Wednesday, July 18, 2012

Is Genomic Medicine Clinically Useful Yet?

Brian Klepper

Posted 7/16/12 on Medscape Connect’s Care and Cost
The news of my wife Elaine’s primary peritoneal cancer 27 months ago began a fevered effort to learn all we could about her disease and our options. Peritoneal cancer, which is close in form and behavior to ovarian, is rooted in the abdominal lining. “Gold standard” treatments notwithstanding, the prognosis isn’t good. After a 12-36 month remission in which tumors are inactive, the disease generally returns, and a high percentage of women are gone within 5 years of diagnosis.
Cancer elicits a primal fear that can provoke fantasy and baseless speculation. Cancer patients in remission have told us they are cured. Others, well-meaning, have announced they know someone with “exactly what you have,” and that theirs went away by applying a strict dietary or spiritual discipline.
But the science is clear that cancer is really many diseases, with hundreds or thousands of different configurations influenced by heredity and environment. It presents massive complexity that likely isn’t susceptible to silver bullets. This fact is underscored by the wildly variable efficacy of current therapies, both in different forms of cancer and between patients with the “same” cancer. Diagnosed with thyroid cancer, your chances are great. Pancreatic, not so much. Or not. Uncertainty rules.