“癌症”一词倾向于唤起一种侵略性疾病的想法，这种疾病迅速增长，在身体周围散布，最终会杀死如果不接受治疗。
But this isn’t always the case. Some things that are diagnosed as ‘cancer’ can grow so slowly that they may not even cause harm in a person’s lifetime, and so don’t need any treatment.
问题在于，目前我们无法分辨这些缓慢的癌症与侵略性癌症之间的区别。
这个“过度诊断”是一个大问题。我们已经在乳腺癌筛查before, but it’s also a big issue in prostate cancer, where we often hear about ‘tigers’ (aggressive cancers that can spread and kill) and ‘pussycats’ (slow-growing tumors that wouldn’t cause an issue in a man’s entire lifetime). And overdiagnosis is increasingly being linked toother类型的cancerstoo.
But we also have issues detecting some of the most aggressive types of cancer early enough, meaning we only find them when it’s often too late to tackle them.
We still want to detect cancers early when they’re most curable, but not subject patients to unnecessary treatment if they don’t need it. We want things that are extremely accurate.
布莱恩·德鲁克教授
So our fourth Grand Challenge is all about delving deeper into cancer’s biology to solve two of the most important mysteries in medicine – how to tell the difference between the cancers that can kill and the slow-growing forms of the disease that don’t, and how to track down the cancers that stay hidden until it’s too late.
“这个盛大的挑战至关重要，”大挑战咨询小组成员，主任布莱恩·德鲁克（Brian Druker）教授说。Oregon Health and Science University Knight Cancer Institutein the US.
“We know that cancers are easier to cure if they’re found early – that’s clear for every type of cancer. But the next issue is whether our early detection tests are really what we want them to be right now.”
危害与利益
“过度诊断”的癌症的影响可能改变生活和不必要 - 导致人们的压力和焦虑症的压力和焦虑，以及所有治疗的不利影响，包括潜在的严重副作用。
“随着我们在发现癌症方面变得更好，我们还发现不需要治疗的早期癌症。然后是一个问题，即通过治疗这些癌症，我们是否对弊大于利。
“At the moment there’s a bit of a balance, because despite there being clear benefits, there are also definite harms. But if we were able to identify cancers that don’t need treatment, it would mean the benefits of better detection would out-weigh the harms.”
另一个至关重要的突破是找到侵略性癌症的能力（例如pancreatic,lung,brain和卵巢癌) sooner which are often deadly because they’rehardest to treatwhen found late. These cancers, too, can also be difficult to tell apart from more harmless lumps on scans and other tests.
According to Druker, technology has a big part to play.
他说：“我们正在尝试在这两个问题的中间开会，以便我们拥有更准确的技术来帮助我们适当治疗患者。”
“我们仍然希望在最可治愈的癌症后尽早检测到癌症，但如果不需要患者，则不会接受不必要的治疗。我们想要非常准确的事情。”
由于缺乏某种类型的癌症中的生物学差异以及它们与早期的癌前变化，研究人员以前无法做到这一点。
值得庆幸的是，在过去的十年左右的时间里，新技术发生了爆炸，可以详细分析我们的基因，从血液中提取肿瘤细胞和DNA，并研究我们体内的蛋白质以及它们在前所未有的细节中所做的事情。
And alongside our deeper understanding of cancer biology, these technologies now stand us in good stead of overcoming this grand challenge.
“We want a team of biologists who understand what distinguishes a lethal from a non-lethal cancer, combined with a group of technology experts who can find the right technology to apply this,” says Druker.
“When you look at many scientific advances, it’s often when you get different areas of research or technology coming together that you see dramatic breakthroughs.”
An advance of this kind could not only save lives from aggressive cancers by finding them earlier, but also reduce the harm caused by treating people with cancers that will never cause them any problems.
This, in turn, could lead to great improvements in how we screen for cancer, by helping us understand what to do with过度诊断的癌症.
Re-branding cancers
But there’s also a second challenge waiting for us if we get this right. ‘Cancer’ is a hugely emotive word. The idea that some cancers don’t need treating is a hard one to get your head round. How would people respond to being told that their cancer was safe to live with and won’t need treating?
Professor Druker sees this as an important issue when discussing such tumours: “We have to stop calling things that are non-lethal ‘cancer’, because if a doctor says you’ve got cancer you’re going to want to get rid of it. As soon as you say ‘cancer’ people get worried, so we’ve got to come up with a different name.”
虽然许多癌症still need prompt treatment, we will get to a place where we will be able to confidently say that others won’t ever cause harm, so don’t need treatment.
Professor Peter Sasieni
一些科学家已经观察了tac的方法kle this problem. Dr Laura Esserman and colleagues propose the term ‘IDLE’ (which stands for‘Indolent Lesion of Epithelial origin’) to describe non-lethal tumours.
她争论doctors must lead the way in changing how people think about cancer, increasing awareness of IDLE tumors and how they should be dealt with. And that our one-size-fits-all approach to naming cancer isn’t suitable now we know there are lethal and non-lethal versions of the disease.
“Science has taught us quite a bit about the disease in the last few decades, so a one-size-fits-all definition is no longer the right fit because there isn’t just one type of cancer – there are many,” she told CNN back in 2015.
“就像过敏一样；我们可以轻松地理解，不仅有一种过敏。过敏的类型和严重程度差异很大，并不是每个人都会导致过敏性冲击或死亡。
“有些过敏只会导致眼睛发痒或流鼻涕。同样的原理是癌症的。而且由于癌症一词被恐慌和死亡的含义所包围，因此，在极低风险的病变的情况下，我们应该相应地对其进行重新分类。”
The patient perspective
我认为，大挑战赛将为研究团队提供的鼓励和自由确实令人兴奋。从我的癌症经历中，我看到人们很早就被诊断出来，但仍死于癌症，而其他人则被诊断出来并幸存下来。早期诊断对于提高生存率至关重要，但仅早期检测到癌症是不够的 - 我们还需要能够识别需要治疗的致命癌症。这涵盖了复杂的科学，随着人们对癌症的看法的改变，这使它引人入胜。换句话说，有技术挑战是找到将致命和非致命性癌症区分开的方法（这本身就是足够的挑战），但必须将其付诸实践。我希望研究团队可以从中汲取灵感来做一些令人难以置信的事情。
– Jim, member of the Grand Challenge patient panel
A change of this kind would have a huge impact in both how society views cancer and how doctors treat it – in all of its guises.
正如Sasieni教授所考虑的那样：“最终，我怀疑 - 尽管许多癌症仍然需要及时的治疗，但我们将到达一个我们可以自信地说别人永远不会造成伤害的地方，因此不需要治疗。
“但是，当他们听到'癌症'一词时，他们现在不会想到现在的想法，当然也不是人们在40年前想到的死刑。”
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