There are two groups of women when it comes to screening mammography -- women in whom mammography works very well and has saved thousands of lives and women in whom it doesn't work well at all. Do you know which group you're in? If you don't, you're not alone. Because the breast has become a very political organ. The truth has become lost in all the rhetoric coming from the press, politicians, radiologists and medical imaging companies. I will do my best this morning to tell you what I think is the truth. But first, my disclosures. I am not a breast cancer survivor. I'm not a radiologist. I don't have any patents, and I've never received any money from a medical imaging company, and I am not seeking your vote.
Postoje dvije grupe žena kad se govori o probirnoj mamografiji -- žene kod kojih mamografija veoma dobro djeluje i spasila je tisuće života i žene kod kojih uopće dobro ne djeluje. Znate li vi u kojoj ste skupini? Ako ne znate, niste same. To je stoga što su grudi postale veoma politički organ. Istina se izgubila među retoričkim dolaskom novinara, političara, radiologa i tvrtki za medicinska snimanja. Dat ću sve od sebe da vam ispričam što smatram istinom. Ali prvo da vam se predstavim. Nisam preživjela rak dojke. Nisam radiolog. Ne posjedujem nikakve izume i nikada nisam primila novac od bilo kakve tvrtke za medicinska snimanja. I ne tražim vaš glas.
(Laughter)
(Smijeh)
What I am is a doctor of internal medicine who became passionately interested in this topic about 10 years ago when a patient asked me a question. She came to see me after discovering a breast lump. Her sister had been diagnosed with breast cancer in her 40s. She and I were both very pregnant at that time, and my heart just ached for her, imagining how afraid she must be. Fortunately, her lump proved to be benign. But she asked me a question: how confident was I that I would find a tumor early on her mammogram if she developed one? So I studied her mammogram, and I reviewed the radiology literature, and I was shocked to discover that, in her case, our chances of finding a tumor early on the mammogram were less than the toss of a coin.
Doktorica sam interne medicine koja se strastveno zainteresirala za ovu temu prije 10 godina kada mi je pacijentica postavila pitanje. Došla je k meni nakon što je otkrila kvržicu na dojci. Njenoj sestri je dijagnosticiran rak dojke u četrdesetima. Ona i ja smo u to vrijeme bile u visokom stupnju trudnoće i bila sam tužna zbog nje, zamišljajući koliko se vjerojatno boji. Srećom, dokazalo se da je njena kvržica benigna. Ali postavila mi je pitanje: koliko sam sigurna da bih pronašla tumor rano na njenom mamogramu, da ga je razvila? Pa sam proučila njezin mamogram i pregledala radiološku literaturu te sam bila šokirana kad sam otkrila da je u njenom slučaju vjerojatnost ranog otkrivanja tumora na mamogramu bila veoma malena.
You may recall a year ago when a firestorm erupted after the United States Preventive Services Task Force reviewed the world's mammography screening literature and issued a guideline recommending against screening mammograms in women in their 40s. Now everybody rushed to criticize the Task Force, even though most of them weren't in anyway familiar with the mammography studies. It took the Senate just 17 days to ban the use of the guidelines in determining insurance coverage. Radiologists were outraged by the guidelines. The pre-eminent mammographer in the United States issued the following quote to the Washington Post. The radiologists were, in turn, criticized for protecting their own financial self-interest. But in my view, the radiologists are heroes. There's a shortage of radiologists qualified to read mammograms, and that's because mammograms are one of the most complex of all radiology studies to interpret, and because radiologists are sued more often over missed breast cancer than any other cause. But that very fact is telling.
Možda ćete se sjetiti stihije koja je prije godinu dana nastala nakon što je Operativna Grupa Preventivnih Usluga SAD-a prikazala svjetsku literaturu mamografskog probira i izdala direktivu protiv probirujućih mamograma žena u četrdesetima. Svi su krenuli kritizirati operativnu grupu iako ih većina uopće nije bila upoznata s mamografskim studijama. Senatu je trebalo samo 17 dana da zabrani upotrebu direktive u određivanju osiguranja. Radiolozi su bili uvrijeđeni direktivama. Eminentni mamografer u Sjedinjenim Američkim Državama poslao je pismo Washington Postu. Radiolozi su bili kritizirani zbog toga što su štitili vlastite financijske interese. Ali s mog stajališta, radiolozi su junaci. Imamo nedostatak radiologa koji su osposobljeni za čitanje mamograma i to je zato što su mamogrami od svih radioloških studija najsloženiji za tumačenje i zato što su radiolozi češće tuženi zbog promaknutog raka dojke nego u bilo kojem drugom slučaju. Ali ta činjenica govori sama za sebe.
Where there is this much legal smoke, there is likely to be some fire. The factor most responsible for that fire is breast density. Breast density refers to the relative amount of fat -- pictured here in yellow -- versus connective and epithelial tissues -- pictured in pink. And that proportion is primarily genetically determined. Two-thirds of women in their 40s have dense breast tissue, which is why mammography doesn't work as well in them. And although breast density generally declines with age, up to a third of women retain dense breast tissue for years after menopause.
Gdje je mnogo pravnog dima, vjerojatno će biti i nešto vatre. Faktor koji je najodgovorniji za tu vatru je gustoća dojke. Gustoća dojke se odnosi na relativnu količinu masti -- ovdje obojano žuto -- naspram vezivnog i epitelnog tkiva -- obojano rozo. I taj razmjer je primarno genetički određen. Dvije trećine žena u četrdesetima imaju gusto tkivo dojke, što je razlog zbog kojeg mamografija za njih ne radi kako treba. I unatoč tome što gustoća dojke pada s godinama, trećina žena zadržava gusto tkivo dojke godinama nakon menopauze.
So how do you know if your breasts are dense? Well, you need to read the details of your mammography report. Radiologists classify breast density into four categories based on the appearance of the tissue on a mammogram. If the breast is less than 25 percent dense, that's called fatty-replaced. The next category is scattered fibroglandular densities, followed by heterogeneously dense and extremely dense. And breasts that fall into these two categories are considered dense. The problem with breast density is that it's truly the wolf in sheep's clothing. Both tumors and dense breast tissue appear white on a mammogram, and the X-ray often can't distinguish between the two. So it's easy to see this tumor in the upper part of this fatty breast. But imagine how difficult it would be to find that tumor in this dense breast. That's why mammograms find over 80 percent of tumors in fatty breasts, but as few as 40 percent in extremely dense breasts.
Dakle, kako znate da su vam dojke guste? Pa, trebate pročitati detalje vaše mamografije. Radiolozi grupiraju gustoću dojke u četiri kategorije bazirane na pojavi tkiva na mamogramu. Ako u dojci ima manje od 25% gustoće, to se zove masna zamijena. Sljedeća kategorija je raspršena vlaknastožljezdana gustoća, koju slijedi heterogena gustoća i ekstremna gustoća. Dojke koje spadaju u ove dvije kategorije smatraju se gustima. Problem s gustoćom dojke je to što je to doista vuk u janjećoj koži. I tumori i gusto tkivo dojke se javljaju kao bijela pojava na mamogramu i rendgenske zrake često ne mogu razlikovati to dvoje. Dakle, jednostavno je vidjeti ovaj tumor u gornjem dijelu ove masne dojke. Ali zamislite kako bi bilo teško pronaći taj tumor u ovoj gustoj dojci. Zato mamogrami pronalaze više od 80% tumora u masnim dojkama, ali manje od 40% u ekstremno gustim dojkama.
Now it's bad enough that breast density makes it hard to find a cancer, but it turns out that it's also a powerful predictor of your risk for breast cancer. It's a stronger risk factor than having a mother or a sister with breast cancer. At the time my patient posed this question to me, breast density was an obscure topic in the radiology literature, and very few women having mammograms, or the physicians ordering them, knew about this. But what else could I offer her?
Dovoljno je loše što gustoća dojke otežava pronalazak karcinoma, ali čini se da je to također veoma moćan pokazatelj vašeg rizika za karcinom dojke. To je jači faktor rizika od toga da imate majku ili sestru s karcinomom dojke. U vrijeme kad mi je pacijentica postavila ovo pitanje, gustoća dojke je bila nepoznata tema u radiološkoj literaturi i jako je malo žena koje su obavljale mamografiju ili doktora koji su ih tražili znalo za to. Ali što sam joj drugo mogla ponuditi?
Mammograms have been around since the 1960's, and it's changed very little. There have been surprisingly few innovations, until digital mammography was approved in 2000. Digital mammography is still an X-ray of the breast, but the images can be stored and manipulated digitally, just like we can with a digital camera. The U.S. has invested four billion dollars converting to digital mammography equipment, and what have we gained from that investment? In a study funded by over 25 million taxpayer dollars, digital mammography was found to be no better over all than traditional mammography, and in fact, it was worse in older women. But it was better in one group, and that was women under 50 who were pre-menopausal and had dense breasts, and in those women, digital mammography found twice as many cancers, but it still only found 60 percent. So digital mammography has been a giant leap forward for manufacturers of digital mammography equipment, but it's been a very small step forward for womankind.
Mamografija postoji negdje od 1960. godine. I veoma malo se promijenila. Imamo iznenađujuće malo inovacija sve dok 2000. nije odobrena digitalna mamografija. Digitalna mamografija je još uvijek rendgenska snimka dojke, ali se slike mogu pohraniti i obraditi digitalno, kao što mi možemo digitalnom kamerom. SAD je uložio 4 milijarde dolara prilikom prelaska na digitalnu mamografsku opremu. I što smo dobili tim ulaganjem? U studiji koju je financiralo 25 milijuna dolara poreznih obveznika, ustanovljeno je da digitalna mamografija nije ništa bolja od klasične mamografije. I zapravo, bila je gora kod starijih žena. Ali je bila bolja u jednoj skupini, a to su žene ispod 50 godina koje su bile pred menopauzom i imale guste dojke. I kod tih žena digitalna je mamografija pronašla duplo manje karcinoma, ali je još uvijek pronalazila 60%. Dakle, digitalna je mamografija bila ogroman skok naprijed za proizvođače opreme za digitalnu mamografiju, ali je bio veoma mali korak naprijed za ženski rod.
What about ultrasound? Ultrasound generates more biopsies that are unnecessary relative to other technologies, so it's not widely used. And MRI is exquisitely sensitive for finding tumors, but it's also very expensive. If we think about disruptive technology, we see an almost ubiquitous pattern of the technology getting smaller and less expensive. Think about iPods compared to stereos. But it's the exact opposite in health care. The machines get ever bigger and ever more expensive. Screening the average young woman with an MRI is kind of like driving to the grocery store in a Hummer. It's just way too much equipment. One MRI scan costs 10 times what a digital mammogram costs. And sooner or later, we're going to have to accept the fact that health care innovation can't always come at a much higher price.
Što je s ultrazvukom? Ultrazvuk zahtijeva više biopsija koje su nepotrebne u odnosu na druge tehnologije, pa nije mnogo korištena. A magnetna rezonanca je veoma osjetljiva za pronalazak tumora, ali je također veoma skupa. Ako razmišljamo o tehnologiji koja remeti, vidimo gotovo sveprisutni obrazac tehnologije koja postaje sve manja i jeftinija. Razmislite o iPodovima u usporedbi sa stereo uređajima. Ali potpuno je suprotno u zdravstvu. Uređaji postaju sve veći i sve skuplji. Snimanje prosječne mlade žene magnetnom rezonancom je poput ulaska u trgovinu mješovitom robom u Hummeru. To je jedostavno previše opreme. Jedna magnetna rezonanca košta deset puta više no što košta digitalna mamografija. I prije ili kasnije morat ćemo prihvatiti činjenicu da inovacije u zdravstvu ne mogu uvijek biti skuplje.
Malcolm Gladwell wrote an article in the New Yorker on innovation, and he made the case that scientific discoveries are rarely the product of one individual's genius. Rather, big ideas can be orchestrated, if you can simply gather people with different perspectives in a room and get them to talk about things that they don't ordinarily talk about. It's like the essence of TED. He quotes one innovator who says, "The only time a physician and a physicist get together is when the physicist gets sick." (Laughter) This makes no sense, because physicians have all kinds of problems that they don't realize have solutions. And physicists have all kinds of solutions for things that they don't realize are problems. Now, take a look at this cartoon that accompanied Gladwell's article, and tell me if you see something disturbing about this depiction of innovative thinkers.
Malcolm Gladwell napisao je članak u New Yorkeru o inovacijama i objasnio je da su znanstvena otkrića rijetko proizvod jednog jedinog genija. Točnije, velike ideje mogu biti izvedene ako jednostavno skupite ljude s različitim perspektivama u prostoriju i date im da razgovaraju o stvarima o kojima inače ne razgovaraju. To je kao srž TED-a. Gladwell citira jednog inovatora koji kaže, „Jedini put kada se liječnik i fizičar nađu je kada se fizičar razboli.“ (Smijeh) To nema smisla zato što liječnici imaju raznovrsne probleme za koje nemaju rješenje. A fizičari imaju razna rješenja za stvari za koje ne shvaćaju da su problemi. A sada, pogledajmo ovu karikaturu vezanu za Gladwellov članak i recite mi vidite li nešto uznemirujuće u ovom prikazu inovativnih mislioca.
(Laughter)
(Smijeh)
So if you will allow me a little creative license, I will tell you the story of the serendipitous collision of my patient's problem with a physicist's solution. Shortly after her visit, I was introduced to a nuclear physicist at Mayo named Michael O'Conner, who was a specialist in cardiac imaging, something I had nothing to do with. And he happened to tell me about a conference he'd just returned from in Israel, where they were talking about a new type of gamma detector. Now gamma imaging has been around for a long time to image the heart, and it had even been tried to image the breast. But the problem was that the gamma detectors were these huge, bulky tubes, and they were filled with these scintillating crystals, and you just couldn't get them close enough around the breast to find small tumors. But the potential advantage was that gamma rays, unlike X-rays, are not influenced by breast density. But this technology could not find tumors when they're small, and finding a small tumor is critical for survival. If you can find a tumor when it's less than a centimeter, survival exceeds 90 percent, but drops off rapidly as tumor size increases. But Michael told me about a new type of gamma detector that he'd seen, and this is it. It's made not of a bulky tube, but of a thin layer of a semiconductor material that serves as the gamma detector. And I started talking to him about this problem with breast density, and we realized that we might be able to get this detector close enough around the breast to actually find small tumors.
Dakle, dozvolite mi sada malo kreativne slobode, ispričat ću vam priču o slučajnom otkrivanju zavjere problema mojih pacijenata s rješenjem fizičara. Ubrzo nakon njenog posjeta, upoznata sam s nuklearnim fizičarom u Mayo klinici pod imenom Michael O'Conner, koji je specijalist u snimanju srca, nečemu s čim uopće nemam veze. I on mi je pričao o skupu s kojeg se baš vratio iz Izraela gdje su pričali o novom obliku gama detektora. Gama snimanje je u uporabi već duže vrijeme što se tiče snimanja srca i čak se njime pokušavalo snimiti dojku. Ali problem je bio u tome što su gama detektori velike, teške cijevi i punjene su svjetlucavim kristalima i jednostavno ih nismo mogli dovoljno približiti dojkama da bismo pronašli male tumore. Potencijalna prednost je bila ta da na gama zrake, za razliku od rendgenskih zraka ne utječe gustoća dojke. Ali ta tehnologija nije mogla pronaći tumore kada su bili mali. A pronalazak malog tumora je kritičan za preživljavanje. Ako možete pronaći tumor dok je manji od centimetra, preživljavanje iznosi 90%, ali brzo pada kako se veličina tumora povećava. Ali Michael mi je pričao o novom tipu gama detektora koji je vidio i to je upravo ovo. Napravljeno je, ne od teške cijevi, već od tankog sloja poluprovodnog materijala koji služi kao gama detektor. Počela sam s njim razgovarati o problemu gustoće dojke i shvatili smo da bismo mogli biti u mogućnosti dovesti ovaj detektor dovoljno blizu dojke da bi zapravo našli male tumore.
So after putting together a grid of these cubes with tape -- (Laughter) -- Michael hacked off the X-ray plate of a mammography machine that was about to be thrown out, and we attached the new detector, and we decided to call this machine Molecular Breast Imaging, or MBI. This is an image from our first patient. And you can see, using the old gamma technology, that it just looked like noise. But using our new detector, we could begin to see the outline of a tumor.
Dakle, nakon što smo skupili ovu mrežu kocki s trakom -- (Smijeh) -- Michael je isjekao rendgensku ploču iz mamografskog aparata koji je trebao biti bačen. I pričvrstili smo novi detektor i odlučili nazvati ovaj aparat Molekularno Snimanje Dojke ili MSD. Ovo je slika naše prve pacijentice. I možete vidjeti, koristeći staru gama tehnologiju, da je to izgledalo kao šum. Ali koristeći naš novi detektor, mogli smo vidjeti obris tumora.
So here we were, a nuclear physicist, an internist, soon joined by Carrie Hruska, a biomedical engineer, and two radiologists, and we were trying to take on the entrenched world of mammography with a machine that was held together by duct tape. To say that we faced high doses of skepticism in those early years is just a huge understatement, but we were so convinced that we might be able to make this work that we chipped away with incremental modifications to this system. This is our current detector. And you can see that it looks a lot different. The duct tape is gone, and we added a second detector on top of the breast, which has further improved our tumor detection.
Dakle, evo nas, nuklearni fizičar i internist kojem će se uskoro pridružiti Carrie Hruska, biomedicinski inženjer i dva radiologa i pokušavamo promijeniti ukorijenjeni svijet mamografije s aparatom kojeg drži ljepljiva traka. Reći da smo se susreli s velikom dozom sumnjičavosti u tim ranim godinama je eufemizam. Ali također smo bili uvjereni da bismo mogli ovo osposobiti kada bismo uklonili neke dijelove dodane ovom sistemu. Ovo je naš trenutni detektor. Možete vidjeti da izgleda dosta drugačije. Nema više ljepljive trake i dodali smo drugi detektor na vrh dojke koji je dodatno unaprijedio detekciju tumora.
So how does this work? The patient receives an injection of a radio tracer that's taken up by rapidly proliferating tumor cells, but not by normal cells, and this is the key difference from mammography. Mammography relies on differences in the appearance of the tumor from the background tissue, and we've seen that those differences can be obscured in a dense breast. But MBI exploits the different molecular behavior of tumors, and therefore, it's impervious to breast density. After the injection, the patient's breast is placed between the detectors. And if you've ever had a mammogram -- if you're old enough to have had a mammogram -- you know what comes next: pain. You may be surprised to know that mammography is the only radiologic study that's regulated by federal law, and the law requires that the equivalent of a 40-pound car battery come down on your breast during this study. But with MBI, we use just light, pain-free compression. (Applause) And the detector then transmits the image to the computer.
Dakle, kako ovo radi? Pacijentu se ubrizga radio tragač kojeg primaju brzorastuće tumorske stanice, ali ne i normalne stanice. I ovo je ključna razlika od mamografije. Mamografija se oslanja na razlici u izgledu tumora od pozadinskog tkiva, a vidjeli smo da te razlike mogu biti nejasne u gustoj dojci. Ali MSD koristi drugačije molekularno ponašanje tumora i zato je neprohodno za gustoću dojke. Nakon ubrizgavanja dojke pacijentice se smještaju između detektora. I ako ste ikada išli na mamografiju -- ako ste dovoljno stari da bi išli na mamografiju -- znate što je sljedeće: bol. Iznenadit ćete se kad čujete da je mamografija jedina radiološka studija koja je regulirana saveznim zakonom i zakon zahtijeva ekvivalent od 18 kilograma automobilske baterije da vam se spusti na dojke tijekom ove studije. Ali s MSD-om, koristimo samo laganu, bezbolnu kompresiju. (Pljesak) I nakon toga detektor šalje sliku na računalo.
So here's an example. You can see, on the right, a mammogram showing a faint tumor, the edges of which are blurred by the dense tissue. But the MBI image shows that tumor much more clearly, as well as a second tumor, which profoundly influence that patient's surgical options. In this example, although the mammogram found one tumor, we were able to demonstrate three discrete tumors -- one is small as three millimeters.
Ovdje je primjer. Desno možete vidjeti mamografiju koja pokazuje nejasan tumor, čiji su rubovi nejasni zbog gustog tkiva. Ali MSD slika nam jasnije pokazuje tumor, baš kao i drugi tumor koji veoma utječe na kirurške opcije te pacijentice. U ovom primjeru, iako je mamograf pronašao jedan tumor, možemo demonstrirati tri diskretna tumora -- jedan je velik svega tri milimetra.
Our big break came in 2004. After we had demonstrated that we could find small tumors, we used these images to submit a grant to the Susan G. Komen Foundation. And we were elated when they took a chance on a team of completely unknown investigators and funded us to study 1,000 women with dense breasts, comparing a screening mammogram to an MBI. Of the tumors that we found, mammography found only 25 percent of those tumors. MBI found 83 percent. Here's an example from that screening study. The digital mammogram was read as normal and shows lots of dense tissue, but the MBI shows an area of intense uptake, which correlated with a two-centimeter tumor. In this case, a one-centimeter tumor. And in this case, a 45-year-old medical secretary at Mayo, who had lost her mother to breast cancer when she was very young, wanted to enroll in our study. And her mammogram showed an area of very dense tissue, but her MBI showed an area of worrisome uptake, which we can also see on a color image. And this corresponded to a tumor the size of a golf ball. But fortunately it was removed before it had spread to her lymph nodes.
Naš se veliki uspjeh dogodio 2004. Nakon što smo demonstrirali da možemo pronaći male tumore, upotrijebili smo ove slike da podnesemo subvenciju za Zakladu Susan G. Komen. Bili smo ushićeni kada su riskirali i uzeli ekipu potpuno nepoznatih istraživača i osnovali nas da proučimo 1.000 žena s gustim dojkama, uspoređujući probir mamografa i MSD-a. Od tumora koje smo pronašli, mamografija je pronašla samo 25% tih tumora. MSD je pronašao 83%. Evo primjera te probirne studije. Digitalna mamografija je pročitana kao normalna i pokazuje nam mnogo gustog tkiva, ali MSD pokazuje područje intenzivnog obuhvaćanja, što korelira s tumorom od dva centimetra. U ovom slučaju, tumor od jednog centimetra. A u ovom slučaju, 45-ogodišnja medicinska tajnica u Mayo klinici koja je izgubila majku zbog karcinoma dojke kada je bila veoma mlada, željela je sudjelovati u našoj studiji. Njena mamografija je pokazala područje veoma gustog tkiva, ali njen MSD je pokazao područje zabrinjavajućeg obuhvaćanja koji također vidimo i na slici u boji. A to korelira s tumorom veličine loptice za golf. Ali srećom, odstranjen je prije no što se proširio na njene limfne čvorove.
So now that we knew that this technology could find three times more tumors in a dense breast, we had to solve one very important problem. We had to figure out how to lower the radiation dose, and we have spent the last three years making modifications to every aspect of the imaging system to allow this. And I'm very happy to report that we're now using a dose of radiation that is equivalent to the effective dose from one digital mammogram. And at this low dose, we're continuing this screening study, and this image from three weeks ago in a 67-year-old woman shows a normal digital mammogram, but an MBI image showing an uptake that proved to be a large cancer. So this is not just young women that it's benefiting. It's also older women with dense tissue. And we're now routinely using one-fifth the radiation dose that's used in any other type of gamma technology.
Dakle, sada kada smo znali da ova tehnologija može pronaći tri puta više tumora u gustoj dojci, morali smo riješiti jedan veoma važan problem. Morali smo smisliti kako smanjiti dozu zračenja. I proveli smo posljednje tri godine praveći modifikacije svakog aspekta u sustavu snimanja da bi ovo dozvolili. I veoma sam sretna što vam mogu priopćiti da sada koristimo dozu zračenja koja je jednaka efektivnoj dozi jedne digitalne mamografije. I u ovoj niskoj dozi, nastavljamo probirnu studiju, a ovo je slika od prije tri tjedna koja pokazuje normalnu digitalnu mamografiju kod 67-ogodišnje žene, ali MSD slika pokazuje mjesto za koje se dokazalo da je veliki karcinom. Dakle, ovo ne koristi samo mladim ženama. Već također i starijim ženama s gustim tkivom. Sada rutinski koristimo petinu doze zračenja koja se koristi u bilo kojoj drugoj vrsti gama tehnologije.
MBI generates four images per breast. MRI generates over a thousand. It takes a radiologist years of specialty training to become expert in differentiating the normal anatomic detail from the worrisome finding. But I suspect even the non-radiologists in the room can find the tumor on the MBI image. But this is why MBI is so potentially disruptive -- it's as accurate as MRI, it's far less complex to interpret, and it's a fraction of the cost. But you can understand why there may be forces in the breast-imaging world who prefer the status quo.
MSD daje četiri slike po dojci. Magnetna rezonanca ih daje više od tisuću. Radiologu trebaju godine posebne obuke da bi postao stručnjak u diferencijaciji normalnog anatomskog detalja od zabrinjavajućeg. Ali slutim da čak i ne-radiolozi u sobi mogu naći tumor na MSD slici. Ali ovo je razlog zašto je MSD tako potencijalno poremećen. Precizan je poput magnetne rezonance, mnogo je jednostavniji za interpretaciju i manje košta. Ali možete razumijeti zašto mogu postojati snage u svijetu snimanja dojke koje preferiraju status quo.
After achieving what we felt were remarkable results, our manuscript was rejected by four journals. After the fourth rejection, we requested reconsideration of the manuscript, because we strongly suspected that one of the reviewers who had rejected it had a financial conflict of interest in a competing technology. Our manuscript was then accepted and will be published later this month in the journal Radiology. (Applause) We still need to complete the screening study using the low dose, and then our findings will need to be replicated at other institutions, and this could take five or more years. If this technology is widely adopted, I will not benefit financially in any way, and that is very important to me, because it allows me to continue to tell you the truth. But I recognize -- (Applause) I recognize that the adoption of this technology will depend as much on economic and political forces as it will on the soundness of the science.
Nakon što smo postigli sjajne rezultate, četiri časopisa odbila su naš rukopis. Nakon četvrte odbijenice, zatražili smo ponovno razmatranje rukopisa jer smo sumnjali da je jedan od recenzenata koji nas je odbio imao financijski sukob interesa s konkurirajućom tehnologijom. Naš rukopis je tada prihvaćen i bit će objavljen kasnije ovog mjeseca u časopisu Radiologija. (Pljesak) Još trebamo dovršiti probirnu studiju upotrebljavajući nisku dozu i onda će naši nalazi biti ponovljeni u drugim ustanovama. I to bi moglo potrajati pet godina ili više. Ako ova tehnologija bude širom prihvaćena, neću imati nikakve financijske koristi od nje na ikoji način. A to mi je veoma važno zato što mi dopušta da vam nastavim govoriti istinu. Ali prepoznajem -- (Pljesak) Prepoznajem da će usvajanje ove tehnologije ovisiti o ekonomskim i političkim snagama kao i o čvrstoći znanosti.
The MBI unit has now been FDA approved, but it's not yet widely available. So until something is available for women with dense breasts, there are things that you should know to protect yourself. First, know your density. Ninety percent of women don't, and 95 percent of women don't know that it increases your breast cancer risk. The State of Connecticut became the first and only state to mandate that women receive notification of their breast density after a mammogram. I was at a conference of 60,000 people in breast-imaging last week in Chicago, and I was stunned that there was a heated debate as to whether we should be telling women what their breast density is. Of course we should. And if you don't know, please ask your doctor or read the details of your mammography report. Second, if you're pre-menopausal, try to schedule your mammogram in the first two weeks of your menstrual cycle, when breast density is relatively lower. Third, if you notice a persistent change in your breast, insist on additional imaging. And fourth and most important, the mammography debate will rage on, but I do believe that all women 40 and older should have an annual mammogram.
MSD zajednica je sada odobrena od strane FDA, ali još nije naširoko dostupna. Dakle dok nešto ne bude dostupno za žene s gustim dojkama, postoje stvari koje trebate znati da bi se zaštitili. Prvo, znajte svoju gustoću. 90% žena ne zna, a 95% žena ne zna da povećava rizik od karcinoma dojke. Država Connecticut je postala prva i jedina država koja zahtijeva da žene dobiju obavijest o gustoći dojke nakon mamografije. Bila sam na konferenciji sa 60.000 ljudi u vezi snimanja dojki, prošlog tjedna u Chicagu. I bila sam zapanjena da je tamo bila užarena rasprava o tome da li ženama treba govoriti kakva im je gustoća dojki. Naravno da treba. A ako ne znate, molim vas, pitajte svog doktora da vam pročita detalje vaše mamografije. Drugo, ako ste pred menopauzom, pokušajte zakazati svoju mamografiju u prva dva tjedna menstrualnog ciklusa kada je gustoća dojke relativno niža. Treće, ako primijetite ustrajnu promjenu na vašim grudima, inzistirajte na dodatnom snimanju. I četvrto i najvažnije, debata oko mamografije će i dalje bjesniti, ali vjerujem da sve žene s 40 i više trebaju imati godišnju mamografiju.
Mammography isn't perfect, but it's the only test that's been proven to reduce mortality from breast cancer. But this mortality banner is the very sword which mammography's most ardent advocates use to deter innovation. Some women who develop breast cancer die from it many years later, and most women, thankfully, survive. So it takes 10 or more years for any screening method to demonstrate a reduction in mortality from breast cancer. Mammography's the only one that's been around long enough to have a chance of making that claim. It is time for us to accept both the extraordinary successes of mammography and the limitations. We need to individualize screening based on density. For women without dense breasts, mammography is the best choice. But for women with dense breasts; we shouldn't abandon screening altogether, we need to offer them something better.
Mamografija nije savršena, ali je to jedini test kojim je dokazano smanjenje smrtnosti od raka dojke. Ali ova smrtna zastava je sami mač koju mamografski najžešći odvjetnici koriste da zadrže inovacije. Neke žene koje razviju rak dojke umru mnogo godina kasnije. A većina žena, hvala Bogu, preživi. Potrebno je 10 ili više godina za bilo koju probirnu metodu da bi dokazala smanjenje smrtnosti od raka dojke. Mamografija je jedina koja je tu negdje dovoljno dugo da bi imala priliku napraviti takav zahtjev. Vrijeme nam je da prihvatimo i izvanredne uspjehe mamografije i ograničenja. Trebamo individualizirati probir ovisno o gustoći. Za žene bez gustih dojki, mamografija je najbolji odabir. Ali za žene s gustim dojkama ne bismo svi skupa trebali napustiti probir, trebamo ponuditi nešto bolje.
The babies that we were carrying when my patient first asked me this question are now both in middle school, and the answer has been so slow to come. She's given me her blessing to share this story with you. After undergoing biopsies that further increased her risk for cancer and losing her sister to cancer, she made the difficult decision to have a prophylactic mastectomy. We can and must do better, not just in time for her granddaughters and my daughters, but in time for you.
Djeca koju smo nosile kada me pacijentica upitala pitanje su sada u srednjoj školi, a odgovor presporo dolazi. Dala mi je svoj blagoslov da podijelim ovu priču s vama. Nakon biopsija koje su u tijeku i kasnije povećale njen rizik od raka i toga što je izgubila sestru od raka, donijela je tešku odluku da napravi profilaktičnu mastektomiju. Možemo i moramo bolje, ne samo na vrijeme za njene unuke i moje kćeri, već na vrijeme za vas.
Thank you.
Hvala vam.
(Applause)
(Pljesak)