Sunday, April 15, 2012

Controversy in prenatal testing for breast cancer

Prenatal testing for mutations in the BRCA1 and BRCA2 genes (genes linked to breast and ovarian cancers) has become a controversial issue in the medical realm. I came across an article in the Journal of Medical Genetics that addresses this issue in several situations. The article, Clinical geneticists' attitudes and practice towards testing for breast cancer susceptibility genes, also provides responses to these situations from all clinical centers in the UK.

After reading this article, do you think prenatal genetic testing for mutations in BRCA1 or BRCA2 should be conducted? Do you think it should be circumstantial - for example, should testing only be conducted if there is a family history for breast or ovarian cancer? Lastly, if you believe that prenatal genetic testing should be conducted, do you think that a positive result (there is a mutation in the BRCA1 or BRCA2 gene) is a valid reason to have an abortion?


  1. I think that your article topic is very interesting and it raises several legitimate ethical concerns. I have only had a chance to skim the article but here are my 2 cents:

    1) In response to your first question, I think that BRCA1 and BRCA 2 prenatal testing should not be regulated. Raising a healthy child in itself is a very demanding task for parents. If parents choose to keep the child (I will address your second question later), prenatal testing simply allows parents to gain information that makes raising a child easier. In regards to BRCA1 and BRCA2 testing, a positive result could encourage parents to screen their children more regularly for signs of cancer. Furthermore, parents may be more inclined to raise their children with a lifestyle that could be less conducive to cancer development. However, given your second question, I see that your major concern is most parents will choose to have an abortion rather than use prenatal testing information as a tool for raising their child. But if that is the major concern, the regulation should be placed at the decision to have an abortion, not at prenatal testing.

    2) Ultimately, the answer to your question depends on a person’s stance on abortion. If someone believes that human life/personhood begins at conception then they would obviously oppose prenatal testing. This could be due to the fact that it encourages abortions.

    I personally do not believe that personhood/human life begins at conception. I also am not completely sure I support the country’s current policy on abortion. Given this, I still think BRCA1 and BRCA2 prenatal testing, followed by selective abortion is ethically questionable. For one, having BRCA1 or BRCA2 does not guarantee that an individual will develop breast or ovarian cancer. While the odds of developing cancer are much higher, having those particular genes is not an automatic death sentence. Furthermore, these are late-onset diseases. The individual could still have a quality life despite having the genes. It’s one thing if having BRCA1 and BRCA2 means you will die before you are five and another thing when you still have a significant life expectancy.

    I do understand the other side, however. If you chose not to have an abortion and your child suffers from breast or ovarian cancer, how would you feel? You would be placing a burden on her family, friends, and others. One could argue that given the choice to have two children (one with BRCA1/2 and one without), the ethically responsible choice would be to have the healthy one.

    Nevertheless, I would argue that women who have had breast/ovarian cancer would say that they would have rather lived with cancer rather than not have existed at all. If caught early, they are diseases that are treatable.

  2. ange13:this paper is about the variability in responses by genetic counselors in the UK to four different scenarios. Isn't the variability seen distressing to anyone?