The Wumeng Mountains pass through Xuanwei, the county seat lying on a slope on the border between Yunnan and Guizhou.
Farmers were busy harvesting corn and tobacco leaves in their fields in July, and while growing tobacco leaves more money than corn, farmers say rotating plantings can make the land more fertile.
Many things are not as sure as farmers are about farming.
Since the 1970s, Xuanwei's lung cancer morbidity and mortality have ranked among the top in the country. Until now, Xuanwei is still a high-incidence area of lung cancer.
Generations of scholars and research teams went to this county-level city under Qujing City, Yunnan Province to find the cause of the high incidence of lung cancer.
Because tobacco leaves are readily available?
It seems not.
The smoking rate of local women is much lower than that of men, but the incidence of men and women is not much different.
related to altitude?
It doesn't seem to be either.
Villagers living at high and low altitudes had similar incidence rates.
Something to do with the locals using coal to make a fire for cooking?
Beginning in the late 1980s, the government advocated villagers to change their furnaces to stoves, but many villagers still suffer from lung cancer.
As of today, the mystery has not been fully solved.
Since 2018, another group of doctors have entered this mysterious place. They have mobilized villagers from village to village to do a free early lung cancer screening project and perform free surgery for those relatively poor early-stage lung cancer patients.
Liu Bin, director of the Chinese and Western Medicine Lung Cancer Center of Qujing Hospital of Traditional Chinese Medicine, is one of them.
He said that he wanted the lung cancer patients on this land to live well and die of old age.
1
Lung cancer has circled Liu Bin's family: in 2002, after his mother was diagnosed with advanced lung cancer, he died after a six-month period; a few years ago, his father and eldest sister were diagnosed with early stage lung cancer, and after timely surgery, now they are are alive and healthy.
"Maybe in the eyes of outsiders, lung cancer is a terrible disease, but in our place, it is too common, too common." Liu Bin said.
The death of his mother prompted Liu Bin to choose to be a thoracic surgeon, although at the time, very few were willing to be a thoracic surgeon, because in the local area, this was a department that "couldn't see the light of life". dead."
The thoracic surgeon, who was born in Qujing in 1976, has seen many families suffering from lung cancer. "Not long ago, a nurse in our hospital had a CT scan and suspected lung cancer. He was only 31 years old."
Over the years, he has seen the youngest lung cancer patient, only about 18 years old.
There was a 21-year-old female college student who had just graduated from college and was diagnosed with early-stage lung cancer.
He had received some advanced cases in clinic, exhausted the treatment methods he could apply, and could not save the patient's life.
In Sherwin, lung cancer is a problem that plagues many people.
In the early 1970s, the Cancer Prevention and Control Office of the Ministry of Health announced the survey results. From 1973 to 1975, Xuanwei County in Qujing City was a place with a high incidence of lung cancer. Among them, the mortality rate of lung cancer among women ranked first in the country.
Paradoxically, smoking, occupational exposure, air pollution, ionizing radiation and other recognized lung cancer-causing factors do not seem to be the main reasons for the high incidence of lung cancer in Xuanwei.
Liu Bin's mother is neither a smoker nor a native of Xuanwei, and has never worked in a coal mine; his father and eldest sister, both civil servants, have almost never been exposed to the pathogenic factors of lung cancer.
In 2017, Liu Bin was transferred to Qujing Hospital of Traditional Chinese Medicine and became the director of the newly established thoracic surgery department of this tertiary hospital.
"Not to mention Qujing, there is no reputation in the hospital." He recalled that when the department was first established, the medical staff were not competent enough and there were few patients. Most of the lung cancer patients in Qujing did not trust the local hospital and preferred to go to Yunnan Province in Kunming. Cancer hospital.
Just when he was worried about how to develop this new department, a colleague mentioned that Zhao Xiaojing, director of the Thoracic Surgery Department of Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, was conducting an early lung cancer screening and early diagnosis project for relatively poor areas.
The Qujing Traditional Chinese Medicine Hospital almost sent a delegation to Shanghai to find Zhao Xiaojing: the president of the hospital, the director of the thoracic surgery department, and the leaders of three important departments.
In Shanghai, these five Qujing doctors discovered that they were all family members, close friends, and relatives of lung cancer patients. Some people lost important people in their lives because of lung cancer, and some people's family members were suffering from lung cancer at the time.
Liu Bin also did not expect that his colleagues in the same industry had similar experiences, although he knew that in Qujing, "there are so many families like this, so many are unnecessary."
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Zhao Xiaojing from Shanghai Renji Hospital has never been to Qujing before, and has never seen patients from Qujing, but he knows that Xuanwei is one of the places with the highest incidence of lung cancer in the world. "All thoracic surgeons in China know Xuanwei. ".
Sitting in the restaurant of Renji Hospital, listening to Dr. Qu Jing tell the stories of those families, he was a little moved. He could read the "determination to do something" in the eyes of the other person.
He has been looking for a suitable location for the project.
In 2013, Zhao Xiaojing established the Cijing Foundation under the Ai Public Welfare Fund of the Ministry of Civil Affairs of the People's Republic of China. She wanted to provide early lung cancer screening and early diagnosis projects for poor people in places with high incidence of lung cancer in China.
The first landing of the project was in Linyi, Shandong.
In the screening of 168 high-risk groups in the local area, 7 lung cancer patients were identified, but those 7 people refused to do free surgery, they mistakenly thought it was a group of liars, "I have no symptoms, how could I have a tumor!"
"This means that my project only told the patient a bad news, but did not solve the bad news." Zhao Xiaojing was not reconciled.
A doctor from Henan who came to Shanghai for further studies suggested that his hometown of Anyang, Henan, has a group of financially distressed steel factory workers who may be Zhao Xiaojing's target group.
However, after more than half a year of cooperation, the local hospitals are not very cooperative, the number of patients screened is small, and no one has lung cancer.
Zhao Xiaojing went to Minhe County, Qinghai Province, a high-altitude and relatively poor area.
The local medical staff are highly motivated and screened about 500 farmers in two or three weeks. However, the CT imaging in the county town was so poor that Zhao Xiaojing could not accurately judge the patient's condition.
Minhe County organized a group of buses to take all the suspected patients to the provincial capital hospital and checked them again. In the end, only one lung cancer patient was found, and the incidence here is relatively low.
From 2013 to 2018, Zhao Xiaojing gradually figured out what conditions are needed for the project to be implemented: to find an area with a high incidence of lung cancer; a relatively poor group; local doctors and nurses have urgency and enthusiasm, and want to reduce the mortality rate of lung cancer.
And Qujing Traditional Chinese Medicine Hospital seems to be a suitable partner.
Their common enemy, lung cancer, is an elusive and difficult opponent.
At present, lung cancer is the malignant tumor with the highest incidence in China and the world.
Liu Bin felt the same way: he clearly excised the lesion for a patient, but half a year later, the cancer cells suddenly proliferated in the patient's body explosively, and the patient died soon after; The patient, who has survived to the present, is almost a miracle.
Zhao Xiaojing has also been fighting with this opponent.
In 2016, the incidence of lung cancer among women in Shanghai surpassed that of breast cancer, becoming the most common malignant tumor disease in women, and it ranks first so far. "I can't tell why."
He is very clear that an important clinical means to reduce mortality is to use low-dose spiral CT to screen patients to find patients with early lung cancer.
He has tried many methods to promote early screening and early diagnosis.
A thoracic surgeon in Zhejiang approached Zhao Xiaojing and said that the hospital's thoracic surgery has not developed and there are no patients.
Zhao Xiaojing came up with an idea: first, conduct CT examinations for hospital employees over 50 years old to find lung cancer patients, and then conduct screening for the staff of government agencies, so that officials also start to pay attention to early lung cancer screening and early diagnosis, and slowly, the concept is extended to Citywide.
"It is very difficult to rely on the common people to awaken themselves. We must first make medical staff aware of the importance of early screening and early diagnosis." Zhao Xiaojing said that this idea of promoting early screening and early diagnosis has been successively implemented in Qidong in Nantong, Wenling in Taizhou, Jiaxing, etc. implemented.
After five doctors Qu Jing and Zhao Xiaojing met in Shanghai, the cooperation began.
Qujing Traditional Chinese Medicine Hospital sent 10 nurses to Shanghai Renji Hospital for further study.
On December 29, 2018, Zhao Xiaojing arrived in Qujing for the first time to perform free surgery on 18 early-stage lung cancer patients.
These 18 people were slowly found by Liu Bin, who spent more than three months organizing medical staff to go to the village to mobilize 498 people for free screening.
Zhao Xiaojing finally found the ideal partner: Liu Bin has strong executive skills, is familiar with the local medical system and government departments, and is responsible for connecting with government officials and grass-roots health workers; while Zhao Xiaojing is outgoing and talkative, and has a professional background, which makes the villagers feel trusting, "Shanghai The big experts have really come.”
Liu Bin is determined to promote early screening and early diagnosis in Qujing.
His father and eldest sister, thanks to early screening and early surgery, are now living safely.
Liu Bin said that in this era when he does not worry about food and clothing, he can do this in his life.
3
Sherwin-Williams has never been short of puzzle solvers, at least for the last 50 years.
In 1979, more than 100 multidisciplinary experts plunged into Xuanwei, trying to find the answer - why is this county with the highest incidence of lung cancer in the country?
They cooperated with local medical units to set up a Xuanwei lung cancer etiology research project group.
The person in charge of the project team was He Xingzhou, who was then the director of the Environmental Epidemiology Research Office of the Institute of Environmental Health and Hygiene Work, Chinese Academy of Preventive Medicine.
Since then, he has spent 27 years solving puzzles in Xuanwei, wanting to "protect more than a million peasants".
At that time, the living conditions in Xuanwei were harsh. The researchers could only eat two meals a day, with corn mixed with a small amount of rice, and slept in the farmer's house at night to lay the ground floor, and the field was their toilet.
But He Xingzhou insisted, "To do epidemiological research, you need to be on the spot." In 1983, the US Environmental Protection Agency's Institute of Health Effects also joined this research, responsible for developing technologies, instruments and equipment to jointly explore the mystery of Xuanwei lung cancer.
He has too many things to manage: as small as taking care of experimental animals, sprinkling water and sweeping the floor, dissecting animal carcasses, as large as taking care of hundreds of people in the project team, and going abroad for exchanges and inspections.
This puzzle is too difficult.
He Xingzhou wrote in his memoirs that according to past experience, lung cancer is generally high in cities, in smokers, and in men.
However, in Xuanwei, the number of male and female lung cancer patients is equal, and in some places there are even more females than males, and there is obvious family clustering and township clustering.
For example, in 1985, in a peasant family in Zhutun Village, Laibin Town, Xuanwei, the grandfather, father and son died of lung cancer at the beginning of the year, the middle of the year and the end of the year respectively.
He used it for 15 years, tracked 45,000 people, and used more than 2,200 rats, mice, and golden hamsters for experiments.
Does it have anything to do with coal mines?
Xuanwei Coal Mine has developed resources, and there are many small coal mines, but the vast majority of patients who died of lung cancer were farmers, and the mortality rate of farmers was 9.8 times that of factories, mines, government workers and their families.
Is tobacco the culprit?
The local area is rich in tobacco, and most men smoke, while the smoking rate of women is less than 0.21%, but the mortality rate of lung cancer between men and women is not much different.
He Xingzhou ruled out that industrial pollution and smoking are not the main reasons for the high incidence of lung cancer in Xuanwei.
The answer he finally found was that every local household had a "fire pond", an open stove that burns coal indoors. It was the center of the whole family's life activities. meal.
Fire ponds are so common that the villagers ignore them. The indoor air cannot be circulated. Housewives who do housework near the fire ponds become the family members who are most likely to inhale a lot of smoke and dust.
This finding lays a solid foundation for the follow-up study of Xuanwei lung cancer.
He Xingzhou said that those who participated in the puzzle-solving included not only 169 people from 9 units, but also the local "thousands of health workers, who are the result of the work of several generations."
In 2005, the International Society for Indoor Air Quality Science and Technology presented He Xingzhou with the "Lifetime Achievement Award", which was the first time a Chinese person had won in this field.
He trained more than 20 master and doctoral students in epidemiology, toxicology, and chemistry in this project group. Later, his "disciples and grandchildren" went to study lung cancer around the world, but they still paid attention to Xuanwei's research progress.
This research conclusion has also promoted the trend of changing furnaces and stoves in Xuanwei.
Li Jihua, chief physician of epidemiology at the Qujing Center for Disease Control and Prevention, recalled that since the late 1980s, the government has given economic subsidies to villagers for changing stoves and stoves, and also encouraged the installation of exhaust systems on coal-fired stoves.
Many villagers have switched to electricity as the main energy source for their households.
After retiring, He Xingzhou still went to Xuanwei many times to continue his research. He found that after changing the stove and stove, the risk of chronic obstructive pulmonary disease in Xuanwei families was greatly reduced.
He Xingzhou didn't suspend Xuanwei-related research until he suffered from stomach cancer. His students went to visit and saw him reading Xuanwei's latest research report in the ward.
After years of refurbishment and refurbishment, Xuanwei is still one of the areas with the highest incidence of lung cancer in the world. There is a local family, 6 brothers and sisters, and 4 of them are suffering from lung cancer.
It can be seen that the "fire pond" is not the only answer to Xuanwei's high incidence of lung cancer.
Li Jihua recalled that two weeks before He Xingzhou's death, he called him for 4 hours, and he was still concerned about the situation of Xuanwei.
After He Xingzhou's death, Li Jihua continued to do epidemiological investigations on the basis of the original research.
This is a repetitive, tedious, and attentive work: spending years in the village, learning about the details of farmers’ lives.
Li Jihua grew up in the countryside and knew how to deal with the locals.
For example, he would not directly ask the villagers how many kilograms of coal they burn each year, because many villagers have no concept of "jin".
Do you use an ox cart or a horse-drawn cart to pull coal?
How many times a year do you pull coal?
How long does it take to pull coal each time?
Finally, he got the answer.
During a visit to the village, he found that living in a low-altitude area, the villagers' houses are not ventilated, which is easy to aggravate indoor coal-burning pollution. Need to burn more coal for heating.
After the furnace was changed to a stove, some villagers were not used to using electric heating for heating and still burned coal in winter.
Whenever he encounters a family or village where lung cancer patients gather, Li Jihua will record the specific location. Slowly, he finds out the high incidence map of Qujing.
These positioning not only provide convenience for foreign scholars, but also help Liu Bin to do screening to accurately find high-risk groups.
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Fuyuan County, where Li Jihua was born, is only separated from Xuanwei by a mountain.
After years of research in Sherwin, he turned his attention to his hometown.
In 2007, he presided over a large-scale free lung cancer screening in Fuyuan County, and found that the incidence and mortality of lung cancer in Fuyuan were also high.
Li Jihua analyzed that when the former Ministry of Health came to investigate in the early 1970s, Xuanwei had more than 20 state-owned factories, equipped with hospitals and X-ray machines, while Fuyuan had only two factories at that time and little inspection equipment. Therefore, Xuanwei farmers’ lung cancer Problems are detected and paid attention to earlier.
He published several papers on lung cancer investigation in Fuyuan County in domestic medical journals, attracting scholars and doctors to pay attention to his hometown.
The terrain of Fuyuan is like a long and narrow gourd. The villagers in the north of the gourd use more coal, and the villagers in the south use more firewood. Li Jihua found that the incidence of lung cancer in the north of the gourd is significantly higher than that in the south, which highlights the relationship between coal and the incidence of lung cancer.
Since 2018, the medical staff of Qujing Traditional Chinese Medicine Hospital, following the points provided by Li Jihua, have traveled to 30 villages in Xuanwei and Fuyuan, and conducted free CT screening for more than 4,000 high-risk groups, including 151 early-stage lung cancer patients. received free surgery.
Liu Hui, a nurse in Liu Bin's department, has nursed two to three hundred lung cancer patients in the past four years.
She is well aware of the suffering of terminally ill patients.
The early-stage patients she has cared for are all alive and healthy now. Once, during a return visit to the village, an early-stage patient who was not long after the operation was doing farm work in the fields.
She is in line with Zhao Xiaojing's conception, the group of medical staff who realize the importance of early screening and early diagnosis.
Sometimes when visiting the village, the village doctor would point to the distance and tell her, "Next time you can go to the village over there, there are more lung cancers there."
This drives her eagerness to mobilize more people for early detection and early surgery.
She wants to run quickly to outperform the proliferation rate of cancer cells, "I want to go to every corner of Fuyuan".
More and more doctors are relaying.
Housuo Town is located at the northernmost "Hulu" mouth of Fuyuan County. Wang Meng, director of the town health center, participated in the 2007 Fuyuan County Lung Cancer Screening.
At that time, he was a medical worker who had just graduated for two years. He had hoped that the big screening would solve the problem of lung cancer in Fuyuan County.
When he was eight or nine years old, his neighbor got lung cancer, and he died within a month. He knew the pain of lung cancer since he was a child.
He did not pay attention to Li Jihua's paper, and mistakenly thought that the big screening at that time "will be finished without results".
He felt pity for this, but it would be "there is no way".
But now, he is the director of the town health center, and finally has the opportunity to do something for lung cancer patients.
"I want to publicize this free project so that ordinary people can get more benefits."
At the staff meeting of the hospital, he asked the medical staff to promote the project to 10 people around him. "This trick is learned from insurance companies."
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10, 10, 10 more... More and more villagers are participating in free early lung cancer screening.
The early screening promotion method that Zhao Xiaojing has practiced in many places in Jiangsu and Zhejiang is also effective in the county town of the gourd terrain in the southwest.
When the medical staff of Qujing Traditional Chinese Medicine Hospital followed up after the operation, some patients could not wait to unload half of the ham hanging at home and cook it for the medical staff to eat; Said, "Such a small incision, and my disease is cured!"
Some researchers have speculated that some families have genetic problems, and family clustering disease occurs.
Liu Bin tried to use the most local words as an analogy, "Our tumor suppressor genes are asleep, and it is useless to run to the moon."
He accepted a cruel fact: at least in his generation, this story of inescapable lung cancer will continue, "it is impossible for everyone to move to Beijing, Shanghai and Guangzhou."
But he still delays the occurrence of lung cancer under the conditions of his ability: after the death of his mother, he no longer eats braised tofu, which was his favorite food. The original coal has been given away, and electrical appliances have been completely switched to; cigarettes have long since stopped smoking, and alcohol, until after the early screening and diagnosis of lung cancer in the past few years, the entertainment has increased, and he has only drank a little.
Many of his patients have a similar situation to him: both father and son are his patients, and his father is a farmer in his 60s. He was diagnosed with early-stage lung cancer in 2020 and underwent free lung cancer surgery in Qujing Hospital of Traditional Chinese Medicine; his son is only in his early 40s , At the end of 2021, a tumor was found in the lung. The pathological test after surgery was benign, but a new tumor was found in the postoperative review.
The father said to the hospitalized son, "I am alive and well. Your (tumor) is not as big as a soybean, so you must be fine."
Compared with the 2.6-centimeter tumor that once grew in his body, the father was more concerned about the recent growth of the cow and how the crops were growing.
He was busy planting corn, rice, and potatoes on a dozen acres of land, and raised seven or eight cows.
The local farmers are popular to smoke dry tobacco - after picking the tobacco leaves, tie them up to dry until they turn yellowish brown, and he still smokes after the operation.
"My family has this disease, and it's fucking unfortunate," his son said.
His son gave birth to 3 children, and the illness made his son suddenly realize, "I can't be a lifelong support for the 3 children."
When he was hospitalized, his son called his eldest child to the hospital and accompanies him for various medical examinations, "Of course I can't tell him, hurry up and get out of this ghost place, my father has this disease, but I put it another way. , go to a better place and pass the test."
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Last summer, Zhao Xiaojing set foot in Qujing for the sixth time.
He has a new idea - to put the flow on the agenda.
In the clinic of a village in Housuo Town, he, Li Jihua and Wang Lan, a professor at the School of Architecture and Urban Planning of Tongji University, spread out the map of Qujing on the table. There are many red dots on the map, which were collected by Li Jihua for most of his life. High-incidence areas.
Zhao Xiaojing pointed to one of the bright red dots and said, "Why don't you do more things in this place?" At first, he only wanted to help villagers who have no financial ability and no awareness of early screening to do screening, promote the concept of early screening and early diagnosis, and then Taking Qujing as a template, it was extended to other relatively poor areas, but slowly, he also wanted to try to solve the puzzle.
So, three people from different fields gathered in the clinic to start discussions: one was a well-known thoracic surgeon in Shanghai, the other was a disease control worker who ran on mud legs in Qujing, and the other was a long-term Scholars who are concerned about the impact of the urban environment on respiratory health regard healthy cities as the forefront of research.
They plan to rationally plan the screening area of the early screening project. Instead of mobilizing many villages, they will focus on a high-incidence village to screen all the population.
They chatted for two more days, in the clinic, in the car to the countryside, in the hospital, looking for the intersection of their respective knowledge structures.
Zhao Xiaojing has not been so excited for many years, calling Li Jihua an "old mage", not seeking fame and fortune, being pragmatic and pure.
He decided to take over the baton based on Li Jihua's research, and also wanted to find the thread end of the ball of wool.
Li Jihua said, "I hope that more people can come to study lung cancer, and maybe see the effect in 8 or 10 years."
Zhao Xiaojing analyzed that the early screening and early diagnosis project has been in place for 4 years, covering screening, treatment, and surgery.
Compared with other lung cancer funds that only provide free screening and no treatment, the team that provides free treatment for patients is more likely to gain the trust of the villagers and reduce the difficulty of epidemiology.
After Wang Lan left Qujing, she used her professional knowledge to add a new column of "living environment" to the original health questionnaire to investigate the construction age and building materials of the villagers' houses. Specifically, the main room, bedroom, and kitchen have several windows. , Is there any ventilation after opening the window?
She also found that in Xuanwei and Fuyuan and other places, in addition to housing ventilation problems, the geometric distance between industrial and mining land and residential land interacted with wind direction and hydrology, which also affected the incidence of lung cancer.
Many patients in Shanghai heard about the program and volunteered to join it.
The foundation slowly raised four or five million yuan, and the least one came from an old lady who donated 100 yuan.
Zhao Xiaojing also donates 100,000 yuan to the foundation every year.
A colleague heard about what Zhao Xiaojing was doing in Qujing, and also wanted to set up a foundation to help more people.
Zhao Xiaojing wants to promote the early screening and early diagnosis project more widely in the local area, so that more people can benefit.
The city leaders of Qujing once went to Shanghai to meet Zhao Xiaojing to help this project take root in Qujing.
Liu Bin said that the project can be carried out in Qujing for four years without the support of relevant government departments.
Every time I go to the village for screening, the Qujing Municipal Health and Health Committee holds a coordination meeting in advance.
A staff member of the Qujing Municipal Health and Health Commission who has participated in the coordination meeting many times said that they strongly support this non-governmental project because it has a complete chain. The real effect has really benefited the villagers.
This anti-cancer marathon, which took nearly 50 years, has achieved some results after repeated tossing from generation to generation.
Li Jihua's survey found that the mortality rate of lung cancer in Xuanwei is gradually slowing down: from the 1970s to the 1990s, it was a fast period, and the standardized mortality rate increased by 179.6%; from 1990 to 2000, it was a slow period, with an increase of 35.3%; Since 2000, thanks to the update of lung cancer treatment methods, it has entered a stable period.
After the original pathogenic factors were eliminated, new risk factors emerged: He Xingzhou's early research believed that smoking was not an important factor in Xuanwei lung cancer, but after the furnace was renovated, the impact of living fuels was reduced. In recent years, smoking This factor becomes more prominent.
In the past 20 years, Li Jihua has become a person who thread the needle.
He has received experts in environmental science, geology, chemistry and other disciplines from all over the country, and he has also seen scholars from Japan and the United States who made a special trip to Qujing, and brought these people to the village to help spread the dots.
Over the years, so many foreign teams have come to Qujing for research. Once, Li Jihua picked up a sampling plastic tube in the laboratory and found the words printed on the glass tube, which were donated by Guangdong.
Next year, Li Jihua will retire.
He had accepted the harsh reality that it would be difficult to figure out the puzzle, and after retiring he decided to pursue lung cancer research.
"When you look at Americans doing research, what they think about is 20 or 30 years from now." In the early years, when Americans came to Qujing for research, he observed Americans collecting air and soil and using three test tubes. , 3 copies per sample.
Curious, he asked why?
The other party's answer was: one to go back to the experiment, one to review the experimental results, and one for future scientists.
He remembered the word "future" firmly.
China Youth Daily, China Youth Daily reporter Wei Xi Source: China Youth Daily