And will it be good for America?

By Erika Fry
May 2, 2017

There are few diagnoses more terrifying to patients than cancer. And accordingly, there are few visions of future healthcare that are more comforting than those promised by “precision medicine,” the idea that medical treatment will be wondrously personalized and efficient, and possibly spare us—through genomics, genetic testing, and studying personal data—from cancers and other dreaded disease. Will we ever get there?

The medical community has made great strides in that direction, said Lloyd Minor, dean of Stanford’s School of Medicine, speaking at Fortune’s Brainstorm Health conference in San Diego Tuesday afternoon. He cites the progress the medical community has made in treating cancer through immunotherapy, and he’s a big believer in the potential in precision health. “The opportunities are enormous, and they’re limited only by our imagination and the ability to execute on it.”

He says the development of new early-stage diagnostic tools—more so than the development of new, targeted medicines—is what’s really needed to accelerate progress.

Yet, while Shelley Hwang, chief of breast surgery at Duke Cancer Institute and vice chair of research at Duke University’s Department of Surgery, agrees in principle, she also has concerns about all the new diagnostic potential that will come with precision medicine. “When you start applying even the most basic technology, you’re changing the game,” she said. “You pick up conditions way before people have symptoms and way before they’re likely to spread anywhere.” (She notes since introducing the mammogram, there has been a five-fold increase in Stage Zero breast cancer, a condition in which abnormal cells are found—but are not actively spreading—in the breast.)

The tricky question becomes when it’s appropriate to intervene. In certain cases, as some argue with Stage Zero breast cancer, it may be better to wait and monitor the condition than to have the patient undergo a drastic course of treatment. Hwang said the goal should be: “right procedure, right time, right patient.”

She worries that may be an even trickier standard to maintain as cancer screening technologies move earlier and earlier in the diagnostic process, particularly in the U.S., where Hwang said the medical culture is to “find things, do things, and do evermore things.” She added, “the set point for our cancer screening tool is one where we miss few cancers but we also pick up a lot of non-cancers.”

She compared the American approach to casting a wide net that captures both sharks and minnows. “As a society, we’ve decided that’s okay,” said Hwang who also argued it’s time to re-evaluate that premise. “Are we so risk-averse that we’d like to catch a lot of minnows, too even if that means exposing people to a lot of treatment-related morbidity?” In other words, additional health complications because of that treatment.

As precision medicine-enabling technologies develop, she said, “There’s a huge need to be very careful about when we want to pick up these conditions, and once we do, how we [explain] that information to patients.”

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