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Predictive cancer tests: To tell or not?

June 24, 2009 12:00:00 AM PDT
If you were diagnosed with cancer, would you want to know your chances of survival if doctors could predict it with a genetic test? It's a double-edged sword for many doctors, but new research reveals people want to know regardless of the outcome. But is this good medicine?Graduation is a grand occasion in any family, but seeing her granddaughter mark this milestone is especially meaningful for 63-year-old Alice Bakman.

"Every benchmark I reach or every little stone in the road that I cross over is special," said Alice.

About three years ago, Alice was diagnosed with ocular melanoma, a rare form of eye cancer. Even with treatment, 50 percent of patients end up succumbing to this cancer after about five years. The other 50 percent usually get cured.

The difference between these two groups: a missing copy of chromosome 3. Ocular melanoma will usually spread in those missing the copy.

"We find that if patients have a loss of this one copy of chromosome 3 -- and it's often termed monosome 3 -- that puts you in the high risk," said Dr. Tara McCannel, UCLA Jules Stein Eye Institute.

Alice's test results put her in the high-risk category. The dilemma for doctors: whether to tell her this information.

"I guess my colleagues are of the thinking that giving patients bad news with no treatment is bad medicine," said Dr. McCannel.

But Dr. McCannel doesn't agree. She and her colleagues conducted a study of about 100 ocular melanoma patients to find if sharing this information hurts or helps patients.

They found 99 percent of patients wanted the predictive testing.

"I remember Dr. McCannel called me, I answered the phone in the den and she said, 'Susan, I have great news,'" said Susan Rosenthal.

Susan did not have a missing copy. She's a three-time cancer survivor. When Susan agreed to participate in the study she knew she had a 50/50 chance of hearing bad news, but she wanted to know.

"If you're given the information, you can plan, you can decide what's important to you and you can be thankful for every day," said Susan.

"Even patients who were given the poor prognosis, it didn't alter their mental status," said Dr. McCannel. "They handled the information well."

"I don't see it as a ticking time bomb," said Alice.

Doctors told Alice her odds were not as good, but she says knowing empowers her.

"I like logic," said Alice. "If I can understand something I can deal with it much better than if it's nebulous."

Alice gets checked twice a year and continues with her life as normal. Alice says knowing as much information as possible not only helps her, it'll help doctors discover new methods of treatment.

"These people are practicing physicians, and practicing tells me they're still working out the details," said Alice.

Dr. McCannel says having this information about how aggressive a cancer is can help doctors develop some sort of therapeutic strategy to help prolong survival.

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