title: What ethical and legal principles should guide the genotyping of children as part of a personalised screening programme for common cancer?
abstract: Increased knowledge of the gene-disease associations contributing to common cancer development raises the prospect of population stratification by genotype and other risk factors. Individual risk assessments could be used to target interventions such as screening, treatment and health education. Genotyping neonates, infants or young children as part of a systematic programme would improve coverage and uptake, and facilitate a screening package that maximises potential benefits and minimises harms including overdiagnosis. This paper explores the potential justifications and risks of genotyping children for genetic variants associated with common cancer development within a personalised screening programme. It identifies the ethical and legal principles that might guide population genotyping where the predictive value of the testing is modest and associated risks might arise in the future, and considers the standards required by population screening programme validity measures (such as the Wilson and Jungner criteria including cost-effectiveness and equitable access). These are distinguished from the normative principles underpinning predictive genetic testing of children for adult-onset diseases-namely, to make best-interests judgements and to preserve autonomy. While the case for population-based genotyping of neonates or young children has not yet been made, the justifications for this approach are likely to become increasingly compelling. A modified evaluative and normative framework should be developed, capturing elements from individualistic and population-based approaches. This should emphasise proper communication and genuine parental consent or informed choice, while recognising the challenges associated with making unsolicited approaches to an asymptomatic group. Such a framework would be strengthened by complementary empirical research.
authors: PHG Foundation (Foundation for Genomics and Population Health), , Cambridge, UK.
authors: Alison Elizabeth
authors: AE
authors: Hall
authors: Susmita
authors: S
authors: Chowdhury
authors: Nora
authors: N
authors: Pashayan
authors: Nina
authors: N
authors: Hallowell
authors: Paul
authors: P
authors: Pharoah
authors: Hilary
authors: H
authors: Burton
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005060:Europe; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000941:ethics* / Q000331:legislation & jurisprudence*; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000941:ethics*; D009014:Morals; D009369:Neoplasms / Q000235:genetics*; D033282:Parental Consent; D057285:Precision Medicine / Q000941:ethics; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
keywords: Autonomy; Genethics; Genetic Screening/Testing; Newborns and Minors; Public Health Ethics