How Two Cancer Breakthroughs Forged Very Different Legacies
Exploring the paradox of similar innovations with divergent public perceptions
In the high-stakes world of medical innovation, we often imagine a straightforward narrative: brilliant scientists develop life-saving technologies, and grateful patients receive their benefits. But the reality is far more complex, shaped not just by scientific merit but by business strategies, public perception, and the delicate balance between profit and patient access.
Nowhere is this duality more striking than in the parallel stories of two groundbreaking cancer technologies that emerged in the 1990s: Genentech's Herceptin® for breast cancer treatment and Myriad Genetics' BRACAnalysis® for hereditary cancer risk assessment 1 5 .
Both represented monumental scientific achievements. Both were protected by extensive patent portfolios. Both addressed breast cancer, a disease with powerful advocacy groups and public attention. Yet one company was celebrated as a corporate hero while the other was vilified as a ruthless villain 1 . What caused these divergent paths, and what does this reveal about how we judge medical innovation? This article explores how identical scientific and legal foundations can build strikingly different public narratives in the delicate ecosystem of healthcare breakthroughs.
Two different approaches to fighting cancer
Identifies mutations in the BRCA1 and BRCA2 genes to assess hereditary cancer risk.
Monoclonal antibody treatment for HER2-positive breast cancer.
| Feature | BRACAnalysis® | Herceptin® |
|---|---|---|
| Type | Diagnostic test | Therapeutic drug |
| Function | Identifies BRCA1/2 gene mutations | Blocks HER2 receptor signaling |
| Primary Use | Assessing hereditary cancer risk | Treating HER2+ breast cancer |
| Scientific Basis | DNA sequencing of blood/saliva samples | Monoclonal antibody targeting |
| Impact | Informs prevention and treatment decisions | Directly treats existing cancer |
The race for breakthroughs in the 1990s
Dr. Mary-Claire King at UC Berkeley links a gene on chromosome 17 to hereditary breast cancer 1 .
Myriad Genetics team led by Mark Skolnick sequences BRCA1 (1994) and BRCA2 (1995) 1 .
Research establishes HER2 overexpression in aggressive breast cancers .
Both companies secure extensive patent protection for their technologies 1 .
How business strategy shapes perception
Public Perception
Public Perception
The scientist's toolkit for accurate assessment
| Test Type | Procedure | Interpretation | Next Steps |
|---|---|---|---|
| IHC (Immunohistochemistry) | Chemical dye stains HER2 proteins |
Scores 0-1+: HER2-negative Score 2+: Borderline Score 3+: HER2-positive |
No Herceptin therapy FISH confirmation required Herceptin appropriate |
| FISH (Fluorescence In Situ Hybridization) | Fluorescent labels attach to HER2 genes |
Positive: HER2 amplification Negative: No amplification |
Herceptin appropriate No Herceptin therapy |
This balanced approach correctly determines HER2 status in approximately 96% of patients 4 . This testing ecosystem stands in stark contrast to Myriad's exclusive approach with BRACAnalysis.
Economic factors, clinical impacts, and stakeholder engagement
| Scenario | BRACAnalysis Result | Herceptin Eligibility |
|---|---|---|
| Positive Findings | BRCA mutation identified → consideration of risk-reducing surgeries or enhanced screening | HER2-positive status → Herceptin therapy initiated with chemotherapy |
| Negative Findings | No mutation detected → routine cancer screening recommended | HER2-negative status → alternative treatments pursued |
| Uncertain Results | Variant of uncertain significance (VUS) → continued monitoring and family assessment | Borderline IHC (2+) → FISH testing required for definitive determination |
Intellectual property as scapegoat
The most intriguing aspect of the Myriad-Genentech comparison is what scholars have termed the "patent paradox" 1 5 . Both companies relied heavily on patent protection, yet patents bore the brunt of criticism in the Myriad case while attracting little attention in the Herceptin story.
The evidence suggests that patents alone don't determine public perception—it's how companies exercise their patent rights that triggers backlash 1 . Myriad's business strategy of exclusivity and limited access, enabled by patents, created the controversy. Genentech's approach of licensing and collaboration, using those same patent rights, generated praise.
As one analysis concluded, "Patents were a necessary but not sufficient cause of controversy" 1 . The distinction lies in corporate citizenship—how companies balance legitimate profit motives with responsibility to patient communities and the broader scientific ecosystem.
The twin stories of BRACAnalysis and Herceptin reveal that medical breakthroughs are judged not only on their scientific merit but on their implementation. We celebrate innovations that balance commercial success with patient access, and question those that prioritize exclusivity over inclusivity.
As we enter an era of increasingly sophisticated genetic technologies and targeted therapies, these cases offer crucial lessons for companies, clinicians, and patients. The framework of hero versus villain may be simplistic, but it reflects real values in how we expect medical advances to be developed and delivered.
The next generation of breakthroughs—from CRISPR-based therapies to AI-driven diagnostics—will face similar scrutiny. Whether their developers are remembered as heroes or villains won't depend solely on the science, but on their commitment to equitable access, transparent practices, and collaborative spirit. In the delicate ecosystem of medical innovation, corporate responsibility may be the most important patent of all.