序言：寫作是分享個人見解和探索未知領(lǐng)域的橋梁，我們?yōu)槟x了8篇的婦科醫(yī)生論文樣本，期待這些樣本能夠?yàn)槟峁┴S富的參考和啟發(fā)，請盡情閱讀。

第1篇

論文摘要：隨著教育事業(yè)發(fā)展，圖書館工作核心已逐漸從為讀者服務(wù)到主動引導(dǎo)讀者獲取適當(dāng)?shù)闹R。圖書館的日常運(yùn)作已不能滿足新功能發(fā)展的需要，項(xiàng)目管理把人力、財力、物力進(jìn)行集中，具有目標(biāo)性強(qiáng)、效率高、操作性強(qiáng)等特點(diǎn)，以項(xiàng)目管理的方式既能維持圖書館傳統(tǒng)功能，又能更好地開拓圖書館新功能。 

    循規(guī)蹈矩的管理方式可以為人們提供一個長期有效的環(huán)境，然而隨著社會、信息技術(shù)的發(fā)展，組織環(huán)境不斷地發(fā)生變化，基于項(xiàng)目的組織越來越普遍，基于項(xiàng)目的管理也逐漸成為新一代的通用管理模式。圖書館事業(yè)的發(fā)展正面臨著許多改變、機(jī)遇、挑戰(zhàn)，把項(xiàng)目管理的一些概念和方法引用到圖書館管理中，可以使圖書館提高管理效率和排除一些管理中的障礙。 

1、項(xiàng)目管理的基本概念 

1. 1項(xiàng)目的定義 

    項(xiàng)目是一種努力(endeavor)，它以一種新的方式將人力、財力和物資進(jìn)行組織，完成由獨(dú)特范圍定義的工作，使工作結(jié)果符合特定的規(guī)格要求，同時滿足時間和成本的約束條件。項(xiàng)目具有定量和定性的目標(biāo)，實(shí)現(xiàn)項(xiàng)目目標(biāo)就是能夠?qū)崿F(xiàn)有利的變化。 

1.2項(xiàng)目管理的特質(zhì) 

    以目標(biāo)為導(dǎo)向的管理思路;管理方法具有普遍意義，可應(yīng)用于各個行業(yè):管理過程模塊化，具有可“重復(fù)”應(yīng)用的性質(zhì)，易于移植;系統(tǒng)的管理方法有一定的標(biāo)準(zhǔn)體系。 

1. 3項(xiàng)目管理的優(yōu)勢 

    有助于實(shí)現(xiàn)組織的戰(zhàn)略目標(biāo):規(guī)范的管理方法，降低組織的管理成本;利于組織人才的培養(yǎng)及提升企業(yè)的凝聚力;明確的管理過程，使管理結(jié)構(gòu)更加扁平化，提高管理效率。 

1. 4項(xiàng)目管理的過程 

    項(xiàng)目管理是一個一次性的、漸進(jìn)的、系統(tǒng)的過程，它主要分為:(1)啟動過程;(2)計劃過程;(3)執(zhí)行過程;(4)控制過程;(5)結(jié)束過程。 

2、圖書館開展項(xiàng)目管理的必要性 

    一個組織之所以做項(xiàng)目，是因?yàn)樵趯?shí)施計劃的過程中，一段時間后，發(fā)展的方向會逐漸偏離目標(biāo)。如果圖書館的目標(biāo)是更好地為讀者服務(wù)，進(jìn)一步的是引導(dǎo)讀者獲取相應(yīng)的信息，在實(shí)際的工作中，往往不能滿足讀者的要求，不能履行引導(dǎo)讀者獲取信息的功能或一些矛盾，如采用項(xiàng)目管理的方式，會使計劃落差縮小，如圖1。 

    在圖書館的管理中，往往缺少計劃和目標(biāo)，都是一些日常的管理。這些不利于圖書館與社會發(fā)展接軌與創(chuàng)新。雖然圖書館不是以經(jīng)濟(jì)利益為目標(biāo)，但以項(xiàng)目的方式開展一些工作，必定會使圖書館的發(fā)展有所創(chuàng)新和得以持續(xù)性發(fā)展。 

3、圖書館的一些功能滿足項(xiàng)目管理的特質(zhì) 

3. 1研究生撰寫論文進(jìn)行專題服務(wù) 

    圖書館應(yīng)為研究生提供足夠的信息檢索點(diǎn)，編制各種專題目錄，提供最新期刊信息通報、索引、文摘等二次文獻(xiàn)以及提供專題綜述、圖書評述等三次文獻(xiàn)，建立學(xué)位論文數(shù)據(jù)庫等。每年研究生論文撰寫有高峰期，研究的具體方向也不同，有新增的專業(yè)，有國內(nèi)國際新的研究成果，都需要一個專門的項(xiàng)目管理團(tuán)隊(duì)來完成。其目標(biāo)就是更好地服務(wù)于研究生，創(chuàng)造質(zhì)量更高的研究生論文，提高學(xué)校教學(xué)質(zhì)量。 

3. 2科研項(xiàng)目提供重點(diǎn)服務(wù) 

    每個科研項(xiàng)目都有一定的截止日期，各個方向的不同都需要專業(yè)的人士提供信息，項(xiàng)目管理運(yùn)用在各個方向科研項(xiàng)目中，提高質(zhì)量與速度。 

3. 3圖書館特色數(shù)據(jù)庫的建設(shè) 

    圖書館數(shù)據(jù)庫的開發(fā)，往往有一定的周期性，開展起來需要一定的經(jīng)費(fèi)和資源。按照項(xiàng)目管理的模式，可對成本進(jìn)行估算、控制、管理現(xiàn)金流等。 

3. 4圖書館組織的各種學(xué)生活動 

    例如每年的講座等都可以由項(xiàng)目的形式展開。 

3. 5圖書館人才培養(yǎng)等管理工作 

    在圖書館所有日常管理中，圖書館的人才培養(yǎng)是最適合開展項(xiàng)目的。圖書館一直存在吸收高級人才難的問題，對圖書館現(xiàn)有人才進(jìn)行培養(yǎng)，可為圖書館的發(fā)展提供人才。圖書館人才培養(yǎng)可按年為時間單位，開展不同內(nèi)容和不同層次的培訓(xùn)，對培訓(xùn)的結(jié)果還可進(jìn)行考核和評估。 

4、項(xiàng)目管理方式開展圖書館工作的步驟 

4. 1項(xiàng)目規(guī)劃與計劃 

    首先要組建團(tuán)隊(duì)，團(tuán)隊(duì)的成員必須了解獲取圖書館信息途徑，和一定的專業(yè)背景和協(xié)調(diào)能力;其次是計劃為服務(wù)對象開展哪些服務(wù)，為研究生和教職工撰寫論文提供服務(wù)，內(nèi)容可有以下幾個方面:(1)咨詢服務(wù)，為服務(wù)對象提供面對面服務(wù)，包括介紹、指導(dǎo)服務(wù)對象研究方向的館藏資源等;(2)整理、編寫相關(guān)專業(yè)的二次文獻(xiàn)，最新研究動向等;(3)與采購部門聯(lián)系引進(jìn)服務(wù)對象需要的資源;(4)開展論文寫作講座或交流等活動;(5)建設(shè)與學(xué)校專業(yè)相關(guān)的特色論文數(shù)據(jù)庫;(6)幫助服務(wù)對象進(jìn)行科技查新工作;(7)對一些服務(wù)進(jìn)行合理收費(fèi)工作;(8)在館內(nèi)設(shè)立研究生論文撰寫教室，配備相關(guān)計算機(jī)等資源，為學(xué)生與指導(dǎo)教師提供交流的平臺等。 

4. 2項(xiàng)目組織形成 

    由于項(xiàng)目的一次性與獨(dú)特性的特點(diǎn)，在決定一個項(xiàng)目以后，就需要根據(jù)這一項(xiàng)目的具體情況，建立項(xiàng)目的管理班子，負(fù)責(zé)項(xiàng)目的實(shí)施、費(fèi)用控制、時間控制和質(zhì)量控制，按項(xiàng)目的目標(biāo)去實(shí)現(xiàn)項(xiàng)目。按照組織結(jié)構(gòu)的基本原理和模式，項(xiàng)目的組織結(jié)構(gòu)也可分為線性的項(xiàng)目組織結(jié)構(gòu)、職能的項(xiàng)目組織結(jié)構(gòu)和矩陣的項(xiàng)目結(jié)構(gòu)等若干形式。項(xiàng)目管理組織的結(jié)構(gòu)實(shí)質(zhì)上決定了項(xiàng)目管理班子實(shí)施項(xiàng)目獲取所需資源的可能方法與相應(yīng)的權(quán)力，不同的項(xiàng)目組織結(jié)構(gòu)對項(xiàng)目的實(shí)施會產(chǎn)生不同的影響。由于圖書館開展的項(xiàng)目相對比較單純，也不是以純粹的經(jīng)濟(jì)利益為目的，可采取線形和職能相結(jié)合的形式，見圖2。 

4. 3項(xiàng)目實(shí)施及控制 

4. 3. 1對項(xiàng)目進(jìn)行資源分配 

   每個組織的人力資源配置都有一定的限額。當(dāng)圖書館開展項(xiàng)目的時候，不可能專門配置項(xiàng)目人員。對資源的分配要避免“按人員分配工作還是按工作分配人員”的風(fēng)險。以為研究生、教職工撰寫論文及開展課題提供服務(wù)為例。見圖2，項(xiàng)目組長直接向館長負(fù)責(zé)，主要由組長服務(wù)對象，由組織成員收集信息、整理信息及一些服務(wù)服務(wù)對象的工作。組織成員可由各部門的人員參加，如采編，信息，流通等部門，組織成員最好具有外語、計算機(jī)及其他專業(yè)知識背景、對本部門工作熟悉，便于開展工作，由項(xiàng)目組長協(xié)調(diào)工作。 

4.3. 2實(shí)施計劃 

    實(shí)施計劃的過程主要包括:對將進(jìn)行的活動進(jìn)行計劃安排，包括估算工作內(nèi)容和工期，在工作范圍內(nèi)對活動進(jìn)行日程安排等:對工作授權(quán);描述活動的日程安排和描述時間進(jìn)度。以為研究生、教職工撰寫論文及開展課題提供服務(wù)為例，項(xiàng)目組成后，在實(shí)施的過程中由項(xiàng)目組長對工作進(jìn)行安排，定義團(tuán)隊(duì)，組織工作人員進(jìn)行工作。 

4. 3. 3分配工作 

    當(dāng)工作即將開展時，要明確每個項(xiàng)目成員的工作職責(zé)、范圍及時間等。以為研究生和教職工撰寫論文提供服務(wù)為例，分配工作包括:項(xiàng)目組長開展講座等活動、負(fù)責(zé)內(nèi)部協(xié)調(diào)、擬訂研究方向、收集資料、科技查新及服務(wù)等工作，項(xiàng)目成員按照項(xiàng)目組長的要求，分別負(fù)責(zé)收集資料，制作數(shù)據(jù)庫，向項(xiàng)目組長提供信息、服務(wù)等工作。 

4. 3. 4有效控制 

    當(dāng)項(xiàng)目被運(yùn)行，我們必須確保它能取得預(yù)期的效果，以為研究生、教職工撰寫論文及開展課題提供服務(wù)為例，項(xiàng)目的運(yùn)行是更好地服務(wù)于服務(wù)對象，從而提高論文的數(shù)量與質(zhì)量。在項(xiàng)目的開展過程中，肯定會出現(xiàn)一些矛盾和困難使服務(wù)對象不能獲取相應(yīng)的最新的信息或使服務(wù)對象不愿意接受服務(wù)。如果出現(xiàn)這樣大的偏差就采取糾正措施，這種結(jié)構(gòu)化的方法就是控制，控制過程包含以下4個關(guān)鍵步驟:(1)指定計劃并估算執(zhí)行情況;(2)檢測并報告結(jié)果;(3)將報告結(jié)果與計劃進(jìn)行對比，并預(yù)計未來結(jié)果;(4)計劃并采取有效行動來修復(fù)原訂計劃，或者將偏差減少到最小，見圖3。 

第2篇

凌晨四點(diǎn)守在電話旁等待喜訊。這顯然不會是奧利弗?哈特第一次這樣做了。

無論是作為學(xué)者還是師長，奧利弗?哈特都無愧大家稱號。諾貝爾經(jīng)濟(jì)學(xué)獎對他的褒獎，或許只是一份遲來的認(rèn)可。 子不承父業(yè)

招牌的露齒微笑，嚴(yán)苛的治學(xué)態(tài)度。哈特在同行與學(xué)生的眼中是一名良師益友。探尋其未來的功成名就，早期良好的家庭教育顯然非常重要。

哈特出身名門望族，祖輩Samuel Montagu是一位銀行家和政治家，曾擔(dān)任多年的英國眾議院議員，并被授予貴族爵位。哈特教授的父親Philip D'Arcy Hart則是英國知名的內(nèi)科醫(yī)學(xué)家，在治療肺結(jié)核方面貢獻(xiàn)突出，以106歲的高壽辭世。其母親Ruth Meyer是一位婦科醫(yī)生。

與經(jīng)商的家族企業(yè)不同，知識分子的家族傳承通常不會要求家族后代必須從事某一項(xiàng)工作，而是秉承家族的一貫精神。因此從小對數(shù)學(xué)感興趣的哈特，并未遵循祖輩與父輩的足跡，去涉足政治或是醫(yī)療行業(yè)。

這一傳統(tǒng)在哈特家族仍在延續(xù)。他的兩個兒子Daniel和Benjamin都不在經(jīng)濟(jì)學(xué)界。哈特的妻子說，孩子們應(yīng)該選擇自己喜歡的事業(yè)。哈特教授醉心于經(jīng)濟(jì)學(xué)研究，她可不希望一家人在一起只能討論經(jīng)濟(jì)學(xué)。

1969年，哈特從英國劍橋大學(xué)國王學(xué)院畢業(yè)，并獲得了數(shù)學(xué)學(xué)士學(xué)位，這也為他日后成為一名理論派經(jīng)濟(jì)學(xué)家奠定了扎實(shí)的基礎(chǔ)。在讀大學(xué)時，哈特開始對經(jīng)濟(jì)學(xué)產(chǎn)生了興趣，于是轉(zhuǎn)攻經(jīng)濟(jì)學(xué)，并于1972年在英國華威大學(xué)獲得經(jīng)濟(jì)學(xué)碩士學(xué)位。 年少成名

眾所周知，諾貝爾經(jīng)濟(jì)學(xué)獎得主基本上都被理論經(jīng)濟(jì)學(xué)家所承包，而從數(shù)學(xué)專業(yè)轉(zhuǎn)投經(jīng)濟(jì)學(xué)的經(jīng)濟(jì)學(xué)家更是不在少數(shù)。

隨后，哈特來到了執(zhí)經(jīng)濟(jì)學(xué)研究牛耳的美國，而彼時正值資本主義黃金發(fā)展的窗口期，經(jīng)濟(jì)學(xué)也迎來了百家爭鳴的繁榮格局。風(fēng)險決策理論、博弈論、信息經(jīng)濟(jì)學(xué)和企業(yè)理論等微觀經(jīng)濟(jì)學(xué)新分支，如雨后春筍般不斷涌現(xiàn)。這些理論研究學(xué)派的大本營之一普林斯頓大學(xué)，成為了哈特向往的新目標(biāo)。

于是，1972年哈特越過大西洋，來到美國普林斯頓大學(xué)求學(xué)，并于兩年后獲得經(jīng)濟(jì)學(xué)博士學(xué)位。

博士畢業(yè)后，哈特榮歸故里，并在艾塞克斯大學(xué)擔(dān)任講師。對于學(xué)院派經(jīng)濟(jì)學(xué)家而言，博士畢業(yè)后的幾年是一個人決定其學(xué)術(shù)地位的關(guān)鍵時期。年輕的哈特博士在畢業(yè)后的三年內(nèi)，在國際頂級期刊雜志上先后發(fā)表了六篇關(guān)于不完全市場和金融市場均衡的優(yōu)秀論文，在學(xué)術(shù)界初露崢嶸。

隨后哈特的身價水漲船高，并且受聘于劍橋大學(xué)丘吉爾學(xué)院。在之后的六年中，他繼續(xù)研究金融市場上的接管問題，并涉獵壟斷競爭理論。

由于哈特在學(xué)術(shù)界的高質(zhì)高產(chǎn)，年僅31歲的他當(dāng)選為世界計量經(jīng)濟(jì)學(xué)會院士。而后，他還被倫敦經(jīng)濟(jì)學(xué)院直接聘為正教授，跳過了副教授。1984年，哈特作為訪問學(xué)者來到了麻省理工學(xué)院，隨后正式定居美國，并入駐麻省理工學(xué)院經(jīng)濟(jì)系擔(dān)任教授。

經(jīng)過幾年的縱橫捭闔，哈特與其學(xué)術(shù)生涯最為重要的搭檔格羅斯曼合作的《所有權(quán)的成本與收益》一文發(fā)表。不多久，與莫爾合作的《產(chǎn)權(quán)與企業(yè)的本質(zhì)》也問世。

兩篇論文從不完全契約的角度，分析了企業(yè)產(chǎn)權(quán)的新框架。奠定了其在不完全契約理論和企業(yè)的產(chǎn)權(quán)理論的領(lǐng)軍者地位。

也正是因?yàn)槠湓诓煌耆跫s理論方面的奠基性貢獻(xiàn)，哈特始終被視為近幾年諾獎經(jīng)濟(jì)學(xué)獎的熱門人選。

而他本人也對此報以厚望，這也無怪乎今年諾獎致電通知他時，哈特表示：“這么晚還沒打電話，我以為今年我又錯過了呢”。 不完全契約的啟示

簡2007年諾獎得主埃里克?馬斯金并不十分認(rèn)可哈特關(guān)于不完全契約的論述。他認(rèn)為如果合同是不完備的，那么事先總能設(shè)計一個機(jī)制，能夠控制事后的爭議。

這一質(zhì)疑正是哈特所研究理論的精髓所在。哈特認(rèn)為，設(shè)計再完備，現(xiàn)實(shí)中的爭議終究難以避免。哈特曾表示，豐富理論經(jīng)驗(yàn)一定要看律師的判案，一旦你研究過法律案例，就會發(fā)現(xiàn)任何的合同都是有爭議的。

曾經(jīng)師從哈特的人民大學(xué)經(jīng)濟(jì)學(xué)院教授聶輝華介紹，契約理論就是將所有交易和制度都看作是一種契約（合同），在考慮信息不對稱的情況下，設(shè)計最優(yōu)的契約來減少道德風(fēng)險、逆向選擇和敲竹杠等問題，提高社會總福利。

例如，婚姻就是男女雙方之間的一種契約，這個契約隱性地假定雙方都要承擔(dān)家庭的義務(wù)，要對彼此忠貞，要共同撫養(yǎng)孩子。但是，事前雙方不可能想到婚后所有的情況，比如一旦發(fā)生財產(chǎn)糾紛怎么辦？一旦決策有分歧怎么辦？這些事情法律不會管得很具體，但是婚前雙方也沒法商量好，這就出現(xiàn)了不完全契約。

聶輝華介紹，根據(jù)哈特的理論，一旦契約不完全了，事后的控制權(quán)應(yīng)該配置給對投資或總產(chǎn)出重要的一方，或者簡單地說權(quán)力應(yīng)該安排給重要的一方。

因此，如果妻子對家庭收入的貢獻(xiàn)更大，那么一旦發(fā)生經(jīng)濟(jì)決策方面的分歧，妻子擁有優(yōu)先決定權(quán)。這保證了妻子有更大的激勵去增加收入，因?yàn)樗雷约旱母冻龊涂刂茩?quán)是匹配的，這就是所謂的激勵相容原理。

“如果雙方的利益是沖突的，那么就必須優(yōu)先保證對總收入更重要的一方的利益，然后這一方可以對另一方進(jìn)行補(bǔ)償，從而實(shí)現(xiàn)總收入最大化。”聶輝華說。

第3篇

At the beginning of 2015， Singer Yao Beina who was called “the beautiful voice of China” died of breast cancer. Among the sorry sound， the horrible words breast cancer came into the public eye again. How to effectively treat breast cancer is concerned and cared by more and more people and becomes a major issue of public health now. The pass away of Yao Beina struck a wake-up call for all the females， especially those “iron ladies” who are too busy to look after themselves， that they should slow down their steps and change unhealthy lifestyle to care their breasts and avoid horrible cancer.

2015年伊始，有著“中國好聲音”之稱的歌手姚貝娜因乳腺癌復(fù)發(fā)離開人世。在一片哀嘆惋惜聲中，乳腺癌這個可怕的名詞也隨之再次進(jìn)入公眾視線，如何對乳腺癌進(jìn)行有效防治受到越來越多人的關(guān)心與重視，成為當(dāng)前社會的重大公共衛(wèi)生問題。姚貝娜的去世，給廣大女性敲響了一記警鐘，尤其提醒那些忙碌于事業(yè)無暇顧及自身的“女強(qiáng)人”們，更應(yīng)當(dāng)放慢腳步，改變不好的生活方式，呵護(hù)自己的，遠(yuǎn)離可怕的癌癥。

How far is breast cancer away from us？

乳腺癌離我們有多遠(yuǎn)？

When heard breast cancer， maybe someone think it is just one of the cancers that will not come upon it easily. So they just keep on busy doing jobs and when heard stars died of breast cancer， they would stop say “what a pity” and continue to focus on the “unfinished business”. In fact， breast cancer is the most frequent cancer for females in the world and 99% of it happens to women and just 1% for men. According to the statistics of WHO， there were 1.7 million females diagnosed with breast cancer in 2012 and more than 520，000 died of it. In recent decades， the morbidity of breast cancer is increasing， at usual， it is faster in rich countries than in poor countries. At the same time， breast cancer also has a relatively high death rate among women that one of eight cancer death cases is breast cancer. The statistics of WHO shows that， since 2008， the breast cancer case is increasing over 20% annually and that of its death rate is 14%.

The morbidity of breast cancer is varied worldwide and the age standardized incidence can reach 0.0994% in North America. It is lower in East Europe， South America， South Africa and West Asia， but it is increasing too. The lowest morbidity is in most African countries. But in low-income and mid-income countries， since the extension of life expectancy， aggravation of urbanization and the adoption of western lifestyle， the breast cancer morbidity keeps increasing in past several years. And due to the lack of proper diagnose and treatment facilities in underdeveloped countries， the survival rate of breast cancer patients is relatively low. Like in 2008， the survival rate of breast cancer patients in low-income countries was less than 40%， while that in North America， Sweden and Japan was 80% or even higher.

談起乳腺癌，也許有人認(rèn)為那不過是眾多癌癥中的一種，不會輕易降臨到自己身上，于是繼續(xù)忙工作、忙生活，倘若偶然聽到患乳腺癌的明星去世，停下來說一句“好可惜”，轉(zhuǎn)而又開始匆匆忙忙專注于那些“還未完成的事業(yè)”。其實(shí)乳腺癌是全世界婦女最常見的癌癥，乳腺癌中99%發(fā)生在女性身上，男性僅占1%。據(jù)世界衛(wèi)生組織的數(shù)據(jù)顯示，乳腺癌占所有婦女癌癥的16%。據(jù)統(tǒng)計，2012年全球有170萬婦女被診斷患有乳腺癌，超過52萬人因罹患乳腺癌而死亡。近幾十年來，乳腺癌的發(fā)病率呈上升趨勢，通常情況下，在富裕國家比貧窮國家上升得更快。同時，乳腺癌也是婦女死亡率較高的癌癥，每8例癌癥死亡病例中就有一例為乳腺癌。世界衛(wèi)生組織的數(shù)據(jù)顯示，自2008年起，全球每年乳腺癌病例以超過20%的速度增長，而死亡率每年增長14%。

在全球范圍內(nèi)，乳腺癌的發(fā)病率相差很大，年齡標(biāo)化發(fā)病率在北美洲能達(dá)到0.0994%。而東歐、南美洲、非洲南部和西亞的發(fā)病率略低，卻也在增長。最低的發(fā)病率出現(xiàn)在多數(shù)非洲國家。但在低收入和中等收入國家，由于期望壽命的延長、城市化的加劇以及對西方生活方式的采用，乳腺癌的發(fā)病率在過去若干年以來一直不斷上升。并且由于不發(fā)達(dá)國家缺少適當(dāng)?shù)脑\斷和治療設(shè)施，這些國家中乳腺癌患者的存活率也相對較低。如2008年低收入國家乳腺癌患者存活率僅有40%以下，而北美、瑞典和日本等發(fā)達(dá)國家存活率可高達(dá)80%甚至以上。

Take China as an example， the China’s Breast Cancer Status Report in the recent authoritative medical journal the Lancet’s tumor special said that， in every 100 new diagnosed breast cancer cases， there are 12 from China， the new morbidity growth rate of which is twice of that of the world and the average onset age is 10-15 years earlier than that of western countries. Shao Zhimin， director of breast surgery of Tumor Hospital affiliated to Fudan University， said that， breast cancer is of the highest morbidity of females in China and is increasing in these years with a younger trend. It is estimated that， till 2030， the breast cancer cases in China will reach 234，000， 31.15% more than that in 2008.

When seeing this numbers， do you still feel breast cancer is far away from you？ Maybe when thinking back， in our life， we always hear the news of breast cancer of famous people or relatives or friends. The importance of breast to women goes without saying. The unfortunate women with breast cancer will not only face the hurts and damage physically， but also the mental misery after the removal of breast， even in some extreme situation C the spread of cancer cells and the loss of precious life. Although the morbidity of breast cancer is high and not timely treatment will bring serious result， we need not to “be panic when talking about it”. As long as it can be found at the early stage and diagnosed and treated in a proper way， it has relatively high cure rate.

以中國為例，在近期的權(quán)威醫(yī)學(xué)期刊《柳葉刀》的腫瘤特刊上，《中國乳腺癌現(xiàn)狀報告》顯示，全球每100個新確診的乳癌病例中，有12個來自中國，新發(fā)病率增長速度是世界平均水平的2倍，平均發(fā)病年齡比西方國家早10-15年。上海復(fù)旦大學(xué)附屬腫瘤醫(yī)院乳腺外科主任邵志敏表示，乳腺癌是中國女性發(fā)病率最高的癌癥類型，其發(fā)病率在近幾年呈逐年遞增之勢，且年輕化趨勢顯著。預(yù)計到2030年，中國女性乳腺癌發(fā)病數(shù)將達(dá)23.4萬例，比2008年上升31.15%。

看到這一串?dāng)?shù)據(jù)，你是否還會覺得乳腺癌離你很遙遠(yuǎn)？或許可以回想一下，在我們的生活中，似乎總能聽到周遭名人或者身邊親戚朋友患乳腺癌的案例。對于女性的重要性是不言而喻的，不幸得了乳腺癌的女性不僅將面對身體上的疼痛和摧殘，有的還將面臨由手術(shù)切除之后帶來的心理傷害，甚至出現(xiàn)更極端的情況――癌細(xì)胞擴(kuò)散轉(zhuǎn)移，最終失去寶貴的生命。雖然乳腺癌的發(fā)病率較高，不及時治療會造成嚴(yán)重的后果，但也不需要“談之色變”，只要能夠及時在早期發(fā)現(xiàn)，并作出適當(dāng)?shù)脑\斷和治療，乳腺癌還是會有著較高的治愈率。

The mystery of breast cancer

乳腺癌之謎

The death of Yao Beina makes people regret the impermanence of life. Famous people like Chen Xiaoxu， Li Yuanyuan， Yefan， A Sang…are all died of it in a young age. Besides， Chinese and foreign stars like Cai Qin， Wang Mingquan， the former first lady of America Nancy Regan， Shirley Temple and Kylie Minogue were all doomed to have this disease. But they survived the struggle with the cancer， defeated it and continued the glorious life. Of course， there are thousands of ordinary people， who suffered imaginable pains because of breast cancer.

When talking about the reason of the disease， it is still a mystery. But like other related cases， breast cancer has its “preference”. Women that have family genetic history， long time smoke and drink， eat high fat diet， never do sports， are of long-term pressure， are in polluted areas or contact with hormones are easy to be targeted. For genetic inheritance， scientists found that， the variation of susceptibility gene BRCA1and BRCA2 would largely increase the risk of women to have breast cancer， but only less than 10% patients have this gene. The morbidity rate of breast cancer in Southeast Asia and African countries is 5 times lower than that in developed countries， which makes people to guess if the lifestyle of women in developed countries let them be easier to get breast cancer. Dr. Tim Key， epidemiologists and cancer experts of Oxford University said that， “we cannot say some groups are immune for this disease genetically， because， if people move from poor countries to rich countries， after one or two generations， the morbidity of them would be the same as that of western people. This is related to lifestyle.”

姚貝娜的離開讓人感慨生命的無常，回顧一下那些患過乳腺癌的名人，演員陳曉旭、李媛媛，歌手葉凡、阿?！家蛉橄侔┒阆駳尅４送膺€有蔡琴、汪明荃、美國前第一夫人南希?里根，美國演員秀蘭?鄧波兒，歌手凱莉?米洛等中外明星，也都難逃厄運(yùn)。但她們在與病痛的斗爭中堅(jiān)持了下來，戰(zhàn)勝了乳腺癌，延續(xù)了生命的光彩。當(dāng)然還有千千萬萬的普通人，也曾因乳腺癌承受著我們難以想象的折磨。

說起乳腺癌的病因，目前仍是一個謎。但是，和其他相關(guān)病例一樣，乳腺癌也有格外“青睞”的人群。有家族遺傳史，長期吸煙飲酒、高脂飲食、疏于運(yùn)動、長期壓力過大及處于污染生活環(huán)境中和長期接觸激素的女性，都更容易中招。針對基因遺傳，科學(xué)家發(fā)現(xiàn)，乳腺癌易感基因BRCA1和BRCA2的變異確實(shí)會大大增加女性患乳腺癌的風(fēng)險，但僅有不到10%的乳腺癌患者攜帶遺傳性突變基因。一些東南亞國家和非洲國家的乳腺癌發(fā)病率比發(fā)達(dá)國家要低五倍，讓人不禁要猜想是否發(fā)達(dá)國家女性的生活方式使他們更有可能患乳腺癌？牛津大學(xué)流行病學(xué)家和癌癥專家Tim Key博士說：“不能說有哪些人群從基因上就對該病免疫，因?yàn)槲覀冎溃绻藗儚母F國移居富國，一兩代人之后，他們的發(fā)病率就和西方人一樣了。這和人們的生活方式有關(guān)?！?/p>

Then， how “l(fā)ifestyle” affects the high morbidity of breast cancer？ Studies show that， obesity and alcohol consumption are related to breast cancer. Dr. Key said， “the level of estrogen （hormone） in the blood of fat women is higher since fat cells to produce estrogen.” Estrogen will stimulate the growth of breast cancer tumor. Alcohol also is related to the increase of hormone in blood and maybe leads to the rise of risks of having breast cancer. Besides， birth condition all leads to the difference in breast cancer risks worldwide. Such as in some places of Africa， the morbidity is low because women there give birth to children in a very young age and do breast feeding， which lower down the estrogen level as well as the risks of getting breast cancer. What’s more， Dr.Philip Landrigan in New York Mount Sinai Medical Center， said that， the more the menstrual cycles， the higher risk of the breast cancer. Women of early puberty and late pregnancy have more menstrual cycles. Hormone Replacement Therapy and oral contraceptive are resource of estrogen and proved to be the dangerous elements for breast cancer， and many chemicals are proved to add the risks of getting cancer.

那么，“生活方式”是如何影響乳腺癌的高發(fā)病率的呢。有研究表明，肥胖和飲酒與乳腺癌有關(guān)。Key博士說：“肥胖婦女血液中荷爾蒙雌激素的含量更高，因?yàn)橹炯?xì)胞會產(chǎn)生雌激素?！倍萍に貢碳ご蟛糠秩橄侔┠[瘤的生長。酒精也與血液中荷爾蒙含量升高有關(guān)，可能就是由于這個原因飲酒也會增加女性患乳腺癌的風(fēng)險。另外，生育狀況也造成全球乳腺癌風(fēng)險方面的巨大差異。如非洲一些地方乳腺癌發(fā)病率低，因?yàn)楫?dāng)?shù)嘏暂^早生育孩子，并且對孩子進(jìn)行母乳喂養(yǎng)，這樣就降低了女性雌激素水平，從而降低患乳腺癌的風(fēng)險。此外，紐約西奈山醫(yī)療中心的Philip Landrigan博士認(rèn)為，女性一生經(jīng)歷的月經(jīng)周期越多，患乳腺癌的風(fēng)險就越大，過早進(jìn)入青春期的女性和過晚懷孕的女性經(jīng)歷的月經(jīng)周期會越多。據(jù)悉，荷爾蒙替代療法和口服避孕藥都是雌激素來源，而且均有研究證明是患乳腺癌的危險因素，許多化學(xué)品也在實(shí)驗(yàn)中被證明會增加人類的致癌風(fēng)險。

“Iron ladies” have higher risk of breast cancer

“女強(qiáng)人”患乳腺癌風(fēng)險更高

Besides the above factors for cancer risk， irregular work and rest and depressed mind that cannot be sent out are more influential. Straif， researcher of International Agency for Research on Cancer said， “it is more conclusive of the evidence for reverse shift work day and night leading cancer than chemicals.” He also said， the shift work that lead to destruction of normal sleep habits is listed in the “2 A kind of carcinogen the International Agency for Research on Cancer”， which means it may bring cancer to human beings. Recently published paper further supports a causal relationship between the two. Straif said， “the shift work is frequent in modern society， which is a dangerous elements for the whole group of human beings.” Besides， too much mental pressure， anxiety， less counseling and longtime depression will lead endocrine disorders that may cause breast cancer. Israel scientist Peled’s report on Biomedicine said， he and his colleagues compared 255 breast cancer patients and 367 healthy women of the same age， and they all less than 45 years old. They found that， young women facing with kinds of pressures will have 62% higher risk of getting the disease.

When we looking back the women are or were of breast cancer， maybe can find something in common from the above famous people with same painful experience. No matter the former first lady Nancy Regan or just passed away Yao Beina， they both suited for the definition of “iron lady”. It is not refer to those women with tough looks， but those talented and smart ones， which is a title for women focusing on careers and also achieving success.

除了以上致癌的因素外，對乳腺癌影響更大的是不規(guī)律的作息和無法排遣的壓抑情緒。國際癌癥研究機(jī)構(gòu)的研究員Straif說：“有關(guān)晝夜顛倒的倒班工作造成乳腺癌的證據(jù)比化學(xué)品引起乳腺癌的證據(jù)更為確鑿。”他還補(bǔ)充說，導(dǎo)致正常睡眠習(xí)慣被破壞的倒班工作目前被列為“國際癌癥研究機(jī)構(gòu)2A類致癌物”，也就是說對人類很有可能有致癌性。最近發(fā)表的論文進(jìn)一步支持兩者之間存在因果關(guān)系。Straif說：“考慮到現(xiàn)代社會中倒班工作很常見，這可能對整個人群而言都屬于危險因素。”另外，精神壓力過大、焦慮，又沒有及時疏導(dǎo)，長期精神抑郁，導(dǎo)致內(nèi)分泌功能紊亂也容易招來乳腺癌。以色列科學(xué)家佩萊德在網(wǎng)絡(luò)雜志《生物醫(yī)學(xué)》上報告說，他和同事將255名乳腺癌患者與367名同齡健康女性進(jìn)行了對比研究，他們的年齡均小于45歲。研究人員發(fā)現(xiàn)，面臨種種壓力的年輕女性患乳腺癌的風(fēng)險會增加62%。

反觀一下那些患有或患過乳腺癌的女性，或許如前所列的有過相同痛苦經(jīng)歷的名人身上，我們多少能找到一些共性。不論是前第一夫人南希?里根還是剛剛?cè)ナ赖囊ω惸?，她們基本都符合我們所說的“女強(qiáng)人”定義?！芭畯?qiáng)人”不一定是外表看上去很強(qiáng)悍的女人，但指的是才能出眾，精明干練的女性，也是對專注事業(yè)并獲得成就的女性的一種稱呼。

This kind of “iron lady” can develop to urban women in daily life. They always have strict high standards for themselves or even overcritical. They all wants progress in career and feel too much pressure or depressed due to some obstacles. Besides mental pressure， in their life， they would neglect themselves due to the desperate pursuit of career. Like they are too busy to have meal on time， or even don’t have meal and sometimes eat and drink too much; more and more females often stay very late at night due to work or “era disease”; many white-collar female workers have no time to do sports and the time they sit in front of the desk is more than that of their sleep; when feel too much pressure or have to do social engagement， they would smoke or drink; their over pursuit of external beauty makes them use excessive hormone cosmetics that their skin are stimulated for a long time and leads to hormonal disorders; since not will to delay the development of career， late marriage and child birth are the choice of many career-first woman…so except genetic heritance and variation， all of these elements that may trigger cancer can be found in “iron ladies”.

Another group of statistics： in 2014， there were 187000 breast cancer patients covering 25% of females with cancer. The coastal developed cities like Beijing， Shanghai and Guangzhou are the “severely afflicted area” of breast cancer， which 7 times of that in less developed middle and western parts. Why developed cities are the high incidence areas of breast cancer？ Besides the different living environment， the longtime pressure on people can also be related. White-collar females in big cities always give up the original regular life due to the working pressure. Diet structure disorder， too much mental pressure， especially longtime delay childbearing are all bad elements inducing breast lesions. Some materials show that， the morbidity rate of women never have childbirth is 30% of that of women have had babies; the morbidity rate of non-nursing women is 1.5 times of that of nursing women. So “iron ladies” if do not pay attention to the regular routine and health when pursuing career， they will largely increase the possibility of having breast cancer.

這樣的“女強(qiáng)人”代表可以衍生到日常生活中的都市女性身上。她們往往對自己有著嚴(yán)格的高標(biāo)準(zhǔn)，有時甚至過于苛求自己。她們普遍希望自己在事業(yè)上有所發(fā)展，有時會因?yàn)橐恍┳枇κ艿酱驌舳鴮?dǎo)致壓力過大甚至產(chǎn)生抑郁情緒。除了心理上的壓力外，在她們的生活中，很可能因?yàn)閷κ聵I(yè)的極致追求而忽略自身。比如工作太忙讓她們無法按時吃飯，或者有時不吃飯，有時又暴飲暴食;越來越多的女性因?yàn)楣ぷ骰蛘摺皶r代病”會經(jīng)常在晚上熬夜;許多白領(lǐng)女性沒有時間去運(yùn)動，每天坐在辦公桌前的時間也許會多過睡覺的時間;“女強(qiáng)人”們壓力過大或者不得以需要應(yīng)酬的時候，也許還會抽點(diǎn)煙喝點(diǎn)酒;她們對外在的過分追求也許會讓她們過多使用激素類美容品，肌膚長期受到刺激，導(dǎo)致荷爾蒙分泌紊亂;由于不愿耽誤事業(yè)的發(fā)展，晚婚晚育也成為多數(shù)事業(yè)型女人的選擇……由此可見，除了基因遺傳和變異，所有這些也許會引發(fā)高致癌的因素，似乎都可以在“女強(qiáng)人”身上捕捉到影子。

再拿一組數(shù)據(jù)作為支撐：2014年，中國乳腺癌發(fā)病人數(shù)18.7萬人，占女性癌癥的25%。北京、上海、廣州等沿海一線發(fā)達(dá)城市是乳腺癌“重災(zāi)區(qū)”，是經(jīng)濟(jì)欠發(fā)達(dá)的中西部的近7倍。為什么一線發(fā)達(dá)城市會成為乳腺癌的高發(fā)區(qū)？除了生活環(huán)境不一樣，恐怕與大城市長期給人帶來的壓力也不無關(guān)系。居住在大城市的白領(lǐng)女性，往往因?yàn)槊媾R工作壓力，而放棄原有的規(guī)律生活。飲食結(jié)構(gòu)紊亂、精神壓力過大，尤其是過長時間推遲生育，都成為誘發(fā)乳腺病變的不良因素。有關(guān)資料表明，從未生育婦女患該病的危險性比已生育婦女高30%;未哺乳婦女患該病的危險性比哺乳婦女高1.5倍以上。因此“女強(qiáng)人”在對事業(yè)的追求中如果不同時注重自身的規(guī)律作息和身體健康，在很大程度上會為自己增加許多罹患乳腺癌的概率。

Protect breast and keep away from cancer

保護(hù)乳腺遠(yuǎn)離癌

Since people don’t fully understand the reason caused breast cancer， the early detection of it is still the foundation of the control of breast cancer. If people can enhance their awareness and have proper diagnose and treatment at the early stage of breast cancer， the possibility of healing is still high. However， “iron ladies” who pay too much attention to career and family can hardly do this. They may be too busy to neglect the physical discomfort and anomalies of themselves or forget to do annual breast examination. They will come to the hospital when there is obvious syndrome， which would largely delay the treatment.

The purpose for examination is to nip in the bud. For malignant tumor like breast cancer， some experts said the death rate can be largely lowered down by early examination of breast and early treatment. Gynecologist Chen Yuman said， it is because the early and regular breast examinations haven’t been done that most breast cancers have developed into malignant tumor and spread to the whole body. In her opinion， urban women from 20 to 40 can check their breast by hands to find if there is lump or abnormalities with the week after the menstruation every month. For women over 40 and of climacteric should have screening mammography every year. This can guarantee health and is an attitude of being responsible for them.

If being diagnosed of breast cancer， the patient should actively corporate with the treatment plan of the doctor and adjust psychological mood in time with less pressure. After the cure， the patient should keep relaxed and happy mood and rest often. Yao Beina died of relapse of breast cancer. Her surgeon once said， “according to the treatment of state of Yao at first， the chance of relapse was less than 5%， but such a low probability became 100% to her.” The first breast cancer surgery of Yao was a success， but she stepped on the stage of competition just after the recovery. Her surgeon Cao Yingming said， when busy， she often forgot to review. Cai said when Yao Beina was known by everyone， she had less rest time and even flew to different cities to perform in very short time， and even sang and danced at the same time. “Yao loved her career too much that she was willing to sacrifice many things，” said Cao. But it never occurred to anyone that Yao sacrificed her life for her career.

由于目前人們尚不完全了解乳腺癌的病因，因此疾病的早期發(fā)現(xiàn)仍然是乳腺癌控制工作的基礎(chǔ)。如果能夠提高意識，在乳腺癌早期就發(fā)現(xiàn)并作出適當(dāng)診斷和治療，乳腺癌治愈的可能性還是很高的。而往往對于這一點(diǎn)，過分把重心放在事業(yè)和家庭上的“女強(qiáng)人”們卻很難做到。她們也許會因?yàn)樘Χ雎缘糇约荷眢w上的不適與異常，忘記或者沒有習(xí)慣去做每年的檢查，她們通常會等到出現(xiàn)了較明顯的癥狀之后才去醫(yī)院就診，這樣大大延誤了乳腺癌的治療。

檢查的目的自然是為了防患于未然。對乳腺癌這樣一種惡性腫瘤，有專家表示可以通過前期檢查乳腺健康狀況，早期發(fā)現(xiàn)治療便可以大大降低死亡率。婦科醫(yī)生陳玉曼介紹，之所以大多數(shù)乳腺癌被確診時都已然發(fā)展為惡性腫瘤，并開始全身擴(kuò)散，其主要原因便是因?yàn)榍捌跊]做或者沒有認(rèn)真定期的進(jìn)行乳腺癌檢查。在她看來，20至40歲的都市女性，每月月經(jīng)結(jié)束后一周內(nèi)可以自己用手檢查一下有無腫塊或異常。對于40歲以上和進(jìn)入更年期的女性，每年去醫(yī)院進(jìn)行一次造影篩查。這樣既保證了身體的健康，也是對自我負(fù)責(zé)任的態(tài)度。

若被診斷出乳腺癌，患者應(yīng)當(dāng)積極配合醫(yī)生的治療方案，及時調(diào)整心理情緒，不給自己過多的壓力，治愈之后也應(yīng)保持放松和愉快的心情，并應(yīng)當(dāng)多休息。姚貝娜死于乳腺癌復(fù)發(fā)，她的主刀醫(yī)生曾說：“根據(jù)姚貝娜最初的治療狀態(tài)，復(fù)發(fā)的概率不到5%，可是這么低的概率，在姚貝娜這里卻變成了100%”。姚貝娜第一次的乳腺癌切除手術(shù)其實(shí)很成功，但她在剛恢復(fù)沒多久就踏上了舞臺參加比賽，她的主治醫(yī)生曹迎明說，忙起來時，姚貝娜經(jīng)常忘記了去復(fù)查。據(jù)曹迎明介紹，姚貝娜在被大家認(rèn)識后，更加沒有自己休息的時間，經(jīng)常在短時間內(nèi)飛到不同的城市演出，甚至邊唱邊跳。“姚貝娜太熱愛自己的事業(yè)了，寧可犧牲很多其他東西”，曹迎明說道?？蓻]想到姚貝娜為了事業(yè)，最后卻犧牲掉了自己的生命。

For females without breast cancer， to change into a better lifestyle can achieve effective prevention result. WHO pointed out that： by controlling changeable specific high-risk elements for breast cancer and effectively prevent non-infective disease in an all-round way to improve healthy diet， physical activities and control drinking， overweight and obesity can finally lower down the morbidity of breast cancer in a long time. The research result of Institute of psychology Research Chinese Academy of Sciences also said： in modern life， long-term nervous in work and study， inharmonious in work and family and big unfortunate things in life are three major elements cause cancer. When seeing the pass away stars like A Sang， Chen Xiaoxu and Yao Beina， they all experiences low ebb at certain stage in their life， which seriously affected their mood and brought them strong depression. Some studies show that， the mood affects the immune system of a person that good mood can promote the coordination of organs and the ability to fight against disease while bad mood may lead organ function disorder， reduce the human body immunity， and let the cancer cell get in. The saying that “all diseases come from the heart” also means this. Cui Shude， chief physician of breast surgery in Henan Tumor Hospital said， depression and negative mood may increase milk hormone and may lead to breast cancer. Among breast cancer patients， city overweighs rural area and intellectual women overweigh ordinary working women.

So though we cannot say that there is necessary connection between iron ladies and breast cancer， the elements of irregular work and rest， late marriage and late childbirth， dink family， longtime pressure and negative mood are all increasing the risk of getting breast cancer. It is an admirable thing for women to have their own career and fight for it， but they should not neglect their health for this. “Iron ladies” should care about the changes of their body and look after their mood. They should talk to relatives and friends when feel depressed and do sports and outdoor tourism to distract attention. They should lower the probability of having breast cancer through changing unhealthy lifestyle. When facing breast cancer， we need not to fear irrationally. Protecting breast can start from small things in our daily life. Try to treat our body with a positive and rational mind and understand that a healthy body is the foundation for career and treat it in a good way is the best blessing for us.