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February
2003
Neglected Questions
The news that certain
genetic signatures may help doctors predict whether breast cancer
will run rampant through the body or confine itself to a more easily
removed tumor is a glimpse at the near future of medicine. Right
around the corner, researchers see a world where genes are the basis
of "designer" health care - treatments tailored especially
for you, based on the information your genetic code holds about
your disease or your tolerance of certain drugs. Your genes might
even hold the secret to whether you're destined for disease before
symptoms appear.
And there's the longer-term
future of medicine: What does it mean to know your genes? Lost in
the excitement surrounding powerful technologies like genetic screening,
it's a neglected question that needs thoughtful answers. How will
doctors change their treatments when confronted with new genetic
information? How will patients react when they hear about a genetic
test that may predict their odds of surviving a feared disease like
cancer? And most important, how big of a revolution will genetic
medicine really unleash when the main causes of some of the biggest
killers are behaviors like smoking or eating too much saturated
fat?
Researchers are understandably
excited about the new breast cancer findings. It gives them a powerful
tool to predict which cancers require close watching and which treatments
in their arsenal might be useful in preventing a breast tumor's
spread. If further studies bear out the connection between a "good"
pattern of gene expression and a relatively quiet tumor, simple
genetic screenings could spare some women months of painful chemotherapy.
But even the researchers
who completed the recent study acknowledge that their conclusions
don't rule out the importance of behavior to early detection of
breast cancer. Just because a tumor appears to be "hard-wired"
to spread doesn't mean that it already has, and early detection
technologies like mammography still will be important.
These are the questions
not just of DNA geography but of social and behavioral science,
ones that will have to be answered jointly by geneticists and psychologists,
biologists and economists, policy makers and patients.
Genetic screening
is still all about the odds. It's neither a death sentence nor a
reprieve, just a likelihood; and we still have to make health decisions
based on some uncertainty, not absolutes.
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