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

62,064 views ・ 2011-01-06

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譯者: Nim Chen 審譯者: K. C. Peng
00:15
There are two groups of women
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依照乳房X光攝影有效的檢測程度
00:18
when it comes to screening mammography --
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我們可以將女性區分為兩大群組
00:20
women in whom mammography works very well
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其中一群人可透過乳房X光攝影有效的診斷
00:23
and has saved thousands of lives
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因此拯救了許多的生命
00:25
and women in whom it doesn't work well at all.
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然而另一群女性卻無法被乳房X光攝影有效的診斷
00:29
Do you know which group you're in?
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妳知道妳屬於哪一群組嗎?
00:32
If you don't, you're not alone.
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別擔心,妳並不是少數不知道的
00:34
Because the breast has become
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因為乳房可說是
00:36
a very political organ.
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一個敏感議題的器官
00:39
The truth has become lost
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許多真相
00:41
in all the rhetoric
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已因修飾而遺失 有
00:43
coming from the press, politicians,
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來自媒體、政客
00:45
radiologists
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放射科醫師
00:47
and medical imaging companies.
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以及醫用影像公司的花言巧語中
00:49
I will do my best this morning
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而現在我將要盡我所能的
00:51
to tell you what I think is the truth.
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告訴大家我所知道的真相
00:54
But first, my disclosures.
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但首先讓我澄清一下
00:57
I am not a breast cancer survivor.
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我未曾罹患乳癌
00:59
I'm not a radiologist.
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我也不是個放射科醫師
01:01
I don't have any patents,
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我沒有任何的專利
01:03
and I've never received any money from a medical imaging company,
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而我也未曾從任何的醫用影像公司獲得任何利益
01:06
and I am not seeking your vote.
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我更不是說服各位哪天要投我一票
01:09
(Laughter)
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(眾笑)
01:11
What I am
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我僅僅只是
01:13
is a doctor of internal medicine
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一名
01:15
who became passionately interested in this topic
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熱衷於此一領域的內科醫師
01:17
about 10 years ago
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大約在十年前
01:19
when a patient asked me a question.
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有一名病患問了我一個問題
01:23
She came to see me
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她是在發現了一個乳房腫塊之後
01:25
after discovering a breast lump.
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來找我的
01:27
Her sister had been diagnosed with breast cancer
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她的姊姊在四十多歲時被診斷
01:30
in her 40s.
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罹患乳癌
01:32
She and I were both very pregnant at that time,
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當時她與我都在懷孕末期了
01:35
and my heart just ached for her,
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我深深的為她感到心疼
01:37
imagining how afraid she must be.
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並試想著她當時該有多害怕
01:40
Fortunately, her lump proved to be benign.
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很幸運地,她的乳房腫塊是良性的
01:43
But she asked me a question:
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但她問我
01:45
how confident was I
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我有幾成的把握
01:47
that I would find a tumor early on her mammogram
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可以及早的透過她的乳房X光片診斷出是否罹患腫瘤
01:49
if she developed one?
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如果她真的不幸罹患的話?
01:51
So I studied her mammogram,
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於是我便判讀了她的乳房X光片
01:53
and I reviewed the radiology literature,
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並且檢視了文獻以及相關紀錄
01:55
and I was shocked to discover
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我很震驚的發現
01:57
that, in her case,
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在她的例子
01:59
our chances of finding a tumor early on the mammogram
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要透過乳房X光攝影及早發現腫瘤的機率
02:01
were less than the toss of a coin.
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甚至不到二分之一
02:04
You may recall a year ago
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各位大概還記得一年前
02:06
when a firestorm erupted
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的一場風暴
02:08
after the United States Preventive Services Task Force
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也就是美國預防醫學工作小組
02:12
reviewed the world's mammography screening literature
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在檢視了乳房X光攝影術的相關期刊後
02:15
and issued a guideline
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發布了一項準則
02:17
recommending against screening mammograms
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建議女性在四十歲以後
02:20
in women in their 40s.
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應避免進行乳房X光攝影術
02:22
Now everybody rushed to criticize the Task Force,
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很快的引發許多人批評此一工作小組
02:25
even though most of them weren't in anyway familiar
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而其中許多人甚至根本不熟悉
02:27
with the mammography studies.
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乳房X光攝影術
02:30
It took the Senate just 17 days
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參議院花了僅僅十七天
02:32
to ban the use of the guidelines
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便決定在考量保險理賠範圍上
02:34
in determining insurance coverage.
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禁止使用該項準則
02:38
Radiologists were outraged
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而放射治療師也因為這項準則
02:40
by the guidelines.
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而義憤填膺
02:42
The pre-eminent mammographer in the United States
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一名傑出的乳房X光攝影師
02:44
issued the following quote
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在華盛頓郵報上
02:46
to the Washington Post.
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發表了這樣的評論
02:49
The radiologists were, in turn, criticized
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於是放射科醫師更被視為是
02:52
for protecting their own financial self-interest.
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為了保護自己的既得利益而飽受批評
02:55
But in my view,
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但在我看來
02:57
the radiologists are heroes.
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放射線治療師可說是英雄
02:59
There's a shortage of radiologists
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能判讀乳房X光攝影術的放射線治療師
03:01
qualified to read mammograms,
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可說是少之又少
03:03
and that's because mammograms are one of the most complex
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這是因為乳房X光片
03:06
of all radiology studies to interpret,
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是所有放射線科中最複雜也最難判讀的
03:09
and because radiologists
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也因為放射科醫師
03:11
are sued more often
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最常因為
03:13
over missed breast cancer
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未察覺乳癌
03:15
than any other cause.
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而被控告
03:17
But that very fact is telling.
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但事實的真相其實是顯而易見的
03:20
Where there is this much legal smoke,
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這麼多的訴訟
03:23
there is likely to be some fire.
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那一定是有些狀況的
03:26
The factor most responsible for that fire
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而會造成判讀上的錯誤或疏失
03:29
is breast density.
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主要是因為乳房密度
03:33
Breast density refers to the relative amount of fat --
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乳房密度指的是乳房中的脂肪
03:35
pictured here in yellow --
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在圖中以黃色顯示
03:37
versus connective and epithelial tissues --
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以及結締組織和上皮組織的相對含量
03:39
pictured in pink.
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在圖上以粉紅色表示
03:41
And that proportion
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乳房密度
03:43
is primarily genetically determined.
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基本上是由基因所決定的
03:45
Two-thirds of women in their 40s
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三分之二的女性在四十歲以後
03:47
have dense breast tissue,
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會有乳房密度偏高的現象
03:49
which is why mammography doesn't work as well in them.
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這也就是為什麼乳房X光攝影術無法對這些女性進行準確判讀
03:52
And although breast density generally declines with age,
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雖然一般而言乳房密度會隨著年齡而下降
03:55
up to a third of women
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然而三分之一的女性
03:57
retain dense breast tissue
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即使在更年期後數年
03:59
for years after menopause.
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其乳房密度仍不會下降
04:03
So how do you know if your breasts are dense?
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而女性們如何知道自己的乳房密度是否偏高?
04:06
Well, you need to read the details
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你需要好好的檢視
04:08
of your mammography report.
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乳房X光攝影術報告中的許多細節
04:10
Radiologists classify breast density
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放射科醫師將乳房密度
04:12
into four categories
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依照乳房X光片的結果
04:14
based on the appearance of the tissue on a mammogram.
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將乳房區分成四類
04:17
If the breast is less than 25 percent dense,
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若乳房密度低於25%
04:20
that's called fatty-replaced.
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便稱為脂肪型乳房(fatty replaced)
04:22
The next category
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下一個類別
04:24
is scattered fibroglandular densities,
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則是散在纖維腺體型(25-50%)
04:26
followed by heterogeneously dense
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以及不均質型(50-75%)
04:28
and extremely dense.
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緻密型(75%以上)
04:30
And breasts that fall into these two categories
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乳房密度落於後兩個類別的話
04:32
are considered dense.
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便視為高密度型乳房
04:34
The problem with breast density
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而乳房密度所潛藏的危機
04:36
is that it's truly the wolf in sheep's clothing.
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是它讓危險的腫瘤像是批著羊皮的狼隱藏在乳房中
04:39
Both tumors and dense breast tissue
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腫瘤跟高密度乳房組織
04:41
appear white on a mammogram,
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在乳房X光片上都呈白色
04:44
and the X-ray often can't distinguish between the two.
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而X光往往無法順利區分兩者
04:47
So it's easy to see this tumor
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所以要在充滿脂肪的乳房中
04:49
in the upper part of this fatty breast.
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發現腫瘤比較容易
04:52
But imagine how difficult it would be
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但是試想看看
04:54
to find that tumor in this dense breast.
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要在高乳房密度中發現腫瘤該有多難
04:57
That's why mammograms find
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這也就是為什麼透過乳房X光片
04:59
over 80 percent of tumors in fatty breasts,
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在多脂肪的乳房能診斷出超過 80% 的腫瘤
05:02
but as few as 40 percent in extremely dense breasts.
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但是在高乳房密度的女性中正確診斷的機率卻少於 40%
05:05
Now it's bad enough that breast density
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高乳房密度
05:07
makes it hard to find a cancer,
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使得腫瘤診斷變得困難,這已經很糟了
05:09
but it turns out
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更糟的是,高乳房密度
05:11
that it's also a powerful predictor
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也是罹患乳癌機率的
05:13
of your risk for breast cancer.
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有效預測指標
05:15
It's a stronger risk factor
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高乳房密度是罹患乳癌的風險因素之一
05:17
than having a mother or a sister with breast cancer.
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甚至比母親或姊妹有乳癌病史更危險
05:20
At the time my patient posed this question to me,
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在那位病患對我提出問題的年代
05:23
breast density was an obscure topic
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乳房密度在放射線學文獻中
05:25
in the radiology literature,
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仍是一個鮮為人知的主題
05:27
and very few women having mammograms,
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當時很少女性會進行乳房X光攝影術
05:29
or the physicians ordering them,
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也很少醫師要求病患進行檢測
05:31
knew about this.
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甚至也不瞭解乳房X光攝影術
05:33
But what else could I offer her?
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而在當時我們還能夠提供為她進行什麼檢測呢?
05:36
Mammograms have been around since the 1960's,
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乳房X光攝影術在1960年代就被發現了
05:39
and it's changed very little.
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但是它到現在仍沒什麼進步
05:41
There have been surprisingly few innovations,
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這項技術的創新出乎意料的少
05:44
until digital mammography was approved
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直到2000年時數位化乳房X光攝影
05:46
in 2000.
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才被核可
05:48
Digital mammography is still an X-ray of the breast,
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數位乳房X光攝影仍然是透過X光來檢測乳房
05:51
but the images
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但是所診測的影像
05:53
can be stored and manipulated digitally,
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可以被數位化儲存並進行調整 (使影像更清晰)
05:55
just like we can with a digital camera.
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就好像我們所使用的數位相機
05:58
The U.S. has invested
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為此,美國政府投資了
06:00
four billion dollars
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四十億美元
06:02
converting to digital mammography equipment,
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將乳房X光攝影術的儀器進行更新
06:05
and what have we gained from that investment?
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而這項投資到底帶給了我們什麼好處?
06:08
In a study funded by over 25 million taxpayer dollars,
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在一個花了納稅人2500萬美元的研究中顯示
06:12
digital mammography was found
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數位乳房X光攝影術
06:14
to be no better over all
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整體而言並沒有比
06:16
than traditional mammography,
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傳統的乳房X光攝影術來的好
06:18
and in fact, it was worse in older women.
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事實上,它對年長女性的檢測能力甚至更糟
06:21
But it was better in one group,
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但是數位乳房X光攝影
06:24
and that was women under 50
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針對五十歲以下的女性檢測能力較傳統的好
06:26
who were pre-menopausal and had dense breasts,
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而她們通常是停經期前且有著高密度乳房的女性
06:29
and in those women,
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在這些女性中
06:31
digital mammography found twice as many cancers,
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數位乳房X光攝影術比起傳統攝影術更加有效
06:34
but it still only found 60 percent.
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但成功診斷的機率仍只有60%
06:37
So digital mammography
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所以數位乳房X光攝影
06:39
has been a giant leap forward
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對於相關的儀器製造商
06:41
for manufacturers
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可說是大有貢獻
06:43
of digital mammography equipment,
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.
06:45
but it's been a very small step forward for
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但是對女性整體而言
06:47
womankind.
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其幫助可說是微乎其微
06:50
What about ultrasound?
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那麼超音波呢?
06:52
Ultrasound generates more biopsies
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比起其他檢測方法
06:54
that are unnecessary relative to other technologies,
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超音波需要更多的生物檢體
06:56
so it's not widely used.
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因此鮮少被使用
06:59
And MRI is exquisitely sensitive for finding tumors,
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而核磁共振顯影(MRI)可以非常有效的診斷乳癌
07:02
but it's also very expensive.
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但它卻非常的昂貴
07:06
If we think about disruptive technology,
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想想那些革命性的科技
07:09
we see an almost ubiquitous pattern
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我們總是可以發現廣泛存在的趨勢
07:11
of the technology getting smaller and less expensive.
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也就是它們總是變得越來越小、越便宜
07:14
Think about iPods compared to stereos.
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比較看看iPods跟以前的音響
07:17
But it's the exact opposite in health care.
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但是在醫療產業中趨勢卻是剛好相反
07:20
The machines get ever bigger
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需多醫療儀器都越變越大
07:22
and ever more expensive.
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而且越來越昂貴
07:26
Screening the average young woman with an MRI
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使用核磁共振儀來檢測
07:29
is kind of like driving to the grocery store in a Hummer.
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就好像開著一台悍馬車進雜貨店一樣
07:33
It's just way too much equipment.
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實在有太多儀器、設備了
07:35
One MRI scan
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一次核磁共振掃描
07:37
costs 10 times what a digital mammogram costs.
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所花費的金錢約是數位X光掃描的10倍
07:40
And sooner or later, we're going to have to accept the fact
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遲早我們都必須要接受一個事實
07:42
that health care innovation
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也就是醫療儀器的創新
07:44
can't always come at a much higher price.
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不能總是發明出更昂貴的設備
07:49
Malcolm Gladwell wrote an article in the New Yorker
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Malcolm Gladwell在"紐約客"雜誌上寫了一篇
07:51
on innovation,
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關於創新的文章
07:53
and he made the case that scientific discoveries
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而他認為科學上的重大發展
07:56
are rarely the product of one individual's genius.
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很少是由一個天才單打獨鬥所創造的
08:00
Rather, big ideas can be orchestrated,
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相反的,有創意的點子可以互相共鳴與影響
08:03
if you can simply gather
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所以如果我們能夠
08:05
people with different perspectives in a room
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將不同領域的人才聚集在一起
08:07
and get them to talk about things
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讓他們討論某些
08:09
that they don't ordinarily talk about.
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他們平常時不太會討論的議題
08:11
It's like the essence of TED.
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就好像TED的本質那樣
08:14
He quotes one innovator who says,
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他引用了一個創新者說的話
08:16
"The only time a physician and a physicist get together
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"醫生跟物理學家難得會聚在一起的時候
08:20
is when the physicist gets sick."
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就是物理學家生病的時候"
08:22
(Laughter)
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.
08:24
This makes no sense,
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這一點道理都沒有
08:26
because physicians have all kinds of problems
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因為醫生其實面對了許多的問題
08:28
that they don't realize have solutions.
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而他們甚至沒有意識到這些問題其實是可以被解決的
08:31
And physicists have all kinds of solutions for things
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而物理學家可以為許多事物找到解決的辦法
08:33
that they don't realize are problems.
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但是他們卻不知道醫生所遇到的問題
08:36
Now, take a look at this cartoon
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現在大家看看
08:39
that accompanied Gladwell's article,
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Gladwell 文章中所附的插圖
08:41
and tell me if you see something disturbing
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這幅關於創新思考者的插圖
08:43
about this depiction of innovative thinkers.
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是不是讓你覺得怪怪的呢?
08:46
(Laughter)
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.
08:48
So if you will allow me a little creative license,
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如果各位不介意的話
08:52
I will tell you the story
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我將要向各位分享
08:54
of the serendipitous collision
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一次由我病患所提出的問題
08:56
of my patient's problem
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以及醫生與科學家們所得的解答
08:58
with a physicist's solution.
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之間偶然的碰撞
09:00
Shortly after her visit,
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在我的病患拜訪完之後不久
09:02
I was introduced to a nuclear physicist
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我被引薦給一位
09:04
at Mayo
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在Mayo的核子物理學家
09:06
named Michael O'Conner,
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Michael O'Conner
09:08
who was a specialist in cardiac imaging,
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他是一位心臟顯影方面的專家
09:10
something I had nothing to do with.
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其實不是跟我的研究有關的領域
09:12
And he happened to tell me
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但他碰巧告訴我
09:14
about a conference he'd just returned from in Israel,
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一個他剛去以色列所參加的會議
09:17
where they were talking about a new type of gamma detector.
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與會人士討論到一種全新的伽馬(gamma)偵測器
09:20
Now gamma imaging has been around for a long time
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利用伽馬射線來進行心臟顯影
09:22
to image the heart,
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已經有數年的歷史了
09:24
and it had even been tried to image the breast.
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而它也曾被嘗試用來進行檢測乳房
09:27
But the problem was
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但問題是
09:29
that the gamma detectors
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使用伽馬射線探測器
09:31
were these huge, bulky tubes,
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是由體積龐大又笨重的管子組成的
09:33
and they were filled with these scintillating crystals,
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裡面還填充著螢光特性的晶體
09:35
and you just couldn't get them close enough around the breast
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所以我們就是沒辦法讓這些偵測器非常靠近乳房
09:38
to find small tumors.
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來檢測小型腫瘤
09:40
But the potential advantage was
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但是其中一項潛在的優勢是
09:42
that gamma rays, unlike X-rays,
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伽瑪射線不像X光
09:44
are not influenced by breast density.
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並不會受到乳房密度的影響
09:47
But this technology
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但是伽馬射線
09:49
could not find tumors when they're small,
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無法在腫瘤還很小就偵測到
09:51
and finding a small tumor is critical for survival.
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但是及早發現小腫瘤對於病患的存活率是很重要的
09:54
If you can find a tumor
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如果我們能在
09:56
when it's less than a centimeter,
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腫瘤還小於一公分時就發現它
09:58
survival exceeds 90 percent,
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那麼病患的存活率可高達九十以上
10:00
but drops off rapidly
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但是若等到腫瘤變更大後才發現
10:02
as tumor size increases.
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存活機率便會大大下降
10:05
But Michael told me about
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而Michael告訴我
10:07
a new type of gamma detector that he'd seen,
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他曾經見過一種新的伽馬偵測器
10:09
and this is it.
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也就是這一個
10:11
It's made
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它不是用
10:13
not of a bulky tube,
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龐大的管子所構成
10:15
but of a thin layer of a semiconductor material
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而是用一層薄薄的
10:18
that serves as the gamma detector.
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用來偵測伽瑪的半導體材料所做的
10:20
And I started talking to him
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於是我開始跟他討論
10:22
about this problem with breast density,
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關於乳房密度與乳癌的問題
10:24
and we realized that we might be able to get this detector
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接著我們認為我們應該可以讓這個偵測器
10:27
close enough around the breast
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更靠近乳房
10:29
to actually find small tumors.
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來增加發現小腫瘤的機率
10:31
So after putting together
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所以把這些小小偵測器
10:33
a grid of these cubes with tape --
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用膠帶黏起來之後
10:36
(Laughter)
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.
10:39
-- Michael hacked off the X-ray plate
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Michael把乳房X光攝影器
10:42
of a mammography machine
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上面的X光版給拔掉了
10:44
that was about to be thrown out,
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而且X光版之後大概也真的要被淘汰掉了
10:46
and we attached the new detector,
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我們就把新的偵測器黏上去
10:49
and we decided to call this machine
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然後我們決定把這台機器
10:51
Molecular Breast Imaging, or MBI.
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叫做MBI
10:55
This is an image from our first patient.
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這是我們用MBI檢測的第一位病患所得的影像
10:57
And you can see, using the old gamma technology,
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大家可以看到,使用舊的伽馬偵測器
10:59
that it just looked like noise.
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所得的結果大部分是雜訊
11:01
But using our new detector,
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但使用我們所發展的新的偵測器(MBI)
11:03
we could begin to see the outline of a tumor.
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我們便可以看到腫瘤的存在
11:06
So here we were, a nuclear physicist,
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結果,一個核子物理學家
11:08
an internist,
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一個內科醫師
11:10
soon joined by Carrie Hruska, a biomedical engineer,
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還有Carrie Hruska這位生醫工程師
11:13
and two radiologists,
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以及兩位放射科醫師組合成一個團隊
11:15
and we were trying to take on
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然後我們試著要
11:17
the entrenched world of mammography
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用我們那以膠帶組合起來的新機器
11:19
with a machine that was held together by duct tape.
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在乳房攝影這個領域中尋求突破
11:23
To say that we faced
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我們
11:25
high doses of skepticism
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在早期時
11:27
in those early years
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所遭遇到的高度質疑與批判
11:29
is just a huge understatement,
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簡直就是難以形容
11:31
but we were so convinced that we might be able to make this work
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但是我們非常的有信心我們可以讓它實現
11:34
that we chipped away with incremental modifications
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於是我們將整個系統
11:37
to this system.
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去蕪存菁、更進一步改進
11:39
This is our current detector.
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這是我們目前所發展出來的偵測器
11:41
And you can see that it looks a lot different.
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如各位所見,它看起來非常的不同
11:43
The duct tape is gone,
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膠帶不見了
11:47
and we added a second detector on top of the breast,
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而且我們在胸部上方又增加了另一個偵測器
11:49
which has further improved our tumor detection.
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因此可以進一步提高檢測的靈敏度
11:52
So how does this work?
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而它到底是怎麼運作的呢?
11:54
The patient receives an injection of a radio tracer
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首先病患需要注射放射性追蹤劑
11:57
that's taken up by rapidly proliferating tumor cells,
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而此一藥劑會被快速增生的腫瘤細胞所吸收
12:00
but not by normal cells,
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但是正常的細胞卻不會
12:02
and this is the key difference from mammography.
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而這便是我們所發展的偵測器與乳房X光攝影最大的不同
12:05
Mammography relies on differences
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乳房X光攝影依靠的是
12:07
in the appearance of the tumor from the background tissue,
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"腫瘤與其他組織具有不同的外觀" 來偵測腫瘤
12:10
and we've seen that those differences
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但是我們知道兩者外觀的不同
12:12
can be obscured in a dense breast.
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在高密度乳房的女性中其實是很微小的
12:15
But MBI exploits
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但是MBI所利用的
12:17
the different molecular behavior of tumors,
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卻是"腫瘤細胞與正常細胞之間性質的不同" 來偵測腫瘤
12:20
and therefore, it's impervious to breast density.
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因此MBI並不會受到乳房密度的影響
12:24
After the injection,
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在注射放射性追蹤劑後
12:26
the patient's breast is placed between the detectors.
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病患的乳房會被放置在偵測器之間
12:28
And if you've ever had a mammogram --
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如果你曾經做過乳房X光攝影
12:30
if you're old enough to have had a mammogram --
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或者你因為年紀的關係而作過乳房X光攝影
12:32
you know what comes next:
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你就知道接下來是什麼
12:34
pain.
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也就是難以忍受的疼痛
12:36
You may be surprised to know
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你大概不知道
12:38
that mammography is the only radiologic study
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乳房X光攝影是唯一放射性影像學中
12:41
that's regulated by federal law,
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被聯邦法律所謹慎規範的
12:43
and the law requires
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而聯邦法律准許
12:45
that the equivalent of a 40-pound car battery
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乳房X光攝影用大約四十磅的重量
12:48
come down on your breast during this study.
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壓在你的胸部上來進行檢測
12:52
But with MBI,
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但使用MBI
12:54
we use just light, pain-free compression.
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我們僅僅需要輕輕的、無痛的碰觸便可以完成檢測
12:57
(Applause)
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.
13:03
And the detector
315
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隨後偵測器
13:05
then transmits the image to the computer.
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便會將影像傳到電腦
13:07
So here's an example.
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這邊是其中一例
13:09
You can see, on the right, a mammogram
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大家可以看到在右邊
13:11
showing a faint tumor,
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乳房X光片模糊的顯示出似乎有個腫瘤
13:13
the edges of which are blurred by the dense tissue.
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而腫瘤的邊緣因為高密度的組織而顯得模糊
13:15
But the MBI image shows that tumor much more clearly,
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但是用MBI所得的影像則清晰的多
13:18
as well as a second tumor,
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甚至還可以發現第二個小腫瘤
13:20
which profoundly influence that patient's surgical options.
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也因此徹底的影響了病患選擇手術施行的意願
13:24
In this example, although the mammogram found one tumor,
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而在這個例子,雖然乳房X光攝影發現了一個腫瘤
13:27
we were able to demonstrate three discrete tumors --
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但是MBI卻發現其實是三個
13:30
one is small as three millimeters.
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其中一個甚至小到只有三公厘
13:33
Our big break came in 2004.
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我們最重大的突破出現在2004年
13:38
After we had demonstrated that we could find small tumors,
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在我們證實我們的MBI能夠有效的發現小型腫瘤
13:41
we used these images
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我們便用這些影像結果
13:43
to submit a grant to the Susan G. Komen Foundation.
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向Susan G. Komen 基金會申請一項計劃費
13:46
And we were elated when they took a chance
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我們很慶興他們最終同意
13:49
on a team of completely unknown investigators
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讓一群投資者
13:51
and funded us to study
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贊助我們研究
13:53
1,000 women with dense breasts,
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一千名高密度乳房的女性
13:55
comparing a screening mammogram to an MBI.
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使用乳房X光攝影以及MBI檢測的差異
13:58
Of the tumors that we found,
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在所有我們研究中所發現的腫瘤
14:00
mammography found
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乳房X光攝影只能
14:02
only 25 percent of those tumors.
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檢測出25%的腫瘤
14:05
MBI found 83 percent.
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MBI則能夠檢測出83%的腫瘤
14:08
Here's an example from that screening study.
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這裡以其中一項檢測作為例子
14:11
The digital mammogram was read as normal
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數位乳房X光攝影判讀結果為正常
14:13
and shows lots of dense tissue,
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並在圖上顯示許多高密度的組織
14:15
but the MBI shows an area of intense uptake,
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但是MBI卻發現有一個區域會吸收高量的放射性追蹤劑
14:18
which correlated with a two-centimeter tumor.
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而結果證實是一個兩公分大的腫瘤
14:21
In this case, a one-centimeter tumor.
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在這個例子則是一個一公分的腫瘤
14:24
And in this case,
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接下來的例子
14:26
a 45-year-old medical secretary at Mayo,
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一位在Mayo的四十五歲的醫務秘書
14:29
who had lost her mother to breast cancer when she was very young,
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在她還很年輕時,她的母親由於乳癌而過世
14:32
wanted to enroll in our study.
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而她主動要求進入我們的研究
14:34
And her mammogram showed an area of very dense tissue,
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而她的乳房X光片中有一個區域分布著高密度的組織
14:37
but her MBI showed an area
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但是她的MBI檢測結果卻顯示
14:39
of worrisome uptake,
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有異常的放射性追蹤劑吸收現象
14:41
which we can also see on a color image.
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而我們也可以從這張影像結果上看出來
14:44
And this corresponded
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而它所顯示的
14:46
to a tumor the size of a golf ball.
355
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其實是一個高爾夫球大小的腫瘤
14:48
But fortunately it was removed
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但是很幸運的已經及早在腫瘤
14:50
before it had spread to her lymph nodes.
357
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轉移到淋巴結前移除
14:54
So now that we knew that this technology
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所以現在我們知道這項科技(MBI)
14:56
could find three times more tumors in a dense breast,
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可以提高偵測高密度乳房女性的腫瘤靈敏度達三倍
14:59
we had to solve one very important problem.
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我們已經解決了一個非常重要的問題
15:02
We had to figure out how to lower the radiation dose,
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接下來必須要思考如何減低放射性追蹤劑的劑量
15:05
and we have spent the last three years
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而過去三年
15:08
making modifications to every aspect of the imaging system
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我們盡其可能的改善此一系統
15:11
to allow this.
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來達到這個目標
15:13
And I'm very happy to report that we're now using a dose of radiation
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而現在我很高興能夠告訴大家
15:16
that is equivalent to the effective dose
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MBI所需的劑量
15:18
from one digital mammogram.
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與數位乳房X光攝影所需的劑量是相同的
15:20
And at this low dose, we're continuing this screening study,
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而用這樣低的劑量,我們繼續研究MBI檢測的效率
15:23
and this image from three weeks ago
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這張影像是來自三星期以前
15:26
in a 67-year-old woman
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一位67歲的女性
15:28
shows a normal digital mammogram,
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她的乳房X光片結果顯示正常
15:30
but an MBI image
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但是MBI影像結果
15:32
showing an uptake that proved to be a large cancer.
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卻顯示出一個大型的腫瘤
15:35
So this is not just young women that it's benefiting.
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所以MBI嘉惠的對象不只是年輕的女性
15:38
It's also older women with dense tissue.
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還有年長但仍保有高密度乳房的女性
15:41
And we're now routinely using one-fifth the radiation dose
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而我們現在已經例行性的用
15:44
that's used in any other type of gamma technology.
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其他伽馬檢測技術所需劑量的五分之一來進行檢測
15:48
MBI generates four images per breast.
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每次MBI檢測會產生四張影像結果
15:51
MRI generates over a thousand.
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而MRI則會產生超過一千張影像
15:54
It takes a radiologist
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一名放射科醫生
15:56
years of specialty training
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需要數年的專業化訓練
15:58
to become expert in differentiating
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才能夠成功分辨
16:00
the normal anatomic detail
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正常的乳房組織
16:02
from the worrisome finding.
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與腫瘤
16:04
But I suspect even the non-radiologists in the room
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不過我想在座的各位即便不是放射科醫師
16:07
can find the tumor on the MBI image.
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也能夠在MBI影像上判讀出腫瘤的存在
16:10
But this is why MBI
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這也就是為什麼
16:12
is so potentially disruptive --
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MBI是如此的潛力無窮又革命性的科技
16:14
it's as accurate as MRI,
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它與MRI一樣的準確
16:16
it's far less complex to interpret,
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但是卻更容易判讀
16:19
and it's a fraction of the cost.
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而且所花費的金錢也較少
16:21
But you can understand why there may be
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也因此各位可以稍微想想看
16:23
forces in the breast-imaging world
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為什麼醫療用乳房攝影的領域
16:25
who prefer the status quo.
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會偏好維持現狀
16:29
After achieving what we felt were remarkable results,
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在獲得我們這些突破性的結果之後
16:32
our manuscript was rejected
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我們的文章
16:35
by four journals.
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卻被四個期刊拒絕
16:37
After the fourth rejection,
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在第四個期刊拒絕登載我們的文章後
16:39
we requested reconsideration of the manuscript,
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我們要求再一次審議我們的文章
16:41
because we strongly suspected
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因為我們強烈的懷疑
16:43
that one of the reviewers who had rejected it
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其中一位拒絕我們文章的審查者
16:45
had a financial conflict of interest
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因為參與了另一項與MBI競爭的科技
16:47
in a competing technology.
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因此有著利益衝突的考量
16:50
Our manuscript was then accepted
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結果我們的文章便被接受了
16:52
and will be published later this month
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將在這個月底
16:55
in the journal Radiology.
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在Radiology期刊上發表
16:57
(Applause)
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.
17:05
We still need to complete the screening study using the low dose,
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我們仍然要想辦法進一步減少放射性追蹤劑的劑量
17:08
and then our findings will need to be replicated
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而我們的檢測結果也需要
17:10
at other institutions,
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被其他機構重複驗證
17:12
and this could take five or more years.
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而這將會耗費五年或甚至更久
17:15
If this technology is widely adopted,
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如果這項科技有朝一日能夠被廣泛的應用
17:18
I will not benefit financially in any way,
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我完全不會從中得到任何商業利益
17:21
and that is very important to me,
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而這一點對我很重要
17:24
because it allows me to continue to tell you the truth.
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因為這樣才能夠讓我持續告訴社會大眾真正的事實
17:28
But I recognize --
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而我認為
17:30
(Applause)
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.
17:34
I recognize that the adoption of this technology
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我想這項科技要真的被廣泛的接受與應用
17:37
will depend as much on economic
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將需要經濟上
17:39
and political forces
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以及醫療政策的支持
17:41
as it will on the soundness of the science.
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如同它需要健全、透徹的科學研究作為背景一樣
17:44
The MBI unit has now been FDA approved,
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現在美國食品藥物管理局已經核准MBI了
17:47
but it's not yet widely available.
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但是MBI卻仍無法為大眾所使用
17:50
So until something is available
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高密度乳房的女性
17:52
for women with dense breasts,
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在能夠進行檢測之前
17:54
there are things that you should know
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應該要知道以下幾件事
17:56
to protect yourself.
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來保護自己
17:58
First, know your density.
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首先,要知道自己的乳房密度落在哪一範圍
18:00
Ninety percent of women don't,
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90%並不知道自己的乳房密度
18:02
and 95 percent of women don't know
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而更有95%的女性不知道
18:04
that it increases your breast cancer risk.
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高乳房密度會增加罹患乳癌的風險
18:07
The State of Connecticut became the first and only state
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康乃狄克州是第一個,也是目前唯一一個州
18:10
to mandate that women receive notification
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規定女性在接受乳房X光攝影後
18:12
of their breast density
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其檢測報告應包含乳房密度
18:14
after a mammogram.
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.
18:17
I was at a conference of 60,000 people in breast-imaging
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上周我與六萬人共同參加了一場
18:20
last week in Chicago,
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在芝加哥所舉辦的關於乳房攝影的研討會
18:22
and I was stunned that there was a heated debate
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而我非常訝異於其中一項爭議性的討論
18:25
as to whether we should be telling women
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也就是是否應該告訴女性
18:27
what their breast density is.
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她們的乳房密度
18:29
Of course we should.
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但我認為這是相當理所當然的
18:31
And if you don't know, please ask your doctor
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所以如果妳不知道自己乳房密度的話,請詢問妳的醫生
18:34
or read the details of your mammography report.
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或是詳閱乳房X光攝影的結果報告
18:37
Second, if you're pre-menopausal,
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第二,若你仍在停經前的話
18:39
try to schedule your mammogram
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試著安排乳房X光攝影
18:41
in the first two weeks of your menstrual cycle,
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並安排在自己生理期的前兩周去檢測
18:43
when breast density is relatively lower.
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那時胸部密度會相對的較低
18:46
Third, if you notice a persistent change in your breast,
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第三,若你發現自己的胸部有持續的微小變化
18:49
insist on additional imaging.
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請務必要進行更進一步的檢測、獲得更多影像
18:52
And fourth and most important,
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第四點,同時也是最重要的一點
18:54
the mammography debate will rage on,
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關於乳房X光攝影所存在的爭議會一直持續下去
18:57
but I do believe that all women 40 and older
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但我相信所有超過四十歲的女性
19:00
should have an annual mammogram.
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每年都應該要進行一次乳房X光攝影
19:02
Mammography isn't perfect,
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的確,乳房X光攝影並不是完美的
19:04
but it's the only test that's been proven
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但是它卻是唯一證實
19:06
to reduce mortality from breast cancer.
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能夠減低乳癌致死機率的檢測
19:09
But this mortality banner
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死亡率這個議題
19:11
is the very sword
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其實是一把兩面刃
19:13
which mammography's most ardent advocates use
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許多乳房X光攝影的擁護者以它作為藉口
19:16
to deter innovation.
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反對其它可能的創新
19:18
Some women who develop breast cancer
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有些女性在診斷出乳癌之後
19:21
die from it many years later,
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會在數年以後死亡
19:23
and most women, thankfully, survive.
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然而值得慶幸的是,大部分的女性都會存活下來
19:25
So it takes 10 or more years
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所以任何的檢測技術
19:27
for any screening method
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都需要十年甚至更久
19:29
to demonstrate a reduction
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才能夠證實
19:31
in mortality from breast cancer.
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它能夠降低乳癌致死率的程度
19:33
Mammography's the only one that's been around long enough
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而乳房X光攝影則是目前唯一一項
19:35
to have a chance of making that claim.
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有權宣稱其檢測效果的技術
19:38
It is time for us to accept
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我們承認並同意
19:41
both the extraordinary successes of mammography
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乳房X光攝影至今所貢獻的偉大成就
19:43
and the limitations.
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但同時也必須要關注它所存在的限制
19:45
We need to individualize screening
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我們應該要將乳癌檢測個人化
19:47
based on density.
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並依照乳房密度來挑選適當的檢測方式
19:49
For women without dense breasts,
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對於不具有高密度乳房的女性而言
19:51
mammography is the best choice.
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乳房X光檢測是她們最好的選擇
19:54
But for women with dense breasts;
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但是最於高密度乳房的女性來說
19:56
we shouldn't abandon screening altogether,
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我們不應該用一樣的方式來檢測
19:58
we need to offer them something better.
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我們必須要提供給她們更好的選擇
20:03
The babies that we were carrying
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在我的病患問我那個問題時
20:05
when my patient first asked me this question
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我們當時所懷的孩子
20:08
are now both in middle school,
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現在都已經在念中學了
20:11
and the answer has been so slow to come.
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而問題的答案已經等了那麼才出現一道曙光
20:16
She's given me her blessing
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她同意我
20:18
to share this story with you.
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向在座各位分享接下來的故事
20:21
After undergoing biopsies
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在進一步進行組織切片檢測後
20:23
that further increased her risk for cancer
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顯示她罹患癌症的風險更高了
20:26
and losing her sister to cancer,
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也因為她的姊姊死於癌症
20:28
she made the difficult decision
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她做了一個非常困難的決定
20:30
to have a prophylactic mastectomy.
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進行了預防性乳房切除術
20:34
We can and must do better,
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我們有能力、也必須要做得更好
20:37
not just in time for her granddaughters
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不僅是為了能夠幫助她的孫女那一代
20:40
and my daughters,
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或是幫助我女兒這一代
20:42
but in time for you.
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而是及時的能夠在我們這一代
20:44
Thank you.
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謝謝各位
20:46
(Applause)
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.
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