Panel discussion: The sixth sense of the oncologist. How doctors can find cancer earlier and why you may not necessarily want to know
For the majority of cancer patients, a diagnosis is made after symptoms become clinically apparent. By that time, cancer is often at an advanced stage and treatments usually involve some combination of chemotherapy, radiotherapy and surgery. These treatments are gruelling and survival rates are highly variable depending on the type of cancer and the stage at which it is detected.
Cancer develops slowly over several years through an evolutionary process in which cells with a fitness advantage survive and can become dominant, rather akin to Darwin’s theories for population genetics. Early detection of cancer aims to identify pre-cancerous changes in a tissue at risk of evolving into an invasive cancer. The rationale for deploying tests in search of pre-cancerous changes is that treatment at an early stage is likely to offer higher chances of cure than when cancer is detected at an advanced stage. Accurate predictions about the natural history of a lesion is therefore at the core of early detection of cancer; this is increasingly possible as the result of the improved epidemiological, clinical and molecular information available which can be linked to cancer statistics for hundreds of thousands of patients.
In addition to NHS led healthcare programmes, we also live in a world in which there is increasing interest in the individual taking ownership of their health outcomes. There are opportunities to self-prescribe screening tests and undergo healthcare checks without a full understanding of the significance and implications of what a positive or negative result might imply.
A panel of experts will guide you in trying to answer some of the important questions arising from the rapid evolution of early cancer detection: How likely is early cancer to become a clinically relevant problem during my lifetime? And how does that risk compare to other healthcare problems? If I am found to be at risk of cancer does it mean I am now a "sick person" or am I still a healthy individual? What level of false positive or negative test results is acceptable? How can we weigh up the side-effects of preventative testing on a large-scale healthy population versus the poorer outcomes advanced cancer on a per individual basis? How does screening stack up with inequality in healthcare systems?
Please join us in the scenic Garden Room of St Edmund College for a debate on the many factors that contribute to the definition of harm benefit balance of early detection of cancer at the individual and societal level.
This is the second of three workshops on philosophical and ethical issues around cancer to be held Cambridge during 2017-2018 organised with the support of the CRUK Cambridge Centre Cambridge Early detection program, the Von Hügel Institute at St Edmund College, CRASSH and the Cambridge Philosophy and Medicine group.
- Mr Vincent Gnanapragasam - University Lecturer in Uro-oncology and Consultant Urologist
- Dr Maryon McDonald – Department of Social Anthropology and Editor-in-Chief, The Cambridge Journal of Anthropology
- Dr Gianmarco Contino - Clinical Lecturer, University of Cambridge and Research Associate of the Von Hügel Institute
- Dr Stephen John – Hatton Lecturer in the Philosophy of Public Health
- Dr Jacob Stegenga - University Lecturer in the Philosophy of Science, Department of History and Philosophy of Science
- Prof Rebecca Fitzgerald - Professor of Cancer Prevention, University of Cambridge