Routine informed consent for mismatch repair testing in endometrial cancers: Review and ethical analysis
Joseph A DeMari1, David I Shalowitz1
1Section on Gynecologic Oncology, Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Objective:
To review available data regarding consent for tumor testing for mismatch repair (MMR), and to make recommendation for ethical best practices based on synthesis of contemporary data and ethical principles.
Methods:
PubMed and CINAHL databases were searched through September 2021; articles reporting on consent for MMR tumor testing for patients at risk for Lynch Syndrome were abstracted. Additional articles were identified through review of references. Key data and ethical principles were extracted, summarized, and analyzed in the context of contemporary clinical practice.
Results:
16 articles met inclusion criteria for this review, none of which specifically related to MMR testing for endometrial cancers. All but two studies were published prior to the approval of pembrolizumab for treatment of MMR-deficient tumors. Scant available data suggest that routine consent prior to tumor testing is uncommon; however, several decision aids improved patient knowledge and satisfaction prior to deciding whether to proceed with tumor testing. Previous ethical analyses invoke clinical utility, potential germline implications, and logistical factors in making recommendations regarding consent practices. These analyses varied in their final recommendations; however, all had significant deficits in their arguments related to contemporary clinical care for patients with endometrial cancer.
Conclusion:
Current data are needed to assess the impact of potential consent strategies for tumor testing. Based on available data, and consistent with contemporary ethical best practices, we recommend that planned MMR testing of endometrial cancers be discussed routinely with patients verbally or in surgical consent documents.
