BBC.地平线.2022.认识癌症（2022）

只有一半的癌症患者觉得
Only half of cancer patients feel
治疗的长♥期♥副作用
that long-term side-effects of treatment
得到了详细地解释
are fully explained to them.
目前来说
At the moment,
这些副作用和统计数据被公布的情况
the way that these side-effects and statistics are given,
好像是随意给出的一串数字
it’s like…reeled off like a list of numbers.
我绝不是在说
I’m not saying for a second that
这些治疗不是件好事
these treatments aren’t a good thing.
我只是想人们应该得到…
I just think that people should be given…
那种机会
the opportunity
能理解他们所参与的治疗是何种目的
to understand what they’re really signing up for.
当你处于人生危机之中
Life-changing decisions are so hard to make
要做出改变一生的决定是非常难的
when you’re in the middle of a crisis.
然而你并不参与决定什么风险值得承担
But if you’re not part of deciding what risks are worth taking,
癌症治疗最终是一件你被动接受的事
cancer care can end up feeling like something that’s done to you.
而非你真正参与的一件事
Not with you.
我一直在回想这一切是如何开始的
I keep thinking about how this all started,
我推迟的那次子♥宫♥涂片检查
the smear test that I put off,
这个检查随后发现了我的癌症
and the one that later found my cancer.
这是涂片检查通知信
That’s the smear test letter,
我忽略了这封通知信
the one that I missed.
然后这是他们寄给我的后续通知
And then there’s the one that they sent as the follow-up.
在这两封信之间
What happened…
我的身体发生了什么我所不知道的情况呢
in my body that I didn’t know about between then and then?
假如我做了第一次检查 他们会发现什么呢
And what would they have found if I’d gone to that one?
子♥宫♥颈筛查项目
The cervical screening programme
是国民医疗服务体系提供的三个筛查中的一种
is one of only three screening tests offered by the NHS,
其余是针对五十岁以上人群的乳腺癌和肠癌
along with breast and bowel cancer for those over 50.
国民医疗服务体系估计其子♥宫♥颈筛查项目
The NHS estimates that their cervical screening programme
每年可拯救约五千人的性命
saves around 5,000 lives every year.
但即使是筛查也引起了争议
But even screening provokes debate.
我在格拉斯哥 去见玛格丽特·麦卡特尼博士
I’m in Glasgow to meet Dr Margaret McCartney.
她是一名全科医生
She’s a GP and an honorary fellow
以及循证医学中心的荣誉成员
at the Centre for Evidence-Based Medicine.
她要跟我谈谈关于一些能够扭转
She wants to tell me about some research that turns the tables
我们对癌症认知的研究
on what we think we know about cancer.
我在医学院读书的时候
So, when I was at medical school,
学生们学到的仍是癌症是一件坏事
very much you were taught that cancer is a bad thing,
当然患癌大多情况下是一件坏事
and certainly very often it is a bad thing.
它是一种你想要了解并治疗的东西
It’s something you would want to know about and treat,
玛格丽特·麦卡特尼医生N全科医生
但癌症比这种理解要更复杂
but it’s more complicated than that as well.
我们知道有很多在身体里
We know that there are many people
长了癌的人
who’ve got a cancer in their bodies
假如他们没有去做癌症筛查
that they would not have known about
他们就不会知道自己患上癌症
had they not gone to get tested for it,
他们可能不会知道自己患过病
and they would never have known about it
因为这种癌症并非一定会
because it wasn’t a cancer that was destined
扩散 致死 或者造成别的问题
to spread or to kill them or to cause problems.
人们罹患癌症却不会丧命
Is this quite a rare thing, though,
这是不是仍是少数情况
that people have cancers that won’t go on to kill them?
之前有个情况很典型
There’s a background that’s useful,
过去几十年间
which is that there have been a lot of autopsy studies
进行了很多尸检
done over the last few decades,
需要做尸检的人通常是
where people have examined the tissues of individuals
突然死亡 或意外身亡
who have died suddenly and unexpectedly,
大多是由于交通事故 因为他们突然身故
usually road traffic accidents. So, they’ve had a sudden death,
他们之前没有进行过癌症治疗
and these people weren’t being treated for cancer.
也没有进行过癌症筛查
They weren’t being investigated for cancer.
他们没有任何症状
They didn’t have symptoms
表明他们罹患癌症
that we knew about that would suggest cancer
但是在尸检的人体组织中
and the tissues have been examined
-百分之七的案例发现了癌症 -百分之七吗
– but have found cancer in around about 7% of cases. – 7%?
是的 没错
Yeah, yeah.
听起来确实很令人震惊
This does seem like quite an astonishing thing to say.
这件事确实很难想象
It’s a really weird thing to try and think about
因为它有悖与所有
because it runs counter to everything
我们了解和学习到的事情
that we’re taught and we’re told.
如果你想找恶性肿瘤
If you go and look for cancer,
你就能找到 这点毋庸置疑
you will find cancer. There’s no question about that,
所以如果你去
so if you go and put, you know,
让几百个人做CT或者MRI扫描
hundreds of people through a CT scanner or an MRI scanner,
你就会发现没有症状
you will find cancers that they had no symptoms of,
或者根本没有迹象的恶性肿瘤
they didn’t have any inkling about.
问题的关键在于 癌症之后
The big question is whether that cancer was
是否会继续发展 是否会对人造成伤害
going to go on and do that person harm.
部分根据MRI资料研究得出的数据稍微偏低
Some of the studies using MRIs put this number slightly lower,
但是我们知道确实有些肿瘤
but we do know that there is a pool
未被检测出来
of undiagnosed tumours out there.
但是为了了解这些恶性肿瘤是否会造成伤害
But to discover whether those cancers will cause harm,
玛格丽特想要告诉我些特别的东西
Margaret wanted to show me something extraordinary
为什么找寻癌症细胞
that reveals why hunting for cancer cells
并不一定是件好事
isn’t always a good thing.
这幅图展示了
So, this is a graph of what happened
韩国之前决定给国民
in South Korea when they decided
进行甲状腺癌筛查的情况
to offer the population screening for thyroid cancer,
他们从1999年开始筛查
and they started to screen people just in 1999.
所以 你可以看见
So, you’ll see that,
当他们开始筛查甲状腺癌
as they started to screen for thyroid cancer,
发病率
死亡率
他们发现了越来越多的甲状腺癌
they found more and more and more and more thyroid cancer.
但是你需要知道的是
But what you really need to know is,
这会对死亡率造成什么影响吗
does this make a difference to death rates?
看这条在底部的橘色线条
Look at the orange line down the bottom,
你可以看见 死亡率没有变化
and you’ll see that the mortality is a flatline.
这张图经典地表现了过度诊断
This is a classic graph showing overdiagnosis,
因为你虽然在不断地诊断出
because what you’re doing is you’re diagnosing
甲状腺恶性肿瘤
more and more and more thyroid cancer,
但是死亡率并没有变化
but you’re not making any difference to death rates.
你要是确诊了甲状腺癌会怎么样
If you get diagnosed with thyroid cancer, what happens?
该怎么治疗呢 肿瘤都在颈部 对吧
What is the treatment for it? It’s all in the neck, isn’t it?
对 没错 都在甲状腺附近
Yeah, that’s right. It’s your thyroid gland around here.
你可能会需要做手术
You’re going to be offered surgery,
也可能需要进行放疗
you might be offered radiotherapy,
之后你也可能需要进行长♥期♥治疗
you might have to go into long-term treatment after that,
得有很多干预
so lots of interventions.
所以有些人会在颈部做手术
So, there will be some people who’ve had surgery on their necks
-虽然可能并没有手术的必要 -没错
– that they didn’t need? – Totally, absolutely.
如果你的治疗并没有用
If you’re not going to benefit from a treatment,
你可能得到的就只是副作用而已
all it can possibly do is give you side-effects.
在英国 我印象中 像甲状腺癌这样的病症
I guess, in the UK, for something like thyroid cancer,
-我们都不会筛查 -没错
– we don’t screen… – Yeah.
但是有些种类的癌症还是会做筛查
..But then there are other types of cancer where we do.
比如乳腺癌
Like breast cancer, for example.
像这样的癌症 筛查有用吗
So, in that case, then, is the equation flipped?
筛查会带来明显的好处吗
Is it very obvious that there’s a benefit to do it?
我想说 是的 但其中的原理更复杂
Well, I’d love to say that there was, but it is more complex.
所以政♥府♥做的这个决定
So the government have made a decision
对女性来说很划算
that it’s cost-effective to offer it to women.
马默特报告根据
So, the Marmot Review looked at the evidence
近几年的调查
around this a few years ago
研究发现
and they concluded that,
每两百位做过乳腺癌筛查的女性中
for every 200 women that had breast cancer screening,
会有一位女性因为筛查延后了死亡时间
you would delay the death of one woman,
但会有其他三位女性因为查出乳腺癌
but at the cost of three women being over-treated
-而受到过度治疗 -过度治疗是指
– for breast cancer. – And when you say overtreated,
那些患有癌症的女性
are those the type of women who have cancer,
自己并不清楚病况
but don’t know about it,
但癌症也不会对她们造成影响
and it’s not really going to go on to cause a problem,
然而 她们却得切除乳♥房♥♥
and yet they’re having things like mastectomies
进行活检 还有担心这一切 是吗