasulira zikwi zikwi za Amwenye chaka chilichonse.
Malinga ndi zotsatira zafukufuku United States Preventive Task Force (USPSTF) yakulimbikitsani kuyang'ana:
- Akuluakulu a zaka zapakati pa 55 ndi 80 omwe ali ndi mbiri ya zaka 30 za kusuta, komanso
- Pitirizani kusuta kapena kusiya kusuta fodya m'zaka 15 zapitazo
Kuwonetsetsa kungakhale koyenera kwa anthu ena, monga omwe apezeka ndi asibesitosi, mbiri ya chifuwa chachikulu, radon exposure , BRCA2 kusintha kwa majini , ndi zina.
Zifukwa Zokhalira Osangalala Pa LDCT Lungwe Khansa Kuyeza
- Pakalipano, osachepera 40 peresenti ya anthu omwe ali ndi khansara yamapapu amapezeka ngati matendawa ayamba kale mpaka khansa ya m'mapapo 4 .
- Mpaka wa zaka zisanu zapakati pa khansa ya mapapu ndifupi ndi 17 peresenti.
- Khansara yamapapu imapezeka m'mayambiriro oyambirira, kupulumuka ndikokwanira.
- Mitundu ina yowunikira yomwe yapimidwa mpaka pano, monga chifuwa x-ray ndi sputum cytology , sinapezeke kuchepetsa imfa.
- Khansara ya m'magazi ndiyo yomwe imayambitsa matenda a khansa kwa amuna ndi akazi ku United States. Imapha amayi pafupifupi kawiri kuposa khansa ya m'mawere.
- Posachedwa zapezeka kuti anthu osuta fodya omwe ali ndi kuwonetsetsa kwa LDCT amatha kusiya kusiyana ndi ngati alibe chiyeso. Ngakhale kuti ndi koyambirira kwambiri kuti anene, kudziŵa matenda ena omwe amayamba chifukwa cha kusuta kumasonyeza kuti, monga kuwonjezeka kwa mapaipi, kuyezetsa kansa ya m'mapapo kungachepetse chiopsezo cha matenda a mtima, COPD, ndi zina zambiri.
- Pakati pa a Medicare opindula, akuganiza kuti kuyeza kwa LDCT chaka ndi chaka kungapangitse kawiri kawiri peresenti ya matenda a khansa ya m'mapapo. Phunziro 2 ndilo 40 mpaka 50 peresenti. Pakati pa 4yi ndi zosakwana 5 peresenti.) Zimaganiziridwa kuti kuyang'ana uku kudzazindikiritsa khansa zamapapo 54,000 pachaka (32,000 kumayambiriro.)
- Ngati ndondomeko yoyang'anira idachitidwa mwamsanga, ndipo ngati aliyense amene ali ndi zifukwa zoyenera kufufuza, angapulumutsidwe miyezi 18,000 chaka chilichonse.
Mavuto Ogwirizana ndi Kuwunika
Kuyesedwa kulikonse kumabwera ndi mavuto ena. Ambiri mwa inu mumadziwa za wina yemwe adawopsyeza pamimba - kuti amve kuti ndizoopsa. Zina mwa mavuto omwe ali ndi kuyang'anitsitsa khansa yamapapu ingaphatikizepo:
- Zolakwika zabodza
- Zolakwika zabodza
- Kugonjetsa matenda
- Kutuluka kwa mazira
Kodi Kuyeza Khansa Kwambiri Kumaphimbidwa?
Gulu la United States Preventive Task Force (USPSTF) yalimbikitsa kanema ya mapapu monga maphunziro a Gulu la B. Pansi pa inshuwalansi yodalirika ya Affordable Care Act (ACA) amayenera kutseka njira zowunikira pogwiritsa ntchito Gulu B kapena apamwamba (onani m'munsimu). Izi zikugwira ntchito bwino mu Januari 2015. Kuwunika kumayang'aniridwa ndi Dipatimenti ya Mphamvu, Dipatimenti ya Veteran Affairs (zikondwerero, ngati achikulire ali ndi chiopsezo chachikulu cha khansa ya m'mapapo,) ndi ena.
Nanga Bwanji za Medicare?
Mu April, Komiti Yowunikira Bungwe la Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) inavomereza motsutsana ndi kuyang'anira khansa ya m'magazi ya LDCT kwa opindula - mwa kuyankhula kwina, siyikudziwika ngati "zofunika phindu la thanzi" popanda mtengo. Chifukwa chake n'chakuti iwo sakhulupirira kuti madalitso adzapitirira mavutowa. Mosiyana ndi a inshuwalansi, Medicare madalitso sali pansi pa Affordable Care Act . Chisankho chomaliza sichingapangidwe mpaka February 2015.
Ndani ali mu Support of Screening Lung Cancer Screening?
Kupenda mofulumira kwa Webusaiti imapeza mabungwe otsatirawa kuthandizira kuwunika khansa yamapapo (akutsutsana ndi chisankho cha Medicare :)
- American Medical Association (AMA)
- American College of Radiology (ACR)
- Lung Cancer Alliance (LCA) - LCA yatumiza pempho la National Detection Determination for screening cancer.
- Gulu la United States Preventive Services Task Force (USPSTF)
- American Society of Clinical Oncology
- American Cancer Society (ACS)
- Sosaite ya Thoracic Surgeons (STS)
- Asenema ambiri ndi Oimira boma
Amene Sagwirizane ndi Kuyezetsa Khansa Kwambiri
Pofika mu mwezi wa Oktoba wa 2016, American Academy of Family Practice inati pali umboni wosatsutsika wolamulira kapena kutsutsana.
Zokambirana / Zotsutsana Zothandizira Kuyezetsa Khansa Kwambiri - Kuyerekezera Maapulo ndi Maapulo
- Mankhwala othandizira umboni . Kuwonetsetsa khansa ya m'magazi yasonyezedwa kupyolera mankhwala othandizira kuti apulumutse miyoyo. Kafukufuku waposachedwapa akuti kuwonetsetsa khansa ya m'mawere sikuchita. Phunziro laposachedwapa la PLos One linapeza kuti kuyang'ana mafinya kumakhudza kwambiri amayi omwe ali ndi zaka zapakati pa 50 ndi 69, komanso zotsatira zosafunika kwenikweni kwa amayi oposa zaka 70. Kuyezetsa khansa ya m'magazi kumayembekezereka kufa kwa khansa ya m'mapapo mwa iwo Medicare zaka gulu. Ngakhale izi, Medicare imalipira ndalama zambiri koma sizimalipira kansa ya m'mapapo.
- Mavuto a Ndalama - Mtengo wophimba kansa ya m'mapapo kwa odwala omwe amawapatsa mankhwala ndiwowonjezera, koma amatanthawuza pafupifupi $ 3 pamwezi pa wothandizira. Phindu la kuyang'anitsitsa khansa ya m'mawere kwa odwala omwe amagwiritsa ntchito mankhwala amatanthawuza pafupifupi madola 2.50 pamwezi. Onani kuti $ 3 pamwezi poyezetsa khansa yamapapo imaphatikizapo kutsata (mwachitsanzo kufunafuna chinyengo), koma $ 2.50 pamwezi pa kuyang'anitsitsa khansa ya m'mawere sikuphatikizapo kuyesa ndikutsata njira. Poyang'ana chiwerengero china mu maphunziro ena, ankaganiza kuti ayenera kutenga Medicare $ 2 biliyoni pachaka kuti apereke kansa ya m'mapapo ndi 1.08 mpaka 1,36 biliyoni chifukwa cha mammograms. Ganizirani kuti abambo ndi abambo omwe amapindula nawo angapindule ndi kuyang'ana mapapu, koma nthawi zambiri amai okha amalandira mammograms. Sindidzapita ku mtengo wamachiritso. Kuwunika, ndithudi, kudzawonjezera chiwerengero cha opaleshoni ya khansa ya m'mapapo chifukwa cha kuwonjezereka kwa matenda oyambirira, ndipo ndithudi, ndiza mtengo wapatali kukwaniritsa ndalama za kupulumutsidwa ndi khansa ndi kutsata kuposa imfa. Titha kuyeza mtengo wa mankhwalawa ndi khansa ya m'mapapo oyambirira ndi zofunikira za kusamalira khansa ya m'mapapo ndi mapeto a moyo, komabe sindifuna kupita kumeneko. Kuchokera pambali pa bedi, palibe kusiyana. Inde, ndawonapo ululu pamene anthu amachira kuchokera ku opaleshoni, koma zimakhala zosiyana poyerekezera ndi ululu wa moyo wamphongo ndi mitsempha ya fupa ndi mpweya wochepa.
- Kutsutsana kuganizira za kusuta fodya . Inde, izi ndi zofunikira, komabe, sizingathandize omwe akufunsidwa kuti ayese kufufuza omwe adasiya zaka 15 zapitazo. Ndizosangalatsanso kuti, monga tawonera pamwambapa, kufufuza kumawonjezera kuchuluka kwa kusuta fodya mwa anthu ena (komanso mogwira mtima mowerengera kusiyana ndi mapulogalamu ndi zithandizo zomwe tili nazo.) Koma chofunika kwambiri - ngati tifuna kuthandiza anthu omwe ali pangozi wa khansa ya m'mapapo mofanana kwa iwo omwe ali pangozi ya mitundu ina ya khansa ife tikuyenera kuchita chimodzi mwa zinthu ziwiri. Kaya Medicare iyenera kuika chithunzi cha LDCT pa kansa ya m'mapapo, kapena kugwiritsa ntchito njira yomweyi ya tsankho kwa anthu omwe ali pangozi ya mitundu ina ya kansa ya kansa. Mwachitsanzo, ngati Medicare ikufuna kulipira kusuta fodya mmalo mwa kuyang'anitsitsa khansa ya m'mapapo, zimatsatira kuti ziyenera kulipilira kuti aphunzitse amayi kuyamwitsa ana awo, osati kulipira mamemogram. Ikutsatiraninso kuti Medicare iyenera kuganizira zolimbikitsa zolimbitsa thupi m'malo mophimba colonoscopies ngati khansara yamtunduwu imakhudzana ndi moyo wokhala ndi moyo wokhazikika nthawi zina. (Inde, ndikukumana ndi mavuto, koma nkofunika kuti ndipitirize kuyerekeza maapulo ndi maapulo, ndipo chisankho ichi chikundikhudza ine kuti kunyada kwa khansara yamapapu ikhoza kuthandizira pa chisankho.) M'kalasi lake la mbiri yakale chaka chino chimodzi mwa ana anafunsidwa funso ili. "Kodi malo oyenera kukhala akapolo ndi ati?" Yankho lake linali ku Caribbean, chifukwa mmalo modyetsa ndi kusamalira kapolo, kunali kosavuta kuti "mumugwiritse ntchito" ndikugula wina. Mwachifukwa china, malingalirowa adakumbukirabe pamene ndinayambitsa ndemanga iyi.
- Ziphuphu zenizeni - Inde, kuyang'ana khansa ya m'mapapo kumabweretsa chinyengo. Chimodzimodzinso kufufuza khansa ya m'mawere. Ziphuphu zakhala zikudziwika kuti ndi anthu 25% omwe akudwala kansa ya mapapu, omwe amafuna kuwunikira komanso nthawi zina zowonongeka. Odwala amatsatiridwa ndi zaka zapakati pa zaka khumi, chiwerengero cha zonyenga chinali 50 mpaka 60%. Kuonjezera apo, odwala 90,000 adatsatiridwa zaka makumi awiri ndi zisanu ndi makumi awiri ndi makumi awiri ndi makumi asanu ndi awiri (25%) ndi kuyang'anitsitsa kwa mammogram, 22% sanadziwidwe kapena kupatsidwa chithandizo chosafunikira. Komabe mammography ndi phindu lopindulira pansi pa Medicare, koma kuyang'anitsitsa khansa ya m'mapapo siyomwe amaganiza kuti kuvulaza (chinyengo, kupatsirana kwa matenda) kungapindule kwambiri (kupitirira 20 peresenti ya kuchuluka kwa moyo.) MEDCAC ikuyembekeza kuti idzayenera kuthana ndi kuponderezedwa a pinki ngati amayenera kuchitira maapulo monga maapulo ndikukana kuphimba mamemogmams chifukwa cha chiopsezo cha chinyengo?
- Kuwopsa kwa mafunde - Taphunzira kuti kuyang'ana kwa mankhwala ochizira matenda sikuti kulibe zoopsa.
- USPSTF Bulu B - Bungwe la United States Preventive Task Force "masewera" omwe amayang'ana phindu la kupereka thandizo kwa odwala. Kalasi B imatanthauza kuti USPSTF imalimbikitsa utumiki chifukwa pali chitsimikizo chokwanira kuti phindu lopindula ndilokhazikika kapena kuti pali chitsimikizo chotsimikizika kuti phindu lachindunji ndilokhazikika kwambiri. Kuwonetsa kansa ya m'mapapo, kuyang'ana kwa LDCT kumayikidwa mu Bulu la odwala oyenera monga momwe tafotokozera pamwambapa. Kuyezetsa khansa ya m'mimba pogwiritsa ntchito mammography kumatchedwanso Gawo B la akazi kuyambira zaka 1 mpaka 2 patatha zaka 40.
- Kukangana pa zomwe taphunzira ku kuyang'ana khansa ya prostate - Kukangana kwinanso pa webusaiti ndikuti tiyenera kusamala ndi kuyang'ana khansa yamapapo ndi kugwiritsa ntchito chitsanzo cha kanema ya prostate monga chitsanzo. Kwa zaka zambiri, amuna adalimbikitsidwa kukhala ndi kansa ya prostate, ndipo mayeso a PSA akhala mawu apakhomo. Kufufuza kwa Cochrane kafukufuku wambiri tsopano wapeza kuti kanema ya prostate siimachepetsa kufala kwa khansa ya prostate (imfa) kapena imfa yonse. Kuonjezerapo, kuvulazidwa (kuchoka ku matenda opatsirana ndi kupitirira muyeso) kunkawerengedwa ngati wamba komanso wochepa. Kachilombo ka khansa ya prostate ya zaka 5 ndi 99%. Kodi izi zikuyerekeza maapulo ndi maapulo?
- Odwala ndi savvy . Ponena kuti sakudziwa kuti madalitso omwe amaposa chiopsezo cha anthuwa, Medicare akutsutsa odwala ufulu wopanga zosankha zawo zokha - zisankho zomwe zimapangidwa mothandizidwa ndi dokotala yemwe angathe kuthandiza odwala omwe akufunitsitsa kuyamba kuyang'ana onetsetsani kuopsa ndi phindu la umoyo wawo ndi mkhalidwe wawo. Anthu amafunika kupanga zosankhazo tsiku ndi tsiku - zina zomwe zingakhale zofunika kwambiri kwa moyo wathanzi, monga kukhala ndi matayala abwino a galimoto yanu.
- Osauka adzasauka (kapena kufa) ndipo olemera adzakhala olemera (kapena amakhala). Mtengo wowonetsera kanjira ka CT kumasiyana, koma kawirikawiri muli $ 350. Anthu ena pa Medicare amatha kudzipiritsa okha, koma ena sangathe. Kafukufuku apeza kuti anthu sangafune kufufuza mayeso kuti adziwe matenda oyambirira pamene akuyenera kulipira m'thumba, makamaka makamaka ngati ndalamazo zimafuna kuti iwo apereke zina, monga chakudya.
- Justice. Zikuwoneka ngati kupanda chilungamo kotengedwa pazinthu zomwe tazitchula pamwambapa, kuti omwe ali pangozi ya khansa ya m'mapapo sakuchitidwa chimodzimodzi. Monga momwe Martin Luther King adanenera, " Kusalungama paliponse kuli ponseponse poopseza chilungamo kulikonse ." Ndiziopsezo ziti zomwe zimayang'anira chisamaliro cha nzika zathu?
Kuwukambirana nawo Pamwamba ndi Zotsatira Zotsatira
Ngati inu kapena wokondedwa wanu mukukumana ndi zoyenera zowunikira khansa ya m'mapapo, pali chiyembekezo. Medicare asanasankhe komaliza pa kufalitsa. Ngati muli ndi inshuwalansi yowonjezerapo (kapena ndi wachikulire, pakati pa ena a inshuwalansi) muli ndi mwayi. Monga taonera pamwamba pa Care Affableable Act amafuna kuti zojambulazo ziphimbidwe. Zosankha ngati mulibe ndalama zowonjezerapo zimaphatikizapo kudzipangira nokha. Ngakhale kuti Medicare sichikuyang'ana kansa ya m'mapapo, muli ndi ufulu kuti mayesero apangidwe ndi kulipira nokha. Ngati khansara yamapapu ingapezeke pamene mukudzipiritsa kuti muyesedwe, Medicare angafunikire kulipira.
> Zosowa
Maofesi a Medicare ndi Utumiki wa Boma. Kusankha kwa Kusankha kwa Kufufuza kwa Khansa Yam'mimba ndi Mphase Wochepa Wojambula Pamaso. Inapezeka pa 02/07/15. http://lungcancer.about.com/od/whatislungcancer/a/screeninglung.htm
Ersek, J., Eberth, J., McDonnell, K., Strayer, S., Sercy, E., Cartmell, K., ndi D. Friedman. Kudziwa, Malingaliro, ndi Kugwiritsa Ntchito Masewero Ochepa Omwe Amagwiritsidwa Ntchito Pojambula Khansa Yam'mimba Pakati pa Makolo a Banja. Khansa . 2016. 122 (15): 2324-31.
Gross, G. et al. Mtengo wa kuyang'anitsitsa khansa ya m'mawere m'magulu a Medicare. JAMA Internal Medicine . 2013. 173 (3): 220-6.
II, D., Neuberger, M., Diulbegovic, M., ndi P. Dahm. Kuyeza kansa ya prostate. Dongosolo la Cochrane la Zosintha Zogwirizana . 2013 Jan 31.
Irvin, V., ndi R. Kaplan. Kuchepetsa kufala kwa khansa ndi khansa ya m'mawere: meta-kusanthula maphunziro apamwamba. PLoS One . 2014 Jun 2.
Tammemagi, M. et al. Zotsatira za kuyang'ana khansa ya m'mapapo zimayambitsa kusuta fodya. Journal of National Cancer Institute . 2014. 106 (6): dju084.