健康新視野——治愈癌癥的幾率取決于你生活的地方？

Audie Cornish （Host）： The largest ever global cancer study has now been published—a survey of more than 27 million cancer patients. And it 1）yields this statistic. In the developing world， more people die of cancer than HIV， 2）malaria and 3）tuberculosis combined. As NPR’s Anders Kelto reports， it also reveals a huge 4）gulf in cancer survival rates worldwide. Anders Kelto （Byline）： So basically， there’s some good news and some bad news. Here’s Dr. Michael Coleman from the London School of 5）Hygiene and Tropical Medicine—one of the authors of the study. Michael Coleman： The good news is that in most countries survival from some of the commonest c a n c e r s h a s b e e n improving.

Kelto： Breast cancer， colon cancer， stomach cancer—more people are surviving these diseases than ever before， especially in the U.S. and Europe. Some low-income and middle-income countries are making progress， too. Coleman： There are many countries in Latin America， for example， and Southeast Asia where survival has improved quite 6）markedly. Even in Mongolia there have been quite sizable increases in survival from some cancers.

Kelto： But then， there’s the bad news. The study published in The Lancet shows that there’s still a huge gap between rich countries and poor ones. Take childhood 7）leukemia. In the U.S.， 9 out of 10 kids who get it will live. Now compare that—a 90 percent survival rate—to some poorer nations.

Coleman： In Jordan， it’s 16 percent. In 8）Lesotho in southern Africa， it’s 40 percent. And in the central region of 9）Tunisia in northern Africa， it is 50 percent.

Kelto： There are also countries where we have no idea how many kids are dying from leukemia because there just isn’t good data. So just how bad is it in these places？ I asked that to Dr. Corey Casper， the head of global 10）oncology at the Fred Hutchinson Cancer Research Center in Seattle. He told me about this doctor he met in Uganda a few years ago.

Corey Casper： This one guy was seeing 10，000 patients a year in a 11）facility that had， you know， no roof， 12）inconsistent electricity and no meds.

Kelto： That guy was literally the only cancer doctor for Uganda and four surrounding countries. And then there are cultural barriers， too.

Casper： Uganda has 57 different tribes， and there are different languages within each of those tribes. And many of them don’t even have a word for cancer because it’s so not part of， you know， the local culture.

Kelto： So people go a very long time before they even realize they have a problem. And when they seek care， it’s usually too late.

Coleman： More than 75 percent of the patients who come to the Cancer Institute in Uganda come with stage three or four cancer.

Kelto： But Casper says look， it’s not all 13）doom and 14）gloom. Uganda is opening up a 10-million-dollar cancer center next month. And smaller centers have sprung up elsewhere in Africa and in Latin America and Southeast Asia. And he says it’s no big surprise that the countries making the biggest 15）strides are the ones investing the most in cancer care.

奧迪·科尼什（主持人）：有史以來最大的全球癌癥研究報(bào)告發(fā)表了——這項(xiàng)研究調(diào)查了超過2700萬癌癥病人。由此得到了如下數(shù)據(jù)：在發(fā)展中國家，死于癌癥的人數(shù)比死于艾滋病、瘧疾和肺結(jié)核人數(shù)的總和還多。據(jù)NPR新聞的安德斯·科洛圖報(bào)道，這項(xiàng)研究報(bào)告同時(shí)也揭示出了全球癌癥存活率的一個(gè)巨大差異。

安德斯·科洛圖（撰稿人）：因此大體上，由此得到的消息有好有壞。有請(qǐng)這項(xiàng)研究的作者之一—來自倫敦衛(wèi)生和熱帶醫(yī)藥學(xué)院的邁克爾·科爾曼醫(yī)生。

邁克爾·科爾曼：好消息是，在大多數(shù)國家，一些最常見癌癥的存活情況一直有所改善。

科洛圖：乳腺癌、結(jié)腸癌、胃癌——比起以往任何時(shí)候，更多的人能夠在這些疾病中存活下來，特別是在美國和歐洲。一些低收入和中等收入的國家也在改善中。

科爾曼：例如，許多拉丁美洲的國家以及東南亞地區(qū)癌癥存活的情況得到了顯著的改善。甚至在蒙古，一些癌癥存活率也得到了大幅度的提高。

科洛圖：但是，也有不好的消息。發(fā)表在《柳葉刀》（譯者注：該雜志是目前世界醫(yī)學(xué)界最權(quán)威的學(xué)術(shù)刊物之一）的研究表明，（癌癥存活率）在富國和窮國之間依然存在著巨大的差異。以兒童白血病為例。在美國，10個(gè)病孩里有9個(gè)都能活下去?，F(xiàn)在把這90%的存活率與一些相對(duì)貧困的國家相比。

科爾曼：在約旦，是16%；在南非的萊索托，是40%；在北非突尼斯的中部地區(qū)，是50%。

科洛圖：還有一些國家我們無從得知有多少孩子死于白血病，因?yàn)槟抢锏臄?shù)據(jù)還不夠完善。那么在這些地方情況有多糟呢？我咨詢了科里·卡斯珀醫(yī)生，他是西雅圖費(fèi)雷德·哈欽森癌癥研究中心全球腫瘤學(xué)的負(fù)責(zé)人。他跟我說起了他幾年前在烏干達(dá)遇到的一位醫(yī)生。

科里·卡斯珀：這位醫(yī)生一個(gè)人每年要給1萬名病人看病。那里的設(shè)施，你知道的—沒有屋頂、間斷的電源以及藥物供應(yīng)不足。

科洛圖：這個(gè)人事實(shí)上是烏干達(dá)和其周邊四個(gè)國家唯一的癌癥醫(yī)生。然而那里也存在著文化障礙。

卡斯珀：烏干達(dá)有57個(gè)不同的部落，每個(gè)部落都有不同的語言。很多部落甚至沒有癌癥專用的一個(gè)詞，因?yàn)槟愣?，這不是當(dāng)?shù)匚幕囊徊糠帧?/p>

科洛圖：所以那里的人們用了很長(zhǎng)的時(shí)間才意識(shí)到自己的問題。而當(dāng)他們尋求醫(yī)治的時(shí)候，通常為時(shí)已晚。

科爾曼：超過75%的患者在來到烏干達(dá)癌癥研究所的時(shí)候，癌癥已經(jīng)到了3期或者4期了。

科洛圖：但是卡斯珀說，其實(shí)情況也沒有那么凄慘。烏干達(dá)在下個(gè)月將要成立一個(gè)耗資1000萬美元的癌癥中心。小的中心也陸續(xù)在非洲其他地區(qū)、拉丁美洲和東南亞出現(xiàn)。他說毫無疑問那些在癌癥治療投入最多的國家一定會(huì)在這方面取得最大的進(jìn)展。