Biomarkers, the molecular gaze and the transformation of cancer survivorship

Abstract

Over the past two decades, molecular technologies have transformed the landscape of cancer diagnosis, treatment and disease surveillance. However, although the effects of these technologies in the areas of primary and secondary cancer prevention have been the focus of growing study, their role in tertiary prevention remains largely unexamined. Treating this topic as a problematic to be conceptually explored rather than empirically demonstrated, this article focuses on the molecularisation of tertiary prevention, especially the growing use of molecular biomarkers to monitor disease recurrence. Taking a semiotic approach, I speculate on the potential meanings of molecular biomarkers for people living with and beyond cancer and suggest the meanings of these technologies may differ in important ways for those on both sides of the risk divide: that is, those ‘at risk' for cancer and those living with realised risk. Although molecular biomarkers may intensify a sense of ‘measured vulnerability', by indexing cancer's presence they may also prove reassuring. Moreover, as an invisible but ostensibly ‘transparent' sign, in some contexts they appear to enable cancer survivors to challenge biomedical decision making. In the light of recent oncological debates about the value of these biomarkers in tertiary prevention, I conclude by suggesting that signs can never be reduced to their ‘objective' biomedical denotation in spite of professional attempts to expunge meaning and value from care.

Rethinking ovarian cancer II: reducing mortality from high-grade serous ovarian cancer

“…In particular, until a better estimate of risk is obtained, we believe that it is premature to offer panel genetic testing beyond BRCA1 and BRCA2 as part of routine clinical care for HGSOC. As increasing numbers of women at elevated risk of HGSOC are identified through more comprehensive genetic screening, it will be important to understand the psychosocial 153 and medical needs of women who are at risk but have not yet developed cancer 154 .…”

The collective/affective practice of cancer survivorship

“…As a result, survivorship remains a contested concept, which has come to mean many things to many people: a particular therapeutic outcome, an everyday practice, an individual desire, a cultural pressure, a moral imperative, and a pharmico‐philanthropic industry (e.g. Bell , , , ; Feuerstein ). Cancer survivorship incorporates a range of material, discursive, and affective elements (Bell ; Jain ), and importantly for this paper, represents a form of sociality that is deeply infused with emotion and forms of morality that give rise to patterns of recognition, and relational mis recognition (Frank ; Fraser ).…”

‘Take ownership of your condition’: Australian women’s health and risk talk in relation to their experiences of breast cancer

“…Individual risk management is promoted structurally through the ever-increasing biomedical and public health focus on cancer screening and genetic risk counselling, practices which position individuals as central in the monitoring and detection of cancer (Aasen & Skolbekken, 2014;Bell, 2013;Hallowell, 1999). As Hallowell (1999) showed in her analysis of genetic consultations for risk of breast or ovarian cancer, clinicians can present information in prescriptive ways and construct risk as something that individual women need to manage.…”

“…Cancer, like health in general, is entwined with discourses of morality -what it means to be a 'good' person (Bell, 2010;Willig, 2009) -and therefore those who are diagnosed with it are required to reconstruct their identities in a positive light. With the rise in biomedicalisation and surveillance within Western society and the 'new public health', the parameters of being 'at risk' of developing cancer or a recurrence of cancer have widened (Bell, 2013;Fosket, 2010;Nettleton, 2013). Risk of recurrence has long featured in the accounts of people who have had cancer and is captured by the phrase, 'living under the shadow' (Sarenmalm, Thorén-Jönssen, Gaston-Johanssen, & Öhlén, 2009, p. 1116.…”

“…Within a context marked by government withdrawal from health and welfare services, health has become constructed as individuals' responsibility and as an 'unstable property, something to be constantly worked on' (Petersen & Lupton, 1996, p. xiv) especially in light of health threats, such as cancer (Bell, 2013). Significant theoretical work from a Foucauldian perspective has discussed how dominant medical and social discourses around what it means to be a 'healthy citizen' or a 'health consumer' serve to subjectify the individual (Petersen & Bunton, 1997;Rose, 2007) and define how individuals can and should act to 'achieve' health (Nettleton, 1997) and avert the 'risk' of illness (Petersen, 1997;Petersen & Lupton, 1996;Rose, 2007).…”