Research on what disease screening can do

The current topics that can be done in the field of disease screening basically focus on the two core pain points of "improving the actual benefits of screening and reducing unnecessary harm." Whether it is public health, clinical or medical-engineering intersection, there are a large number of unfilled gaps.

To put it most intuitively, in the free colorectal cancer screening programs in many places, less than 30% of those who are positive for fecal occult blood are ultimately willing to undergo colonoscopy for diagnosis. Community public health doctors call every day to urge them. Some elderly people find it troublesome and do not dare to go, and some young people are afraid of pain. Screening is equivalent to a screening. If you follow this pain point and study the impact of different follow-up intervention models on the medical treatment compliance of people who screen positive, such as sending text messages to positive people to directly make an appointment for colonoscopy, and a 1-minute short video on painless colonoscopy popularization, coupled with precise follow-up by community doctors, how much can the conversion rate be improved in comparison? This kind of research can not only publish papers, but it can really save many people if it is implemented.

At this point, we have to mention the "excessive" issue of screening that is currently very controversial in the industry, such as routine screening for thyroid cancer and low-risk prostate cancer. One school of thought says that early screening can increase the 5-year survival rate to more than 99%, while the other school of thought believes that many screened cancers are indolent, and if they are removed, they will have to take lifelong medication, which seriously affects the quality of life. It is better to actively monitor. However, most of the current data for this type of research comes from European and American populations. Our domestic cancer incidence characteristics and physical examination population structures are different. Directly copying foreign screening guidelines will definitely not be suitable for the local environment. If we can conduct a localized study on the health economic benefits of cancer screening for low-risk groups, for example, whether routine thyroid ultrasound screening is cost-effective for people under 30 years old without high-risk factors, the conclusions drawn may directly affect the subsequent formulation of screening policies.

There is no need to focus on policy and epidemiological topics. There is also a special lack of implementation research in the technical direction. It does not mean that we have to pursue popular early tumor screening molecular markers. Many grassroots scenario adaptation research is more practical. I previously went to a pastoral area in Qinghai for research. The local hydatid disease screening required ultrasonography and required venous blood extraction. Transportation in the pastoral area was inconvenient, and many herders traveled dozens of kilometers to do it once. Later, a team studied to adapt fingertip blood rapid test technology to local screening scenarios. The accuracy can reach more than 90% without the need for specialized inspectors. This kind of research may not seem "high-end", but it can really help hundreds of thousands of herdsmen.

There is another direction that many people have not noticed, which is psychological intervention after screening. Now hundreds of millions of people undergo health examinations every year. The false positive rate of screening for common tumors alone is 10%-30%. Many people feel that they are about to get gastric cancer or breast cancer when they find out that they are positive for Helicobacter pylori. I worry about whether the nodule 4a biopsy is benign or not. Some people even do unnecessary tests repeatedly for "peace of mind." The psychological burden and extra medical consumption caused by such false positives are actually not a small social cost, but there are very few people doing research in this direction in China.

In fact, to use an analogy, disease screening is like fishing for fish in the water. In the past two decades, everyone was studying how to weave a denser net and how to fish out the deep-hiding fish. Now, they are gradually realizing that whether the fish should be put back, whether the fishing process will muddy the water, and how to smoothly deliver the fish to the kitchen. These issues are no less valuable than weaving a net. I was chatting with public health doctors in the community a while ago. They said that the scales currently used to screen for cognitive impairment in the elderly are all translated. Many rural elderly people are illiterate and cannot even figure out "what year is it" and "what month is it now" on the scale. There are many errors and omissions in the screening results. If we can make a simplified cognitive screening scale suitable for the elderly with low education levels, it does not require complicated equipment and can be used by community doctors in half an hour. This kind of research is not much more valuable than a topic created by gathering hot topics.

To put it bluntly, when doing screening-related topics now, you don’t have to focus on hot topics in top publications to follow trends. You can really sink into the front line and see where you get stuck when you actually implement it. Digging deeper into any small pain points is a good topic that can solve practical problems.