[Annotated] Closing in on cancer

Science will win the technical battle against^[각주:1] cancer. But that is only half the fight

The numbers are stark^[각주:2]. Cancer claimed the lives of 8.8m people in 2015; only heart disease caused more deaths^[각주:3]. Around 40% of Americans will be told they have cancer during their lifetimes^[각주:4]. It is now a bigger killer of Africans than malaria. But the statistics do not begin to capture the fear^[각주:5] inspired by^[각주:6] cancer's silent and implacable^[각주:7] cellular^[각주:8] mutiny^[각주:9]. Only Alzheimer's exerts a similar grip^[각주:10] on^[각주:11] the imagination.

Confronted with this sort of enemy, people understandably^[각주:12] focus on the potential for^[각주:13] scientific breakthroughs^[각주:14] that will deliver a cure^[각주:15]. their hope is not misplaced^[각주:16]. Cancer has become more and more survivable^[각주:17] over recent decades owing to^[각주:18] a host of^[각주:19] advances^[각주:20], from genetic sequencing to targeted therapies^[각주:21]. The five-year survival rate for^[각주:22] leukemia^[각주:23] 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^[각주:24] and breast cancer have jumped by as much as a fifth in only a decade^[각주:25]. 

From a purely^[각주:26] technical perspective^[각주:27], it is reasonable to expect that science will one day turn most cancers into either chronic diseases^[각주:28] or curable ones^[각주:29]. But cancer is not fought only in the lab. It is also fought in doctor's surgeries^[각주:30], in schools, in public-health systems and in government departments. The dispatches from these battlefields are much less encouraging.

Cell-side research

First, the good news. Caught early, many cancers are now highly treatable^[각주:31]. Three out of four British men who received a prostate-cancer diagnosis^[각주:32] 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^[각주:33] 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^[각주:34]; blood tests can track^[각주:35] fragments of^[각주:36] DNA shed from^[각주:37] tumors. Genome sequencing^[각주:38] makes it ever easier to identify new drug targets. 

The established trio of^[각주:39] 20th-century cancer treatments - surgery, radiation and chemotherapy^[각주:40] - are all still improving. Radiotherapists^[각주:41] can create webs of gamma rays^[각주:42], whose intersections^[각주:43] deliver doses^[각주:44] high enough to kill tumors but which do less damage to healthy tissue^[각주:45] as they enter and leave the body. Some new drugs throttle the growth of^[각주:46] blood vessels^[각주:47] bringing nutrients to tumors; others attack cancer cells' own DNA-repair kits. Cancer may be relentless^[각주:48]; so too is science. 

The greatest excitement is reserved for^[각주:49] immunotherapy^[각주:50], a new approach that has emerged in the past few years. The human immune system^[각주:51] is equipped with^[각주:52] a set of brakes^[각주:53] that cancer cells are able to activate; the first immunotherapy treatment in effect disables the brakes, enabling white blood cells^[각주:54] to attack the tumors. It is early days, but in a small subset of^[각주:55] patients this mechanism^[각주:56] has produced long-term^[각주:57] remissions^[각주:58] that are tantamount to cures^[각주:59]. Well over 1,000 clinical trials of^[각주:60] such treatments are under way^[각주:61], targeting a wide range of different cancers. It is even now possible to reprogram^[각주:62] immune cells^[각주:63] to fight cancer better by editing their genomes; the first such gene therapy^[각주:64] was approved for use^[각주:65] in America last month. 

Yet cancer sufferers^[각주:66] need not wait for the therapies of tomorrow to have a better chance of survival today. Across rich and poor countries, the survivability of^[각주:67] 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^[각주:68]. 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^[각주:69] exist within countries, too. America does well in its treatment of cancer overall, but suffers extraordinary inequalities^[각주:70] in outcomes^[각주:71]. 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^[각주:72] one in its cities. 

Practical as well as pioneering^[각주:73]

Variations between^[각주:74] countries are partly^[각주:75] a reflection of^[각주:76] 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^[각주:77] do not guarantee good outcomes. Iceland and Portugal do not outspend^[각주:78] England and Denmark on health care as a proportion of^[각주:79] GDP, but past studies show wide variation^[각주:80] in survivability in all cancers.

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)^[각주:81], which causes cancers of the cervix^[각주:82] in women, as well as cancers of the head and neck. Rwanda started a programme of routine^[각주:83] vaccination^[각주:84] in 2011, and aims to eradicate^[각주:85] cervical cancer by 2020. Other countries are far less systematic. Vaccinations could help prevent cervical cancer^[각주:86] 120,000 Indian women each year. 

Policymakers^[각주:87] are not powerless^[각주:88]. More can be done to verify^[각주:89] which treatments (and combinations thereof^[각주:90]) work best. A £1.3bn ($2bn) cancer-drug fund^[각주:91] in England, which made expensive new^[각주:92] medicines easier to obtain^[각주:93], did not assess^[각주:94] the efficacy^[각주:95] of the drugs it provided - a huge missed opportunity. Measuring the incidence and survival of cancer, through cancer registries^[각주:96], spotlights where^[각주:97] 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^[각주:98]. And prevention remains the best cure of all. Efforts to rein in^[각주:99] tobacco use averted 22m deaths^[각주:100] (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 Organization.

Taxes and budgeting are a lot less exciting than tumor-zapping^[각주:101] proton beams^[각주:102] and antibodies^[각주:103] with superpowers. But the decisions of technocrats^[각주:104] are as important as the work of technicians. Cancer kills millions of people not simply for want of^[각주:105] scientific advance^[각주:106], but also because of bad policy. 

1. battle against ; …와 싸우다, 투병 [본문으로]
2. stark ; 2. (불쾌하지만 피할 수 없는) 냉혹한[엄연한] [본문으로]
3. claim ; 6. CAUSE DEATH | [타동사][VN] (재난・사고 등이) (목숨을) 앗아 가다 [본문으로]
4. during[in] one's lifetime ; 살아생전에, 일생동안 [본문으로]
5. capture ; 5. FEELING/ATMOSPHERE | (사진이나 글로 감정・분위기 등을) 정확히 포착하다[담아내다] [본문으로]
6. inspire ; 3. [타동사][VN] ~ sb (with sth) | ~ sth (in sb) (감정 등을) 불어넣다[고취시키다] [본문으로]
7. implacable ; 1. (강하게 부정적인 의견이나 감정이) 확고한, 바꿀 수 없는 [본문으로]
8. cellular ; 1. 세포의 [본문으로]
9. mutiny ; [U , C] (pl. -ies) (특히 군인・선원들의) 반란[폭동] [본문으로]
10. grip ; 3. UNDERSTANDING | [sing.] ~ (on sth) 이해, 파악 [본문으로]
11. exert ; 1. (권력・영향력을) 가하다[행사하다] [본문으로]
12. understandably ; [부사] 당연하게도, 당연히 [본문으로]
13. a potential for ; …의 가능성. [본문으로]
14. scientific breakthrough ; 과학적으로 획기적인 성과, 과학의 커다란 진보, 과학적 발전 [본문으로]
15. deliver ; 3. KEEP PROMISE | ~ (on sth) (약속을) 지키다; (사람들의 기대대로 결과를) 내놓다[산출하다] [본문으로]
16. misplace ; [타동사][VN] (특히 짧은 시간 동안 무엇을) 제자리에 두지 않다(그래서 찾지를 못하다) [본문으로]
17. survivable ; [형용사] 사고・경험에서 살아남을 수 있는, 생존 가능한 [본문으로]
18. owing to ; [전치사] … 때문에 [본문으로]
19. a host of ; 다수의, 많은 [본문으로]
20. advance ; 2. DEVELOPMENT | [C , U] ~ (in sth) 진전, 발전 [본문으로]
21. targeted therapy ; 표적치료, 표적치료제 [본문으로]
22. survival rate ; 생존율 [본문으로]
23. leukemia ; [명사] (병리) 백혈병 ;; US [lu:kí:miə] UK [lju:-] [본문으로]
24. prostate ; [명사] (또한 |prostate gland) 전립선 [본문으로]
25. in only a decade ; 불과 10년 새에 [본문으로]
26. purely ; [부사] 순전히, 전적으로, 오직 [본문으로]
27. technical perspective ; 기술적 관점, 기술적 측면 [본문으로]
28. chronic disease ; 만성질환 [본문으로]
29. curable ; [형용사] 병이 치유 가능한 [본문으로]
30. surgery ; 3. [C] (美 office) (英) (의사의) 진료소 [본문으로]
31. treatable ; [형용사] 처리할 수 있는, 치료할 수 있는 [본문으로]
32. diagnosis ; [C , U] (pl. diag・noses / -siːz /) ~ (of sth) 진단 [본문으로]
33. pancreas ; [명사] 췌장 [본문으로]
34. breath ; 1. [U] (숨을 쉴 때 입에서 나오는) 입김[숨] [본문으로]
35. track ; 2. FOLLOW | (특히 특수 전자 장비를 이용하여) 추적하다 [본문으로]
36. fragment ; [명사] 조각, 파편 [본문으로]
37. shed ; 2. <잎 등을> 저절로 떨어지게 하다, <가죽·껍질·뿔 등을> 벗다, 갈다, 탈락시키다; <옷을> 벗어버리다; <무용지물·나쁜 버릇을> 버리다; 해고하다; 이혼하다 [본문으로]
38. genome sequencing ; 유전체 배열 [본문으로]
39. trio ; (pl. -os) 1. [C+sing./pl. v.] 3인조, 3개가 한 조로 된 것 ;; 참고 ; duo [본문으로]
40. chemotherapy ; [U] (특히 암에 대한) 화학 요법 ;; 참고 ; radiation, radiotherapy [본문으로]
41. radiotherapist ; [명사] 방사선 치료사 [본문으로]
42. gamma rays ; (의학) 감마선(~線). 핵반응에 의하여 원자핵으로부터 방출되는 단파장의 전자방사선, 고에너지 광자로부터 이루어지며, 질량, 하전 모두 없고, 광속으로 진행하며, 보통 β선을 동반한다. ;; 참고 ; ray [본문으로]
43. intersection ; 1. [C] 교차로, 교차 지점 [본문으로]
44. dose ; 2. (비격식) (어느 정도의) 양, 약간 [본문으로]
45. tissue ; 1. [U] (tis・sues [pl.]) (세포들로 이뤄진) 조직 [본문으로]
46. throttle ; [타동사][VN] 목을 조르다; 목을 졸라 죽이다 [본문으로]
47. blood vessel ; [명사] 혈관 ;; 참고 ; artery, capillary, vein [본문으로]
48. relentless ; 1. 수그러들지 않는, 끈질긴 [본문으로]
49. reserve ; 2. ~ sth (for sb/sth) (자리 등을) 따로 잡아[남겨] 두다; (판단 등을) 보류[유보]하다 [본문으로]
50. immunotherapy ; [명사] (의학) 면역 요법, 면역제 치료법 [본문으로]
51. immune system ; [명사] 면역 체계 [본문으로]
52. be equipped with ; ~을 갖추고 있다, 비치되어 있다, 장착되어 있다 [본문으로]
53. brake ; 2. ~ (on sth) 제동(을 거는 것) [본문으로]
54. white blood cells ; 백혈구(白血球) [본문으로]
55. subset ; [명사] (전문 용어) 부분 집합 [본문으로]
56. mechanism ; 3. (생물체 내에서 특정한 기능을 수행하는) 구조[기제] [본문으로]
57. long-term ; [주로 명사 앞에 씀], (참고: short-term) 1. 장기적인(오랫동안 지속되거나 효과가 있는) [본문으로]
58. remission ; [U , C] 1. (병의) 차도 [본문으로]
59. tantamount to ; …에 버금가는. [본문으로]
60. clinical trial ; (의학) 임상 시험 [본문으로]
61. be under way ; have started and be now progressing or taking place [본문으로]
62. reprogram ; [타동사, 자동사] (컴퓨터) 프로그램을 다시 만들다 ;; 굳이 컴퓨터 분야가 아니라도 활용 가능한 것을 확인 [본문으로]
63. immune cell ; 면역세포 [본문으로]
64. gene therapy ; [명사] (의학) 유전자 치료 [본문으로]
65. be approved for ; ~의 대한 것을 승인, 허용하다 [본문으로]
66. sufferer ; [명사] 고통받는[괴로워하는] 사람, (특히) 환자 [본문으로]
67. survivability ; [명사] 살아 남을 수 있는 힘; 생존 가능성. [본문으로]
68. comparably ; [부사] 비교할 수 있을 만큼; 동등하게 [본문으로]
69. disparity ; [U , C] (pl. -ies) (격식) (특히 한쪽에 불공평한) 차이 [본문으로]
70. inequality ; [U , C] (pl. -ies) 불평등, 불균등 [본문으로]
71. outcome ; [명사] 결과 [본문으로]
72. deadly ; (dead・lier , dead・li・est), (more deadly와 deadliest가 일반적으로 쓰이는 형태이다. most deadly도 쓰이기는 한다.) 1. 생명을 앗아가는[앗아갈], 치명적인 [본문으로]
73. pioneering ; [형용사] (주로 명사 앞에 씀) 개척[선구]적인 [본문으로]
74. variation ; 1. [C , U] ~ (in/of sth) (특히 양・정도의) 변화[차이] [본문으로]
75. partly ; [부사] 부분적으로, 어느 정도 [본문으로]
76. reflection ; 3. [C] (상태・속성 등의) 반영 [본문으로]
77. big budget ; 고 예산, 많은 예산 [본문으로]
78. outspend ; [타동사] (-spent[-spént]) …보다 많이 쓰다 [본문으로]
79. proportion ; 1. PART OF WHOLE | [C+sing./pl. v.] (전체의) 부분, (전체에서 차지하는) 비율 [본문으로]
80. wide variation ; [명사] 큰 폭의 변화[차이] ;; variation ; 1. [C , U] ~ (in/of sth) (특히 양・정도의) 변화[차이] [본문으로]
81. Human papillomavirus ; 인간 유두종바이러스 ;; US·UK [pæ̀pəlóuməvàiərəs] [본문으로]
82. cervix ; [명사] pl. cer・vi・ces / -vIsiːz / 또는 cer・vi・xes / -vIksIz / (해부) 자궁 경관 ;; US [|sɜ:rvɪks] UK [|sɜ:vɪks] [본문으로]
83. routine ; [주로 명사 앞에 씀] 1. 정례적인 [본문으로]
84. vaccination ; 1. [UC] 백신[예방] 접종, ((특히)) 종두 [본문으로]
85. eradicate ; [타동사][VN] ~ sth (from sth) 근절하다, 뿌리뽑다 [본문으로]
86. cervical cancer ; [명사] (생명과학) 자궁경부암(子宮頸部癌) [본문으로]
87. policymaker ; [명사] 정책 입안자[담당자] [본문으로]
88. powerless ; 1. 힘없는, 무력한 [본문으로]
89. verify ; 2. 입증하다, (진실이라고・정확하다고) 확인해[말해] 주다 [본문으로]
90. thereof ; [부사] (격식 또는 법률) (앞에 언급된) 그것의 [본문으로]
91. cancer drug ; [명사] any of several drugs that control or kill neoplastic cells; used in chemotherapy to kill cancer cells; all have unpleasant side effects that may include nausea and vomiting and hair loss and suppression of bone marrow function ;; [유의어] antineoplastic, antineoplastic drug [본문으로]
92. expensive new ; 형용사 순서, expensive가 new보다 먼저 오는 것을 확인 [본문으로]
93. obtain ; (격식) 1. [타동사][VN] (특히 노력 끝에) 얻다[구하다/입수하다] [본문으로]
94. assess ; 1. ~ sb/sth (as sth) (특성・자질 등을) 재다[가늠하다] [본문으로]
95. efficacy ; [U] (격식) (특히 약이나 치료의) 효험 ;; US.UK [|efɪkəsi] [본문으로]
96. cancer registry ; (의학) 암등록체계 ;; 참고 ; registry [본문으로]
97. spotlight ; (spot・lit , spot・lit / -lIt / * 특히 2번 뜻일 때에는 과거형이나 과거분사형으로 spotlighted도 쓰인다.), [vn] 2. 세간의 이목을 집중시키다, 집중 조명하다 [본문으로]
98. enact ; 1. [흔히 수동태로] (법률) (법을) 제정하다 [본문으로]
99. rein in ; to control somebody or something more strictly [본문으로]
100. avert ; [vn] 1. 방지하다, 피하다 [본문으로]
101. zap ; (-pp-), (비격식) 1. [타동사][VN] ~ sb/sth (with sth) (사정없이) 제압하다[해치우다/없애 버리다] [본문으로]
102. proton beam ; 양성자 빔 [본문으로]
103. antibody ; [명사] pl. -ies 항체 ;; US [|ӕntibɑ:di] UK [|ӕntibɒdi] [본문으로]
104. technocrat ; [명사] 테크노크라트(많은 권력을 행사하는 과학 기술 분야 전문가) ;; US·UK [|teknəkrӕt] [본문으로]
105. for (the) want of ; ~ 부족으로[~이 없어서] [본문으로]
106. scientific advance ; 과학적 진보, 발전 [본문으로]