In recent days, political Quebec has been consumed by a nasty public spat between physicians and the health minister revolving around the accuracy of diagnostic tests for women with breast cancer.
The dispute has left the public confused and cancer patients needlessly frightened. So let's wade through the rhetoric and expose the real issues and their import beyond Quebec's borders.
The story began a week ago when Radio-Canada television released results of a study that suggested that between 15 and 30 per cent of certain breast cancer tests had been botched, and that some women were being denied lifesaving treatment as a result. Dr. Louis Gaboury, president of the Quebec Association of Pathologists and author of the study, likened the situation to what recently happened in Newfoundland and Labrador.
But the situations in the two provinces are in no way comparable.
In a single lab in Newfoundland and Labrador, hormone receptor tests were done incorrectly over a prolonged period. After retesting was done, it was revealed that almost 400 women were denied prompt treatment. Worse still, the health region tried to cover up its failings. A public inquiry was called.
In Quebec, a small study was conducted: Samples were sent to 25 labs around the province. There, two kinds of tests were conducted, one to identify markers for hormone receptors and a second to identify a specific protein, HER2, that suggests women would respond well to a drug called Herceptin. In 15 to 30 per cent of cases, there were discrepancies in how the tests were interpreted by the various labs.
These are complex tests that do not provide black-or-white answers. Rather, there are ranges and interpretation is required.
The data provided to Radio-Canada in no way suggest that the tests were all wrong, and there's no evidence that anyone was denied proper treatment. What the results do suggest is that Quebec needs a clear set of standards, and quality-control measures to ensure those standards are met.
Unfortunately, Quebec Health Minister Yves Bolduc botched the file thoroughly. He vacillated wildly in his responses, from saying it was a potential crisis to lashing out at physicians for fear-mongering, and he never did get to the heart of the matter.
The reality is that about 85 per cent of decisions that physicians make about the diagnosis and treatment of patients are based on laboratory tests, from blood tests to cancer biopsies. The work of pathologists and laboratory technologists is an essential component of good health care, but they are hidden away in the backrooms – or, more precisely, hospital basements and off-site labs – and taken for granted.
After bodily fluids (or solids) are collected, test results are not produced magically. There is precise work and interpretation required. To ensure that tests are accurate, useful and cost-effective, standards are required. There must be checks and balances. This is particularly true in areas where variations are expected, like hormone receptor testing in breast cancer.
There have been numerous inquiries and investigations of this issue over the years, and the recommendations are always more-or-less the same. So politicians and health professionals in Quebec and elsewhere should lay down their rhetorical arms and focus on what ultimately matters to patients: quick, reliable and accurate results.
The reason Quebec pathologists cried wolf was to draw attention to a severe lack of resources. Their complaints are legitimate, even if their method of garnering media attention was not.
Regardless of their excesses, the fact remains that the scandals involving botched tests have their root in severe shortages of qualified staff and outdated equipment. When health-care cuts were instituted in the 1990s, laboratories were hit savagely, in large part because their work is invisible and they don't have a media presence.
Today, the work of many lab technologists and pathologists in Canada is still hampered because, in better times, governments did not adequately invest in this area. Worse, as the recession deepens, there will be further cuts to health-care spending.
In such times, we need to ask ourselves if all the testing and re-testing we do is really necessary. But tests will continue to be done and it is essential that those doing the testing and interpretation, in addition to having adequate resources, are competent to practise safely and effectively. This requires professional regulation and a single national standard for certifying laboratory technologists. It is worth noting that Quebec has the country's most lax certification standards for lab workers.
In addition to certifying employees, medical labs themselves need to be accredited. Currently, certification is done in a piecemeal fashion. There is no reason every lab in Canada should not meet the internationally accepted standard.
In brief, there is much to be concerned about in this area but, instead of focusing on the minutiae of specific studies, as has been the case in Quebec, we need to step back and look at the big picture.
The quality of pathology and laboratory testing is a serious patient safety issue, and one that has not received its due.
