A simple new blood test that can catch cancer early | Jimmy Lin

翻译人员: Mengyu Zheng 校对人员: cookie fu

Cancer.

癌症，

Many of us have lost family, friends or loved ones

很多人的家人、朋友、爱人

to this horrible disease.

因为这种可怕的疾病离去。

I know there are some of you in the audience

我知道观众里有一些人

是癌症的幸存者，

who are cancer survivors,

or who are fighting cancer at this moment.

或者正在与病魔做斗争。

My heart goes out to you.

我的心和你们在一起。

While this word often conjures up emotions of sadness and anger and fear,

人们说起癌症的时候 通常会悲伤、愤怒和恐惧，

I bring you good news from the front lines of cancer research.

而我今天为你们带来了 癌症研究最前沿的好消息。

The fact is, we are starting to win the war on cancer.

事实上，我们对癌症的战争 已经开始走向胜利。

In fact, we lie at the intersection

我们正面对着

of the three of the most exciting developments within cancer research.

癌症研究中三项最令人振奋的进展。

The first is cancer genomics.

第一项是肿瘤基因组学。

The genome is a composition

基因组包含了

of all the genetic information encoded by DNA

生物体中由DNA编码记载的

in an organism.

所有遗传信息。

In cancers, changes in the DNA called mutations

在肿瘤里，DNA的变化被称为突变，

are what drive these cancers to go out of control.

这是肿瘤失控的成因。

Around 10 years ago, I was part of the team at Johns Hopkins

大约十年前，我加入了 约翰 · 霍普金斯大学的一个团队。

that first mapped the mutations of cancers.

肿瘤突变的位置是 由他们首先绘制出来的。

We did this first for colorectal,

我们首先完成绘制的是结直肠癌、

breast, pancreatic and brain cancers.

乳腺癌、胰腺癌和脑瘤。

And since then, there have been over 90 projects in 70 countries

从那时开始，已经有超过 90个项目在全世界

all over the world,

70个国家中进行，

working to understand the genetic basis of these diseases.

试图理解这些疾病的遗传基础。

Today, tens of thousands of cancers are understood

如今，我们对上万种癌症的理解

down to exquisite molecular detail.

都已经达到了精确的分子级别。

The second revolution is precision medicine,

第二项技术革命是精准医学，

also known as "personalized medicine."

也被称为“个性化医疗”。

Instead of one-size-fits-all methods to be able to treat cancers,

与一刀切的癌症治疗方法相比，

there is a whole new class of drugs that are able to target cancers

有一类全新的药物可以 根据不同癌症独特的基因档案

based on their unique genetic profile.

进行针对性的治疗。

Today, there are a host of these tailor-made drugs,

今天，有了这些被称为靶向治疗的

called targeted therapies,

特制药物，

available to physicians even today

如今的医生们已经可以

to be able to personalize their therapy for their patients,

为病人定制他们独有的治疗方法，

and many others are in development.

而还有更多的新疗法正在研发中。

The third exciting revolution is immunotherapy,

第三项令人振奋的 技术革命是免疫疗法。

and this is really exciting.

这真的很令人振奋。

Scientists have been able to leverage the immune system

科学家们试图利用免疫系统

in the fight against cancer.

来对抗癌症。

For example, there have been ways where we find the off switches of cancer,

例如，我们已经发现了 一些遏制癌症的方法，

and new drugs have been able to turn the immune system back on,

以及一些能够重启 免疫系统的药物

to be able to fight cancer.

来对抗癌症。

In addition, there are ways where you can take away immune cells

此外，我们还可以从人体里

from the body,

取出一些免疫细胞，

train them, engineer them and put them back into the body

训练它们，改变它们的结构， 再重新放回人体内，

to fight cancer.

让它们来对付癌症。

Almost sounds like science fiction, doesn't it?

这听起来简直像科幻小说，不是吗？

While I was a researcher at the National Cancer Institute,

作为国家癌症中心的研究员，

I had the privilege of working with some of the pioneers of this field

我有幸与一些这个领域的先驱共事，

and watched the development firsthand.

并在一线目睹了这些发展。

It's been pretty amazing.

简直太不可思议了。

Today, over 600 clinical trials are open,

现在已经有超过600项临床实验

actively recruiting patients to explore all aspects in immunotherapy.

在积极招募病人来研究免疫治疗。

While these three exciting revolutions are ongoing,

这三项技术革命正在进行过程中，

unfortunately, this is only the beginning,

然而遗憾的是，这才只是开始。

and there are still many, many challenges.

我们还面临着很多很多的挑战。

Let me illustrate with a patient.

让我们来看一位病人。

Here is a patient with a skin cancer called melanoma.

这位病人患上了一种皮肤癌， 叫做黑色素瘤。

It's horrible; the cancer has gone everywhere.

这很可怕，癌症已经 遍布了全身各处。

However, scientists were able to map the mutations of this cancer

但是科学家们得以绘制出 这种癌症的突变位置，

and give a specific treatment that targets one of the mutations.

并对其中一种突变 进行针对性的治疗。

And the result is almost miraculous.

治疗结果几乎称得上是奇迹。

Tumors almost seem to melt away.

肿瘤已经几乎看不到了。

Unfortunately, this is not the end of the story.

很不幸，这并不是故事的全部。

A few months later, this picture is taken.

几个月后，我们拍下了这张照片。

The tumor has come back.

肿瘤卷土重来了。

The question is: Why?

问题是，为什么会这样呢？

The answer is tumor heterogeneity.

答案是肿瘤的异质性。

Let me explain.

让我来解释一下。

Even a cancer as small as one centimeter in diameter

即使小到直径 只有一厘米的肿瘤

harbors over a hundred million different cells.

都包含了超过 一亿个不同的细胞。

While genetically similar,

尽管它们的基因很相似，

there are small differences in these different cancers

不同的肿瘤之间 还是存在微小的差异，

that make them differently prone to different drugs.

使得它们对不同药物 的反应不尽相同。

So even if you have a drug that's highly effective,

所以即使有一种 非常有效的药物，

that kills almost all the cells,

能够几乎杀死 所有的肿瘤细胞，

there is a chance that there's a small population

仍然有一小部分 对药物有抗性的细胞

that's resistant to the drug.

有机会残留下来。

This ultimately is the population

最后就是这些残留的细胞

that comes back,

卷土重来

and takes over the patient.

并遍布了病人的全身。

So then the question is: What do we do with this information?

那么现在的问题是， 我们要怎么做呢？

Well, the key, then,

关键在于

is to apply all these exciting advancements in cancer therapy earlier,

要尽可能早地 将最新最先进的癌症治疗方法

as soon as we can,

应用在病人身上，

before these resistance clones emerge.

抢在有抗药性的癌细胞出现之前。

The key to cancer and curing cancer is early detection.

治疗癌症的关键在于尽早发现。

And we intuitively know this.

这我们一直都知道。

Finding cancer early results in better outcomes,

越早检测出癌症， 就越能更好地治疗。

and the numbers show this as well.

这一点也在数据中有所体现。

For example, in ovarian cancer, if you detect cancer in stage four,

比如说，如果患有卵巢癌的病人 在癌症四期的时候才检测出来，

only 17 percent of the women survive at five years.

只有17%的女性病人能存活五年以上。

However, if you are able to detect this cancer as early as stage one,

然而，如果女性在癌症二期， 甚至一期的时候就能检测出来，

over 92 percent of women will survive.

就会有超过92%的病人得以存活下来。

But the sad fact is, only 15 percent of women are detected at stage one,

但令人悲痛的事实是，仅有15% 的 女性在一期癌症的时候得到确诊，

whereas the vast majority, 70 percent, are detected in stages three and four.

而70%的大多数病人都在 三期或四期癌症时才确诊。

We desperately need better detection mechanisms for cancers.

我们迫切地需要更好的方法检测癌症。

The current best ways to screen cancer fall into one of three categories.

现阶段最好的 癌症检测方法分为三类。

First is medical procedures,

第一是医疗手段，

which is like colonoscopy for colon cancer.

比如用肠镜来检测结肠癌。

Second is protein biomarkers, like PSA for prostate cancer.

第二是生物标记蛋白， 比如检测前列腺癌的前列腺特异抗原。

Or third, imaging techniques,

还有第三种是成像技术，

such as mammography for breast cancer.

比如通过乳房X线照相 来检查乳腺癌。

Medical procedures are the gold standard;

医疗手段是黄金标准，

however, they are highly invasive

但是非常痛苦，

and require a large infrastructure to implement.

而且需要依靠大型设备来实施。

Protein markers, while effective in some populations,

至于蛋白标记，虽然对一些人很有效，

are not very specific in some circumstances,

但有些时候并不是非常准确，

resulting in high numbers of false positives,

造成了大量的假阳性，

which then results in unnecessary work-ups and unnecessary procedures.

并导致病人经受了多余的检查和手术。

Imaging methods, while useful in some populations,

显像技术在一些人群中很有效，

expose patients to harmful radiation.

但是会让病人承受有害的辐射。

In addition, it is not applicable to all patients.

另外，并不是所有病人 都能接受显像技术。

For example, mammography has problems in women with dense breasts.

比如说，一些女性有致密乳房， 用乳房X射线照相术检测有一定难度。

So what we need is a method that is noninvasive,

所以我们需要的是一种无创的、

that is light in infrastructure,

仅需要小型设备、

that is highly specific,

而且特异性很强,

that also does not have false positives,

不会造成假阳性的方法。

does not use any radiation

这种方法还要避免辐射，

and is applicable to large populations.

而且可以普遍用于广大病人。

Even more importantly,

更重要的是，

we need a method to be able to detect cancers

我们需要一种方法， 在癌症长到一亿细胞大小之前

before they're 100 million cells in size.

就能检测出它的存在。

Does such a technology exist?

有这样一种技术存在吗？

Well, I wouldn't be up here giving a talk if it didn't.

如果没有，我就不会 站在这里演讲了。

I'm excited to tell you about this latest technology we've developed.

我很高兴能向你们介绍 我们正在研发的最新技术。

Central to our technology is a simple blood test.

这种技术的核心是 简单的血液检验。

The blood circulatory system, while seemingly mundane,

血液循环系统，看起来很普通，

is essential for you to survive,

却对我们的生存至关重要。

providing oxygen and nutrients to your cells,

血液为我们的细胞 提供氧气和养分，

and removing waste and carbon dioxide.

同时移除废物和二氧化碳。

Here's a key biological insight:

这里有一个重要的生物知识：

Cancer cells grow and die faster than normal cells,

癌细胞生长和死亡的速度 远超过正常细胞。

and when they die,

当癌细胞死亡时，

DNA is shed into the blood system.

它们的DNA散落进血液里。

Since we know the signatures of these cancer cells

从各种癌症基因组测序项目中，

from all the different cancer genome sequencing projects,

我们可以知道这些癌细胞的特性，

we can look for those signals in the blood

我们可以在血液中 寻找这些特殊的信号，

to be able to detect these cancers early.

以提前检测出癌症的存在。

So instead of waiting for cancers to be large enough to cause symptoms,

这样我们就可以不用等到 肿瘤大到已经表现出症状，

or for them to be dense enough to show up on imaging,

或者密度高到可以在显像中出现，

or for them to be prominent enough

或者足够明显到

for you to be able to visualize on medical procedures,

你可以通过医疗手段看到，

we can start looking for cancers while they are relatively pretty small,

我们可以在肿瘤相对 还很小的时候进行检测，

by looking for these small amounts of DNA in the blood.

在血液里寻找这些微量的DNA。

So let me tell you how we do this.

那么让我来告诉你们， 我们是如何做到的。

First, like I said, we start off with a simple blood test --

首先，如我所说， 我们从简单的验血开始——

no radiation, no complicated equipment --

没有辐射，没有复杂的仪器——

a simple blood test.

就是简单的验血。

Then the blood is shipped to us,

然后血液样本被寄给我们，

and what we do is extract the DNA out of it.

我们会从中提取出DNA。

While your body is mostly healthy cells,

当你的身体基本上全是健康细胞时，

most of the DNA that's detected will be from healthy cells.

大多数检测到的DNA 都是来自健康细胞的。

However, there will be a small amount, less than one percent,

不过仍然有很小一部分， 不到百分之一，

that comes from the cancer cells.

来自于癌细胞。

Then we use molecular biology methods to be able to enrich this DNA

然后我们用分子生物技术来复制

for areas of the genome which are known to be associated with cancer,

这些与癌症基因相关的DNA，

based on the information from the cancer genomics projects.

主要根据肿瘤基因组学项目的 信息来判断是否相关。

We're able to then put this DNA into DNA-sequencing machines

然后，我们将这些DNA 放入DNA测序仪器，

and are able to digitize the DNA into A's, C's, T's and G's

将DNA数字化， 变成A、C、T、G组成的编码。

and have this final readout.

这就是最终的读取数据。

Ultimately, we have information of billions of letters

最终，我们会从整个过程中

that output from this run.

得到由亿万字母组成的信息。

We then apply statistical and computational methods

接下来，我们使用统计和计算方法

to be able to find the small signal that's present,

来寻找其中存在的微小信号，

indicative of the small amount of cancer DNA in the blood.

证明血液中可能存在的肿瘤DNA。

So does this actually work in patients?

这个方法在病人身上可行吗？

Well, because there's no way of really predicting right now

由于目前并没有办法真的预测

which patients will get cancer,

哪些病人会得癌症，

we use the next best population:

我们选择了第二合适的 人群进行研究：

cancers in remission;

癌症减缓期的病人；

specifically, lung cancer.

更具体地说，是肺癌。

The sad fact is, even with the best drugs that we have today,

令人遗憾的是，即使是 使用了现有最好的药物，

most lung cancers come back.

大多数肺癌还是会复发。

The key, then, is to see

那么关键就在于

whether we're able to detect these recurrences of cancers

我们能否比标准方法更早地

earlier than with standard methods.

检测出癌症的复发。

We just finished a major trial

我们与伦敦大学学院的

with Professor Charles Swanton at University College London,

查尔斯·斯旺顿教授一起探索 这种方法，并且刚刚完成了一项大型的

examining this.

临床研究。

Let me walk you through an example of one patient.

我来带你们看一个病例。

Here's an example of one patient who undergoes surgery

这位病人接受了手术，

at time point zero,

这里是起始时间点。

and then undergoes chemotherapy.

然后他接受了化疗，

Then the patient is under remission.

接下来他的症状开始缓解。

He is monitored using clinical exams and imaging methods.

他一直在接受各种临床检验 和显像技术的检测。

Around day 450, unfortunately, the cancer comes back.

大约第450天的时候，很不幸， 他的癌症复发了。

The question is: Are we able to catch this earlier?

问题是，我们能更早地 发现癌症复发吗？

During this whole time, we've been collecting blood serially

在这期间，我们一直在 收集他的血液样本，

to be able to measure the amount of ctDNA in the blood.

以便测量他血液的循环肿瘤DNA。

So at the initial time point, as expected,

在开始的时候，如我们所料，

there's a high level of cancer DNA in the blood.

血液里的肿瘤DNA含量很高。

However, this goes away to zero in subsequent time points

然而在接下来的时间点， 这些DNA慢慢消失，

and remains negligible after subsequent points.

一直在几乎可以忽略的水平。

However, around day 340, we see the rise of cancer DNA in the blood,

在第340天前后，我们发现了 血液中肿瘤DNA水平开始上升，

and eventually, it goes up higher for days 400 and 450.

最终在第400天和 第450天时上升到更高。

Here's the key, if you've missed it:

你也许还没意识到，这就是关键：

At day 340, we see the rise in the cancer DNA in the blood.

在第340天，我们看到了 血液里肿瘤DNA的上升。

That means we are catching this cancer over a hundred days earlier

这意味着，与传统方法相比， 我们能提前超过一百天

than traditional methods.

检测出癌症。

This is a hundred days earlier where we can give therapies,

这说明，我们可以 提前一百天开始治疗，

a hundred days earlier where we can do surgical interventions,

提前一百天进行手术干预，

or even a hundred days less for the cancer to grow

让肿瘤生长的时间减少一百天，

or a hundred days less for resistance to occur.

或者让抗药性癌细胞 少一百天的产生机会。

For some patients, this hundred days means the matter of life and death.

对于一些病人来说， 这一百天就是生与死的区别。

We're really excited about this information.

我们对此非常的激动。

Because of this assignment, we've done additional studies now

介于这样的结果， 我们还针对其它癌症

in other cancers,

完成了另外几项研究，

including breast cancer, lung cancer

包括乳腺癌、肺癌

and ovarian cancer,

和卵巢癌，

and I can't wait to see how much earlier we can find these cancers.

我已经迫不及待地想看到 我们能多早检测到癌症。

Ultimately, I have a dream,

我有一个最终的梦想，

a dream of two vials of blood,

关于两管血液的梦想，

and that, in the future, as part of all of our standard physical exams,

在未来，作为我们标准体检的一部分，

we'll have two vials of blood drawn.

我们会抽两管血。

And from these two vials of blood we will be able to compare

用这两管血，我们能够比较

the DNA from all known signatures of cancer,

所有已知的肿瘤DNA，

and hopefully then detect cancers months to even years earlier.

但愿这样可以提前几个月， 甚至几年检查出癌症。

Even with the therapies we have currently,

即使用我们现有的治疗方法，

this could mean that millions of lives could be saved.

这也意味着能拯救上百万的生命。

And if you add on to that recent advancements in immunotherapy

如果你再算上免疫疗法的最新进展，

and targeted therapies,

以及靶向治疗，

the end of cancer is in sight.

终结癌症已经指日可待了。

The next time you hear the word "cancer,"

下次你听到“癌症”这个词，

I want you to add to the emotions: hope.

我希望你能感受到希望。

Hold on.

坚持住。

Cancer researchers all around the world are working feverishly

全世界肿瘤研究学者 都在狂热地工作，

to beat this disease,

想要打败这种疾病，

and tremendous progress is being made.

并且已经取得了巨大的成就。

This is the beginning of the end.

这是终结的开始。

We will win the war on cancer.

我们会打赢这场与癌症的战争。

And to me, this is amazing news.

对我来说，这是最棒的消息。

Thank you.

谢谢大家。

(Applause)

（掌声）