IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v278y2021ics0277953621002975.html
   My bibliography  Save this article

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

Author

Listed:
  • Ross, Emily
  • Swallow, Julia
  • Kerr, Anne
  • Chekar, Choon Key
  • Cunningham-Burley, Sarah

Abstract

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.

Suggested Citation

  • Ross, Emily & Swallow, Julia & Kerr, Anne & Chekar, Choon Key & Cunningham-Burley, Sarah, 2021. "Diagnostic layering: Patient accounts of breast cancer classification in the molecular era," Social Science & Medicine, Elsevier, vol. 278(C).
  • Handle: RePEc:eee:socmed:v:278:y:2021:i:c:s0277953621002975
    DOI: 10.1016/j.socscimed.2021.113965
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621002975
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2021.113965?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Joyce, Kelly & Jeske, Melanie, 2020. "Using autoimmune strategically: Diagnostic lumping, splitting, and the experience of illness," Social Science & Medicine, Elsevier, vol. 246(C).
    2. Dumit, Joseph, 2006. "Illnesses you have to fight to get: Facts as forces in uncertain, emergent illnesses," Social Science & Medicine, Elsevier, vol. 62(3), pages 577-590, February.
    3. Bourret, Pascale & Keating, Peter & Cambrosio, Alberto, 2011. "Regulating diagnosis in post-genomic medicine: Re-aligning clinical judgment?," Social Science & Medicine, Elsevier, vol. 73(6), pages 816-824, September.
    4. Nettleton, Sarah, 2006. "'I just want permission to be ill': Towards a sociology of medically unexplained symptoms," Social Science & Medicine, Elsevier, vol. 62(5), pages 1167-1178, March.
    5. Madden, Sue & Sim, Julius, 2006. "Creating meaning in fibromyalgia syndrome," Social Science & Medicine, Elsevier, vol. 63(11), pages 2962-2973, December.
    6. Bell, Kirsten, 2009. "'If it almost kills you that means it's working!' Cultural models of chemotherapy expressed in a cancer support group," Social Science & Medicine, Elsevier, vol. 68(1), pages 169-176, January.
    7. Hallowell, N. & Foster, C. & Eeles, R. & Ardern-Jones, A. & Watson, M., 2004. "Accommodating risk: Responses to BRCA1/2 genetic testing of women who have had cancer," Social Science & Medicine, Elsevier, vol. 59(3), pages 553-565, August.
    8. Bourgain, Catherine & Pourtau, Lionel & Mazouni, Chafika & Bungener, Martine & Bonastre, et Julia, 2020. "Imperfect biomarkers for adjuvant chemotherapy in early stage breast cancer with good prognosis," Social Science & Medicine, Elsevier, vol. 246(C).
    9. Gardner, John & Dew, Kevin & Stubbe, Maria & Dowell, Tony & Macdonald, Lindsay, 2011. "Patchwork diagnoses: The production of coherence, uncertainty, and manageable bodies," Social Science & Medicine, Elsevier, vol. 73(6), pages 843-850, September.
    10. Jutel, Annemarie & Nettleton, Sarah, 2011. "Towards a sociology of diagnosis: Reflections and opportunities," Social Science & Medicine, Elsevier, vol. 73(6), pages 793-800, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Brown, Eliza, 2020. "Projected diagnosis, anticipatory medicine, and uncertainty: How medical providers ‘rule out’ potential pregnancy in contraceptive counseling," Social Science & Medicine, Elsevier, vol. 258(C).
    2. Greco, Monica, 2012. "The classification and nomenclature of ‘medically unexplained symptoms’: Conflict, performativity and critique," Social Science & Medicine, Elsevier, vol. 75(12), pages 2362-2369.
    3. Hayes, Jennie & McCabe, Rose & Ford, Tamsin & Parker, Daisy & Russell, Ginny, 2021. "‘Not at the diagnosis point’: Dealing with contradiction in autism assessment teams," Social Science & Medicine, Elsevier, vol. 268(C).
    4. Jutel, Annemarie, 2016. "Truth and lies: Disclosure and the power of diagnosis," Social Science & Medicine, Elsevier, vol. 165(C), pages 92-98.
    5. Locock, Louise & Nettleton, Sarah & Kirkpatrick, Susan & Ryan, Sara & Ziebland, Sue, 2016. "‘I knew before I was told’: Breaches, cues and clues in the diagnostic assemblage," Social Science & Medicine, Elsevier, vol. 154(C), pages 85-92.
    6. Stockl, Andrea, 2007. "Complex syndromes, ambivalent diagnosis, and existential uncertainty: The case of Systemic Lupus Erythematosus (SLE)," Social Science & Medicine, Elsevier, vol. 65(7), pages 1549-1559, October.
    7. Trundle, Catherine, 2011. "Biopolitical endpoints: Diagnosing a deserving British nuclear test veteran," Social Science & Medicine, Elsevier, vol. 73(6), pages 882-888, September.
    8. Armstrong, David, 2019. "Diagnosis: From classification to prediction," Social Science & Medicine, Elsevier, vol. 237(C), pages 1-1.
    9. Wild, Cervantée & MacLean, Alice & Nettleton, Sarah & Hunt, Kate & Ziebland, Sue, 2024. "The double invisibility of Long Covid in children," Social Science & Medicine, Elsevier, vol. 347(C).
    10. Turowetz, Jason, 2015. "Citing conduct, individualizing symptoms: Accomplishing autism diagnosis in clinical case conferences," Social Science & Medicine, Elsevier, vol. 142(C), pages 214-222.
    11. Bojovic, Neva & Geiger, Susi, 2023. "Epistemic and institutional recognition work in changing conditions of social visibility: Anosmia's journey from the shadows to the spotlight," Social Science & Medicine, Elsevier, vol. 338(C).
    12. Groenevelt, I.P.(Irene) & de Boer, M.L.(Marjolein), 2023. "Contesting misrecognition online: Experiences of epistemic in/justice by vloggers with contested illnesses," Social Science & Medicine, Elsevier, vol. 327(C).
    13. Boersma, Jolanda J. & Brown, Patrick, 2020. "The tired hero and her (il)legitimation: Reworking Parsons to analyse experiences of burnout within the Dutch employment system and lifeworld," Social Science & Medicine, Elsevier, vol. 265(C).
    14. Russell, Ginny & Kelly, Susan E. & Ford, Tamsin & Steer, Colin, 2012. "Diagnosis as a social determinant: The development of prosocial behaviour before and after an autism spectrum diagnosis," Social Science & Medicine, Elsevier, vol. 75(9), pages 1642-1649.
    15. Fisher, Michael P., 2021. "Politicized disease surveillance: A theoretical lens for understanding sociopolitical influence on the monitoring of disease epidemics," Social Science & Medicine, Elsevier, vol. 291(C).
    16. Whitmarsh, Ian & Davis, Arlene M. & Skinner, Debra & Bailey, Donald Jr., 2007. "A place for genetic uncertainty: Parents valuing an unknown in the meaning of disease," Social Science & Medicine, Elsevier, vol. 65(6), pages 1082-1093, September.
    17. Jovanovic, Maja, 2014. "Creating the ‘dis-ease’ of high cholesterol: A sociology of diagnosis reception analysis," Social Science & Medicine, Elsevier, vol. 101(C), pages 120-128.
    18. Nettleton, Sarah & Kitzinger, Jenny & Kitzinger, Celia, 2014. "A diagnostic illusory? The case of distinguishing between “vegetative” and “minimally conscious” states," Social Science & Medicine, Elsevier, vol. 116(C), pages 134-141.
    19. Phillips, Tarryn, 2012. "Repressive authenticity in the quest for legitimacy: Surveillance and the contested illness lawsuit," Social Science & Medicine, Elsevier, vol. 75(10), pages 1762-1768.
    20. Nicole Brown, 2021. "The Social Course of Fibromyalgia: Resisting Processes of Marginalisation," IJERPH, MDPI, vol. 19(1), pages 1-13, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:278:y:2021:i:c:s0277953621002975. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.