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我们进入了一个癌症研究非常好的时代?

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发表于 2016-9-3 08:40:24 | 显示全部楼层 |阅读模式
转载自我的博客-->生信菜鸟团!
        在推特上面看到某人推荐了一篇好文,好像是某位大佬在science上面写的,大概就是鼓吹大家进入癌症研究领域。
http://science.sciencemag.org/content/352/6282/123.full
感觉写的还不错,就翻译了一下,译文如下:

上个世纪六十年代,我还是一名普通学生,有幸在大名鼎鼎的纽约医疗中心受训,那时候,癌症研究还是一个小众领域。癌症患者一般都在特定的医院就诊,得到的医疗照顾很少,也没有现在这么多的学生去拜访他们。如果无法从放射性化疗或者手术切除等治疗手段下活下来,那么该患者一般就被判死刑了。癌症领域的研究,也远不如其它诸如感染,内分泌,自免疫,心脏病或者神经相关疾病得到的关注多。
现如今,不管是在研究领域,还是教学或者医疗照顾方面,对癌症的关注度都已经发生了翻天覆地的改变。源于我们对癌症病理生理学机制的了解,在癌症治疗方向也出现了很多良好的兆头。研究已经证实,癌症是人生命进程中无可避免的疾病,是基因组相关的疾病,因为基因组的变异,打乱了一些信号通路及必须的细胞功能。现在对癌症的诊断已经不仅仅是形态学方面的了,新的技术主要依赖于对人体遗传特性的全面了解。而且也有了有效的防护措施,包括癌症病毒疫苗,还有保证一个健康的生活习惯,尽可能的避免个体暴露在能诱导DNA变异的物质下。癌症筛查技术也能使得癌症患者能在还能通过手术治愈之前就诊断出来。随着对个体基因组损伤的了解程度加深,并且发现了越来越多的癌症相关抗原的免疫反应情况,更好的治疗策略被提出来了。所有的这些努力使得美国每年癌症患者死亡率略微减少1~2%。
这些振奋人心的信号激励了地方性的,全国性的,甚至全球性的努力奋斗,也大大加快了攻克癌症的进程。早在1971年,尼克松总统就签署了美国国家癌症法案,直到现在它都是人类针对癌症的战争宣言。而就在2015年,奥巴马总统提出了精准医疗的概念,决定投入三分之一的精力在癌症医疗领域。希望借用新兴的组学技术,信息学技术,并且重新设计临床试验希望借此根本性的变革癌症诊断,开发新的癌症治疗方案。这一举动把近半个时间前的癌症治疗可能性变成了一个清晰的策略。当局最近关于癌症的发言是由副总统拜登做的,类似于登月计划,激励癌症研究进展更迅速一点。希望通过一系列举动来用5年的时间完成10年的任务,包括扫清各种迂腐的规矩,连接各个健康中心,打通学术界与 工业界的隔阂。一些不切实际的目标使得这次与癌症的战役早期行动蒙受了阴影,比如规定在某个截止日期我们要彻底治愈某几类癌症。与当年的登月计划一样,是那么的荒唐,那样的不可能实现。
如果没有加大研究资金的支持力度,仅凭执政者的关注对癌症研究有帮助吗?毕竟,如果不算那每年20亿美元资金增长,国立健康研究院的预算比十年前的五分之一还要少,癌症生物学的基础困难并没有克服。一个最突出的问题是,癌症细胞是如何迁移的,从原发灶到转移灶,虽然不少文章都提到了该问题。而这样的问题的进展离不开收集更多的肿瘤样本资源,而却缺乏足够的资金支持。
而且,还有个更重要的问题有待解决,即使国会不增加资金支持。白宫已经充分利用了它召集力来促进各类癌症研究者之间的更好的合作,资源分享。副总统可以利用他的影响力在白宫运作以促进癌症研究重点转为癌症防御。像以前防御HPV和HBV一样,禁烟,控制肥胖,等各种举措都可以。当局还可以赋予癌症攻克相关的监管部门更多的权利,比如,让医保可以部分报销癌症样本的测序费用,这样可以大增加癌症数据,积累遗传资源,为更好的研究癌症打下坚实的基础。还可以分享脱敏的患者其它临床数据,让监管部门做出决策更快更方便。
我们现在进入了一个癌症研究非常好的时代,关于癌症研究的各个部门单位都合作非常紧密,而且也非常受当局支持。让我们把握住这个机会,即使国家并没有增加预算。

原文如下:
When I was trained at a prominent New York medical center in the 1960s, cancer was relegated to a minor place in the curriculum. Cancer patients were housed in a separate hospital, rarely visited by students or the medical house staff. If not amenable to surgery or radiotherapy, most cancers were regarded as hopeless. Research on cancer was not accorded the attention received by infectious, endocrine, autoimmune, cardiovascular, or neuropsychiatric disorders.
Now things are dramatically different in research, teaching, and care. Much of the new optimism comes from an understanding of cancer’s pathophysiology. Research has shown that cancers are intimately entwined with basic life processes—diseases of the genome, with perturbations of signaling pathways and essential cell functions. New diagnostic categories are based on genetic profiles, not just morphology. Effective prevention occurs through viral vaccines and behavioral changes that reduce exposure to mutagens; screening detects some cancers early enough for curative surgery. Therapeutic strategies are increasingly informed by underlying genomic damage or by the immunological responses to cancer-associated antigens. Such knowledge has driven annual reductions of 1 to 2% in age-adjusted cancer mortality rates in the United States for many years.
These encouraging signs have stimulated local, national, and even global efforts to hasten progress against cancer, with clearer strategies than were possible when President Nixon signed the National Cancer Act in 1971 and launched what is still called the “war on cancer.” President Obama’s 2015 decision to devote a third of his Precision Medicine Initiative to oncology was predicated on the new promise of using genomics, informatics, and redesigned clinical trials to revise cancer diagnostics, improve prognostic tools, and develop new therapeutics. The Administration’s more recent announcement of a cancer “moonshot,” led by Vice President Biden, aspires to move cancer research more quickly—accomplishing 10 years of work in 5 years—by leaping fences between disciplines, connecting health centers, and interweaving the academic and industrial sectors. Implausible goals that tarnished earlier campaigns, such as the elimination or cure of certain cancers by a certain date—the equivalent of a true moonshot—have been conspicuously absent.
Can such attention from national leaders be helpful without additional funds to support research? After all, despite this year’s $2 billion increase, the budget of the U.S. National Institutes of Health remains about 20% below its value a decade ago, and fundamental problems in cancer biology remain unsolved. One prominent example—how cancer cells metastasize from primary to distant sites—is addressed by several articles in this special issue of Science (see page 162). Expanded work on such questions requires expanded resources, yet provision of such funds remains uncertain.
Still, there are important things to do, even without enlarged Congressional appropriations. The White House is already using its convening power to encourage greater collaboration, information sharing, and team efforts. The vice president could use his popularity and bully pulpit to move beyond research to emphasize cancer prevention: the life-saving values of vaccines for human papilloma and hepatitis B viruses, the avoidance of tobacco use, the control of obesity. The Administration could also exercise its regulatory authority—most potently, to direct the Centers for Medicare and Medicaid Services (CMS) to allow reimbursement for molecular profiling of cancers. That would vastly increase the data available for analysis, accelerate interpretation of genetic profiles, provide a test bed for true sharing of clinical information, and allow future coverage determinations by CMS to be made more quickly and sensibly.
We are living in a remarkable time for cancer research, with synergies among its components and strong backing from the nation’s leaders. Let us take advantage of this moment, even without the certainty of additional dollars.
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发表于 2016-12-14 21:31:06 | 显示全部楼层
感觉国内数据还是不如国外开放。
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