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癌症:奋战40年,谁是最后赢家 – 译学馆
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癌症:奋战40年,谁是最后赢家

War on cancer, year 40: who’s winning?

I am a medical oncologist of both an epide… an epidemiologist
我既是肿瘤医师 也是流行病学家
and I get to sit back and look at what’s going on in cancer.
我有机会坐下来研究癌症现在是什么情况了
Now 40 years ago, this past December,
在40年前的12月份
Richard Nixon signed the National Cancer Act.
理查德·尼克松签署了《国家癌症法案》
Many people considered that the nation declaring the war on cancer.
许多人把那看作是国家对癌症的宣战
It was about 7 years after,
大概七年之后
Luthry Terry, the then Surgeon General,
卢瑟瑞·泰瑞 是当时的卫生局局长
had said the cigarettes caused lung cancer.
都认为吸烟导致肺癌
It’s after a long experience with cancer. As you can see
这是在很久的癌症研究经验后得出的结论 如你所见
here, I don’t have too many number of slides,
我没有太多的幻灯片
but I am an epidemiologist, so give me a break.
但是我只是一位流行病学家 饶了我吧
Going from 1900 through 1971
从1900年到1971年
1970,1971, when the National Cancer Act was signed,
1970年 1971年 《国家癌症法案》被签署时
you can see there was a dramatic rise in the mortality rate from cancer.
你能看到癌症的死亡率出现戏剧性的升高
Now 40 years later, it is very appropriate that we ask
现在40年以后 我们应该问一问
what has now happened.
到现在为止发生了什么
What did we get out of this 40 years’ war?
在这40年的战役中我们得到了什么
Well, the first thing that I’ll show you is
嗯 首先我想向你展示的是
the climb in mortality that we’ve seen since 1990.
我们看到的从1990年开始 死亡率的上升
The Act was signed in 1971. Some people thought we’d cure cancer
法案签署于1971年 有人认为我们将会治愈癌症
by the Bicentennial in 1976. That was a little forward thinking.
在1976年二百周年纪念前 那是有一些超前的想法
And then, but finally in 1991
然后 最终在1991年
cancer rate started going down, indeed today
癌症发病率开始下降 确实现在
the risk of death for an American is 20% lower than it was in 1991.
对于一个美国人来说 死亡的概率比1991年时低了20%
Indeed, for breast cancer, the risk of death is 30% lower,
的确 乳腺癌的死亡率低了30%
for colon cancer 35% lower.
结肠癌低了35%
So we have made some progress.
所以我们取得了一些进展
We’ve also learned a few things.
我们也学到了一些事
Here you can see, men have a higher death rate than women, but the
如你所见 男性死亡率高于女性
death rate for men is going down faster than for women.
但男性死亡率的下降速度比女性快
There is a male-female disparity that favors females.
男女的不一致性偏益于女性
Here you can see that there are some racial disparities.
你能看到一些种族差异
Black’s having a higher mortality rate than white,
黑人比白人死亡率高
and white’s having a higher mortality rate than
白人的死亡率高于
other racial and ethnic groups in the United States.
美国的其他种族
We’ve actually learned something new as well.
我们也学到了一些新东西
We’ve learned that race is not a biological categorization.
我们知道了人种不是生物学分类法
We’ve learned that race and ethnicity actually
我们知道了人种和种族划分
apply much more through customs and habits that cause cancer
更适用于区分那些导致癌症的习俗
than they do to racial genetics.
而不是区分种族的基因
From some of these studies we’ve actually figured out what
从一些这样的研究中 我们确切的发现了
some of the causes of cancer are, and here are the major causes of cancer.
一些导致癌症的原因 这里是癌症的主要致病原因
Today, a third of all cancers is caused by smoking
当下 三分之一的癌症由吸烟导致
and nearly a third of all cancers is caused by this combination of obesity,
接近三分之一的癌症由肥胖
poor nutrition, and physical inactivity that you heard about so much yesterday.
营养不良和缺乏运动共同导致 你应该已听说过很多次了
Literally over half of all cancers are caused by those two factors.
不夸张的说 超过一半的癌症由这两个因素导致
Here you can see the decline in smoking
在此你可以看到吸烟的下降
from 1964,1965 when the Surgeon General made
从1964年 1965年 那时的全体外科医生记录的
the report on lung cancer to today,
肺癌的报告 直到今天
about 20%~25% of Americans still smoke.
大约有20%到25%的美国人仍然吸烟
We can still do something and do something very positive.
我们依旧可以做些什么 做些积极的事
Here you can see the problem with obesity in 1970
你能看到在1970年的肥胖问题
15% of adults were obese, 2008, 35%.
15%的成年人是胖子 在2008年是35%
In 1970 this is even more important.
在1970年 这甚至更重要
4% of kids were obese, 20% of kids are obese today
4%的儿童肥胖 现在是20%的儿童肥胖
It takes 20 to 40 years of obesity to cause cancer.
肥胖持续20到40年就会引发癌症
As we’ve had this incredible increase in the rate of obesity,
而我们的肥胖率已经有这样惊人的增长
it’s pushing up on that mortality curve that I’ve shown you is going down.
它推动我刚才展示的下降的死亡率曲线向上增长
I am worried that over the next 10 to 15 years
我担心在未来的10到15年
obesity, lack of physical activity and poor diet would be a
肥胖 缺乏运动和营养不良会
greater cause of cancer than tobacco in the United States.
在美国成为超越吸烟的更大的癌症致病因素
I’m worried that instead of the decline in mortality
我担心再过二十年死亡率不会低于我们现在
that we’ve had now for more than 20 years
我担心再过二十年死亡率不会低于我们现在
we’re gonna have a mortality rate that’s starting to go up.
我们的死亡率将开始上升
Mortality rate, keep in mind, I told you has gone down,
死亡率 请记住 我提过了已经在下降
partially because of prevention,
部分原因是由于预防
also this thing called early detection.
这也叫作早期检测
People being aware, women saying
人们变得警觉 女性发觉
what’s this in my breast and going to the doctor
有什么在我的乳房里 并去看医生
people realizing there’s a change in the color of their stools.
人们意识到他们粪便的颜色变了
and going to the doctor being assessed for colorectal cancer.
就去看医生 做直肠结肠癌的检查评估
But screening, doing certain test in people who are totally asymptomatic
但是筛查 以及一些检测 使无症状的人
has also been beneficial.
也受益了
Treatment has also been improving over time.
随着时间过去 治疗手段一直在改善
Now let’s talk a little bit about the screening thing cause it’s a problem there.
现在我们一起来讨论一点关于筛查的问题吧 这里有个问题
Well American tend to think screening is a lot more
美国人倾向于把筛查想的更有效
effective than it actually is.
比它本身更有效
I’ve got in trouble in the past for saying that.
我曾经因为这么说而陷入麻烦
But I’m gonna say it again.
但我还是要再说一次
You see in breast cancer,
你看到的乳腺癌
the decline in breast cancer mortality,
乳腺癌死亡率下降
that 30% decline I told you about,
我告诉你的30%的下降
less than half of the decline
不到一半的下降
is due to mammographic screening.
是由于乳房摄影扫描
The majority of decline is due to women saying’ hey, what’s this’
大多数的下降是由于女性说 嘿 这是什么
and improvements in treatment.
以及治疗手段的改善
It’s not radiology that’s caused the majority of the decline.
导致下降的主要因素不是放射学
It’s awareness in early detection and improvements in treatment.
是早期检测时的警觉和治疗手段的改善
Now, mammography is important. It’s actually caused 40-45% of decline
现在 乳房X线照相术很重要 它确切地导致了40%到45%的下降
but it is not the overwhelming thing many people think it is.
但它不是像人们所想有压倒性的重要性
We (are) starting to realize
我们开始意识到
there’s a type of mammo… there’s a type of screening
有一种乳房摄影术 有一种拍摄术
that is actually not healthy and actually not good.
是实际上不健康的不好的
And the big issue is over diagnosis.
有一个大问题是过度诊断
There is a type of cancer that we sometimes find
有一种癌症我们有时发现
that looks like cancer, but
看起来像癌症
it is not predestined to grow, metastasize and kill.
但是它注定不会增长 转移或致命
It may be 25% of all localised breast cancers.
包括大约25%的局限性乳腺癌
It may be as much as 60% of all localised prostate cancers
60%的局限性前列腺癌
and exists in lung cancer, thyroid cancer and other diseases.
也存在于肺癌 甲状腺癌和其他癌症中
But there is a type of cancer that we can diagnose with today’s technology
但有一种癌症我们可以用目前的技术诊断
that will not kill and indeed the worst thing we can do is actually treat it.
它不会致命 而且明确的我们能做的最坏的事就是去治疗它
Unfortunately we don’t have a test for it.
不幸的是我们没有这种检查
Now how could we get into this?
那么我们又如何知道呢
The answer lies with this fellow, fellow named Virchow, pathologist.
答案来自于这位伙伴 他名为菲尔绍 是病理学家
Active in 1840s and 1850s, he did a lot of autopsy studies.
活跃于19世纪40年代和50年代 他做了很多尸体解剖研究
And Virchow, by the way, was the guy who figured out
顺便说一句 菲尔绍是发现
that cancer was uncontrolled cell growth.
癌症是细胞的不可控生长的人
He did his work with H&E staining which he helped to invent,
他通过他曾协助发明的H&E染色方法做这项工作
and with this new thing called a light microscope
并且使用了一种叫做光显微镜的新工具
and he drew the profile of what cancer looks like.
他画下了癌组织的形状的轮廓
He would look at something like this. This is an H&E slide,
他会看一些这样的东西 这是一张H&E染色的幻灯
heaped of breast cancer.
堆满乳腺癌组织
Look at something like this,
看这样的东西
and then he’d be able to dry it out and say
然后他可以把它干燥然后说
”This is what I’m seeing. This is cancer.”
这是我看到的 这是癌症
And he really defined the profile for cancer.
他真的定义了癌症的范围
And you see today, with all of our technologies,
你们今天看到的 通过我们的技术手段
with all of radiologic imaging and other things that we have today,
通过放射成像和现在我们有的其他的手段
we can now actually find a one-centimeter tumor in woman’s breast
我们可以确切的发现女性乳腺中一厘米大小的肿瘤
or a one-centimeter tumor in a man’s prostate.
或者男性前列腺中一厘米大小的肿瘤
Send it to a pathologist, and the pathologist says
把它送到病理学家那 病理学家说
this fits the profile of what Virchow called cancer.
这符合了菲尔绍定义的癌症
They are not really saying this is cancer.
他们不是说这就是真正的癌症
They are saying this is what Virchow called cancer in the 1840s. You see
他们说这是菲尔绍在19世纪40年代定义的癌症 你看看
the control in metaphor here is profiling,
控制这个象征意义的是定义
something in the news a lot today.
这种东西现在的新闻中有很多
We as pathologists and doctors are using
我们病理学家和医生们在21世纪使用
a 19th century definition of cancer in the 21st century.
一个19世纪的癌症的定义
It’s actually an early 19th century definition.
准确的说 它是19世纪早期的定义
We acutually need to have a genomic difinition, a modern-day definition,
我们确实需要有一个基因组上的定义 一个现代的定义
so we can say this thing that looks like cancer
所以我们可以认为 这个东西看起来像癌症
is inherently programmed to either stay
是由内在的程序控制的
at one centimeter and never move, never metastasize , never cause harm,
要么保持一公分大 不会变化 不会转移 不会产生伤害
or it’s genomically programmed to metastasize.
要么它在基因上被设置好了会转移
The cancer that we need to watch versus the cancer that we need to treat.
我们要监测的癌症对比于我们要治疗的癌症
Right now we know that we are over treating a lot of cancers
现在我们知道我们在过度治疗一些癌症
and breast cancer we over treat, but we save lives.
我们过度治疗乳腺癌 但我们拯救了生命
In prostate cancer,
在前列腺癌中
we hope we’re saving lives. We don’t know as well.
我们希望我们在拯救生命 我们也不确定
The data’s just not so certain.
数据不是很明确
So we really need to be careful.
所以我们真的应该小心
We really need to start being more scientific.
我们真的应该开始更科学
We need to think a little bit about what we’re doing
我们需要想想我们在做什么
at every step as we’re doing it.
在我们做的每一步
And as I like to say,
并且我想说
a good scientist understands three things:
一名优秀的科学家明白这三件事:
what we know, what we don’t know, what we believe.
我们知道什么 我们不知道什么 我们相信什么
And a good scientist is constantly reexamining.
并且一名优秀的科学家是在不断的重复考量
What we do is called research
我们所做的事叫做研究
because we have to keep going over and over searching for the truth.
因为我们必须不断的反复寻找真相
And when we think something is true, we then need to question that.
当我们认为某事是正确的 我们又需要反问
Unfortunately it took us 170 years to get to that point
不幸的是我们花了170年才发现这一点
in terms of our definition of cancer.
在我们的癌症定义方面
But we’re there today.
但是我们今天在这里
There are a number of genomic studies,
有很多基因组研究
genomic tests that are being developed
基因组实验已经发展成熟
may help us have a definition of cancer
可以帮我们找到癌症的定义
that doesn’t even require that we say lung cancer or breast cancer.
那甚至不需要我们称其为肺癌或乳腺癌
It’s going to be what 21 genes are turned on or turned off or over-expressed.
这将会是关于21个基因组是启动还是关闭或者过度表达
So thank you very much.
感谢各位聆听

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视频概述

奋战癌症四十年,让我们一起反思一下,我们面对着什么情景,需要做些什么。

听录译者

我来人间转一转

翻译译者

[MED]思佳

审核员

瞌睡虫儿

视频来源

https://www.youtube.com/watch?v=ctsqa7J4Ank

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