Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK; Department of Sociological Studies, University of Sheffield, Elmfield Building, Northumberland Road, Sheffield, S10 2TU, UK.
Centre for Biomedicine, Self and Society, Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK.
Soc Sci Med. 2021 Jun;278:113965. doi: 10.1016/j.socscimed.2021.113965. Epub 2021 Apr 28.
Social scientific work has considered the promise of genomic medicine to transform healthcare by personalising treatment. However, little qualitative research attends to already well-established molecular techniques in routine care. In this article we consider women's experiences of routine breast cancer diagnosis in the UK NHS. We attend to patient accounts of the techniques used to subtype breast cancer and guide individual treatment. We introduce the concept of 'diagnostic layering' to make sense of how the range of clinical techniques used to classify breast cancer shape patient experiences of diagnosis. The process of diagnostic layering, whereby various levels of diagnostic information are received by patients over time, can render diagnosis as incomplete and subject to change. In the example of early breast cancer, progressive layers of diagnostic information are closely tied to chemotherapy recommendations. In recent years a genomic test, gene expression profiling, has become introduced into routine care. Because gene expression profiling could indicate a treatment recommendation where standard tools had failed, the technique could represent a 'final layer' of diagnosis for some patients. However, the test could also invalidate previous understandings of the cancer, require additional interpretation and further prolong the diagnostic process. This research contributes to the sociology of diagnosis by outlining how practices of cancer subtyping shape patient experiences of breast cancer. We add to social scientific work attending to the complexities of molecular and genomic techniques by considering the blurring of diagnostic and therapeutic activities from a patient perspective.
社会科学研究曾考虑通过个性化治疗使基因组医学改变医疗保健的前景。然而，很少有定性研究关注常规护理中已经成熟的分子技术。本文考虑了英国国民保健制度中女性在常规乳腺癌诊断中的经历。我们关注患者对用于乳腺癌亚型分类的技术的描述，以及这些技术如何指导个体治疗。我们引入“诊断分层”的概念，以理解用于分类乳腺癌的各种临床技术如何塑造患者的诊断体验。随着时间的推移，诊断分层的过程，即患者逐渐接收不同层次的诊断信息，可以使诊断变得不完整且可能发生变化。在早期乳腺癌的例子中，逐步的诊断信息层与化疗建议密切相关。近年来，一种名为基因表达谱分析的基因组测试已被引入常规护理。由于基因表达谱分析可以为标准工具未能确定的治疗建议提供依据，因此该技术可能代表一些患者的“最终诊断层”。然而，该测试也可能使之前对癌症的理解失效，需要进一步解释，并进一步延长诊断过程。本研究通过概述癌症分型实践如何塑造患者的乳腺癌体验，为诊断社会学做出了贡献。我们通过从患者角度考虑诊断和治疗活动的模糊性，增加了关注分子和基因组技术复杂性的社会科学研究。
