Diagnostic layering: patient accounts of breast cancer classification in the molecular era

Ross, E., Swallow, J., Kerr, A. , Chekar, C. K. and Cunningham-Burley, S. (2021) Diagnostic layering: patient accounts of breast cancer classification in the molecular era. Social Science and Medicine, 278, 113965. (doi: 10.1016/j.socscimed.2021.113965) (PMID:33940433) (PMCID:PMC8146724)

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Social scientific work has considered the promise of genomic medicine to transform the delivery of 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.

Item Type:Articles
Additional Information:This article is based on research funded by the Wellcome Trust (Collaborative Senior Investigator Award in Society and Ethics across University of Leeds and University of Edinburgh, grant reference: 104831/Z/14/Z).
Glasgow Author(s) Enlighten ID:Kerr, Professor Anne and Chekar, Dr Choon Key
Authors: Ross, E., Swallow, J., Kerr, A., Chekar, C. K., and Cunningham-Burley, S.
Subjects:H Social Sciences > HM Sociology
College/School:College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
Journal Name:Social Science and Medicine
ISSN (Online):1873-5347
Published Online:28 April 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Social Science and Medicine 278: 113965
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
311196Translations and transformations in patienthood: cancer in the post-genomics eraElizabeth Anne KerrWellcome Trust (WELLCOTR)104832/B/14/ZS&PS - Sociology