Earlier this year, President Joe Biden revived Cancer Moonshota lofty effort to tackle the disease that is currently the second leading cause of death in the US The initiative seeks to reduce the country’s cancer death rate by at least half over the next 25 years, as well as “improve the experience of people and their families living with and surviving cancer.”
If the medical field wants to make serious progress on those goals, it must expand its definition of personalized medicine and explore fresh approaches to cancer prevention, said Dr. Siddhartha Mukherjeea Pulitzer Prize-winning author and cancer physician at Columbia University Medical Center. He spoke Monday at RSNA 2022the annual radiology and medical imaging conference in Chicago.
The way that doctors currently talk about it, personalized medicine has “a very narrow definition,” Dr. Mukherjee declared.
“Personalized medicine has become equated with genomics,” he said. “But it’s not just that. Personalized medicine includes risk assessment and empirical testing.”
For example, when doctors check a patient’s bone density, they can make a better decision about whether to put the patient on a medication that increases bone density. The doctor can make that decision not just based on a radiological scan, but rather “based on who the person is and the likelihood that he or she will fall,” Dr. Mukherjee said.
He gave another example: assessing a patient’s risk for cancer recurrence. Two Dr. Mukherjee, it is personalized medicine every time that a doctor looks at a patient’s anastomosis (a connection between two tubular structures in the body), sees there is a scar formation, and makes a decision whether or not to perform a biopsy on the area.
At every step of the cancer care process, it is important that doctors remember to make decisions based on each patient’s unique biology and life, he argued.
“What I would like to do is to divorce the idea that personalized medicine equals genomics,” Dr. Mukherjee said. “Genomics is one edge of it. If you think about total care, there are arenas of personalized medicine that all of us are involved in and need to be continuously involved in.”
To improve cancer care and outcomes in this country, the medical world must focus on prevention, early detection and treatment. While advancements are being made in all three of these areas, Dr. Mukherjee said cancer care would benefit if researchers took a new approach to studying prevention.
“In the last 10 to 20 years, we have not found a single preventable carcinogen with a major impact on human societies,” he declared.
Each word in that proclamation was carefully chosen, Dr. Mukherjee noted. Researchers have certainly identified a multitude of carcinogens, but these carcinogens don’t really have a significant impact on cancer in his book. Obesity might be the exception, but it’s hard to say because the medical community isn’t sure whether to call it a carcinogen or carcinogenic state, he said.
“Are we looking in the wrong places? Should we re-examine how we’re looking? Because everyone says, ‘Well, there’s carcinogens everywhere, that’s why there’s so much cancer. But when I ask them, ‘Well, what are they?’ there is no answer,” Dr. Mukherjee said.
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