好英语网肺癌并非瘾君子专利 不吸烟有时也难免
As a lung cancer researcher and patient advocate at Trinity College Dublin, Anne-Marie Baird gets mixed responses when she tells people about her profession. One of the more memorable was when, at a scientific conference, she was asked “Why would you even bother researching that? They deserve it – and they’re all going to die anyway.”
贝尔德（Anne-Marie Baird）是都柏林三一学院（Trinity College Dublin）的一名肺癌研究员和肺癌病人关注者。她在向人们介绍自己的职业时常常会听到不同的反应。令她印象较深的是有次在一个科学会议上，有人问她"你干嘛费劲去研究那个？肺癌患者是自己找死——无论如何这些人都难逃死劫。"
Lung cancer is the most common cancer globally, with 1.8 million new cases diagnosed worldwide in 2012 (the most up-to-date figures available). Although 58% of new cases were in developing countries, the disease is a widespread problem – 45,000 people are diagnosed with it annually in the UK, 230,000 in the US and 12,500 in Australia.
肺癌是全球最常见的癌症，2012年全世界的新确诊病例有180万宗（是当前最新统计数据）。虽然58%的新病例出现在发展中国家，但这一疾病却是全球性的——英国每年有4.5万人确诊，美国23万人，澳大利亚1.25万人。
Making matters worse, over the last few decades, patient survival has barely improved. In 1971-1972, the chance of surviving for 10 years after diagnosis was just 3%. By 2010-2011, 5%. Over the same period, a woman with breast cancer nearly doubled her chance of living 10 years after diagnosis – from 40% to 78.5%.
更为糟糕的是，几十年来肺癌的治愈率几乎没有提升。在1971-1972年间，病人在确诊后能够继续生活十年的概率只有3%。到了2010-2011年间，这一数字是5%。而同一时期女性乳腺癌的死亡率则下降了34%。
A common view of lung cancer is that it is self-inflicted by smoking – and that the problem will eventually disappear when everyone gives up the habit. But aside from the fact that none of this helps former or current smokers who currently have the disease, there are two major flaws with this thinking.
人们普遍认为，肺癌是因为吸烟恶习自我造成的，任何人只要能够戒烟这一问题最终会消失。然而对于正患有肺癌的人来说，无论你已戒烟或现在还在抽，此说根本无济于事。除此之外，人们的这种观念还有两个主要错误。
First, lung cancer cases aren’t declining across the board.
首先，肺癌病例并未因戒烟而全面下降。
The gender gap is one obvious example. More men than women still are diagnosed with lung cancer – in the US, a man’s lifetime risk is 1 in 15 while a woman’s is 1 in 17. But while a recent US study found that rate of lung cancer among men continues to fall, in young white women it has increased. And globally, while the number of men diagnosed with lung cancer has dropped over the last two decades, among women it’s risen by 27%.
性别差异是一个明显的例子。确诊肺癌的人当中男性仍然多于女性——在美国，男性一生中罹患肺癌的概率是1/15，女性则是1/17。然而美国最近一项研究发现，男性的肺癌发病率在持续下降，但年轻的白人女性发病率却增加了。过去20年内全球男性确诊肺癌的比列下降，女性则增加了27%。
Researchers aren’t sure why. But there is some science to suggest that women might react differently to nicotine, and that women’s DNA is damaged more easily and more profoundly by carcinogens in tobacco.
研究人员尚不能确定原因。但是有一些科学研究认为，女性对于尼古丁的反应可能和男性不一样，烟草中的致癌物质对女性的DNA更容易造成损害，而且损害程度也更深。
The health risks to women also may be becoming apparent later because women began smoking after men. Few women smoked in the 1920s in the US, for example. But as the habit began to be marketed – and seen – as a symbol of emancipation, female smoking rates rose. One study of more than 100 countries found that the link between gender equality and female smoking rates endures.
女性吸烟的健康风险日后可能更为显着，因为女性开始吸烟的时间晚于男性。比如在美国，20世纪20年代很少有女性吸烟。但随着吸烟开始成为大众消费，并且吸烟被当作个性解放的一种象征，女性吸烟者开始增加。一项曾在100多个国家展开过的研究调查结果发现，性别平等、女性地位的上升与女性吸烟率的上升是相关联的。
“In countries where women have higher empowerment, women’s smoking rates are higher than men’s,” write researchers Sara Hitchman and Geoffrey Fong.
研究员希契曼（Sara Hitchman）和冯（Geoffrey Fong）在报告中写道， "在女性享有更大权利的国家，女性的吸烟率高于男性。"
As a result, though men are five times as likely to smoke as women globally, that’s not true in many countries. In the US, 22% of men and 15% of women smoke; in Australia, 19% of men and 13% of women. And the younger the cohort, the less of a gender gap. Of 13 to 15-year-olds, 12% of girls smoke compared to under 15% of boys in the US; in Australia, 5% of adolescents of both ages. In France and the UK, more 15-year-old girls smoke than 15-year-old boys.
结果是，尽管全球男性的吸烟率是女性的5倍，但在很多国家却并非如此。在美国，男性有22%吸烟，女性则有15%；在澳大利亚，男性为19%，女性则有13%。越年轻的人群当中吸烟率的性别差异也越小。在美国13-15岁的人当中，女孩有12%吸烟，男孩则低于15%；澳大利亚的青少年中男孩和女孩的吸烟率均为5%。在法国和英国，15岁的女孩吸烟人数甚至高于同龄的男孩吸烟人数。
“Women’s empowerment must continue,” write Hitchman and Fong. “But does the bad necessarily have to follow from the good?”
"女性必须继续享有权利，"希契曼（Sara Hitchman）和冯写道。"但是为了这个正确的目的就一定要接受这个坏的习惯吗？"
Second hand
二手烟
But while smoking causes approximately 85% of lung cancers – and the single biggest thing we can do to reduce our risk of getting lung (and other) cancers is not to smoke – not smoking is not a guarantee.
然而尽管大约85%的肺癌是吸烟引发的——我们要降低患肺癌（或者其他癌症）的风险最该做的也就是不吸烟——但不吸烟并不能确保我们不患癌。
“Non-smoking lung cancer is not a trivial issue,” says Charles Swanton, chief clinician of Cancer Research UK. “In my practice, 5-10% of patients have never smoked.”
斯旺顿（Charles Swanton）是帝国癌症研究基金会（Cancer Research UK）的首席临床医师，他说，"我们并不能小看非吸烟因素导致的肺癌，在我的医疗实践中，5-10%的患者从来不吸烟。"
This, too, seems to affect women differently: one study has found that one in five women who develop lung cancer have never smoked, compared to one in 10 men. A review of lung cancer patients undergoing surgery from 2008 to 2014 in the UK, meanwhile, found that 67% of those who never had smoked were female.
而这对女性的影响似乎也不一样：一项研究发现，患肺癌的女性中有五分之一从来不吸烟，患肺癌的男性中这一比例则为十分之一。英国曾经有一项研究，研究对象是在2008-2014年间接受过手术的肺癌患者，研究发现从来不吸烟的肺癌患者中67%是女性。
Part of this disparity likely stems from the exposure of non-smoking women to secondhand smoke. Even if women have been catching up in some countries, the fact that more men than women historically have smoked means the chance of a non-smoking woman being married to a husband who smokes is higher than vice versa.
产生这种差异的部分原因很可能在于不吸烟的女性接触过二手烟。尽管在一些国家吸烟女性的数目和吸烟男性的数目差距一直在缩小，然而从历史上来看吸烟的男性还是多于女性，这也就是说妻子不吸烟而丈夫吸烟的概率要高于妻子吸烟而丈夫不吸烟。
Making matters worse, as the World Health Organisation points out, “Women and children often lack power to negotiate smoke-free spaces, including in their homes.” Secondhand smoke increases the chance of a non-smoker getting lung cancer by 20-30% and causes 430,000 deaths worldwide each year – 64% of which are women.
更糟糕的是，世界卫生组织（World Health Organisation）指出，"女性和儿童常常没法获得一个非吸烟的环境，包括在自己的家中。"吸食二手烟会令不吸烟者换肺癌的概率增加20-30%，而且全球每年有43万人死于吸食二手烟，其中64%为女性。
Gender-based roles may also be relevant in some situations. The use of indoor coal fires for cooking and heating have been linked to lung cancer in non-smoking women in China, and certain Indian cooking fuels have similarly been shown to increase risk of lung cancer.
在有些情况下，性别所决定的家庭角色可能也是其中一个因素。在中国，煮饭和供暖产生的室内煤火与不吸烟女性罹患肺癌有关。与此类似的是，人们已经证明某些印度家庭煮饭用的燃料可以增加患肺癌的风险。
Meanwhile, the proportion of lung cancer patients who never have smoked is going up. One US study reported that 17% of people diagnosed with the most common form of lung cancer in 2011-2013 had never smoked, compared to 8.9% of people diagnosed in 1990-1995. In the UK, researchers reported that the proportion of non-smokers undergoing surgery for lung cancer jumped from 13% to 28% from 2008 to 2014.
而肺癌患者中不吸烟者的比例正在上升。据一项美国研究报道，2011-2013年间，被确诊为肺癌最常见类型的人当中有17%从不吸烟，而1990-1995年间这一数字是8.9%。在英国，研究人员指出，接受肺癌手术的患者当中不吸烟者的比例从2008年的13%上升到了2014年的28%。
These proportions may represent fewer people smoking overall, even as other risk factors (say, cooking fumes) remain equally dangerous. It’s also important to remember that the majority of lung cancer patients remain smokers.
这些数据表明患者中的吸烟者整体有所减少，即使其他风险性因素（比如说煮饭产生的油烟）的危害程度维持不变。不过同样重要的是，我们得记住肺癌患者大多数仍然是吸烟者。
But even small percentages have an impact: just 0.2% of the female non-smokers in the UK Million Women Study were diagnosed with lung cancer, but that adds up to 1,469 women who had never smoked getting the disease.
然而比例尽管较低，产生的影响却很大：英国的百万女性研究（Million Women Study）显示，不吸烟的女性中确诊肺癌的比例只有0.2%，但这一比例对应的人数却达到1469人，即1469位从不吸烟的女性患上了肺癌。
Smoking-related lung cancers and non-smoking related lung cancers are very different. Different genes are changed, or mutated, in each. For non-smokers, cancer is more commonly caused by changes in the EGFR gene – which can be targeted by relatively new and effective lung cancer drugs.
吸烟者所患的肺癌和不吸烟者所患的肺癌是很不一样的。两者体内产生变化或者变异的基因不同。不吸烟者所患的肺癌更多地是因为EGFR基因发生了改变，而这可以通过相对较新及较为有效的抗癌药物来做针对性的标靶治疗。
Cancer cause
致癌原因
In general, cancers develop when the normal processes which keep us healthy and alive by making new cells go wrong. Carcinogenic chemicals, ultraviolet light and viruses can all damage the DNA in cells, causing a cancerous malfunction. But in many cancers there isn’t an identifiable, external risk – and this may be the case for some of the non-smokers who get lung cancer.
通常来说，人体是通过不断产生新的细胞来替代死去的细胞，以维持人的生存并保持健康，当增生新细胞的过程紊乱出错时便会导致癌症。致癌的化学物质、紫外光和病毒都可以损伤细胞的DNA，导致病变的机能失常。然而很多癌症并没有可识别的外部风险——一些不吸烟的人患上肺癌或许就是这种情况。
But aside from coal fires and cooking fuels, there are other factors, such as radon gas or asbestos, which can increase a person’s chances of getting lung cancer.
不过除了煤火和煮饭的油烟之外还有其他因素，比如说氡气或石棉，这些物质都能增加人体患肺癌的几率。
There also have been fears – and headlines – about air pollution, which was listed as a carcinogen by the International Agency for Research on Cancer in 2013. The agency estimated that 223,000 annual lung cancer deaths could be attributed to PM2.5s, tiny particles that come from diesel exhausts and construction. More than half of these deaths were in China and other East Asian countries, which have seen rapid industrialisation and resulting smoggy cities. In the UK, about eight in 100 lung cancer cases each year stem from exposure to PM2.5s. (Find out more about air pollution and its effects in the BBC series So I can breathe).
空气污染同样令人担忧，这一问题经常登上新闻报道的头条，国际癌症研究机构（International Agency for Research on Cancer）在2013年将空气污染列为致癌因素。该机构估计，每年有22.3万人死于肺癌，其因可以归咎于PM2.5，一种来自于柴油尾气和建筑施工悬浮在空气中的微型颗粒物。这些死于肺癌的人超过一半生活在中国和其他东亚国家，这些国家经历了快速的工业化进程，造成了许多烟雾弥漫的城市。在英国，每年100个肺癌案例中约有8个是因为接触了PM2.5。
Still, as Cancer Research UK puts it: “Air pollution increases the risk of lung cancer but the risk is small for each individual so it’s important to keep this in perspective and not shut yourself away because it’s difficult to avoid some air pollution.”
不过正如帝国癌症研究基金会所说："空气污染虽然增加了人们患肺癌的风险，但对每个个体来说风险还是很小的，所以重点在于我们要认清这一点，不要躲在室内不出去，因为要想避免让自己受到空气污染的影响是很困难的。"
Smoke screen
烟幕
Despite the media attention paid to non-smoking-related risks, most non-smokers have a “false sense of safety” about lung cancer – which can make matters worse. If they see lung cancer as unlikely, even when their symptoms are typical they tend not spot them early enough, so they tend to be diagnosed when their cancer is at an advanced stage.
尽管媒体的焦点常常集中在非吸烟因素所构成的风险上，大多数不吸烟的人对肺癌却有一种"错误的安全感"——这会让事情更加糟糕。如果他们认为自己不太可能患上肺癌，甚至当症状非常明显的时候他们却往往没有及早察觉到，但到他们有可能被确诊为肺癌时，癌症已经处于晚期。
That makes it much more difficult to treat. Within a year of diagnosis, 70% of lung cancer patients whose disease was caught early will still be alive, compared with just 14% of patients whose tumour was already at an advanced stage.
晚期治疗起来更加困难。在确诊后的一年内，早期肺癌患者70%的仍然可以存活，如果确诊时已经处于癌症晚期，那么这一存活率就只有14%。
“Anybody who has sinister chest symptoms needs to seek urgent medical advice, especially if these are long-term or not resolved with antibiotics,” Swanton says. In particular, coughing up blood is “a red flag symptom”, whether someone ever has smoked or not.
斯旺顿说，"任何人只要胸部出现令人不安的症状都要立即寻求医疗建议，尤其是如果这些症状长期存在，或者使用了抗生素也无法缓解。"特别值得一提的是，咳嗽出血是一个"危险症状"，不论咳嗽者是否吸烟。
After being diagnosed, the stigma of lung cancer can also be difficult. “Not a lot of people want to come out and say, ‘I’m a lung cancer patient’,” Baird says. “With breast and other cancers, people say it more freely.”
确诊之后，肺癌带给患者的耻辱同样会令事件难以处理。贝尔德说，"没有很多人愿意站出来说'我是肺癌患者。如果是乳腺癌或者其他癌症，病人会更坦率地说出来。"
Due to the general assumption that people with lung cancer are smokers, those who have never taken a puff still suffer from the stigma that they ‘caused’ their own disease, either.
人们一般认为肺癌患者都是吸烟者，所以那些从不吸烟的患者也会受到这种陈见的伤害，因为有人会说他们是"咎由自取"。
US researchers interviewed lung cancer patients including smokers, recent quitters, and never-smokers. Even some of the never-smokers reported negative responses from their medical team.
美国的研究人员采访过一些肺癌患者，其中包括吸烟者，刚戒烟的人以及从不吸烟的人。一些从不吸烟的人甚至讲述了自己遭受到医疗人员对他们的负面对待。
One participant who had never smoked told the researchers: “The first negative reaction I got was in the hospital, from the respiratory therapist… She said this under her breath while I was having respiratory therapy post-op, ‘That’s what you get for smoking.’”
一位从不吸烟的受访者告诉研究人员："我收到的第一个负面反应发生在医院，来自一位呼吸治疗师……我当时正在接受术后呼吸治疗，只听她窃窃私语地说，'这就是吸烟导致的后果。'"
That stigma has also meant that lung cancer receives only a small share of the billions of dollars globally that are ploughed into researching cancer. In Canada, for example, which has the second-highest rate of lung cancer in the world, the disease receives just 7% of research funding – despite causing 25% of cancer deaths. The opposite has been reported for breast cancer.
对肺癌的这种陈见导致的后果是：全世界投入到癌症研究领域的数十亿资金里面只有很少一部分用于肺癌研究。以加拿大为例，加拿大是全球肺癌发病率第二高的国家，在这里肺癌的研究资金所占比例仅为7%——而肺癌造成的死亡人数比例却高达25%。而乳腺癌的情况却恰恰相反。
Still, there are reasons to be hopeful. In the last few years UK expenditure on lung cancer research, for example, has been climbing, making up 11.5% of the total money spent on total cancer research in the 2016-17 financial year.
不过人们还是很有乐观的理由。例如过去几年间英国对于肺癌研究的支出在不断增加，2016-2017财年所有癌症研究资金中肺癌研究的资金占比达到了11.5%。
Meanwhile, Swanton is leading the £14 million TRACERx study, which will examine how lung cancers change over time in 850 patients. Studies like this give researchers the potential to delve deeper into the differences from patient to patient, between smokers and non-smokers, men and women. Understanding these differences makes it possible to design more effective treatments for individual patients.
而斯旺顿正在负责一项耗资1400万英镑的追踪者（TRACERx）研究项目，这一研究项目将会检测850位患者体内肺癌情况的变化。诸如此类的项目让研究人员可以更深入地探究患者与患者间的差异， 如吸烟者和非吸烟者患者、以及男性与女性患者的差异。弄清楚这些差异之后，人们就可以设计出针对各个患者的更有效的治疗方案。
The future of lung cancer is a more hopeful one. But a catchphrase used by those campaigning for more funding into research for lung cancer should serve as a reminder to all of us about what is at stake.
对于肺癌治疗的未来人们更加充满希望。然而呼吁社会投入更多资金用于肺癌研究时所采用的标语应该提醒大家，我们正处于危急关头的是什么。
“Lung cancer doesn’t discriminate, and neither should you.”
"人人都可能患肺癌，因此请不要歧视肺癌患者。"