Deborah Rhodes: A tool that finds 3x more breast tumors, and why it's not available to you

Prevoditelj: Senzos Osijek Recezent: Tilen Pigac - EFZG

There are two groups of women

Postoje dvije grupe žena

when it comes to screening mammography --

kad se govori o probirnoj mamografiji --

women in whom mammography works very well

žene kod kojih mamografija veoma dobro djeluje

and has saved thousands of lives

i spasila je tisuće života

and women in whom it doesn't work well at all.

i žene kod kojih uopće dobro ne djeluje.

Do you know which group you're in?

Znate li vi u kojoj ste skupini?

If you don't, you're not alone.

Ako ne znate, niste same.

Because the breast has become

To je stoga što su grudi postale

a very political organ.

veoma politički organ.

The truth has become lost

Istina se izgubila

in all the rhetoric

među retoričkim

coming from the press, politicians,

dolaskom novinara, političara,

radiologists

radiologa

and medical imaging companies.

i tvrtki za medicinska snimanja.

I will do my best this morning

Dat ću sve od sebe

to tell you what I think is the truth.

da vam ispričam što smatram istinom.

But first, my disclosures.

Ali prvo da vam se predstavim.

I am not a breast cancer survivor.

Nisam preživjela rak dojke.

I'm not a radiologist.

Nisam radiolog.

I don't have any patents,

Ne posjedujem nikakve izume

and I've never received any money from a medical imaging company,

i nikada nisam primila novac od bilo kakve tvrtke za medicinska snimanja.

and I am not seeking your vote.

I ne tražim vaš glas.

(Laughter)

(Smijeh)

What I am

Doktorica sam

is a doctor of internal medicine

interne medicine

who became passionately interested in this topic

koja se strastveno zainteresirala za ovu temu

about 10 years ago

prije 10 godina

when a patient asked me a question.

kada mi je pacijentica postavila pitanje.

She came to see me

Došla je k meni

after discovering a breast lump.

nakon što je otkrila kvržicu na dojci.

Her sister had been diagnosed with breast cancer

Njenoj sestri je dijagnosticiran rak dojke

in her 40s.

u četrdesetima.

She and I were both very pregnant at that time,

Ona i ja smo u to vrijeme bile u visokom stupnju trudnoće

and my heart just ached for her,

i bila sam tužna zbog nje,

imagining how afraid she must be.

zamišljajući koliko se vjerojatno boji.

Fortunately, her lump proved to be benign.

Srećom, dokazalo se da je njena kvržica benigna.

But she asked me a question:

Ali postavila mi je pitanje:

how confident was I

koliko sam sigurna

that I would find a tumor early on her mammogram

da bih pronašla tumor rano na njenom mamogramu,

if she developed one?

da ga je razvila?

So I studied her mammogram,

Pa sam proučila njezin mamogram

and I reviewed the radiology literature,

i pregledala radiološku literaturu

and I was shocked to discover

te sam bila šokirana

that, in her case,

kad sam otkrila

our chances of finding a tumor early on the mammogram

da je u njenom slučaju vjerojatnost ranog otkrivanja tumora na mamogramu

were less than the toss of a coin.

bila veoma malena.

You may recall a year ago

Možda ćete se sjetiti stihije

when a firestorm erupted

koja je prije godinu dana nastala

after the United States Preventive Services Task Force

nakon što je Operativna Grupa Preventivnih Usluga SAD-a

reviewed the world's mammography screening literature

prikazala svjetsku literaturu mamografskog probira

and issued a guideline

i izdala direktivu

recommending against screening mammograms

protiv probirujućih mamograma

in women in their 40s.

žena u četrdesetima.

Now everybody rushed to criticize the Task Force,

Svi su krenuli kritizirati operativnu grupu

even though most of them weren't in anyway familiar

iako ih većina uopće nije bila upoznata

with the mammography studies.

s mamografskim studijama.

It took the Senate just 17 days

Senatu je trebalo samo 17 dana

to ban the use of the guidelines

da zabrani upotrebu direktive

in determining insurance coverage.

u određivanju osiguranja.

Radiologists were outraged

Radiolozi su bili uvrijeđeni

by the guidelines.

direktivama.

The pre-eminent mammographer in the United States

Eminentni mamografer u Sjedinjenim Američkim Državama

issued the following quote

poslao je pismo

to the Washington Post.

Washington Postu.

The radiologists were, in turn, criticized

Radiolozi su bili kritizirani

for protecting their own financial self-interest.

zbog toga što su štitili vlastite financijske interese.

But in my view,

Ali s mog stajališta,

the radiologists are heroes.

radiolozi su junaci.

There's a shortage of radiologists

Imamo nedostatak radiologa

qualified to read mammograms,

koji su osposobljeni za čitanje mamograma

and that's because mammograms are one of the most complex

i to je zato što su mamogrami

of all radiology studies to interpret,

od svih radioloških studija najsloženiji za tumačenje

and because radiologists

i zato što su radiolozi

are sued more often

češće tuženi

over missed breast cancer

zbog promaknutog raka dojke

than any other cause.

nego u bilo kojem drugom slučaju.

But that very fact is telling.

Ali ta činjenica govori sama za sebe.

Where there is this much legal smoke,

Gdje je mnogo pravnog dima,

there is likely to be some fire.

vjerojatno će biti i nešto vatre.

The factor most responsible for that fire

Faktor koji je najodgovorniji za tu vatru

is breast density.

je gustoća dojke.

Breast density refers to the relative amount of fat --

Gustoća dojke se odnosi na relativnu količinu masti --

pictured here in yellow --

ovdje obojano žuto --

versus connective and epithelial tissues --

naspram vezivnog i epitelnog tkiva --

pictured in pink.

obojano rozo.

And that proportion

I taj razmjer je

is primarily genetically determined.

primarno genetički određen.

Two-thirds of women in their 40s

Dvije trećine žena u četrdesetima

have dense breast tissue,

imaju gusto tkivo dojke,

which is why mammography doesn't work as well in them.

što je razlog zbog kojeg mamografija za njih ne radi kako treba.

And although breast density generally declines with age,

I unatoč tome što gustoća dojke pada s godinama,

up to a third of women

trećina žena

retain dense breast tissue

zadržava gusto tkivo dojke

for years after menopause.

godinama nakon menopauze.

So how do you know if your breasts are dense?

Dakle, kako znate da su vam dojke guste?

Well, you need to read the details

Pa, trebate pročitati detalje

of your mammography report.

vaše mamografije.

Radiologists classify breast density

Radiolozi grupiraju gustoću dojke

into four categories

u četiri kategorije

based on the appearance of the tissue on a mammogram.

bazirane na pojavi tkiva na mamogramu.

If the breast is less than 25 percent dense,

Ako u dojci ima manje od 25% gustoće,

that's called fatty-replaced.

to se zove masna zamijena.

The next category

Sljedeća kategorija je

is scattered fibroglandular densities,

raspršena vlaknastožljezdana gustoća,

followed by heterogeneously dense

koju slijedi heterogena gustoća

and extremely dense.

i ekstremna gustoća.

And breasts that fall into these two categories

Dojke koje spadaju u ove dvije kategorije

are considered dense.

smatraju se gustima.

The problem with breast density

Problem s gustoćom dojke

is that it's truly the wolf in sheep's clothing.

je to što je to doista vuk u janjećoj koži.

Both tumors and dense breast tissue

I tumori i gusto tkivo dojke

appear white on a mammogram,

se javljaju kao bijela pojava na mamogramu

and the X-ray often can't distinguish between the two.

i rendgenske zrake često ne mogu razlikovati to dvoje.

So it's easy to see this tumor

Dakle, jednostavno je vidjeti ovaj tumor

in the upper part of this fatty breast.

u gornjem dijelu ove masne dojke.

But imagine how difficult it would be

Ali zamislite kako bi bilo teško

to find that tumor in this dense breast.

pronaći taj tumor u ovoj gustoj dojci.

That's why mammograms find

Zato mamogrami pronalaze

over 80 percent of tumors in fatty breasts,

više od 80% tumora u masnim dojkama,

but as few as 40 percent in extremely dense breasts.

ali manje od 40% u ekstremno gustim dojkama.

Now it's bad enough that breast density

Dovoljno je loše što gustoća dojke

makes it hard to find a cancer,

otežava pronalazak karcinoma,

but it turns out

ali čini se da

that it's also a powerful predictor

je to također veoma moćan pokazatelj

of your risk for breast cancer.

vašeg rizika za karcinom dojke.

It's a stronger risk factor

To je jači faktor rizika

than having a mother or a sister with breast cancer.

od toga da imate majku ili sestru s karcinomom dojke.

At the time my patient posed this question to me,

U vrijeme kad mi je pacijentica postavila ovo pitanje,

breast density was an obscure topic

gustoća dojke je bila nepoznata tema

in the radiology literature,

u radiološkoj literaturi

and very few women having mammograms,

i jako je malo žena koje su obavljale mamografiju

or the physicians ordering them,

ili doktora koji su ih tražili

knew about this.

znalo za to.

But what else could I offer her?

Ali što sam joj drugo mogla ponuditi?

Mammograms have been around since the 1960's,

Mamografija postoji negdje od 1960. godine.

and it's changed very little.

I veoma malo se promijenila.

There have been surprisingly few innovations,

Imamo iznenađujuće malo inovacija

until digital mammography was approved

sve dok 2000. nije odobrena

in 2000.

digitalna mamografija.

Digital mammography is still an X-ray of the breast,

Digitalna mamografija je još uvijek rendgenska snimka dojke,

but the images

ali se slike

can be stored and manipulated digitally,

mogu pohraniti i obraditi digitalno,

just like we can with a digital camera.

kao što mi možemo digitalnom kamerom.

The U.S. has invested

SAD je uložio

four billion dollars

4 milijarde dolara

converting to digital mammography equipment,

prilikom prelaska na digitalnu mamografsku opremu.

and what have we gained from that investment?

I što smo dobili tim ulaganjem?

In a study funded by over 25 million taxpayer dollars,

U studiji koju je financiralo 25 milijuna dolara poreznih obveznika,

digital mammography was found

ustanovljeno je da digitalna mamografija

to be no better over all

nije ništa bolja

than traditional mammography,

od klasične mamografije.

and in fact, it was worse in older women.

I zapravo, bila je gora kod starijih žena.

But it was better in one group,

Ali je bila bolja u jednoj skupini,

and that was women under 50

a to su žene ispod 50 godina

who were pre-menopausal and had dense breasts,

koje su bile pred menopauzom i imale guste dojke.

and in those women,

I kod tih žena

digital mammography found twice as many cancers,

digitalna je mamografija pronašla duplo manje karcinoma,

but it still only found 60 percent.

ali je još uvijek pronalazila 60%.

So digital mammography

Dakle, digitalna je mamografija

has been a giant leap forward

bila ogroman skok naprijed

for manufacturers

za proizvođače

of digital mammography equipment,

opreme za digitalnu mamografiju,

but it's been a very small step forward for

ali je bio veoma mali korak naprijed

womankind.

za ženski rod.

What about ultrasound?

Što je s ultrazvukom?

Ultrasound generates more biopsies

Ultrazvuk zahtijeva više biopsija

that are unnecessary relative to other technologies,

koje su nepotrebne u odnosu na druge tehnologije,

so it's not widely used.

pa nije mnogo korištena.

And MRI is exquisitely sensitive for finding tumors,

A magnetna rezonanca je veoma osjetljiva za pronalazak tumora,

but it's also very expensive.

ali je također veoma skupa.

If we think about disruptive technology,

Ako razmišljamo o tehnologiji koja remeti,

we see an almost ubiquitous pattern

vidimo gotovo sveprisutni obrazac

of the technology getting smaller and less expensive.

tehnologije koja postaje sve manja i jeftinija.

Think about iPods compared to stereos.

Razmislite o iPodovima u usporedbi sa stereo uređajima.

But it's the exact opposite in health care.

Ali potpuno je suprotno u zdravstvu.

The machines get ever bigger

Uređaji postaju sve veći

and ever more expensive.

i sve skuplji.

Screening the average young woman with an MRI

Snimanje prosječne mlade žene magnetnom rezonancom

is kind of like driving to the grocery store in a Hummer.

je poput ulaska u trgovinu mješovitom robom u Hummeru.

It's just way too much equipment.

To je jedostavno previše opreme.

One MRI scan

Jedna magnetna rezonanca

costs 10 times what a digital mammogram costs.

košta deset puta više no što košta digitalna mamografija.

And sooner or later, we're going to have to accept the fact

I prije ili kasnije morat ćemo prihvatiti činjenicu

that health care innovation

da inovacije u zdravstvu

can't always come at a much higher price.

ne mogu uvijek biti skuplje.

Malcolm Gladwell wrote an article in the New Yorker

Malcolm Gladwell napisao je članak u New Yorkeru

on innovation,

o inovacijama

and he made the case that scientific discoveries

i objasnio je da su znanstvena otkrića

are rarely the product of one individual's genius.

rijetko proizvod jednog jedinog genija.

Rather, big ideas can be orchestrated,

Točnije, velike ideje mogu biti izvedene

if you can simply gather

ako jednostavno skupite ljude

people with different perspectives in a room

s različitim perspektivama u prostoriju

and get them to talk about things

i date im da razgovaraju o stvarima

that they don't ordinarily talk about.

o kojima inače ne razgovaraju.

It's like the essence of TED.

To je kao srž TED-a.

He quotes one innovator who says,

Gladwell citira jednog inovatora koji kaže,

"The only time a physician and a physicist get together

„Jedini put kada se liječnik i fizičar nađu

is when the physicist gets sick."

je kada se fizičar razboli.“

(Laughter)

(Smijeh)

This makes no sense,

To nema smisla

because physicians have all kinds of problems

zato što liječnici imaju raznovrsne probleme

that they don't realize have solutions.

za koje nemaju rješenje.

And physicists have all kinds of solutions for things

A fizičari imaju razna rješenja za stvari

that they don't realize are problems.

za koje ne shvaćaju da su problemi.

Now, take a look at this cartoon

A sada, pogledajmo ovu karikaturu

that accompanied Gladwell's article,

vezanu za Gladwellov članak

and tell me if you see something disturbing

i recite mi vidite li nešto uznemirujuće

about this depiction of innovative thinkers.

u ovom prikazu inovativnih mislioca.

(Laughter)

(Smijeh)

So if you will allow me a little creative license,

Dakle, dozvolite mi sada malo kreativne slobode,

I will tell you the story

ispričat ću vam priču

of the serendipitous collision

o slučajnom otkrivanju zavjere

of my patient's problem

problema mojih pacijenata

with a physicist's solution.

s rješenjem fizičara.

Shortly after her visit,

Ubrzo nakon njenog posjeta,

I was introduced to a nuclear physicist

upoznata sam s nuklearnim fizičarom

at Mayo

u Mayo klinici

named Michael O'Conner,

pod imenom Michael O'Conner,

who was a specialist in cardiac imaging,

koji je specijalist u snimanju srca,

something I had nothing to do with.

nečemu s čim uopće nemam veze.

And he happened to tell me

I on mi je pričao o

about a conference he'd just returned from in Israel,

skupu s kojeg se baš vratio iz Izraela

where they were talking about a new type of gamma detector.

gdje su pričali o novom obliku gama detektora.

Now gamma imaging has been around for a long time

Gama snimanje je u uporabi već duže vrijeme

to image the heart,

što se tiče snimanja srca

and it had even been tried to image the breast.

i čak se njime pokušavalo snimiti dojku.

But the problem was

Ali problem je bio u tome

that the gamma detectors

što su gama detektori

were these huge, bulky tubes,

velike, teške cijevi

and they were filled with these scintillating crystals,

i punjene su svjetlucavim kristalima

and you just couldn't get them close enough around the breast

i jednostavno ih nismo mogli dovoljno približiti dojkama

to find small tumors.

da bismo pronašli male tumore.

But the potential advantage was

Potencijalna prednost je bila ta

that gamma rays, unlike X-rays,

da na gama zrake, za razliku od rendgenskih zraka

are not influenced by breast density.

ne utječe gustoća dojke.

But this technology

Ali ta tehnologija

could not find tumors when they're small,

nije mogla pronaći tumore kada su bili mali.

and finding a small tumor is critical for survival.

A pronalazak malog tumora je kritičan za preživljavanje.

If you can find a tumor

Ako možete pronaći tumor

when it's less than a centimeter,

dok je manji od centimetra,

survival exceeds 90 percent,

preživljavanje iznosi 90%,

but drops off rapidly

ali brzo pada

as tumor size increases.

kako se veličina tumora povećava.

But Michael told me about

Ali Michael mi je pričao o

a new type of gamma detector that he'd seen,

novom tipu gama detektora koji je vidio

and this is it.

i to je upravo ovo.

It's made

Napravljeno je,

not of a bulky tube,

ne od teške cijevi,

but of a thin layer of a semiconductor material

već od tankog sloja poluprovodnog materijala

that serves as the gamma detector.

koji služi kao gama detektor.

And I started talking to him

Počela sam s njim razgovarati

about this problem with breast density,

o problemu gustoće dojke

and we realized that we might be able to get this detector

i shvatili smo da bismo mogli biti u mogućnosti

close enough around the breast

dovesti ovaj detektor dovoljno blizu dojke

to actually find small tumors.

da bi zapravo našli male tumore.

So after putting together

Dakle, nakon što smo skupili

a grid of these cubes with tape --

ovu mrežu kocki s trakom --

(Laughter)

(Smijeh)

-- Michael hacked off the X-ray plate

-- Michael je isjekao rendgensku ploču

of a mammography machine

iz mamografskog aparata

that was about to be thrown out,

koji je trebao biti bačen.

and we attached the new detector,

I pričvrstili smo novi detektor

and we decided to call this machine

i odlučili nazvati ovaj aparat

Molecular Breast Imaging, or MBI.

Molekularno Snimanje Dojke ili MSD.

This is an image from our first patient.

Ovo je slika naše prve pacijentice.

And you can see, using the old gamma technology,

I možete vidjeti, koristeći staru gama tehnologiju,

that it just looked like noise.

da je to izgledalo kao šum.

But using our new detector,

Ali koristeći naš novi detektor,

we could begin to see the outline of a tumor.

mogli smo vidjeti obris tumora.

So here we were, a nuclear physicist,

Dakle, evo nas, nuklearni fizičar

an internist,

i internist

soon joined by Carrie Hruska, a biomedical engineer,

kojem će se uskoro pridružiti Carrie Hruska, biomedicinski inženjer

and two radiologists,

i dva radiologa

and we were trying to take on

i pokušavamo promijeniti

the entrenched world of mammography

ukorijenjeni svijet mamografije

with a machine that was held together by duct tape.

s aparatom kojeg drži ljepljiva traka.

To say that we faced

Reći da smo se susreli

high doses of skepticism

s velikom dozom sumnjičavosti

in those early years

u tim ranim godinama

is just a huge understatement,

je eufemizam.

but we were so convinced that we might be able to make this work

Ali također smo bili uvjereni da bismo mogli ovo osposobiti

that we chipped away with incremental modifications

kada bismo uklonili neke dijelove dodane

to this system.

ovom sistemu.

This is our current detector.

Ovo je naš trenutni detektor.

And you can see that it looks a lot different.

Možete vidjeti da izgleda dosta drugačije.

The duct tape is gone,

Nema više ljepljive trake

and we added a second detector on top of the breast,

i dodali smo drugi detektor na vrh dojke

which has further improved our tumor detection.

koji je dodatno unaprijedio detekciju tumora.

So how does this work?

Dakle, kako ovo radi?

The patient receives an injection of a radio tracer

Pacijentu se ubrizga radio tragač

that's taken up by rapidly proliferating tumor cells,

kojeg primaju brzorastuće tumorske stanice,

but not by normal cells,

ali ne i normalne stanice.

and this is the key difference from mammography.

I ovo je ključna razlika od mamografije.

Mammography relies on differences

Mamografija se oslanja na razlici

in the appearance of the tumor from the background tissue,

u izgledu tumora od pozadinskog tkiva,

and we've seen that those differences

a vidjeli smo da te razlike

can be obscured in a dense breast.

mogu biti nejasne u gustoj dojci.

But MBI exploits

Ali MSD koristi

the different molecular behavior of tumors,

drugačije molekularno ponašanje tumora

and therefore, it's impervious to breast density.

i zato je neprohodno za gustoću dojke.

After the injection,

Nakon ubrizgavanja

the patient's breast is placed between the detectors.

dojke pacijentice se smještaju između detektora.

And if you've ever had a mammogram --

I ako ste ikada išli na mamografiju --

if you're old enough to have had a mammogram --

ako ste dovoljno stari da bi išli na mamografiju --

you know what comes next:

znate što je sljedeće:

pain.

bol.

You may be surprised to know

Iznenadit ćete se kad čujete

that mammography is the only radiologic study

da je mamografija jedina radiološka studija

that's regulated by federal law,

koja je regulirana saveznim zakonom

and the law requires

i zakon zahtijeva

that the equivalent of a 40-pound car battery

ekvivalent od 18 kilograma automobilske baterije

come down on your breast during this study.

da vam se spusti na dojke tijekom ove studije.

But with MBI,

Ali s MSD-om,

we use just light, pain-free compression.

koristimo samo laganu, bezbolnu kompresiju.

(Applause)

(Pljesak)

And the detector

I nakon toga detektor

then transmits the image to the computer.

šalje sliku na računalo.

So here's an example.

Ovdje je primjer.

You can see, on the right, a mammogram

Desno možete vidjeti mamografiju

showing a faint tumor,

koja pokazuje nejasan tumor,

the edges of which are blurred by the dense tissue.

čiji su rubovi nejasni zbog gustog tkiva.

But the MBI image shows that tumor much more clearly,

Ali MSD slika nam jasnije pokazuje tumor,

as well as a second tumor,

baš kao i drugi tumor

which profoundly influence that patient's surgical options.

koji veoma utječe na kirurške opcije te pacijentice.

In this example, although the mammogram found one tumor,

U ovom primjeru, iako je mamograf pronašao jedan tumor,

we were able to demonstrate three discrete tumors --

možemo demonstrirati tri diskretna tumora --

one is small as three millimeters.

jedan je velik svega tri milimetra.

Our big break came in 2004.

Naš se veliki uspjeh dogodio 2004.

After we had demonstrated that we could find small tumors,

Nakon što smo demonstrirali da možemo pronaći male tumore,

we used these images

upotrijebili smo ove slike

to submit a grant to the Susan G. Komen Foundation.

da podnesemo subvenciju za Zakladu Susan G. Komen.

And we were elated when they took a chance

Bili smo ushićeni kada su riskirali

on a team of completely unknown investigators

i uzeli ekipu potpuno nepoznatih istraživača

and funded us to study

i osnovali nas da proučimo

1,000 women with dense breasts,

1.000 žena s gustim dojkama,

comparing a screening mammogram to an MBI.

uspoređujući probir mamografa i MSD-a.

Of the tumors that we found,

Od tumora koje smo pronašli,

mammography found

mamografija je pronašla

only 25 percent of those tumors.

samo 25% tih tumora.

MBI found 83 percent.

MSD je pronašao 83%.

Here's an example from that screening study.

Evo primjera te probirne studije.

The digital mammogram was read as normal

Digitalna mamografija je pročitana kao normalna

and shows lots of dense tissue,

i pokazuje nam mnogo gustog tkiva,

but the MBI shows an area of intense uptake,

ali MSD pokazuje područje intenzivnog obuhvaćanja,

which correlated with a two-centimeter tumor.

što korelira s tumorom od dva centimetra.

In this case, a one-centimeter tumor.

U ovom slučaju, tumor od jednog centimetra.

And in this case,

A u ovom slučaju,

a 45-year-old medical secretary at Mayo,

45-ogodišnja medicinska tajnica u Mayo klinici

who had lost her mother to breast cancer when she was very young,

koja je izgubila majku zbog karcinoma dojke kada je bila veoma mlada,

wanted to enroll in our study.

željela je sudjelovati u našoj studiji.

And her mammogram showed an area of very dense tissue,

Njena mamografija je pokazala područje veoma gustog tkiva,

but her MBI showed an area

ali njen MSD je pokazao područje

of worrisome uptake,

zabrinjavajućeg obuhvaćanja

which we can also see on a color image.

koji također vidimo i na slici u boji.

And this corresponded

A to korelira

to a tumor the size of a golf ball.

s tumorom veličine loptice za golf.

But fortunately it was removed

Ali srećom,

before it had spread to her lymph nodes.

odstranjen je prije no što se proširio na njene limfne čvorove.

So now that we knew that this technology

Dakle, sada kada smo znali da ova tehnologija

could find three times more tumors in a dense breast,

može pronaći tri puta više tumora u gustoj dojci,

we had to solve one very important problem.

morali smo riješiti jedan veoma važan problem.

We had to figure out how to lower the radiation dose,

Morali smo smisliti kako smanjiti dozu zračenja.

and we have spent the last three years

I proveli smo posljednje tri godine

making modifications to every aspect of the imaging system

praveći modifikacije svakog aspekta u sustavu snimanja

to allow this.

da bi ovo dozvolili.

And I'm very happy to report that we're now using a dose of radiation

I veoma sam sretna što vam mogu priopćiti da sada koristimo dozu zračenja

that is equivalent to the effective dose

koja je jednaka efektivnoj dozi

from one digital mammogram.

jedne digitalne mamografije.

And at this low dose, we're continuing this screening study,

I u ovoj niskoj dozi, nastavljamo probirnu studiju,

and this image from three weeks ago

a ovo je slika od prije tri tjedna

in a 67-year-old woman

koja pokazuje normalnu digitalnu mamografiju

shows a normal digital mammogram,

kod 67-ogodišnje žene,

but an MBI image

ali MSD slika

showing an uptake that proved to be a large cancer.

pokazuje mjesto za koje se dokazalo da je veliki karcinom.

So this is not just young women that it's benefiting.

Dakle, ovo ne koristi samo mladim ženama.

It's also older women with dense tissue.

Već također i starijim ženama s gustim tkivom.

And we're now routinely using one-fifth the radiation dose

Sada rutinski koristimo petinu doze zračenja

that's used in any other type of gamma technology.

koja se koristi u bilo kojoj drugoj vrsti gama tehnologije.

MBI generates four images per breast.

MSD daje četiri slike po dojci.

MRI generates over a thousand.

Magnetna rezonanca ih daje više od tisuću.

It takes a radiologist

Radiologu trebaju

years of specialty training

godine posebne obuke

to become expert in differentiating

da bi postao stručnjak u diferencijaciji

the normal anatomic detail

normalnog anatomskog detalja

from the worrisome finding.

od zabrinjavajućeg.

But I suspect even the non-radiologists in the room

Ali slutim da čak i ne-radiolozi u sobi

can find the tumor on the MBI image.

mogu naći tumor na MSD slici.

But this is why MBI

Ali ovo je razlog zašto je MSD

is so potentially disruptive --

tako potencijalno poremećen.

it's as accurate as MRI,

Precizan je poput magnetne rezonance,

it's far less complex to interpret,

mnogo je jednostavniji za interpretaciju

and it's a fraction of the cost.

i manje košta.

But you can understand why there may be

Ali možete razumijeti zašto mogu postojati

forces in the breast-imaging world

snage u svijetu snimanja dojke

who prefer the status quo.

koje preferiraju status quo.

After achieving what we felt were remarkable results,

Nakon što smo postigli sjajne rezultate,

our manuscript was rejected

četiri časopisa odbila su

by four journals.

naš rukopis.

After the fourth rejection,

Nakon četvrte odbijenice,

we requested reconsideration of the manuscript,

zatražili smo ponovno razmatranje rukopisa

because we strongly suspected

jer smo sumnjali

that one of the reviewers who had rejected it

da je jedan od recenzenata koji nas je odbio

had a financial conflict of interest

imao financijski sukob interesa

in a competing technology.

s konkurirajućom tehnologijom.

Our manuscript was then accepted

Naš rukopis je tada prihvaćen

and will be published later this month

i bit će objavljen kasnije ovog mjeseca

in the journal Radiology.

u časopisu Radiologija.

(Applause)

(Pljesak)

We still need to complete the screening study using the low dose,

Još trebamo dovršiti probirnu studiju upotrebljavajući nisku dozu

and then our findings will need to be replicated

i onda će naši nalazi biti ponovljeni

at other institutions,

u drugim ustanovama.

and this could take five or more years.

I to bi moglo potrajati pet godina ili više.

If this technology is widely adopted,

Ako ova tehnologija bude širom prihvaćena,

I will not benefit financially in any way,

neću imati nikakve financijske koristi od nje na ikoji način.

and that is very important to me,

A to mi je veoma važno

because it allows me to continue to tell you the truth.

zato što mi dopušta da vam nastavim govoriti istinu.

But I recognize --

Ali prepoznajem --

(Applause)

(Pljesak)

I recognize that the adoption of this technology

Prepoznajem da će usvajanje ove tehnologije

will depend as much on economic

ovisiti o ekonomskim

and political forces

i političkim snagama

as it will on the soundness of the science.

kao i o čvrstoći znanosti.

The MBI unit has now been FDA approved,

MSD zajednica je sada odobrena od strane FDA,

but it's not yet widely available.

ali još nije naširoko dostupna.

So until something is available

Dakle dok nešto ne bude dostupno

for women with dense breasts,

za žene s gustim dojkama,

there are things that you should know

postoje stvari koje trebate znati

to protect yourself.

da bi se zaštitili.

First, know your density.

Prvo, znajte svoju gustoću.

Ninety percent of women don't,

90% žena ne zna,

and 95 percent of women don't know

a 95% žena ne zna

that it increases your breast cancer risk.

da povećava rizik od karcinoma dojke.

The State of Connecticut became the first and only state

Država Connecticut je postala prva i jedina država

to mandate that women receive notification

koja zahtijeva da žene dobiju obavijest

of their breast density

o gustoći dojke

after a mammogram.

nakon mamografije.

I was at a conference of 60,000 people in breast-imaging

Bila sam na konferenciji sa 60.000 ljudi u vezi snimanja dojki,

last week in Chicago,

prošlog tjedna u Chicagu.

and I was stunned that there was a heated debate

I bila sam zapanjena da je tamo bila užarena rasprava

as to whether we should be telling women

o tome da li ženama treba govoriti

what their breast density is.

kakva im je gustoća dojki.

Of course we should.

Naravno da treba.

And if you don't know, please ask your doctor

A ako ne znate, molim vas, pitajte svog doktora

or read the details of your mammography report.

da vam pročita detalje vaše mamografije.

Second, if you're pre-menopausal,

Drugo, ako ste pred menopauzom,

try to schedule your mammogram

pokušajte zakazati svoju mamografiju

in the first two weeks of your menstrual cycle,

u prva dva tjedna menstrualnog ciklusa

when breast density is relatively lower.

kada je gustoća dojke relativno niža.

Third, if you notice a persistent change in your breast,

Treće, ako primijetite ustrajnu promjenu na vašim grudima,

insist on additional imaging.

inzistirajte na dodatnom snimanju.

And fourth and most important,

I četvrto i najvažnije,

the mammography debate will rage on,

debata oko mamografije će i dalje bjesniti,

but I do believe that all women 40 and older

ali vjerujem da sve žene s 40 i više

should have an annual mammogram.

trebaju imati godišnju mamografiju.

Mammography isn't perfect,

Mamografija nije savršena,

but it's the only test that's been proven

ali je to jedini test kojim je dokazano

to reduce mortality from breast cancer.

smanjenje smrtnosti od raka dojke.

But this mortality banner

Ali ova smrtna zastava

is the very sword

je sami mač

which mammography's most ardent advocates use

koju mamografski najžešći odvjetnici koriste

to deter innovation.

da zadrže inovacije.

Some women who develop breast cancer

Neke žene koje razviju rak dojke

die from it many years later,

umru mnogo godina kasnije.

and most women, thankfully, survive.

A većina žena, hvala Bogu, preživi.

So it takes 10 or more years

Potrebno je 10 ili više godina

for any screening method

za bilo koju probirnu metodu

to demonstrate a reduction

da bi dokazala smanjenje

in mortality from breast cancer.

smrtnosti od raka dojke.

Mammography's the only one that's been around long enough

Mamografija je jedina koja je tu negdje dovoljno dugo

to have a chance of making that claim.

da bi imala priliku napraviti takav zahtjev.

It is time for us to accept

Vrijeme nam je da prihvatimo

both the extraordinary successes of mammography

i izvanredne uspjehe mamografije

and the limitations.

i ograničenja.

We need to individualize screening

Trebamo individualizirati probir

based on density.

ovisno o gustoći.

For women without dense breasts,

Za žene bez gustih dojki,

mammography is the best choice.

mamografija je najbolji odabir.

But for women with dense breasts;

Ali za žene s gustim dojkama

we shouldn't abandon screening altogether,

ne bismo svi skupa trebali napustiti probir,

we need to offer them something better.

trebamo ponuditi nešto bolje.

The babies that we were carrying

Djeca koju smo nosile

when my patient first asked me this question

kada me pacijentica upitala pitanje

are now both in middle school,

su sada u srednjoj školi,

and the answer has been so slow to come.

a odgovor presporo dolazi.

She's given me her blessing

Dala mi je svoj blagoslov

to share this story with you.

da podijelim ovu priču s vama.

After undergoing biopsies

Nakon biopsija koje su u tijeku

that further increased her risk for cancer

i kasnije povećale njen rizik od raka

and losing her sister to cancer,

i toga što je izgubila sestru od raka,

she made the difficult decision

donijela je tešku odluku

to have a prophylactic mastectomy.

da napravi profilaktičnu mastektomiju.

We can and must do better,

Možemo i moramo bolje,

not just in time for her granddaughters

ne samo na vrijeme za njene unuke

and my daughters,

i moje kćeri,

but in time for you.

već na vrijeme za vas.

Thank you.

Hvala vam.

(Applause)

(Pljesak)