Sadly, about 40 percent of us will hear those three words within our lifetime,

「你得了癌症。」

and half will not survive.

很不幸，約有 40% 的人 會在活著時聽到這幾個字，

This means that two out of five of your closest friends and relatives

其中半數終將不治。

will be diagnosed with some form of cancer,

意味著我們每五個親友當中

and one will die.

有兩個會被診斷出罹患某種癌症，

Beyond the physical hardships,

而一個會病故。

roughly one-third of cancer survivors here in the US

除了身心受苦，

will go into debt from treatment.

大約三分之一的美國癌症倖存者

And they're at least two and a half times more likely to declare bankruptcy

會因為醫療而負債累累；

than those without cancer.

他們破產的機率

This disease is pervasive.

至少是未罹癌者的 2.5 倍。

It's emotionally draining

癌症無所不在，

and, for many,

它損耗人的情感，

financially destructive.

使許多人

But a cancer diagnosis doesn't have to be a death sentence.

散盡家財。

Finding cancer early,

但是被診斷出罹癌不等於被宣判死刑。

closer its genesis,

及早發現

is one of the critical factors to improving treatment options,

和貼近找出它的成因，

reducing its emotional impact

對於提高存活率、

and minimizing financial burdens.

減低情緒影響，

Most importantly,

和降低財務負擔至關重要。

finding cancer early --

最關鍵的是要儘早發現癌症，

which is one of the primary aims of my research --

這也是我主要的研究目標之一，

greatly enhances your odds of survival.

能夠大大提高存活率。

If we just look at the case of breast cancer for example,

舉乳癌為例，

we find that those who are diagnosed and treated at stage one

在第一期就診斷且治療的患者

have a five-year survival rate of nearly 100 percent --

五年的存活率幾近百分之百，

odds that decrease to just 22 percent if treated at stage four.

如果到第四期才治療就只剩 22%。

And similar trends are found for colorectal and ovarian cancer.

大腸直腸癌和卵巢癌的情況類似。

Now, we're all aware that an early diagnosis that is accurate

大家都知道，早期的準確診斷

is critical for survival.

是存活與否的關鍵。

The problem is that many cancer diagnostic tools are invasive,

問題是很多癌症篩檢具有侵入性，

costly,

價格昂貴，

often inaccurate

常常不準確，

and they can take an agonizing amount of time to get the results back.

並且等待結果既焦慮又曠日費時。

Still worse, when it comes to some forms of cancer,

更糟的是若干癌症，

such as ovarian, liver or pancreatic cancer,

例如卵巢癌、肝癌、胰臟癌，

good screening methods simply don't exist,

根本沒有好的檢驗方式，

meaning that often people wait until physical symptoms surface,

意味著等到出現症狀時

which are themselves already indicators of late-stage progression.

已經到了癌症擴散的晚期。

Like a tornado strike in an area without an early warning system,

就好像在沒有龍捲風預警的地區

there is no alarm to warn,

沒有警報，

for the danger is already at your doorstep

一旦龍捲風到了家門口，

when your odds of survival are greatly reduced.

存活的機會就大大減少了。

Having the convenience and accessibility of regular screening options

方便、易取得、

that are affordable, noninvasive and could provide results much sooner,

便宜、非侵入性

would provide us with a formidable weapon in the fight against cancer.

和快篩的定期檢驗方式

An early warning would allow us to get out ahead of the disease

將會是我們對抗癌症的強大利器。

instead of merely following in its relentless wake.

及早發現讓我們能搶得治療先機，

And this is exactly what I've been doing.

而非只苦追在它殘酷無情的腳步後面。

For the past three years, I've been developing technologies

這正是我的工作。

that could ultimately aid clinicians

過去三年來，

with rapid, early-stage cancer diagnostics.

我一直在研發能夠幫助臨床醫生

And I've been fueled by a deep scientific curiosity,

快速、早期診斷癌症的科技。

and a passion to change these statistics.

強烈的科學好奇心與熱情

Last year however,

推動我要改變那些癌症的統計數據。

this fight became much more personal

去年

when my wife was diagnosed with breast cancer.

我的妻子被診斷出罹患乳癌，

It was an experience that added a strong and unexpected emotional dimension

使這努力成了與自身息息相關的戰鬥，

to these efforts.

參雜了我始料未及的情感層面。

I know firsthand how life-altering treatment can be,

我親身體驗到

and I'm keenly aware of the emotional havoc

治療對生活所造成的巨大衝擊，

that cancer can wreak on a family,

十分清楚它帶來的精神浩劫，

which in our case included our two young daughters.

癌症可能會毀滅我們的家庭，

Because we found it early during a routine mammogram,

包括我們兩個年幼的女兒。

we were able to focus primarily on treatment options

經由定期乳房攝影檢查及早發現，

for the localized tumor,

我們得以專注治療仍限於局部的腫瘤，

reaffirming to me how important an early diagnosis is.

使得我再次確認早期診斷極其重要。

Unlike other forms of cancer,

不同於其他的癌症，

mammograms do offer an early-stage screening option for breast cancer.

乳房攝影檢查能有效偵測早期乳癌。

Still, not everyone has this done,

儘管如此，仍有人沒定期做檢查，

or they may develop breast cancer

也有人未達建議該接受乳房攝影 檢查的年齡之前就已罹患乳癌。

before the middle age recommendation for having a mammogram.

因此，即便已有篩檢方式的癌症 仍有很大的改善空間。

So, there's still a lot of room for improvement,

而那些尚未有篩檢法的癌症 更將會大大受益。

even for cancers that do have screening options,

癌症研究者的關鍵挑戰在於

and, of course, considerable benefits for those that don't.

開發出一種用於定期體檢，

A key challenge then for cancer researchers

能夠更容易查出多種癌症的方法。

is to develop methods

想像這情境：

that make regular screening for many types of cancers

醫生在定期體檢時能採取 簡單、非侵入性的尿液樣本

much more accessible.

或是其他的液狀活檢體，

Imagine a scenario where during your regular checkup,

在你離開診所之前就告訴你結果。

your doctor can take a simple, noninvasive urine sample,

這樣的科技能夠大量減少

or other liquid biopsy,

早期癌症篩檢所漏掉的人數。

and present you with the results before you even leave the doctor's office.

我的工程與生化研究團隊面對這挑戰，

Such a technology could dramatically reduce the number of people

正試圖找出一種能在人們仍健康時

who slip through the net of an early-stage cancer diagnosis.

就會觸發應該去做定期體檢的警示，

My research team of engineers and biochemists

一旦出現癌症徵兆，馬上採取行動，

is working on exactly this challenge.

不讓它有機會擴展到中、後期。

We're working on ways to frequently activate an early-stage cancer alarm

此處的殺手鐧被稱為「胞外染色體」，

by enabling regular screenings that would start when a person is healthy

是細胞經常脫落的小小逃生艙。

so that action could be taken to stop cancer the moment it emerges,

胞外染色體

and before it can progress beyond its infancy.

是能在癌症早期預警的重要生物標記。

The silver bullet in this case are tiny vesicles,

這些標記大量而廣泛存在體液裡，

little escape pods regularly shed by cells called exosomes.

包括血液、尿液和唾液中，

Exosomes are important biomarkers

不具侵入性，極具液體活檢的優勢。

that provide an early-warning system for the development of cancer.

但這裡仍然有個問題，

And because they're abundantly present in just about every bodily fluid,

能夠自動快篩這些生物標記的機制

including blood, urine and saliva,

目前並不存在。

they're extremely attractive for noninvasive liquid biopsies.

我們建立了稱作「奈米 DLD」的科技

There's just one problem.

能夠精準做到

An automated system for rapidly sorting these important biomarkers

自動分離出胞外染色體

is not currently available.

以快速癌症篩檢。

We've created a technology that we call nano-DLD

胞外染色體是出現在液體活檢陣線的

that is capable of precisely this:

最新早期預警利器。

automated exosome isolation

它們非常微小，

to aid rapid cancer diagnostics.

直徑僅有 30 到 150 奈米，

Exosomes are the newest early-warning weapon, if you will,

小到

to emerge on the liquid biopsy front.

一粒紅血球的體積裡能裝下一百萬個，

And they're really, really small.

比例相當於一顆高爾夫球

They measure just 30 to 150 nanometers in diameter.

對應於一粒沙子。

This is so tiny

它雖曾被認為是細胞廢物的垃圾桶，

that you could fit about a million of them into a single red blood cell.

後來卻發現，事實上細胞經由

That's roughly the difference between a golf ball

產生和吸收胞外染色體來互相溝通，

and a fine grain piece of sand.

因為它們具有表面接收器、蛋白質

Once thought to be little bins for unwanted cellular waste,

以及母細胞所給予的基因。

it has been found that cells actually communicate

一旦被臨近的細胞所吸收，

by producing and absorbing these exosomes

胞外染色體就會釋放內含的物質，

which contain surface receptors,

大幅改變接收細胞的基因表現。

proteins and other genetic material collected from their cell of origin.

有些是好的改變；

When absorbed by a neighboring cell,

但在癌症的情況下

exosomes release their contents into the receiving cell,

則是不好的改變。

and can set in motion fundamental changes in gene expression --

因為它們被母細胞的物質包覆著，

some good,

裡頭含有環境的樣本，

and this is where cancer comes in,

可以提供來源細胞的健康情況。

some bad.

胞外染色體具有這些無價的特質

Because they are clothed in the material of the mother cell,

使得醫生能從細胞層面

and contain a sample of its environment,

監測你的健康水平。

they provide a genetic snapshot of that cell's health and its origin.

但想要儘早發現癌症

All of these qualities make exosomes invaluable messengers

就必須頻繁截取這些訊息，

that potentially allow physicians

看體內潛伏的鬧事份子

to eavesdrop on your health at the cellular level.

是不是要滋事了。

To catch cancer early, however,

這就是為什麼定期檢查非常重要，

you have to frequently intercept these messages

以及我們為什麼要發展這科技。

to determine when cancer-causing troublemakers within your body

儘管今年市場上出現了 首宗胞外染色體檢驗機制，

decide to start staging a coup,

它們還不是主流的篩檢選項。

which is why regular screening is so critical

除了上市的時間很短，

and why we're developing technologies to make this possible.

另一個影響普及的因素

While the first exosome-based diagnostics emerged on the market just this year,

是目前尚無法自動分離出胞外染色體，

they are not yet part of mainstream healthcare options.

所以用於定期體檢仍不夠便宜。

In addition to their recent emergence,

當下隔絕胞外染色體的標準做法，

another factor that's limiting their widespread adoption

包括超速離心法，

is that currently, no automated exosome isolation system exists

必須使用昂貴的實驗器材，

to make regular screening economically accessible.

由專業培訓過的技師操作，

The current gold standard for exosome isolation

耗費三十小時來處理一份樣本。

includes ultracentrifugation,

我們想出另一種方法，

a process requiring expensive laboratory equipment,

從尿液之類的液體樣本

a trained lab tech

自動分離出胞外染色體。

and about 30 hours of time to process a sample.

我們用基於晶片的持續流動分離技術，

We've come up with a different approach for achieving automated exosome isolation

這方法稱為「確定性側向位移」。

from a sample such as urine.

藉由過去五十年來半導體產業

We use a chip-based, continuous flow separation technique

非常成功的晶片微縮技術，

called deterministic lateral displacement.

我們把這技術

And we have done with it

從微米縮小到了真正的奈米等級。

what the semiconductor industry has done so successfully for the past 50 years.

原理是什麼呢？

We shrunk the dimensions of this technology

簡單來說，

from the micron scale to the true nanoscale.

把許多有奈米級間隙的細小柱子

So how does it work?

排成能讓液體細細分流的形式，

In a nutshell,

較大的癌症奈米粒子會改道，

a set of tiny pillars separated by nanoscopic gaps

與較小的健康粒子分流；

are arranged in such a way

另一方面，

that the system divides the fluid into streamlines,

體積較小的健康粒子 會沿著之字形的方向移動。

with the larger cancer-related nanoparticles being separated

結果大小兩種粒子被完全分開了。

through a process of redirection from the smaller, healthier ones,

可以把分離的過程

which can in contrast

觀想成用有高度限制的穿山隧道

move around the pillars in a zigzag-type motion

把車流一分為二：

in the direction of fluid flow.

一條進隧道，另一條繞山而過。

The net result is a complete separation of these two particle populations.

像這樣，小車可以進入隧道，

You can visualize this separation process

而載有危險物品的大卡車

similar to traffic on a highway that separates into two roads,

只能繞路。

with one road going into a low-clearance tunnel under a mountain,

由車輛的大小和載物的種類引導，

and the other road going around it.

不會阻礙車流。

Here, smaller cars can go through the tunnel

我們建置的工作原理相同，

while larger trucks, carrying potentially hazardous material,

只是規模遠小得多。

are forced to take the detour route.

用分離篩檢的理念來分析

Traffic is effectively separated by size and contents

簡易取得的尿液、血液或唾液樣本，

without impeding its flow.

近幾年內就可實行。

And this is exactly how our system works on a much, much smaller scale.

最終，這方法能分離和偵測出

The idea here is that the separation process for screening

與特定癌症相關的胞外染色體，

could be as simple as processing a sample of urine, blood or saliva,

而且自偵測至結果僅需數分鐘，

which is a near-term possibility within the next few years.

使得篩檢的過程快速且無痛。

Ultimately, it could be used to isolate and detect target exosomes

廣泛說，

associated with a particular type of cancer,

有了奈米級精準的自動化分離機制

sensing and reporting their presence within minutes.

與濃縮的生物標記，

This would make rapid diagnostics virtually painless.

使我們更能了解癌症等疾病；

Broadly speaking,

它的應用廣泛，從準備樣品、診斷，

the ability to separate and enrich biomarkers

至觀察抗藥性和治療都能做。

with nanoscale precision in an automated way,

即使在我的妻子罹癌之前，

opens the door to better understanding diseases such as cancer,

我​​已經夢想要自動化檢驗的過程，

with applications ranging from sample preparation to diagnostics,

要使定期檢查更容易，

and from drug resistance monitoring to therapeutics.

就像亨利·福特自動化汽車的生產線，

Even before my wife's bout with cancer,

使得普羅大眾買得起汽車那樣。

it was a dream of mine to facilitate the automation of this process --

自動化是普及的關鍵。

to make regular screening more accessible,

就像胡佛選總統的逐夢精神口號：

similar to the way Henry Ford made the automobile accessible

「每只鍋裡有雞肉，每間車庫有輛車。」

to the general population

我們開發這技術

through development of the assembly line.

為的是把早期的癌症預警系統

Automation is the key to accessibility.

最終普及於每個家庭。

And in the spirit of the Hoover dream,

讓每個男人、女人和小孩

"a chicken in every pot and a car in every garage,"

都能夠在仍然健康時就定期做檢查，

we're developing a technology

在初發的早期就偵測到癌症。

that could ultimately place an early-warning cancer detection system

我希望，我夢想

in every home.

要幫助世人

This would allow every man, woman and child

避掉癌症患者所面對的昂貴開銷，

the opportunity to be regularly tested while they're still healthy,

免去身體、財務和精神層面的艱辛，

catching cancer when it first emerges.

那是我再熟悉也不過的艱辛。

It is my hope and dream

我也開心地告訴大家，

to help people around the world avoid the high costs --

由於發現得早，

physical, financial and emotional --

我的妻子治癌成功，

faced by today's cancer patients,

謝天謝地，現在她已肅清癌細胞。

hardships that I'm well acquainted with.

（掌聲）

I'm also happy to report that because we caught my wife's cancer early,

我希望每位罹癌者都能被治癒。

her treatment was successful,

我團隊開發的奈米生物標記分離法

and she is now, thankfully, cancer-free.

能快速、早期偵測出癌症。

(Applause)

我樂觀看待在未來十年內，

It is an outcome that I would like to see for everyone with a cancer diagnosis.

這技術會被用來

With the work that my team has already done

保護我們的朋友、家人和子孫後代。

on separation of nanoscale biomarkers

即便我們不幸被診斷出癌症，

for rapid, early-stage cancer diagnostics,

早期警示將會提供更大的治癒希望。

I am optimistic that within the next decade,

謝謝大家。

this type of technology will be available,

（掌聲）

helping protect our friends, our family and future generations.

Even if we are so unlucky as to be diagnosed with cancer,

that early-stage alarm will provide a strong beacon of hope.

Thank you.

(Applause)