Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer

See here for article and comment

This paper suggests that this test, a new high tech ‘personalised’ (but actually still a population risk score) genetic signature, enables women to judge whether it is worth risking chemotherapy (in addition to the mastectomy they have already had etc) to prevent a recurrence. In effect it promotes use of the test. But there is more to this than meets the eye.

This is my comment

The wrong Question?

This research promotes the use of this test.

The list price of this test is £2500 a time, in the UK.

It will be offered as ‘good practice’ to thousands of women.

It will cause financial hardship to those who pay privately – many in countries such as the USA without adequate public health services financing.

A few key points:

• The test has not been compared with the currently available free test to assess recurrence risk.

• As such it may be adding zero clinical benefits and only adding cost.

• When budgets are limited for healthcare ( as they are for publicly funded health services as in the UK NHS) such ‘new’ tests must be paid for out of existing monies: so, a) that money is not available for other services and b) replaces other more cost effective care so that overall health gain is actually reduced.

• Many patients being over treated with chemotherapy to prevent recurrence have already been overtreated with mastectomy as a result of overdiagnosis by screening.

The ‘science’ and discourse of this research promotes a neoliberal pragmatism wedded to innovation and a flow of new products for the market.

It should be put in a diagnostic and socio-economic context otherwise it is harmful and misleading.

The test is OncotypeDX

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