Ethics and breast cancer risk assessment

Clinical risk assessment holds great promise for identifying individuals who might benefit from preventive interventions. In the case of breast cancer, statistical models, notably the Gail model, have been developed to assess an individual woman's future risk of developing disease. However, the estimates derived from these models are subject to substantial uncertainty and there is controversy over how to translate risk information into prevention and control measures.In light of these uncertainties, ethical concerns have been raised about appropriate use of these models. The potential benefits of individualized risk assessment must be weighed against current limitations and potential harms. The fact that breast cancer is a significant source of anxiety for many women suggests that the potential harms from misinformation are substantial.This paper concludes that the profound uncertainties surrounding breast cancer risk assessment warrant caution in the use of such models. Breast cancer risk assessment tools occupy a grey area between public health education and individualized clinical attention. When public health officials promise individualized risk information, there is potential for women to place too much importance and trust in these risk estimates. Moreover, use of these models in counseling women about participation in clinical trials should be responsive to the complexity of informed consent.