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“We can really wonder about the environmental causes”

The ordeal of Shiloh, who died at the age of 12 from breast angiosarcoma, raises questions about the care and causes of pediatric cancers.

Shiloh, a 12-year-old girl, died of cancer in the left breast in December 2021. The young girl died in less than a year from breast angiosarcoma, an extremely rare vascular tumor with a very poor prognosis. His parents, who denounce medical wandering and a series of errors in care, today, file a complaint.

This drama, which reminds us that cancer also affects childhood and adolescence, raises several questions. Are childhood cancers properly diagnosed? Are we witnessing an “epidemic of childhood cancers”, as certain researchers claim? Why do children develop cancers when they don’t smoke, drink or have fifty years of poor nutrition behind them?

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The figures are stable, around 2500 new cases per year

Despite a survival rate of 80% at five years, often synonymous with recovery, cancer remains the leading cause of death by disease in children over 1 year old, and two thirds of those who survived have or will have sequelae. , sometimes irreversible, linked to the treatments. Worse, the incidence of these cancers increased by 18% between 2003 and 2019, according to data from the National Health Insurance Fund. “False information”, according to the French Society for the Fight against Childhood and Adolescent Cancer and Leukemia (SFCE) and the Gustave Roussy Institute (Villejuif), where Dr Christelle Dufour, head of the oncology department of children and adolescents, disputes the reliability of the statistics. “We rely on the National Childhood Cancer Registry (RNCA), which is regularly updated with health insurance and hospital data. The figures are generally stable. We are still at 2,500 new cases per year: 1,700 in children under 15 and 800 between 15 and 18 years old.

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Leukemias, brain tumors, and lymphomas can affect children and adolescents, but also “various embryonic tumors, such as neuroblastomas, hepatoblastomas, nephroblastomas, which are not seen in adults”, specifies the oncopediatrician . “These diseases are different in children because they also have a much faster evolutionary profile and better sensitivity to chemotherapy treatment.”

Is early diagnosis always possible in children? “In some cases, it is complicated. For some brain tumours, when the child presents with non-specific signs (headaches, vomiting), other common illnesses are first checked before a diagnosis of cancer is made. Our studies show that this delay in diagnosis, for some pathologies with a poor prognosis, has no impact on the cure rate.”

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The problem is that of all these cancers detected in time, but which we do not know how to treat.

“Beyond a possible loss of opportunity linked to a lack of access to pediatric oncology services, in certain territories, or to a lack of training for general practitioners, the most recurrent problem is that of all these cancers detected in time, in children, but which we do not know how to treat”, explains Stéphane Vedrenne, president of the association “Eva for life”, and vice-president of “Growing up without cancer”, which brings together researchers and around a hundred associations fighting against cancer and serious illnesses in children. In 2011, this father of a family lost “in appalling conditions” his first daughter, Eva, suffering from an infiltrating glioma of the brainstem, a rare tumor which affects 50 children each year. Although detected early, the tumor is incurable. “There are diseases that are treated very well, such as Burkitt’s lymphoma and certain types of brain tumors, and those that are not cured at all or weakly,” admits Dr. Dufour.

“If the cancer is close to that of the adult, the child has a significant chance of being cured. If this is not the case, it is a rare disease and there is no cure”, explains Stéphane Vedrenne, whose association has been campaigning for years for specific funds to be allocated to research. on childhood cancer. Both to develop therapeutic approaches and to understand the causes and origins of these diseases in children.

We have not identified any environmental factors, despite numerous studies

Today, we do not really know why a child develops cancer. “5 to 8% of children have a genetic predisposition syndrome and in other patients, there is no explanation. But it is possible that new genetic factors will be discovered. At Gustave Roussy, research is ongoing,” explains Dr. Dufour. What about environmental causes? “We haven’t identified any environmental factors, despite numerous studies, but we’re still looking.”

Also read. Cancer in children: a 13% increase in twenty years

No established proof at this stage, but suspicions. In a report published in 2013 and updated in 2021, Inserm underlines “a strong presumption of a link between exposure to pesticides of the mother during pregnancy or in children and the risk of certain cancers, in particular leukemia and tumors of the central nervous system”. Across the Atlantic, where the National Cancer Institute (NCI) records a sharp increase in the incidence of cancer in American children (leukemia, tumors of the central nervous system), between 1975 and 2018, doctors and environmental health specialists warn: these increases are too rapid to be due to better access to care or better detection of cancer cases.

Also read. Childhood cancer: the call for mobilization of a deputy

“Research on the causes of pediatric cancers must be invested heavily, it is a question of prevention. It is possible that we will discover new genetic factors that explain the occurrence of these cancers in children. But when we see the increase in cases, we can really wonder about the environmental causes, ”concludes Stéphane Vedrenne.

Find the story of Shiloh’s parents in our magazine n°3813.

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