0:00:00.740,0:00:04.426
In the space that used[br]to house one transistor,

0:00:04.426,0:00:07.265
we can now fit one billion.

0:00:07.819,0:00:11.661
That made it so that a computer[br]the size of an entire room

0:00:11.661,0:00:14.036
now fits in your pocket.

0:00:14.273,0:00:17.292
You might say the future is small.

0:00:17.731,0:00:18.961
As an engineer,

0:00:18.961,0:00:22.815
I'm inspired by this miniaturization[br]revolution in computers.

0:00:23.034,0:00:24.358
As a physician,

0:00:24.358,0:00:30.104
I wonder whether we could use it[br]to reduce the number of lives lost

0:00:30.104,0:00:34.173
due to one of the fastest-growing[br]diseases on Earth:

0:00:34.173,0:00:35.249
cancer.

0:00:35.646,0:00:36.924
Now when I say that,

0:00:36.924,0:00:40.337
what most people hear me say[br]is that we're working on curing cancer.

0:00:40.682,0:00:42.028
And we are,

0:00:42.028,0:00:44.724
but it turns out that there's[br]an incredible opportunity

0:00:44.724,0:00:49.508
to save lives through the early[br]detection and prevention of cancer.

0:00:49.833,0:00:55.343
Worldwide, over two-thirds of deaths[br]due to cancer are fully preventable

0:00:55.343,0:00:58.479
using methods that we already[br]have in hand today.

0:00:58.479,0:01:03.611
Things like vaccination, timely screening[br]and of course, stopping smoking.

0:01:04.419,0:01:08.035
But even with the best tools[br]and technologies that we have today,

0:01:08.035,0:01:10.121
some tumors can't be detected

0:01:10.121,0:01:13.814
until 10 years after[br]they've started growing,

0:01:13.814,0:01:17.577
when they are 50 million[br]cancer cells strong.

0:01:18.178,0:01:19.964
What if we had better technologies

0:01:19.964,0:01:23.093
to detect some of these more[br]deadly cancers sooner?

0:01:23.093,0:01:24.616
When they could be removed,

0:01:24.616,0:01:26.427
when they were just getting started.

0:01:26.673,0:01:29.924
Let me tell you about how[br]miniaturization might get us there.

0:01:31.204,0:01:33.735
This is a microscope in a typical lab

0:01:33.735,0:01:37.159
that a pathologist would use[br]for looking at a tissue specimen,

0:01:37.159,0:01:39.597
like a biopsy or a pap smear.

0:01:40.054,0:01:42.253
This $7,000 microscope

0:01:42.253,0:01:45.532
would be used by somebody[br]with years of specialized training

0:01:45.532,0:01:47.321
to spot cancer cells.

0:01:48.277,0:01:51.346
This is an image from a colleague[br]of mine at Rice University,

0:01:51.346,0:01:52.949
Rebecca Richards-Kortum.

0:01:52.949,0:01:54.434
What she and her team have done

0:01:54.434,0:01:58.783
is miniaturize that whole[br]microscope into this $10 part

0:01:58.783,0:02:01.802
and it fits on the end[br]of an optical fiber.

0:02:02.122,0:02:05.779
Now what that means is instead[br]of taking a sample from a patient

0:02:05.779,0:02:07.451
and sending it to the microscope,

0:02:07.451,0:02:10.066
you can bring the microscope[br]to the patient.

0:02:10.324,0:02:14.802
And then instead of requiring[br]a specialist to look at the images,

0:02:14.802,0:02:19.864
you can train the computer to score[br]normal versus cancerous cells.

0:02:20.212,0:02:21.560
Now this is important

0:02:21.560,0:02:24.620
because what they found[br]working in rural communities,

0:02:24.620,0:02:27.746
is that even when they have[br]a mobile screening van

0:02:27.746,0:02:30.685
that can go out into the community[br]and perform exams

0:02:30.685,0:02:32.085
and collect samples,

0:02:32.085,0:02:35.263
and send them to the central[br]hospital for analysis,

0:02:35.263,0:02:36.630
that days later,

0:02:36.630,0:02:39.320
women get a call[br]with an abnormal test result

0:02:39.320,0:02:41.033
and they're asked to come in.

0:02:41.033,0:02:45.190
Fully half of them don't turn up[br]because they can't afford the trip.

0:02:45.857,0:02:49.304
Now with the integrated microscope[br]and computer analysis,

0:02:49.304,0:02:52.155
Rebecca and her colleagues[br]have been able to create a van

0:02:52.155,0:02:55.615
that has both a diagnostic setup[br]and a treatment setup.

0:02:56.034,0:02:58.771
And what that means[br]is that they can do a diagnosis

0:02:58.771,0:03:01.375
and perform therapy on the spot,

0:03:01.375,0:03:03.513
so no one is lost to follow up.

0:03:03.950,0:03:07.898
That's just one example of how[br]miniaturization can save lives.

0:03:08.236,0:03:09.427
Now as engineers,

0:03:09.427,0:03:11.819
we think of this as[br]straight-up miniaturization.

0:03:12.213,0:03:14.396
You took a big thing[br]and you made it little.

0:03:14.644,0:03:16.957
But what I told you before about computers

0:03:16.957,0:03:19.290
was that they transformed our lives

0:03:19.290,0:03:23.516
when they became small enough[br]for us to take them everywhere.

0:03:23.873,0:03:28.169
So what is the transformational[br]equivalent like that in medicine?

0:03:28.683,0:03:31.811
Well, what if you had a detector

0:03:31.811,0:03:36.096
that was so small that it could[br]circulate in your body,

0:03:36.096,0:03:38.383
find the tumor all by itself

0:03:38.383,0:03:40.752
and send a signal to the outside world?

0:03:41.185,0:03:43.239
It sounds a little bit[br]like science fiction,

0:03:43.239,0:03:47.060
but actually, nanotechnology[br]allows us to do just that.

0:03:47.487,0:03:52.391
Nanotechnology allows us to shrink[br]the parts that make up the detector

0:03:52.391,0:03:54.475
from the width of a human hair,

0:03:54.475,0:03:55.976
which is 100 microns,

0:03:55.976,0:03:58.602
to a thousand times smaller,

0:03:58.602,0:04:00.297
which is 100 nanometers.

0:04:00.527,0:04:03.337
And that has profound implications.

0:04:03.762,0:04:04.757
It turns out

0:04:04.757,0:04:09.021
that materials actually change[br]their properties at the nanoscale.

0:04:09.446,0:04:11.967
You take a common material like gold,

0:04:11.967,0:04:13.676
and you grind it into dust,

0:04:13.676,0:04:15.266
into gold nanoparticles,

0:04:15.266,0:04:18.578
and it changes from looking[br]gold to looking red.

0:04:19.297,0:04:23.133
If you take a more exotic material[br]like cadmium selenide --

0:04:23.133,0:04:25.284
forms a big, black crystal --

0:04:25.284,0:04:27.998
if you make nanocrystals[br]out of this material

0:04:27.998,0:04:29.594
and you put it in a liquid,

0:04:29.594,0:04:31.307
and you shine light on it,

0:04:31.307,0:04:32.638
they glow.

0:04:32.638,0:04:38.292
And they glow blue, green,[br]yellow, orange, red,

0:04:38.292,0:04:40.567
depending only on their size.

0:04:40.991,0:04:41.991
It's wild.

0:04:41.991,0:04:45.097
Can you imagine an object[br]like that in the macro world?

0:04:45.097,0:04:51.691
It would be like all the denim jeans[br]in your closet are all made of cotton,

0:04:51.691,0:04:56.002
but they are different colors[br]depending only on their size.

0:04:56.538,0:04:57.908
(Laughter)

0:04:59.070,0:05:00.686
So as a physician,

0:05:00.686,0:05:02.933
what's just as interesting to me,

0:05:02.933,0:05:05.305
is that it's not just[br]the color of materials

0:05:05.305,0:05:07.145
that changes at the nanoscale;

0:05:07.145,0:05:10.860
the way they travel[br]in your body also changes.

0:05:11.304,0:05:14.113
And this is the kind of observation[br]that we're going to use

0:05:14.113,0:05:16.253
to make a better cancer detector.

0:05:16.253,0:05:18.211
So let me show you what I mean.

0:05:18.902,0:05:21.201
This is a blood vessel in the body.

0:05:21.201,0:05:23.590
Surrounding the blood vessel is a tumor.

0:05:23.838,0:05:26.953
We're going to inject nanoparticles[br]into the blood vessel

0:05:26.953,0:05:31.133
and watch how they travel[br]from the bloodstream into the tumor.

0:05:31.559,0:05:35.934
Now it turns out that the blood vessels[br]of many tumors are leaky,

0:05:35.934,0:05:40.300
and so nanoparticles can leak out[br]from the bloodstream into the tumor.

0:05:40.732,0:05:43.866
Whether they leak out[br]depends on their size.

0:05:44.188,0:05:45.303
So in this image,

0:05:45.303,0:05:49.870
the smaller, hundred-nanometer,[br]blue nanoparticles are leaking out,

0:05:49.870,0:05:53.289
and the larger, 500-nanometer,[br]red nanoparticles

0:05:53.289,0:05:54.794
are stuck in the bloodstream.

0:05:55.134,0:05:57.245
So that means as an engineer,

0:05:57.245,0:06:01.260
depending on how big[br]or small I make a material,

0:06:01.260,0:06:04.301
I can change where it goes in your body.

0:06:05.448,0:06:10.142
In my lab, we recently made[br]a cancer nanodetector

0:06:10.142,0:06:15.390
that is so small that it could travel[br]into the body and look for tumors.

0:06:15.691,0:06:19.737
We designed it to listen[br]for tumor invasion:

0:06:19.737,0:06:24.386
the orchestra of chemical signals[br]that tumors need to make to spread.

0:06:25.012,0:06:28.015
For a tumor to break out[br]of the tissue that it's born in,

0:06:28.015,0:06:30.694
it has to make chemicals called enzymes

0:06:30.694,0:06:33.804
to chew through[br]the scaffolding of tissues.

0:06:34.001,0:06:38.575
We designed these nanoparticles[br]to be activated by these enzymes.

0:06:39.233,0:06:45.582
One enzyme can activate a thousand[br]of these chemical reactions in an hour.

0:06:45.582,0:06:46.683
Now in engineering,

0:06:46.683,0:06:50.727
we call that one-to-one thousand[br]ratio a form of amplification,

0:06:50.727,0:06:53.096
and it makes something ultrasensitive.

0:06:53.096,0:06:57.131
So we've made an ultrasensitive[br]cancer detector.

0:06:57.395,0:07:02.318
OK, but how do I get this activated[br]signal to the outside world

0:07:02.318,0:07:04.079
where I can act on it?

0:07:04.079,0:07:07.654
For this we're going to use[br]one more piece of nanoscale biology

0:07:07.654,0:07:09.504
and that has to do with the kidney.

0:07:09.818,0:07:11.931
So the kidney is a filter.

0:07:12.209,0:07:16.783
It's job is to filter out the blood[br]and put waste into the urine.

0:07:17.324,0:07:22.548
It turns out that what the kidney filters[br]is also dependent on size.

0:07:22.943,0:07:24.075
So in this image,

0:07:24.075,0:07:25.253
what you can see

0:07:25.253,0:07:29.843
is that everything smaller than five[br]nanometers is going from the blood,

0:07:29.843,0:07:32.107
through the kidney into the urine,

0:07:32.107,0:07:34.777
and everything else[br]that's bigger is retained.

0:07:35.406,0:07:40.376
OK, so if I make a 100-nanometer[br]cancer detector,

0:07:40.376,0:07:42.871
I inject it in the bloodstream,

0:07:42.871,0:07:45.180
it can leak into the tumor,

0:07:45.180,0:07:50.653
where it's activated by tumor enzymes[br]to release a small signal

0:07:50.653,0:07:54.027
that is small enough to be[br]filtered out of the kidney

0:07:54.027,0:07:56.124
and put into the urine,

0:07:56.124,0:08:00.165
I have a signal in the outside[br]world that I can detect.

0:08:00.723,0:08:02.464
OK, but there's one more problem.

0:08:02.783,0:08:04.592
This is a tiny, little signal,

0:08:04.592,0:08:06.564
so how do I detect it?

0:08:06.897,0:08:09.077
Well, the signal is just a molecule.

0:08:09.077,0:08:11.905
There are molecules[br]that we designed as engineers --

0:08:11.905,0:08:13.764
they're completely synthetic --

0:08:13.764,0:08:18.319
and we can design them so that they[br]are compatible with our tool of choice.

0:08:18.319,0:08:21.855
If we want to use a really[br]sensitive, fancy instrument

0:08:21.855,0:08:23.790
called a mass spectrometer,

0:08:23.790,0:08:26.182
then we make a molecule[br]with a unique mass.

0:08:26.806,0:08:30.173
Or maybe we want make something[br]that's more inexpensive and portable.

0:08:30.657,0:08:34.369
Then we make molecules[br]that we can trap on paper,

0:08:34.369,0:08:36.161
like a pregnancy test.

0:08:36.161,0:08:38.810
In fact there's a whole[br]world of paper tests

0:08:38.810,0:08:43.322
that are becoming available[br]in a field called Paper Diagnostics.

0:08:43.910,0:08:46.236
All right, where are we going with this?

0:08:46.812,0:08:48.554
What I'm going to tell you next,

0:08:48.554,0:08:50.247
as a life-long researcher,

0:08:50.247,0:08:52.126
represents a dream of mine.

0:08:52.571,0:08:54.665
I can't say that's it's a promise;

0:08:54.665,0:08:55.942
it's a dream.

0:08:56.180,0:08:59.850
But I think we all have to have dreams[br]to keep us pushing forward,

0:08:59.850,0:09:00.850
even --

0:09:00.850,0:09:03.626
and maybe especially,[br]cancer researchers.

0:09:03.816,0:09:07.220
I'm going to tell you what I hope[br]will happen with my technology,

0:09:07.220,0:09:10.013
that my team and I will try --

0:09:10.013,0:09:13.417
we'll put our heart and souls[br]into making a reality.

0:09:13.417,0:09:15.182
OK, here goes ...

0:09:15.194,0:09:18.572
I dream that one day,

0:09:18.572,0:09:23.379
instead of going into an expensive[br]screening facility to get a colonoscopy,

0:09:23.379,0:09:24.725
or a mammogram,

0:09:24.725,0:09:26.935
or a pap smear,

0:09:26.935,0:09:28.536
that you could get a shot,

0:09:28.536,0:09:30.219
wait an hour,

0:09:30.219,0:09:33.377
and do a urine test on a paper strip.

0:09:33.876,0:09:39.486
I imagine that this could even happen[br]without the need for steady electricity,

0:09:39.486,0:09:42.067
or a medical professional in the room.

0:09:42.067,0:09:43.550
Maybe they could be far away

0:09:43.550,0:09:46.360
and connected only by[br]the image on a smartphone.

0:09:46.955,0:09:48.671
Now I know this sounds like a dream,

0:09:48.671,0:09:51.897
but in the lab we already[br]have this working in mice,

0:09:51.897,0:09:54.137
where it works better[br]than existing methods

0:09:54.137,0:09:58.108
for the detection of lung, colon[br]and ovarian cancer.

0:09:58.834,0:10:01.028
And I hope that what this means

0:10:01.028,0:10:06.186
is that one day we can[br]detect tumors in patients

0:10:06.186,0:10:09.590
sooner than 10 years[br]after they've started growing,

0:10:09.590,0:10:11.598
in all walks of life,

0:10:11.598,0:10:13.470
all around the globe,

0:10:13.470,0:10:16.228
and that this would lead[br]to earlier treatments,

0:10:16.228,0:10:21.058
and that we could save more lives[br]than we can today with early detection.

0:10:21.686,0:10:22.801
Thank you.

0:10:23.242,0:10:24.728
(Applause)