| 牟思博,周昌明,王泽洲,等.健康检查中常见癌症早期漏检率的估计研究[J].中国肿瘤,2026,35(2):95-102. |
| 健康检查中常见癌症早期漏检率的估计研究 |
| An Estimation Study on Missed Detection Rate of Early-Stage Common Cancers in Health Examinations |
| 投稿时间：2025-10-30 |
| DOI：10.11735/j.issn.1004-0242.2026.02.A003 |
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| 中文关键词: 健康检查 癌症筛查 漏检率 等效早期检出比例 体检 |
| 英文关键词:health examination cancer screening missed detection rate equivalent early detection proportion medical examination |
| 基金项目:上海市2024年度“科技创新行动计划“科普专项（24DZ2300300）；上海市加强公共卫生体系建设三年行动计划（2023—2025年）优青项目（GWVI-11.2-YO37）；上海市公共卫生研究专项（2024年度）（2024GKM32）；复旦大学-中国人保健康管理研究院资助项目（RBZD202417）；上海申康医院发展中心市级医院诊疗技术推广及优化管理项目（SHDC22024239）；徐汇区院地合作项目（23XHYD-04） |
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| 中文摘要: |
| 摘 要：［目的］ 分析中国健康检查中常见癌症早期病例的早期漏检率，为提高体检的癌症筛查健康收益提供策略依据。［方法］ 基于健康检查覆盖率、人群癌症早期比例等公开数据，构建漏检过程模拟模型，采用贝叶斯检验理论，以健康检查率和预期早期检出比例为先验概率计算理论早期患者检出率，结合实际早期患者比例（后验概率）估算早期漏检率，并推导等效早期检出比例。［结果］ 健康检查率为30%、预期早期检出比例为90%时，5种常见癌症早期合计漏检率达47.9%；其中女性乳腺癌漏检率最低（15.4%），食管癌最高（57.4%），胃癌、结直肠癌、肺癌依次为49.2%、55.7%、56.4%。当健康检查率提升至40%（预期早期检出比例维持90%），合计漏检率进一步上升至59.2%；若健康检查率降至20%，合计漏检率则为27.7%。不同预期早期检出比例下，漏检率呈规律性变化：健康检查率为30%时，预期早期检出比例80%对应合计漏检率42.2%，70%对应35.1%。5种常见癌症等效早期检出比例合计为41.3%，其中女性乳腺癌（74.3%）显著高于其他癌种，食管癌（31.7%）、肺癌（32.7%）较低。［结论］ 健康检查中近半数可检出的癌症早期患者发生漏检，健康检查早期检出有效性不足是核心问题；在未提升检出有效性的前提下，单纯提高健康检查率会增加早期漏检数量，应将优化健康检查质量作为降低漏检率的关键抓手。 |
| 英文摘要: |
| Abstract：［Purpose］ To estimate the missed detection rate of early-stage common cancers in health examinations in China， and to provide evidence for improving the health benefits of cancer screening through physical examinations. ［Methods］ Based on public data such as health examination coverage and population-based early-stage cancer proportion， a model was constructed to simulate the missed detection process. Using Bayesian test theory， the theoretical early-stage detection rate was calculated with health examination rate and expected early detection proportion as prior probabilities， and the actual early-stage proportion as posterior probability to estimate the early missed detection rate. The equivalent early detection proportion was further derived. ［Results］ When the health examination rate was 30% and the expected early detection proportion was 90%， the aggregate missed detection rate of five common cancers was 47.9%； among them， female breast cancer had the lowest missed detection rate (15.4%)， esophageal cancer the highest (57.4%)， followed by gastric cancer (49.2%)， colorectal cancer (55.7%)， and lung cancer (56.4%). When the health examination rate increased to 40% (with the expected early detection proportion maintained at 90%)， the aggregate missed detection rate rose to 59.2%； when the health examination rate decreased to 20%， the aggregate missed detection rate was 27.7%. Under different expected early detection proportions， the missed detection rate showed a regular change： at a health examination rate of 30%， the aggregate missed detection rate was 42.2% corresponding to an expected early detection proportion of 80%， and 35.1% corresponding to 70%. According to the current health examination coverage (30.52%)， the aggregate equivalent early detection proportion of the five common cancers was 41.3%， among which female breast cancer (74.3%) was significantly higher than other cancer types， while esophageal cancer(31.7%) and lung cancer (32.7%) were the lowest. ［Conclusion］ Nearly half of the detectable early-stage cancer patients are missed in health examinations， and the insufficient effectiveness of early detection in health examinations is the core problem. Without improving the detection effectiveness， simply increasing the health examination rate will increase the number of early missed detections. Optimizing the quality of health examinations should be the key to reducing the missed detection rate. |
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