title: Implementing risk-stratified screening for common cancers: a review of potential ethical, legal and social issues.
abstract: BACKGROUND
  The identification of common genetic variants associated with common cancers including breast, prostate and ovarian cancers would allow population stratification by genotype to effectively target screening and treatment. As scientific, clinical and economic evidence mounts there will be increasing pressure for risk-stratified screening programmes to be implemented.
  
  
  METHODS
  This paper reviews some of the main ethical, legal and social issues (ELSI) raised by the introduction of genotyping into risk-stratified screening programmes, in terms of Beauchamp and Childress's four principles of biomedical ethics--respect for autonomy, non-maleficence, beneficence and justice. Two alternative approaches to data collection, storage, communication and consent are used to exemplify the ELSI issues that are likely to be raised.
  
  
  RESULTS
  Ultimately, the provision of risk-stratified screening using genotyping raises fundamental questions about respective roles of individuals, healthcare providers and the state in organizing or mandating such programmes, and the principles, which underpin their provision, particularly the requirement for distributive justice.
  
  
  CONCLUSIONS
  The scope and breadth of these issues suggest that ELSI relating to risk-stratified screening will become increasingly important for policy-makers, healthcare professionals and a wide diversity of stakeholders.
authors.affiliation: PHG Foundation (Foundation for Genomics and Population Health), 2 Worts Causeway, Cambridge CB1 8RN, UK.
authors.forename: A E
authors.initials: AE
authors.lastname: Hall
authors.affiliation: PHG Foundation (Foundation for Genomics and Population Health), 2 Worts Causeway, Cambridge CB1 8RN, UK.
authors.forename: S
authors.initials: S
authors.lastname: Chowdhury
authors.affiliation: PHG Foundation (Foundation for Genomics and Population Health), 2 Worts Causeway, Cambridge CB1 8RN, UK.
authors.forename: N
authors.initials: N
authors.lastname: Hallowell
authors.affiliation: UCL Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
authors.forename: N
authors.initials: N
authors.lastname: Pashayan
authors.affiliation: PHG Foundation (Foundation for Genomics and Population Health), 2 Worts Causeway, Cambridge CB1 8RN, UK.
authors.forename: T
authors.initials: T
authors.lastname: Dent
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge CB2 OSR, UK Department of Oncology, University of Cambridge, Cambridge CB2 2QQ, UK.
authors.forename: P
authors.initials: P
authors.lastname: Pharoah
authors.affiliation: PHG Foundation (Foundation for Genomics and Population Health), 2 Worts Causeway, Cambridge CB1 8RN, UK.
authors.forename: H
authors.initials: H
authors.lastname: Burton
mesh_terms: D022126:Access to Information / Q000941:ethics / Q000331:legislation & jurisprudence; D003142:Communication; D003625:Data Collection / Q000941:ethics / Q000331:legislation & jurisprudence; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000941:ethics / Q000331:legislation & jurisprudence*; D005838:Genotype; D006801:Humans; D008403:Mass Screening / Q000941:ethics* / Q000331:legislation & jurisprudence*; D009369:Neoplasms / Q000175:diagnosis*; D018570:Risk Assessment / Q000941:ethics* / Q000331:legislation & jurisprudence*; D012307:Risk Factors; D012935:Social Justice
keywords: cancer; consent; distributive justice; personalized screening; risk-stratified screening