Biomarkers, the molecular gaze and the transformation of cancer survivorship

Over the past two decades, molecular technologies have transformed the landscape of cancer diagnosis, treatment and disease surveillance. However, although the effects of these technologies in the areas of primary and secondary cancer prevention have been the focus of growing study, their role in tertiary prevention remains largely unexamined. Treating this topic as a problematic to be conceptually explored rather than empirically demonstrated, this article focuses on the molecularisation of tertiary prevention, especially the growing use of molecular biomarkers to monitor disease recurrence. Taking a semiotic approach, I speculate on the potential meanings of molecular biomarkers for people living with and beyond cancer and suggest the meanings of these technologies may differ in important ways for those on both sides of the risk divide: that is, those ‘at risk' for cancer and those living with realised risk. Although molecular biomarkers may intensify a sense of ‘measured vulnerability', by indexing cancer's presence they may also prove reassuring. Moreover, as an invisible but ostensibly ‘transparent' sign, in some contexts they appear to enable cancer survivors to challenge biomedical decision making. In the light of recent oncological debates about the value of these biomarkers in tertiary prevention, I conclude by suggesting that signs can never be reduced to their ‘objective' biomedical denotation in spite of professional attempts to expunge meaning and value from care.