Bell Kirsten
Department of Anthropology, University of British Columbia , 6303 NW Marine Dr, Vancouver, BC V6 T 1Z3, Canada . E-mail:
Biosocieties. 2013 Jun;8(2):124-143. doi: 10.1057/biosoc.2013.6.
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.
在过去二十年中，分子技术改变了癌症诊断、治疗和疾病监测的局面。然而，尽管这些技术在癌症一级和二级预防领域的作用已成为越来越多研究的焦点，但其在三级预防中的作用仍基本未得到审视。本文将这一主题视为一个需要从概念上进行探索而非通过实证证明的问题，重点关注三级预防的分子化，尤其是分子生物标志物在监测疾病复发方面的日益广泛应用。采用符号学方法，我推测分子生物标志物对癌症患者及康复者可能具有的潜在意义，并指出这些技术对于处于风险两端的人群，即癌症“高危”人群和已确诊患癌人群，其意义可能在重要方面存在差异。尽管分子生物标志物可能会强化一种“可衡量的脆弱感”，但通过指示癌症的存在，它们也可能会让人感到安心。此外，作为一种无形但表面上“透明”的符号，在某些情况下，它们似乎能使癌症幸存者对生物医学决策提出质疑。鉴于近期肿瘤学界关于这些生物标志物在三级预防中的价值的争论，我在结论中指出，尽管专业人士试图从医疗护理中消除意义和价值，但符号永远不能简化为其“客观”的生物医学含义。
