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.
依照乳房X光攝影有效的檢測程度 我們可以將女性區分為兩大群組 其中一群人可透過乳房X光攝影有效的診斷 因此拯救了許多的生命 然而另一群女性卻無法被乳房X光攝影有效的診斷 妳知道妳屬於哪一群組嗎? 別擔心,妳並不是少數不知道的 因為乳房可說是 一個敏感議題的器官 許多真相 已因修飾而遺失 有 來自媒體、政客 放射科醫師 以及醫用影像公司的花言巧語中 而現在我將要盡我所能的 告訴大家我所知道的真相 但首先讓我澄清一下 我未曾罹患乳癌 我也不是個放射科醫師 我沒有任何的專利 而我也未曾從任何的醫用影像公司獲得任何利益 我更不是說服各位哪天要投我一票
(Laughter)
(眾笑)
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.
我僅僅只是 一名 熱衷於此一領域的內科醫師 大約在十年前 有一名病患問了我一個問題 她是在發現了一個乳房腫塊之後 來找我的 她的姊姊在四十多歲時被診斷 罹患乳癌 當時她與我都在懷孕末期了 我深深的為她感到心疼 並試想著她當時該有多害怕 很幸運地,她的乳房腫塊是良性的 但她問我 我有幾成的把握 可以及早的透過她的乳房X光片診斷出是否罹患腫瘤 如果她真的不幸罹患的話? 於是我便判讀了她的乳房X光片 並且檢視了文獻以及相關紀錄 我很震驚的發現 在她的例子 要透過乳房X光攝影及早發現腫瘤的機率 甚至不到二分之一
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.
各位大概還記得一年前 的一場風暴 也就是美國預防醫學工作小組 在檢視了乳房X光攝影術的相關期刊後 發布了一項準則 建議女性在四十歲以後 應避免進行乳房X光攝影術 很快的引發許多人批評此一工作小組 而其中許多人甚至根本不熟悉 乳房X光攝影術 參議院花了僅僅十七天 便決定在考量保險理賠範圍上 禁止使用該項準則 而放射治療師也因為這項準則 而義憤填膺 一名傑出的乳房X光攝影師 在華盛頓郵報上 發表了這樣的評論 於是放射科醫師更被視為是 為了保護自己的既得利益而飽受批評 但在我看來 放射線治療師可說是英雄 能判讀乳房X光攝影術的放射線治療師 可說是少之又少 這是因為乳房X光片 是所有放射線科中最複雜也最難判讀的 也因為放射科醫師 最常因為 未察覺乳癌 而被控告 但事實的真相其實是顯而易見的
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.
這麼多的訴訟 那一定是有些狀況的 而會造成判讀上的錯誤或疏失 主要是因為乳房密度 乳房密度指的是乳房中的脂肪 在圖中以黃色顯示 以及結締組織和上皮組織的相對含量 在圖上以粉紅色表示 乳房密度 基本上是由基因所決定的 三分之二的女性在四十歲以後 會有乳房密度偏高的現象 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 雖然一般而言乳房密度會隨著年齡而下降 然而三分之一的女性 即使在更年期後數年 其乳房密度仍不會下降
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.
而女性們如何知道自己的乳房密度是否偏高? 你需要好好的檢視 乳房X光攝影術報告中的許多細節 放射科醫師將乳房密度 依照乳房X光片的結果 將乳房區分成四類 若乳房密度低於25% 便稱為脂肪型乳房(fatty replaced) 下一個類別 則是散在纖維腺體型(25-50%) 以及不均質型(50-75%) 緻密型(75%以上) 乳房密度落於後兩個類別的話 便視為高密度型乳房 而乳房密度所潛藏的危機 是它讓危險的腫瘤像是批著羊皮的狼隱藏在乳房中 腫瘤跟高密度乳房組織 在乳房X光片上都呈白色 而X光往往無法順利區分兩者 所以要在充滿脂肪的乳房中 發現腫瘤比較容易 但是試想看看 要在高乳房密度中發現腫瘤該有多難 這也就是為什麼透過乳房X光片 在多脂肪的乳房能診斷出超過 80% 的腫瘤 但是在高乳房密度的女性中正確診斷的機率卻少於 40%
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?
高乳房密度 使得腫瘤診斷變得困難,這已經很糟了 更糟的是,高乳房密度 也是罹患乳癌機率的 有效預測指標 高乳房密度是罹患乳癌的風險因素之一 甚至比母親或姊妹有乳癌病史更危險 在那位病患對我提出問題的年代 乳房密度在放射線學文獻中 仍是一個鮮為人知的主題 當時很少女性會進行乳房X光攝影術 也很少醫師要求病患進行檢測 甚至也不瞭解乳房X光攝影術 而在當時我們還能夠提供為她進行什麼檢測呢?
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.
乳房X光攝影術在1960年代就被發現了 但是它到現在仍沒什麼進步 這項技術的創新出乎意料的少 直到2000年時數位化乳房X光攝影 才被核可 數位乳房X光攝影仍然是透過X光來檢測乳房 但是所診測的影像 可以被數位化儲存並進行調整 (使影像更清晰) 就好像我們所使用的數位相機 為此,美國政府投資了 四十億美元 將乳房X光攝影術的儀器進行更新 而這項投資到底帶給了我們什麼好處? 在一個花了納稅人2500萬美元的研究中顯示 數位乳房X光攝影術 整體而言並沒有比 傳統的乳房X光攝影術來的好 事實上,它對年長女性的檢測能力甚至更糟 但是數位乳房X光攝影 針對五十歲以下的女性檢測能力較傳統的好 而她們通常是停經期前且有著高密度乳房的女性 在這些女性中 數位乳房X光攝影術比起傳統攝影術更加有效 但成功診斷的機率仍只有60% 所以數位乳房X光攝影 對於相關的儀器製造商 可說是大有貢獻 . 但是對女性整體而言 其幫助可說是微乎其微
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.
那麼超音波呢? 比起其他檢測方法 超音波需要更多的生物檢體 因此鮮少被使用 而核磁共振顯影(MRI)可以非常有效的診斷乳癌 但它卻非常的昂貴 想想那些革命性的科技 我們總是可以發現廣泛存在的趨勢 也就是它們總是變得越來越小、越便宜 比較看看iPods跟以前的音響 但是在醫療產業中趨勢卻是剛好相反 需多醫療儀器都越變越大 而且越來越昂貴 使用核磁共振儀來檢測 就好像開著一台悍馬車進雜貨店一樣 實在有太多儀器、設備了 一次核磁共振掃描 所花費的金錢約是數位X光掃描的10倍 遲早我們都必須要接受一個事實 也就是醫療儀器的創新 不能總是發明出更昂貴的設備
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在"紐約客"雜誌上寫了一篇 關於創新的文章 而他認為科學上的重大發展 很少是由一個天才單打獨鬥所創造的 相反的,有創意的點子可以互相共鳴與影響 所以如果我們能夠 將不同領域的人才聚集在一起 讓他們討論某些 他們平常時不太會討論的議題 就好像TED的本質那樣 他引用了一個創新者說的話 "醫生跟物理學家難得會聚在一起的時候 就是物理學家生病的時候" . 這一點道理都沒有 因為醫生其實面對了許多的問題 而他們甚至沒有意識到這些問題其實是可以被解決的 而物理學家可以為許多事物找到解決的辦法 但是他們卻不知道醫生所遇到的問題 現在大家看看 Gladwell 文章中所附的插圖 這幅關於創新思考者的插圖 是不是讓你覺得怪怪的呢?
(Laughter)
.
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.
如果各位不介意的話 我將要向各位分享 一次由我病患所提出的問題 以及醫生與科學家們所得的解答 之間偶然的碰撞 在我的病患拜訪完之後不久 我被引薦給一位 在Mayo的核子物理學家 Michael O'Conner 他是一位心臟顯影方面的專家 其實不是跟我的研究有關的領域 但他碰巧告訴我 一個他剛去以色列所參加的會議 與會人士討論到一種全新的伽馬(gamma)偵測器 利用伽馬射線來進行心臟顯影 已經有數年的歷史了 而它也曾被嘗試用來進行檢測乳房 但問題是 使用伽馬射線探測器 是由體積龐大又笨重的管子組成的 裡面還填充著螢光特性的晶體 所以我們就是沒辦法讓這些偵測器非常靠近乳房 來檢測小型腫瘤 但是其中一項潛在的優勢是 伽瑪射線不像X光 並不會受到乳房密度的影響 但是伽馬射線 無法在腫瘤還很小就偵測到 但是及早發現小腫瘤對於病患的存活率是很重要的 如果我們能在 腫瘤還小於一公分時就發現它 那麼病患的存活率可高達九十以上 但是若等到腫瘤變更大後才發現 存活機率便會大大下降 而Michael告訴我 他曾經見過一種新的伽馬偵測器 也就是這一個 它不是用 龐大的管子所構成 而是用一層薄薄的 用來偵測伽瑪的半導體材料所做的 於是我開始跟他討論 關於乳房密度與乳癌的問題 接著我們認為我們應該可以讓這個偵測器 更靠近乳房 來增加發現小腫瘤的機率
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.
所以把這些小小偵測器 用膠帶黏起來之後 . Michael把乳房X光攝影器 上面的X光版給拔掉了 而且X光版之後大概也真的要被淘汰掉了 我們就把新的偵測器黏上去 然後我們決定把這台機器 叫做MBI 這是我們用MBI檢測的第一位病患所得的影像 大家可以看到,使用舊的伽馬偵測器 所得的結果大部分是雜訊 但使用我們所發展的新的偵測器(MBI) 我們便可以看到腫瘤的存在
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.
結果,一個核子物理學家 一個內科醫師 還有Carrie Hruska這位生醫工程師 以及兩位放射科醫師組合成一個團隊 然後我們試著要 用我們那以膠帶組合起來的新機器 在乳房攝影這個領域中尋求突破 我們 在早期時 所遭遇到的高度質疑與批判 簡直就是難以形容 但是我們非常的有信心我們可以讓它實現 於是我們將整個系統 去蕪存菁、更進一步改進 這是我們目前所發展出來的偵測器 如各位所見,它看起來非常的不同 膠帶不見了 而且我們在胸部上方又增加了另一個偵測器 因此可以進一步提高檢測的靈敏度
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.
而它到底是怎麼運作的呢? 首先病患需要注射放射性追蹤劑 而此一藥劑會被快速增生的腫瘤細胞所吸收 但是正常的細胞卻不會 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 乳房X光攝影依靠的是 "腫瘤與其他組織具有不同的外觀" 來偵測腫瘤 但是我們知道兩者外觀的不同 在高密度乳房的女性中其實是很微小的 但是MBI所利用的 卻是"腫瘤細胞與正常細胞之間性質的不同" 來偵測腫瘤 因此MBI並不會受到乳房密度的影響 在注射放射性追蹤劑後 病患的乳房會被放置在偵測器之間 如果你曾經做過乳房X光攝影 或者你因為年紀的關係而作過乳房X光攝影 你就知道接下來是什麼 也就是難以忍受的疼痛 你大概不知道 乳房X光攝影是唯一放射性影像學中 被聯邦法律所謹慎規範的 而聯邦法律准許 乳房X光攝影用大約四十磅的重量 壓在你的胸部上來進行檢測 但使用MBI 我們僅僅需要輕輕的、無痛的碰觸便可以完成檢測 . 隨後偵測器 便會將影像傳到電腦
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.
這邊是其中一例 大家可以看到在右邊 乳房X光片模糊的顯示出似乎有個腫瘤 而腫瘤的邊緣因為高密度的組織而顯得模糊 但是用MBI所得的影像則清晰的多 甚至還可以發現第二個小腫瘤 也因此徹底的影響了病患選擇手術施行的意願 而在這個例子,雖然乳房X光攝影發現了一個腫瘤 但是MBI卻發現其實是三個 其中一個甚至小到只有三公厘
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.
我們最重大的突破出現在2004年 在我們證實我們的MBI能夠有效的發現小型腫瘤 我們便用這些影像結果 向Susan G. Komen 基金會申請一項計劃費 我們很慶興他們最終同意 讓一群投資者 贊助我們研究 一千名高密度乳房的女性 使用乳房X光攝影以及MBI檢測的差異 在所有我們研究中所發現的腫瘤 乳房X光攝影只能 檢測出25%的腫瘤 MBI則能夠檢測出83%的腫瘤 這裡以其中一項檢測作為例子 數位乳房X光攝影判讀結果為正常 並在圖上顯示許多高密度的組織 但是MBI卻發現有一個區域會吸收高量的放射性追蹤劑 而結果證實是一個兩公分大的腫瘤 在這個例子則是一個一公分的腫瘤 接下來的例子 一位在Mayo的四十五歲的醫務秘書 在她還很年輕時,她的母親由於乳癌而過世 而她主動要求進入我們的研究 而她的乳房X光片中有一個區域分布著高密度的組織 但是她的MBI檢測結果卻顯示 有異常的放射性追蹤劑吸收現象 而我們也可以從這張影像結果上看出來 而它所顯示的 其實是一個高爾夫球大小的腫瘤 但是很幸運的已經及早在腫瘤 轉移到淋巴結前移除
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.
所以現在我們知道這項科技(MBI) 可以提高偵測高密度乳房女性的腫瘤靈敏度達三倍 我們已經解決了一個非常重要的問題 接下來必須要思考如何減低放射性追蹤劑的劑量 而過去三年 我們盡其可能的改善此一系統 來達到這個目標 而現在我很高興能夠告訴大家 MBI所需的劑量 與數位乳房X光攝影所需的劑量是相同的 而用這樣低的劑量,我們繼續研究MBI檢測的效率 這張影像是來自三星期以前 一位67歲的女性 她的乳房X光片結果顯示正常 但是MBI影像結果 卻顯示出一個大型的腫瘤 所以MBI嘉惠的對象不只是年輕的女性 還有年長但仍保有高密度乳房的女性 而我們現在已經例行性的用 其他伽馬檢測技術所需劑量的五分之一來進行檢測
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.
每次MBI檢測會產生四張影像結果 而MRI則會產生超過一千張影像 一名放射科醫生 需要數年的專業化訓練 才能夠成功分辨 正常的乳房組織 與腫瘤 不過我想在座的各位即便不是放射科醫師 也能夠在MBI影像上判讀出腫瘤的存在 這也就是為什麼 MBI是如此的潛力無窮又革命性的科技 它與MRI一樣的準確 但是卻更容易判讀 而且所花費的金錢也較少 也因此各位可以稍微想想看 為什麼醫療用乳房攝影的領域 會偏好維持現狀
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.
在獲得我們這些突破性的結果之後 我們的文章 卻被四個期刊拒絕 在第四個期刊拒絕登載我們的文章後 我們要求再一次審議我們的文章 因為我們強烈的懷疑 其中一位拒絕我們文章的審查者 因為參與了另一項與MBI競爭的科技 因此有著利益衝突的考量 結果我們的文章便被接受了 將在這個月底 在Radiology期刊上發表 . 我們仍然要想辦法進一步減少放射性追蹤劑的劑量 而我們的檢測結果也需要 被其他機構重複驗證 而這將會耗費五年或甚至更久 如果這項科技有朝一日能夠被廣泛的應用 我完全不會從中得到任何商業利益 而這一點對我很重要 因為這樣才能夠讓我持續告訴社會大眾真正的事實 而我認為 . 我想這項科技要真的被廣泛的接受與應用 將需要經濟上 以及醫療政策的支持 如同它需要健全、透徹的科學研究作為背景一樣
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.
現在美國食品藥物管理局已經核准MBI了 但是MBI卻仍無法為大眾所使用 高密度乳房的女性 在能夠進行檢測之前 應該要知道以下幾件事 來保護自己 首先,要知道自己的乳房密度落在哪一範圍 90%並不知道自己的乳房密度 而更有95%的女性不知道 高乳房密度會增加罹患乳癌的風險 康乃狄克州是第一個,也是目前唯一一個州 規定女性在接受乳房X光攝影後 其檢測報告應包含乳房密度 . 上周我與六萬人共同參加了一場 在芝加哥所舉辦的關於乳房攝影的研討會 而我非常訝異於其中一項爭議性的討論 也就是是否應該告訴女性 她們的乳房密度 但我認為這是相當理所當然的 所以如果妳不知道自己乳房密度的話,請詢問妳的醫生 或是詳閱乳房X光攝影的結果報告 第二,若你仍在停經前的話 試著安排乳房X光攝影 並安排在自己生理期的前兩周去檢測 那時胸部密度會相對的較低 第三,若你發現自己的胸部有持續的微小變化 請務必要進行更進一步的檢測、獲得更多影像 第四點,同時也是最重要的一點 關於乳房X光攝影所存在的爭議會一直持續下去 但我相信所有超過四十歲的女性 每年都應該要進行一次乳房X光攝影
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.
的確,乳房X光攝影並不是完美的 但是它卻是唯一證實 能夠減低乳癌致死機率的檢測 死亡率這個議題 其實是一把兩面刃 許多乳房X光攝影的擁護者以它作為藉口 反對其它可能的創新 有些女性在診斷出乳癌之後 會在數年以後死亡 然而值得慶幸的是,大部分的女性都會存活下來 所以任何的檢測技術 都需要十年甚至更久 才能夠證實 它能夠降低乳癌致死率的程度 而乳房X光攝影則是目前唯一一項 有權宣稱其檢測效果的技術 我們承認並同意 乳房X光攝影至今所貢獻的偉大成就 但同時也必須要關注它所存在的限制 我們應該要將乳癌檢測個人化 並依照乳房密度來挑選適當的檢測方式 對於不具有高密度乳房的女性而言 乳房X光檢測是她們最好的選擇 但是最於高密度乳房的女性來說 我們不應該用一樣的方式來檢測 我們必須要提供給她們更好的選擇
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.
在我的病患問我那個問題時 我們當時所懷的孩子 現在都已經在念中學了 而問題的答案已經等了那麼才出現一道曙光 她同意我 向在座各位分享接下來的故事 在進一步進行組織切片檢測後 顯示她罹患癌症的風險更高了 也因為她的姊姊死於癌症 她做了一個非常困難的決定 進行了預防性乳房切除術 我們有能力、也必須要做得更好 不僅是為了能夠幫助她的孫女那一代 或是幫助我女兒這一代 而是及時的能夠在我們這一代
Thank you.
謝謝各位
(Applause)
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