Pathways to personalisation: The practice of BRCA stratification

Personalised medicine is gathering pace across advanced cancer settings in the UK NHS, and care pathways are becoming increasingly filled with different steps, stages and treatments. One key personalised medicine practice is stratifying patients according to their molecular profile. Nevertheless, understanding how this practice shapes lived experience of cancer patients remains an under-researched area. To shed light on this question this paper focuses on the practice of stratifying patients according to their BRCA gene prior to or at the beginning of a late-stage ovarian cancer personalised medicine pathway. I draw on interviews and observations with 17 ovarian cancer patients, who formed part of a larger comparative ethnographic study, which took place between 2020 and 2021 in a tertiary hospital in the South-East of England. Focus on this one practice made it possible to demonstrate how as well as being a diagnostic tool stratification is an affective technology that cultivates range of feelings including inclusion or exclusion, and novel kinds of 'biosociality' (Rabinow, 1999). These findings offer critical insight into the importance to separate and scrutinise its practices on long pathways to understand the lived and felt experience of care.