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HOME > PAST ISSUE > March-April 2007 > Article Detail

MARGINALIA

By Any Other Name

By giving tumors their right names, scientists gain power over them

Robert L. Dorit

Variations and a Theme

Yet hopelessly complicated is not the same as chaotic. As more and more breast tumors are scrutinized at this level of detail, new patterns have emerged. Our worst fear—that every tumor would be unique, precluding an overall understanding of breast tumors—has not been realized. There are ways of grouping breast tumors based on the study of their molecular voices, and the resulting number of tumor classes, in the range of 5 to 10, has remained manageable. But what is most important is not that each class of breast cancer deserves its own name. What matters is that these detailed portraits of breast tumors have profound implications for diagnosis and treatment. These categories provide starting points for the development of specific therapies tailored to newly revealed types of "breast cancer." These classes respond differently to chemotherapy and to radiation. They have different probabilities of recurrence, remission and metastasis. Distinguishing them is hardly hair-splitting; these differences matter to all involved.

We are witnessing a radical shift in our approach to illness: away from symptoms and toward diagnoses based on cause and mechanism. For many complex diseases, the perception of one monolithic condition with a single name based on symptoms will likely give way to more nuanced, mechanism-based nomenclatures. What we call an illness is not just a matter of semantics. Everything—diagnosis, treatment, research, funding and ultimately prevention and cure—rides on getting the name right.





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