From Alpha to Omega. From beginning to end. This hallowed expression brings us back to the use of the ancient Greek alphabet. We especially wonder how many letters fit between Omicron and Omega. Seeking to imprint in our minds that the number of SARS-COV2 variants should be limited… Magical thinking!
Posted yesterday at 9:00 a.m.
I firmly believe that the coronavirus does not have a great knowledge of the Greek alphabet and that it will not stop bothering us because there are no letters left to name it. We have to rely on other biological phenomena and solid data to help us. And certainly not just for COVID! Cancer also changes over time.
Like COVID, it is therefore necessary to properly list the diseases, count them, determine the variables over time that may be associated with a poorer prognosis or an increase in incidence. So, and above all, is it with cancer. Recently, The Press presented a file on the absence of a registry of cancer cases in Quebec1. What is spreading before our eyes in Rouyn-Noranda is the consequence and should lead public health actors to demand the establishment of such a register with a sense of urgency. The question must be asked: why is there a crisis at the moment when demonstrations of difference in incidence do not appear overnight and can be identified early and confirmed over time?
A properly constituted tumor registry makes it possible to measure in real time as many characteristics as possible of each case of cancer, of the treatment given, of the consequent results.
And as in Rouyn-Noranda, following the evolution of cancer cases over the years and determining whether the characteristics of the population (smoking, age, race, etc.) or environmental characteristics (smog index, toxic components, emissions radon, etc.) can be invoked in the increased incidence of lung cancer and the associated mortality.
For the relevance of the processing
In addition, for almost 20 years, anomalies of multiple genes have been reported for lung cancer. Despite this, and despite the fact that more than 20 anomalies make it possible to predict the response to various treatments, Quebec remains unable to offer a refined diagnosis to a large number of patients struggling with this disease, unlike COVID. In fact, defining whether the lung cancers found in Quebec have attributes similar to what is reported in the world literature is essential and is essential to decide on the relevance of the treatments administered.
For example, abnormalities in the EGFR and ALK genes occur mostly in younger women, and particularly in South Asian populations. Therapies exist and target these abnormalities, allowing better survival. What is the real prevalence of abnormalities of these genes in Quebec? No register. No accumulation of data generated locally by hospitals and molecular diagnostic laboratories. No initiative from Public Health or the National Institute of Excellence in Health and Social Services (INESSS) to define whether the lung cancer from which Quebecers suffer has particularities that should lead us to develop new therapies, to study etiological associations (cause) with ancestral characteristics of Quebecers or factors in our environment.
Thus, beyond the current controversy that is shaking the population of Rouyn-Noranda, and while the Dr Luc Boileau will visit this place to explain the conduct of Public Health, there is reason to ask him some specific questions:
— Since when has the incidence of lung cancer increased in Rouyn-Noranda?
— Is it the only type of cancer whose incidence is higher than that of the province?
— Does the genomic profile of the cases show regional variations?
If, like British Columbia in 1938, Quebec had set up a tumor registry and an independent organization responsible for supervising and controlling epidemiological, therapeutic and cancer research activities, there would be no no scoop to discuss cancer in Abitibi or elsewhere in Quebec.
It would be a continuous, structured discourse, leading to a structuring of preventive, diagnostic and therapeutic capacities. Unfortunately, the current crisis takes on an eminently political counterpart on “who knew what and when”. These questions are not unimportant, but they will mean nothing tomorrow for a population that has the right to benefit from an authority in terms of Public Health and the Department of the fight against cancer capable of extracting itself from the immediate media. to propose real ways to regulate the health of Quebecers.
Of course, political scientists will quote Seneca: “We must punish, not to punish, but to prevent. However, in this world contaminated by social networks, punishing goes hand in hand with the potential to prevent. On the eve of the election period, let us demand that our politicians come out of their belligerent nature of the National Assembly to prove that Rouyn-Noranda will not be just a political episode, that this city will officiate the beginning of a takeover conscience on how to count diseases and treat them in Quebec.