肺癌CT篩查20年數據對未來的幫助
從1999年我們的第一份出版物到NELSON結果分析，篩查的證據仍在不斷增加，我們同時也期待著中國的結果。每一項試驗都表明CT篩查非常有效且挽救了眾多生命。如果每年做一次篩查，可以挽救80%的肺癌患者，這是一個巨大的獲益。
Well, the evidence is continuing to increase from our first publication in 1999 to the analyst of the nelson, and we're looking forward to the, uh, results in china. Uh, each each of those trials show that ct screening is very effective and saves many many lives. If it's done on an annual basis, it can save eighty percent of those who are diagnosed with lung cancer. That's a huge benefit.
所以我認為，現在證據已經很清晰了，篩查具有很大的好處。我認為我們也已經做了足夠多的實踐來證明它的好處，但是現在需要做的是闡明一些更為詳細的問題，如篩查的頻率、篩查多長時間、生物標記的作用。
So I think that the evidence is very clear now that there is a substantial benefit to screening. I think we've done enough trials to demonstrate the benefits, but now needs to happen and is happening is that we need to understand, uh, some of the more subtle aspects, how often we need to be screened, how long we need to be screened, the role of bio markers.
這些都是亟需解答的問題。但對於篩查是否有益這個問題，已經有很明確的肯定答案了。
Those are the type of questions now that need to be answered. But the question of whether there's a benefit and whether it's a strong benefit has significantly been answered.
美國肺癌篩查有何新進展？
不盡人意，據估計大約僅有1%-4%的人接受篩查，這取決於在美國有哪些人有資格接受篩查，相比真正應該接受篩查的人群這是一個非常有限數字。所以，僅有1%-4%的人接受了篩查，我們仍需要去推廣篩查項目。篩查項目的推廣與發展確實需要一些時間，即使像現在已有超過70%-80% 符合條件的人群參與的乳腺癌篩查，也是經過一定時間發展而來的。
Well, It's been quite poor. So it's estimated that some between one to four percent.
depending on which part of the US of the people have who are eligible for screening, which is already a limited number of those who really should be screened.
So only one to four percent are really opting to be screened. And we need to develop that screening programs do take some time to develop even.
screening for breast cancer, which now is I think over seventy, eighty percent of people who are eligible are screened for breast cancer.
我們需要大力推動肺癌CT篩查項目的發展。儘管我們已經有了一個斥資巨大的NELSON隨機試驗篩查結果的支持，但令人驚訝的是篩查接受率仍然很低。一些可能的解釋包括，肺癌篩查相對而言仍比較新興，也許接受的人群會隨著時間的推移而增加。
That took a while to develop, and we need to very strongly push it further for ct screening for lung cancer.
Yes even though we had the results of a expensive large randomized trial supporting screening.
The uptake has been surprisingly low. Now some of the explanations for this might be that it's still relatively new and perhaps it will increase over time.
但另一種解釋是，我認為，在於過分強調篩查的危害，甚至誇大了篩查的危害，而忽視了篩查的真正好處。我認為，以上因素可能就是美國肺癌篩查率低的原因，當然，這也是整個歐洲乃至亞洲部分地區肺癌篩查率低的原因。我認為隨著信息的不斷湧現，人們的接受意願也在不斷提高。
But the other explanation for that relates to, I think, in over emphasis on the harms of screening.Perhaps even an exaggeration of the harms and similarly and under emphasis on what the true benefits of screening are.
I think when you take all these factors together that probably accounts for the low uptake in the united states.and surely it's accounted for the low uptake throughout europe and and even parts of asia as well. So I think that as information continues to come out, the uptake willing improve.
NELSON結果對肺癌篩查的啟示
NELSON研究結果將對歐洲產生重大影響，因為他們一直在等待這個試驗結果。在未來的一年半內，一系列的舉措將在歐洲實施。NELSON的研究結果將對歐洲的肺癌CT篩查產生重大影響，希望在世界範圍內也是如此。是的，我想很多歐洲國家都在等待該試驗的結果，有一種感覺是，他們需要了解關於自己的試驗在自己的掌控下進行，這樣他們就可以自己作效益-成本分析了。
The nelson results will have a big impact in europe because they've been waiting for this trial. And they now have already, uh, set out in eighteen months, sequence of events that need to happen for them to start implementing it throughout europe.
So the nelson results will have a major impact on ct screening for lung cancer in europe, hopefully around the world as well.
Yes. I think many european countries were waiting specifically for that trial to come out.
There's a feeling that they needed their own trial that was done under their own control with then and that would allow them to do their own cost analyses.
現在他們有了結果，我認為他們更有能力影響政府的政策決定。正如Henschke教授所說，不僅僅在歐洲，還有幾個亞洲國家也在等待另一個試驗結果。所以，現在有兩個大型的、斥資巨大的、做得很好的隨機試驗顯示了篩查的好處，我認為篩查試驗的實施是不可抗拒的。
So now they have it. I think they're going to be much more in a position to influence governments to change their policies. And his doctor Henschke, she points out, It's not just in europe.
There are several asian countries as well that were waiting for another trial. So now there are too large and very expensive.
Well done randomized trials showing a benefit. So I think that it's gonna be very hard to resist implementing screening.
中國肺癌篩查試驗對全球的意義
中國的試驗中有生物標誌物，這是第一個包含生物標誌物的大型CT篩查試驗，所以它應該會為生物標記的作用提供非常有用的信息。同時，中國的試驗進行了每年與隔年篩查的對比，儘管NELSON給出了一些初步的結果，但中國的這項研究，將可能為隨機選擇每年或隔年篩查的間隔問題提供決定性的證據。
The Chinese trial has bio markers in it. And that's really the first large trial with ct that includes bio markers. So it should provide a very, very useful information as to the role of bio markers.
It also is looking at two years versus one year. And although the nelson gives some preliminary results on that, this study is where they're randomly selected into one year or two year intervals should provide conclusive evidence.
同樣重要的是，這是在中國本土進行的一項試驗。我們已經討論過美國的試驗並沒有影響歐洲開始篩查，但如果NELSON的結果出來，美國不一定會在分析結果出來之前開始篩查。我認為由中國人自己設計並實施於本土人群的篩查試驗非常重要，這樣他們可以在他們自己的國家進行成本分析以確保試驗是有效的。
Yeah. It's also important because It's a trial that's being done in China. And I think,you know the US trial didn't influence europe to start screening, and we've talked about that. Had the nelson come out first, I doubt the US would have started screening until the analyst iii came out.
And I think it's gonna be very important that the chinese have a trial, if they've designed, where it's done on their own people, and they can look at their own cost analysis within their own country to provide the kind of additional assurance that it's going to be effective.
Henschke教授提到的其他方面也非常重要， 我認為這些問題是具有全球性意義的。這些關於篩查間隔的結果，可能會對篩查產生巨大的影響。同樣，我們都知道生物標誌物最終會被納入篩查使之更好更有效，我認為這是第一個試驗它將以一種非常嚴謹和有意義的方式結合生物標誌物市場，這將產生全球性影響。
The additionalaspects that doctor H
mentioned are very important.
These are questions that I think will have global significance though.
You know these are the additional findings of expanding the intervals. This is could have a tremendous impact on screen.
And similarly we all know that bio markers will ultimately be added to screening to make it better and more efficient.
And I think this is the first trial that's really going to be looking in a very serious and meaningful way incorporate bio markets.
And this will have global impact.
美國醫生如何看待中國肺癌篩查？
首先，目前為止，他們顯示了良好的登記率。當然，每個試驗納入受檢者都是有挑戰的，你必須根據不同的社區進行調整，我相信他們非常專業，他們也有充足的社區受檢人群源，所以他們的篩查登記會很成功。
I think so far they've demonstrated very good enrollment in their in their studies.
And every trial has challenges in rolling individuals. You have to really tailor it to the different communities.
And i am sure they're very sensitive to that they have individuals from those communities.
And so I have no doubt that they will be very successful in their enrollment.
在分析方面，他們同樣擅長統計、數學和計算機技術方面。所以我完全相信，它將會提供非常有用、非常有意義的結果。中國的這次試驗是精心設計的。
And in terms of the analysis, they are also very good in statistical and mathematical and computer technology.
So I have full confidence that it will be it will they will provide very useful and very interesting results. Yeah. This trial was very carefully designed.
中國人在篩查方面已經有了豐富的經驗，不僅對世界各地的信息資源加以利用，併為研究開發了各種篩查小程序，他們已掌握了篩查試驗的精要所在。
Chinese have a large experience already in screening. They have utilized information from around the world, basically and they developed screening programs for research purposes that are smaller so that they've learned all of the intricacies of screening.
現在，針對全面的篩查試驗，我認為他們已經有了足夠的經驗來管理所有的篩查參與者，同時他們也引進了全球顧問來協助他們。因此我認為這次試驗不僅會對中國產生影響，也會對全球產生影響。
And now for their full blown trial, I think they have a large experience already to base the management of all the screening participants.
They have brought in, you know, global consultants to work with them to help.
So I think that this trial will have, as I said, impact not only in china, but really will have global impact as well.
中國篩查試驗的領導團隊非常出色，這是一次尤為重要的試驗。
I have no doubt that it will be successful.
The leadership team that they have here within china is outstanding, and I think it should be a very important trial.
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