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

Prevodilac: Tanja Kostadinović Lektor: Ivana Korom

There are two groups of women

Postoje dve grupe žena

when it comes to screening mammography --

kada je mamografija u pitanju:

women in whom mammography works very well

žene kod kojih mamografija odlično funkcioniše

and has saved thousands of lives

i spasila je hiljade života

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

i žene kod kojih uopšte ne funkcioniše dobro.

Do you know which group you're in?

Da li znate kojoj grupi pripadate?

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

Ako ne znate, niste usamljene.

Because the breast has become

Zato što su grudi postale

a very political organ.

u velikoj meri politizovan organ.

The truth has become lost

Istina se izgubila

in all the rhetoric

u svoj toj retorici

coming from the press, politicians,

novinara, političara

radiologists

radiologa

and medical imaging companies.

i medicinskih kompanija.

I will do my best this morning

Daću sve od sebe ovog jutra

to tell you what I think is the truth.

da vam kažem ono što smatram da je istina.

But first, my disclosures.

Ali najpre, moje stanovište.

I am not a breast cancer survivor.

Ja nisam preživela rak.

I'm not a radiologist.

Nisam radiolog.

I don't have any patents,

Nemam nikakav patent,

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

i nisam nikada primila novac od medicinske kompanije.

and I am not seeking your vote.

I ne tražim vaš glas.

(Laughter)

(Smeh)

What I am

Ja sam

is a doctor of internal medicine

doktorka interne medicine

who became passionately interested in this topic

koja je postala veoma zainteresovana za ovu temu

about 10 years ago

pre oko 10 godina

when a patient asked me a question.

kada mi je pacijentkinja postavila pitanje.

She came to see me

Došla je kod mene

after discovering a breast lump.

nakon što je otkrila čvorić na dojci.

Her sister had been diagnosed with breast cancer

Njenoj sestri je već bio dijagnostikovan rak dojke

in her 40s.

u njenim četrdesetim.

She and I were both very pregnant at that time,

I ona i ja smo bile u odmakloj trudnoći u to vreme,

and my heart just ached for her,

i srce me je bolelo zbog nje,

imagining how afraid she must be.

kad sam zamislila koliko je uplašena.

Fortunately, her lump proved to be benign.

Na svu sreću, ispostavilo se da je njen čvorić bio benigan.

But she asked me a question:

Ali mi je postavila pitanje:

how confident was I

koliko sam sigurna

that I would find a tumor early on her mammogram

da ću pronaći tumor u ranoj fazi na mamografu

if she developed one?

ako ga ima?

So I studied her mammogram,

Tako da sam prostudirala njen mamograf,

and I reviewed the radiology literature,

i radiološku literaturu,

and I was shocked to discover

i bila sam šokirana kada sam otkrila

that, in her case,

da, u njenom slučaju,

our chances of finding a tumor early on the mammogram

šanse za pronalaženje ranog tumora na mamografu

were less than the toss of a coin.

su bile manje nego da bacamo novčić.

You may recall a year ago

Možda se sećate pre nekoliko godina

when a firestorm erupted

kada se digla buka

after the United States Preventive Services Task Force

kada je Radna grupa za prevenciju Sjedninjenih Država

reviewed the world's mammography screening literature

revidovala svetsku literaturu o skeniranju mamografom

and issued a guideline

i izdala smernice

recommending against screening mammograms

koje preporučuju da se mamografija ne radi

in women in their 40s.

ženama u četrdesetim.

Now everybody rushed to criticize the Task Force,

Svi su požurili da kritikuju Radnu grupu,

even though most of them weren't in anyway familiar

iako većina njih nije ni na koji način bila

with the mammography studies.

upoznata sa studijama o mamografiji.

It took the Senate just 17 days

Senatu je trebalo samo 17 dana

to ban the use of the guidelines

da zabrani upotrebu ovih smernica

in determining insurance coverage.

kao odrednica za određivanje obima osiguranja.

Radiologists were outraged

Radiolozi su bili besni

by the guidelines.

zbog smernica.

The pre-eminent mammographer in the United States

Istaknuti stručnjak za mamografiju u SAD

issued the following quote

je dao sledeću izjavu

to the Washington Post.

"Vašington Postu".

The radiologists were, in turn, criticized

Sa druge strane, radiolozi su bili kritikovani

for protecting their own financial self-interest.

jer su štitili sopstvene finansijske interese.

But in my view,

Ali po mom mišljenju,

the radiologists are heroes.

radiolozi su heroji.

There's a shortage of radiologists

Postoji manjak radiologa

qualified to read mammograms,

kvalifikovanih za čitanje mamograma

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

i to je zbog toga što su mamogrami jedni od najkompleksnijih

of all radiology studies to interpret,

radioloških studija za interpretaciju,

and because radiologists

i zato što radiolozi

are sued more often

su tuženi češće

over missed breast cancer

zbog raka dojke koji su prevideli

than any other cause.

nego iz bilo kog drugog razloga.

But that very fact is telling.

Ali sama ta činjenica nam nešto govori.

Where there is this much legal smoke,

Tamo gde ima mnogo 'pravničkog' dima,

there is likely to be some fire.

verovatno ima i vatre.

The factor most responsible for that fire

Faktor koji je najveći uzročnik te vatre

is breast density.

je gustina tkiva dojke.

Breast density refers to the relative amount of fat --

Gustina tkiva se odnosi na odnos količine masnog tkiva...

pictured here in yellow --

ovde prikazane žutom bojom...

versus connective and epithelial tissues --

prema vezivnom i epitelnom tkivu...

pictured in pink.

koje je prikazano roze bojom.

And that proportion

I taj odnos

is primarily genetically determined.

je uglavnom određen genetikom.

Two-thirds of women in their 40s

Dve trećine žena u četrdesetim godinama

have dense breast tissue,

ima gusto tkivo dojke

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

i zbog toga mamografija kod njih ne funkcioniše tako dobro.

And although breast density generally declines with age,

Iako gustina tkiva dojke uglavnom opada sa starošću,

up to a third of women

i do 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?

Prema tome, kako znate da su vaše grudi 'guste'?

Well, you need to read the details

Pa, treba da čitate detalje

of your mammography report.

vašeg mamografskog izveštaja.

Radiologists classify breast density

Radiolozi klasifikuju gustinu tkiva dojke

into four categories

na četiri kategorije

based on the appearance of the tissue on a mammogram.

prema izgledu tkiva na mamogramu.

If the breast is less than 25 percent dense,

Ako dojka ima gustinu manju od 25 procenata

that's called fatty-replaced.

smatra se da je ispunjena masnim tkivom.

The next category

Sledeća kategorija

is scattered fibroglandular densities,

ima raštrkane fibroglandularne mase,

followed by heterogeneously dense

praćena heterogeno gustom

and extremely dense.

i ekstremno gustom.

And breasts that fall into these two categories

I grudi koje spadaju u ove dve kategorije

are considered dense.

se smatraju gustim.

The problem with breast density

Problem sa gustinom dojki

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

je što je to vuk u ovčijoj koži.

Both tumors and dense breast tissue

I tumori i gusto tkivo dojke

appear white on a mammogram,

izgledaju belo na mamogramu

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

i rendgen često ne može da napravi razliku između ta dva.

So it's easy to see this tumor

Tako da je lako uočiti tumor

in the upper part of this fatty breast.

na gornjem delu ove dojke sa masnim tkivom.

But imagine how difficult it would be

Ali zamislite kako bi bilo teško

to find that tumor in this dense breast.

naći tumor u ovoj dojci sa gustim tkivom.

That's why mammograms find

Zato mamografi pronalaze

over 80 percent of tumors in fatty breasts,

preko 80 procenata tumora u dojkama sa masnim tkivom,

but as few as 40 percent in extremely dense breasts.

ali manje od 40 procenata u dojkama sa veoma gustim tkivom.

Now it's bad enough that breast density

Sad, dovoljno je loše to što gustina tkiva dojke

makes it hard to find a cancer,

otežava pronalaženje raka,

but it turns out

ali ispostavilo se

that it's also a powerful predictor

da je takođe i veoma jak faktor

of your risk for breast cancer.

rizika za dobijanje raka dojke.

It's a stronger risk factor

To je veći faktor rizika

than having a mother or a sister with breast cancer.

nego imati majku ili sestru sa rakom dojke.

At the time my patient posed this question to me,

U vreme kada mi je pacijentkinja postavila ovo pitanje,

breast density was an obscure topic

gustina tkiva dojke je bila nepoznata tema

in the radiology literature,

u radiološkoj literaturi

and very few women having mammograms,

i veoma malo žena koje su išle na mamografiju,

or the physicians ordering them,

i lekara koji su ih vodili,

knew about this.

su znali za ovo.

But what else could I offer her?

Ali šta sam joj drugo mogla ponuditi?

Mammograms have been around since the 1960's,

Mamografi su tu od 1960-ih.

and it's changed very little.

I veoma malo se promenilo.

There have been surprisingly few innovations,

Bilo je iznenađujuće malo inovacija,

until digital mammography was approved

dok digitalna mamografija nije bila odobrena

in 2000.

u 2000.

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

Digitalna mamografija je i dalje rendgensko snimanje dojke,

but the images

ali slike

can be stored and manipulated digitally,

mogu biti čuvane i obrađivane digitalno,

just like we can with a digital camera.

kao što bi se to radilo na digitalnom foto-aparatu.

The U.S. has invested

SAD su investirale

four billion dollars

četiri milijarde dolara

converting to digital mammography equipment,

u prelazak na digitalnu mamografiju.

and what have we gained from that investment?

I šta smo dobili od te investicije?

In a study funded by over 25 million taxpayer dollars,

U studiji koju je finansiralo 25 miliona dolara od poreza,

digital mammography was found

zaključeno je da digitalna mamografija

to be no better over all

u celini uzev nije bolja

than traditional mammography,

od tradicionalne mamografije.

and in fact, it was worse in older women.

I zapravo je lošija kod starijih žena.

But it was better in one group,

Ali bila je bolja kod jedne grupe

and that was women under 50

a to su žene mlađe od 50 godina

who were pre-menopausal and had dense breasts,

koje još nisu ušle u menopauzu i imaju gusto tkivo dojke.

and in those women,

I kod tih žena

digital mammography found twice as many cancers,

digitalna mamografija je pronašla duplo više tumora

but it still only found 60 percent.

ali je i dalje pronašla samo 60 procenata.

So digital mammography

Tako da je digitalna mamografija

has been a giant leap forward

bila veliki korak napred

for manufacturers

za proizvođače

of digital mammography equipment,

opreme za digitalnu mamografiju,

but it's been a very small step forward for

ali je bila veoma mali korak napred

womankind.

za žene.

What about ultrasound?

A šta je sa ultrazvukom?

Ultrasound generates more biopsies

Ultrazvuk generiše više biopsija

that are unnecessary relative to other technologies,

koje su nepotrebne u odnosu na druge tehnologije,

so it's not widely used.

tako da nema široku upotrebu.

And MRI is exquisitely sensitive for finding tumors,

Magnetna rezonanca je izuzetno precizna za pronalaženje tumora,

but it's also very expensive.

ali je takođe veoma skupa.

If we think about disruptive technology,

Ako pomislimo na tehnologiju

we see an almost ubiquitous pattern

imamo skoro opšti princip

of the technology getting smaller and less expensive.

da se tehnologija smanjuje i postaje jeftinija.

Think about iPods compared to stereos.

Pogledajte iPod u poređenju sa muzičkim stubom.

But it's the exact opposite in health care.

Ali u zdravstvu je proces obrnut.

The machines get ever bigger

Mašine se stalno povećavaju

and ever more expensive.

i postaju skuplje.

Screening the average young woman with an MRI

Skenirati prosečnu mladu ženu magnetnom rezonancom

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

je u neku ruku kao voziti se Hamerom u samoposlugu.

It's just way too much equipment.

To je jednostavno suviše opreme.

One MRI scan

Jedno skeniranje magnetnom rezonancom

costs 10 times what a digital mammogram costs.

košta 10 puta više nego digitalni mamograf.

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

I pre ili kasnije, moraćemo da prihvatimo činjenicu

that health care innovation

da inovacija u zdravstvu

can't always come at a much higher price.

ne može uvek doći po mnogo višoj ceni.

Malcolm Gladwell wrote an article in the New Yorker

Malkolm Gledvel je napisao članak u ''Njujorkeru''

on innovation,

na temu inovacije,

and he made the case that scientific discoveries

i njegovo stanovište je da su naučna otkrića

are rarely the product of one individual's genius.

retko proizvod individualnog genija.

Rather, big ideas can be orchestrated,

Nasuprot tome, velike ideje mogu biti orkestrirane,

if you can simply gather

ako jednostavno skupite

people with different perspectives in a room

ljude sa različitim pogledima u jednu prostoriju

and get them to talk about things

i navedete ih da razgovaraju o stvarima

that they don't ordinarily talk about.

o kojima obično ne razgovaraju.

It's like the essence of TED.

To je kao suština TED-a.

He quotes one innovator who says,

On citira jednog pronalazača koji kaže:

"The only time a physician and a physicist get together

''Jedini put kada se lekar i fizičar sretnu

is when the physicist gets sick."

je kada se fizičar razboli.''

(Laughter)

(Smeh)

This makes no sense,

Ovo nema nikakvog smisla,

because physicians have all kinds of problems

jer lekari imaju raznorazne probleme

that they don't realize have solutions.

za koje ni ne znaju da postoje rešenja.

And physicists have all kinds of solutions for things

A fizičari imaju razna rešenja za stvari

that they don't realize are problems.

za koje ne shvataju da su problemi.

Now, take a look at this cartoon

Sad, pogledajte ovu ilustraciju

that accompanied Gladwell's article,

koja je pratila Gledvelov članak,

and tell me if you see something disturbing

i recite mi da li vidite nešto uznemirujuće

about this depiction of innovative thinkers.

u opisu inovativnih mislilaca.

(Laughter)

(Smeh)

So if you will allow me a little creative license,

Tako da ako mi date malo kreativnog prostora,

I will tell you the story

ispričaću vam priču

of the serendipitous collision

o sudbinskom susretu

of my patient's problem

problema moje pacijentkinje

with a physicist's solution.

i rešenja fizičara.

Shortly after her visit,

Ubrzo nakon njene posete,

I was introduced to a nuclear physicist

upoznala sam nuklearnog fizičara

at Mayo

na Majo klinici

named Michael O'Conner,

po imenu Majkl O'Koner,

who was a specialist in cardiac imaging,

koji je bio specijalista za kardiološko snimanje,

something I had nothing to do with.

nešto što sa mnom nije imalo nikakve veze.

And he happened to tell me

I on mi je slučajno ispričao

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

o konferenciji u Izraelu sa koje se upravo vratio,

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

gde su pričali o novom tipu gama detektora.

Now gamma imaging has been around for a long time

Sad, gama snimanje se koristi već dugo

to image the heart,

za snimanje srca,

and it had even been tried to image the breast.

i čak je bilo isprobano za snimanje dojki.

But the problem was

Ali problem je bio u tome

that the gamma detectors

što su gama detektori

were these huge, bulky tubes,

ogromne, glomazne cevi

and they were filled with these scintillating crystals,

i ispunjene su ovim svetlucavim kristalima,

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

i niste ih jednostavno mogli dovoljno približiti dojci

to find small tumors.

da bi pronašli male tumore.

But the potential advantage was

Ali potencijalna prednost je bila u tome

that gamma rays, unlike X-rays,

da na gama zrake, za razliku od rendgenskih,

are not influenced by breast density.

ne utiče gustina tkiva.

But this technology

Ali ova tehnoogija

could not find tumors when they're small,

nije mogla naći male tumore.

and finding a small tumor is critical for survival.

A nalaženje malih tumora je krucijalno za preživljavanje.

If you can find a tumor

Ako možete pronaći tumor

when it's less than a centimeter,

kada je manji od centimetra,

survival exceeds 90 percent,

verovatnoća da se preživi je preko 90 procenata

but drops off rapidly

ali ona strmo opada

as tumor size increases.

kako se veličina tumora povećava.

But Michael told me about

Ali Majkl mi je ispričao o

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

novom tipu gama detektora koji je video

and this is it.

i to je to.

It's made

Napravljen je

not of a bulky tube,

ne od glomazne cevi

but of a thin layer of a semiconductor material

već od tankog sloja poluprovodljivog materijala

that serves as the gamma detector.

koji funkcioniše kao gama detektor.

And I started talking to him

I počela sam da razgovaram sa njim

about this problem with breast density,

o problemu gustine tkiva dojke,

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

i shvatili smo da bi ovaj detektor mogli

close enough around the breast

dovoljno približiti grudima

to actually find small tumors.

da bi zaista našli male tumore.

So after putting together

Nakon što smo napravili

a grid of these cubes with tape --

raster od ovih kocki povezanih lepljivom trakom -

(Laughter)

(Smeh)

-- Michael hacked off the X-ray plate

- Majkl je skinuo rendgensku ploču

of a mammography machine

sa mamografa

that was about to be thrown out,

koji je bio škartiran.

and we attached the new detector,

I pričvrstili smo novi detektor,

and we decided to call this machine

i odlučili smo da nazovemo ovu mašinu

Molecular Breast Imaging, or MBI.

Molekularni skener dojke, odnosno MSD.

This is an image from our first patient.

Ovo je snimak naše prve pacijentkinje.

And you can see, using the old gamma technology,

Kao što možete videti, koristeći staru gama tehnologiju,

that it just looked like noise.

izgleda kao šum.

But using our new detector,

Ali koristeći naš novi detektor,

we could begin to see the outline of a tumor.

mogli smo videti obrise tumora.

So here we were, a nuclear physicist,

Tako da eto nas, nukleani fizičar,

an internist,

internista

soon joined by Carrie Hruska, a biomedical engineer,

kojima se uskoro pridružila Keri Hraška, biomedicinski inženjer,

and two radiologists,

i dvoje radiologa,

and we were trying to take on

i pokušavali smo da se suprotstavimo

the entrenched world of mammography

krutom svetu mamografije

with a machine that was held together by duct tape.

sa mašinom koja je bila sastavljena lepljivom trakom.

To say that we faced

Reći da smo se suočili

high doses of skepticism

sa velikom količinom skepticizma

in those early years

u tim ranim godinama

is just a huge understatement,

je blago rečeno.

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

Ali bili smo tako ubeđeni da možemo da učinimo da ovo finkcioniše

that we chipped away with incremental modifications

da smo nastavljali dalje sa postepenim modifikacijama

to this system.

sistema.

This is our current detector.

Ovo je naš trenutni detektor.

And you can see that it looks a lot different.

I možete videti da izgleda dosta drugačije.

The duct tape is gone,

Nema više lepljive trake,

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

i dodali smo drugi detektor na gornji deo dojke,

which has further improved our tumor detection.

koji je dodatno poboljšao detekciju tumora.

So how does this work?

Kako ovo zapravo funkcioniše?

The patient receives an injection of a radio tracer

Pacijent dobije injekciju radioaktivnog materijala koji obeležava

that's taken up by rapidly proliferating tumor cells,

i koji upijaju ćelije tumora koje se brzo dele

but not by normal cells,

a ne upijaju ga normalne ćelije.

and this is the key difference from mammography.

I ovo je osnovna razlika u odnosu na mamografiju.

Mammography relies on differences

Mamografija se oslanja na razlike

in the appearance of the tumor from the background tissue,

u izgledu između tumora i okolnog tkiva,

and we've seen that those differences

i videli smo da ove razlike

can be obscured in a dense breast.

mogu biti zanemarljive kod dojki sa gustim tkivom.

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 zbog toga je imun na problem gustine tkiva dojke.

After the injection,

Posle injekcije,

the patient's breast is placed between the detectors.

grudi pacijenta se postave između detektora.

And if you've ever had a mammogram --

I ako ste ikada radili mamogram -

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

ako ste dovoljno stari da ste radili mamogram -

you know what comes next:

znate šta sledi:

pain.

bol.

You may be surprised to know

Možda ćete biti iznenađeni

that mammography is the only radiologic study

da je mamografija jedina radiloška studija

that's regulated by federal law,

koja je regulisana federalnim zakonom,

and the law requires

i zakon zahteva

that the equivalent of a 40-pound car battery

da se uređaj ekvivalentan akumulatoru od oko 18kg

come down on your breast during this study.

spusti na vašu dojku prilikom ovog pregleda.

But with MBI,

Ali kod MSD

we use just light, pain-free compression.

mi koristimo lak, bezbolni pritisak.

(Applause)

(Aplauz)

And the detector

I detektor

then transmits the image to the computer.

onda prenosi sliku na računar.

So here's an example.

Prema tome, evo primera.

You can see, on the right, a mammogram

Možete videti na desnoj strani mamogram

showing a faint tumor,

koji pokazuje bledi tumor,

the edges of which are blurred by the dense tissue.

čije su ivice zamućene gustim tkivom dojke.

But the MBI image shows that tumor much more clearly,

Ali MSD pokazuje ovaj tumor mnogo jasnije,

as well as a second tumor,

kao i još jedan tumor,

which profoundly influence that patient's surgical options.

što suštinski utiče na pacijentove mogućnosti za operaciju.

In this example, although the mammogram found one tumor,

U ovom primeru, iako je mamograf našao jedan tumor,

we were able to demonstrate three discrete tumors --

mi smo mogli da pokažemo tri mala tumora...

one is small as three millimeters.

jedan je veličine 3 milimetra.

Our big break came in 2004.

Naš veliki proboj je došao u 2004.

After we had demonstrated that we could find small tumors,

Nakon što smo pokazali da možemo pronaći male tumore,

we used these images

iskoristili smo ove snimke

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

da se prijavimo za finansiranje Suzan G. Komen fondacije.

And we were elated when they took a chance

I bili smo oduševljeni kada su dali šansu

on a team of completely unknown investigators

timu potpuno nepoznatih istraživača

and funded us to study

i finansirali nas da proučimo

1,000 women with dense breasts,

1.000 žena sa gustim tkivom dojke,

comparing a screening mammogram to an MBI.

poredeći mamografsko snimanje sa našim MSD.

Of the tumors that we found,

Od tumora koje smo pronašli,

mammography found

mamograf je pronašao

only 25 percent of those tumors.

samo 25 procenata.

MBI found 83 percent.

MSD je pronašao 83 procenata.

Here's an example from that screening study.

Evo primera iz te studije.

The digital mammogram was read as normal

Digitalni mamogram je bio crven kao i obično

and shows lots of dense tissue,

i pokazuje dosta gustog tkiva,

but the MBI shows an area of intense uptake,

ali MSD pokazuje prostor intenzivne boje,

which correlated with a two-centimeter tumor.

koji odgovara tumoru 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,

četrdesetpetogodišnja medicinska sekretarica u Maju,

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

koja je izgubila majku zbog raka dojke kad je bila veoma mala,

wanted to enroll in our study.

je želela da bude deo naše studije.

And her mammogram showed an area of very dense tissue,

I njen mamogram je pokazivao predeo sa veoma gustim tkivom,

but her MBI showed an area

ali je njen MSD pokazao deo

of worrisome uptake,

sa zabinjavajućim intenzitetom

which we can also see on a color image.

koji vidimo i na snimku u boji.

And this corresponded

I ovo je odgovaralo

to a tumor the size of a golf ball.

tumoru velikom kao loptica za golf.

But fortunately it was removed

Ali, na svu sreću, bio je odstranjen

before it had spread to her lymph nodes.

pre nego što se proširio na njene limfne čvorove.

So now that we knew that this technology

I sad kad smo znali da ova tehnologija

could find three times more tumors in a dense breast,

može pronaći tri puta više tumora kod dojki sa gustim tkivom,

we had to solve one very important problem.

morali smo da rešimo veoma bitan problem.

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

Trebalo je da smislimo kako da smanjimo dozu radijacije.

and we have spent the last three years

I proveli smo poslednje tri godine

making modifications to every aspect of the imaging system

menjajući svaki aspekt sistema za snimanje

to allow this.

da bi ovo omogućili.

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

I srećna sam što mogu da vam saopštim da sad koristimo dozu radijacije

that is equivalent to the effective dose

koja je ekvivalentna efektivnoj dozi

from one digital mammogram.

jednog digitalnog mamografa.

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

I pri ovoj maloj dozi smo nastavili studiju

and this image from three weeks ago

i ovaj snimak od pre tri nedelje

in a 67-year-old woman

kod šezdesetsedmogodišnje žene

shows a normal digital mammogram,

pokazuje normalni digitalni mamogram,

but an MBI image

ali MSD snimak

showing an uptake that proved to be a large cancer.

pokazuje mrlju koja se pokazala kao veliki tumor.

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

Tako da nemaju samo mlade žene koristi od ovoga.

It's also older women with dense tissue.

Imaju i starije žene sa gustim tkivom dojke.

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

I sada rutiski koristimo jednu petinu doze radijacije

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

koja se koristi u bilo kom drugom tipu gama tehnologije.

MBI generates four images per breast.

MSD pravi po četiri slike za svaku dojku.

MRI generates over a thousand.

Magnetna rezonanca preko hiljadu.

It takes a radiologist

Radiologu su potrebne

years of specialty training

godine specijalističke obuke

to become expert in differentiating

da bi postao stručnjak u razlikovanju

the normal anatomic detail

detalja normalne anatomije

from the worrisome finding.

od zabrinjavajućih nalaza.

But I suspect even the non-radiologists in the room

Ali slutim da bi i oni u prostoriji koji nisu radiolozi

can find the tumor on the MBI image.

mogli naći tumor na MSD snimku.

But this is why MBI

Ali to je razlog zašto je MSD

is so potentially disruptive --

takva potencijalna pretnja.

it's as accurate as MRI,

On je precizan kao i magnetna rezonanca,

it's far less complex to interpret,

mnogo manje složen za tumačenje,

and it's a fraction of the cost.

i za mnogo manju cenu.

But you can understand why there may be

Ali razumete zašto možda postoje

forces in the breast-imaging world

sile u svetu skeniranja dojki

who prefer the status quo.

kojima više odgovara status kvo.

After achieving what we felt were remarkable results,

Nakon što smo postigli nešto za šta smo smatrali da su izuzetni rezultati

our manuscript was rejected

naš rad je bio odbijen

by four journals.

od strane četiri časopisa.

After the fourth rejection,

Posle četvrtog odbijanja,

we requested reconsideration of the manuscript,

tražili smo da se ponovo razmotri naš rad,

because we strongly suspected

jer smo imali izražene sumnje

that one of the reviewers who had rejected it

da je jedan od ocenjivača koji ga je odbio

had a financial conflict of interest

imao finansijski konflikt interesa

in a competing technology.

sa konkurentnom tehnologijom.

Our manuscript was then accepted

Naš rad je onda bio prihvaćen

and will be published later this month

i biće objavljen kasnije ovog meseca

in the journal Radiology.

u časopisu "Radiologija".

(Applause)

(Aplauz)

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

Još treba da završimo studiju koristeći manju dozu

and then our findings will need to be replicated

i onda naši rezultati treba da budu ponovljeni

at other institutions,

u drugim institucijama.

and this could take five or more years.

I to može potrajati pet ili više godina.

If this technology is widely adopted,

Ako ova tehnologija bude široko usvojena,

I will not benefit financially in any way,

ja neću finansijski profitirati ni na koji način.

and that is very important to me,

I to mi je veoma važno

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

jer mogu da nastavim da vam govorim istinu.

But I recognize --

Ali shvatam -

(Applause)

(Aplauz)

I recognize that the adoption of this technology

Shvatam da će primena ove tehnologije

will depend as much on economic

zavisiti koliko od ekonomskih

and political forces

i političkih struja

as it will on the soundness of the science.

toliko i od utemeljenosti nauke.

The MBI unit has now been FDA approved,

MSD je do sada bio odobren od strane administracije za hranu

but it's not yet widely available.

i lekove, ali još uvek nije široko dostupan.

So until something is available

Tako da dok nešto ne bude bilo na raspolaganju

for women with dense breasts,

ženama sa gustim tkivom dojke

there are things that you should know

ima stvari koje treba da znate

to protect yourself.

da bi se zaštitile.

First, know your density.

Prvo, saznajte koliko vam je tkivo gusto.

Ninety percent of women don't,

90 procenata žena to ne zna,

and 95 percent of women don't know

i 95 procenata žena ne zna

that it increases your breast cancer risk.

da im to povećava rizik da dobiju rak.

The State of Connecticut became the first and only state

Država Konektikat je postala prva i jedina država

to mandate that women receive notification

koja propisuje da žene budu obaveštene

of their breast density

o gustini svog tkiva dojke

after a mammogram.

posle mamograma.

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

Bila sam na konferenciji sa 60.000 ljudi koji se bave skeniranjem grudi

last week in Chicago,

prošle nedelje u Čikagu.

and I was stunned that there was a heated debate

I bila sam šokirana kada se razvila žustra rasprava

as to whether we should be telling women

o tome da li treba da govorimo ženama

what their breast density is.

koja je gustina njihovog tkiva dojke.

Of course we should.

Naravno da bi trebalo.

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

I ako ne znate, molim vas, pitajte svog lekara

or read the details of your mammography report.

ili pročitaje detalje svog izveštaja sa mamografije.

Second, if you're pre-menopausal,

Drugo, ako niste još u menopauzi,

try to schedule your mammogram

probajte da zakažete sebi mamogram

in the first two weeks of your menstrual cycle,

u prve dve nedelje menstrualnog ciklusa,

when breast density is relatively lower.

kada je gustina tkiva dojke relativno manja.

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

Treće, ako primetite trajnu promenu na svojoj dojci

insist on additional imaging.

insistirajte na dodatnom snimanju.

And fourth and most important,

I četvrto i najvažnije,

the mammography debate will rage on,

debata o mamografiji će i dalje divljati,

but I do believe that all women 40 and older

ali ja i zaista verujem da bi sve žene od 40 i više godina

should have an annual mammogram.

trebalo da imaju mamogram jednom godišnje.

Mammography isn't perfect,

Mamografija nije savršena,

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

ali je jedini test za koji je dokazano

to reduce mortality from breast cancer.

da smanjuje smrtnost od raka dojke.

But this mortality banner

Ali ovaj barjak smrtnosti

is the very sword

je oružje

which mammography's most ardent advocates use

koje koriste najzagriženiji zagovornici mamografije

to deter innovation.

da spreče inovaciju.

Some women who develop breast cancer

Neke žene kod kojih se razvije rak dojke

die from it many years later,

umru od njega posle mnogo godina.

and most women, thankfully, survive.

A većina žena, na svu sreću, preživi.

So it takes 10 or more years

Tako da treba 10 i više godina

for any screening method

da bilo koji metod snimanja

to demonstrate a reduction

pokaže smanjenje

in mortality from breast cancer.

u smrtnosti od raka dojke.

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

Mamografija je jedina koja već dovoljno dugo postoji

to have a chance of making that claim.

da bi mogla da to tvrdi.

It is time for us to accept

Vreme je da prihvatimo

both the extraordinary successes of mammography

i izuzetne uspehe mamografije

and the limitations.

i njena ograničenja.

We need to individualize screening

Moramo da prilagodimo snimanje

based on density.

gustini.

For women without dense breasts,

Za žene koje nemaju gusto tkivo grudi,

mammography is the best choice.

mamografija je najbolji izbor.

But for women with dense breasts;

Ali za žene koje imaju gusto tkivo,

we shouldn't abandon screening altogether,

ne smemo potpuno odustati od snimanja,

we need to offer them something better.

moramo im ponuditi nešto bolje.

The babies that we were carrying

Bebe koje smo čekale

when my patient first asked me this question

kada mi je pacijentkinja postavila ovo pitanje

are now both in middle school,

sada obe završavaju osnovnu školu,

and the answer has been so slow to come.

i odgovor je došao tako polako.

She's given me her blessing

Dala mi je svoj blagoslov

to share this story with you.

da sa vama podelim ovu priču.

After undergoing biopsies

Nakon biopsija

that further increased her risk for cancer

koje su dodatno povećale njen rizik da oboli od raka

and losing her sister to cancer,

i nakon gubitka sestre zbog raka

she made the difficult decision

donela je tešku odluku

to have a prophylactic mastectomy.

da se podvrgne odstranjivanju dojke.

We can and must do better,

Mi možemo i moramo da učinimo nešto bolje,

not just in time for her granddaughters

ne samo na vreme za njene unuke,

and my daughters,

i moje ćerke,

but in time for you.

već na vreme za vas.

Thank you.

Hvala vam.

(Applause)

(Aplauz)