【经济学人】科技能否彻底消灭癌症？

科技能否彻底消灭癌症？

译者：鲁城华 & 倪婷

校对：伍豪

策划：鲁迅

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

科学可以在技术层面打倒癌症，但无法解决另一面的问题。

本文选自 The Economist | 取经号原创翻译

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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.

与癌症有关的数字是惊人的。2015年，癌症夺走了880万人的生命，在统计数据上仅次于心脏病。约40%的美国人会在生命中某个阶段患上癌症。癌症甚至超越了疟疾成为非洲人民的第一杀手。不过，癌症的恐怖之处在于你的细胞会悄悄走向 不可逆的 恶变，而统计数字完全不能体现出这一点。除了癌症，能让人如此不寒而栗的也就只有阿兹海默症了。

Implacable [ɪm'plækəb(ə)l] adj. incapable of being placated 不能安抚的；难和解的；不能缓和的

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.

面临这类敌人，人们理所当然地将希望寄托在科学技术上，期待能通过科技发展获得治愈之法。科技也确实没有辜负人类的期望。得益于广泛的科学进步，从基因序列疗法到靶向治疗，过去几十年里越来越多癌症患者得以治愈。美国白血病患者的五年生存率也实现了翻倍，从二十世纪七十年代中期的34%提高到了2006年底的63%。美国有1550万人逃过了癌症的魔爪，未来十年内这个数字还将增至2000万。发展中地区也大大受益：在中、南美洲，前列腺和乳腺癌的生还率仅十年内就增长了25%。

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.

仅从技术角度可以合理预测，科学终有一天能够彻底治愈大部分癌症，或将其转变成慢性病。不过，实验室并非对抗癌症的唯一战场，还有医生的诊所、学校、公共卫生系统和政府部门都需要在癌症战争中发挥作用。但相对而言，这些战场取得的成果很有限。

Cell-side research

细胞研究

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 in this issue 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.

首先是好消息。如果发现得早，许多癌症已经有很大概率治愈。在二十世纪七十年代早期，英国75%的前列腺癌症患者不会多活过十年；如今，80%的患者能够活得更久。还有一些癌症，如肺癌、 胰腺 癌和脑癌等，不容易发现和治疗。但本报的科技季刊显示，这些问题已取得进展。在用于前期诊断的设备中加入某种装置，可以通过检测呼吸探测癌症；验血可以追踪从源自肿瘤中流出的DNA碎片信息。基因序列能够帮助更好地识别新的药物作用对象。

Pancreas ['pæŋkrɪəs] n.a large elongated exocrine gland located behind the stomach [解剖] 胰腺

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.

20世纪创建的癌症治疗三件套——手术、放疗和化疗——也都有了新进展。放疗医师课已经能通过建立伽马射线网，在其节点释放足量药剂杀死肿瘤，并且在进出人体时较少损伤健康组织。此外科学家还开发了新药用以遏制血管给肿瘤输送营养；还有一些药能够打击破坏癌症细胞修复自身DNA的工具。癌症或许将长期存在，但科学也会一直发展。

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.

最令人振奋的压轴好消息是免疫疗法的诞生，这是近几年才发现的新疗法。人体免疫系统拥有一套制动装置，而癌症细胞能够激活它。第一代有效的 免疫疗法 能够关闭这套制动装置，让白细胞攻击肿瘤。现在谈成功还为时尚早，但对一小部分患者而言，这项机制所带来的让长期病情得以缓解就已经等同于治愈了。目前针对各类癌症的类似疗法，已有远超过1000个临床试验正在进行中。现在甚至可能通过改写基因重构免疫细胞，实现更好的癌症攻击效果；首例基因疗法已于上个月在美国批准使用。

Immunotherapy [ɪ'mjəno'θɛrəpi] n. the treatment of disease by stimulating the body's production of antibodies 免疫疗法; 对刺激身体抗体生产的疾病的治疗

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.

然而癌症患者不需要等待未来的治疗方法来获得更大的存活机会。在富裕国家和贫困国家之间，癌症患者的存活率的差异巨大。在有些国家，男性患者的死亡率远高于女性患者，而在其他一些发展程度相似的国家，男女患者的死亡率相差无几。在美国和加拿大，三种常见癌症的患者五年存活率均高于70%，德国达到64%，而在英国这一比例仅为52%。在国家内部也存在着差异。美国对于癌症治疗的总体情况较好，但在治疗效果上存在着较为明显的差异。美国黑人男性患者的癌症死亡率较美国白人男性高24%，而黑人的乳腺癌死亡率则较白人高42%。美国农村地区确诊出癌症比在城市更为致命。

Practical as well as pioneering

仰望星空，脚踏实地

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.

国家之间的差异一定程度上反应了医疗支出的不同：在低收入和中等收入国家，一半以上需要放疗的患者无法接受得到治疗。但是，巨额预算并不能保证好的治疗结果。冰岛和葡萄牙的医疗 费用支出 占GDP的比例并不比英国和丹麦 高 ，但是过去的研究显示，它们之间各种癌症患者的存活率差异巨大。

outspend UK [ˌaut'spend]US[aʊtˈspɛnd]to exceed the limits of in spending 比...多花费

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，问题往往在于钱怎么花，而不是花了多少钱。举个例子，有一种疫苗可以抵抗人乳头瘤病毒（HPV），这种病毒会导致妇女患宫颈癌，同时还会引发头颈癌。2011年卢旺达启动了常规疫苗接种计划，旨在到2020年 消除 宫颈癌。其他国家则远远缺乏计划性。 接种疫苗 本可以每年使印度12万名妇女免于患宫颈癌。

vaccine UK['væksiːn] US[væk'sin] a substance which contains a form that is not harmful of a virus or bacterium (= extremely small organism) and which is given to a person or animal to prevent them from getting the disease which the virus or bacterium causes 疫苗