Ethical issues in genetic screening for cancer

Area of Science:

• Medical Genetics
• Bioethics
• Public Health

Background:

• Late-onset genetic diseases, such as BRCA1-dependent breast cancer and Huntington's disease, can be predicted through mutation screening in high-risk families.
• Genetic screening involves ethical conflicts between individual autonomy (the 'right not to know') and familial responsibility ('duty to know' for descendants).
• Uncertainty regarding the benefits of screening, especially for conditions lacking effective therapies, poses ethical challenges.

Purpose of the Study:

• To analyze the ethical considerations and practical implications of genetic screening for late-onset and susceptibility-based diseases.
• To compare the cost-effectiveness and feasibility of genetic screening against primary prevention strategies.
• To examine the potential negative consequences of prioritizing genetic screening over primary prevention, including research limitations and discriminatory practices.

Main Methods:

• Review of ethical principles related to genetic screening, including autonomy, beneficence, and justice.
• Analysis of the economic and practical aspects of genetic screening versus primary prevention.
• Examination of potential societal impacts, such as employee selection and ethnic disparities.

Main Results:

• Genetic screening for diseases like breast cancer and Huntington's disease involves complex ethical trade-offs.
• While potentially cost-effective, prioritizing genetic screening over primary prevention is deemed unacceptable due to significant risks.
• Potential harms include hindering primary prevention research and enabling discriminatory employment practices based on genetic predispositions.

Conclusions:

• Ethical frameworks must balance the right to know with the right not to know in genetic screening.
• Primary prevention strategies should not be overshadowed by genetic screening, despite potential economic advantages.
• Genetic screening policies must address equity concerns, particularly regarding ethnic variations in metabolic polymorphisms and potential for discrimination.