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

62,064 views ・ 2011-01-06

TED


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翻译人员: Qian Yue 校对人员: Angelia King
00:15
There are two groups of women
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在乳腺X光造影诊断中,
00:18
when it comes to screening mammography --
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有两类女性:
00:20
women in whom mammography works very well
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X光造影诊断对其中一类十分有效,
00:23
and has saved thousands of lives
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已经拯救了数千人的生命;
00:25
and women in whom it doesn't work well at all.
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但对另一类却无法做出有效诊断。
00:29
Do you know which group you're in?
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你是否知道你是哪一类?
00:32
If you don't, you're not alone.
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你并非唯一不了解的人。
00:34
Because the breast has become
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因为乳房已经成为
00:36
a very political organ.
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一种非常政治化的器官。
00:39
The truth has become lost
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真相正日渐式微,
00:41
in all the rhetoric
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淹没于各大媒体、
00:43
coming from the press, politicians,
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政治家、
00:45
radiologists
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放射学家、
00:47
and medical imaging companies.
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以及医学成像公司的虚夸雄辩。
00:49
I will do my best this morning
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今天早上,我将尽自己最大的努力
00:51
to tell you what I think is the truth.
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告诉你们我所认为的真相。
00:54
But first, my disclosures.
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但首先我必须坦白,
00:57
I am not a breast cancer survivor.
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我不曾战胜过乳腺癌。
00:59
I'm not a radiologist.
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我也不是放射学家。
01:01
I don't have any patents,
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我没有任何专利,
01:03
and I've never received any money from a medical imaging company,
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我也从未从任何一家医学造影公司拿过一分钱。
01:06
and I am not seeking your vote.
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而且我并不期待你们的投票。
01:09
(Laughter)
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(笑声)
01:11
What I am
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我只是
01:13
is a doctor of internal medicine
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一位内服药品医生,
01:15
who became passionately interested in this topic
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大约十年前,
01:17
about 10 years ago
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一个病人的问题
01:19
when a patient asked me a question.
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让我对这个领域产生了浓厚的兴趣。
01:23
She came to see me
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她来见我
01:25
after discovering a breast lump.
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她刚被诊断出一个乳房肿块。
01:27
Her sister had been diagnosed with breast cancer
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她的姐姐在四十岁时,
01:30
in her 40s.
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被诊断为乳腺癌。
01:32
She and I were both very pregnant at that time,
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当时她和我都已经是大腹便便的孕妇了,
01:35
and my heart just ached for her,
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我为她感到心痛,
01:37
imagining how afraid she must be.
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我想她该有多担心害怕。
01:40
Fortunately, her lump proved to be benign.
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幸运的是,她的肿块是良性的。
01:43
But she asked me a question:
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但她问了我一个问题:
01:45
how confident was I
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我有多大的把握
01:47
that I would find a tumor early on her mammogram
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能在她的乳房X光片中
01:49
if she developed one?
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发现早期肿瘤?
01:51
So I studied her mammogram,
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于是我仔细看了她的乳房X光片,
01:53
and I reviewed the radiology literature,
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我查阅了放射学文献,
01:55
and I was shocked to discover
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我震惊地发现,
01:57
that, in her case,
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在她的情况下,
01:59
our chances of finding a tumor early on the mammogram
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在乳房X光片中发现早期肿瘤的可能性,
02:01
were less than the toss of a coin.
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竟然小于50%.
02:04
You may recall a year ago
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你大概可以想起来,一年前
02:06
when a firestorm erupted
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那次事件大爆发,
02:08
after the United States Preventive Services Task Force
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美国预防服务工作组
02:12
reviewed the world's mammography screening literature
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审查了全球乳房X光造影诊断技术的文献,
02:15
and issued a guideline
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发布了一个准则
02:17
recommending against screening mammograms
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表示不推荐四十岁的女性
02:20
in women in their 40s.
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使用乳房X光造影诊断。
02:22
Now everybody rushed to criticize the Task Force,
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然后所有人都指责工作组,
02:25
even though most of them weren't in anyway familiar
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即使他们中根本没有人
02:27
with the mammography studies.
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真的了解乳房X光造影诊断。
02:30
It took the Senate just 17 days
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参议院又花了17天,
02:32
to ban the use of the guidelines
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禁止在保险覆盖条例中
02:34
in determining insurance coverage.
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使用这个条例。
02:38
Radiologists were outraged
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放射学家对这个条例
02:40
by the guidelines.
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十分愤慨。
02:42
The pre-eminent mammographer in the United States
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美国最杰出的乳房X光造影技术专家
02:44
issued the following quote
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在华盛顿邮报上
02:46
to the Washington Post.
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发表声明。
02:49
The radiologists were, in turn, criticized
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放射学家反被指责
02:52
for protecting their own financial self-interest.
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过分关注个人经济利益。
02:55
But in my view,
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然而我认为,
02:57
the radiologists are heroes.
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这些放射学家才是真英雄。
02:59
There's a shortage of radiologists
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一直以来,有资质看乳房X光片的
03:01
qualified to read mammograms,
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放射学家是不多的,
03:03
and that's because mammograms are one of the most complex
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因为解读乳房X光片是
03:06
of all radiology studies to interpret,
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所有放射性研究中最为复杂的,
03:09
and because radiologists
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另外相比其他原因,
03:11
are sued more often
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放射学家更容易因此
03:13
over missed breast cancer
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而被指控
03:15
than any other cause.
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误诊乳腺癌。
03:17
But that very fact is telling.
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但事实胜于雄辩。
03:20
Where there is this much legal smoke,
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哪里有硝烟,
03:23
there is likely to be some fire.
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哪里就有烈火。
03:26
The factor most responsible for that fire
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导致这场激辩烈火的重要因素
03:29
is breast density.
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是乳腺密度。
03:33
Breast density refers to the relative amount of fat --
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乳腺密度是指脂肪含量-
03:35
pictured here in yellow --
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(图中黄色的部分)--
03:37
versus connective and epithelial tissues --
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与结缔组织含量(图中粉色部分)--
03:39
pictured in pink.
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的比例。
03:41
And that proportion
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这个比例
03:43
is primarily genetically determined.
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主要是由基因决定的。
03:45
Two-thirds of women in their 40s
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2/3的四十岁女性
03:47
have dense breast tissue,
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属于高乳腺密度,
03:49
which is why mammography doesn't work as well in them.
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这就是为什么乳房X光造影技术无法对他们做出有效诊断的原因。
03:52
And although breast density generally declines with age,
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尽管乳腺密度一般随年龄增长而下降,
03:55
up to a third of women
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仍有1/3的女性
03:57
retain dense breast tissue
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在停经数年后
03:59
for years after menopause.
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仍属于高乳腺密度的群体。
04:03
So how do you know if your breasts are dense?
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那你该如何知道你是否属于高乳腺密度呢?
04:06
Well, you need to read the details
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你需要非常仔细地阅读
04:08
of your mammography report.
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你的乳房X光片报告。
04:10
Radiologists classify breast density
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放射学家
04:12
into four categories
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根据乳腺组织的成像
04:14
based on the appearance of the tissue on a mammogram.
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将乳腺密度分为四类。
04:17
If the breast is less than 25 percent dense,
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乳腺密度小于25%,
04:20
that's called fatty-replaced.
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称为脂肪替代型;
04:22
The next category
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第二种
04:24
is scattered fibroglandular densities,
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是分散乳腺纤维密度型;
04:26
followed by heterogeneously dense
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然后是混合密度型,
04:28
and extremely dense.
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和最高密度型。
04:30
And breasts that fall into these two categories
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最后两类,
04:32
are considered dense.
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是高密度型的。
04:34
The problem with breast density
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高密度乳腺所带来的问题
04:36
is that it's truly the wolf in sheep's clothing.
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就好像披着羊皮的狼。
04:39
Both tumors and dense breast tissue
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肿瘤和高密度乳腺组织
04:41
appear white on a mammogram,
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在乳房X光片上都呈现为白色,
04:44
and the X-ray often can't distinguish between the two.
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通常X光无法辨别这两者。
04:47
So it's easy to see this tumor
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所以很容易
04:49
in the upper part of this fatty breast.
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在此处上部的脂肪组织中看到肿瘤。
04:52
But imagine how difficult it would be
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但你无法想象
04:54
to find that tumor in this dense breast.
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在高密度乳腺中找到肿瘤是多么困难。
04:57
That's why mammograms find
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这就是为什么,乳房X光造影成像技术
04:59
over 80 percent of tumors in fatty breasts,
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可以在低乳腺密度的乳房中找到80%以上的肿瘤,
05:02
but as few as 40 percent in extremely dense breasts.
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而在极高乳腺密度的乳房中只能找到40%。
05:05
Now it's bad enough that breast density
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好吧,高乳腺密度已经导致
05:07
makes it hard to find a cancer,
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寻找肿瘤比其它情况更困难,
05:09
but it turns out
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然而更糟的是
05:11
that it's also a powerful predictor
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高乳腺密度也有力地预示
05:13
of your risk for breast cancer.
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乳腺癌患病率的高风险。
05:15
It's a stronger risk factor
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它的风险系数
05:17
than having a mother or a sister with breast cancer.
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比母亲或姐妹有乳腺癌病史更强。
05:20
At the time my patient posed this question to me,
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当年我的病人问我这个问题时,
05:23
breast density was an obscure topic
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乳腺密度在放射性学的学术界
05:25
in the radiology literature,
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还未引起重视,
05:27
and very few women having mammograms,
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很少有接受乳房X光造影诊断的女性,
05:29
or the physicians ordering them,
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或者使用乳房X光造影诊断的内科医生
05:31
knew about this.
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了解这一点。
05:33
But what else could I offer her?
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但我又能为她做些什么?
05:36
Mammograms have been around since the 1960's,
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乳房X光造影诊断于1960年前后开始流行,
05:39
and it's changed very little.
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此后几乎没有什么改进。
05:41
There have been surprisingly few innovations,
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几乎没有令人震惊的创新,
05:44
until digital mammography was approved
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直到2000年,
05:46
in 2000.
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数码乳房X光造影技术被批准进入市场。
05:48
Digital mammography is still an X-ray of the breast,
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数码乳房X光造影仍然使用X光,
05:51
but the images
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但是图像
05:53
can be stored and manipulated digitally,
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可以储存并进行数码操纵,
05:55
just like we can with a digital camera.
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就像我们用数码相机一样。
05:58
The U.S. has invested
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美国已经投入
06:00
four billion dollars
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40亿美元
06:02
converting to digital mammography equipment,
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更新换代至数码乳房X光造影设备。
06:05
and what have we gained from that investment?
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我们又从这笔投资中得到了什么呢?
06:08
In a study funded by over 25 million taxpayer dollars,
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一项耗费纳税人两千五百万美金的调查显示,
06:12
digital mammography was found
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数码乳房X光仪
06:14
to be no better over all
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并不比传统设备
06:16
than traditional mammography,
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有更好的综合表现。
06:18
and in fact, it was worse in older women.
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事实上,对老年女性来说,表现更糟。
06:21
But it was better in one group,
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不过,
06:24
and that was women under 50
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对50岁以下女性来说,表现更好,
06:26
who were pre-menopausal and had dense breasts,
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这一群体还未绝经,且乳腺组织密度较高。
06:29
and in those women,
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在这个群体中,
06:31
digital mammography found twice as many cancers,
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数码乳房X光诊断可以找到两倍多的肿瘤,
06:34
but it still only found 60 percent.
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尽管仍只有60%。
06:37
So digital mammography
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所以数码乳房X光造影技术
06:39
has been a giant leap forward
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对数码乳房X光造影设备的
06:41
for manufacturers
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制造商来说,
06:43
of digital mammography equipment,
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是一次巨大的飞跃,
06:45
but it's been a very small step forward for
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但对女性来说,
06:47
womankind.
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却只是一小步而已。
06:50
What about ultrasound?
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那么超声波呢?
06:52
Ultrasound generates more biopsies
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与其他技术相比,超声波检查必须配合
06:54
that are unnecessary relative to other technologies,
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更多不必要的活组织检查,
06:56
so it's not widely used.
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所以并未得到广泛使用。
06:59
And MRI is exquisitely sensitive for finding tumors,
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核磁共振在肿瘤诊断方面相当灵敏,
07:02
but it's also very expensive.
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但它也非常昂贵。
07:06
If we think about disruptive technology,
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联想到其他领域的各种科技,
07:09
we see an almost ubiquitous pattern
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可以发现一种普遍存在的模式,
07:11
of the technology getting smaller and less expensive.
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就是它们总是像更小、更经济的方向发展。
07:14
Think about iPods compared to stereos.
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比较一下iPod和立体声音响吧。
07:17
But it's the exact opposite in health care.
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但在医疗保健领域,情况则完全相反。
07:20
The machines get ever bigger
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设备越来越大,
07:22
and ever more expensive.
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越来越昂贵。
07:26
Screening the average young woman with an MRI
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女性做一次核磁共振扫描,
07:29
is kind of like driving to the grocery store in a Hummer.
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就像驾着悍马轰隆隆进杂货店一样。
07:33
It's just way too much equipment.
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杀鸡用牛刀。
07:35
One MRI scan
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一次核磁共振扫描,
07:37
costs 10 times what a digital mammogram costs.
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价格约为数码X光造影的10倍。
07:40
And sooner or later, we're going to have to accept the fact
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迟早我们会接受这个现实:
07:42
that health care innovation
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医疗保健领域的创新
07:44
can't always come at a much higher price.
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不可能总是如此价格高昂。
07:49
Malcolm Gladwell wrote an article in the New Yorker
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马尔科姆·葛拉威尔Malcolm Gladwell在纽约人上写过一篇
07:51
on innovation,
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有关创新的文章,
07:53
and he made the case that scientific discoveries
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他认为科学发现
07:56
are rarely the product of one individual's genius.
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绝非个人天才的产品,
08:00
Rather, big ideas can be orchestrated,
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反之,伟大的思想可以和谐交融,
08:03
if you can simply gather
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如果你能把
08:05
people with different perspectives in a room
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持有各种观点的人集中在一个房间内,
08:07
and get them to talk about things
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让他们就一般不会谈及的事务
08:09
that they don't ordinarily talk about.
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充分交流沟通。
08:11
It's like the essence of TED.
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这其实就类似于TED的精髓了。
08:14
He quotes one innovator who says,
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他引用一位创新者的话:
08:16
"The only time a physician and a physicist get together
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“只有一种情况能让内科医生和物理学家见面,
08:20
is when the physicist gets sick."
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就是物理学家病了。”
08:22
(Laughter)
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(笑声)
08:24
This makes no sense,
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这说法很不对,
08:26
because physicians have all kinds of problems
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因为物理学家一直以来都没有意识到
08:28
that they don't realize have solutions.
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他们的很多问题都是有解决办法的。
08:31
And physicists have all kinds of solutions for things
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内科医生也没有意识到
08:33
that they don't realize are problems.
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他们正可以提供许多问题的解法。
08:36
Now, take a look at this cartoon
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看这副漫画
08:39
that accompanied Gladwell's article,
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葛拉威尔Gladwell在文章中也引用过它,
08:41
and tell me if you see something disturbing
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告诉我这幅画对创新者的描绘,
08:43
about this depiction of innovative thinkers.
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是否让你感到有些困惑。
08:46
(Laughter)
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(笑声)
08:48
So if you will allow me a little creative license,
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如果你们不介意我发挥一点创造力,
08:52
I will tell you the story
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我要告诉你们一个
08:54
of the serendipitous collision
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极其偶然的巧合,
08:56
of my patient's problem
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有关我病人的问题
08:58
with a physicist's solution.
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和一个医生的解决办法。
09:00
Shortly after her visit,
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在她拜访我之后不久,
09:02
I was introduced to a nuclear physicist
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我认识了一位核物理学家,
09:04
at Mayo
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他来自Mayo(译者注:梅奥,爱尔兰西北一郡)
09:06
named Michael O'Conner,
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名叫迈克尔·奥康纳Michael O'Conner,
09:08
who was a specialist in cardiac imaging,
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他是心血管造影的专家,
09:10
something I had nothing to do with.
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而我对心血管造影那是一窍不通。
09:12
And he happened to tell me
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一个偶然,他告诉我
09:14
about a conference he'd just returned from in Israel,
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他刚从以色列开会回来,
09:17
where they were talking about a new type of gamma detector.
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他们正讨论某种新型伽马探测器,
09:20
Now gamma imaging has been around for a long time
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当时伽马线造影已经出现有段时间了,
09:22
to image the heart,
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一直被用于心脏造影,
09:24
and it had even been tried to image the breast.
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也曾有人尝试将其用于乳房造影。
09:27
But the problem was
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但问题是
09:29
that the gamma detectors
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伽马线的探测器
09:31
were these huge, bulky tubes,
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是这种块头巨大的显像管,
09:33
and they were filled with these scintillating crystals,
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里面塞满这样亮晶晶的晶状物,
09:35
and you just couldn't get them close enough around the breast
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你根本没有办法把它们放到距离乳房足够近的地方
09:38
to find small tumors.
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去找到小肿瘤。
09:40
But the potential advantage was
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但隐性的优势在于
09:42
that gamma rays, unlike X-rays,
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伽马射线与X射线不同,
09:44
are not influenced by breast density.
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并不会被乳腺密度影响。
09:47
But this technology
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但这项技术
09:49
could not find tumors when they're small,
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没有办法找到小型的肿瘤。
09:51
and finding a small tumor is critical for survival.
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找到小型肿瘤对存活率非常关键。
09:54
If you can find a tumor
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如果你能找到一个
09:56
when it's less than a centimeter,
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直径小于1厘米的肿瘤,
09:58
survival exceeds 90 percent,
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存活率超过90%,
10:00
but drops off rapidly
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之后存活率随着
10:02
as tumor size increases.
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肿瘤增大而迅速下降。
10:05
But Michael told me about
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迈克尔Michael告诉我,
10:07
a new type of gamma detector that he'd seen,
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他见到的一种新型伽马探测器,
10:09
and this is it.
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就是这个东西。
10:11
It's made
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它并非
10:13
not of a bulky tube,
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由巨大的晶体管造成,
10:15
but of a thin layer of a semiconductor material
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取而代之的是一层轻薄的半导体材料,
10:18
that serves as the gamma detector.
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来作为伽马线探测器。
10:20
And I started talking to him
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于是我开始与他讨论
10:22
about this problem with breast density,
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乳腺密度的问题,
10:24
and we realized that we might be able to get this detector
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我们意识到也许我们可以
10:27
close enough around the breast
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把这个探测器放到距离乳房足够近的地方
10:29
to actually find small tumors.
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去找到小肿瘤。
10:31
So after putting together
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接着我们
10:33
a grid of these cubes with tape --
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用胶带纸把这些小方块粘在一起--
10:36
(Laughter)
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(笑声)
10:39
-- Michael hacked off the X-ray plate
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--迈克尔Michael去掉了一台
10:42
of a mammography machine
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即将废弃的乳房X光仪上的
10:44
that was about to be thrown out,
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X射线板。
10:46
and we attached the new detector,
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我们连上新的探测器,
10:49
and we decided to call this machine
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我们决定称这台机器为
10:51
Molecular Breast Imaging, or MBI.
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分子乳房造影,简称MBI。
10:55
This is an image from our first patient.
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这是我们第一位病人的造影片。
10:57
And you can see, using the old gamma technology,
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可以看到,使用古老的伽马线探测技术,
10:59
that it just looked like noise.
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看起来一片模糊。
11:01
But using our new detector,
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但如果使用新的探测器,
11:03
we could begin to see the outline of a tumor.
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我们可以看到肿瘤的轮廓。
11:06
So here we were, a nuclear physicist,
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于是我们,一个核物理学家,
11:08
an internist,
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一个内科医师,
11:10
soon joined by Carrie Hruska, a biomedical engineer,
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之后卡丽·鲁斯卡Carrie Hruska又加入我们,一位生物医学工程师,
11:13
and two radiologists,
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还有两位放射学家,
11:15
and we were trying to take on
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我们尝试使用一台用胶布粘起来的仪器
11:17
the entrenched world of mammography
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去拓展
11:19
with a machine that was held together by duct tape.
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造影成像技术的世界。
11:23
To say that we faced
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要说我们在早年
11:25
high doses of skepticism
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面对了
11:27
in those early years
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大量的嘲讽质疑
11:29
is just a huge understatement,
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都只能说是轻描淡写了。
11:31
but we were so convinced that we might be able to make this work
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但我们都坚信我们一定会成功
11:34
that we chipped away with incremental modifications
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我们一点一点
11:37
to this system.
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改进整个系统。
11:39
This is our current detector.
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这是我们目前的探测器。
11:41
And you can see that it looks a lot different.
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你会发现它看起来已经非常不同。
11:43
The duct tape is gone,
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没有胶布了,
11:47
and we added a second detector on top of the breast,
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我们在乳房上方加入第二块探测器,
11:49
which has further improved our tumor detection.
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进一步改进了我们探测肿瘤的能力。
11:52
So how does this work?
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它实际作用如何?
11:54
The patient receives an injection of a radio tracer
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这位病人注射了放射性跟踪剂,
11:57
that's taken up by rapidly proliferating tumor cells,
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繁殖旺盛的肿瘤细胞会迅速吸收这种放射性跟踪剂,
12:00
but not by normal cells,
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正常细胞则不会。
12:02
and this is the key difference from mammography.
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这里显示造影片的巨大区别。
12:05
Mammography relies on differences
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造影技术依靠的就是
12:07
in the appearance of the tumor from the background tissue,
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肿瘤组织与周边组织的突显区别,
12:10
and we've seen that those differences
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我们看到这些区别
12:12
can be obscured in a dense breast.
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在高乳腺密度的乳房中很模糊。
12:15
But MBI exploits
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但是MBI完整显现了
12:17
the different molecular behavior of tumors,
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肿瘤与其他细胞的区别,
12:20
and therefore, it's impervious to breast density.
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因此不受乳腺密度的影响。
12:24
After the injection,
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在注射后,
12:26
the patient's breast is placed between the detectors.
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这位病人的乳房被置于两个探测器中间。
12:28
And if you've ever had a mammogram --
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如果你曾做过乳房X光造影诊断--
12:30
if you're old enough to have had a mammogram --
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如果你年龄足够大的话--
12:32
you know what comes next:
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你知道随之而来的是:
12:34
pain.
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疼痛。
12:36
You may be surprised to know
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你也许会很惊讶,
12:38
that mammography is the only radiologic study
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乳房X光造影
12:41
that's regulated by federal law,
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是唯一被联邦法律允许的放射性研究技术,
12:43
and the law requires
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法律要求
12:45
that the equivalent of a 40-pound car battery
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其强度约等于一块40磅的汽车电池
12:48
come down on your breast during this study.
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砸向你的乳房。
12:52
But with MBI,
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但是用MBI,
12:54
we use just light, pain-free compression.
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只有轻微的压痛感。
12:57
(Applause)
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(掌声)
13:03
And the detector
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探测器
13:05
then transmits the image to the computer.
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随后把图像传回到计算机。
13:07
So here's an example.
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这是一个例子。
13:09
You can see, on the right, a mammogram
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你可以看到右侧,X光片
13:11
showing a faint tumor,
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显示一个成像模糊的肿瘤,
13:13
the edges of which are blurred by the dense tissue.
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肿瘤边缘由于高密度乳腺组织而变得模糊。
13:15
But the MBI image shows that tumor much more clearly,
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但MBI成像中的肿瘤,清楚多了,
13:18
as well as a second tumor,
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还有第二个肿瘤,
13:20
which profoundly influence that patient's surgical options.
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这对病人的手术方案有巨大的影响。
13:24
In this example, although the mammogram found one tumor,
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在这个例子中,X光片找到了一个肿瘤,
13:27
we were able to demonstrate three discrete tumors --
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但我们找到了3个很难探测出的肿瘤--
13:30
one is small as three millimeters.
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其中一个直径只有3毫米。
13:33
Our big break came in 2004.
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我们的突破在2004年。
13:38
After we had demonstrated that we could find small tumors,
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在我们论证能找到小肿瘤之后,
13:41
we used these images
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我们用这些肿瘤成像
13:43
to submit a grant to the Susan G. Komen Foundation.
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申请Susan G.Komen苏珊·G·科曼乳腺癌基金会的赞助。
13:46
And we were elated when they took a chance
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当他们最终决定在一群未曾谋面的探索者身上冒这个险时,
13:49
on a team of completely unknown investigators
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我们是那么的欢欣鼓舞,
13:51
and funded us to study
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他们赞助我们
13:53
1,000 women with dense breasts,
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研究1000名高乳腺密度的女性,
13:55
comparing a screening mammogram to an MBI.
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并比较她们的X光片和MBI成像。
13:58
Of the tumors that we found,
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在所有我们找到的肿瘤中,
14:00
mammography found
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X光片找到了其中的
14:02
only 25 percent of those tumors.
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25%
14:05
MBI found 83 percent.
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MBI找到了83%。
14:08
Here's an example from that screening study.
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这是此次扫描研究的例表。
14:11
The digital mammogram was read as normal
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数码X光片如往常一样
14:13
and shows lots of dense tissue,
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显示大量高密度乳腺组织,
14:15
but the MBI shows an area of intense uptake,
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但是MBI显示了一片高密度区域,
14:18
which correlated with a two-centimeter tumor.
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该区域与一个直径2厘米的肿瘤有关。
14:21
In this case, a one-centimeter tumor.
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在这个例子中,一个直径1厘米的肿瘤。
14:24
And in this case,
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这个例子,
14:26
a 45-year-old medical secretary at Mayo,
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一位来自梅奥的45岁医学秘书,
14:29
who had lost her mother to breast cancer when she was very young,
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她很小时候母亲就患乳腺癌去世了,
14:32
wanted to enroll in our study.
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因此她希望参与我们的研究。
14:34
And her mammogram showed an area of very dense tissue,
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她的X光片显示一片高密度乳腺组织,
14:37
but her MBI showed an area
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而她的MBI显示
14:39
of worrisome uptake,
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该区域值得忧虑,
14:41
which we can also see on a color image.
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在彩片中也可以看到。
14:44
And this corresponded
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与此对应的
14:46
to a tumor the size of a golf ball.
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是一个高尔夫球大小的肿瘤。
14:48
But fortunately it was removed
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幸运的是我们摘除了它,
14:50
before it had spread to her lymph nodes.
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当时它还未扩散到淋巴结。
14:54
So now that we knew that this technology
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所以现在我们得知这项技术
14:56
could find three times more tumors in a dense breast,
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可以在高乳腺密度的乳房中找到3倍多的肿瘤,
14:59
we had to solve one very important problem.
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还有一个很重要的问题需要解决。
15:02
We had to figure out how to lower the radiation dose,
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我们必须尝试降低放射量。
15:05
and we have spent the last three years
362
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最近这三年,
15:08
making modifications to every aspect of the imaging system
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我们对这个造影系统的每一个细节都做了改进,
15:11
to allow this.
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致力于降低它的放射量。
15:13
And I'm very happy to report that we're now using a dose of radiation
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我现在非常高兴地告诉大家,我们现在使用的放射量
15:16
that is equivalent to the effective dose
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已经与数码X光造影的有效放射量
15:18
from one digital mammogram.
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完全相等。
15:20
And at this low dose, we're continuing this screening study,
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使用低放射量,我们继续这项扫描研究,
15:23
and this image from three weeks ago
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这张图片,来自于3周前,
15:26
in a 67-year-old woman
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一位67岁的妇女,
15:28
shows a normal digital mammogram,
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其数码X光片显示一切正常,
15:30
but an MBI image
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但是MBI图像显示
15:32
showing an uptake that proved to be a large cancer.
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这是一大片癌细胞,之后也被验证确实如此。
15:35
So this is not just young women that it's benefiting.
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所以这不仅仅是有益于低年龄层女性了。
15:38
It's also older women with dense tissue.
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高年龄层的、乳腺密度较高的女性同样受益。
15:41
And we're now routinely using one-fifth the radiation dose
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现在我们一般只使用,1/5于
15:44
that's used in any other type of gamma technology.
377
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其他类型伽马射线技术的放射量。
15:48
MBI generates four images per breast.
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MBI对每个乳房呈现4张图像。
15:51
MRI generates over a thousand.
379
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而核磁共振成像则超过1000张。
15:54
It takes a radiologist
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一个放射学家
15:56
years of specialty training
381
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需要很多年专业训练
15:58
to become expert in differentiating
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才能成为辨别
16:00
the normal anatomic detail
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普通解剖学细节组织
16:02
from the worrisome finding.
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和真正病灶的专家。
16:04
But I suspect even the non-radiologists in the room
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但我猜想,这个房间里,即使你不是一位放射学专家,
16:07
can find the tumor on the MBI image.
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你也可以在MBI成像中找到肿瘤。
16:10
But this is why MBI
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然而这正是MBI
16:12
is so potentially disruptive --
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受到百般阻挠的原因。
16:14
it's as accurate as MRI,
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它和核磁共振一样精确,
16:16
it's far less complex to interpret,
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但又比核磁共振好辨认得多,
16:19
and it's a fraction of the cost.
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而且花费只是核磁共振的一个零头。
16:21
But you can understand why there may be
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也许你能明白
16:23
forces in the breast-imaging world
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在乳房成像领域中,
16:25
who prefer the status quo.
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有些人却安于现状,施加阻力的原因。
16:29
After achieving what we felt were remarkable results,
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在获得这个我们自认为非凡的成就之后,
16:32
our manuscript was rejected
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我们的稿件
16:35
by four journals.
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被4家杂志拒收。
16:37
After the fourth rejection,
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在第四次拒收后,
16:39
we requested reconsideration of the manuscript,
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我们要求对稿件进行重审,
16:41
because we strongly suspected
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因为我们严重怀疑
16:43
that one of the reviewers who had rejected it
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审核小组中一位拒绝此稿件的成员
16:45
had a financial conflict of interest
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在与之竞争的技术领域
16:47
in a competing technology.
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有经济利益纠葛。
16:50
Our manuscript was then accepted
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之后我们的稿件被接收了
16:52
and will be published later this month
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并即将在本月末刊登在
16:55
in the journal Radiology.
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《放射学研究》期刊中。
16:57
(Applause)
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(掌声)
17:05
We still need to complete the screening study using the low dose,
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我们继续用低放射量完成整个扫描研究,
17:08
and then our findings will need to be replicated
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然后我们的成果将需要
17:10
at other institutions,
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其它研究机构重新检验。
17:12
and this could take five or more years.
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这可能会耗费五年或更长时间。
17:15
If this technology is widely adopted,
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如果这项技术被广泛运用,
17:18
I will not benefit financially in any way,
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我不会图取任何经济利益。
17:21
and that is very important to me,
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这对我很重要,
17:24
because it allows me to continue to tell you the truth.
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因为这一点让我坚持告诉你们真相。
17:28
But I recognize --
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但我意识到--
17:30
(Applause)
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(掌声)
17:34
I recognize that the adoption of this technology
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我意识到要推广这项技术,
17:37
will depend as much on economic
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不仅需要强大的科学技术支持,
17:39
and political forces
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也需要经济力量
17:41
as it will on the soundness of the science.
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和政治力量的支持。
17:44
The MBI unit has now been FDA approved,
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MBI已经被FDA美国食品及药物管理局批准了,
17:47
but it's not yet widely available.
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但仍未被广泛运用。
17:50
So until something is available
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因此在MBI面世之前,
17:52
for women with dense breasts,
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对于高乳腺密度的女性,
17:54
there are things that you should know
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有些东西你们需要了解
17:56
to protect yourself.
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来保护你们自己。
17:58
First, know your density.
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第一,了解你的乳腺密度。
18:00
Ninety percent of women don't,
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90%的女性不了解自己的乳腺密度,
18:02
and 95 percent of women don't know
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95%的女性不了解
18:04
that it increases your breast cancer risk.
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乳腺密度的增加也会增加罹患乳腺癌的风险。
18:07
The State of Connecticut became the first and only state
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康涅狄格州成为第一个,也是唯一一个
18:10
to mandate that women receive notification
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要求女性在乳房X光片诊断后
18:12
of their breast density
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了解
18:14
after a mammogram.
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自己乳腺密度的州。
18:17
I was at a conference of 60,000 people in breast-imaging
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上周在芝加哥,我参加了一个
18:20
last week in Chicago,
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6万人与会的乳房造影技术大会。
18:22
and I was stunned that there was a heated debate
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我惊讶于看到一场激烈的辩论,
18:25
as to whether we should be telling women
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关于是否应该告诉女性
18:27
what their breast density is.
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她们的乳腺密度。
18:29
Of course we should.
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我们当然应该告诉她们。
18:31
And if you don't know, please ask your doctor
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如果你不知道,请询问你的医生
18:34
or read the details of your mammography report.
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或者仔细研究你的乳房X光诊断报告。
18:37
Second, if you're pre-menopausal,
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第二,如果你还未绝经,
18:39
try to schedule your mammogram
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请尝试把你的乳房X光诊断
18:41
in the first two weeks of your menstrual cycle,
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计划安排在月经周期的前两周,
18:43
when breast density is relatively lower.
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这段时间你的乳腺密度相对较低。
18:46
Third, if you notice a persistent change in your breast,
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第三,如果你注意到你的乳房有一些慢性病变,
18:49
insist on additional imaging.
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请坚持要求更多的成像检查。
18:52
And fourth and most important,
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第四,也是最重要的一点,
18:54
the mammography debate will rage on,
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乳房X光诊断的辩论将会持续升温,
18:57
but I do believe that all women 40 and older
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但我坚信40岁以上的女性应该每年做一次
19:00
should have an annual mammogram.
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乳房X光检查。
19:02
Mammography isn't perfect,
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乳房X光检查并不完美,
19:04
but it's the only test that's been proven
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但它是目前为止唯一被验证
19:06
to reduce mortality from breast cancer.
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可以降低乳腺癌死亡率的诊断方式。
19:09
But this mortality banner
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但这个死亡率招牌
19:11
is the very sword
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正是一把双刃剑,
19:13
which mammography's most ardent advocates use
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乳房X光诊断的热诚簇拥者们用这把剑
19:16
to deter innovation.
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来打击创新。
19:18
Some women who develop breast cancer
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而另一些身患乳腺癌的女性
19:21
die from it many years later,
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多年后却因它而死。
19:23
and most women, thankfully, survive.
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谢天谢地的是,大部分女性,活了下来。
19:25
So it takes 10 or more years
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所以任何新的造影成像技术要花费10年
19:27
for any screening method
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甚至更多年
19:29
to demonstrate a reduction
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来证明其诊断降低了
19:31
in mortality from breast cancer.
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乳腺癌死亡率。
19:33
Mammography's the only one that's been around long enough
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长久以来,乳房X光造影
19:35
to have a chance of making that claim.
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是唯一有机会声明它可以降低乳腺癌死亡率的。
19:38
It is time for us to accept
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但现在是时候让我们接受
19:41
both the extraordinary successes of mammography
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乳房X光造影不仅有非凡的成功之处,
19:43
and the limitations.
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也存在许多限制。
19:45
We need to individualize screening
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我们需要对不同乳腺密度的个体
19:47
based on density.
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使用个性化的扫描成像技术。
19:49
For women without dense breasts,
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对于低乳腺密度的女性来说,
19:51
mammography is the best choice.
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乳房X光造影是最佳选择。
19:54
But for women with dense breasts;
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但对于高乳腺密度的女性来说,
19:56
we shouldn't abandon screening altogether,
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我们不该一刀子斩断所有的造影诊断技术,
19:58
we need to offer them something better.
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我们要为她们提供更好的诊断技术。
20:03
The babies that we were carrying
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当年我的病人问我问题时
20:05
when my patient first asked me this question
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我们怀着的孩子
20:08
are now both in middle school,
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现如今已双双进入中学,
20:11
and the answer has been so slow to come.
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答案却还迟迟未来。
20:16
She's given me her blessing
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她给我祝福,
20:18
to share this story with you.
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让我把这个故事与你们分享。
20:21
After undergoing biopsies
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在接受活组织检查后,
20:23
that further increased her risk for cancer
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而活组织检查会增加患癌症风险,
20:26
and losing her sister to cancer,
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以及经历被癌症夺去姐姐的痛苦之后,
20:28
she made the difficult decision
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她终于做出了艰难的决定,
20:30
to have a prophylactic mastectomy.
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为避免乳腺癌而做了乳房切除术。
20:34
We can and must do better,
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我们有能力,并且必须做的更好,
20:37
not just in time for her granddaughters
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这不仅是为了她的孙女,
20:40
and my daughters,
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还有我的女儿,
20:42
but in time for you.
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还有在座的各位。
20:44
Thank you.
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谢谢。
20:46
(Applause)
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(掌声)
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