SO MANY GENES, SO LITTLE TIME

Carolyn's wedding

Note sign in background

ASCO, The American Society of Clinical Oncologists, is holding its annual meeting right now, which means that my web-based tip sheet is flooded with articles on ovarian cancer – most of which either cost money to read, or are beyond my comprehension.  Here is one that is neither.

A report presented by a Stanford researcher, based on a data set of 100,000 women, reports that an additional 11 genes have been identified that (when mutated, I presume) contribute to the probability of contracting ovarian cancer.  This brings the total to 25 – and, probably, still counting.  Three of these are well understood; BRCA1,2 and something called Lynch syndrome (of which I had never heard until today).  Lynch syndrome is more commonly associated with colon cancer and, like the BRCA genes, involves the disabling of a DNA damage-repair gene.  The “odds ratios” (think of the relative probabilities of contracting OVCA) vary from 12 for BRCA1 to almost nothing.  Oddly, and to the surprise of the investigators, a gene called STK11 came in at 4, almost as high as BRCA2. It doesn’t appear to be clear WHY many of these genes are bad, only that they are.  So what to think?

Well, Jim Watson (yes, that Jim Watson) said it best (I paraphrase):  “We all thought that determining which genes are responsible for diseases would yield a major therapeutic  pay off, but it hasn’t”.  (Watson is well known for “off-the-wall-isms”, AKA gaffes, but this isn’t one of them.)  He is right.

That there are two dozen genes that contribute to OVCA is interesting, but also discouraging.  To make use of this information it would be necessary to determine what each gene does, then devise a drug to interfere with or undo its malign effect.  This would cost unimaginable sums of money, might result in therapy involving several dozen drugs – and would be only marginally effective since most cases of OVCA are sporadic – that is, the result of bad luck rather than bad genes.  Better to concentrate in immunotherapy or personalized therapy. Put the money on the fastest horse.  You agree, I assume – Mr. Right Honorable VP Joe Biden Sir?  (You do read my blogs, right?)

Ladies - after you have had so many babies that you can't tolerate the thought of having any more - have your Fallopian tubes removed at the first opportunity.

Or so it seems to me.

http://www.medpagetoday.com/clinical-context/GynecologicCancers/58322