当中国科技界在热议50-90年代屠呦呦和张亭栋发现中华传统医学对现代疾病的神奇疗效时，美国人正在《时代周刊》上展望下个十年如何攻克癌症的办法……
通常我不会撰写周年纪念文章，但为这件事破例。距离1971年尼克松总统签订国家癌症法案已经过去40年了，这项另世人瞩目的历史性法案——也许更为重要的是，政府资助——需要研究和找到攻克癌症的疗法。
40年过去了，形势发生了很大的变化。当年医生所知的病症和今天研究的病症呈现出很大的差异。从一个方面来说，科学家们更深刻地认识到，癌症不单是一种突然使得细胞的生长失控的疾病，而是上百种不同的疾病。实际上，根据美国癌症研究协会（AACR）的癌症研究进展报告，实际上癌症包括约200种不同的疾病，每种疾病在病因上有轻微的不同，需要对症下药。
专家们一开始所采取的办法是盲目地把治疗措施聚焦肿瘤自身，而现在的研究者们把研究的目光拓展了许多，并对其它关键性特征进行考察，例如病人本身的体格如何影响病症等。科学家们也关注到，肿瘤如何因自身的病理需要与环境协同产生变化，把健康组织变成癌变组织，这个过程使得癌症陡然难以控制。
“继续投入研究和资助是草率的，有时你需要停下来环顾四周，并回顾我们所取得的成绩，” William Dalton（威廉。道尔顿）博士写道，他是Moffitt癌症中心和研究所的主任兼CEO，也担任AACR撰写报告委员会的主席，“在过去40多年里，难以置信的是众多普通癌症患者死亡率有所下降。其中很重要的原因在于，人们在攻克某种对任何社会而言是最大的健康威胁的病症方面，取得巨大的进展。”
的确，在1990年到2007年间，美国癌症男性死亡率下降到22%，女性下降到14%。在1975年，仅有50%的癌症患者被确诊后有望再活5年，现在这个比例接近70%。在儿童癌症患者中，成就更为显著：目前有80%的幼儿患者可望幸福地度过童年时光，而在1975年，这一比例仅为52%。
众多成功事例归因于癌症研究领域的两大里程碑：一是了解致癌的简单生活方式中的因素，另外一个相反的极端则是技术领域——2001年绘制人类的基因组。人类行为方式的变化，如戒烟和避免暴露紫外线光照，已经成为避免肺癌和皮肤癌重要的途径，然而人类基因组绘制工程依然在控制癌症基因等方面获取着新的和有用信息。
“假如对过去40年取得影响我们了解癌症的成就进行排位的话，我可以说基因组绘制排在第一位，生活方式的因素排在第二位，”道尔顿说。
基因方面的发展使攻克癌症转到下一阶段成为可能，到时可以根据每个病人的癌症情况采取更为个人化的方式医治他或她的病例。在过去的十年间，科学家们已经采取了专门针对癌细胞的更为精确的疗法，而且这些疗法比过去更为常规和精确，医生们将会对特定的癌症采取较为适合的最佳疗法。
“当我展望下一个40年时，治疗癌症的终极目标是个人化药物，”道尔顿说，“我想个人化药物将会对攻克癌症产生最大的影响。”研发针对个人的癌症状况的最佳疗法，即控制肿瘤向诱发疾病或者死亡的癌症发展，将会是一个漫长的过程，个人化药物也会帮助发现潜在癌症最高风险的人。
阻止癌症扩散和治愈癌症同样重要，道尔顿说，尤其是在美国人中，“总体而言，癌症更多地会在年纪大的人中确诊，我们活得寿命越长，我们得癌症的几率就越高，”他说。在今后的十年中，攻克癌症的方法是在病情初期控制成本和死亡率。根据国家健康研究所的报告，2010年癌症治疗花费26.38亿美元，包括直接医疗费用和间接费用——当然这笔费用是由于工作低效和早期死亡所导致的。
因此，当AACR报告中强调研究者们了解癌症的程度时，显然我们还没有接近攻克癌症的目标——至少尚未达到。去年，有将近570,000人死于癌症，研究者们在未来依然可以希望通过努力使这个数字减少。
原文
In 40 Years of Cancer Research, How Far Have We Come?
I don't normally write about anniversaries, but this one seems worth noting. It's been 40 years since President Richard Nixon signed the National Cancer Act in 1971, the historic legislation that focused attention — and perhaps more importantly, government funding — on the need to research and find treatments for cancer. A lot has changed in the past four decades. The disease that doctors thought they knew then is very different from the cancer they're studying today. For one thing, scientists have a much better understanding that cancer isn't simply one disease in which cells suddenly start to grow out of control, but rather hundreds of different diseases. In fact, according to the American Association for Cancer Research (AACR) Cancer Progress Report, cancer is actually more like 200 distinct diseases, each spurred on by slightly different causes and requiring different treatments. And instead of focusing so slavishly on the tumors themselves, as experts did initially, researchers have enlarged the window through which they study cancer, allowing the consideration of other critical features, such as how the patient's own makeup might affect the disease. Scientists also look at how tumors tend to co-opt their environment for their own pathological needs, turning healthy tissues into diseased ones in a process that makes cancer increasingly difficult to control. "In the haste to continue research and fund it, you sometimes need to stop and turn around and look back at what we've accomplished," notes Dr. William Dalton, president, CEO and center director of the Moffitt Cancer Center and Research Institute and a co-chair of the AACR committee writing the report. "The reduction in death rates of many common cancers that has occurred over the last 40 years is incredible. That's important because that's huge progress against something that is probably the biggest health scare for any society." Indeed, the death rates for cancer in the U.S. have dropped by 22% for men and 14% for women between 1990 and 2007. And in 1975, only 50% of people diagnosed with cancer could expect to live for another five years; now nearly 70% do. Among children, the gains are even greater: 80% of youngsters can expect to survive their childhood cancer today, compared with 52% in 1975. Much of that success can be attributed to two key milestones in cancer research: understanding the simple lifestyle factors that contribute to cancer and, on the opposite end of the technological spectrum, the mapping of the human genome in 2001. Behavioral changes such as quitting smoking and avoiding exposure to UV rays, for example, have played a significant role in preventing lung and skin cancers, while the Human Genome Project continues to yield new and useful information on the genetic drivers of cancer. "If I were to rank developments over the past 40 years that have had the most impact on our understanding of cancer, I would say genetics is No. 1, and lifestyle factors are No. 2," says Dalton. Advances in genetics are making it possible to shift into the next phase of cancer care, a more personalized approach in which every patient's cancer will be treated in the way that best suits his or her case. Already, in the past decade scientists have developed more tailored therapies that target cancer cells specifically, and as these approaches become more routine and refined, physicians will be better able to match the right therapies with the right cancers. "When I think of the next 40 years, the ultimate goal is personalized medicine," says Dalton. "I think personalized medicine will have the greatest impact on prevention." Matching an individual's cancer biology to the best treatments for that tumor will go a long way toward controlling illness and death from cancer, and personalized approaches can help identify people at highest risk of developing cancer as well. Preventing cancer is just as important as treating it, he says, especially as the U.S. population ages. "By and large, cancer affects older people; the longer we live, the more likely we will be to develop cancer," he says. That means that stopping the disease before it even starts will have a huge impact on controlling costs and deaths in coming decades. According to the National Institutes of Health, cancer care in 2010 cost $263.8 billion, including direct medical expenses as well as indirect costs due to lost productivity and early death. So while the AACR report highlights how far researchers have come in understanding cancer, it's clear that we're not close to conquering cancer — at least not yet. Last year, more than 570,000 people died of cancer, still a sobering number that experts hope to shrink in coming years.
http://pop.6 p a r k.com/chan2/messages/17364.html
http://healthland.time.com/2011/09/21/cancer-researchs-40th-anniversary-how-far-have-we-come/
选择“Disable on www.wenxuecity.com”
选择“don't run on pages on this domain”
