TEDWomen 2010
Deborah Rhodes: A test that finds 3x more breast tumors, and why it's not available to you
德博拉·罗兹Deborah Rhodes:一种提高乳腺癌诊断率3倍的新技术，但为什么我们只能望之兴叹
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德博拉·罗兹Deborah Rhodes博士与一群物理学家合作开发出一种针对密集乳腺组织，它是一种比传统乳腺X光造影技术灵敏3倍的肿瘤检测技术，其拯救生命的意义令人咂舌。可是为什么这项技术不为人知？让罗兹Rhodes与我们分享这项技术背后的研发故事，以及错综复杂的政治经济因素是如何阻碍其进入主流治疗手段的。
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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在乳腺X光造影诊断中，
00:18
when it comes to screening mammography --
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有两类女性：
00:20
women in whom mammography works very well
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X光造影诊断对其中一类十分有效，
00:23
and has saved thousands of lives
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已经拯救了数千人的生命；
00:25
and women in whom it doesn't work well at all.
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但对另一类却无法做出有效诊断。
00:29
Do you know which group you're in?
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你是否知道你是哪一类？
00:32
If you don't, you're not alone.
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你并非唯一不了解的人。
00:34
Because the breast has become
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因为乳房已经成为
00:36
are very political organ.
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一种非常政治化的器官。
00:39
The truth has become lost
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真相正日渐式微，
00:41
in all the rhetoric
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淹没于各大媒体、
00:43
coming from the press, politicians,
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政治家、
00:45
radiologists
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放射学家、
00:47
and medical imaging companies.
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以及医学成像公司的虚夸雄辩。
00:49
I will do my best this morning
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今天早上，我将尽自己最大的努力
00:51
to tell you what I think is the truth.
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告诉你们我所认为的真相。
00:54
But first, my disclosures.
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但首先我必须坦白，
00:57
I am not a breast cancer survivor.
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我不曾战胜过乳腺癌。
00:59
I'm not a radiologist.
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我也不是放射学家。
01:01
I don't have any patents,
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我没有任何专利，
01:03
and I've never received any money from a medical imaging company,
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我也从未从任何一家医学造影公司拿过一分钱。
01:06
and I am not seeking your vote.
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而且我并不期待你们的投票。
01:09
(Laughter)
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（笑声）
01:11
What I am
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我只是
01:13
is a doctor of internal medicine
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一位内服药品医生，
01:15
who became passionately interested in this topic
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大约十年前，
01:17
about 10 years ago
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一个病人的问题
01:19
when a patient asked me a question.
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让我对这个领域产生了浓厚的兴趣。
01:23
She came to see me
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她来见我
01:25
after discovering a breast lump.
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她刚被诊断出一个乳房肿块。
01:27
Her sister had been diagnosed with breast cancer
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她的姐姐在四十岁时，
01:30
in her 40s.
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被诊断为乳腺癌。
01:32
She and I were both very pregnant at that time,
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当时她和我都已经是大腹便便的孕妇了，
01:35
and my heart just ached for her,
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我为她感到心痛，
01:37
imagining how afraid she must be.
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我想她该有多担心害怕。
01:40
Fortunately, her lump proved to be benign.
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幸运的是，她的肿块是良性的。
01:43
But she asked me a question:
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但她问了我一个问题：
01:45
how confident was I
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我有多大的把握
01:47
that I would find a tumor early on her mammogram
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能在她的乳房X光片中
01:49
if she developed one?
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发现早期肿瘤？
01:51
So I studied her mammogram,
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于是我仔细看了她的乳房X光片，
01:53
and I reviewed the radiology literature,
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我查阅了放射学文献，
01:55
and I was shocked to discover
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我震惊地发现，
01:57
that, in her case,
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在她的情况下，
01:59
our chances of finding a tumor early on the mammogram
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在乳房X光片中发现早期肿瘤的可能性，
02:01
were less than the toss of a coin.
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竟然小于50%.
02:04
You may recall a year ago
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你大概可以想起来，一年前
02:06
when a firestorm erupted
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那次事件大爆发，
02:08
after the United States Preventive Services Task Force
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美国预防服务工作组
02:12
reviewed the world's mammography screening literature
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审查了全球乳房X光造影诊断技术的文献，
02:15
and issued a guideline
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发布了一个准则
02:17
recommending against screening mammograms
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表示不推荐四十岁的女性
02:20
in women in their 40s.
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使用乳房X光造影诊断。
02:22
Now everybody rushed to criticize the Task Force,
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然后所有人都指责工作组，
02:25
even though most of them weren't in anyway familiar
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即使他们中根本没有人
02:27
with the mammography studies.
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真的了解乳房X光造影诊断。
02:30
It took the Senate just 17 days
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参议院又花了17天，
02:32
to ban the use of the guidelines
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禁止在保险覆盖条例中
02:34
in determining insurance coverage.
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使用这个条例。
02:38
Radiologists were outraged
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放射学家对这个条例
02:40
by the guidelines.
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十分愤慨。
02:42
The pre-eminent mammographer in the United States
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美国最杰出的乳房X光造影技术专家
02:44
issued the following quote
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在华盛顿邮报上
02:46
to the Washington Post.
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发表声明。
02:49
The radiologists were, in turn, criticized
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放射学家反被指责
02:52
for protecting their own financial self-interest.
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过分关注个人经济利益。
02:55
But in my view,
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然而我认为，
02:57
the radiologists are heroes.
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这些放射学家才是真英雄。
02:59
There's a shortage of radiologists
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一直以来，有资质看乳房X光片的
03:01
qualified to read mammograms,
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放射学家是不多的，
03:03
and that's because mammograms are one of the most complex
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因为解读乳房X光片是
03:06
of all radiology studies to interpret,
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所有放射性研究中最为复杂的，
03:09
and because radiologists
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另外相比其他原因，
03:11
are sued more often
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放射学家更容易因此
03:13
over missed breast cancer
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而被指控
03:15
than any other cause.
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误诊乳腺癌。
03:17
But that very fact is telling.
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但事实胜于雄辩。
03:20
Where there is this much legal smoke,
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哪里有硝烟，
03:23
there is likely to be some fire.
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哪里就有烈火。
03:26
The factor most responsible for that fire
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导致这场激辩烈火的重要因素
03:29
is breast density.
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是乳腺密度。
03:33
Breast density refers to the relative amount of fat --
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乳腺密度是指脂肪含量-
03:35
pictured here in yellow --
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（图中黄色的部分）--
03:37
versus connective and epithelial tissues --
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与结缔组织含量（图中粉色部分）--
03:39
pictured in pink.
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的比例。
03:41
And that proportion
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这个比例
03:43
is primarily genetically determined.
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主要是由基因决定的。
03:45
Two-thirds of women in their 40s
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2/3的四十岁女性
03:47
have dense breast tissue,
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属于高乳腺密度，
03:49
which is why mammography doesn't work as well in them.
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这就是为什么乳房X光造影技术无法对他们做出有效诊断的原因。
03:52
And although breast density generally declines with age,
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尽管乳腺密度一般随年龄增长而下降，
03:55
up to a third of women
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仍有1/3的女性
03:57
retain dense breast tissue
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在停经数年后
03:59
for years after menopause.
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仍属于高乳腺密度的群体。
04:03
So how do you know if your breasts are dense?
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那你该如何知道你是否属于高乳腺密度呢？
04:06
Well, you need to read the details
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你需要非常仔细地阅读
04:08
of your mammography report.
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你的乳房X光片报告。
04:10
Radiologists classify breast density
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放射学家
04:12
into four categories
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根据乳腺组织的成像
04:14
based on the appearance of the tissue on a mammogram.
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将乳腺密度分为四类。
04:17
If the breast is less than 25 percent dense,
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乳腺密度小于25%，
04:20
that's called fatty-replaced.
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称为脂肪替代型；
04:22
The next category
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第二种
04:24
is scattered fibroglandular densities,
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是分散乳腺纤维密度型；
04:26
followed by heterogeneously dense
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然后是混合密度型，
04:28
and extremely dense.
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和最高密度型。
04:30
And breasts that fall into these two categories
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最后两类，
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are considered dense.
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是高密度型的。
04:34
The problem with breast density
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高密度乳腺所带来的问题
04:36
is that it's truly the wolf in sheep's clothing.
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就好像披着羊皮的狼。
04:39
Both tumors and dense breast tissue
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肿瘤和高密度乳腺组织
04:41
appear white on a mammogram,
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在乳房X光片上都呈现为白色，
04:44
and the X-ray often can't distinguish between the two.
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通常X光无法辨别这两者。
04:47
So it's easy to see this tumor
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所以很容易
04:49
in the upper part of this fatty breast.
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在此处上部的脂肪组织中看到肿瘤。
04:52
But imagine how difficult it would be
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但你无法想象
04:54
to find that tumor in this dense breast.
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在高密度乳腺中找到肿瘤是多么困难。
04:57
That's why mammograms find
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这就是为什么，乳房X光造影成像技术
04:59
over 80 percent of tumors in fatty breasts,
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可以在低乳腺密度的乳房中找到80%以上的肿瘤，
05:02
but as few as 40 percent in extremely dense breasts.
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而在极高乳腺密度的乳房中只能找到40%。
05:05
Now it's bad enough that breast density
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好吧，高乳腺密度已经导致
05:07
makes it hard to find a cancer,
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寻找肿瘤比其它情况更困难，
05:09
but it turns out
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然而更糟的是
05:11
that it's also a powerful predictor
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高乳腺密度也有力地预示
05:13
of your risk for breast cancer.
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乳腺癌患病率的高风险。
05:15
It's a stronger risk factor
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它的风险系数
05:17
than having a mother or a sister with breast cancer.
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比母亲或姐妹有乳腺癌病史更强。
05:20
At the time my patient posed this question to me,
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当年我的病人问我这个问题时，
05:23
breast density was an obscure topic
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乳腺密度在放射性学的学术界
05:25
in the radiology literature,
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还未引起重视，
05:27
and very few women having mammograms,
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很少有接受乳房X光造影诊断的女性，
05:29
or the physicians ordering them,
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或者使用乳房X光造影诊断的内科医生
05:31
knew about this.
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了解这一点。
05:33
But what else could I offer her?
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但我又能为她做些什么？
05:36
Mammograms have been around since the 1960's,
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乳房X光造影诊断于1960年前后开始流行，
05:39
and it's changed very little.
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此后几乎没有什么改进。
05:41
There have been surprisingly few innovations,
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几乎没有令人震惊的创新，
05:44
until digital mammography was approved
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直到2000年，
05:46
in 2000.
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数码乳房X光造影技术被批准进入市场。
05:48
Digital mammography is still an X-ray of the breast,
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数码乳房X光造影仍然使用X光，
05:51
but the images
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但是图像
05:53
can be stored and manipulated digitally,
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可以储存并进行数码操纵，
05:55
just like we can with a digital camera.
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就像我们用数码相机一样。
05:58
The U.S. has invested
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美国已经投入
06:00
four billion dollars
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40亿美元
06:02
converting to digital mammography equipment,
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更新换代至数码乳房X光造影设备。
06:05
and what have we gained from that investment?
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我们又从这笔投资中得到了什么呢？
06:08
In a study funded by over 25 million taxpayer dollars,
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一项耗费纳税人两千五百万美金的调查显示，
06:12
digital mammography was found
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数码乳房X光仪
06:14
to be no better over all
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并不比传统设备
06:16
than traditional mammography,
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有更好的综合表现。
06:18
and in fact, it was worse in older women.
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事实上，对老年女性来说，表现更糟。
06:21
But it was better in one group,
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不过，
06:24
and that was women under 50
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对50岁以下女性来说，表现更好，
06:26
who were pre-menopausal and had dense breasts,
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这一群体还未绝经，且乳腺组织密度较高。
06:29
and in those women,
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在这个群体中，
06:31
digital mammography found twice as many cancers,
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数码乳房X光诊断可以找到两倍多的肿瘤，
06:34
but it still only found 60 percent.
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尽管仍只有60%。
06:37
So digital mammography
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所以数码乳房X光造影技术
06:39
has been a giant leap forward
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对数码乳房X光造影设备的
06:41
for manufacturers
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制造商来说，
06:43
of digital mammography equipment,
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是一次巨大的飞跃，
06:45
but it's been a very small step forward for
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但对女性来说，
06:47
womankind.
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却只是一小步而已。
06:50
What about ultrasound?
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那么超声波呢？
06:52
Ultrasound generates more biopsies
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与其他技术相比，超声波检查必须配合
06:54
that are unnecessary relative to other technologies,
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更多不必要的活组织检查，
06:56
so it's not widely used.
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所以并未得到广泛使用。
06:59
And MRI is exquisitely sensitive for finding tumors,
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核磁共振在肿瘤诊断方面相当灵敏，
07:02
but it's also very expensive.
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但它也非常昂贵。
07:06
If we think about disruptive technology,
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联想到其他领域的各种科技，
07:09
we see an almost ubiquitous pattern
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可以发现一种普遍存在的模式，
07:11
of the technology getting smaller and less expensive.
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就是它们总是像更小、更经济的方向发展。
07:14
Think about iPods compared to stereos.
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比较一下iPod和立体声音响吧。
07:17
But it's the exact opposite in health care.
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但在医疗保健领域，情况则完全相反。
07:20
The machines get ever bigger
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设备越来越大，
07:22
and ever more expensive.
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越来越昂贵。
07:26
Screening the average young woman with an MRI
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女性做一次核磁共振扫描，
07:29
is kind of like driving to the grocery store in a Hummer.
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就像驾着悍马轰隆隆进杂货店一样。
07:33
It's just way too much equipment.
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杀鸡用牛刀。
07:35
One MRI scan
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一次核磁共振扫描，
07:37
costs 10 times what a digital mammogram costs.
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价格约为数码X光造影的10倍。
07:40
And sooner or later, we're going to have to accept the fact
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迟早我们会接受这个现实：
07:42
that health care innovation
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医疗保健领域的创新
07:44
can't always come at a much higher price.
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不可能总是如此价格高昂。
07:49
Malcolm Gladwell wrote an article in the New Yorker
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马尔科姆·葛拉威尔Malcolm Gladwell在纽约人上写过一篇
07:51
on innovation,
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有关创新的文章，
07:53
and he made the case that scientific discoveries
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他认为科学发现
07:56
are rarely the product of one individual's genius.
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绝非个人天才的产品，
08:00
Rather, big ideas can be orchestrated,
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反之，伟大的思想可以和谐交融，
08:03
if you can simply gather
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如果你能把
08:05
people with different perspectives in a room
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持有各种观点的人集中在一个房间内，
08:07
and get them to talk about things
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让他们就一般不会谈及的事务
08:09
that they don't ordinarily talk about.
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充分交流沟通。
08:11
It's like the essence of TED.
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这其实就类似于TED的精髓了。
08:14
He quotes one innovator who says,
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他引用一位创新者的话：
08:16
"The only time a physician and a physicist get together
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“只有一种情况能让内科医生和物理学家见面，
08:20
is when the physicist gets sick."
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就是物理学家病了。”
08:22
(Laughter)
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（笑声）
08:24
This makes no sense,
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这说法很不对，
08:26
because physicians have all kinds of problems
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因为物理学家一直以来都没有意识到
08:28
that they don't realize have solutions.
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他们的很多问题都是有解决办法的。
08:31
And physicists have all kinds of solutions for things
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内科医生也没有意识到
08:33
that they don't realize are problems.
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他们正可以提供许多问题的解法。
08:36
Now, take a look at this cartoon
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看这副漫画
08:39
that accompanied Gladwell's article,
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葛拉威尔Gladwell在文章中也引用过它，
08:41
and tell me if you see something disturbing
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告诉我这幅画对创新者的描绘，
08:43
about this depiction of innovative thinkers.
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是否让你感到有些困惑。
08:46
(Laughter)
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（笑声）
08:48
So if you will allow me a little creative license,
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如果你们不介意我发挥一点创造力，
08:52
I will tell you the story
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我要告诉你们一个
08:54
of the serendipitous collision
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极其偶然的巧合，
08:56
of my patient's problem
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有关我病人的问题
08:58
with a physicist's solution.
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和一个医生的解决办法。
09:00
Shortly after her visit,
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在她拜访我之后不久，
09:02
I was introduced to a nuclear physicist
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我认识了一位核物理学家，
09:04
at Mayo
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他来自Mayo(译者注：梅奥，爱尔兰西北一郡)
09:06
named Michael O'Conner,
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名叫迈克尔·奥康纳Michael O'Conner，
09:08
who was a specialist in cardiac imaging,
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他是心血管造影的专家，
09:10
something I had nothing to do with.
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而我对心血管造影那是一窍不通。
09:12
And he happened to tell me
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一个偶然，他告诉我
09:14
about a conference he'd just returned from in Israel,
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他刚从以色列开会回来，
09:17
where they were talking about a new type of gamma detector.
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他们正讨论某种新型伽马探测器，
09:20
Now gamma imaging has been around for a long time
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当时伽马线造影已经出现有段时间了，
09:22
to image the heart,
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一直被用于心脏造影，
09:24
and it had even been tried to image the breast.
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也曾有人尝试将其用于乳房造影。
09:27
But the problem was
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但问题是
09:29
that the gamma detectors
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伽马线的探测器
09:31
were these huge, bulky tubes,
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是这种块头巨大的显像管，
09:33
and they were filled with these scintillating crystals,
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里面塞满这样亮晶晶的晶状物，
09:35
and you just couldn't get them close enough around the breast
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你根本没有办法把它们放到距离乳房足够近的地方
09:38
to find small tumors.
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去找到小肿瘤。
09:40
But the potential advantage was
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但隐性的优势在于
09:42
that gamma rays, unlike X-rays,
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伽马射线与X射线不同，
09:44
are not influenced by breast density.
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并不会被乳腺密度影响。
09:47
But this technology
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但这项技术
09:49
could not find tumors when they're small,
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没有办法找到小型的肿瘤。
09:51
and finding a small tumor is critical for survival.
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找到小型肿瘤对存活率非常关键。
09:54
If you can find a tumor
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如果你能找到一个
09:56
when it's less than a centimeter,
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直径小于1厘米的肿瘤，
09:58
survival exceeds 90 percent,
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存活率超过90%，
10:00
but drops off rapidly
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之后存活率随着
10:02
as tumor size increases.
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肿瘤增大而迅速下降。
10:05
But Michael told me about
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迈克尔Michael告诉我，
10:07
a new type of gamma detector that he'd seen,
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他见到的一种新型伽马探测器，
10:09
and this is it.
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就是这个东西。
10:11
It's made
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它并非
10:13
not of a bulky tube,
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由巨大的晶体管造成，
10:15
but of a thin layer of a semiconductor material
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取而代之的是一层轻薄的半导体材料，
10:18
that serves as the gamma detector.
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来作为伽马线探测器。
10:20
And I started talking to him
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于是我开始与他讨论
10:22
about this problem with breast density,
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乳腺密度的问题，
10:24
and we realized that we might be able to get this detector
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我们意识到也许我们可以
10:27
close enough around the breast
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把这个探测器放到距离乳房足够近的地方
10:29
to actually find small tumors.
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去找到小肿瘤。
10:31
So after putting together
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接着我们
10:33
a grid of these cubes with tape --
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用胶带纸把这些小方块粘在一起--
10:36
(Laughter)
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（笑声）
10:39
-- Michael hacked off the X-ray plate
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--迈克尔Michael去掉了一台
10:42
of a mammography machine
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即将废弃的乳房X光仪上的
10:44
that was about to be thrown out,
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X射线板。
10:46
and we attached the new detector,
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我们连上新的探测器，
10:49
and we decided to call this machine
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我们决定称这台机器为
10:51
Molecular Breast Imaging, or MBI.
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分子乳房造影，简称MBI。
10:55
This is an image from our first patient.
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这是我们第一位病人的造影片。
10:57
And you can see, using the old gamma technology,
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可以看到，使用古老的伽马线探测技术，
10:59
that it just looked like noise.
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看起来一片模糊。
11:01
But using our new detector,
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但如果使用新的探测器，
11:03
we could begin to see the outline of a tumor.
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我们可以看到肿瘤的轮廓。
11:06
So here we were, a nuclear physicist,
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于是我们，一个核物理学家，
11:08
an internist,
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一个内科医师，
11:10
soon joined by Carrie Hruska, a biomedical engineer,
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之后卡丽·鲁斯卡Carrie Hruska又加入我们，一位生物医学工程师，
11:13
and two radiologists,
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还有两位放射学家，
11:15
and we were trying to take on
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我们尝试使用一台用胶布粘起来的仪器
11:17
the entrenched world of mammography
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去拓展
11:19
with a machine that was held together by duct tape.
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造影成像技术的世界。
11:23
To say that we faced
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要说我们在早年
11:25
high doses of skepticism
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面对了
11:27
in those early years
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大量的嘲讽质疑
11:29
is just a huge understatement,
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都只能说是轻描淡写了。
11:31
but we were so convinced that we might be able to make this work
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但我们都坚信我们一定会成功
11:34
that we chipped away with incremental modifications
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我们一点一点
11:37
to this system.
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改进整个系统。
11:39
This is our current detector.
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这是我们目前的探测器。
11:41
And you can see that it looks a lot different.
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你会发现它看起来已经非常不同。
11:43
The duct tape is gone,
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没有胶布了，
11:47
and we added a second detector on top of the breast,
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我们在乳房上方加入第二块探测器，
11:49
which has further improved our tumor detection.
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进一步改进了我们探测肿瘤的能力。
11:52
So how does this work?
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它实际作用如何？
11:54
The patient receives an injection of a radio tracer
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这位病人注射了放射性跟踪剂，
11:57
that's taken up by rapidly proliferating tumor cells,
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繁殖旺盛的肿瘤细胞会迅速吸收这种放射性跟踪剂，
12:00
but not by normal cells,
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正常细胞则不会。
12:02
and this is the key difference from mammography.
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这里显示造影片的巨大区别。
12:05
Mammography relies on differences
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造影技术依靠的就是
12:07
in the appearance of the tumor from the background tissue,
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肿瘤组织与周边组织的突显区别，
12:10
and we've seen that those differences
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我们看到这些区别
12:12
can be obscured in a dense breast.
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在高乳腺密度的乳房中很模糊。
12:15
But MBI exploits
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但是MBI完整显现了
12:17
the different molecular behavior of tumors,
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肿瘤与其他细胞的区别，
12:20
and therefore, it's impervious to breast density.
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因此不受乳腺密度的影响。
12:24
After the injection,
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在注射后，
12:26
the patient's breast is placed between the detectors.
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这位病人的乳房被置于两个探测器中间。
12:28
And if you've ever had a mammogram --
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如果你曾做过乳房X光造影诊断--
12:30
if you're old enough to have had a mammogram --
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如果你年龄足够大的话--
12:32
you know what comes next:
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你知道随之而来的是：
12:34
pain.
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疼痛。
12:36
You may be surprised to know
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你也许会很惊讶，
12:38
that mammography is the only radiologic study
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乳房X光造影
12:41
that's regulated by federal law,
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是唯一被联邦法律允许的放射性研究技术，
12:43
and the law requires
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法律要求
12:45
that the equivalent of a 40-pound car battery
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其强度约等于一块40磅的汽车电池
12:48
come down on your breast during this study.
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砸向你的乳房。
12:52
But with MBI,
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但是用MBI，
12:54
we use just light, pain-free compression.
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只有轻微的压痛感。
12:57
(Applause)
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（掌声）
13:03
And the detector
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探测器
13:05
then transmits the image to the computer.
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随后把图像传回到计算机。
13:07
So here's an example.
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这是一个例子。
13:09
You can see, on the right, a mammogram
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你可以看到右侧，X光片
13:11
showing a faint tumor,
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显示一个成像模糊的肿瘤，
13:13
the edges of which are blurred by the dense tissue.
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肿瘤边缘由于高密度乳腺组织而变得模糊。
13:15
But the MBI image shows that tumor much more clearly,
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但MBI成像中的肿瘤，清楚多了，
13:18
as well as a second tumor,
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还有第二个肿瘤，
13:20
which profoundly influence that patient's surgical options.
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这对病人的手术方案有巨大的影响。
13:24
In this example, although the mammogram found one tumor,
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在这个例子中，X光片找到了一个肿瘤，
13:27
we were able to demonstrate three discrete tumors --
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但我们找到了3个很难探测出的肿瘤--
13:30
one is small as three millimeters.
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其中一个直径只有3毫米。
13:33
Our big break came in 2004.
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我们的突破在2004年。
13:38
After we had demonstrated that we could find small tumors,
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在我们论证能找到小肿瘤之后，
13:41
we used these images
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我们用这些肿瘤成像
13:43
to submit a grant to the Susan G. Komen Foundation.
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申请Susan G.Komen苏珊·G·科曼乳腺癌基金会的赞助。
13:46
And we were elated when they took a chance
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当他们最终决定在一群未曾谋面的探索者身上冒这个险时，
13:49
on a team of completely unknown investigators
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我们是那么的欢欣鼓舞，
13:51
and funded us to study
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他们赞助我们
13:53
1,000 women with dense breasts,
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研究1000名高乳腺密度的女性，
13:55
comparing a screening mammogram to an MBI.
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并比较她们的X光片和MBI成像。
13:58
Of the tumors that we found,
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在所有我们找到的肿瘤中，
14:00
mammography found
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X光片找到了其中的
14:02
only 25 percent of those tumors.
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25%
14:05
MBI found 83 percent.
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MBI找到了83%。
14:08
Here's an example from that screening study.
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这是此次扫描研究的例表。
14:11
The digital mammogram was read as normal
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数码X光片如往常一样
14:13
and shows lots of dense tissue,
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显示大量高密度乳腺组织，
14:15
but the MBI shows an area of intense uptake,
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但是MBI显示了一片高密度区域，
14:18
which correlated with a two-centimeter tumor.
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该区域与一个直径2厘米的肿瘤有关。
14:21
In this case, a one-centimeter tumor.
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在这个例子中，一个直径1厘米的肿瘤。
14:24
And in this case,
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这个例子，
14:26
a 45-year-old medical secretary at Mayo,
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一位来自梅奥的45岁医学秘书，
14:29
who had lost her mother to breast cancer when she was very young,
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她很小时候母亲就患乳腺癌去世了，
14:32
wanted to enroll in our study.
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因此她希望参与我们的研究。
14:34
And her mammogram showed an area of very dense tissue,
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她的X光片显示一片高密度乳腺组织，
14:37
but her MBI showed an area
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而她的MBI显示
14:39
of worrisome uptake,
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该区域值得忧虑，
14:41
which we can also see on a color image.
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在彩片中也可以看到。
14:44
And this corresponded
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与此对应的
14:46
to a tumor the size of a golf ball.
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是一个高尔夫球大小的肿瘤。
14:48
But fortunately it was removed
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幸运的是我们摘除了它，
14:50
before it had spread to her lymph nodes.
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当时它还未扩散到淋巴结。
14:54
So now that we knew that this technology
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所以现在我们得知这项技术
14:56
could find three times more tumors in a dense breast,
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可以在高乳腺密度的乳房中找到3倍多的肿瘤，
14:59
we had to solve one very important problem.
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还有一个很重要的问题需要解决。
15:02
We had to figure out how to lower the radiation dose,
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我们必须尝试降低放射量。
15:05
and we have spent the last three years
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最近这三年，
15:08
making modifications to every aspect of the imaging system
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我们对这个造影系统的每一个细节都做了改进，
15:11
to allow this.
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致力于降低它的放射量。
15:13
And I'm very happy to report that we're now using a dose of radiation
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我现在非常高兴地告诉大家，我们现在使用的放射量
15:16
that is equivalent to the effective dose
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已经与数码X光造影的有效放射量
15:18
from one digital mammogram.
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完全相等。
15:20
And at this low dose, we're continuing this screening study,
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使用低放射量，我们继续这项扫描研究，
15:23
and this image from three weeks ago
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这张图片，来自于3周前，
15:26
in a 67-year-old woman
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一位67岁的妇女，
15:28
shows a normal digital mammogram,
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其数码X光片显示一切正常，
15:30
but an MBI image
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但是MBI图像显示
15:32
showing an uptake that proved to be a large cancer.
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这是一大片癌细胞，之后也被验证确实如此。
15:35
So this is not just young women that it's benefiting.
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所以这不仅仅是有益于低年龄层女性了。
15:38
It's also older women with dense tissue.
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高年龄层的、乳腺密度较高的女性同样受益。
15:41
And we're now routinely using one-fifth the radiation dose
376
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现在我们一般只使用，1/5于
15:44
that's used in any other type of gamma technology.
377
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其他类型伽马射线技术的放射量。
15:48
MBI generates four images per breast.
378
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MBI对每个乳房呈现4张图像。
15:51
MRI generates over a thousand.
379
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而核磁共振成像则超过1000张。
15:54
It takes a radiologist
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一个放射学家
15:56
years of specialty training
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需要很多年专业训练
15:58
to become expert in differentiating
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才能成为辨别
16:00
the normal anatomic detail
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普通解剖学细节组织
16:02
from the worrisome finding.
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和真正病灶的专家。
16:04
But I suspect even the non-radiologists in the room
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但我猜想，这个房间里，即使你不是一位放射学专家，
16:07
can find the tumor on the MBI image.
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你也可以在MBI成像中找到肿瘤。
16:10
But this is why MBI
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然而这正是MBI
16:12
is so potentially disruptive --
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受到百般阻挠的原因。
16:14
it's as accurate as MRI,
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它和核磁共振一样精确，
16:16
it's far less complex to interpret,
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但又比核磁共振好辨认得多，
16:19
and it's a fraction of the cost.
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而且花费只是核磁共振的一个零头。
16:21
But you can understand why there may be
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也许你能明白
16:23
forces in the breast-imaging world
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在乳房成像领域中，
16:25
who prefer the status quo.
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有些人却安于现状，施加阻力的原因。
16:29
After achieving what we felt were remarkable results,
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在获得这个我们自认为非凡的成就之后，
16:32
our manuscript was rejected
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我们的稿件
16:35
by four journals.
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被4家杂志拒收。
16:37
After the fourth rejection,
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在第四次拒收后，
16:39
we requested reconsideration of the manuscript,
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我们要求对稿件进行重审，
16:41
because we strongly suspected
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因为我们严重怀疑
16:43
that one of the reviewers who had rejected it
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审核小组中一位拒绝此稿件的成员
16:45
had a financial conflict of interest
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在与之竞争的技术领域
16:47
in a competing technology.
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有经济利益纠葛。
16:50
Our manuscript was then accepted
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之后我们的稿件被接收了
16:52
and will be published later this month
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并即将在本月末刊登在
16:55
in the journal Radiology.
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《放射学研究》期刊中。
16:57
(Applause)
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（掌声）
17:05
We still need to complete the screening study using the low dose,
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我们继续用低放射量完成整个扫描研究，
17:08
and then our findings will need to be replicated
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然后我们的成果将需要
17:10
at other institutions,
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其它研究机构重新检验。
17:12
and this could take five or more years.
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这可能会耗费五年或更长时间。
17:15
If this technology is widely adopted,
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如果这项技术被广泛运用，
17:18
I will not benefit financially in any way,
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我不会图取任何经济利益。
17:21
and that is very important to me,
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这对我很重要，
17:24
because it allows me to continue to tell you the truth.
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因为这一点让我坚持告诉你们真相。
17:28
But I recognize --
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但我意识到--
17:30
(Applause)
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（掌声）
17:34
I recognize that the adoption of this technology
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我意识到要推广这项技术，
17:37
will depend as much on economic
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不仅需要强大的科学技术支持，
17:39
and political forces
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也需要经济力量
17:41
as it will on the soundness of the science.
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和政治力量的支持。
17:44
The MBI unit has now been FDA approved,
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MBI已经被FDA美国食品及药物管理局批准了，
17:47
but it's not yet widely available.
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但仍未被广泛运用。
17:50
So until something is available
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因此在MBI面世之前，
17:52
for women with dense breasts,
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对于高乳腺密度的女性，
17:54
there are things that you should know
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有些东西你们需要了解
17:56
to protect yourself.
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来保护你们自己。
17:58
First, know your density.
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第一，了解你的乳腺密度。
18:00
Ninety percent of women don't,
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90%的女性不了解自己的乳腺密度，
18:02
and 95 percent of women don't know
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95%的女性不了解
18:04
that it increases your breast cancer risk.
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乳腺密度的增加也会增加罹患乳腺癌的风险。
18:07
The State of Connecticut became the first and only state
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康涅狄格州成为第一个，也是唯一一个
18:10
to mandate that women receive notification
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要求女性在乳房X光片诊断后
18:12
of their breast density
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了解
18:14
after a mammogram.
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自己乳腺密度的州。
18:17
I was at a conference of 60,000 people in breast-imaging
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上周在芝加哥，我参加了一个
18:20
last week in Chicago,
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6万人与会的乳房造影技术大会。
18:22
and I was stunned that there was a heated debate
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我惊讶于看到一场激烈的辩论，
18:25
as to whether we should be telling women
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关于是否应该告诉女性
18:27
what their breast density is.
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她们的乳腺密度。
18:29
Of course we should.
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我们当然应该告诉她们。
18:31
And if you don't know, please ask your doctor
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如果你不知道，请询问你的医生
18:34
or read the details of your mammography report.
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或者仔细研究你的乳房X光诊断报告。
18:37
Second, if you're pre-menopausal,
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第二，如果你还未绝经，
18:39
try to schedule your mammogram
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请尝试把你的乳房X光诊断
18:41
in the first two weeks of your menstrual cycle,
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计划安排在月经周期的前两周，
18:43
when breast density is relatively lower.
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这段时间你的乳腺密度相对较低。
18:46
Third, if you notice a persistent change in your breast,
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第三，如果你注意到你的乳房有一些慢性病变，
18:49
insist on additional imaging.
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请坚持要求更多的成像检查。
18:52
And fourth and most important,
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第四，也是最重要的一点，
18:54
the mammography debate will rage on,
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乳房X光诊断的辩论将会持续升温，
18:57
but I do believe that all women 40 and older
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但我坚信40岁以上的女性应该每年做一次
19:00
should have an annual mammogram.
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乳房X光检查。
19:02
Mammography isn't perfect,
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乳房X光检查并不完美，
19:04
but it's the only test that's been proven
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但它是目前为止唯一被验证
19:06
to reduce mortality from breast cancer.
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可以降低乳腺癌死亡率的诊断方式。
19:09
But this mortality banner
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但这个死亡率招牌
19:11
is the very sword
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正是一把双刃剑，
19:13
which mammography's most ardent advocates use
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乳房X光诊断的热诚簇拥者们用这把剑
19:16
to deter innovation.
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来打击创新。
19:18
Some women who develop breast cancer
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而另一些身患乳腺癌的女性
19:21
die from it many years later,
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多年后却因它而死。
19:23
and most women, thankfully, survive.
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谢天谢地的是，大部分女性，活了下来。
19:25
So it takes 10 or more years
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所以任何新的造影成像技术要花费10年
19:27
for any screening method
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甚至更多年
19:29
to demonstrate a reduction
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来证明其诊断降低了
19:31
in mortality from breast cancer.
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乳腺癌死亡率。
19:33
Mammography's the only one that's been around long enough
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长久以来，乳房X光造影
19:35
to have a chance of making that claim.
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是唯一有机会声明它可以降低乳腺癌死亡率的。
19:38
It is time for us to accept
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但现在是时候让我们接受
19:41
both the extraordinary successes of mammography
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乳房X光造影不仅有非凡的成功之处，
19:43
and the limitations.
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也存在许多限制。
19:45
We need to individualize screening
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我们需要对不同乳腺密度的个体
19:47
based on density.
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使用个性化的扫描成像技术。
19:49
For women without dense breasts,
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对于低乳腺密度的女性来说，
19:51
mammography is the best choice.
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乳房X光造影是最佳选择。
19:54
But for women with dense breasts;
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但对于高乳腺密度的女性来说，
19:56
we shouldn't abandon screening altogether,
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我们不该一刀子斩断所有的造影诊断技术，
19:58
we need to offer them something better.
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我们要为她们提供更好的诊断技术。
20:03
The babies that we were carrying
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当年我的病人问我问题时
20:05
when my patient first asked me this question
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我们怀着的孩子
20:08
are now both in middle school,
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现如今已双双进入中学，
20:11
and the answer has been so slow to come.
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答案却还迟迟未来。
20:16
She's given me her blessing
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她给我祝福，
20:18
to share this story with you.
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让我把这个故事与你们分享。
20:21
After undergoing biopsies
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在接受活组织检查后，
20:23
that further increased her risk for cancer
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而活组织检查会增加患癌症风险，
20:26
and losing her sister to cancer,
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以及经历被癌症夺去姐姐的痛苦之后，
20:28
she made the difficult decision
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她终于做出了艰难的决定，
20:30
to have a prophylactic mastectomy.
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为避免乳腺癌而做了乳房切除术。
20:34
We can and must do better,
491
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我们有能力，并且必须做的更好，
20:37
not just in time for her granddaughters
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这不仅是为了她的孙女，
20:40
and my daughters,
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还有我的女儿，
20:42
but in time for you.
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还有在座的各位。
20:44
Thank you.
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谢谢。
20:46
(Applause)
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（掌声）
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