【按】本文选自9月16日《经济学人》封面文章，分析了今天的人类在治疗癌症方面有哪些优势（科技方面）和劣势（政策、经济等方面）。读完后你将了解：

• 癌症有多普遍以及为什么说近几十年来癌症变得越来越可治愈？
• 目前有哪些科技手段可以诊断早期癌症以及治疗癌症？
• 不同国家、性别、种族和地域的人之间癌症存活率差别有多大？
• 为什么说治疗癌症不仅仅依靠科技进步，还需要好的政策？

建议阅读时间15-20分钟。

本文食用方法——建议阅读两遍：
第一遍速读，不看注释和翻译，直接阅读原文，遇见生词（大部分已经标粗）猜一下意思或者跳过，不要因为停下了查词而影响了阅读的流畅性。
第二遍精读，不认识的词看段后注释和解析，建议多看英文释义（这样才能理解得更全面、准确同时能锻炼阅读能力），对照中文翻译看看自己是否有理解错误的地方。
有问题欢迎留言讨论~

经济学人封面

Health care

Closing in on cancer

围攻癌症

Science will win the technical battle against cancer. But that is only half the fight

close in on: If a group of people close in on a person or place, they come nearer and nearer to them and gradually surround them.
e.g. Hitler himself committed suicide as Soviet forces were closing in on Berlin...当苏联军队逼近柏林的时候，希特勒自杀了。

1. THE numbers are stark. Cancer claimed the lives of 8.8m people in 2015; only heart disease caused more deaths. Around 40% of Americans will be told they have cancer during their lifetimes. It is now a bigger killer of Africans than malaria. But the statistics do not begin to capture the fear inspired by cancer’s silent and implacable cellular mutiny. Only Alzheimer’s exerts a similar grip on the imagination.

stark: unpleasantly clear and impossible to avoid = harsh
claim the lives: if a war, accident etc claims lives, people die because of it - used especially in news reports
e.g. The earthquake has so far claimed over 3000 lives.
cannot begin to: 根本无法做到
e.g. Even the official numbers do not begin to capture the severity of the problem. 即使是官方数字也未能显示问题的严重性。
capture: If something or someone captures a particular quality, feeling, or atmosphere, they represent or express it successfully.代表（特点);表现,体现(感情、气氛)
e.g. Chef Idris Caldora offers an inspired menu that captures the spirit of the Mediterranean...厨师伊德里斯·卡尔多拉开出一份富有地中海特色的菜单，让人眼前一亮。
mutiny: A mutiny is a rebellion against authority, like when sailors overthrow the captain of a ship or when a class of 8th graders refuses to dissect a frog in biology class.
grip: Someone's grip on something is the power and control they have over it.
e.g. The president maintains an iron grip on his country...总统牢牢地控制着他的国家。

1. 这些数字是触目惊心的。2015年, 癌症夺走880万人的生命。只有心脏病（比癌症）导致更多人死亡。大约40% 的美国人在他们一生中会被告知得了癌症。在非洲它现在是比疟疾更大的杀手。但是, 这些统计数据根本无法体现癌症无声且不妥协的细胞反叛所激起的恐惧。只有阿尔茨海默氏症（老年痴呆症）能对这种想象施加类似的控制。

2. Confronted with this sort of enemy, people understandably focus on the potential for scientific breakthroughs that will deliver a cure. Their hope is not misplaced. Cancer has become more and more survivable over recent decades owing to a host of advances, from genetic sequencing to targeted therapies. The five-year survival rate for leukemia in America has almost doubled, from 34% in the mid-1970s to 63% in 2006-12. America is home to about 15.5m cancer survivors, a number that will grow to 20m in the next ten years. Developing countries have made big gains, too: in parts of Central and South America, survival rates for prostate and breast cancer have jumped by as much as a fifth in only a decade.

3. 面对这类敌人, 人们将重点放在带来治愈方法的科学突破的潜力上，这是可以理解的。他们的希望并无不妥。由于一系列的进展, 从基因测序到针对性疗法, 近几十年来, 癌症已经变得越来越非致命。在美国, 白血病的五年存活率几乎翻了一番, 从1970年代中期的34% 到2006-12年的63% 。美国大约有155万癌症幸存者, 这一数字将在未来十年内增长到2千万。发展中国家也取得了很大的成就: 在中美洲和南美的部分地区, 前列腺癌和乳腺癌的存活率仅仅在十年内就已经跃升了20%。

4. From a purely technical perspective, it is reasonable to expect that science will one day turn most cancers into either chronic diseases or curable ones. But cancer is not fought only in the lab. It is also fought in doctors’ surgeries, in schools, in public-health systems and in government departments. The dispatches from these battlefields are much less encouraging.

dispatches: a message or report sent quickly from one military officer to another or between government officials
e.g. The latest dispatch was held up for three hours at the border.
e.g. He was hailed as a hero, mentioned in dispatches and finally given a medal.他被誉为英雄，得到了通报表彰，最后还获得了一枚勋章

3. 从纯粹的技术角度来看, 有理由期望科学有朝一日将大多数癌症转变为慢性病或可治愈的疾病。但是和癌症的搏斗并不只在实验室里进行。它还在医生的诊所、学校、公共卫生系统和政府部门进行着。这些战场上的战报则要令人沮丧得多。

Cell-side research

4. First, the good news. Caught early, many cancers are now highly treatable. Three out of four British men who received a prostate-cancer diagnosis in the early 1970s did not live for another ten years; today four out of five do. Other cancers, such as those of the lung, pancreas and brain, are harder to find and treat. But as our Technology Quarterly in this issue shows, progress is being made. Techniques to enable early diagnosis include a device designed to detect cancer on the breath; blood tests can track fragments of DNA shed from tumours. Genome sequencing makes it ever easier to identify new drug targets.

shed: pour out in drops or small quantities or as if in drops or small quantities
e.g. Some of the trees were already beginning to shed their leaves.

4. 首先, 好消息。如果及早发现, 许多癌症现在是很有可能被治愈的。七十年代早期四分之三被诊断出前列腺癌的英国男性活不过十年；今天五分之四可以。其他癌症, 如肺癌、胰腺癌和脑癌, 很难被发现并治疗。但是, 正如本期我们的《科技季刊》所示, （此方面）正在取得进展。能够诊断早期癌症的技术包括用呼吸检测癌症的装置；血液测试可以追踪从肿瘤中脱出的 DNA 碎片。基因组测序能更容易确定新药的目标。

5. The established trio of 20th-century cancer treatments—surgery, radiation and chemotherapy—are all still improving. Radiotherapists can create webs of gamma rays, whose intersections deliver doses high enough to kill tumours but which do less damage to healthy tissue as they enter and leave the body. Some new drugs throttle the growth of blood vessels bringing nutrients to tumours; others attack cancer cells’ own DNA-repair kits. Cancer may be relentless; so too is science.

trio: A trio is a group of three people together, especially musicians or singers, or a group of three things that have something in common.
throttle: to make it difficult or impossible for something to succeed
e.g. policies which are throttling many Asian economies
kit: A kit is a group of items that are kept together, often in the same container, because they are all used for similar purposes.
relentless: refusing to give up or be less strict or severe

5. 二十个世纪确立的癌症疗法三件套——手术、放疗和化疗——都还在改进中。放射治疗专科医生可以创建伽玛射线网, 其交叉口提供足够高的剂量以杀死肿瘤, 但在进入和离开身体时对健康组织的损害较小。一些新的药物阻碍给肿瘤带来营养的血管生长；其他药攻击癌细胞自身的 DNA 修复元件。癌症可能是无休无止的；科学也是如此。

6. The greatest excitement is reserved for immunotherapy, a new approach that has emerged in the past few years. The human immune system is equipped with a set of brakes that cancer cells are able to activate; the first immunotherapy treatment in effect disables the brakes, enabling white blood cells to attack the tumours. It is early days, but in a small subset of patients this mechanism has produced long-term remissions that are tantamount to cures. Well over 1,000 clinical trials of such treatments are under way, targeting a wide range of different cancers. It is even now possible to reprogram immune cells to fight cancer better by editing their genomes; the first such gene therapy was approved for use in America last month.

It is early days: used to emphasize that something has just begun, especially when you do not know how it will develop
*e.g. It's early days yet. I don't want to make any predictions. *
remissions: a period when a serious illness improves for a time
e.g. The chemotherapy was successful, and she is now in remission.
tantamount to: When something is tantamount to another thing it is essentially its equivalent. For some animal activists, wearing fur is tantamount to murder.
Well: To a considerable extent or degree 相当地
e.g. well over the estimate 大大地超过预计

6. 最令人兴奋的是免疫疗法, 这是在过去几年中出现的一种新的方法。人体免疫系统配备了一系列的刹车, 癌细胞能够激活它们；第一次免疫治疗事实上使得刹车失灵, 使白细胞能够攻击肿瘤。一切才刚刚开始, 但在一小群病人中, 这种方法已经产生了等同于治愈的长期 缓解。这类治疗的临床试验已经远远超过 1000起, 针对多种不同的癌症。现在甚至可以通过编辑细胞的基因组来重新给免疫细胞编程来更好地抗击癌症。第一个这样的基因治疗上个月在美国被批准使用。

7. Yet cancer sufferers need not wait for the therapies of tomorrow to have a better chance of survival today. Across rich and poor countries, the survivability of cancer varies enormously. Men die at far higher rates than women in some countries; in other countries, at similar levels of development, they do comparably well. The five-year survival rate for a set of three common cancers in America and Canada is above 70%; Germany achieves 64%, whereas Britain manages a mere 52%. Disparities exist within countries, too. America does well in its treatment of cancer overall, but suffers extraordinary inequalities in outcomes. The death rate of black American men from all cancers is 24% higher than it is for white males; breast-cancer death rates among blacks are 42% higher than for whites. A diagnosis in rural America is deadlier than one in its cities.

manage: to succeed in doing something difficult, especially after trying very hard
Disparity: If there is a disparity between two or more things, there is a noticeable difference between them.
deadly: If something is deadly, it is likely or able to cause someone's death, or has already caused someone's death.

7. 然而, 癌症患者不必等待明天的治疗方法来获得今天更好的生存机会。在富国和穷国之间, 癌症的存活率天差地别。在某些国家, 男人死亡率远高于妇女；在类似的发展水平的其他国家, 男人则相对较好。美国和加拿大三种常见癌症的五年生存率高于 70%；德国达到 64%, 而英国仅仅能成功做到52%。国家内部也存在着差异。总的来说, 美国在治疗癌症方面做得很好, 但在结果上却是非常不平等的。美国黑人男性的死亡率比白人男性高出 24%；黑人中的乳腺癌死亡率比白人高42%。美国农村地区诊断出癌症比在城市更致命。

Practical as well as pioneering

8. Variations between countries are partly a reflection of health-care spending: more than half of patients requiring radiotherapy in low- and middle-income countries do not have access to treatment. But big budgets do not guarantee good outcomes. Iceland and Portugal do not outspend England and Denmark on health care as a proportion of GDP, but past studies show wide variation in survivability in all cancers.

low- and middle-income countries：由短横线（hyphen）连接的合成词并列时可以进行省略
have access to: have the opportunity or right to use sth or to see sb/sth
outspend: to spend more money than another person or organization

8. 国家间的差异部分地反映了医疗保健支出（的差异）: 在低收入和中等收入国家中, 需要放疗的患者中有一半以上不能有机会获得治疗。但是大预算并不能保证好的结果。从占国内生产总值的比例上来看，冰岛和葡萄牙在医疗保健上的花费没有超过英国和丹麦, 但过去的研究显示, （它们）在所有癌症的生存率上有很大的差异。

9. Instead, the problem is often how money is spent, not how much of it there is. To take one example, a vaccine exists against the human papillomavirus (HPV), which causes cancers of the cervix in women, as well as cancers of the head and neck. Rwanda started a programme of routine vaccination in 2011, and aims to eradicate cervical cancer by 2020. Other countries are far less systematic. Vaccinations could help prevent cervical cancer in 120,000 Indian women each year.

Vaccinations could help... 这句是虚拟语气，表示“本可能，本能够……”

9. 相反, 问题往往在于钱是怎么花的, 而不是它有多少。举一个例子, 一种疫苗存可用于抵抗人类乳头状瘤病毒, 这种病毒会导致女性子宫颈癌, 以及头部和颈部的癌症。卢旺达于2011年开始实施例行疫苗接种方案, 目的是在2020年之前根除子宫颈癌。其他国家则远没有这么系统性。每年有12万印度妇女本可以接种疫苗来预防子宫颈癌。

10. Policymakers are not powerless. More can be done to verify which treatments (and combinations thereof) work best. A £1.3bn ($2bn) cancer-drug fund in England, which made expensive new medicines easier to obtain, did not assess the efficacy of the drugs it provided—a huge missed opportunity. Measuring the incidence and survival of cancer, through cancer registries, spotlights where patients are being failed. Access to health care matters, too: the number of Americans whose cancers were diagnosed at the earliest possible opportunity went up after Obamacare was enacted. And prevention remains the best cure of all. Efforts to rein in tobacco use averted 22m deaths (many of them to cancer) between 2008 and 2014. Yet only a tenth of the world’s population lives in countries where taxes make up at least three-quarters of the price of cigarettes, as recommended by the World Health Organisation.

spotlight: If something spotlights a particular problem or situation, it makes people notice it and think about it.
fail: to disappoint sb; to be unable to help when needed
e.g. When he lost his job, he felt he had failed his family.
e.g. She tried to be brave, but her courage failed her.
e.g. (figurative) Words fail me(= I cannot express how I feel).
at the first/earliest (possible) opportunity: as soon as possible
rein in: to start to control sb/sth more strictly = check
e.g. She kept her emotions tightly reined in.

10. 政策制定者并非无能为力。（他们）可以采取更多行动来验证哪些治疗 (及其中的组合) 效果最好。在英国，曾有一笔13亿英镑 (20亿美元) 的癌症药物基金使得（人们）更容易获取昂贵的新药，却并没有评估它提供的药物的功效——错失了一个重大的机会。通过癌症登记处来衡量癌症的发病率和生存率使得那些病人不能获得帮助的地方受到关注。获得医疗保健的机会也有影响: 在奥巴马医改法案颁布后, 被尽可能早诊断出癌症的美国人的数量上升了。预防仍然是最好的治疗方法。在2008年和2014年之间控制烟草使用的努力避免了2200万人死亡 (其中许多是癌症)。然而, 世界上只有十分之一的人口，正如世界卫生组织 (WHO) 所建议的那样，生活在税收占卷烟价格至少四分之三的国家。

11. Taxes and budgeting are a lot less exciting than tumour-zapping proton beams and antibodies with superpowers. But the decisions of technocrats are as important as the work of technicians. Cancer kills millions of people not simply for want of scientific advance, but also because of bad policy.

zap: to quickly attack or destroy something, especially using a beam of electricity
technocrats: A technocrat is a scientist, engineer, or other expert who is one of a group of similar people who have political power as well as technical knowledge.
want: something that you need but do not have
e.g. a want of manners and charm...缺乏风度和魅力
e.g. The men were daily becoming weaker from want of rest..

11. 税收和预算不如杀死肿瘤的质子束和有超强力的抗体令人兴奋。但技术专家官员的决定和技术专家的工作一样重要。癌症杀死数百万人不仅是因为缺乏科学的进步, 而且还因为糟糕的政策。

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原文出处：经济学人

翻译：七呵夫

本译文仅供个人研习、欣赏语言之用，谢绝任何转载及用于任何商业用途。本译文不代表本人立场。本人同意简书平台在接获有关著作权人的通知后，删除文章。