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Small Tumors as Risk Factors not Disease

Published online by Cambridge University Press:  01 January 2022

Peter H. Schwartz
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Abstract

I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment for DCIS based on the risks it poses and the risks and benefits of treatment, not on its disease status.

Type
Medical and Social Sciences
Information
Philosophy of Science , Volume 81 , Issue 5 , December 2014 , pp. 986 - 998
Copyright
Copyright © The Philosophy of Science Association

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Footnotes

†

Thanks to Chris Boorse, Dan Hausman, Eric Meslin, and Greg Sachs for discussion. Thanks to Anya Plutynski for inviting me to participate in this panel and Miriam Solomon for her commentary. My research was supported in part by a career development award from the American Cancer Society (CCCDA-10-085-01) and by the Indiana Clinical and Translational Sciences Institute (National Institutes of Health [NIH]/National Center for Research Resources [NCRR]: 1 UL TR001108-01).

References

Boorse, Christopher. 1977. “Health as a Theoretical Concept.” Philosophy of Science 44 (4): 542–73.10.1086/288768CrossRefGoogle Scholar
Boorse, Christopher 1987. “Concepts of Health.” In Health Care Ethics: An Introduction, ed. VanDeVeer, D. and Regan, T., 359–93. Philadelphia: Temple University Press.Google Scholar
Regan, T. 1997. “A Rebuttal on Health.” In What Is Disease? ed. Humber, James M. and Almeder, Rober F., 3–134. Totowa, NJ: Humana.Google ScholarPubMed
Almeder, Rober F. 2012. “Clinical Normality.” Confernence paper, Christopher Boorse and the Philosophy of Medicine symposium, University of Hamburg, September 12. http://www.philosophie.uni-hamburg.de/Schramme/Konferenzen_/Boorse%20Clinical%20Normality.pdf.Google Scholar
Chobanian, Aram V., et al. 2003. “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report.” JAMA 289 (19): 2560–72.10.1001/jama.289.19.2560CrossRefGoogle ScholarPubMed
Clouser, K. Danner, Culver, Charles M., and Gert, Bernard. 1981. “Malady: A New Treatment of Disease.” Hastings Center Report 11 (3): 29–37.10.2307/3561321CrossRefGoogle ScholarPubMed
Croswell, Jennifer M., Brawley, Otis W., and Kramer, Barnett S.. 2011. “Prevention and Early Detection of Cancer.” In Harrison’s Principles of Internal Medicine, 18th ed., ed. Longo, D., Kasper, D., Jameson, J., Fauci, A., Hauser, S., and Loscalzo, J., 655–62. New York: McGraw-Hill.Google Scholar
Daniels, Norman. 2008. Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press.Google Scholar
Erbas, Bircan, Provenzano, Elena, Armes, Jane, and Gertig, Dorota. 2006. “The Natural History of Ductal Carcinoma In Situ of the Breast: A Review.” Breast Cancer Research and Treatment 97 (2): 135–44.10.1007/s10549-005-9101-zCrossRefGoogle ScholarPubMed
Ernster, Virginia L., Barclay, John, Kerlikowske, Karla, Grady, Deborah, and Henderson, I. Craig. 1996. “Incidence of and Treatment for Ductal Carcinoma In Situ of the Breast.” JAMA 275 (12): 913–18.CrossRefGoogle ScholarPubMed
Eusebi, V., Feudale, E., Foschini, M., Micheli, A., Conti, A., Riva, C., Palma, S. Di, and Rilke, F.. 1994. “Long-Term Follow-Up of In Situ Carcinoma of the Breast.” Seminars in Diagnostic Pathology 11 (3): 223–35.Google ScholarPubMed
Greene, Jeremy. 2007. Prescribing by the Numbers: Drugs and the Definition of Disease. Baltimore: Johns Hopkins University Press.Google Scholar
Hausman, Daniel M. 2012. “Health, Naturalism, and Functional Efficiency.” Philosophy of Science 79 (4): 519–41.10.1086/668005CrossRefGoogle Scholar
Kuerer, Henry M., et al. 2009. “Ductal Carcinoma In Situ: State of the Science and Roadmap to Advance the Field.” Journal of Clinical Oncology 27 (2): 279–88.10.1200/JCO.2008.18.3103CrossRefGoogle ScholarPubMed
Miller, Franklin G., and Brody, Howard. 2001. “The Internal Morality of Medicine: An Evolutionary Perspective.” Journal of Medicine and Philosophy 26 (6): 581–99.10.1076/jmep.26.6.581.2993CrossRefGoogle Scholar
National Cholesterol Education Program (NCEP), Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). 2002. “Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report.” Circulation 106:3143–421.Google Scholar
Omer, Zehra B., Hwang, E. Shelley, Esserman, Laura J., Howe, Rebecca, and Ozanne, Elissa M.. 2013. “Impact of Ductal Carcinoma In Situ Terminology on Patient Treatment Preferences.” JAMA Internal Medicine 173 (19): 1830–31.10.1001/jamainternmed.2013.8405CrossRefGoogle ScholarPubMed
Page, David L., Dupont, William D., Rogers, Lowell W., and Landenberger, Marie. 1982. “Intraductal Carcinoma of the Breast: Follow-Up after Biopsy Only.” Cancer 49 (4): 751–58.10.1002/1097-0142(19820215)49:4<751::AID-CNCR2820490426>3.0.CO;2-Y3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Schwartz, Peter H. 2007a. “Decision and Discovery in Defining ‘Disease.’” In Establishing Medical Reality: Essays in the Metaphysics and Epistemology of Biomedical Science, ed. Kincaid, H. and McKitrick, J., 47–64. Dordrecht: Springer.10.1007/1-4020-5216-2_5CrossRefGoogle Scholar
McKitrick, J. 2007b. “Defining Dysfunction: Natural Selection, Design, and Drawing a Line.” Philosophy of Science 74 (7): 364–85.Google Scholar
McKitrick, J. 2008. “Risk and Disease.” Perspectives in Biology and Medicine 51 (3): 320–34.Google Scholar
US Preventive Services Task Force. 2008. US Preventive Services Task Force Procedure Manual. Ed. Agency of Healthcare Research and Quality (AHRQ). AHRQ Publication no. 08-05118-EF. http://www.uspreventiveservicestaskforce.org/uspstf08/methods/procmanual.pdf.Google Scholar
Vickers, Andrew J., Basch, Ethan, and Kattan, Michael W.. 2008. “Against Diagnosis.” Annals of Internal Medicine 149 (3): 200–203.10.7326/0003-4819-149-3-200808050-00010CrossRefGoogle ScholarPubMed
Wakefield, Jerome C. 1992a. “The Concept of Mental Disorder: On the Boundary between Biological Facts and Social Values.” American Psychologist 47 (3): 373–88.CrossRefGoogle Scholar
Wakefield, Jerome C. 1992b. “Disorder as Harmful Dysfunction: A Conceptual Critique of DSM-III’s Definition of Mental Disorder.” Psychological Review 99 (2): 232–47.10.1037/0033-295X.99.2.232CrossRefGoogle Scholar
Welch, H. Gilbert, and Black, William C.. 1997. “Using Autopsy Series to Estimate the Disease ‘Reservoir’ for Ductal Carcinoma In Situ of the Breast: How Much More Breast Cancer Can We Find?” Annals of Internal Medicine 127 (11): 1023–28.CrossRefGoogle ScholarPubMed
Westin, Steinar, and Heath, Iona. 2005. “Thresholds for Normal Blood Pressure and Serum Cholesterol.” BMJ 330 (7506): 1461–62.10.1136/bmj.330.7506.1461CrossRefGoogle ScholarPubMed