Breast cancer is second only to skin cancer as the most common malignancy diagnosed in women in the United States. In 2001, about 192,200 new cases of invasive breast cancer were diagnosed and 40,200 women died of the disease. Only lung cancer accounts for more cancer deaths in women. The incidence of breast cancer has increased over the last 20 years. Although some of the increase can be attributed to changes in reproductive patterns, such as delayed childbearing and having fewer children, much of the rise is due to the increased detection of smaller, earlier-stage cancers with the widespread adoption of mammography screening in asymptomatic women. According to data from the Surveillance, Epidemiology, and End Results Program, incidence rates of tumors less than 2.0 cm in diameter more than doubled from 1980 to 1987, whereas rates of tumors greater than 3.0 cm decreased by 27%. In particular, incidence rates of in situ breast cancer have risen dramatically over the last 25 years. The annual increase in age-adjusted ductal carcinoma in situ incidence rates from 1983 to 1992 was 17.5%. Although the incidence of breast cancer has been increasing, there has been a decline in breast cancer mortality. Death rates decreased 1.6% annually between 1989 and 1995, then 3.4% annually between 1995 and 1998. This improvement in the mortality rate has been attributed to both mammography screening and improvements in breast cancer treatment. Breast cancer has a number of identifiable risk factors. Aside from a personal history of breast cancer, the most important risk factor in women is age. Between 1994 and 1998, 77% of new cases of breast cancer and 84% of breast cancer deaths occurred in women older than 50 years. Other nonmodifiable risk factors include family history, age at birth of the woman’s first child, early menarche, and late menopause. Potentially modifiable risk factors include alcohol consumption, use of postmenopausal hormones, and obesity after menopause. Risk factors and their relative risk are listed in table 1 in order of the strength of their association. Although most breast cancer cases are sporadic, up to 10% are linked to genetic predisposition. Women with a family history of breast cancer, especially in a first-degree relative(ie, mother, sister, or daughter), have an increased risk of breast cancer. In general, a “positive family history“ of breast cancer confers a relative risk of 2.0 to 3.0, with the degree of risk varying directly with the closeness of the relationship. Paternal and maternal relatives with breast cancer contribute similarly to the increased risk. Most women with a family history of breast cancer do not have a history striking enough to suggest the presence of an inherited breast cancer syndrome. In many cases, primary care physicians can readily distinguish between families with heritable cancers and those with several sporadic cases. Women at high risk of inherited breast cancers typically have several relatives with breast cancer diagnosed before age 45 to 50 and may also have a family history of bilateral breast cancer, ovarian cancer, or male breast cancer.

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Overcoming setbacks takes time, efforts and perseverance. maintenance assistance persistence determination

Initial reports were that multiple waves of warplanes bombed central Baghdad, hitting oil refineries and the airport. beating knocking hurting striking

The president is often awakened by a noisy crowd which assembles on the White House. concentrates assumes involves gathers

Overcoming setbacks takes time, efforts and perseverance. maintenance assistance persistence determination

The human nose is an underrated tool. Humans are often thought to be insensitive smellers compared with animals, but this is largely because,【C1】______animals, we stand upright. This means that our noses are【C2】______to perceiving those smells which float through the air, missing the majority of smells which stick to surfaces. In fact, though, we are extremely sensitive to smells, even if we do not generally realize it. Our noses are capable of【C3】______human smells even when these are【C4】______to far below one part in one million. Strangely, some people find that they can smell one type of flower but not another, whereas others are sensitive to the smells of both flowers. This may be because some people do not have the genes necessary to generate【C5】______smell receptors in the nose. These receptors are the cells which sense smells and send【C6】______to the brain. However, it has been found that even people insensitive to a certain smell at first can suddenly become sensitive to it when【C7】______to it often enough. The explanation for insensitivity to smell seems to be that brain finds it inefficient to keep all smell receptors working all the time but can【C8】______new receptors if necessary. This may also explain why we are not usually sensitive to our own smells we simply do not need to be. We are not【C9】______of the usual smell of our own house but we notice new smells when we visit someone else’s. The brain finds it best to keep smell receptors【C10】______for unfamiliar and emergency signals such as the smell of smoke, which might indicate the danger of fire.

Most people would be impressed by the high quality of medicine available to most Americans. There is a lot of specialization, a great deal of attention to the individual, a vast amount of advanced technical equipment, and intense effort not to make mistakes because of the financial risk which doctors and hospitals must face in the courts if they handle things badly. But the Americans are in a mess. The problem is the way in which health care is organized and financed. Contrary to public belief, it is not just a free competition system. To the private system has been joined a large public system, because private care was simply not looking after the less fortunate and the elderly. But even with this huge public part of the system, which this year will eat up 84.5 billion dollars— more than 10 percent of the U.S. budget—large numbers of Americans are left out. These include about half the 11 million unemployed and those who fail to meet the strict limits on income fixed by a government trying to make savings where it can. The basic problem, however, is that there is no central control over the health system. There is no limit to what doctors and hospitals charge for their services. Other than what the public is able to pay. The number of doctors has shot up and prices have climbed. When faced with toothache, a sick child, or a heart attack, all the unfortunate person concerned can do is pay up. Two-thirds of the population are covered by medical insurance. Doctors charge as much as they want knowing that the insurance company will pay the bill. The medical profession has as a result become America’s new big businessmen. The average income of doctors has now reached $100,000 a year. With such vast incomes the talk in the doctor’s surgery is as likely to be about the doctor’s latest financial deal, as about whether the minor operation he is recommending at several thousand dollars is entirely necessary. The rising cost of medicine in the U.S.A. is among the most worrying problem facing the country. In 1981 the country’s health cost climbed 15.9 percent—about twice as fast as prices in general.

Please read the following article in Chinese carefully, and then write a summary of 200 words in English on the ANSWER SHEET. Make sure that you cover all the major points of the article. 医德之风随着经济体制市场化改革的逐步深入，我国自20世纪80年代以来对传统的医疗制度进行了一系列的改革。但是，由于医疗制度的复杂性，国内对出台的医疗制度改革方案还存在不少意见分歧。随着医疗卫生改革的不断深入，医德医风建设也面临着新的问题，卫生行业的不正之风已引起了全社会的关注。在新形势下，如何加强医德医风建设，改善行业作风，是摆在医院管理者面前的重大课题。在医疗卫生战线上，广大职工能够自觉遵守社会主义医德原则和规范，在平凡而又光荣的岗位上兢兢业业地履行白衣天使的职责，以高尚的医德医风、精湛的医疗技术战斗在救死扶伤的第一线，为保障人民群众的身体健康作出了贡献，受到社会各界和人民群众的好评。但是因受市场经济负面效应的影响，少数医务工作者政治学习有些放松，为人民服务的思想观念有些淡薄，在行业作风建设的认识上产生了误区，表现为重经济效益、轻社会效益，服务意识不强，对患者检查不仔细，诊疗不认真，不按规章制度办事，缺乏责任心。目前热点问题反应较多的是给病员开大处方、检查多、用好药多、费用高，增加了患者的负担。这些问题都属于医德问题，虽是少数人的事，但其影响不可低估，它使医患之间产生了鸿沟，甚至互不信任，直接影响到医疗卫生战线的形象，同时还会给党和政府造成不良影响。目前我国医疗系统医德医风存在的问题主要有：(1)部分医务人员不讲救死扶伤的人道主义医德观，不讲为人民服务的宗旨，把医疗服务视为商品交换，用等价交换原则看待医患关系，这些少数的害群之马，严重践踏了医疗道德，损坏了医务人员的形象。目前，有些医务人员事业心不强，有的医生满足于一般性的应付，上班无精打采，看病马马虎虎，对患者缺乏感情，缺乏责任心；有的甚至酿成医疗事故，造成医患纠纷；有的给患者留下后遗症，带来终生痛苦：有的使危重患者错过了抢救时间，使患者失去了宝贵的生命。(2)为医不廉，收受好处。有的患者总是怕医生不尽心，觉得送了红包心里才踏实，一些医护人员也就泰然笑纳。有的医生道德素质较差，暗示甚至索要好处。有的医生被医药代表买通，为了按一定比例获取提成而乱施高价药。至于接受请客吃饭，收点土特产则已经不当一回事了。(3)不平衡和消极埋怨的心理。市场经济使一些行业在一定时期内有较大的赢利，社会上一一部分人员收入过高，与医务人员的收入差距较大，一些医务人员产生了“拿手术刀不如拿剃头刀的”不正常心态，这种心态在医务人员中有一定的市场。(4)部分医务人员在经济利益的驱使下，医德医风削弱，义务感淡薄，在医疗活动中不讲医德，把单纯追求经济利益作为最高准则，认为医疗工作也应全面适应市场经济，一切以经济效益为依据，以赚钱获利为日的，拒绝执行国家有关规定和医德规范，一切向钱看。一些医疗机构盲目花高价购进大最诊断和治疗设备，为急于收回投资和产生利润，不顾患者需要不需要，照样开单检查。有的医院要搞基本建设，改善环境，就给各科室下创收任务，要求必须完成规定指标，否则不发奖金。如少数医院和科室或个别医生无病当有病看，小病当大病看，不需检查也检查，尽量使用昂贵药品。有的医生习惯于开大处方，不管什么病，都要用最好的药。这些做法，不仅加重了患者负担，而且造成了医疗资源的浪费。

Let’s begin today by discussing enzymes. Enzymes are what make many of the body’s biochemical reactions possible. Actually biochemical reactions can take place without them, but at much lower rates. In fact an enzyme may cause a reaction to proceed billions of times faster than it would otherwise. Before I go on to the biochemical specifics of how this works, let me provide a figurative example. I think it will help illustrate the power of enzymes more clearly. Now, suppose you got a bag and you put a bunch of locks in it, just small padlocks. Then you put in all the keys that go with the locks. And you closed the bag and shook it hard. No matter how long you shook, chances are very small that any key would get inserted in any of the locks. But if you took them all out of the bag and this time used your hands to insert the keys in the locks, you could combine them much quicker. Enzymes act like your hands, quickly allowing chemical reactions that would otherwise take much longer. Now, there are two reasons that enzymes are so effective at enabling biochemical reactions. First, enzymes greatly reduce the amount of energy required to start the reactions, and with less energy needed the reactions can proceed a lot faster than they could without the enzyme. The second reason is that a small amount of an enzyme is needed to enable the biochemical reaction. That’s because the chemical structure of the enzyme itself does not become altered as if enables the reaction. So a single enzyme can be used to start the same biochemical reaction over and over again. Questions 21 - 25 are based on the passage you have just heard. 21. What is the passage mainly about? 22. What point does the professor make about an enzyme when it is involved in a biochemical reaction? 23. What do enzymes do to help start a biochemical reaction? 24. Why does the professor talk about locks and keys? 25. What is enzymes? The impact of enzymes on chemical reactions. The way the body produces enzymes. The structure of enzymes. Types of chemical products created with enzymes.

Peter was seen crying when he came out of the office. We can deduce that he must have been punished. confer refer prefer infer

On September 2, 1937, President Roosevelt signed legislation that was to have far-reaching consequences for American wildlife. effect disaster challenge magic

Sometimes the messages are conveyed through deliberate ’conscious gestures’, other times, our bodies talk without our even knowing it. definite intentional interactive delicate

The scenery on the way was truly spectacular, with beautiful mountains, rivers and valleys, and I took a lot of pictures from the window. notorious amazing noble diplomatic

Providing first-class service is one of the tactics the airline adopts to attract passengers. methods attitudes thoughts solutions

The boss felt suspicious about the truth of the account, therefore, he determined to get down to having a good check. mistrustful furious considerate depressed

On September 2, 1937, President Roosevelt signed legislation that was to have far-reaching consequences for American wildlife. effect disaster challenge magic

Sometimes the messages are conveyed through deliberate ’conscious gestures’, other times, our bodies talk without our even knowing it. definite intentional interactive delicate

Initial reports were that multiple waves of warplanes bombed central Baghdad, hitting oil refineries and the airport. beating knocking hurting striking

The scenery on the way was truly spectacular, with beautiful mountains, rivers and valleys, and I took a lot of pictures from the window. notorious amazing noble diplomatic

The boss felt suspicious about the truth of the account, therefore, he determined to get down to having a good check. mistrustful furious considerate depressed

The author of the passage is mainly concerned with______.

The author implies that there were fewer cases of breast cancer in the past______.

The incidence of breast cancer has increased while mortality has decreased owing to______.

Risk factors of breast cancer do NOT include which of the following?

According to the passage, women with a family history of breast cancer______.