People want personalized medical care. I would like to think that we doctors have
always treated our patients based on their individual health status, including factors
such as their medical history, family history, laboratory data, results of imaging,
and patient wishes. Personalized medicine, as a term, has evolved to indicate that
the results of various forms of genomic analysis are applied to tailor an individual
patient's medical care. Patients don't know, and indeed, most doctors don't understand
the future that the emerging molecular technologies can bring to the practice of medicine.
Still, there are clear advantages that supplement but do not replace traditional clinical
medicine. These advantages include the potential for predicting susceptibility to
disease and as a result, more detailed screening or prophylactic preventive treatment.
Personalized medicine also offers the potential for the diagnosis of disease at an
early and more effectively treated time when the sequelae of the disease may be ameliorated.
This is particularly true in the cancer field, where we work. Potential beneficiaries
of the novel technologies will primarily be our patients but those who pay for medical
care will also benefit. There are immense business opportunities for companies that
develop diagnostics, drugs, or methods for data analysis. My message today is to focus
on how we as surgeons have an opportunity and a responsibility to become involved
and influence the development of personalized medicine as a field of discipline. Already
several medical schools have developed institutes, programs, or curriculum focused
on personalized medicine. Companies have been formed marketing individual analyses
that purport to predict one's risk of the development of a myriad of diseases ranging
from Alzheimer's disease or diabetes to male pattern baldness. In my address, I plan
to review the current state of the field as it relates to our practice as endocrine
surgeons.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The role of prophylactic surgery in cancer prevention.World J Surg. 2007; 31: 450-464
- Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer.Gastroenterology. 2000; 118: 829-834
- Benefits of colonoscopic surveillance and prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer mutations.Ann Intern Med. 1998; 129: 787-796
- An alternative to prophylactic colectomy for colon cancer prevention in HNPCC syndrome.Gut. 2005; 54: 169
- Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. The Breast Cancer Linkage Consortium.Am J Hum Genet. 1998; 62: 676-689
- New York Breast Cancer Study Group. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2.Science. 2003; 302: 643-646
- Rotterdam Committee for Medical and Genetic Counseling. Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk.J Clin Oncol. 2001; 19: 924-930
- National Surgical Adjuvant Breast and Bowel Project. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial.JAMA. 2001; 286: 2251-2256
- Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation.N Engl J Med. 2001; 345: 159-164
- Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers.J Nat Cancer Inst. 2001; 93: 1633-1637
- Bilateral prophylactic mastectomy reduces the breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group.J Clin Oncol. 2004; 22: 1055-1062
- Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy.JAMA. 2000; 284: 319-324
- Advances and controversies in the diagnosis and management of medullary thyroid cancer.Am J Med. 1997; 103: 60-69
- Mutations in the RET proto-oncogene are associated with MEN2A and FMTC.Hum Mol Genet. 1993; 2: 851-856
- Germ-line mutations of the RET proto-oncogene in multiple endocrine neoplasia type 2A.Nature. 1993; 363: 458-460
- The relationship between specific RET proto-oncogene mutations and disease phenotype in multiple endocrine neoplasia type 2. International RET mutation consortium analysis.JAMA. 1996; 276: 1575-1579
- Predictive DNA testing and prophylactic thyroidectomy in patients at risk for multiple endocrine neoplasia 2A.Ann Surg. 1994; 220: 237-247
- Pheochromocytoma penetrance varies by RET mutation in MEN 2A.Surgery. 2007; 142: 800-805
- Codon-specific development of pheochromocytoma in multiple endocrine neoplasia type 2.J Clin Endocrinol Metab. 2005; 90: 3999-4003
- Neuronal apoptosis linked to EgIN3 prolyl hydroxylase and familial pheochromocytoma genes: developmental culling and cancer.Cancer Cell. 2005; 8: 155-167
- BRAF mutation in thyroid cancer.Endocr Relat Cancer. 2005; 12: 245-262
- SEER cancer statistics review, 1975-2004.National Cancer Institute, Bethesda, MD2007 (Available from: URL:)
- BRAF mutation in papillary thyroid cancer: Pathogenic role, molecular bases, and clinical implications.Endocrine Rev. 2007; 28: 742-762
- Raf proteins and cancer: B-Raf is identified as a mutational target.Biochim Biophys Acta. 2003; 1653: 25-40
- Clinicopathologic significance of BRAF V600E mutation in papillary carcinomas of the thyroid: a meta-analysis.Cancer. 2007; 110: 38-46
- Association of BRAF V600E mutation with poor clinicopathologic outcomes in 500 consecutive cases of papillary thyroid carcinoma.J Clin Endocrinol Metab. 2007; 92: 4085-4090
- BRAF mutation predicts a poorer clinical prognosis for papillary thyroid cancer.J Clin Endocrinol Metab. 2005; 90: 6373-6379
Magnaldo T. SHH (Sonic hedgehog). Atlas Genet Cytogenet Oncol Haematol. February 2002. Available from: URL: http://AtlasGeneticsOncology.org/Genes/SHHID378.html.
- Is anticancer drug development heading in the right direction?.Cancer Res. 2009; 69: 1259-1261
- Cancer complexity slows quest for cure.Nature. 2008; 455: 148
Article info
Publication history
Accepted:
October 5,
2009
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
