TEDWomen 2010
Deborah Rhodes: A test that finds 3x more breast tumors, and why it's not available to you
Deborah Rhode：一項更有效找到3倍多乳癌偵測技術的發明故事，以及它至今鮮為人知的原因
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與一群物理學家的團隊工作，德博拉羅茲博士開發出一種新的腫瘤檢測工具，是傳'統檢測的3倍，尤其是婦女乳房組織過於緻密。拯救生命的影響是驚人的。那麼，為什麼我們還沒有聽說過呢？羅茲分享儀器創造背後的故事，以及政治和經濟的複雜夠面使它還不能成為主流作法。
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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依照乳房X光攝影有效的檢測程度
00:18
when it comes to screening mammography --
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我們可以將女性區分為兩大群組
00:20
women in whom mammography works very well
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其中一群人可透過乳房X光攝影有效的診斷
00:23
and has saved thousands of lives
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因此拯救了許多的生命
00:25
and women in whom it doesn't work well at all.
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然而另一群女性卻無法被乳房X光攝影有效的診斷
00:29
Do you know which group you're in?
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妳知道妳屬於哪一群組嗎?
00:32
If you don't, you're not alone.
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別擔心，妳並不是少數不知道的
00:34
Because the breast has become
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因為乳房可說是
00:36
are very political organ.
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一個敏感議題的器官
00:39
The truth has become lost
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許多真相
00:41
in all the rhetoric
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已因修飾而遺失 有
00:43
coming from the press, politicians,
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來自媒體、政客
00:45
radiologists
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放射科醫師
00:47
and medical imaging companies.
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以及醫用影像公司的花言巧語中
00:49
I will do my best this morning
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而現在我將要盡我所能的
00:51
to tell you what I think is the truth.
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告訴大家我所知道的真相
00:54
But first, my disclosures.
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但首先讓我澄清一下
00:57
I am not a breast cancer survivor.
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我未曾罹患乳癌
00:59
I'm not a radiologist.
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我也不是個放射科醫師
01:01
I don't have any patents,
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我沒有任何的專利
01:03
and I've never received any money from a medical imaging company,
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而我也未曾從任何的醫用影像公司獲得任何利益
01:06
and I am not seeking your vote.
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我更不是說服各位哪天要投我一票
01:09
(Laughter)
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（眾笑）
01:11
What I am
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我僅僅只是
01:13
is a doctor of internal medicine
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一名
01:15
who became passionately interested in this topic
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熱衷於此一領域的內科醫師
01:17
about 10 years ago
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大約在十年前
01:19
when a patient asked me a question.
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有一名病患問了我一個問題
01:23
She came to see me
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她是在發現了一個乳房腫塊之後
01:25
after discovering a breast lump.
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來找我的
01:27
Her sister had been diagnosed with breast cancer
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她的姊姊在四十多歲時被診斷
01:30
in her 40s.
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罹患乳癌
01:32
She and I were both very pregnant at that time,
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當時她與我都在懷孕末期了
01:35
and my heart just ached for her,
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我深深的為她感到心疼
01:37
imagining how afraid she must be.
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並試想著她當時該有多害怕
01:40
Fortunately, her lump proved to be benign.
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很幸運地，她的乳房腫塊是良性的
01:43
But she asked me a question:
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但她問我
01:45
how confident was I
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我有幾成的把握
01:47
that I would find a tumor early on her mammogram
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可以及早的透過她的乳房X光片診斷出是否罹患腫瘤
01:49
if she developed one?
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如果她真的不幸罹患的話?
01:51
So I studied her mammogram,
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於是我便判讀了她的乳房X光片
01:53
and I reviewed the radiology literature,
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並且檢視了文獻以及相關紀錄
01:55
and I was shocked to discover
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我很震驚的發現
01:57
that, in her case,
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在她的例子
01:59
our chances of finding a tumor early on the mammogram
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要透過乳房X光攝影及早發現腫瘤的機率
02:01
were less than the toss of a coin.
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甚至不到二分之一
02:04
You may recall a year ago
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各位大概還記得一年前
02:06
when a firestorm erupted
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的一場風暴
02:08
after the United States Preventive Services Task Force
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也就是美國預防醫學工作小組
02:12
reviewed the world's mammography screening literature
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在檢視了乳房X光攝影術的相關期刊後
02:15
and issued a guideline
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發布了一項準則
02:17
recommending against screening mammograms
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建議女性在四十歲以後
02:20
in women in their 40s.
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應避免進行乳房X光攝影術
02:22
Now everybody rushed to criticize the Task Force,
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很快的引發許多人批評此一工作小組
02:25
even though most of them weren't in anyway familiar
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而其中許多人甚至根本不熟悉
02:27
with the mammography studies.
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乳房X光攝影術
02:30
It took the Senate just 17 days
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參議院花了僅僅十七天
02:32
to ban the use of the guidelines
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便決定在考量保險理賠範圍上
02:34
in determining insurance coverage.
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禁止使用該項準則
02:38
Radiologists were outraged
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而放射治療師也因為這項準則
02:40
by the guidelines.
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而義憤填膺
02:42
The pre-eminent mammographer in the United States
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一名傑出的乳房X光攝影師
02:44
issued the following quote
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在華盛頓郵報上
02:46
to the Washington Post.
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發表了這樣的評論
02:49
The radiologists were, in turn, criticized
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於是放射科醫師更被視為是
02:52
for protecting their own financial self-interest.
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為了保護自己的既得利益而飽受批評
02:55
But in my view,
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但在我看來
02:57
the radiologists are heroes.
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放射線治療師可說是英雄
02:59
There's a shortage of radiologists
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能判讀乳房X光攝影術的放射線治療師
03:01
qualified to read mammograms,
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可說是少之又少
03:03
and that's because mammograms are one of the most complex
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這是因為乳房X光片
03:06
of all radiology studies to interpret,
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是所有放射線科中最複雜也最難判讀的
03:09
and because radiologists
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也因為放射科醫師
03:11
are sued more often
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最常因為
03:13
over missed breast cancer
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未察覺乳癌
03:15
than any other cause.
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而被控告
03:17
But that very fact is telling.
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但事實的真相其實是顯而易見的
03:20
Where there is this much legal smoke,
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這麼多的訴訟
03:23
there is likely to be some fire.
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那一定是有些狀況的
03:26
The factor most responsible for that fire
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而會造成判讀上的錯誤或疏失
03:29
is breast density.
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主要是因為乳房密度
03:33
Breast density refers to the relative amount of fat --
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乳房密度指的是乳房中的脂肪
03:35
pictured here in yellow --
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在圖中以黃色顯示
03:37
versus connective and epithelial tissues --
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以及結締組織和上皮組織的相對含量
03:39
pictured in pink.
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在圖上以粉紅色表示
03:41
And that proportion
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乳房密度
03:43
is primarily genetically determined.
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基本上是由基因所決定的
03:45
Two-thirds of women in their 40s
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三分之二的女性在四十歲以後
03:47
have dense breast tissue,
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會有乳房密度偏高的現象
03:49
which is why mammography doesn't work as well in them.
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這也就是為什麼乳房X光攝影術無法對這些女性進行準確判讀
03:52
And although breast density generally declines with age,
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雖然一般而言乳房密度會隨著年齡而下降
03:55
up to a third of women
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然而三分之一的女性
03:57
retain dense breast tissue
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即使在更年期後數年
03:59
for years after menopause.
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其乳房密度仍不會下降
04:03
So how do you know if your breasts are dense?
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而女性們如何知道自己的乳房密度是否偏高?
04:06
Well, you need to read the details
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你需要好好的檢視
04:08
of your mammography report.
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乳房X光攝影術報告中的許多細節
04:10
Radiologists classify breast density
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放射科醫師將乳房密度
04:12
into four categories
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依照乳房X光片的結果
04:14
based on the appearance of the tissue on a mammogram.
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將乳房區分成四類
04:17
If the breast is less than 25 percent dense,
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若乳房密度低於25%
04:20
that's called fatty-replaced.
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便稱為脂肪型乳房(fatty replaced)
04:22
The next category
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下一個類別
04:24
is scattered fibroglandular densities,
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則是散在纖維腺體型(25-50%)
04:26
followed by heterogeneously dense
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以及不均質型(50-75%)
04:28
and extremely dense.
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緻密型(75%以上)
04:30
And breasts that fall into these two categories
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乳房密度落於後兩個類別的話
04:32
are considered dense.
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便視為高密度型乳房
04:34
The problem with breast density
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而乳房密度所潛藏的危機
04:36
is that it's truly the wolf in sheep's clothing.
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是它讓危險的腫瘤像是批著羊皮的狼隱藏在乳房中
04:39
Both tumors and dense breast tissue
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腫瘤跟高密度乳房組織
04:41
appear white on a mammogram,
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在乳房X光片上都呈白色
04:44
and the X-ray often can't distinguish between the two.
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而X光往往無法順利區分兩者
04:47
So it's easy to see this tumor
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所以要在充滿脂肪的乳房中
04:49
in the upper part of this fatty breast.
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發現腫瘤比較容易
04:52
But imagine how difficult it would be
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但是試想看看
04:54
to find that tumor in this dense breast.
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要在高乳房密度中發現腫瘤該有多難
04:57
That's why mammograms find
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這也就是為什麼透過乳房X光片
04:59
over 80 percent of tumors in fatty breasts,
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在多脂肪的乳房能診斷出超過 80% 的腫瘤
05:02
but as few as 40 percent in extremely dense breasts.
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但是在高乳房密度的女性中正確診斷的機率卻少於 40%
05:05
Now it's bad enough that breast density
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高乳房密度
05:07
makes it hard to find a cancer,
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使得腫瘤診斷變得困難，這已經很糟了
05:09
but it turns out
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更糟的是，高乳房密度
05:11
that it's also a powerful predictor
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也是罹患乳癌機率的
05:13
of your risk for breast cancer.
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有效預測指標
05:15
It's a stronger risk factor
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高乳房密度是罹患乳癌的風險因素之一
05:17
than having a mother or a sister with breast cancer.
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甚至比母親或姊妹有乳癌病史更危險
05:20
At the time my patient posed this question to me,
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在那位病患對我提出問題的年代
05:23
breast density was an obscure topic
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乳房密度在放射線學文獻中
05:25
in the radiology literature,
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仍是一個鮮為人知的主題
05:27
and very few women having mammograms,
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當時很少女性會進行乳房X光攝影術
05:29
or the physicians ordering them,
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也很少醫師要求病患進行檢測
05:31
knew about this.
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甚至也不瞭解乳房X光攝影術
05:33
But what else could I offer her?
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而在當時我們還能夠提供為她進行什麼檢測呢?
05:36
Mammograms have been around since the 1960's,
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乳房X光攝影術在1960年代就被發現了
05:39
and it's changed very little.
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但是它到現在仍沒什麼進步
05:41
There have been surprisingly few innovations,
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這項技術的創新出乎意料的少
05:44
until digital mammography was approved
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直到2000年時數位化乳房X光攝影
05:46
in 2000.
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才被核可
05:48
Digital mammography is still an X-ray of the breast,
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數位乳房X光攝影仍然是透過X光來檢測乳房
05:51
but the images
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但是所診測的影像
05:53
can be stored and manipulated digitally,
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可以被數位化儲存並進行調整 (使影像更清晰)
05:55
just like we can with a digital camera.
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就好像我們所使用的數位相機
05:58
The U.S. has invested
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為此，美國政府投資了
06:00
four billion dollars
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四十億美元
06:02
converting to digital mammography equipment,
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將乳房X光攝影術的儀器進行更新
06:05
and what have we gained from that investment?
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而這項投資到底帶給了我們什麼好處?
06:08
In a study funded by over 25 million taxpayer dollars,
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在一個花了納稅人2500萬美元的研究中顯示
06:12
digital mammography was found
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數位乳房X光攝影術
06:14
to be no better over all
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整體而言並沒有比
06:16
than traditional mammography,
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傳統的乳房X光攝影術來的好
06:18
and in fact, it was worse in older women.
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事實上，它對年長女性的檢測能力甚至更糟
06:21
But it was better in one group,
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但是數位乳房X光攝影
06:24
and that was women under 50
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針對五十歲以下的女性檢測能力較傳統的好
06:26
who were pre-menopausal and had dense breasts,
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而她們通常是停經期前且有著高密度乳房的女性
06:29
and in those women,
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在這些女性中
06:31
digital mammography found twice as many cancers,
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數位乳房X光攝影術比起傳統攝影術更加有效
06:34
but it still only found 60 percent.
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但成功診斷的機率仍只有60%
06:37
So digital mammography
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所以數位乳房X光攝影
06:39
has been a giant leap forward
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對於相關的儀器製造商
06:41
for manufacturers
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可說是大有貢獻
06:43
of digital mammography equipment,
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.
06:45
but it's been a very small step forward for
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但是對女性整體而言
06:47
womankind.
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其幫助可說是微乎其微
06:50
What about ultrasound?
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那麼超音波呢?
06:52
Ultrasound generates more biopsies
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比起其他檢測方法
06:54
that are unnecessary relative to other technologies,
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超音波需要更多的生物檢體
06:56
so it's not widely used.
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因此鮮少被使用
06:59
And MRI is exquisitely sensitive for finding tumors,
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而核磁共振顯影(MRI)可以非常有效的診斷乳癌
07:02
but it's also very expensive.
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但它卻非常的昂貴
07:06
If we think about disruptive technology,
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想想那些革命性的科技
07:09
we see an almost ubiquitous pattern
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我們總是可以發現廣泛存在的趨勢
07:11
of the technology getting smaller and less expensive.
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也就是它們總是變得越來越小、越便宜
07:14
Think about iPods compared to stereos.
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比較看看iPods跟以前的音響
07:17
But it's the exact opposite in health care.
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但是在醫療產業中趨勢卻是剛好相反
07:20
The machines get ever bigger
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需多醫療儀器都越變越大
07:22
and ever more expensive.
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而且越來越昂貴
07:26
Screening the average young woman with an MRI
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使用核磁共振儀來檢測
07:29
is kind of like driving to the grocery store in a Hummer.
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就好像開著一台悍馬車進雜貨店一樣
07:33
It's just way too much equipment.
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實在有太多儀器、設備了
07:35
One MRI scan
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一次核磁共振掃描
07:37
costs 10 times what a digital mammogram costs.
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所花費的金錢約是數位X光掃描的10倍
07:40
And sooner or later, we're going to have to accept the fact
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遲早我們都必須要接受一個事實
07:42
that health care innovation
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也就是醫療儀器的創新
07:44
can't always come at a much higher price.
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不能總是發明出更昂貴的設備
07:49
Malcolm Gladwell wrote an article in the New Yorker
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Malcolm Gladwell在"紐約客"雜誌上寫了一篇
07:51
on innovation,
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關於創新的文章
07:53
and he made the case that scientific discoveries
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而他認為科學上的重大發展
07:56
are rarely the product of one individual's genius.
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很少是由一個天才單打獨鬥所創造的
08:00
Rather, big ideas can be orchestrated,
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相反的，有創意的點子可以互相共鳴與影響
08:03
if you can simply gather
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所以如果我們能夠
08:05
people with different perspectives in a room
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將不同領域的人才聚集在一起
08:07
and get them to talk about things
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讓他們討論某些
08:09
that they don't ordinarily talk about.
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他們平常時不太會討論的議題
08:11
It's like the essence of TED.
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就好像TED的本質那樣
08:14
He quotes one innovator who says,
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他引用了一個創新者說的話
08:16
"The only time a physician and a physicist get together
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"醫生跟物理學家難得會聚在一起的時候
08:20
is when the physicist gets sick."
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就是物理學家生病的時候"
08:22
(Laughter)
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.
08:24
This makes no sense,
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這一點道理都沒有
08:26
because physicians have all kinds of problems
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因為醫生其實面對了許多的問題
08:28
that they don't realize have solutions.
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而他們甚至沒有意識到這些問題其實是可以被解決的
08:31
And physicists have all kinds of solutions for things
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而物理學家可以為許多事物找到解決的辦法
08:33
that they don't realize are problems.
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但是他們卻不知道醫生所遇到的問題
08:36
Now, take a look at this cartoon
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現在大家看看
08:39
that accompanied Gladwell's article,
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Gladwell 文章中所附的插圖
08:41
and tell me if you see something disturbing
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這幅關於創新思考者的插圖
08:43
about this depiction of innovative thinkers.
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是不是讓你覺得怪怪的呢?
08:46
(Laughter)
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.
08:48
So if you will allow me a little creative license,
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如果各位不介意的話
08:52
I will tell you the story
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我將要向各位分享
08:54
of the serendipitous collision
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一次由我病患所提出的問題
08:56
of my patient's problem
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以及醫生與科學家們所得的解答
08:58
with a physicist's solution.
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之間偶然的碰撞
09:00
Shortly after her visit,
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在我的病患拜訪完之後不久
09:02
I was introduced to a nuclear physicist
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我被引薦給一位
09:04
at Mayo
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在Mayo的核子物理學家
09:06
named Michael O'Conner,
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Michael O'Conner
09:08
who was a specialist in cardiac imaging,
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他是一位心臟顯影方面的專家
09:10
something I had nothing to do with.
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其實不是跟我的研究有關的領域
09:12
And he happened to tell me
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但他碰巧告訴我
09:14
about a conference he'd just returned from in Israel,
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一個他剛去以色列所參加的會議
09:17
where they were talking about a new type of gamma detector.
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與會人士討論到一種全新的伽馬(gamma)偵測器
09:20
Now gamma imaging has been around for a long time
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利用伽馬射線來進行心臟顯影
09:22
to image the heart,
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已經有數年的歷史了
09:24
and it had even been tried to image the breast.
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而它也曾被嘗試用來進行檢測乳房
09:27
But the problem was
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但問題是
09:29
that the gamma detectors
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使用伽馬射線探測器
09:31
were these huge, bulky tubes,
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是由體積龐大又笨重的管子組成的
09:33
and they were filled with these scintillating crystals,
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裡面還填充著螢光特性的晶體
09:35
and you just couldn't get them close enough around the breast
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所以我們就是沒辦法讓這些偵測器非常靠近乳房
09:38
to find small tumors.
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來檢測小型腫瘤
09:40
But the potential advantage was
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但是其中一項潛在的優勢是
09:42
that gamma rays, unlike X-rays,
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伽瑪射線不像X光
09:44
are not influenced by breast density.
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並不會受到乳房密度的影響
09:47
But this technology
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但是伽馬射線
09:49
could not find tumors when they're small,
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無法在腫瘤還很小就偵測到
09:51
and finding a small tumor is critical for survival.
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但是及早發現小腫瘤對於病患的存活率是很重要的
09:54
If you can find a tumor
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如果我們能在
09:56
when it's less than a centimeter,
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腫瘤還小於一公分時就發現它
09:58
survival exceeds 90 percent,
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那麼病患的存活率可高達九十以上
10:00
but drops off rapidly
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但是若等到腫瘤變更大後才發現
10:02
as tumor size increases.
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存活機率便會大大下降
10:05
But Michael told me about
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而Michael告訴我
10:07
a new type of gamma detector that he'd seen,
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他曾經見過一種新的伽馬偵測器
10:09
and this is it.
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也就是這一個
10:11
It's made
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它不是用
10:13
not of a bulky tube,
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龐大的管子所構成
10:15
but of a thin layer of a semiconductor material
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而是用一層薄薄的
10:18
that serves as the gamma detector.
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用來偵測伽瑪的半導體材料所做的
10:20
And I started talking to him
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於是我開始跟他討論
10:22
about this problem with breast density,
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關於乳房密度與乳癌的問題
10:24
and we realized that we might be able to get this detector
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接著我們認為我們應該可以讓這個偵測器
10:27
close enough around the breast
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更靠近乳房
10:29
to actually find small tumors.
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來增加發現小腫瘤的機率
10:31
So after putting together
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所以把這些小小偵測器
10:33
a grid of these cubes with tape --
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用膠帶黏起來之後
10:36
(Laughter)
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.
10:39
-- Michael hacked off the X-ray plate
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Michael把乳房X光攝影器
10:42
of a mammography machine
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上面的X光版給拔掉了
10:44
that was about to be thrown out,
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而且X光版之後大概也真的要被淘汰掉了
10:46
and we attached the new detector,
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我們就把新的偵測器黏上去
10:49
and we decided to call this machine
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然後我們決定把這台機器
10:51
Molecular Breast Imaging, or MBI.
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叫做MBI
10:55
This is an image from our first patient.
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這是我們用MBI檢測的第一位病患所得的影像
10:57
And you can see, using the old gamma technology,
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大家可以看到，使用舊的伽馬偵測器
10:59
that it just looked like noise.
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所得的結果大部分是雜訊
11:01
But using our new detector,
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但使用我們所發展的新的偵測器(MBI)
11:03
we could begin to see the outline of a tumor.
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我們便可以看到腫瘤的存在
11:06
So here we were, a nuclear physicist,
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結果，一個核子物理學家
11:08
an internist,
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一個內科醫師
11:10
soon joined by Carrie Hruska, a biomedical engineer,
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還有Carrie Hruska這位生醫工程師
11:13
and two radiologists,
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以及兩位放射科醫師組合成一個團隊
11:15
and we were trying to take on
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然後我們試著要
11:17
the entrenched world of mammography
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用我們那以膠帶組合起來的新機器
11:19
with a machine that was held together by duct tape.
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在乳房攝影這個領域中尋求突破
11:23
To say that we faced
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我們
11:25
high doses of skepticism
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在早期時
11:27
in those early years
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所遭遇到的高度質疑與批判
11:29
is just a huge understatement,
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簡直就是難以形容
11:31
but we were so convinced that we might be able to make this work
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但是我們非常的有信心我們可以讓它實現
11:34
that we chipped away with incremental modifications
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於是我們將整個系統
11:37
to this system.
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去蕪存菁、更進一步改進
11:39
This is our current detector.
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這是我們目前所發展出來的偵測器
11:41
And you can see that it looks a lot different.
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如各位所見，它看起來非常的不同
11:43
The duct tape is gone,
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膠帶不見了
11:47
and we added a second detector on top of the breast,
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而且我們在胸部上方又增加了另一個偵測器
11:49
which has further improved our tumor detection.
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因此可以進一步提高檢測的靈敏度
11:52
So how does this work?
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而它到底是怎麼運作的呢?
11:54
The patient receives an injection of a radio tracer
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首先病患需要注射放射性追蹤劑
11:57
that's taken up by rapidly proliferating tumor cells,
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而此一藥劑會被快速增生的腫瘤細胞所吸收
12:00
but not by normal cells,
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但是正常的細胞卻不會
12:02
and this is the key difference from mammography.
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而這便是我們所發展的偵測器與乳房X光攝影最大的不同
12:05
Mammography relies on differences
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乳房X光攝影依靠的是
12:07
in the appearance of the tumor from the background tissue,
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"腫瘤與其他組織具有不同的外觀" 來偵測腫瘤
12:10
and we've seen that those differences
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但是我們知道兩者外觀的不同
12:12
can be obscured in a dense breast.
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在高密度乳房的女性中其實是很微小的
12:15
But MBI exploits
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但是MBI所利用的
12:17
the different molecular behavior of tumors,
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卻是"腫瘤細胞與正常細胞之間性質的不同" 來偵測腫瘤
12:20
and therefore, it's impervious to breast density.
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因此MBI並不會受到乳房密度的影響
12:24
After the injection,
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在注射放射性追蹤劑後
12:26
the patient's breast is placed between the detectors.
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病患的乳房會被放置在偵測器之間
12:28
And if you've ever had a mammogram --
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如果你曾經做過乳房X光攝影
12:30
if you're old enough to have had a mammogram --
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或者你因為年紀的關係而作過乳房X光攝影
12:32
you know what comes next:
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你就知道接下來是什麼
12:34
pain.
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也就是難以忍受的疼痛
12:36
You may be surprised to know
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你大概不知道
12:38
that mammography is the only radiologic study
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乳房X光攝影是唯一放射性影像學中
12:41
that's regulated by federal law,
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被聯邦法律所謹慎規範的
12:43
and the law requires
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而聯邦法律准許
12:45
that the equivalent of a 40-pound car battery
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乳房X光攝影用大約四十磅的重量
12:48
come down on your breast during this study.
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壓在你的胸部上來進行檢測
12:52
But with MBI,
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但使用MBI
12:54
we use just light, pain-free compression.
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我們僅僅需要輕輕的、無痛的碰觸便可以完成檢測
12:57
(Applause)
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.
13:03
And the detector
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隨後偵測器
13:05
then transmits the image to the computer.
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便會將影像傳到電腦
13:07
So here's an example.
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這邊是其中一例
13:09
You can see, on the right, a mammogram
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大家可以看到在右邊
13:11
showing a faint tumor,
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乳房X光片模糊的顯示出似乎有個腫瘤
13:13
the edges of which are blurred by the dense tissue.
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而腫瘤的邊緣因為高密度的組織而顯得模糊
13:15
But the MBI image shows that tumor much more clearly,
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但是用MBI所得的影像則清晰的多
13:18
as well as a second tumor,
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甚至還可以發現第二個小腫瘤
13:20
which profoundly influence that patient's surgical options.
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也因此徹底的影響了病患選擇手術施行的意願
13:24
In this example, although the mammogram found one tumor,
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而在這個例子，雖然乳房X光攝影發現了一個腫瘤
13:27
we were able to demonstrate three discrete tumors --
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但是MBI卻發現其實是三個
13:30
one is small as three millimeters.
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其中一個甚至小到只有三公厘
13:33
Our big break came in 2004.
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我們最重大的突破出現在2004年
13:38
After we had demonstrated that we could find small tumors,
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在我們證實我們的MBI能夠有效的發現小型腫瘤
13:41
we used these images
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我們便用這些影像結果
13:43
to submit a grant to the Susan G. Komen Foundation.
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向Susan G. Komen 基金會申請一項計劃費
13:46
And we were elated when they took a chance
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我們很慶興他們最終同意
13:49
on a team of completely unknown investigators
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讓一群投資者
13:51
and funded us to study
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贊助我們研究
13:53
1,000 women with dense breasts,
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一千名高密度乳房的女性
13:55
comparing a screening mammogram to an MBI.
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使用乳房X光攝影以及MBI檢測的差異
13:58
Of the tumors that we found,
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在所有我們研究中所發現的腫瘤
14:00
mammography found
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乳房X光攝影只能
14:02
only 25 percent of those tumors.
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檢測出25%的腫瘤
14:05
MBI found 83 percent.
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MBI則能夠檢測出83%的腫瘤
14:08
Here's an example from that screening study.
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這裡以其中一項檢測作為例子
14:11
The digital mammogram was read as normal
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數位乳房X光攝影判讀結果為正常
14:13
and shows lots of dense tissue,
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並在圖上顯示許多高密度的組織
14:15
but the MBI shows an area of intense uptake,
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但是MBI卻發現有一個區域會吸收高量的放射性追蹤劑
14:18
which correlated with a two-centimeter tumor.
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而結果證實是一個兩公分大的腫瘤
14:21
In this case, a one-centimeter tumor.
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在這個例子則是一個一公分的腫瘤
14:24
And in this case,
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接下來的例子
14:26
a 45-year-old medical secretary at Mayo,
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一位在Mayo的四十五歲的醫務秘書
14:29
who had lost her mother to breast cancer when she was very young,
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在她還很年輕時，她的母親由於乳癌而過世
14:32
wanted to enroll in our study.
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而她主動要求進入我們的研究
14:34
And her mammogram showed an area of very dense tissue,
350
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而她的乳房X光片中有一個區域分布著高密度的組織
14:37
but her MBI showed an area
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但是她的MBI檢測結果卻顯示
14:39
of worrisome uptake,
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有異常的放射性追蹤劑吸收現象
14:41
which we can also see on a color image.
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而我們也可以從這張影像結果上看出來
14:44
And this corresponded
354
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而它所顯示的
14:46
to a tumor the size of a golf ball.
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其實是一個高爾夫球大小的腫瘤
14:48
But fortunately it was removed
356
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但是很幸運的已經及早在腫瘤
14:50
before it had spread to her lymph nodes.
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轉移到淋巴結前移除
14:54
So now that we knew that this technology
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所以現在我們知道這項科技(MBI)
14:56
could find three times more tumors in a dense breast,
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可以提高偵測高密度乳房女性的腫瘤靈敏度達三倍
14:59
we had to solve one very important problem.
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我們已經解決了一個非常重要的問題
15:02
We had to figure out how to lower the radiation dose,
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接下來必須要思考如何減低放射性追蹤劑的劑量
15:05
and we have spent the last three years
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而過去三年
15:08
making modifications to every aspect of the imaging system
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我們盡其可能的改善此一系統
15:11
to allow this.
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來達到這個目標
15:13
And I'm very happy to report that we're now using a dose of radiation
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而現在我很高興能夠告訴大家
15:16
that is equivalent to the effective dose
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MBI所需的劑量
15:18
from one digital mammogram.
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與數位乳房X光攝影所需的劑量是相同的
15:20
And at this low dose, we're continuing this screening study,
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而用這樣低的劑量，我們繼續研究MBI檢測的效率
15:23
and this image from three weeks ago
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這張影像是來自三星期以前
15:26
in a 67-year-old woman
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一位67歲的女性
15:28
shows a normal digital mammogram,
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她的乳房X光片結果顯示正常
15:30
but an MBI image
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但是MBI影像結果
15:32
showing an uptake that proved to be a large cancer.
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卻顯示出一個大型的腫瘤
15:35
So this is not just young women that it's benefiting.
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所以MBI嘉惠的對象不只是年輕的女性
15:38
It's also older women with dense tissue.
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還有年長但仍保有高密度乳房的女性
15:41
And we're now routinely using one-fifth the radiation dose
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而我們現在已經例行性的用
15:44
that's used in any other type of gamma technology.
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其他伽馬檢測技術所需劑量的五分之一來進行檢測
15:48
MBI generates four images per breast.
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每次MBI檢測會產生四張影像結果
15:51
MRI generates over a thousand.
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而MRI則會產生超過一千張影像
15:54
It takes a radiologist
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一名放射科醫生
15:56
years of specialty training
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需要數年的專業化訓練
15:58
to become expert in differentiating
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才能夠成功分辨
16:00
the normal anatomic detail
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正常的乳房組織
16:02
from the worrisome finding.
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與腫瘤
16:04
But I suspect even the non-radiologists in the room
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不過我想在座的各位即便不是放射科醫師
16:07
can find the tumor on the MBI image.
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也能夠在MBI影像上判讀出腫瘤的存在
16:10
But this is why MBI
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這也就是為什麼
16:12
is so potentially disruptive --
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MBI是如此的潛力無窮又革命性的科技
16:14
it's as accurate as MRI,
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它與MRI一樣的準確
16:16
it's far less complex to interpret,
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但是卻更容易判讀
16:19
and it's a fraction of the cost.
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而且所花費的金錢也較少
16:21
But you can understand why there may be
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也因此各位可以稍微想想看
16:23
forces in the breast-imaging world
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為什麼醫療用乳房攝影的領域
16:25
who prefer the status quo.
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會偏好維持現狀
16:29
After achieving what we felt were remarkable results,
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在獲得我們這些突破性的結果之後
16:32
our manuscript was rejected
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我們的文章
16:35
by four journals.
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卻被四個期刊拒絕
16:37
After the fourth rejection,
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在第四個期刊拒絕登載我們的文章後
16:39
we requested reconsideration of the manuscript,
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我們要求再一次審議我們的文章
16:41
because we strongly suspected
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因為我們強烈的懷疑
16:43
that one of the reviewers who had rejected it
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其中一位拒絕我們文章的審查者
16:45
had a financial conflict of interest
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因為參與了另一項與MBI競爭的科技
16:47
in a competing technology.
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因此有著利益衝突的考量
16:50
Our manuscript was then accepted
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結果我們的文章便被接受了
16:52
and will be published later this month
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將在這個月底
16:55
in the journal Radiology.
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在Radiology期刊上發表
16:57
(Applause)
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.
17:05
We still need to complete the screening study using the low dose,
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我們仍然要想辦法進一步減少放射性追蹤劑的劑量
17:08
and then our findings will need to be replicated
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而我們的檢測結果也需要
17:10
at other institutions,
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被其他機構重複驗證
17:12
and this could take five or more years.
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而這將會耗費五年或甚至更久
17:15
If this technology is widely adopted,
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如果這項科技有朝一日能夠被廣泛的應用
17:18
I will not benefit financially in any way,
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我完全不會從中得到任何商業利益
17:21
and that is very important to me,
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而這一點對我很重要
17:24
because it allows me to continue to tell you the truth.
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因為這樣才能夠讓我持續告訴社會大眾真正的事實
17:28
But I recognize --
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而我認為
17:30
(Applause)
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.
17:34
I recognize that the adoption of this technology
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我想這項科技要真的被廣泛的接受與應用
17:37
will depend as much on economic
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將需要經濟上
17:39
and political forces
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以及醫療政策的支持
17:41
as it will on the soundness of the science.
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如同它需要健全、透徹的科學研究作為背景一樣
17:44
The MBI unit has now been FDA approved,
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現在美國食品藥物管理局已經核准MBI了
17:47
but it's not yet widely available.
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但是MBI卻仍無法為大眾所使用
17:50
So until something is available
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高密度乳房的女性
17:52
for women with dense breasts,
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在能夠進行檢測之前
17:54
there are things that you should know
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應該要知道以下幾件事
17:56
to protect yourself.
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來保護自己
17:58
First, know your density.
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首先，要知道自己的乳房密度落在哪一範圍
18:00
Ninety percent of women don't,
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90%並不知道自己的乳房密度
18:02
and 95 percent of women don't know
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而更有95%的女性不知道
18:04
that it increases your breast cancer risk.
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高乳房密度會增加罹患乳癌的風險
18:07
The State of Connecticut became the first and only state
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康乃狄克州是第一個，也是目前唯一一個州
18:10
to mandate that women receive notification
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規定女性在接受乳房X光攝影後
18:12
of their breast density
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其檢測報告應包含乳房密度
18:14
after a mammogram.
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.
18:17
I was at a conference of 60,000 people in breast-imaging
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上周我與六萬人共同參加了一場
18:20
last week in Chicago,
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在芝加哥所舉辦的關於乳房攝影的研討會
18:22
and I was stunned that there was a heated debate
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而我非常訝異於其中一項爭議性的討論
18:25
as to whether we should be telling women
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也就是是否應該告訴女性
18:27
what their breast density is.
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她們的乳房密度
18:29
Of course we should.
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但我認為這是相當理所當然的
18:31
And if you don't know, please ask your doctor
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所以如果妳不知道自己乳房密度的話，請詢問妳的醫生
18:34
or read the details of your mammography report.
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或是詳閱乳房X光攝影的結果報告
18:37
Second, if you're pre-menopausal,
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第二，若你仍在停經前的話
18:39
try to schedule your mammogram
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試著安排乳房X光攝影
18:41
in the first two weeks of your menstrual cycle,
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並安排在自己生理期的前兩周去檢測
18:43
when breast density is relatively lower.
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那時胸部密度會相對的較低
18:46
Third, if you notice a persistent change in your breast,
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第三，若你發現自己的胸部有持續的微小變化
18:49
insist on additional imaging.
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請務必要進行更進一步的檢測、獲得更多影像
18:52
And fourth and most important,
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第四點，同時也是最重要的一點
18:54
the mammography debate will rage on,
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關於乳房X光攝影所存在的爭議會一直持續下去
18:57
but I do believe that all women 40 and older
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但我相信所有超過四十歲的女性
19:00
should have an annual mammogram.
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每年都應該要進行一次乳房X光攝影
19:02
Mammography isn't perfect,
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的確，乳房X光攝影並不是完美的
19:04
but it's the only test that's been proven
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但是它卻是唯一證實
19:06
to reduce mortality from breast cancer.
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能夠減低乳癌致死機率的檢測
19:09
But this mortality banner
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死亡率這個議題
19:11
is the very sword
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其實是一把兩面刃
19:13
which mammography's most ardent advocates use
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許多乳房X光攝影的擁護者以它作為藉口
19:16
to deter innovation.
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反對其它可能的創新
19:18
Some women who develop breast cancer
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有些女性在診斷出乳癌之後
19:21
die from it many years later,
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會在數年以後死亡
19:23
and most women, thankfully, survive.
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然而值得慶幸的是,大部分的女性都會存活下來
19:25
So it takes 10 or more years
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所以任何的檢測技術
19:27
for any screening method
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都需要十年甚至更久
19:29
to demonstrate a reduction
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才能夠證實
19:31
in mortality from breast cancer.
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它能夠降低乳癌致死率的程度
19:33
Mammography's the only one that's been around long enough
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而乳房X光攝影則是目前唯一一項
19:35
to have a chance of making that claim.
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有權宣稱其檢測效果的技術
19:38
It is time for us to accept
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我們承認並同意
19:41
both the extraordinary successes of mammography
471
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乳房X光攝影至今所貢獻的偉大成就
19:43
and the limitations.
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但同時也必須要關注它所存在的限制
19:45
We need to individualize screening
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我們應該要將乳癌檢測個人化
19:47
based on density.
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並依照乳房密度來挑選適當的檢測方式
19:49
For women without dense breasts,
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對於不具有高密度乳房的女性而言
19:51
mammography is the best choice.
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乳房X光檢測是她們最好的選擇
19:54
But for women with dense breasts;
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但是最於高密度乳房的女性來說
19:56
we shouldn't abandon screening altogether,
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我們不應該用一樣的方式來檢測
19:58
we need to offer them something better.
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我們必須要提供給她們更好的選擇
20:03
The babies that we were carrying
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在我的病患問我那個問題時
20:05
when my patient first asked me this question
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我們當時所懷的孩子
20:08
are now both in middle school,
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現在都已經在念中學了
20:11
and the answer has been so slow to come.
483
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而問題的答案已經等了那麼才出現一道曙光
20:16
She's given me her blessing
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她同意我
20:18
to share this story with you.
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向在座各位分享接下來的故事
20:21
After undergoing biopsies
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在進一步進行組織切片檢測後
20:23
that further increased her risk for cancer
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顯示她罹患癌症的風險更高了
20:26
and losing her sister to cancer,
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也因為她的姊姊死於癌症
20:28
she made the difficult decision
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她做了一個非常困難的決定
20:30
to have a prophylactic mastectomy.
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進行了預防性乳房切除術
20:34
We can and must do better,
491
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我們有能力、也必須要做得更好
20:37
not just in time for her granddaughters
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不僅是為了能夠幫助她的孫女那一代
20:40
and my daughters,
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或是幫助我女兒這一代
20:42
but in time for you.
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而是及時的能夠在我們這一代
20:44
Thank you.
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謝謝各位
20:46
(Applause)
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.
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