Abstract
dc:description.abstractThis dissertation examines a series of conceptual and communicative challenges in contemporary cancer medicine centred around precision oncology, an approach which seeks to individualise cancer treatment using genomic biomarkers. Chapter 1 introduces precision oncology, proposing a definition that captures its novel and distinctive features, and explores its broader ontological, epistemic, and ethical implications. Chapter 2 examines the challenge of assigning actionability to genomic information, which has emerged as a central problem in precision oncology. I outline a taxonomy of actionability concepts as distinct, contextually objective categories, while acknowledging the need for conceptual interaction to handle challenging cases in practice. Chapter 3 focuses on the role of genomic biomarkers in clinical reasoning. I develop an approach to reasoning with biomarkers called clinical abstraction, which addresses key epistemic and ethical challenges surrounding the use of biomarkers in patient care. Chapter 4 analyses minimal residual disease (MRD), an important biomarker in precision oncology intended to measure residual cancer cells after treatment. I argue that the conditions required for MRD’s success as a predictive biomarker are unlikely to hold across cancers, cautioning against its unwarranted use as a guide to cancer treatment. Chapter 5 turns to communicative challenges in cancer clinical trials, focusing specifically on generalisations about the efficacy and safety of new treatments. I offer a novel analysis of these generalisations as generics in natural language and argue that generic claims about cancer treatments are best avoided in reports of clinical trials due to their propensity to mislead. Lastly, Chapter 6 addresses the challenge of communicating a cancer diagnosis and how it can contribute to overtreatment. I argue against an influential approach to preventing overtreatment that seeks to relabel early cancers, proposing instead a revisionist strategy which aims to shift the normative force of the cancer diagnosis itself. Together, these chapters offer new insights into central concepts and communicative practices in contemporary oncology. By evaluating the novelty and impact of precision oncology, clarifying its core concepts, and arguing for clearer communication around cancer diagnosis and treatment, this dissertation uses philosophical tools to help tackle key challenges facing cancer medicine today.
Degree
thesis:*- Name dc:type.qualificationname
- Doctor of Philosophy (PhD)
- Level dc:type.qualificationlevel
- Doctoral
- Grantor dc:publisher.institution
- University of Cambridge
- Year dc:date.issued
- 2025
Author and committee
dc:creator, dc:contributor.*- Author dc:creator
-
- Chin-Yee, Benjamin
- Advisors dc:contributor.advisor
-
- Stegenga, Jacob
- John, Stephen
Subjects
dc:subject × 7Rights
dc:rightsIdentifiers
dc:identifier.*- DOI dc:identifier.doi
- https://doi.org/10.17863/CAM.121771
- OAI identifier oai:identifier
- oai:www.repository.cam.ac.uk:1810/390100