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Towards responsible ctDNA-based multi-cancer screening: a preliminary exploration and discussion of ethically
1Department of Health, Ethics & Society (HES), School for Oncology and Reproduction (GROW), School for Public Health and Primary Care (CAPHRI), Maastricht University, HA Maastricht 6229, the Netherlands.
Extracellular Vesicles and Circulating Nucleic Acids
|December 19, 2024
Summary
Multicancer early detection (MCED) tests show promise for population cancer screening using circulating tumor DNA. Ethical considerations, including defining objectives and managing risks, are crucial for responsible implementation.
Area of Science:
- Oncology
- Genetics
- Bioethics
Background:
- Liquid biopsy, utilizing circulating cell-free tumor DNA, is emerging in cancer care.
- Multicancer early detection (MCED) tests are being developed for population-level cancer screening.
- Large-scale validation in non-patient populations is required for current MCED tests.
Purpose of the Study:
- To proactively explore the ethical aspects of multicancer early detection (MCED) screening.
- To apply the internationally accepted framework of principles for responsible screening.
- To identify and discuss specific ethical issues related to MCED screening.
Main Methods:
- Review and analysis of the World Health Organization (WHO) screening framework by Wilson and Junger.
- Examination of ethical concerns in the context of cancer's heterogeneity and variable clinical utility.
- Comparison with ethical debates from newborn and reproductive genetic screening.
Main Results:
- MCED screening presents unique ethical challenges due to cancer's complexity.
- Not all detected findings may have equal clinical utility, impacting screening benefits.
- Key screening principles include defined objectives, risk mitigation, and benefit-harm balance.
Conclusions:
- Ethical frameworks must guide the development and implementation of MCED tests.
- Clear screening objectives and robust risk management are essential.
- Ensuring that benefits outweigh harms for participants is paramount for responsible screening.
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