Use of the English Language, and Cancer

I am always amazed at how a small bit of insight, perhaps well interpreted, may get presented by the Press as the be all and end all. It is especially true with cancer. The most recent case in point is a study by physicians at a Toronto Hospital as well as at MSKCC and other places that the existence of some CNV, copy number variants, can give some modest prognostic data on prostate cancer. Simply, using some 300 patients in toto, theu compared tumor cells to non tumor cells and determined what CNVs across the genome could possibly be prognostic. With the 300 patient sample they got an ROC with about a 70& AUC. Nice but no cigar frankly.

But now to the Press. A Canadian paper states:

Canadian researchers have developed a genetic test to identify which men are at highest risk for recurrence of prostate cancer following localized treatment with surgery or radiation therapy. The genetic test provides a quick and highly accurate tool to determine which men with prostate cancer would do well with only surgery or radiation, and those who would need additional treatment — chemotherapy and hormone therapy, say the researchers, whose findings are described in Wednesday’s online edition of the journal Lancet Oncology. “Our findings set the stage to tackle the ongoing clinical problem of under-treating men with aggressive disease that will recur in 30 per cent to 50 per cent of patients due to hidden, microscopic disease that is already outside the prostate gland during initial treatment,” said ...a clinician-scientist ... in Toronto. "This genetic test could increase cure rates in intermediate- to high-risk men by preventing progression to this metastatic spread of prostate cancer,” said ... a scientist at the Ontario Institute for Cancer Research.

Now if one reads the opening sentence one could be led to believe that there is some massive discovery here. In my opinion, I will be delivering a more detailed analysis later, the following most likely are the results:

1. CNV are found everywhere in DNA. The fact that CNVs are more extensive in cancer cells may or may not be informative.

2. 300 patients is not a lot, especially not enough to in my opinion justify the first opening sentence.  However in fairness the researcher did say "could". 

3. There is the causative issue here. Why did these CNVs arise and why where they did. That seems to be the compelling issue.

4. Prognosis means that we can tell who after surgery or radiation will fare better or more poorly. But frankly so what if we have no way to mollify the negative results. We get to tell the patient that they are going to die at a greater odds ratio that someone else. We are not really certain but the odds are higher and yes we cannot do anything. Why even have that conversation?

5. There are already dozens of similar tests, genes, mRNAs, CNV, SNPs proteins, exosomes, endosomes, and the list goes on. What does one get by this test?

Yet the real issue is why does the Press make it appear that there is truly something here, here?