British embryo decision sparks call for world policy

Britain’s decision to allow couples to screen embryos for possible cancer genes has highlighted the vastly different practice in the US and revived calls for global agreement on the issue.

In the US there is no government regulation of the screening procedure, called preimplantation genetic diagnosis. Instead, the decision to use genetic screening is up to doctors, patients and healthcare centres.

In a commentary published in the New England Journal of Medicine today, Dr Peter Braude, head of the Department of Women’s Health at King’s College, London, said fresh approaches to the ethics of screening may be necessary in Britain.

Braude referred to the decision in May by a British government regulatory agency to add susceptibility to certain cancers to the list of conditions for which genetic screening is permitted.

“These different policies definitely show us what the problems are,” said Dr George Annas, chairman of the Department of Law, Bioethics and Human Rights at Boston University. “But they don’t help us to solve them.”

The issue, ethicists say, is that technology has outpaced society’s ability to regulate it.

“Right now, we can only screen for a handful of conditions,” Annas said. “But in the future, we’re going to be able to screen for literally everything that has a genetic component and at that point there may be no embryos that are deemed fit for life.”

The decision by Britain’s Human Fertility and Embryology Authority to allow testing for the likelihood of developing cancer is a departure from what had been permitted, namely testing for conditions that are certain to develop, such as cystic fibrosis or Huntington’s disease.

Unlike other conditions for which embryos are screened, cancer genes do not automatically destine a child to develop that disease. Cancer is also preventable, even in people with bad genes, and treatable if they do develop it.

To some experts, testing for potential cancers uncomfortably shifts the goalposts of genetic screening.

“What the British are looking at are susceptibilities, which to me is a big leap,” said Dr Tanmoy Mukherjee, co-director of Reproductive Medicine Associates of New York.

“Having a gene for susceptibility does increase your chances if something else happens down the road, but it doesn’t necessarily mean you will develop these cancers.”

Before making its decision, the Human Fertility and Embryology Authority sought opinions on the ethical and practical issues raised by the testing. Based on these, the agency decided to allow screening for genes that predispose for breast, ovarian and colon cancer.

Still, each request for screening must be considered by the agency’s licensing committee. “This decision doesn’t green-light every single application,” said agency spokeswoman Gemma Wilkie.

“It just provides guidance as to how those decisions should be made.”

The authority has not received any applications for cancer testing.

What is needed, some experts suggest, is an international consensus on screening regulation.

“All countries are making their own decisions on how to use genetic screening and there are certainly differences in how they view the need to regulate it,” said Dr Guido Pennings, a professor of ethics and bioethics at Ghent University in Belgium.

Pennings and other experts admit universal regulation may be difficult to reach, but say without it so-called “reproductive tourism”, where people cross borders to obtain services outlawed in their home countries, will continue.

For example, a Swiss couple recently travelled to Belgium for genetic screening to help them produce a suitable bone-marrow donor sibling for their six-year-old son, who suffers from a rare immune disorder. The case sparked controversy in Switzerland, where the procedure is banned.