The physical examination helps early detection of diseases, so it is accepted by more and more citizens, however, gene sequencing claimed to foretell a hundred diseases, the physical examination package project name, non-medical needs trace element test casually checking ...... In the face of the chaotic phenomenon of the physical examination industry, how should we choose?
Chaos 1
Gene sequencing predicts a hundred diseases
99.99% genetic accuracy, a drop of blood to know the risk of a hundred diseases, can check more than 1,000 kinds of hereditary diseases ......On the Internet, gene sequencing was "blown" to almost omnipotent. "Almost omnipotent, not only can predict the disease, the amount of alcohol, whether there is early love, Internet addiction tendency, etc. also said can be predicted.
Recently, the reporter investigated and found that some organizations claimed that gene sequencing can "detect a hundred diseases" or even "cure a hundred diseases"; some organizations also said that gene sequencing can measure the "talent gene", and realize that the child's genetic predisposition is not only the result of the test, but also the result of the test, which is the most important thing for the child's health. Some organizations also said that gene sequencing can detect "natural genes" and realize "tailor-made education" for children. Under the guidance of this concept, individual hospitals carried out "advantageous talent gene test" and "disease susceptibility gene test" program.
Gene sequencing charges are also very confusing, some organizations to do a full gene sequencing about 380,000 yuan, claiming that more than 20,000 genes in the body can be scanned and arranged once, some of the "genetic testing" physical examination package price of 76,000 yuan, the price of a separate test of 68 genes 34,000 yuan, of course, there are also cheap! The price of the basic package of 125 genetic tests is only more than a thousand dollars.
It is understood that genetic sequencing is mainly for genetic disease examination, through genetic testing technology to make auxiliary diagnosis or genetic counseling, such as two deaf people get married, theoretically, through genetic sequencing, to predict their children's health or not. Alternatively, the incidence of disease can be predicted through genetic testing, such as when movie star Angelina Jolie underwent genetic sequencing and was told that she had a genetic defect that put her at a higher risk of developing breast and ovarian cancer. So she chose to have both breasts removed in the hope of minimizing the risk of breast cancer.
Wu Xueyan, chief physician of endocrinology at Peking Union Medical College (PUMC) Hospital, said there is no point in sequencing genes without targeting them, and genetic testing is not recommended as a routine medical checkup at this stage. At present, there are three main components of genetic examination, in addition to predicting the risk of genetic diseases, but also includes a clear diagnosis, guidance on medication, the latter two can be completed through fluorescence quantitative, microchip and other inspection methods. In addition to scientific research, gene sequencing services are also carried out for some cancer patients who need to use targeted therapeutic drugs to determine a more effective medication regimen. "People with a family history of tumors can undergo genetic sequencing to determine their risk of developing cancer and receive health management as a high-risk group. However, the proportion of genetic factors in all people who develop breast cancer is very low, and the proportion of cancers caused by genetic mutations is likewise very low, and it is not yet possible to accurately determine which of the people who present with the aforementioned genetic mutations will develop breast cancer."
Wang Zhong, vice president of Beijing Tsinghua Changgeng Hospital and head of the health management center, also said that congenital factors (genes) certainly exist in determining a person's life, ageing, sickness and death, but more factors lie in the external environment and acquired factors, such as living habits, physical effects of the environment, microbial effects and so on. Even if we consider genes alone, people with the same disease-causing genes need to be affected by other disease-causing factors in order to cause diseases. It does not seem to be objective enough to state that a person will get a certain disease just from a genetic test. Moreover, genes can only indicate the likelihood of developing a certain disease, often expressed as a percentage. This kind of expression often brings a lot of psychological pressure to the common people. Therefore, the role of genes in health management needs to be further explored.
Chaos 2
The more you check, the more you check
The 60-year-old Mr. Zhou, who lives in Beijing's Fengtai district, was living a less-than-healthy lifestyle, and didn't feel well without smoking and drinking every day. However, the time after retirement, his state has undergone a subversive change - only a few years to "send" away a few old colleagues, the heart is not a taste. Because he did not want to repeat the same mistake, Mr. Zhou began to undergo annual medical checkups, hoping to detect health problems in advance. However, he found that the physical examination program more and more. "I used to physical examination project is just dozens of items, now in the physical examination center staff introduction has increased to nearly 100 items, the price is also getting higher and higher, to nearly 10,000 yuan."
The reporter saw on the website of a well-known private medical check-up organization, the medical check-up organization for different consumers to launch more than ten kinds of packages, and its website prominently marked the first step of the medical check-up process for the experts to design the medical check-up program. Then the reporter contacted the physical examination center customer service, customer service simply asked the age, gender, whether smoking, etc., after the reporter recommended the price of more than 1,000 B package. And in another physical examination organization, the reporter also to the ordinary consumer identity consulting, customer service staff is also a simple inquiry after the reporter recommended a 3,000 yuan of physical examination package.
In a physical examination institution, the reporter also found a physical examination package price as high as 173,000 yuan, the physical examination covers a variety of fields such as clinical medicine, medical imaging, functional medicine, genetic medicine, etc., claiming that it can prevent ultra-early-stage cancers, screening twelve sudden death triggers, prevention and control of chronic diseases, "deciphering the body's genetic code, predicting the future health trends ". The package also claims to be able to assess the risk of 68 diseases in 9 major categories common to the human body (including oncological diseases, cardiovascular and cerebrovascular diseases, diabetes mellitus, liver diseases, susceptibility testing, renal diseases, hematologic disorders, immune-metabolic diseases, and psychophysiological disorders).
Wang Zhong reminded that many diseases do not have obvious manifestations in the early stages of their development, but abnormalities can be detected through appropriate physical examination programs. However, it's not always best to spend a lot of money or have a lot of programs. Medical checkups should be combined according to the age, occupation and family history of different people. For non-diseased people, it is recommended that they undergo a basic checkup once a year to check for hidden health problems; for those who have already been diagnosed with a disease, the checkups should be shortened to once every three to six months. For the non-disease population aged 18 to 35 years old, the general basic checkup package can be; 35-45-year-old people recommended in the basic checkup package, increase bone density, cardiovascular, tumor and other age-appropriate projects; 45-year-old people in addition to the basic checkups, focusing on the recommendation to increase diabetes and other chronic diseases, tumors, coronary heart disease, stroke screening, and so on.
Mess 3
Part of the routine physical examination project is unreliable
Relatively "high-end" genetic physical examination, the ordinary people are most often in contact with the routine physical examination, but recently a widely circulated "five of the most unreliable physical examination project "of the net post upset a lot of people's physical examination program. In this list, X-rays to check lung cancer, ultrasound to check prostate cancer, blood calcium detection of calcium deficiency in children, CT, infrared to check breast cancer, laboratory indicators to check stomach cancer and other physical examination projects are on the list.
X-ray screening for lung cancer is widely recognized as one of the more widely used and highest rate of missed diagnosis. Zhi Xiuyi, director of thoracic surgery at Xuanwu Hospital of Capital Medical University, introduced that because the resolution of chest X-ray is very low, and therefore the detection rate is also very low, and sometimes the check out may have already been advanced, so experts suggest using high-definition CT to check lung cancer with high resolution.
This is also a common approach in Europe and the United States, the detection rate of up to 90% or more, so it is recommended that middle-aged and elderly people or friends with a family history of lung cancer in the physical examination of X-rays to CT.
The physical examination of the abdominal ultrasound is often one of the men in their forties in the physical examination of the other called the "former color" -- the prostate ultrasound, which is the most important part of the examination. Zhang Zhichao, chief physician of Peking University First Hospital Men's Center, introduced that "before the color" can not detect early prostate cancer, there is no way to identify whether it is benign hyperplasia, or prostate cancer. Prostate ultrasound is more effective for patients with serious conditions, not useful for latent or early cancer, if only routine physical examination, can not do.
Zhang Zhichao introduced the prostate-specific antigen (PSA) program to detect prostate cancer is more reliable. PSA is inexpensive, can exclude false-positive problems (prostatitis, urinary tract infections can cause PSA values to rise), is the most convenient and sensitive method of early screening for prostate cancer specificity, when the level of PSA in the blood is more than the normal value (more than 4 ng / ml), then it is necessary to high alert, should promptly go to the hospital to see a specialist. "It's best for men over the age of fifty to have a physical examination to check their PSA every one, two or three years, because if it's prostate cancer, the value will be higher. Generally we are in the screening, the first time to come first to understand whether it is benign hyperplasia or malignant hyperplasia, is to check a PSA first, if the PSA is high, this time we need to do further examination, nuclear magnetic **** vibration is the first choice."
Blood test for calcium, especially children, through the blood to measure trace elements, to determine whether the lack of calcium, this item also has a lot of parents are particularly concerned. Is it reliable or not? Wang Yunfeng, chief physician of pediatrics at China-Japan Hospital, said that trace elements should not be used as a routine children's physical examination program, and its accuracy is not that high. After the results come out, you can't judge whether your child is deficient in zinc, calcium or iron on the basis of such a lab checklist. It is important to ask for a good medical history, because the calcium in the trace elements is the overall calcium, and if the child is really deficient in calcium, his free calcium should be deficient.
In addition, as early as 2013, the National Health Planning Commission has issued a "standardization of children's micronutrient clinical testing notice", clearly put forward "non-diagnostic needs, prohibit all kinds of medical institutions at all levels for children to carry out non-diagnostic needs of micronutrient testing. "
Wang Yunfeng said, for the trace element test as children's physical examination program are not recommended. Generally is the emergence of abnormal conditions to do, but only for reference. Only trace element test results can not judge health problems, but also need to be combined with feeding history, clinical symptoms and other aspects of a comprehensive assessment. In addition, personnel operation, testing methods, equipment and other objective factors can also lead to bias results, "such as testing hair, it actually reflects the growth of the first 3 months, can not be used as a current judgment."
CT and infrared screening for breast cancer have low sensitivity and low specificity. Wan Donggui, chief physician of Chinese and Western medicine combined oncology department of China-Japan Hospital, pointed out that when CT is used for breast cancer detection, there is a disadvantage of low sensitivity and low specificity to the breast. In addition, there are some places will use infrared light to detect the breast, this is also not recommended, because infrared detection is not an international standard, the machine's performance is poor, low sensitivity, error, and the doctor's subjective judgment is strong, now the big hospitals have not used this method to do the test.
Experts suggest that for early screening of breast cancer, it is first recommended to feel oneself, ultrasound, or through the mammogram to determine. Compared with breast CT, MRI is significantly better, but because it is more expensive (around 2,000 yuan), it is only recommended in high-risk groups (e.g., obese women with a family history of breast cancer and breast disease).
Laboratory tests to detect stomach cancer are less accurate. Laboratory test indicators, including red blood cell pressure, hemoglobin, fecal occult blood, gastric fluid condition and many other items, are often used to indicate the health of the stomach during a physical examination. Experts say these indicators are fine for initial screening of stomach diseases, but their accuracy is not up to par if used to screen for stomach cancer.
Experts suggest that gastroscopy is the most standardized and accurate, and is the first choice for screening and confirming the diagnosis of stomach cancer. However, gastroscopy is relatively expensive, painful and invasive, so if the result of the first gastroscopy is benign, it can be done once every 5 years thereafter; however, if the result of the physical examination reveals that the stomach has anisotropic hyperplasia (e.g., inflammation), atrophy, gastric ulcers, or patients with a family history of gastric cancer, it is preferable that the interval between physical examinations is 2-3 years in addition to treating these diseases.
Matters to be noted in medical checkups
The medical checkups should be "1+X"
"First-rate environment, second-rate personnel, third-rate service" is often used to describe some health checkups today, which is manifested as follows The lack of scientific explanation and individualized medical checkup package design suggestions before the medical checkup, the lack of unified and standardized professional service process and path, and the lack of health assessment and tracking management after the medical checkup, make the health checkup's "health output" greatly reduced.
The Chinese Medical Association Health Management Branch, Wu Liuxin pointed out that the current problems in China's health checkups is due to the lack of health checkups in China's norms. According to him, in August 2009, the Ministry of Health issued the "Interim Provisions on the Management of Health Checkups", but the accompanying "health checkups and implementation details of the basic project directory and process" has not been introduced, "no bylaws is the same as no operability.
So how do you choose a package for a medical checkup, and what should you pay attention to?
Zeng Qiang, director of the Institute of Health Management of the General Hospital of the People's Liberation Army, pointed out that China's physical examination of the "two ends" not enough to do, one is the questionnaire before the health checkup, as well as for different answers to the different medical checkup programs recommended; the second is the physical examination after the health management. Zeng Qiang told reporters that the health checkup should take "1 + X" mode, 1 is the basic physical examination project, but also the formation of health checkup report and personal health management files must be project, including health checkup self-test questionnaire, physical examination, involving blood, urine and stool routine checkups, otorhinolaryngology, dentistry, stomatology checkups, gynecology, electrocardiography, etc.. The "X" is for "X" and "X" is for "X". The "X" refers to the "special physical examination program", which is mainly for individuals of different ages, genders and risks of chronic diseases, to carry out special screening programs.
Wu Liuxin said consumers can refer to the May 2014 release of the "health checkup basic project expert *** knowledge" when choosing a physical examination package. According to reports, the **** Knowledge" specifies the mandatory and optional physical examination items. Among them, there are three major categories of mandatory items for physical examination: the first category is physical examination, like height, weight, waist circumference, hip circumference, blood pressure, medical and surgical examination, ophthalmology examination, etc.; the second category is laboratory examination, including blood routine, urine routine, stool routine, and other general examinations, but also includes biochemical examinations, such as liver function, renal function, blood lipids, blood glucose and other biochemical examinations, but also gynecological cytology examination; the third category is auxiliary examination, like electrocardiography, X-ray examination, ultrasound examination and so on. The third category is auxiliary examinations, like electrocardiogram, X-ray, ultrasonography, etc. The health checkup self-test questionnaire is also identified as a mandatory item in the ****Knowledge.
Wang Zhong also said that an effective physical examination should generally be based on age, gender, living habits, personal past health status and family history of genetic disorders, recent developments, lifestyle and other comprehensive factors to consider, choose a menu of physical examination items more suitable for me. Special circumstances can be appropriate to increase the project, in order to get a more comprehensive health information.
Wang Zhong also reminded that we should pay attention to the following three points when choosing the experience institutions
First of all, the qualification of the physical examination center must be excellent, the institution of the physical examination of personnel to be professional, medical staff to have a certificate of practice, to have many years of experience in medicine; equipment not only to be advanced, but also to be audited annually to ensure that the physical examination data is accurate and true.
Secondly, perfect follow-up health management services. The expert pre-screening guidance and consultation, post-screening analysis of the physical examination report, etc., all need a sufficiently authoritative doctor to serve you. Whether the physical examination organization has a complete follow-up service system should also be listed as one of the conditions for consideration. At the same time, it is best to have a large general hospital as a medical technology support behind the physical examination organization.
Finally, the physical examination organization should set up a neat and comfortable physical examination environment for the examinees, and the physical examination area of the physical examination organization should be relatively independent, and should not be in contact with the patients, so as to prevent the phenomenon of cross-infection from occurring.
After the physical examination, we should do a good job of health management
When it comes to the physical examination, most people think of this scene: a lot of people queuing up to do which physical examination program, one by one to the corresponding department to check, and then come to pick up the report of the physical examination every few days. After getting the medical report, to see whether the indicators are normal or not, so that the whole process of physical examination is over. However, Wang Zhong said, the physical examination is only the first step, the medical staff will provide personalized physical examination program for each medical examiner, and do a good job of health management.
"Physical examination institutions to strictly prohibit a thousand people one-sided physical examination report, the requirements of the physical examination report should also be personalized, and at the same time for the physical examination of the person to put forward targeted, specific and feasible recommendations, that is, the physical examination of the person's health assessment, intervention." Wang Zhong said, "If you do not interpret and intervene after the physical examination, the significance of the physical examination is lost."
The interpretation of the experience report mainly includes whether the function of various organs is normal, what is the risk of getting a disease, and the general prediction of the health situation in the next few years, etc., and in this way, the medical checkup person can carry out intervention and management. For example, after a medical examiner has undergone a cardiovascular assessment, the doctor will make clear the incidence of stroke and the risk of heart attack in the next few years, and then recommend further tests at a general hospital and make specific recommendations on lifestyle habits.
However, there are some people who go through medical checkups "for the sake of medical checkups," emphasizing the process but neglecting to read the reports. Some people with serious problems will take the initiative to seek medical attention, but many others will just throw away their medical reports and not read them at all. Even if you read, but also to look around, on the medical report, especially the conclusion of the medical examination and related recommendations do not take it seriously. Wang Zhong said, many medical reports have been made clear that the medical examiner has a diagnosis of a major disease or abnormal positive results prompted by the doctor also gave clear guidance advice, but due to the body does not have any temporary discomfort, and did not cause the medical examiner to pay attention to the results of the delay in the timely discovery of a major disease, such as symptoms have been late, missed the best opportunity for treatment.
Author: also health Qian Yuyang