In this chapter, we revisit the successful story of the HER2 biomarker for breast cancer, to reflect on the conditions of its inception, some of the reasons for its success, and the challenges met along the way. HER2 is a standard in the field of cancer biomarker research, against which all biomarkers are measured. It is also one of the central arguments used for illustrating the feasibility and desirability of precision oncology. But critically revisiting the story of HER2 shows us that it too faced a winding road from its discovery in the lab to its use in the clinic, and that it currently operates in a context of high levels of biological complexity and persistent uncertainties, in particular with regard to cancer heterogeneity and its implications. By drawing a parallel between the story of HER2 and a ‘scientific bandwagon’, we examine some of the legal, social, and economic challenges and dilemmas that HER2 faces, and conclude with some reflections on the future of cancer biomarker research. Notably, we highlight the need for a greater focus on ‘good enough’ biomarkers, particularly in the setting of precision oncology driven by hyper-precision and the wish for molecular certainty. We emphasise the importance of being open about the low success rate of 1% of published biomarkers which reach clinical practice when justifying the risks and opportunity costs of precision oncology.

This introductory chapter gives an overview of the context in which the book was written, and goes through the central themes being addressed. The book is a result of long-held collaborations between oncologists, clinicians, philosophers, STSers, anthropologists, economists, ethicists, and media studies scholars, who, for the most part, are affiliated to the Centre for Cancer Biomarker (CCBIO), in Bergen, Norway. In addressing the issues at stake and matters of concern around precision oncology and cancer biomarker research, the authors come to see precision oncology as a sociotechnical imaginary, around which a high degree of confusion between hope and reality is observed, and where debates around the feasibility and desirability of precision medicine are altogether political, social, ethical, scientific and medical. The contributions to this book variously approach the culture of biomarker research, powered to a significant extent by a sociotechnical imaginary of precision oncology, with a focus on the following overarching themes: (i) the uncomfortable knowledge that comes to undermine the legitimacy of precision oncology by point at its shortfalls, and the lack of ambivalence in the discourses and practices around precision oncology; (ii) the dynamics of framing and overflowing, when trying to control biological, social and ethical complexity; and (iii) the role of the economy of hope in legitimising and sustaining the imaginary of precision oncology, and the starch dichotomy between illness and disease it leads to.

In this short chapter, the editors draw their main conclusions. Using Antonio Gramsci’s analysis of what constitutes a crisis, it begins by reviewing the unsustainable political economy of cancer research as an obstacle for cancer biomarkers. It proceeds to conclude that the imaginary of precision oncology poses inherent risks and limitations to the development of cancer care. Instead, the authors argue for a notion of personalised cancer research and care that combines the advancement of biomarkers with a patient-centred focus. For incurable cancers biomedical research could be better directed towards needs to reduce suffering and ensure integrity and dignity for patients.