字典 |

2018-05-30 10:51


【 liuxue86.com - 托福阅读 】



  Health care

  Closing in on cancer

  Science will win the technical battle against cancer. But that is only half the fight




  THE numbers are stark. Cancer claimed the lives of 8.8m people in 2015; only heart disease caused more deaths. Around 40% of Americans will be told they have cancer during their lifetimes. It is now a bigger killer of Africans than malaria. But the statistics do not begin to capture the fear inspired by cancer’s silent and implacable cellular mutiny. Only Alzheimer’s exerts a similar grip on the imagination.数字是惨烈的。2015年癌症夺走了880万人的生命,只有因心脏病死亡的人数比这更高。约40%的美国人一生中会被告知罹患癌症。对于非洲人来说,如今癌症比疟疾的杀伤力更大。但是统计数据远远不能体现癌症带来的恐惧——细胞变异悄无声息地发生着,却绝不留情。只有阿尔茨海默症能如此抓住人的想像力。

  Confronted with this sort of enemy, people understandably focus on the potential for scientific breakthroughs that will deliver a cure. Their hope is not misplaced. Cancer has become more and more survivable over recent decades owing to a host of advances, from genetic sequencing to targeted therapies. The five-year survival rate for leukemia in America has almost doubled, from 34% in the mid-1970s to 63% in 2006-12. America is home to about 15.5m cancer survivors, a number that will grow to 20m in the next ten years. Developing countries have made big gains, too: in parts of Central and South America, survival rates for prostate and breast cancer have jumped by as much as a fifth in only a decade.面对这样的敌人,可以理解人们为何如此关注科学取得突破、发现抗癌良方的可能性。他们的希望并没落空。从基因测序到靶向治疗,由于这些手段取得的进展,近几十年来癌症患者的存活率越来越高。在美国,白血病的五年存活率从上世纪70年代中期的34%提高到2006年至2012年间的63%,几乎翻了一番。美国有大约1550万癌症幸存者,今后十年这个数字将增至2000万。发展中国家也取得了相当大的进步:在中南美洲部分地区,短短十年内,前列腺癌和乳腺癌的存活率上升了五分之一。

  From a purely technical perspective, it is reasonable to expect that science will one day turn most cancers into either chronic diseases or curable ones. But cancer is not fought only in the lab. It is also fought in doctors’ surgeries, in schools, in public-health systems and in government departments. The dispatches from these battlefields are much less encouraging.从纯技术的角度看,我们有理由相信,有朝一日科学会将大多数癌症转化为慢性病或可治愈的病症。但是抗击癌症的战斗不仅仅是在实验室里展开,手术室、学校、公共卫生系统还有政府部门也是战场。从这些战场传来的讯息就远没那么令人欢欣鼓舞了。

  Cell-side research

  First, the good news. Caught early, many cancers are now highly treatable. Three out of four British men who received a prostate-cancer diagnosis in the early 1970s did not live for another ten years; today four out of five do. Other cancers, such as those of the lung, pancreas and brain, are harder to find and treat. But as our Technology Quarterly shows, progress is being made. Techniques to enable early diagnosis include a device designed to detect cancer on the breath; blood tests can track fragments of DNA shed from tumours. Genome sequencing makes it ever easier to identify new drug targets.



  The established trio of 20th-century cancer treatments—surgery, radiation and chemotherapy—are all still improving. Radiotherapists can create webs of gamma rays, whose intersections deliver doses high enough to kill tumours but which do less damage to healthy tissue as they enter and leave the body. Some new drugs throttle the growth of blood vessels bringing nutrients to tumours; others attack cancer cells’ own DNA-repair kits. Cancer may be relentless; so too is science. 二十世纪的标准抗癌“三重奏”——手术、放疗和化疗——都还在不断改进。放射科医师可以使用伽马射线立体定向治疗,其射线相交的辐射剂量足以杀死肿瘤,但当射线穿越人体时对健康组织的损害较小。一些新药能抑制为肿瘤输送营养物质的血管生长,还有一些新药会攻击癌细胞的DNA自我修复机制。癌症或许残酷无情,但科学也一样。

  The greatest excitement is reserved for immunotherapy, a new approach that has emerged in the past few years. The human immune system is equipped with a set of brakes that cancer cells are able to activate; the first immunotherapy treatment in effect disables the brakes, enabling white blood cells to attack the tumours. It is early days, but in a small subset of patients this mechanism has produced long-term remissions that are tantamount to cures. Well over 1,000 clinical trials of such treatments are under way, targeting a wide range of different cancers. It is even now possible to reprogram immune cells to fight cancer better by editing their genomes; the first such gene therapy was approved for use in America last month.最令人兴奋的是前几年出现的一种新疗法:免疫疗法。人类的免疫系统配有一套“刹车”机制,而癌细胞可以踩下这个“刹车”。首个免疫疗法实际上是把“刹车”禁用了,好让白细胞去攻击肿瘤。该疗法还处于初期阶段,但在一小部分患者身上,它已经产生了长期的缓解作用,相当于治愈。这类疗法正在进行的临床试验远超过1000项,针对的癌症多种多样。现在甚至可以通过编辑基因组对免疫细胞重新编程,使其更好地抗击癌症。上个月,首个这类基因疗法在美国获准使用。

  Yet cancer sufferers need not wait for the therapies of tomorrow to have a better chance of survival today. Across rich and poor countries, the survivability of cancer varies enormously. Men die at far higher rates than women in some countries; in other countries, at similar levels of development, they do comparably well. The five-year survival rate for a set of three common cancers in America and Canada is above 70%; Germany achieves 64%, whereas Britain manages a mere 52%. Disparities exist within countries, too. America does well in its treatment of cancer overall, but suffers extraordinary inequalities in outcomes. The death rate of black American men from all cancers is 24% higher than it is for white males; breast-cancer death rates among blacks are 42% higher than for whites. A diagnosis in rural America is deadlier than one in its cities.不过,癌症患者不需要等待未来的疗法来获得更大的存活机会。不管是富裕国家还是贫穷国家,国与国之间癌症患者的存活率差别很大。在有些国家,男性患者的死亡率远高于女性;而在发展水平相似的另一些国家,男女患者的死亡率并无很大差别。在美国和加拿大,三种常见癌症的患者五年存活率高于70%,在德国达到64%,在英国仅为52%。国家内部也存在差异。美国癌症治疗方面总体情况较好,但取得的效果非常不均衡。美国黑人男性罹患各种癌症后的死亡率比美国白人男性高24%;黑人乳腺癌的死亡率比白人高42%;乡村居民的癌症死亡率高于城市居民。

  Practical as well as pioneering

  Variations between countries are partly a reflection of health-care spending: more than half of patients requiring radiotherapy in low- and middle-income countries do not have access to treatment. But big budgets do not guarantee good outcomes. Iceland and Portugal do not outspend England and Denmark on health care as a proportion of GDP, but past studies show wide variation in survivability in all cancers.



  Instead, the problem is often how money is spent, not how much of it there is. To take one example, a vaccine exists against the human papillomavirus (HPV), which causes cancers of the cervix in women, as well as cancers of the head and neck. Rwanda started a programme of routine vaccination in 2011, and aims to eradicate cervical cancer by 2020. Other countries are far less systematic. Vaccinations could help prevent cervical cancer in 120,000 Indian women each year.相反,问题往往在于钱是怎么花的,而不是花了多少钱。举个例子,人乳头瘤病毒(HPV)会导致妇女罹患宫颈癌,还会引发头部和颈部的癌症,现在就出现了一种针对该病毒的疫苗。2011年卢旺达启动了常规疫苗接种计划,目标是到2020年消灭宫颈癌。其他国家则远没有这样的系统性做法。接种疫苗每年可使12万印度妇女免于患宫颈癌。

  Policymakers are not powerless. More can be done to verify which treatments (and combinations thereof) work best. A £1.3bn ($2bn) cancer-drug fund in England, which made expensive new medicines easier to obtain, did not assess the efficacy of the drugs it provided—a huge missed opportunity. Measuring the incidence and survival of cancer, through cancer registries, spotlights where patients are being failed. Access to health care matters, too: the number of Americans whose cancers were diagnosed at the earliest possible opportunity went up after Obamacare was enacted. And prevention remains the best cure of all. Efforts to rein in tobacco use averted 22m deaths (many of them to cancer) between 2008 and 2014. Yet only a tenth of the world’s population lives in countries where taxes make up at least three-quarters of the price of cigarettes, as recommended by the World Health Organisation.政策制定者并非无能为力。他们可以做更多工作来验证哪种治疗方法(及其组合)效果最好。在英国,一个13亿英镑(20亿美元)的癌症药物基金让人们更容易获得昂贵的新药,却没有评估所提供药物的疗效,这是一个巨大的错失的机会。通过癌症病例登记来计算癌症的发病率和存活率,可以找出治疗在哪些环节上失败了。能享受医保也很重要:奥巴马医改实施后,及早诊断出癌症的美国人数量上升了。而预防仍然是最好的解药。2008年至2014年间,对烟草的控制让2200万人免于死亡(其中许多人可能会死于癌症)。然而世界上只有十分之一的人口所在的国家征收的烟草税占到香烟价格的四分之三——这是世界卫生组织推荐的税率。

  Taxes and budgeting are a lot less exciting than tumour-zapping proton beams and antibodies with superpowers. But the decisions of technocrats are as important as the work of technicians. Cancer kills millions of people not simply for want of scientific advance, but also because of bad policy.比起消灭肿瘤的质子束和拥有超能力的抗体,征税和编预算要无趣得多。但技术官僚的决策和技术人员的工作一样重要。癌症夺走了数百万人的生命不仅是因为缺乏科学进展,糟糕的政策也是原因。






  想了解更多托福阅读网的资讯,请访问: 托福阅读