安阳[微博]每天躺在床上和人聊天，像小孩一样瞪着大眼睛望着李静，开心地喊着“你咋来了，来看我啦？”

　　李静觉得，这最后的时光里，最受煎熬的是安阳的妈妈。

　　一方面她似乎是做好了最坏的准备，在来北京前哭了一夜，治疗过程也始终十分保守，拒绝开颅，拒绝手术，哪怕她知道这样的结果是失去自己的儿子；但另一方面，她似乎仍在期待有奇迹。专家会诊后，李静已经不抱希望了，便花了多很精力说服安阳妈妈接受这个事实，但这位老人却总是说：万一会好呢？偏方，迷信，中药，只要谁说吃什么可以抑制肿瘤，老人就拿来试。

　　对于死亡的最后印象，来自一些与生命毫无关联的细节。比如，安阳最后已无法活动，有一次帮他翻身的时候，发现长了褥疮。李静回想起来，觉得就像一张褪了色的照片，模样情景都历历在目，但又失了真。

　　死亡终于到来。想着这个平常讲究穿戴、爱整洁的男人，最后只能终日卧床，大小便失禁，李静竟然也替他感到了解脱。

　　眼看着他眼睛闭上，把掉下来的下巴合上，呼出最后一口气，帮他穿好寿衣，确定那块褥疮是不是结痂，把骨灰撒到江里⋯⋯“原来死亡是这样的，很具象，就是他临终前的样子，不可爱、不光泽、毫无尊严”。

　　如今，在没有安阳的房间里，李静只能独自享受照进飘窗的阳光，依旧温暖，舒服，但又永远不可能与从前一样了。

　　“他去世后的半年里，我也会遇到开心的事，让我觉得生活有安全感，甚至喜悦，真希望这些能持续下去。但每次我都告诉自己，生活永远都有另外一面，那是疾病、死亡的世界，它甚至跟健康的世界是平行的，随时都会把这里的一切带走。”

　　抗癌科学的艰难进步

　　科学家已经在基因水平上理解肿瘤的发生与发展，肿瘤医学正在进入一个个性化治疗、精确治疗的崭新时代。几十年来的科学进步带来的结果是：癌症已经成为一种可控制，甚至可治愈的疾病，患者的生存率达到从未有过的高度。

　　有一个流传很久但从来未经证实的说法：如果谁能够攻克任何一种癌症，世界卫生组织将在总部前建一座与其本人外形尺寸一样大小的纯金塑像。从40年前美国实施“向癌症宣战计划”起至今，并没有任何一位科学家的贡献哪怕能够引出这一有趣的话题。但是，这主要是由于“攻克癌症”的过程恐怕远远没有人们设想的那么富有戏剧化，而是一个几乎涉及到生物医学各个领域、长期不懈努力的结果。如今，“金像”的传说基本上被淡忘，但人类对癌症的生物学理解已经非常深入，癌症预防、早期诊断、综合治疗的手段都取得了很大的进步。

　　现在，科学家已经在基因水平上理解肿瘤的发生与发展，肿瘤医学正在进入一个个性化治疗、精确治疗的崭新时代。随着癌症基因组计划的推进，更多潜在的药物靶点将被鉴定出来，为新药的开发奠定了基础。同时，分子技术还可能准确预测某些癌症(比如卵巢癌)药物治疗的效果。肿瘤科学几十年来进步带来的结果是：癌症已经成为一种可控制，甚至可治愈的疾病，患者的生存率达到从未有过的高度。

　　生物医学在攻克癌症方面取得了很多显著的进步。

　　靶向治疗：研究发现，不同肿瘤患者的基因有所不同，比如，即使同是患有肺癌的患者，其对药物的反应也可以完全不同。究其原因，在于肿瘤细胞的基因变化不同。靶向治疗的优势在于，治疗药物可以在细胞分子水平上，特异性地选择结合点，干扰肿瘤细胞的生长，将其置之于死地，而不会波及周围的正常细胞。通俗地说，就是只杀“坏细胞”，而不错杀“好细胞”。因此，相对于化疗，靶向治疗不仅精准，而且比较温和，副作用少，患者可以在家中服药治疗，因而也更加方便。

　　肿瘤外科：如今，癌症的外科手术更加精准，微创手术的广泛开展使患者的创伤更小，恢复更快，切口也更美观。临床证据已充分证明了微创手术在治疗癌症方面的安全性，打消了人们的某些顾虑。在不影响手术效果的前提下，肿瘤外科并发症更少、术后引起身体的变形得到更好的弥补。比如，乳腺癌术后接受乳房再造手术的病人比例越来越高，取得的整形效果也更满意，提高了癌症患者术后的生活质量。

　　放射治疗：由于计算机技术、放射物理学、放射生物学、影像学的有力支持，肿瘤的放射治疗技术已经取得了革命性的进步。随着放疗精度的日益提高，精确放疗有效地保证和提高了放疗高剂量落在肿瘤靶区内，而其周边组织和器官处于低剂量照射。放疗在肿瘤治疗中的作用越来越大，世界卫生组织统计，癌症治愈患者中的近一半应归功于放疗。

　　药物研发：在现有的170多种抗癌药物中，大多数都是近十年研发出来的新药。此外，还有大约1000种抗癌药物及癌症疫苗在研发过程中。很多最新开发的抗癌药物，有效地消除了恶心、疼痛、脱发等副作用，给予患者较高的生活质量。同时，另一些新开发的药物较好解决了某些肿瘤治疗的耐药性问题。

　　肿瘤筛查：医学界普遍认为，大约三分之一的癌症可以得到有效预防。其主要方式是：调整生活方式、改善饮食结构和早期筛查。例如，最新研究显示，乙状结肠镜检查能够有效降低结肠直肠癌的发生率和死亡率。与此相反的是，另一项研究得出结论，每年一次的胸部X线检查并不能够在普通人群中降低肺癌的死亡风险，因而不主张人们定期做这一检查。

　　尽管肿瘤科学取得了很大的进步，但迄今为止，癌症仍是世界上最严重的公共健康问题。在世界范围内，预计新发癌症人数将由2008年的1270万，跃升到2030年的2000万以上。尽管肿瘤科学研究不断取得突破，但如何将这些成果有效转化成新的治疗方法，其间的巨大鸿沟还有待跨越。此外，肿瘤治疗的花费在各个国家和地区都非常昂贵，这一问题也显著降低了癌症患者得到理想治疗的机会。

　　China's cancer crisis

　　The tall filing cabinets which occupy the length of an entire wall in Wei Kuangrong's office tell a sad and worrying story. The cabinets are filled with the faded registry cards of cancer patients stretching back over 40 years. Wei's department, the Department of Epidemiology at the Zhongshan Cancer Research Institute in Guangdong Province, has seen the cabinets fill ever more rapidly as the cancer incidence rate keeps climbing. Faced with some 200 new patients every day, Wei and his colleagues now record all patient information on a computer databases instead of the cards, according to a recent report from China News Week。

　　Wei, 50, has been registering cancer patients for 27 years; however yet his work only accounts for a fraction of China's total cancer registry data. According to the 2012 Cancer Registry Annual Report, released in January, one new incidence of cancer is diagnosed every six minutes, resulting in 8,550 people being diagnosed with cancer every day. Of these cases, one in seven will eventually die from the disease. The report states: "China's cancer incidence and mortality rates continue to rise, the situation is grim. Every year, China has approximately 3.5 million new cancer cases and 2.5 million cancer deaths." With air particulate matter readings hitting an alarming PM 2.5, Chinese people are becoming increasingly concerned with the country's rising cancer incidence。

　　The National Cancer Registry Center, located in a small room at the Cancer Hospital under the Chinese Academy of Medical Sciences, has also been affected by the rising cancer figures. The center's deputy direct Chen Wanqing told reporters that instead of publishing the cancer data every five years as before, they now publish data every year. No one at the center was surprised by the sensation caused by the release of this year's data。

　　Changes in cancer situation in Zhongshan

　　The scale of the problem outlined in the National Cancer Registry's report does not surprise Wei. In 2009, Zhongshan, the city where he lives and works saw an average of 8.34 people diagnosed of cancer daily, with 5.27 people dying every day from the disease, rising from 0.78 in 1970.

　　Cancer research is regarded as crucial in Zhongshan due to the fact that in the past, the city had extremely incidence of head and neck cancer. Head and neck cancer is also referred to as "Guangdong cancer" in China, due to its prevalence among residents of Guangdong, Guangxi and Fujian. To date, scientists have been unable to determine the cause of head and neck cancer or why Guangdong residents are most likely to be afflicted by it. Fortunately, head and neck cancer is very treatable and has a comparatively high survival rate and a special cancer prevention and treatment institute was established in Zhongshan in 1970 focusing on screening and early intervention。

　　When Wei was assigned to the Department of Epidemiology after graduating from medical school in 1986, he felt that his work was undervalued and unappreciated. Wei toyed with the idea of transferring to the clinical department. However, Hu Mengxuan, the founder of Wei's department and a retired professor at the School of Medicine at Sun Yat-sen University persuaded him to stay, telling him: "An oncologist can only save one patient a time, but doing epidemiology studies can save many people."

　　Peng Jiewen, oncologist at the People's Hospital of Zhongshan, has also seen rising incidences of cancer. When he joined the oncology department in 1987, there were only a few doctors and 30 to 40 beds, many of which were unoccupied. Most patients were end-stage cancer patients。

　　Peng noticed a difference aroundCancer villages in China

　　Zhongshan City was one of the first cities in China to set up cancer registry sites. Lin County in Henan Province, which has been upgraded to Linzhou City, established the first cancer registry sites as early as 1959, because of its unusually high incidence of esophageal cancer. Jiangsu's Qidong County (which has been upgraded to Qidong City)， sees many lung cancer cases and established a cancer registry mechanism back in 1972.

　　Today, these traditional major cancer sites seem to be getting less attention than before. Some civil groups draw out a map of China's cancer villages based on historical public reports. The map provided a direct impression of China's cancer situation and the phenomenon of cancer villages has attracted worldwide concern; however, the term "cancer village" is not seen in any academic materials. As cancers are the combined results of genetic and environmental factors, it's extremely difficult to determine the reason behind any specific case of cancer. A good example of this is that despite decades of follow-up studies, the reason for Zhongshan's high instance of head and neck cancer is still undetermined。

　　China's Ministry of Environment Protection published its 12th Five-Year Plan for Prevention and Control of Chemical Risks to the Environment. In the plan, the existence of China's cancer villages is admitted for the first time and they are defined as a severe health and social problem. Prior to this, research completed three years ago by Yang Gonghuan, a former deputy director of the Chinese Center for Disease Control and Prevention (CDC)， had already revealed a connection between water pollution and cancer risk in the rural areas along the Huai River. Yang's findings could be seen as the most direct explanation of cancer villages in academic circles. In spite of this, no mention of cancer villages can be found in the 300-plus page government-recognized 2012 Cancer Registry Annual Report。

　　Continuously worsening situation

　　What's worrying is that the outlook for improvement appears bleak at best and hopeless at worst. "We'll be lucky if, in 10 years time, the situation just stops worsening," said Wang Ning, deputy director of Beijing Cancer Prevention & Research Office. "There is no chance incidence of cancer will drop in that time." The prognosis for lung cancer, China's most deadly form of the disease, is even bleaker, with an expert at Beijing Cancer Hospital quoted as saying that China is expected to see a blowout in incidences of lung cancer by 2033.

　　In light of this worsening situation, the Ministry of Health released the "Outlines of China's Cancer Prevention and Control Plan (2004-2010)" in 2003, with the principle aim of improving cancer registration efforts to boost prevention. By the end of 2012, China had 222 cancer registry sites, covering a total of 200 million people. These efforts are only the first step in preventing and controlling cancer in China。

　　China's high cancer incidence rate is a consequence of the country's social development pattern in the past decades taking its toll on the country's environment, population structure and lifestyles. Unlike some illnesses, however, it cannot simply be ascribed to economic circumstances: Incidence rates of both "poor cancers" (cancers that mainly afflict those on low incomes) and "rich cancers" (cancers that are triggered by high-fat, high-sugar or high-salt diets)， are increasing, more young people become cancer patients, and China's population is rapidly aging. If China fails to formulate an effective national strategy to combat cancer, the situation will worsen in the coming decades, leaving every Chinese citizen vulnerable to the increasing cancer threat。

　　On an individual level, a sustained economic development pattern and a healthy personal lifestyle are far more helpful in preventing cancer than medical advancements. Prevention is, after all, better than cure。

　　2000 when, as director of the chemotherapy department, he oversaw an ever-growing number of clinical specialists, and patients. In 2009, the People's Hospital of Zhongshan established specialist cancer center, which now houses the hospital's most expensive and advanced equipment, including a 30-million-yuan Varian Clinic used for radiotherapy. The cancer center's 400-bed ward has a waiting list for admissions。

　　As an expert in cancer statistics, Wei has a better picture of Zhongshan's overall cancer situation than Peng. Since the early nineties, he has seen other types of cancer eclipse head and neck cancer as the most prevalent form of the disease. Although incidences of head and neck cancer are still rising, data from 2009 indicates that head-and-neck cancer ranks third among male Zhongshan citizens and fourth among female citizens, with lung cancer now the most prevalent -- and deadly -- form of the disease. Colorectal cancer rates have also spiked, as have lung cancer cases among male citizens and breast cancer cases among female citizens in Zhongshan。

(英文部分来源：China.org.cn)

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