Making Tumour Genetics Doable in the Clinic: Organizational Fictions and the Management of Uncertainty

• In Event: Precision and Uncertainty in a World of Data - III

Abstract

Tumour genetics has deeply changed the way cancer is understood and research practices are organized in oncology. In recent years, genomic sequencing technologies, along with novel targeted therapies that rely on data from the genomic profiling of tumours, have rapidly and massively been deployed in the clinic, where they constitute an outpost for precision medicine. This genomic molecularization of cancer now extends to the clinical management of the disease itself and no longer of its risk only. Based on an ethnographic study of tumour genetics platforms in constrasted hospital settings in France, our contribution aims at analysing the work required to align current understandings of genetic mutations with clinical practices and health policies. We show that genomic technologies, along with their data-worlds, do not integrate effortlessly and seamlessly into pre-existing clinical routines and infrastructure. On the contrary, their implementation is rife with organizational, scientific and technical uncertainties, that spread far beyond the sole interpretation of genomic data and test results. As professionals collectively strive to establish the sense and trustworthiness of unfamiliar, unstable and incomplete instruments and forms of knowledge, they come to rely on the adoption of a series of organizational fictions. More than mere conventions, the latter take the form of negotiated simplifications that provide robust and manageable enough heuristics to achieve the articulation of molecular analyses and clinical decisions. These fictions therefore constitute practical arrangements which distribute, order and articulate different professional and epistemic rationalities to make tumour genetics doable in clinical practice.

Authors

• Ashveen Peerbaye, Université Paris-Est

• Claire Beaudevin, CNRS

• Catherine Bourgain, Inserm