July 11, 2012

LITTLE TO BE GAINED BUT KNOWLEDGE REGARDING WHETHER TREATMENT US USEFUL:

A Life-Death Predictor Adds to a Cancer's Strain (Gina Kolata, 7/10/12,  The New York Times)

Doctors try to give survival odds based on a tumor's appearance and size, but often that is just an educated guess.

But Ms. Caton had a new option, something that became possible only in this new genetic age. She could have a genetic test of her tumor that could reveal her prognosis with uncanny precision. The test identifies one of two gene patterns in eye melanomas. Almost everyone in Class 1 -- roughly half of patients -- is cured when the tumor is removed. As for those in Class 2, 70 to 80 percent will die within five years. Their cancers will re-emerge as growths in the liver. For them, there is no cure and no way to slow the disease.

No test has ever been so accurate in predicting cancer outcomes, researchers said.

The data from studies of the test are "unbelievably impressive," said Dr. Michael Birrer, an ovarian cancer specialist at Massachusetts General Hospital. "I would die to have something like that in ovarian cancer."

While for now the ocular melanoma test is in a class by itself, cancer researchers say it is a taste of what may be coming as they continue to investigate the genes of cancer cells. Similar tests, not always as definitive but nonetheless able to give prognostic information, are under development or starting to be used for other cancers, like cancers of the blood.

Having a prognosis allows people to plan their lives, but most do not want to know if they have a gene for an incurable, fatal illness, like Huntington's disease or early onset Alzheimer's.

The eye test raises a similar choice, with an added twist. This is not a test offered to healthy people, but to patients who have just gotten the news that they have cancer. The results will either give them reassurance that they will survive the cancer -- or near certainty that they will die from it.

Can patients in the throes of getting this terrifying news really make an informed choice about whether they want the test? Are they able to understand at such a fraught time that, for now at least, there is nothing that can save them if they get the bad prognosis?

Some doctors do not offer the test, reasoning that there is little to be gained.

Posted by at July 11, 2012 5:30 AM
  

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