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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