Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;41(8):1568-1584.
doi: 10.1111/1467-9566.12970. Epub 2019 Jun 13.

Genomic expertise in action: molecular tumour boards and decision-making in precision oncology

Pascale Bourret  1 , Alberto Cambrosio  2
Affiliations
Free article

Genomic expertise in action: molecular tumour boards and decision-making in precision oncology

Pascale Bourret et al. Sociol Health Illn. 2019 Nov.
Free article

Abstract

The recent development of cancer precision medicine is associated with the emergence of 'molecular tumour boards' (MTBs). Attended by a heterogenous set of practitioners, MTBs link genomic platforms to clinical practices by establishing 'actionable' connections between drugs and molecular alterations. Their activities rely on a number of evidential resources - for example databases, clinical trial results, basic knowledge about mutations and pathways - that need to be associated with the clinical trajectory of individual patients. Experts from various domains are required to master and align diverse kinds of information. However, rather than examining MTBs as an institution interfacing different kinds of expertise embedded in individual experts, we argue that expertise is the emergent outcome of MTBs, which can be conceptualised as networks or 'agencements' of humans and devices. Based on the ethnographic analysis of the activities of four clinical trial MTBs (three in France and an international one) and of two French routine-care MTBs, the paper analyses how MTBs produce therapeutic decisions, centring on the new kind of expertise they engender. The development and activities of MTBs signal a profound transformation of the evidentiary basis and processes upon which biomedical expertise and decision-making in oncology are predicated and, in particular, the emergence of a clinic of variants.

Keywords: bio-clinical expertise; cancer genomics; molecular tumour boards; precision medicine.

PubMed Disclaimer

References

    1. Baszanger, I. (2012) One more chemo or one too many? Defining the limits of treatment and innovation in medical oncology, Social Science & Medicine, 75, 5, 864-72.
    1. Berg, M. (1996) Practices of reading and writing. The constitutive role of the patient record in medical work, Sociology of Health and Illness, 18, 4, 499-524.
    1. Bourgeault, I., Dingwall, R. and de Vries, R. (2013) The SAGE Handbook of Qualitative Methods in Health Research. Los Angeles: SAGE.
    1. Cambrosio, A., Limoges, C. and Hoffman, E. (1992) Expertise as a network. A case study of the controversies over the environmental release of genetically engineered organisms. In Stehr, N. and Ericson, R.V. (eds) The Culture and Power of Knowledge. Inquiries into Contemporary Societies pp. 341-61. Berlin, Germany: Walter de Gruyter.
    1. Cambrosio, A., Keating, P., Vignola-Gagné, E., Besle, S., et al. (2018) Extending experimentation. Oncology's fading boundary between research and care, New Genetics & Society, 37, 3, 207-26.

Publication types

Grants and funding