The promise of a treatment regime which is tailored to your exact cancer genotype and allowing the patient to have the drugs that will work best for them and their cancer type has been on the horizon for, well for those of us with Metastatic Cancer, almost a life time. It is always just around the corner, some where very near.
However, as I was reading today http://www.cancernetwork.com/blog/content/article/10165/2151973 this is not quite as simple as just being able to screen someone and give them the right medicines which will prolong their life, and maybe one day save their life. When I was first diagnosed with MBC I couldn’t understand why I wasn’t put straight on some form of chemo. Sadly the only answer I had from the oncologist was that it was “not appropriate at this time”. I just didn’t know what to say to that, and no further explanation was forthcoming. Chemo is the great god of cancer … why wasn’t I having it? Was I too far ‘gone’ to warrant such treatment?
There is already a rudimentary form of personalised medicine in the treatment of breast cancer. Tests are done to find out if you are oestrogen positive/negative, progesterone positive/negative or HER2 positive/negative. Your cancer can be a mixture of the above, all positive or all negative (that is where Triple Negative Breast Cancer gets its name), and over a period of time the cancer can change from positive to negative and so on. More recent research has broken down the subtyping into 10 different forms of cancer http://scienceblog.cancerresearchuk.org/2012/04/18/increasing-the-resolution-on-breast-cancer-the-metabric-study/.
The treatments that are now available can already be very expensive, but there is a danger that with Personalised Medicine it may become even more expensive. It could, therefore, become a treatment option for only those who can afford it. Then who chooses who gets the treatment? Only the wealthy, or in the NHS maybe they would have to choose by certain criteria. For instance I am single, I have no children and although I am ‘only’ 53 would these other factors rule me out of being chosen to get certain treatments. After all, shouldn’t younger people with small children get the treatments first?
Then there are the ethics of what you disclose, not only to the patient, but to their genetic relatives. If you live in a system which has an insurance based medical delivery service then what would that mean for premiums for the patient, but also their family members. Insurance is based, as I understand it, on statistics, probabilities and the likelihood of ‘x’ happening. If there is genetic evidence about the chances of an individual developing a disease should this be made public to the patient, family, insurance company … ? But then what happens if you are one of the 999 in a 1000 that ‘x’ won’t happen to … ?
We all want treatments which will give us the maximum efficacy for the minimum side effects. At present chemo works like a sledge hammer and hits everything in the hope that the cancer will be first on the hit list. My main concern is that they are not looking at the kind of treatments that are natural and work with your body and sustain it to work against the invasion of the cancer cells. Many of these treatments would be cheap and widely available around the globe and not just to the wealthy. Cancer does not discriminate on grounds of wealth, why should its treatment?