TEDWomen 2010
Deborah Rhodes: A test that finds 3x more breast tumors, and why it's not available to you
Debora Rods: Uređaj koji pronalazi 3x više tumora dojke i zašto vam nije dostupan
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Readability: 5.2
1,021,722 views
Radeći sa timom lekara, Dr Debora Rods je razvila novi način otkrivanja tumora koji je 3 puta efikasniji od tradicionalnog mamograma za žene sa gustim tkivom dojke. Rezultati u spašavanju života su zapanjujući. Zašto onda nismo čuli za to? Rods deli sa nama priču o stvaranju ovog uređaja i političkim i ekonomskim mrežama koje sprečavaju njegovu opštu upotrebu.
Deborah Rhodes - Physician, cancer researcher
Deborah Rhodes is an expert at managing breast-cancer risk. The director of the Mayo Clinic’s Executive Health Program is now testing a gamma camera that can see tumors that get missed by mammography. Full bio
Deborah Rhodes is an expert at managing breast-cancer risk. The director of the Mayo Clinic’s Executive Health Program is now testing a gamma camera that can see tumors that get missed by mammography. Full bio
Double-click the English transcript below to play the video.
00:15
There are two groups of women
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Postoje dve grupe žena
00:18
when it comes to screening mammography --
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kada je mamografija u pitanju:
00:20
women in whom mammography works very well
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žene kod kojih mamografija odlično funkcioniše
00:23
and has saved thousands of lives
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i spasila je hiljade života
00:25
and women in whom it doesn't work well at all.
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i žene kod kojih uopšte ne funkcioniše dobro.
00:29
Do you know which group you're in?
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Da li znate kojoj grupi pripadate?
00:32
If you don't, you're not alone.
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Ako ne znate, niste usamljene.
00:34
Because the breast has become
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Zato što su grudi postale
00:36
are very political organ.
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u velikoj meri politizovan organ.
00:39
The truth has become lost
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Istina se izgubila
00:41
in all the rhetoric
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u svoj toj retorici
00:43
coming from the press, politicians,
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novinara, političara
00:45
radiologists
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radiologa
00:47
and medical imaging companies.
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i medicinskih kompanija.
00:49
I will do my best this morning
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Daću sve od sebe ovog jutra
00:51
to tell you what I think is the truth.
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da vam kažem ono što smatram da je istina.
00:54
But first, my disclosures.
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Ali najpre, moje stanovište.
00:57
I am not a breast cancer survivor.
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Ja nisam preživela rak.
00:59
I'm not a radiologist.
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Nisam radiolog.
01:01
I don't have any patents,
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Nemam nikakav patent,
01:03
and I've never received any money from a medical imaging company,
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i nisam nikada primila novac od medicinske kompanije.
01:06
and I am not seeking your vote.
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I ne tražim vaš glas.
01:09
(Laughter)
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(Smeh)
01:11
What I am
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Ja sam
01:13
is a doctor of internal medicine
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doktorka interne medicine
01:15
who became passionately interested in this topic
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koja je postala veoma zainteresovana za ovu temu
01:17
about 10 years ago
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pre oko 10 godina
01:19
when a patient asked me a question.
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kada mi je pacijentkinja postavila pitanje.
01:23
She came to see me
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Došla je kod mene
01:25
after discovering a breast lump.
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nakon što je otkrila čvorić na dojci.
01:27
Her sister had been diagnosed with breast cancer
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Njenoj sestri je već bio dijagnostikovan rak dojke
01:30
in her 40s.
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u njenim četrdesetim.
01:32
She and I were both very pregnant at that time,
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I ona i ja smo bile u odmakloj trudnoći u to vreme,
01:35
and my heart just ached for her,
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i srce me je bolelo zbog nje,
01:37
imagining how afraid she must be.
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kad sam zamislila koliko je uplašena.
01:40
Fortunately, her lump proved to be benign.
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Na svu sreću, ispostavilo se da je njen čvorić bio benigan.
01:43
But she asked me a question:
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Ali mi je postavila pitanje:
01:45
how confident was I
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koliko sam sigurna
01:47
that I would find a tumor early on her mammogram
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da ću pronaći tumor u ranoj fazi na mamografu
01:49
if she developed one?
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ako ga ima?
01:51
So I studied her mammogram,
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Tako da sam prostudirala njen mamograf,
01:53
and I reviewed the radiology literature,
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i radiološku literaturu,
01:55
and I was shocked to discover
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i bila sam šokirana kada sam otkrila
01:57
that, in her case,
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da, u njenom slučaju,
01:59
our chances of finding a tumor early on the mammogram
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šanse za pronalaženje ranog tumora na mamografu
02:01
were less than the toss of a coin.
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su bile manje nego da bacamo novčić.
02:04
You may recall a year ago
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Možda se sećate pre nekoliko godina
02:06
when a firestorm erupted
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kada se digla buka
02:08
after the United States Preventive Services Task Force
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kada je Radna grupa za prevenciju Sjedninjenih Država
02:12
reviewed the world's mammography screening literature
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revidovala svetsku literaturu o skeniranju mamografom
02:15
and issued a guideline
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i izdala smernice
02:17
recommending against screening mammograms
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koje preporučuju da se mamografija ne radi
02:20
in women in their 40s.
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ženama u četrdesetim.
02:22
Now everybody rushed to criticize the Task Force,
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Svi su požurili da kritikuju Radnu grupu,
02:25
even though most of them weren't in anyway familiar
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iako većina njih nije ni na koji način bila
02:27
with the mammography studies.
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upoznata sa studijama o mamografiji.
02:30
It took the Senate just 17 days
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Senatu je trebalo samo 17 dana
02:32
to ban the use of the guidelines
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da zabrani upotrebu ovih smernica
02:34
in determining insurance coverage.
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kao odrednica za određivanje obima osiguranja.
02:38
Radiologists were outraged
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Radiolozi su bili besni
02:40
by the guidelines.
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zbog smernica.
02:42
The pre-eminent mammographer in the United States
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Istaknuti stručnjak za mamografiju u SAD
02:44
issued the following quote
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je dao sledeću izjavu
02:46
to the Washington Post.
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"Vašington Postu".
02:49
The radiologists were, in turn, criticized
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Sa druge strane, radiolozi su bili kritikovani
02:52
for protecting their own financial self-interest.
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jer su štitili sopstvene finansijske interese.
02:55
But in my view,
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Ali po mom mišljenju,
02:57
the radiologists are heroes.
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radiolozi su heroji.
02:59
There's a shortage of radiologists
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Postoji manjak radiologa
03:01
qualified to read mammograms,
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kvalifikovanih za čitanje mamograma
03:03
and that's because mammograms are one of the most complex
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i to je zbog toga što su mamogrami jedni od najkompleksnijih
03:06
of all radiology studies to interpret,
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radioloških studija za interpretaciju,
03:09
and because radiologists
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i zato što radiolozi
03:11
are sued more often
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su tuženi češće
03:13
over missed breast cancer
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zbog raka dojke koji su prevideli
03:15
than any other cause.
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nego iz bilo kog drugog razloga.
03:17
But that very fact is telling.
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Ali sama ta činjenica nam nešto govori.
03:20
Where there is this much legal smoke,
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Tamo gde ima mnogo 'pravničkog' dima,
03:23
there is likely to be some fire.
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verovatno ima i vatre.
03:26
The factor most responsible for that fire
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Faktor koji je najveći uzročnik te vatre
03:29
is breast density.
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je gustina tkiva dojke.
03:33
Breast density refers to the relative amount of fat --
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Gustina tkiva se odnosi na odnos količine masnog tkiva...
03:35
pictured here in yellow --
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ovde prikazane žutom bojom...
03:37
versus connective and epithelial tissues --
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prema vezivnom i epitelnom tkivu...
03:39
pictured in pink.
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koje je prikazano roze bojom.
03:41
And that proportion
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I taj odnos
03:43
is primarily genetically determined.
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je uglavnom određen genetikom.
03:45
Two-thirds of women in their 40s
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Dve trećine žena u četrdesetim godinama
03:47
have dense breast tissue,
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ima gusto tkivo dojke
03:49
which is why mammography doesn't work as well in them.
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i zbog toga mamografija kod njih ne funkcioniše tako dobro.
03:52
And although breast density generally declines with age,
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Iako gustina tkiva dojke uglavnom opada sa starošću,
03:55
up to a third of women
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i do trećina žena
03:57
retain dense breast tissue
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zadržava gusto tkivo dojke
03:59
for years after menopause.
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godinama nakon menopauze.
04:03
So how do you know if your breasts are dense?
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Prema tome, kako znate da su vaše grudi 'guste'?
04:06
Well, you need to read the details
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Pa, treba da čitate detalje
04:08
of your mammography report.
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vašeg mamografskog izveštaja.
04:10
Radiologists classify breast density
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Radiolozi klasifikuju gustinu tkiva dojke
04:12
into four categories
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na četiri kategorije
04:14
based on the appearance of the tissue on a mammogram.
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prema izgledu tkiva na mamogramu.
04:17
If the breast is less than 25 percent dense,
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Ako dojka ima gustinu manju od 25 procenata
04:20
that's called fatty-replaced.
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smatra se da je ispunjena masnim tkivom.
04:22
The next category
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Sledeća kategorija
04:24
is scattered fibroglandular densities,
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ima raštrkane fibroglandularne mase,
04:26
followed by heterogeneously dense
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praćena heterogeno gustom
04:28
and extremely dense.
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i ekstremno gustom.
04:30
And breasts that fall into these two categories
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I grudi koje spadaju u ove dve kategorije
04:32
are considered dense.
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se smatraju gustim.
04:34
The problem with breast density
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Problem sa gustinom dojki
04:36
is that it's truly the wolf in sheep's clothing.
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je što je to vuk u ovčijoj koži.
04:39
Both tumors and dense breast tissue
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I tumori i gusto tkivo dojke
04:41
appear white on a mammogram,
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izgledaju belo na mamogramu
04:44
and the X-ray often can't distinguish between the two.
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i rendgen često ne može da napravi razliku između ta dva.
04:47
So it's easy to see this tumor
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Tako da je lako uočiti tumor
04:49
in the upper part of this fatty breast.
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na gornjem delu ove dojke sa masnim tkivom.
04:52
But imagine how difficult it would be
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Ali zamislite kako bi bilo teško
04:54
to find that tumor in this dense breast.
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naći tumor u ovoj dojci sa gustim tkivom.
04:57
That's why mammograms find
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Zato mamografi pronalaze
04:59
over 80 percent of tumors in fatty breasts,
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preko 80 procenata tumora u dojkama sa masnim tkivom,
05:02
but as few as 40 percent in extremely dense breasts.
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ali manje od 40 procenata u dojkama sa veoma gustim tkivom.
05:05
Now it's bad enough that breast density
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Sad, dovoljno je loše to što gustina tkiva dojke
05:07
makes it hard to find a cancer,
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otežava pronalaženje raka,
05:09
but it turns out
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ali ispostavilo se
05:11
that it's also a powerful predictor
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da je takođe i veoma jak faktor
05:13
of your risk for breast cancer.
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rizika za dobijanje raka dojke.
05:15
It's a stronger risk factor
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To je veći faktor rizika
05:17
than having a mother or a sister with breast cancer.
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nego imati majku ili sestru sa rakom dojke.
05:20
At the time my patient posed this question to me,
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U vreme kada mi je pacijentkinja postavila ovo pitanje,
05:23
breast density was an obscure topic
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gustina tkiva dojke je bila nepoznata tema
05:25
in the radiology literature,
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u radiološkoj literaturi
05:27
and very few women having mammograms,
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i veoma malo žena koje su išle na mamografiju,
05:29
or the physicians ordering them,
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i lekara koji su ih vodili,
05:31
knew about this.
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su znali za ovo.
05:33
But what else could I offer her?
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Ali šta sam joj drugo mogla ponuditi?
05:36
Mammograms have been around since the 1960's,
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Mamografi su tu od 1960-ih.
05:39
and it's changed very little.
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I veoma malo se promenilo.
05:41
There have been surprisingly few innovations,
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Bilo je iznenađujuće malo inovacija,
05:44
until digital mammography was approved
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dok digitalna mamografija nije bila odobrena
05:46
in 2000.
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u 2000.
05:48
Digital mammography is still an X-ray of the breast,
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Digitalna mamografija je i dalje rendgensko snimanje dojke,
05:51
but the images
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ali slike
05:53
can be stored and manipulated digitally,
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mogu biti čuvane i obrađivane digitalno,
05:55
just like we can with a digital camera.
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kao što bi se to radilo na digitalnom foto-aparatu.
05:58
The U.S. has invested
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SAD su investirale
06:00
four billion dollars
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četiri milijarde dolara
06:02
converting to digital mammography equipment,
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u prelazak na digitalnu mamografiju.
06:05
and what have we gained from that investment?
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I šta smo dobili od te investicije?
06:08
In a study funded by over 25 million taxpayer dollars,
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U studiji koju je finansiralo 25 miliona dolara od poreza,
06:12
digital mammography was found
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zaključeno je da digitalna mamografija
06:14
to be no better over all
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u celini uzev nije bolja
06:16
than traditional mammography,
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od tradicionalne mamografije.
06:18
and in fact, it was worse in older women.
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I zapravo je lošija kod starijih žena.
06:21
But it was better in one group,
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Ali bila je bolja kod jedne grupe
06:24
and that was women under 50
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a to su žene mlađe od 50 godina
06:26
who were pre-menopausal and had dense breasts,
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koje još nisu ušle u menopauzu i imaju gusto tkivo dojke.
06:29
and in those women,
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I kod tih žena
06:31
digital mammography found twice as many cancers,
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digitalna mamografija je pronašla duplo više tumora
06:34
but it still only found 60 percent.
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ali je i dalje pronašla samo 60 procenata.
06:37
So digital mammography
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Tako da je digitalna mamografija
06:39
has been a giant leap forward
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bila veliki korak napred
06:41
for manufacturers
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za proizvođače
06:43
of digital mammography equipment,
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opreme za digitalnu mamografiju,
06:45
but it's been a very small step forward for
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ali je bila veoma mali korak napred
06:47
womankind.
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za žene.
06:50
What about ultrasound?
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A šta je sa ultrazvukom?
06:52
Ultrasound generates more biopsies
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Ultrazvuk generiše više biopsija
06:54
that are unnecessary relative to other technologies,
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koje su nepotrebne u odnosu na druge tehnologije,
06:56
so it's not widely used.
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tako da nema široku upotrebu.
06:59
And MRI is exquisitely sensitive for finding tumors,
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Magnetna rezonanca je izuzetno precizna za pronalaženje tumora,
07:02
but it's also very expensive.
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ali je takođe veoma skupa.
07:06
If we think about disruptive technology,
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Ako pomislimo na tehnologiju
07:09
we see an almost ubiquitous pattern
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imamo skoro opšti princip
07:11
of the technology getting smaller and less expensive.
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da se tehnologija smanjuje i postaje jeftinija.
07:14
Think about iPods compared to stereos.
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Pogledajte iPod u poređenju sa muzičkim stubom.
07:17
But it's the exact opposite in health care.
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Ali u zdravstvu je proces obrnut.
07:20
The machines get ever bigger
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Mašine se stalno povećavaju
07:22
and ever more expensive.
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i postaju skuplje.
07:26
Screening the average young woman with an MRI
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Skenirati prosečnu mladu ženu magnetnom rezonancom
07:29
is kind of like driving to the grocery store in a Hummer.
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je u neku ruku kao voziti se Hamerom u samoposlugu.
07:33
It's just way too much equipment.
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To je jednostavno suviše opreme.
07:35
One MRI scan
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Jedno skeniranje magnetnom rezonancom
07:37
costs 10 times what a digital mammogram costs.
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košta 10 puta više nego digitalni mamograf.
07:40
And sooner or later, we're going to have to accept the fact
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I pre ili kasnije, moraćemo da prihvatimo činjenicu
07:42
that health care innovation
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da inovacija u zdravstvu
07:44
can't always come at a much higher price.
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ne može uvek doći po mnogo višoj ceni.
07:49
Malcolm Gladwell wrote an article in the New Yorker
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Malkolm Gledvel je napisao članak u ''Njujorkeru''
07:51
on innovation,
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na temu inovacije,
07:53
and he made the case that scientific discoveries
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i njegovo stanovište je da su naučna otkrića
07:56
are rarely the product of one individual's genius.
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retko proizvod individualnog genija.
08:00
Rather, big ideas can be orchestrated,
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Nasuprot tome, velike ideje mogu biti orkestrirane,
08:03
if you can simply gather
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ako jednostavno skupite
08:05
people with different perspectives in a room
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ljude sa različitim pogledima u jednu prostoriju
08:07
and get them to talk about things
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i navedete ih da razgovaraju o stvarima
08:09
that they don't ordinarily talk about.
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o kojima obično ne razgovaraju.
08:11
It's like the essence of TED.
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To je kao suština TED-a.
08:14
He quotes one innovator who says,
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On citira jednog pronalazača koji kaže:
08:16
"The only time a physician and a physicist get together
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''Jedini put kada se lekar i fizičar sretnu
08:20
is when the physicist gets sick."
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je kada se fizičar razboli.''
08:22
(Laughter)
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(Smeh)
08:24
This makes no sense,
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Ovo nema nikakvog smisla,
08:26
because physicians have all kinds of problems
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jer lekari imaju raznorazne probleme
08:28
that they don't realize have solutions.
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za koje ni ne znaju da postoje rešenja.
08:31
And physicists have all kinds of solutions for things
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A fizičari imaju razna rešenja za stvari
08:33
that they don't realize are problems.
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za koje ne shvataju da su problemi.
08:36
Now, take a look at this cartoon
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Sad, pogledajte ovu ilustraciju
08:39
that accompanied Gladwell's article,
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koja je pratila Gledvelov članak,
08:41
and tell me if you see something disturbing
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i recite mi da li vidite nešto uznemirujuće
08:43
about this depiction of innovative thinkers.
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u opisu inovativnih mislilaca.
08:46
(Laughter)
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(Smeh)
08:48
So if you will allow me a little creative license,
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Tako da ako mi date malo kreativnog prostora,
08:52
I will tell you the story
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ispričaću vam priču
08:54
of the serendipitous collision
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o sudbinskom susretu
08:56
of my patient's problem
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problema moje pacijentkinje
08:58
with a physicist's solution.
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i rešenja fizičara.
09:00
Shortly after her visit,
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Ubrzo nakon njene posete,
09:02
I was introduced to a nuclear physicist
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upoznala sam nuklearnog fizičara
09:04
at Mayo
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na Majo klinici
09:06
named Michael O'Conner,
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po imenu Majkl O'Koner,
09:08
who was a specialist in cardiac imaging,
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koji je bio specijalista za kardiološko snimanje,
09:10
something I had nothing to do with.
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nešto što sa mnom nije imalo nikakve veze.
09:12
And he happened to tell me
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I on mi je slučajno ispričao
09:14
about a conference he'd just returned from in Israel,
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o konferenciji u Izraelu sa koje se upravo vratio,
09:17
where they were talking about a new type of gamma detector.
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gde su pričali o novom tipu gama detektora.
09:20
Now gamma imaging has been around for a long time
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Sad, gama snimanje se koristi već dugo
09:22
to image the heart,
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za snimanje srca,
09:24
and it had even been tried to image the breast.
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i čak je bilo isprobano za snimanje dojki.
09:27
But the problem was
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Ali problem je bio u tome
09:29
that the gamma detectors
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što su gama detektori
09:31
were these huge, bulky tubes,
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ogromne, glomazne cevi
09:33
and they were filled with these scintillating crystals,
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i ispunjene su ovim svetlucavim kristalima,
09:35
and you just couldn't get them close enough around the breast
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i niste ih jednostavno mogli dovoljno približiti dojci
09:38
to find small tumors.
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da bi pronašli male tumore.
09:40
But the potential advantage was
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Ali potencijalna prednost je bila u tome
09:42
that gamma rays, unlike X-rays,
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da na gama zrake, za razliku od rendgenskih,
09:44
are not influenced by breast density.
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ne utiče gustina tkiva.
09:47
But this technology
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Ali ova tehnoogija
09:49
could not find tumors when they're small,
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nije mogla naći male tumore.
09:51
and finding a small tumor is critical for survival.
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A nalaženje malih tumora je krucijalno za preživljavanje.
09:54
If you can find a tumor
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Ako možete pronaći tumor
09:56
when it's less than a centimeter,
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kada je manji od centimetra,
09:58
survival exceeds 90 percent,
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verovatnoća da se preživi je preko 90 procenata
10:00
but drops off rapidly
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ali ona strmo opada
10:02
as tumor size increases.
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kako se veličina tumora povećava.
10:05
But Michael told me about
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Ali Majkl mi je ispričao o
10:07
a new type of gamma detector that he'd seen,
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novom tipu gama detektora koji je video
10:09
and this is it.
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i to je to.
10:11
It's made
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Napravljen je
10:13
not of a bulky tube,
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ne od glomazne cevi
10:15
but of a thin layer of a semiconductor material
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već od tankog sloja poluprovodljivog materijala
10:18
that serves as the gamma detector.
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koji funkcioniše kao gama detektor.
10:20
And I started talking to him
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I počela sam da razgovaram sa njim
10:22
about this problem with breast density,
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o problemu gustine tkiva dojke,
10:24
and we realized that we might be able to get this detector
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i shvatili smo da bi ovaj detektor mogli
10:27
close enough around the breast
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dovoljno približiti grudima
10:29
to actually find small tumors.
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da bi zaista našli male tumore.
10:31
So after putting together
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Nakon što smo napravili
10:33
a grid of these cubes with tape --
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raster od ovih kocki povezanih lepljivom trakom -
10:36
(Laughter)
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(Smeh)
10:39
-- Michael hacked off the X-ray plate
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- Majkl je skinuo rendgensku ploču
10:42
of a mammography machine
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sa mamografa
10:44
that was about to be thrown out,
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koji je bio škartiran.
10:46
and we attached the new detector,
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I pričvrstili smo novi detektor,
10:49
and we decided to call this machine
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i odlučili smo da nazovemo ovu mašinu
10:51
Molecular Breast Imaging, or MBI.
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Molekularni skener dojke, odnosno MSD.
10:55
This is an image from our first patient.
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Ovo je snimak naše prve pacijentkinje.
10:57
And you can see, using the old gamma technology,
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Kao što možete videti, koristeći staru gama tehnologiju,
10:59
that it just looked like noise.
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izgleda kao šum.
11:01
But using our new detector,
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Ali koristeći naš novi detektor,
11:03
we could begin to see the outline of a tumor.
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mogli smo videti obrise tumora.
11:06
So here we were, a nuclear physicist,
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Tako da eto nas, nukleani fizičar,
11:08
an internist,
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internista
11:10
soon joined by Carrie Hruska, a biomedical engineer,
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kojima se uskoro pridružila Keri Hraška, biomedicinski inženjer,
11:13
and two radiologists,
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i dvoje radiologa,
11:15
and we were trying to take on
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i pokušavali smo da se suprotstavimo
11:17
the entrenched world of mammography
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krutom svetu mamografije
11:19
with a machine that was held together by duct tape.
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sa mašinom koja je bila sastavljena lepljivom trakom.
11:23
To say that we faced
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Reći da smo se suočili
11:25
high doses of skepticism
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sa velikom količinom skepticizma
11:27
in those early years
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u tim ranim godinama
11:29
is just a huge understatement,
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je blago rečeno.
11:31
but we were so convinced that we might be able to make this work
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Ali bili smo tako ubeđeni da možemo da učinimo da ovo finkcioniše
11:34
that we chipped away with incremental modifications
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da smo nastavljali dalje sa postepenim modifikacijama
11:37
to this system.
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sistema.
11:39
This is our current detector.
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Ovo je naš trenutni detektor.
11:41
And you can see that it looks a lot different.
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I možete videti da izgleda dosta drugačije.
11:43
The duct tape is gone,
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Nema više lepljive trake,
11:47
and we added a second detector on top of the breast,
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i dodali smo drugi detektor na gornji deo dojke,
11:49
which has further improved our tumor detection.
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koji je dodatno poboljšao detekciju tumora.
11:52
So how does this work?
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Kako ovo zapravo funkcioniše?
11:54
The patient receives an injection of a radio tracer
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Pacijent dobije injekciju radioaktivnog materijala koji obeležava
11:57
that's taken up by rapidly proliferating tumor cells,
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i koji upijaju ćelije tumora koje se brzo dele
12:00
but not by normal cells,
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a ne upijaju ga normalne ćelije.
12:02
and this is the key difference from mammography.
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I ovo je osnovna razlika u odnosu na mamografiju.
12:05
Mammography relies on differences
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Mamografija se oslanja na razlike
12:07
in the appearance of the tumor from the background tissue,
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u izgledu između tumora i okolnog tkiva,
12:10
and we've seen that those differences
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i videli smo da ove razlike
12:12
can be obscured in a dense breast.
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mogu biti zanemarljive kod dojki sa gustim tkivom.
12:15
But MBI exploits
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Ali MSD koristi
12:17
the different molecular behavior of tumors,
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drugačije molekularno ponašanje tumora,
12:20
and therefore, it's impervious to breast density.
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i zbog toga je imun na problem gustine tkiva dojke.
12:24
After the injection,
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Posle injekcije,
12:26
the patient's breast is placed between the detectors.
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grudi pacijenta se postave između detektora.
12:28
And if you've ever had a mammogram --
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I ako ste ikada radili mamogram -
12:30
if you're old enough to have had a mammogram --
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ako ste dovoljno stari da ste radili mamogram -
12:32
you know what comes next:
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znate šta sledi:
12:34
pain.
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bol.
12:36
You may be surprised to know
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Možda ćete biti iznenađeni
12:38
that mammography is the only radiologic study
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da je mamografija jedina radiloška studija
12:41
that's regulated by federal law,
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koja je regulisana federalnim zakonom,
12:43
and the law requires
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i zakon zahteva
12:45
that the equivalent of a 40-pound car battery
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da se uređaj ekvivalentan akumulatoru od oko 18kg
12:48
come down on your breast during this study.
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spusti na vašu dojku prilikom ovog pregleda.
12:52
But with MBI,
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Ali kod MSD
12:54
we use just light, pain-free compression.
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mi koristimo lak, bezbolni pritisak.
12:57
(Applause)
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(Aplauz)
13:03
And the detector
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I detektor
13:05
then transmits the image to the computer.
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onda prenosi sliku na računar.
13:07
So here's an example.
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Prema tome, evo primera.
13:09
You can see, on the right, a mammogram
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Možete videti na desnoj strani mamogram
13:11
showing a faint tumor,
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koji pokazuje bledi tumor,
13:13
the edges of which are blurred by the dense tissue.
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čije su ivice zamućene gustim tkivom dojke.
13:15
But the MBI image shows that tumor much more clearly,
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Ali MSD pokazuje ovaj tumor mnogo jasnije,
13:18
as well as a second tumor,
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kao i još jedan tumor,
13:20
which profoundly influence that patient's surgical options.
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što suštinski utiče na pacijentove mogućnosti za operaciju.
13:24
In this example, although the mammogram found one tumor,
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U ovom primeru, iako je mamograf našao jedan tumor,
13:27
we were able to demonstrate three discrete tumors --
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mi smo mogli da pokažemo tri mala tumora...
13:30
one is small as three millimeters.
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jedan je veličine 3 milimetra.
13:33
Our big break came in 2004.
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Naš veliki proboj je došao u 2004.
13:38
After we had demonstrated that we could find small tumors,
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Nakon što smo pokazali da možemo pronaći male tumore,
13:41
we used these images
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iskoristili smo ove snimke
13:43
to submit a grant to the Susan G. Komen Foundation.
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da se prijavimo za finansiranje Suzan G. Komen fondacije.
13:46
And we were elated when they took a chance
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I bili smo oduševljeni kada su dali šansu
13:49
on a team of completely unknown investigators
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timu potpuno nepoznatih istraživača
13:51
and funded us to study
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i finansirali nas da proučimo
13:53
1,000 women with dense breasts,
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1.000 žena sa gustim tkivom dojke,
13:55
comparing a screening mammogram to an MBI.
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poredeći mamografsko snimanje sa našim MSD.
13:58
Of the tumors that we found,
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Od tumora koje smo pronašli,
14:00
mammography found
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mamograf je pronašao
14:02
only 25 percent of those tumors.
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samo 25 procenata.
14:05
MBI found 83 percent.
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MSD je pronašao 83 procenata.
14:08
Here's an example from that screening study.
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Evo primera iz te studije.
14:11
The digital mammogram was read as normal
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Digitalni mamogram je bio crven kao i obično
14:13
and shows lots of dense tissue,
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i pokazuje dosta gustog tkiva,
14:15
but the MBI shows an area of intense uptake,
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ali MSD pokazuje prostor intenzivne boje,
14:18
which correlated with a two-centimeter tumor.
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koji odgovara tumoru od dva centimetra.
14:21
In this case, a one-centimeter tumor.
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U ovom slučaju, tumor od jednog centimetra.
14:24
And in this case,
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A u ovom slučaju,
14:26
a 45-year-old medical secretary at Mayo,
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četrdesetpetogodišnja medicinska sekretarica u Maju,
14:29
who had lost her mother to breast cancer when she was very young,
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koja je izgubila majku zbog raka dojke kad je bila veoma mala,
14:32
wanted to enroll in our study.
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je želela da bude deo naše studije.
14:34
And her mammogram showed an area of very dense tissue,
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I njen mamogram je pokazivao predeo sa veoma gustim tkivom,
14:37
but her MBI showed an area
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ali je njen MSD pokazao deo
14:39
of worrisome uptake,
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sa zabinjavajućim intenzitetom
14:41
which we can also see on a color image.
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koji vidimo i na snimku u boji.
14:44
And this corresponded
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I ovo je odgovaralo
14:46
to a tumor the size of a golf ball.
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tumoru velikom kao loptica za golf.
14:48
But fortunately it was removed
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Ali, na svu sreću, bio je odstranjen
14:50
before it had spread to her lymph nodes.
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pre nego što se proširio na njene limfne čvorove.
14:54
So now that we knew that this technology
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I sad kad smo znali da ova tehnologija
14:56
could find three times more tumors in a dense breast,
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može pronaći tri puta više tumora kod dojki sa gustim tkivom,
14:59
we had to solve one very important problem.
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morali smo da rešimo veoma bitan problem.
15:02
We had to figure out how to lower the radiation dose,
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Trebalo je da smislimo kako da smanjimo dozu radijacije.
15:05
and we have spent the last three years
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I proveli smo poslednje tri godine
15:08
making modifications to every aspect of the imaging system
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menjajući svaki aspekt sistema za snimanje
15:11
to allow this.
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da bi ovo omogućili.
15:13
And I'm very happy to report that we're now using a dose of radiation
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I srećna sam što mogu da vam saopštim da sad koristimo dozu radijacije
15:16
that is equivalent to the effective dose
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koja je ekvivalentna efektivnoj dozi
15:18
from one digital mammogram.
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jednog digitalnog mamografa.
15:20
And at this low dose, we're continuing this screening study,
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I pri ovoj maloj dozi smo nastavili studiju
15:23
and this image from three weeks ago
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i ovaj snimak od pre tri nedelje
15:26
in a 67-year-old woman
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kod šezdesetsedmogodišnje žene
15:28
shows a normal digital mammogram,
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pokazuje normalni digitalni mamogram,
15:30
but an MBI image
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ali MSD snimak
15:32
showing an uptake that proved to be a large cancer.
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pokazuje mrlju koja se pokazala kao veliki tumor.
15:35
So this is not just young women that it's benefiting.
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Tako da nemaju samo mlade žene koristi od ovoga.
15:38
It's also older women with dense tissue.
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Imaju i starije žene sa gustim tkivom dojke.
15:41
And we're now routinely using one-fifth the radiation dose
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I sada rutiski koristimo jednu petinu doze radijacije
15:44
that's used in any other type of gamma technology.
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koja se koristi u bilo kom drugom tipu gama tehnologije.
15:48
MBI generates four images per breast.
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MSD pravi po četiri slike za svaku dojku.
15:51
MRI generates over a thousand.
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Magnetna rezonanca preko hiljadu.
15:54
It takes a radiologist
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Radiologu su potrebne
15:56
years of specialty training
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godine specijalističke obuke
15:58
to become expert in differentiating
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da bi postao stručnjak u razlikovanju
16:00
the normal anatomic detail
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detalja normalne anatomije
16:02
from the worrisome finding.
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od zabrinjavajućih nalaza.
16:04
But I suspect even the non-radiologists in the room
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Ali slutim da bi i oni u prostoriji koji nisu radiolozi
16:07
can find the tumor on the MBI image.
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mogli naći tumor na MSD snimku.
16:10
But this is why MBI
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Ali to je razlog zašto je MSD
16:12
is so potentially disruptive --
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takva potencijalna pretnja.
16:14
it's as accurate as MRI,
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On je precizan kao i magnetna rezonanca,
16:16
it's far less complex to interpret,
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mnogo manje složen za tumačenje,
16:19
and it's a fraction of the cost.
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i za mnogo manju cenu.
16:21
But you can understand why there may be
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Ali razumete zašto možda postoje
16:23
forces in the breast-imaging world
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sile u svetu skeniranja dojki
16:25
who prefer the status quo.
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kojima više odgovara status kvo.
16:29
After achieving what we felt were remarkable results,
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Nakon što smo postigli nešto za šta smo smatrali da su izuzetni rezultati
16:32
our manuscript was rejected
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naš rad je bio odbijen
16:35
by four journals.
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od strane četiri časopisa.
16:37
After the fourth rejection,
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Posle četvrtog odbijanja,
16:39
we requested reconsideration of the manuscript,
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tražili smo da se ponovo razmotri naš rad,
16:41
because we strongly suspected
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jer smo imali izražene sumnje
16:43
that one of the reviewers who had rejected it
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da je jedan od ocenjivača koji ga je odbio
16:45
had a financial conflict of interest
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imao finansijski konflikt interesa
16:47
in a competing technology.
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sa konkurentnom tehnologijom.
16:50
Our manuscript was then accepted
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Naš rad je onda bio prihvaćen
16:52
and will be published later this month
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i biće objavljen kasnije ovog meseca
16:55
in the journal Radiology.
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u časopisu "Radiologija".
16:57
(Applause)
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(Aplauz)
17:05
We still need to complete the screening study using the low dose,
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Još treba da završimo studiju koristeći manju dozu
17:08
and then our findings will need to be replicated
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i onda naši rezultati treba da budu ponovljeni
17:10
at other institutions,
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u drugim institucijama.
17:12
and this could take five or more years.
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I to može potrajati pet ili više godina.
17:15
If this technology is widely adopted,
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Ako ova tehnologija bude široko usvojena,
17:18
I will not benefit financially in any way,
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ja neću finansijski profitirati ni na koji način.
17:21
and that is very important to me,
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I to mi je veoma važno
17:24
because it allows me to continue to tell you the truth.
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jer mogu da nastavim da vam govorim istinu.
17:28
But I recognize --
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Ali shvatam -
17:30
(Applause)
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(Aplauz)
17:34
I recognize that the adoption of this technology
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Shvatam da će primena ove tehnologije
17:37
will depend as much on economic
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zavisiti koliko od ekonomskih
17:39
and political forces
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i političkih struja
17:41
as it will on the soundness of the science.
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toliko i od utemeljenosti nauke.
17:44
The MBI unit has now been FDA approved,
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MSD je do sada bio odobren od strane administracije za hranu
17:47
but it's not yet widely available.
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i lekove, ali još uvek nije široko dostupan.
17:50
So until something is available
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Tako da dok nešto ne bude bilo na raspolaganju
17:52
for women with dense breasts,
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ženama sa gustim tkivom dojke
17:54
there are things that you should know
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ima stvari koje treba da znate
17:56
to protect yourself.
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da bi se zaštitile.
17:58
First, know your density.
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Prvo, saznajte koliko vam je tkivo gusto.
18:00
Ninety percent of women don't,
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90 procenata žena to ne zna,
18:02
and 95 percent of women don't know
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i 95 procenata žena ne zna
18:04
that it increases your breast cancer risk.
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da im to povećava rizik da dobiju rak.
18:07
The State of Connecticut became the first and only state
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Država Konektikat je postala prva i jedina država
18:10
to mandate that women receive notification
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koja propisuje da žene budu obaveštene
18:12
of their breast density
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o gustini svog tkiva dojke
18:14
after a mammogram.
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posle mamograma.
18:17
I was at a conference of 60,000 people in breast-imaging
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Bila sam na konferenciji sa 60.000 ljudi koji se bave skeniranjem grudi
18:20
last week in Chicago,
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prošle nedelje u Čikagu.
18:22
and I was stunned that there was a heated debate
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I bila sam šokirana kada se razvila žustra rasprava
18:25
as to whether we should be telling women
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o tome da li treba da govorimo ženama
18:27
what their breast density is.
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koja je gustina njihovog tkiva dojke.
18:29
Of course we should.
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Naravno da bi trebalo.
18:31
And if you don't know, please ask your doctor
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I ako ne znate, molim vas, pitajte svog lekara
18:34
or read the details of your mammography report.
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ili pročitaje detalje svog izveštaja sa mamografije.
18:37
Second, if you're pre-menopausal,
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Drugo, ako niste još u menopauzi,
18:39
try to schedule your mammogram
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probajte da zakažete sebi mamogram
18:41
in the first two weeks of your menstrual cycle,
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u prve dve nedelje menstrualnog ciklusa,
18:43
when breast density is relatively lower.
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kada je gustina tkiva dojke relativno manja.
18:46
Third, if you notice a persistent change in your breast,
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Treće, ako primetite trajnu promenu na svojoj dojci
18:49
insist on additional imaging.
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insistirajte na dodatnom snimanju.
18:52
And fourth and most important,
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I četvrto i najvažnije,
18:54
the mammography debate will rage on,
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debata o mamografiji će i dalje divljati,
18:57
but I do believe that all women 40 and older
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ali ja i zaista verujem da bi sve žene od 40 i više godina
19:00
should have an annual mammogram.
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trebalo da imaju mamogram jednom godišnje.
19:02
Mammography isn't perfect,
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Mamografija nije savršena,
19:04
but it's the only test that's been proven
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ali je jedini test za koji je dokazano
19:06
to reduce mortality from breast cancer.
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da smanjuje smrtnost od raka dojke.
19:09
But this mortality banner
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Ali ovaj barjak smrtnosti
19:11
is the very sword
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je oružje
19:13
which mammography's most ardent advocates use
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koje koriste najzagriženiji zagovornici mamografije
19:16
to deter innovation.
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da spreče inovaciju.
19:18
Some women who develop breast cancer
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Neke žene kod kojih se razvije rak dojke
19:21
die from it many years later,
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umru od njega posle mnogo godina.
19:23
and most women, thankfully, survive.
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A većina žena, na svu sreću, preživi.
19:25
So it takes 10 or more years
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Tako da treba 10 i više godina
19:27
for any screening method
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da bilo koji metod snimanja
19:29
to demonstrate a reduction
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pokaže smanjenje
19:31
in mortality from breast cancer.
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u smrtnosti od raka dojke.
19:33
Mammography's the only one that's been around long enough
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Mamografija je jedina koja već dovoljno dugo postoji
19:35
to have a chance of making that claim.
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da bi mogla da to tvrdi.
19:38
It is time for us to accept
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Vreme je da prihvatimo
19:41
both the extraordinary successes of mammography
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i izuzetne uspehe mamografije
19:43
and the limitations.
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i njena ograničenja.
19:45
We need to individualize screening
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Moramo da prilagodimo snimanje
19:47
based on density.
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gustini.
19:49
For women without dense breasts,
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Za žene koje nemaju gusto tkivo grudi,
19:51
mammography is the best choice.
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mamografija je najbolji izbor.
19:54
But for women with dense breasts;
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Ali za žene koje imaju gusto tkivo,
19:56
we shouldn't abandon screening altogether,
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ne smemo potpuno odustati od snimanja,
19:58
we need to offer them something better.
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moramo im ponuditi nešto bolje.
20:03
The babies that we were carrying
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Bebe koje smo čekale
20:05
when my patient first asked me this question
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kada mi je pacijentkinja postavila ovo pitanje
20:08
are now both in middle school,
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sada obe završavaju osnovnu školu,
20:11
and the answer has been so slow to come.
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i odgovor je došao tako polako.
20:16
She's given me her blessing
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Dala mi je svoj blagoslov
20:18
to share this story with you.
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da sa vama podelim ovu priču.
20:21
After undergoing biopsies
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Nakon biopsija
20:23
that further increased her risk for cancer
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koje su dodatno povećale njen rizik da oboli od raka
20:26
and losing her sister to cancer,
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i nakon gubitka sestre zbog raka
20:28
she made the difficult decision
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donela je tešku odluku
20:30
to have a prophylactic mastectomy.
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da se podvrgne odstranjivanju dojke.
20:34
We can and must do better,
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Mi možemo i moramo da učinimo nešto bolje,
20:37
not just in time for her granddaughters
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ne samo na vreme za njene unuke,
20:40
and my daughters,
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i moje ćerke,
20:42
but in time for you.
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već na vreme za vas.
20:44
Thank you.
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Hvala vam.
20:46
(Applause)
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(Aplauz)
ABOUT THE SPEAKER
Deborah Rhodes - Physician, cancer researcherDeborah Rhodes is an expert at managing breast-cancer risk. The director of the Mayo Clinic’s Executive Health Program is now testing a gamma camera that can see tumors that get missed by mammography.
Why you should listen
For all of the lives it saves, mammography still cannot detect the early onset of breast cancer in as many as one of every four women ages 40 to 49. And women with dense breast tissue are four to six times more likely to develop cancer than others. Deborah Rhodes and her colleagues at the Mayo Clinic in Minnesota think they’ve found an effective way to screen these high-risk patients: molecular imaging.
Rhodes, who specializes in evaluating and managing breast cancer, is collaborating with a nuclear physicist and various radiologists on a dual-head “gamma camera” that can capture the tiny tumors in dense tissue. The new technique, which would complement (not replace) mammography, is sensitive enough to pick up a mass two-fifths of an inch in diameter. Molecular breast imaging requires patients to be injected with a radioactive drug, but it is much more comfortable than the vise-grip mammogram and is expected to cost only slightly more.
Deborah Rhodes | Speaker | TED.com