READING

READING PASSAGE 1
You should spend about 20 minutes on Questions 1–13, which are based on
Reading Passage 1 on pages 12 and 13.
Questions 1–7
Reading Passage 1 has seven sections, A–G.
Choose the correct heading for each section from the list of headings below.
Write the correct number, i–x, in boxes 1–7 on your answer sheet.

List of Headings
i Unsatisfactory outcomes
ii The benefits of the new method for various diseases
iii An obscure origin
iv Treatment efficacy still to be assessed
v Disappointment at the lack of development
vi No exact answer
vii Patients with uncommon symptoms
viii A shift in focus
ix Something atypical of its kind
x The importance of the new direction

1 Section A
2 Section B
3 Section C
4 Section D
5 Section E
6 Section F
7 Section G
 Understanding cancer’s secret syndrome
Revealing the molecular make-up of cancer cells could help scientists
develop therapies for one of the most dangerous and puzzling forms of the disease

A The patients who walk into Alwin Krämer’s clinic are seeking medical help for a range
of symptoms. There’s a woman who has found a lump in her armpit but feels otherwise
well, another is experiencing frequent headaches and blurred vision, while a middle-
aged man has been suffering from ongoing stomach pain. Because their symptoms
are so vague and non-specific, it has often taken months for their general practitioners
to refer them for further investigations. Then an MRI or ultrasound scan reveals a
suspicious growth and a biopsy confirms cancer. Even so, these are no ordinary
cancer patients.
B In most cancer patients, the tumour is discovered at the location in the body where a
genetic mutation has prompted a cell to start growing uncontrollably. Cells sometimes
break off from this ‘primary site’ and seed additional tumours – metastases –
elsewhere in the body. But it is the primary tumour which raises the alarm. However,
Krämer specialises in the diagnosis and treatment of cancer of unknown primary
(CUP) syndrome, where the discovered tumour bears little relationship to the organ or
tissue it is growing in.
C This suggests it is the product of one of these cancer seeds – yet the primary tumour
that released them either eludes detection or has mysteriously vanished. There are
various theories, none of them definitive. For instance, in a handful of documented
cases a patient’s primary tumour was destroyed by their immune system, while their
metastases continue to grow. Something similar may be happening in CUP patients.
Alternatively, the primary tumour may be too small and slow growing to be detected.
But some of its cells have developed mutations which make them more aggressive
and prone to peeling off, resulting in faster-growing metastases.
D In the past decade, molecular sequencing methods have emerged which should have
made this hunt for the primary tumour easier. By studying the pattern of gene
expression with RNA as well as genetic and epigenetic markers on tumour cell DNA, it
is possible to identify a tumour’s tissue of origin. The hope was that doing so would
lead to improvements in patients’ survival. But the results of two recent studies using
RNA-based methods to decide which treatment CUP patients should receive, have
been disappointing: ‘Neither showed an advantage for the gene expression based
treatment,’ says Krämer.
E Now there is a different approach based on a growing sense that CUP may be a
specific type of cancer itself, one that is characterised by the very early or immediate
spread of metastases rather than the growth of a single primary tumour. That’s why
the primary tumour may not be found. Cancers also constantly evolve. And a
metastatic tumour may carry different ‘driver’ mutations to the primary tumour. So
rather than trying to identify a CUP’s tissue of origin, scientists are now using genomic
techniques to pinpoint these driver mutations and using this information to inform
patient treatment instead.
 Reading

F Although various types of genomic alteration can lead to cancer, no single sequencing
method can identify all of them, so multiple tests are run in parallel to single out driver
mutations which might be targeted with specific drugs. For instance, a CUP patient
whose tumour harbours a specific mutation in the BRCA1 or BRCA2 gene might be
offered a drug called a PARP inhibitor that exploits a weakness in cells carrying these
mutations, triggering their destruction. One study which analysed tissue from 200 CUP
patients found 85 percent of them had at least one clinically relevant mutation which
could be used to personalise their therapy. Clinical trials are currently underway to test
whether this new approach to treating CUP syndrome has any impact on patients’
survival. If it does, this could herald a new approach to treating cancer more generally.
The current approach hinges on early diagnosis and the removal of the primary
tumour, accompanied by drugs or radiotherapy to destroy any embryonic metastases.
But once metastases become established, the disease becomes much harder to treat.
G Yet mounting evidence from animal studies suggests that metastasis may occur far
earlier than had been assumed, and that these tumour seeds develop independently,
acquiring new mutations. CUP patients may be suffering from this extreme end of
normal cancer evolution. That’s why a better understanding of the molecular
signatures associated with CUP syndrome may provide new insights into the biology of
metastasis more generally, as well as alternative ways to treat it. Since 2017, three
drugs have been approved for the treatment of tumours which harbour specific
mutations – regardless of where they occur in the body. The dawn of such ‘tumour-
agnostic’ therapy is good news for patients with CUP syndrome because most
targeted therapies are only approved for use in anatomically defined cancers, for
example in the lung or colorectal area. But it is also good news for anyone with an
aggressive tumour. ‘Maybe it really doesn’t matter if you say someone has this or that
cancer, or someone has a CUP syndrome, in the end it is the mutational spectrum and
the molecular features that define a certain individual cancer, and not the organ where
the primary tumour has developed,’ Krämer says.
Questions 8–13
Complete the notes below.
Choose NO MORE THAN TWO WORDS from the passage for each answer.
Write your answers in boxes 8–13 on your answer sheet.
Cancer treatment

Conventional approach
• aimed at identifying the 8 ……………………
• capable of destroying 9 …………………… in an early stage
• far less useful when metastases are 10 ……………………

RNA-based method
• ineffective in prolonging 11 ……………………

Genomic technique
• employed to detect 12 ……………………

PARP inhibitor drugs:

• used to kill BRCA1 and BRCA2 defective 13 …………………

14
READING PASSAGE 2
You should spend about 20 minutes on Questions 14–26, which are based on
Reading Passage 2 below.

Soft-winged sentinels
The long-tailed blue butterfly, named for the stringy ‘tails’ on its wings and its iridescent
azure colour, is common across Africa and southern Europe. It has rarely ventured as far
north as the UK. In fact, for most of the time since one was first recorded on the south coast
of England in 1859, only a few dozen more had been spotted there. But over the past
decade or so, the long-tailed blue has been arriving in the country during the late summer in
greater and greater numbers. Last year, eagle-eyed gardeners saw at least 50 adults and
hundreds of eggs.
The sight of such exotic visitors is a thrill for butterfly enthusiasts. For conservationists, it is
something else entirely: a worrying confirmation that butterflies are already feeling the
effects of human-induced global warming. ‘This isn’t something that’s 50 years ahead. This
is happening right now,’ says Dan Hoare, an ecologist and director at UK-based charity
Butterfly Conservation. Although the long-tailed blue is taking advantage of rising
temperatures by expanding its range, most wildlife won’t have it so good. ‘The long-tailed
blue should make us think twice about how nature is going to be able to adapt,’ says Hoare.
As it happens, watching butterflies is one of the best ways to answer that question because
these fragile, transient creatures are bellwethers. When it comes to understanding how
climate change is affecting wildlife and ecosystems, their lifestyles and famous visibility
make them uniquely revealing. So, as temperatures rise, what is becoming of butterflies?
And what do their various fates tell us about how climate change will affect biodiversity in
general?
Butterflies aren’t facing global warming on a firm footing. Around the world, populations are
experiencing steep downturns. In the UK, as the long-tailed blues have moved in, there have
also been serious long-term declines in the majority of butterfly species. It is a similar story
wherever there are reliable figures. Butterfly numbers in the Netherlands have dropped by
more than 80 per cent since 1890, for instance, while all 26 species listed as threatened or
endangered in the US have dwindled to the point of extinction.
Much of that decline has been attributed to habitat loss and the use of pesticides. But now
the effects of global warming are beginning to bite too. The role of human-induced climate
change has, so far, been difficult to disentangle. The intricate and interwoven effects that
global warming can trigger, from severe weather to shifts in the timing of plant life cycles,
make it challenging to decipher the cause of any given species decline. Yet butterflies offer a
unique chance to see through the fog.
As cold-blooded animals that depend on the climate to regulate their temperature, they are
sensitive to warming. Their short but complex lifespans also mean that knock-on effects
quickly become apparent, although that fleetingness should also give them the capacity to
adapt faster than most. ‘Many species of butterfly have more than one generation a year and
are thus subject to rapid selection pressure compared to longer-lived mammals or birds,’
says Hoare. ‘Their diversity, with varying lifestyles and ecological niches, offers lots of
opportunities to respond to environmental change.’
The same could be said of nearly all insects. The problem is that there is precious little data
on many of them. Butterflies, on the other hand, are well-documented, having long been a
favourite of keen-eyed amateur biologists who collect information about their comings and
goings.
As a good proxy for other insects, butterflies serve as an early indicator for the impact
climate change will have more generally. By studying them, we get the first indication of how
human-induced warming is playing out, telling us which species might have the capacity to
adapt, what it takes to do so and the extent to which adaptation can keep pace with rising
temperatures.
One of the most obvious responses to global warming is the drift of species away from the
equator and towards the cooler climes of the poles. Long-tailed blues heading northwards
are far from the only example. A recent study showed that the area in which Canadian and
eastern tiger swallowtail butterflies meet and interbreed – a strip of land stretching from
Minnesota to New England – has shifted 40 kilometres north since the 1980s. Other
butterflies are moving upwards too, with higher elevations offering optimum temperatures as
the climate warms.
Questions 14–18
Choose the correct letter, A, B, C or D.
Write the correct letter in boxes 14–18 on your answer sheet.

14 What does the writer suggest about the increase in the number of the long-tailed blue
in the first paragraph?
A It has great significance.
B It is a noteworthy phenomenon.
C It heralds an adaptation.
D It is easy to be overlooked.

15 In the second paragraph, we learn that Dan Hoare is

A definite about the effects of global warming on butterflies.
B concerned about the alarming rate of global warming.
C dubious about most wildlife’s adaptability to global warming.
D confident about butterflies’ ability to inform about adaptations.

16 In the fourth paragraph, the writer is

A emphasizing the rapid loss of butterflies worldwide.
B describing the adaptation of butterflies worldwide.
C comparing the rates of butterfly decline worldwide.
D explaining the decline in butterfly species worldwide.

17 In the fifth paragraph, what does the writer suggest about global warming?
A Humans are directly responsible for it.
B It is too complicated a problem to solve.
C What it causes forms an organic whole.
D It does not impede butterflies’ visibility.

18 In this article, the writer’s aim is to

A illustrate a point.
B describe an adaptation.
C heighten awareness.
D encourage action.
Questions 19–22
Complete each sentence with the correct ending, A–F below.
Write the correct letter, A–F, in boxes 19–22 on your answer sheet.

19 When it comes to adaptation, butterflies

20 Given the fact that they are easy to see, butterflies
21 Many species, including butterflies,
22 Changes in temperature

A have mostly affected long-tailed blues

B can have an adverse effect on many species, including butterflies
C are of great help in observing the effects of climate change on wildlife
D can affect butterflies easily
E are at an advantage over most animals thanks to their short life cycle
F tend to move further north due to a rise in temperature

Questions 23–26
Choose FOUR letters, A–G.
Write the correct letters in boxes 23–26 on your answer sheet.
Which FOUR pieces of information does the writer say observing butterflies provides?
A how frequent the comings and goings of insects are
B what species of insects might survive
C whether the adaptation of insects is fast enough for their survival
D what species of insects are heading northwards
E what insects need for adaptation
F how global warming is taking place
G what the ideal temperature is for the survival of insects
READING PASSAGE 3
You should spend about 20 minutes on Questions 27–40, which are based on
Reading Passage 3 below.

A HISTORY OF SUGAR –
THE FOOD NOBODY NEEDS, BUT EVERYONE CRAVES
A It seems as though no other substance occupies so much of the world’s land, for so little
benefit to humanity, as sugar. According to the latest data, sugarcane is the world’s third most
valuable crop after cereals and rice, and occupies 26,942,686 hectares of land across the
globe. Its main output – apart from commercial profits – is a global public health crisis, which
has been centuries in the making.
B The obesity epidemic – along with related diseases including cancer, dementia, heart disease
and diabetes – has spread across every nation where sugar-based carbohydrates have come
to dominate the food economy. So at this time, it pays to step back and consider the ancient
origins of sugar, to understand how it has grown to present an imminent threat to our
landscapes, our societies and our health.
C Human physiology evolved on a diet containing very little sugar and virtually no refined
carbohydrate. In fact, sugar probably entered into our diets by accident. It is likely that
sugarcane was primarily a ‘fodder’ crop, used to fatten pigs, though humans may have
chewed on the stalks from time to time. Evidence from plant remnants and DNA suggests that
sugarcane evolved in South East Asia. Researchers are currently hunting for early evidence of
sugarcane cultivation at the Kuk Swamp in Papua New Guinea, where the domestication of
related crops such as taro and banana dates back to approximately 8,000 BC. The crop
spread around the Eastern Pacific and Indian Oceans around 3,500 years ago, carried by
Austronesian and Polynesian seafarers.
D The first chemically refined sugar appeared on the scene in India about 2,500 years ago. From
there, the technique spread east towards China, and west towards Persia and the early
Islamic worlds, eventually reaching the Mediterranean in the 13th century. Cyprus and Sicily
became important centres for sugar production. Throughout the Middle Ages, it was
considered a rare and expensive spice, rather than an everyday condiment. The first place to
cultivate sugarcane explicitly for large-scale refinement and trade was the Atlantic island of
Madeira, during the late 15th century. Then, it was the Portuguese who realised that new and
favourable conditions for sugar plantations existed in Brazil, where a slave-based plantation
economy was established. When Brazilian sugarcane was introduced in the Caribbean, shortly
before 1647, it led to the growth of the industry which came to feed the sugar craze of Western
Europe.
E This food – which nobody needed, but everyone craved – drove the formation of the modern
of the world. There was a huge demand for labour to cultivate the massive sugar plantations in
Brazil and the Caribbean. This need was met by a transatlantic slave trade, which resulted in
around 12,570,000 human beings being shipped from Africa to the Americas between 1501
and 1867. Mortality rates could reach as high as up to 25% on each voyage, and between 1
million and 2 million dead must have been thrown overboard. And of course, goods such as
copper and brass, rum, cloth, tobacco and guns were needed to purchase slaves from the
African elites. These were secured through the expansion of industrial production, particularly
in the English Midlands and South West. Modern-day banking and insurance can trace its
origins to the 18th century Atlantic economy. Meanwhile, the slaves working the plantations
 suffered miserable lives. When they were finally emancipated in 1834 in the British Empire, it
was the slave owners who were fully compensated – not the slaves. Much of this money was
used to build Victorian infrastructure, such as railways and factories.
F In many ways, the story of sugar and tobacco are closely aligned. Both products were initially
produced through slave labour, and were originally seen to be beneficial to health. And
although both sugar and tobacco have ancient origins, it was their sudden, mass consumption
from the mid-17th century onwards that created the health risks we associate with them today.
The idea of ‘industrial epidemics’ of non-communicable diseases, being driven by the profit
motives of major corporations, rings true for both. And while tobacco is widely acknowledged
to be addictive, sugar can also drive behavioural responses that are indistinguishable from
addiction. But in the 21st century, the grip of sugar is stronger than comparable scourges like
tobacco, or even alcohol. Sugar is not only ubiquitous – it is potentially responsible for
approximately 20% of the caloric content of modern diets – but also central to the world’s
economy and cultural heritage.
G Perhaps a better comparison is our reliance on fossil fuels. Fossil fuels are not just a vice or
bad habit, but central to the way we live, and to the geography and politics of the territories
where it is sourced. Likewise, the rise of sugar has been key to global trade and
socioeconomic development, slavery and the African Diaspora and modern cultural norms.
The evolutionary and historical origins of sugarcane may hold insights into why sugar
dominates modern culture, and what we can do to mitigate its malign influence. Like many
great challenges of the 21st century, such as climate change, the science identifying the
problem seems clear. What’s lacking is the public and political will to address it, in ways such
as the proposed sugar tax and prominently displayed health warnings. With sugar still deeply
part of our food system – in 2013, sugar crops made up 6.2% of world’s agricultural yield and
9.4% of its total monetary value – such bold socio-economic measures are needed to make
the necessary changes possible.
Questions 27–32
Reading Passage 3 has seven paragraphs, A–G.
Which paragraph contains the following information?
Write the correct letter, A–G, in boxes 27–32 on your answer sheet.
NB You may use any letter more than once.
27 mention of inequitable treatment of slaves
28 mention of a decrease in the value of sugar over time
29 mention of various aspects likely to be under the influence of sugar
30 mention of reluctance to attend to the rise of sugar
31 reference to that fact that sugar can control the way people function
32 reference to the fact that sugar production used to be a high-stakes activity

Questions 33–35
Complete the sentences below.
Choose NO MORE THAN TWO WORDS from the passage for each answer.
Write your answers in boxes 33–35 on your answer sheet.
33 Sugarcane has posed a threat to public health for ……………………. .
34 Sugar took people in ……………………. by storm.
35 Slave labor on sugar plantations was exchanged for a liquor called ……………………. .

Questions 36–40
Do the following statements agree with the information given in Reading Passage 3?
In boxes 36–40 on your answer sheet, write
TRUE if the statement agrees with the information
FALSE if the statement contradicts the information
NOT GIVEN if there is no information on this
36 The obesity epidemic has swept the globe.
37 Brazil initiated a slave-based plantation economy.
38 Sugar has not always been considered harmful to health.
39 Both fossil fuels and sugar are of great significance in many respects.
40 Tough measures are needed to deal with people’s reliance on fossil fuels.