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Pathways and prospects in cancer research: Securing futures and negotiating boundaries

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Abstract

This paper draws on literature from the sociology of expectations to explore accounts of experts in cancer research and clinical practice. The cancer specialists’ accounts presented in this article are taken from interviews undertaken as part of a project that aimed to develop a research agenda for the next ten to thirty years that will achieve early detection and prevention in the four main cancers: (i) bowel and colorectal, (ii) prostate, (iii) lung and (iv) breast. Drawing on secondary analysis of the interviews, this article provides a sociological exploration of both the experts’ versions of the future and the interactions between the interviewer and research participant to show expectation in the making: the competing stories of what is and what ought to be the focus of cancer research now and in the (near) future. The building of a cancer research agenda is shown to be a contested future, represented by a dominant and resistant view of the cancer problem, in which cancer specialists must engage in performative strategies and boundary work to frame the present problem: what cancer is and how it can be detected and, subsequently, to claim credibility for a future pathway.

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Notes

  1. Gieryn (1999) uses the concept of cartography to describe the mapping of epistemic authority on the basis of credible methods or reliable facts, with borders that locate useful science, that are surrounded by less useful terrain. This idea helps to describe the spatial, material and ontological demarcation that occurs in the accounts and interactions of cancer research experts.

  2. Aligned to the concern over pussycats and tigers, although not fully explored in this expert’s description, is the problem of ‘lead time biases’. This refers to the length of time a ‘cancer’ has been detected but causes no harm, with earlier detection potentially creating years of anxiety (Etzioni et al, 2002).

  3. Jane Calvert’s (2006) and Calvert and Fujimura (2009) work on systems biology is useful to illustrate the engineer’s approach to biology.

  4. Futures not represented in these accounts include the potential human impact of over-diagnoses (Etzioni et al, 2002) that fail to provide useful categories for clinical intervention (Welch, 2006; Black, 2000; Folkman and Kalluri, 2004). Such futures may have provided greater credibility to the resistant view and further challenged the paradigm of early detection and prevention.

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Acknowledgements

We would like to thank the experts, who not only gave their time to be interviewed for the original project, but also gave their permission for their accounts to be transcribed and analysed for the purpose of this article. We would also like to thank the original project team for sharing the interview data and supporting the secondary analysis, particularly Dr. Omnia Allam.

Funding

The interviews presented in this article were undertaken as part of a project supported by the Engineering and Physical Sciences Research Council, Grant Number EP/F058640/1. The cost of transcription was funded by the Economic and Social Research Council’s Centre for the Social and Ethical Aspects of Genomics (Cesagen), based at Cardiff University’s school of social sciences. The secondary analysis and writing of this article has been undertaken as part of a Wellcome Trust Society and Ethics Postdoctoral Fellowship award, WT091772.

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Authors and Affiliations

  1. Cardiff University School of Social Sciences, 10 Museum Place, Cathays, Cardiff, CF10 3BG, UK

    Alexandra Hillman & Jamie Lewis

  2. The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, 03756, USA

    Glyn Elwyn

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  1. Alexandra Hillman
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  2. Jamie Lewis
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Correspondence to Alexandra Hillman.

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Hillman, A., Lewis, J. & Elwyn, G. Pathways and prospects in cancer research: Securing futures and negotiating boundaries. BioSocieties 12, 321–342 (2017). https://doi.org/10.1057/s41292-017-0036-5

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