This essay focuses on the ethical considerations and implications of providing a universal multi-cancer screening test as the best approach to reduce societal cancer burden in a society with limited funds, resources, and infrastructure. With 1.9 million cancer diagnoses each year in the United States, with 86% of all cancers diagnosed in individuals over the age of 50, and with screening tools approved for only four cancer types (breast, cervical, colorectal, and lung (...) class='Hi'>cancer), it seems that a multi-cancer screening test to detect most cancer early that is easy to administer, and is accurate and cost-effective, would be worth considering. Whole-body magnetic resonance imaging and a multi-marker blood test are the two main technologies that we will discuss as a universal screening test. However, to understand and appreciate the societal and clinical breakthrough of such a screening test, we must first consider the accessibility and efficacy of current screening methods. We conclude with a closer examination of the ethical implications of implementing the Galleri test as a multi-cancer detection screening tool as adamantly advocated by the company that developed this blood-based test. (shrink)

A screening test for more than 50 cancers at earlier stages would strike many as a godsend. Such a test would promise, prima facie, to save 160,000 lives annually from a premature death from cancer, reduce the intensity of medical treatment, and reduce social costs. In brief, this is what is promised by the Galleri test. We will delineate those claims in greater detail and critically assess them from medical, economic, and ethical perspectives. We conclude, with many others, (...) that this test lacks clinical validity and clinical utility. In addition, annual public funding of $100 billion for this test would be socially unaffordable; the opportunity costs would be unacceptable for both ethical and economic reasons. Further, the least well off with respect to cancer care would be made worse off if this test were publicly funded for everyone over the age of fifty. (shrink)

This chapter argues that cancer risk assessment scores are becoming more individualized as well as mundane, organizing risk in more personalized ways through the production of “your” score, based on your risk factors, an emerging multi-omic paradigm, your genome. We begin by discussing “lifetime risk”, a common concept in risk scoring, and then turn to the implications of risk factors and surveillance medicine for determining health. The chapter addresses the complexity of current risk calculation tools, including the polygenic (...) risk score, the use of vital statistics, genome-wide association studies, and existing databases. We argue that as disease risk scoring and genetic screenings are being normalized and made commonplace, appearing in People Magazine, on myriad websites, in doctor’s offices, through health advocacy organizations, and in direct-to-consumer genomic risk assessment companies, people are subjected to personalized surveillance in new ways. The incorporation of the scores into people’s everyday lives shapes temporalities as well as subjectivities, emphasizes responsibility, incorporates ideals of rational decision-making, and for some, fosters anxiety. Genetic risk and statistical probabilities, we conclude, are increasingly accepted and ordinary ways to govern life, despite their fraught and multiple calculations. (shrink)

Near-infrared diffuse optical spectroscopy and imaging may enhance existing technologies for breast cancer screening, diagnosis, and treatment. NIR techniques are based on quantitative measurements of functional contrast between healthy and diseased tissue. In this study we measured the spectral dependence of tissue absorption and reduced scattering in the breasts of 30 healthy women and one woman with a fibroadenoma using a seven-wavelength frequency-domain photon migration probe. Subjects included pre- and postmenopausal women between the ages of 18 and 64. (...) Multi-spectral measurements were used along with a four-component fit to determine the concentrations of de-oxy and oxyhemoglobin, water and lipids in breast. The scattering spectral shape was also quantified. Our measurements demonstrate that the measured concentrations of NIR analytes correlate well with known breast physiology. Although the tissue scattering at a single wavelength was found to have little value as a functional parameter, the dependence of the scattering on wavelength provided key insights into breast composition and physiology. Lipids and scattering spectra in the breast were found to increase and decrease, respectively, with increasing body mass index. Simple calculations are also provided to demonstrate potential penalties from ignoring the contributions of water and lipids in breast measurements. Finally, water is shown to be a possible indicator for detecting a fibroadenoma, whereas the hemoglobin saturation was found to be a poor indicator. Multi-spectral measurements, compared to measurements restricted to one or two wavelengths, provide additional information that may be useful in managing breast disease. © 2002 Society of Photo-Optical Instrumentation Engineers. (shrink)

The focus of this chapter will be on the epistemic and normative questions at issue in debates about cancer screening, with a special focus on mammography as a case study. Such questions include: How do we know who needs to be screened? What are the benefits and harms of cancer screening, and what is the quality of evidence for each? How ought we to measure and compare these benefits and harms? What are the sources of uncertainty (...) about our estimates of benefit and harm? Why are such issues so contested? What are the major drivers of dissent and consensus on the data and their interpretation? How, if at all, do values play a role in debates surrounding mammography screening? In sum: In what ways does inductive risk, broadly conceived, 1 come into play in the science behind cancer screening, and mammography screening in particular? (shrink)

Cervical cancer screening remains limited in developing countries due to barriers such as lack of convenience and privacy. These challenges hinder both screening uptake and the process of obtaining informed consent. This study aimed to explore ways to address these barriers and support ethical participation in screening research. The study was conducted in three rural and one urban kebele in Butajira, Southern Ethiopia. A total of 58 participants – including community elders, religious leaders, women’s representatives, and (...) traditional association leaders – were selected through purposive sampling for focus group discussions and in-depth interviews. Two interview guides were used to explore consent, decision-making, and screening preferences. Data were analysed using qualitative content analysis via QCAmap software. Participants generally understood the concept of voluntary participation but emphasized the need for clear communication about benefits. Although women could decide independently, many noted the importance of involving husbands. Initial suspicion about written consent was addressed through trust-building. A strong preference emerged for female providers during consent and procedures to enhance comfort. Self-sampling raised concerns about technical difficulty and cultural norms. Addressing cultural and ethical concerns is vital for improving cervical cancer screening participation. Insights from this study should guide future research and interventions in similar settings. (shrink)

This paper examines the integration of artificial intelligence (AI) into cancer screening programmes, focusing on the associated equity challenges and resource allocation implications. While AI technologies promise significant benefits—such as improved diagnostic accuracy, shorter waiting times, reduced reliance on radiographers, and overall productivity gains and cost-effectiveness—current interventions disproportionately favour those already engaged in screening. This neglect of non-attenders, who face the worst cancer outcomes, exacerbates existing health disparities and undermines the core objectives of screening programmes. (...) Using breast cancer screening as a case study, we argue that AI interventions must not only improve health outcomes and demonstrate cost-effectiveness but also address inequities by prioritising non-attenders. To this end, we advocate for the design and implementation of cost-saving AI interventions. Such interventions could enable reinvestment into strategies specifically aimed at increasing engagement among non-attenders, thereby reducing disparities in cancer outcomes. Decision modelling is presented as a practical method to identify and evaluate these cost-saving interventions. Furthermore, the paper calls for greater transparency in decision-making, urging policymakers to explicitly account for the equity implications and opportunity costs associated with AI investments. Only then will they be able to balance the promise of technological innovation with the ethical imperative to improve health outcomes for all, particularly underserved populations. Methods such as distributional cost-effectiveness analysis are recommended to quantify and address disparities, ensuring more equitable healthcare delivery. (shrink)

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

There are many calls for public engagement in decision‐making around controversial technologies, but far fewer calls for public engagement in deliberation around less controversial interventions. We think the public should be involved in discussing CRISPR, but not in discussing APGAR. Drawing on the case of debates over cancer screening, this paper argues we have things the wrong way around. Given the complex entanglement of fact and value, it is very hard to have high‐quality public deliberation over novel technologies. (...) By contrast, it is easier to have deliberation over more mundane technologies. There is, then, good reason to think we should engage in more public deliberation over mundane technologies. The results of this deliberation can then be used in more high‐profile cases. (shrink)

One in five people worldwide is expected to develop cancer during their lifetime. This study aimed to examine the effect of women’s E-health literacy levels on their healthy lifestyle behaviors about their cancer screening status, within the scope of preventive cancer healthcare services in Türkiye. This cross-sectional analytical study involved 392 women, and a structural equation model (SEM) was used to identify the causal relationships between variables. Data were collected using the “E-health literacy scale” and the (...) “healthy lifestyle behavior scale”. A structural equation model (SEM) was developed to examine the causal relationships among the variables, and the model’s fit indices and test values were analyzed and interpreted. Results showed that both E-health literacy and healthy lifestyle behavior scores were significantly higher among women who had undergone cancer screening. Additionally, women who had been screened for breast and cervical cancer demonstrated higher healthy lifestyle behavior scores. The SEM analysis indicated that E-health literacy had a positive effect on healthy lifestyle behaviors. Based on these findings, enhancing women’s E-health literacy may promote healthier lifestyle behaviors and encourage more consistent participation in preventive screenings such as cancer screenings. (shrink)

Cancer screening programmes cause harm to individuals via overdiagnosis and overtreatment, even where they confer population-level benefit. Screening thus appears to violate the principle of non-maleficence, since it entails medically unnecessary harm to individuals. Can consent to screening programmes negate the moral significance of this harm? In therapeutic medical contexts, consent is used as a means of rendering medical harm morally permissible. However, in this paper, I argue that it is unclear that the model of consent (...) used within therapeutic medicine can be applied unproblematically to preventive medicine. Invitation to screening changes the pragmatic norms and expectations of the patient–doctor encounter such that two key principles of consent may be violated. First, the pragmatics of a medical invitation are such that patients may fail to be adequately informed, since patients appear to assume medical invitations are made with their best interests in mind, even where information to the contrary is outlined. Second, screening invitations may place pressure on patients; in the context of a medical encounter, to make an invitation to screening may constitute an inducement to accept. In order to be sure that a patient’s consent to a screening invitation is valid, we must make clear to patients that their decision to accept screening may be shaped not only by how information about screening is presented, but by the pragmatic form of the invitation itself. (shrink)

November 2009’s announcement of the USPSTF’s recommendations for screening for breast cancer raised a firestorm of objections. Chief among them were that the panel had insufficiently valued patients’ lives or allowed cost considerations to influence recommendations. The publicity about the recommendations, however, often either simplified the actual content of the recommendations or bypassed significant methodological issues, which a philosophical examination of both the science behind screening recommendations and their import reveals. In this article, I discuss two of (...) the leading ethical considerations at issue in screening recommendations: respect for patient autonomy and beneficence and then turn to the most significant methodological issues raised by cancer screening: the potential biases that may infect a trial of screening effectiveness, the problem of base rates in communicating risk, and the trade-offs involved in a judgment of screening effectiveness. These issues reach more broadly, into the use of “evidence-based” medicine generally, and have important implications for informed consent. (shrink)

Breast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50–74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted (...) an expert-group review of the ethical issues surrounding breast cancer mammography screening. (shrink)

Breast cancer and cervical cancer are major contributors to morbidity and mortality among Vietnamese Canadian women. Vietnamese women are at risk because of their low participation rate in cancer‐preventative screening programmes. Drawing from the results of a larger qualitative study, this paper reports factors that influence Vietnamese women's participation in breast and cervical cancer screening from the healthcare providers’ perspectives. The women participants’ perspective was reported elsewhere.Semistructured interviews were conducted with six healthcare providers. Analysis (...) of these interviews reveals several challenges which healthcare providers encountered in their clinical practice. These include the physicians’ cultural awareness about the private body, patient's low socioeconomic status, the healthcare provider–patient relationship, and limited institutional support.This is the first Canadian study to identify the healthcare providers’ perspective on giving breast and cervical cancer preventive care to the Vietnamese immigrant women. The insight gained from these healthcare providers’ experiences are valuable and might be helpful to healthcare professionals caring for immigrant women of similar ethno‐cultural backgrounds. Recommendations for the promotion of breast cancer and cervical cancer screening among Vietnamese women include: (i) effort should be made to recruit Vietnamese‐speaking female healthcare professionals for breast and cervical health‐promotion programmes; (ii) reduce woman–physicians hierarchical relationship and foster effective doctor–patient communication; (iii) healthcare providers must be aware of their own cultural beliefs, values and attitudes that they bring to their practice; and (iv) more institutional support and resources should be given to both Vietnamese Canadian women and their healthcare providers. (shrink)

Are the small and indolent cancers found in abundance in cancer screening normal variations, risk factors, or disease? Naturalists in philosophy of medicine turn to pathophysiological findings to decide such questions objectively. To understand the role of pathophysiological findings in disease definition, we must understand how they mislead in diagnostic reasoning. Participants on all sides of the definition of disease debate attempt to secure objectivity via reductionism. These reductivist routes to objectivity are inconsistent with the Bayesian nature of (...) clinical reasoning; when they appeal to the sciences, they are inconsistent with what philosophy of biology tells us about its natural kinds. Proposals that we narrow the scope of our claims in the disease definition debates are useful, but paradigms can still distort our reasoning in particular cases, even when we are self-conscious about their status. (shrink)

Normative issues associated with the design and implementation of population-based lung cancer screening policies are underexamined. This study was an exposition of the ethical justification for screening and potential ethical issues and their solutions in Canadian jurisdictions. A qualitative description study was conducted. Key informants, defined as policymakers, scientists and clinicians who develop and implement lung cancer screening policies in Canada, were purposively sampled and interviewed using a semi-structured guide informed by population-based disease screening (...) principles and ethical issues in cancer screening. Interview data were analyzed using qualitative content analysis. Fifteen key informants from seven provinces were interviewed. Virtually all justified screening by beneficence, describing that population benefits outweigh individual harms if high-risk people are screened in organized programs according to disease screening principles. Equity of screening access, stigma and lung cancer primary prevention were other ethical issues identified. Key informants prioritized beneficence over concerns for group-level justice issues when making decisions about whether to implement screening policies. This prioritization, though slight, may impede the implementation of screening policies in a way that effectively addresses justice issues, a goal likely to require justice theory and critical interpretation of disease screening principles. (shrink)

Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first address the question which components should be part of IDM in the context of cancer screening. Departing from two diverging interpretations of the value of autonomy—as a (...) right and as an ideal—we describe how this value is operationalized in the practice of informed consent in medicine and translate this to IDM in population-based cancer screening. Next, we specify components of IDM, which is voluntariness and the requirements of disclosure and understanding. We argue that whereas disclosure should contain all information considered relevant in order to enable authentic IDM, understanding of basic information is sufficient for a valid IDM. In the second part of the paper we apply the capability approach in order to argue for the responsibility of the government to warrant equal and real opportunities for invitees for IDM. We argue that additional conditions beyond mere provision of information are needed in order to do so. (shrink)

Informed choice is increasingly recognised as important in supporting patient autonomy and ensuring that people are neither deceived nor coerced. In cancer screening the emphasis has shifted away from just promoting the benefits of screening to providing comprehensive information to enable people to make an informed choice. Cancer screening programmes in the UK now have policies in place which state that it is their responsibility to ensure that individuals are making an individual informed choice. There (...) is a need to evaluate whether such policies mean that those people invited for screening are making informed choices, and how comprehensive information affects other variables such as uptake, cost effectiveness, and satisfaction. At the present time, there is no validated measure of informed choice in cancer screening. Such a measure could be used to evaluate the effectiveness of interventions to increase informed choice and levels of informed choice in a population invited for screening. It could encourage health professionals to be accountable. Factors important when measuring informed choice in cancer screening include an individual’s understanding of the limitations of screening, the ability to make an autonomous choice, and the difference between choice and behaviour. (shrink)

Introduction It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when (...) they believe to have made a 'good' screening decision. Methods We conducted 27 semi-structured interviews with the eligible CRC screening population. The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision. Results Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making. Conclusion Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation. (shrink)

Health technology assessment (HTA) was developed in the 1970s and 1980s to facilitate decision making on the desirability of new biomedical technologies. Since then, many of the standard tools and methods of HTA have been criticized for their implicit normativity. At the same time research into the character of technology in practice has motivated philosophers, sociologists and anthropologists to criticize the traditional view of technology as a neutral instrument designed to perform a specific function. Such research suggests that the tools (...) and methods of more traditional forms of HTA are often inspired by an ‘instrumentalist’ conception of technology that does not fit the way technology actually works. This paper explores this hypothesis for a specific case: the assessments and deliberations leading to the introduction of breast cancer screening in the Netherlands. After reconstructing this history of HTA ‘in the making’ the stepwise model of HTA that emerged during the process is discussed. This model was rooted indeed in an instrumentalist conception of technology. However, a more detailed reconstruction of several episodes from this history reveals how the actors already experienced the inadequacy of some of the instrumentalist presuppositions. The historical case thus shows how an instrumentalist conception of technology may result in implicit normative effects. The paper concludes that an instrumentalist view of technology is not a good starting point for HTA and briefly suggests how the fit between HTA methods and the actual character of technology in practice might be improved. (shrink)

A coherent and helpful public policy based on science is difficult to achieve for at least three reasons. First, there are purely practical problems—for example, that scientific experts often disagree on policy-relevant questions and their debates often continue well beyond policy appropriate timelines. Second, there are epistemic problems—for example, that science is hardly the neutral supplier of factual information that traditionally has been supposed. And third, there are social problems: given the commercialization of today’s science and its enduring limitations, much (...) of scientific research today fails to meet the moral and political standards one would expect it to meet in order to inform public policy. In this paper, we examine such problems in the context of breast cancer screening policy and suggest the role philosophy of science should play in dealing with the situation. (shrink)

It is not clear whether breast cancer screening is a public health intervention or an individual clinical service. The question is important because the concepts best suited for ethical reasoning in public health might be different to the concepts commonly employed in biomedical ethics. We consider it likely that breast screening has elements of a public health intervention and used an empirical ethics approach to explore this further. If breast screening has public health characteristics, it is (...) probable that policy and practice experts will employ socially embedded concepts when reasoning about it. We gathered data on whether and how these concepts existed in the discussion and reasoning of Australian breast screening experts. We found that experts employed these concepts when talking about the purpose and practices of breast screening, and the behaviour of breast screening professionals and consumers. Experts gave varied judgements about breast screening based on reasoning with these concepts, considering it to be more or less successful in contributing to the public interest and in incorporating socially embedded concepts into its operational agenda. Our findings are compatible with breast screening having public health characteristics. We advocate for the incorporation of socially embedded concepts in breast screening policy and practice. (shrink)

Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of (...) life due to a high proportion of overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55–69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions. (shrink)

Although digital breast tomosynthesis has higher sensitivity than digital mammography and at least as high specificity, digital mammography remains the most common method for conducting mammographic screening. At the same time, mammography systems are now delivered “DBT-ready” and can be used for either digital mammography or digital breast tomosynthesis. In this paper, we ask whether it is ethically permissible to use such equipment for digital mammography, given its lower sensitivity. We argue it is not, and that clinics are ethically (...) required to use their DBTready equipment to screen with digital breast tomosynthesis whenever this is practically possible. Our argument relies on a comparison between digital breast tomosynthesis and a hypothesized improvement in the image quality of digital mammography. (shrink)

Volume 26, Issue 5, May 2026, Page 50-52.

© 2015 American Cancer Society. BACKGROUND: Ethnic minorities, especially African Americans and Latinos, bear a disproportionate burden of colorectal cancer, as reflected in incidence, cancer stage, and mortality statistics. In all ethnic groups, first-degree relatives of CRC cases are at an elevated disease risk. However, underuse of CRC screening persists and is particularly evident among minority groups. The current study tested a stepped intervention to increase CRC screening among an ethnically diverse sample of FDRs of (...) CRC cases. METHODS: A statewide cancer registry was used to recruit CRC cases and through them their FDRs. Relatives who were not current on CRC screening were randomized to intervention or usual-care control arms. The stepped intervention consisted of ethnically targeted and individually tailored print materials followed by telephone counseling for those unscreened at 6 months. RESULTS: The study sample of 1280 individuals consisted of 403 Latino, 284 African American, 242 Asian, and 351 white FDRs. Statistically significant effects were observed for the cumulative print plus telephone intervention at 12 months and the print intervention alone at 6 months. The effect of the print intervention alone versus the cumulative interventions was not statistically significantly different. Stratified analyses indicated that the intervention was effective among white, Latino, and Asian individuals, but not among African-Americans. CONCLUSIONS: Overall, the intervention was effective in increasing screening rates. Oversampling racial/ethnic minorities allowed for the examination of effects within subgroups, revealing no effect among African American individuals. This finding illustrates the importance of including sufficient numbers of participants from diverse ethnic subgroups in intervention research to enable such stratified analyses. Cancer 2015;121:2951-2959. (shrink)

The American Journal of Bioethics, Volume 11, Issue 12, Page 26-27, December 2011.

Newborn screening (NBS) is an effective measure of secondary prevention. The application of genomic sequencing in population-based screening would enable further expansions of the NBS disease panel and a genomic NBS (gNBS). The selection of NBS target diseases is still based on the Wilson and Jungner screening principles from 1968, which are considered incomplete, particularly for an extension towards gNBS. The present work aims to establish a multi-dimensional framework for future gNBS programs. An interdisciplinary expert panel (...) comprising researchers from pediatric and adolescent medicine, human genetics, ethics, medical psychology, law, and patient representatives used a nominal group technique-like multi-stage consensus process to define criteria for gNBS, considering ethical, legal, and social implications, medical aspects, and patient perspectives. Overall, 18 criteria were developed, clustered into four subcategories: I. Clinical criteria (characteristics of the target disease); II. Diagnostic criteria (requirements of the test); III. Therapeutic-interventional criteria (prerequisites of the intervention); IV. Program management criteria (requirements of the program). Subcategories I–III define selection criteria for target diseases, subcategory IV defines criteria for how to establish and manage the program. In conclusion, this multi-dimensional framework serves as a well-balanced basis for developing thoroughly revised and internationally accepted consensus screening criteria. (shrink)

The ideal goal of a screening program for breast cancer is to detect the disease at a stage when it is still curable by a simple lumpectomy. This goal would be possible if the tumor had an early latent period before it was vascularized. However, even if there existed a harmless screening examination that was sensitive enough to discover the cancer at this stage the benefit to be gained from a screening program would be highly (...) dependent on the time the tumor spends in the latent stage as well as on the chance of false negatives at the examination. Calculations derived from a mathematical model suggest a variety of theoretically possible situations including: (1) For certain cancers screening every three years would offer almost as much benefit as screening every year; (2) A large increase in the sensitivity of a screening examination does not necessarily lead to a large increase in the benefit of a screening program; (3) For certain cancers the benefit of screening might remain low no matter how sensitive the examination used. (shrink)

This paper illustrates a role that bioethics should play in developing and criticizing protocols for breast cancer genetic screening. It demonstrates how a critical bioethics, using approaches and reflecting concerns of contemporary philosophy of science and science studies, may critically interrogate the normative and conceptual schemes within which ethical considerations about such screening protocols are framed. By exploring various factors that influence the development of such protocols, including politics, cultural norms, and conceptions of disease, this paper and (...) the critical bioethics' approach it endorses illuminate and critically assess some of the competing worldviews informing protocol development. One of the frequently neglected worldviews in traditional bioethics' treatment of protocols concerning breast care is constituted by women's own views of their breasts and breast cancer, both within the technologically-oriented social practice of American medicine and in light of the social construction of their breasted experience in American society. This paper attempts to redress and critically assess this neglect on the part of traditional bioethics. Finally, in contrast to traditional bioethics, critical bioethics critically interrogates its own normative and conceptual commitments. In this final capacity, a critical bioethics' approach makes a valuable contribution to the evolution of bioethics. (shrink)

Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for (...) Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised. (shrink)

In this study a combination of computer tools for coupling and virtual screening is detailed, in 108 active molecules and 3620 decoys to find stabilizers for G quadruplex. To have more precise results, combinations of coupling programs with fifteen energy scoring functions were applied. The validation and evaluation of the metrics was done with the CompScore genetic algorithm. The results showed an increase in BEDROC and EF of 50% compared to other strategies, as well as reflecting early recognition of (...) active molecules. From these results it is possible to work with the molecules that showed a good early recognition and evaluate their effect as G4 stabilizers. This ensures more efficient and accurate results in the preclinical stage for the development of anticancer drugs. Keywords: Enrichment metrics; telomere; G quadruplex ; CompScore. References [1]M. Porru, P. Zizza, M. Franceschin, C. Leonetti and A. Biroccio. «EMICORON: A multi-targeting G4 ligand with a promising preclinical profile» 2017. Biochimica et Biophysica Acta - General Subjects, 1861, 1362–1370. [Online]. Available: https://doi.org/10.1007/s00294-018-0836-6. [2]K. Tomita. «How long does telomerase extend telomeres? Regulation of telomerase release and telomere length homeostasis». Current Genetics, 64, 1177–1181. 2018. [Online]. Available: https://doi.org/10.1016/j.bbagen. 2016.11.010. [3]M. Jafri, S. Ansari, M. Alqahtani and J. Shay. «Roles of telomeres and telomerase in cancer, and advances in telomerase-targeted therapies. Genome Medicine., 2016. [Online]. Available: https://doi.org/10.3390/ijms19020482. [4]J. Huppert and S. Balasubramanian. «G-quadruplexes in promoters throughout the human genome». 35, 406–413. 2007. [Online]. Available: https://doi.org/10.1016/j.bbapap.2017.06.012. [5]S. Joy, Vijayakumar, S. Choi and H. Sunhye. «Role of computer-aided drug design in modern drug discovery». Archives of Pharmacal Research. 2015. [Online]. Available: https://doi.org/10.1007/s12272-015-0640-5. [6]S. Asamitsu, S. Obata, Z. Yu, T. Bando and H. Sugiyama. «Recent Progress of Targeted G-Quadruplex-Preferred Ligands Toward Cancer Therapy». Molecules, 24, 429. 2019. [En línea]. Available: https://doi.org/10.3390/molecules24030429. [7]R. Monsen and J. Trent. «Biochimie G-quadruplex virtual drug screening : A review». Biochimie, 152, 134–148. 2018. [Online]. Available: https://doi.org/10.1039/c9cc06748e. [8]J. Beauvarlet, P. Bensadoun, E. Darbo, G. Labrunie, E. Richard, I. Draskovic and M. Djavaheri-mergny. «Modulation of the ATM / autophagy pathway by a G-quadruplex ligand tips the balance between senescence and apoptosis in cancer cells». 1–18. 2019. [Online]. Available: https://doi.org/10.1093/nar/gkz095. [9].Z. Crees, J. Girard, Z. Rios, G. Botting, K. Harrington and C. Shearrow. « Oligonucleotides and G-quadruplex stabilizers: targeting telomeres and telomerase in cancer therapy».2014. [Online]. Available: https://doi.org/10.2174/1381612820666140630100702. [10].M. Meier, A. Moya-torres, N. Krahn, M. Mcdougall, L. Orriss, E. Mcrae and T. Patel. «Structure and hydrodynamics of a DNA Gquadruplex with a cytosine bulge»., 1–13. 2018. [Online]. Available: https://doi.org/10.1093/nar/gky307. (shrink)

While medicine may agree in principle that cancer screening requires informed consent, such consent is not, in fact, common practice. In the case of prostate-cancer screening this means that men in large numbers undergo PSA testing with little understanding of its liabilities – in particular, that it may or may not decrease mortality, often detects cancer of questionable significance, and may lead to unnecessary surgery. Given that prostate cancer is known to be overtreated and (...) that family history is a risk factor, it follows that a man diagnosed with prostate cancer, even if it is of no clinical significance, automatically promotes his son into the high-risk category; and given that those so categorized are subject to heightened medical surveillance and that the more diligently medicine searches for prostate cancer the more likely it is to find it, it follows that the sons of men diagnosed as a result of PSA testing are at risk of being overdiagnosed (and overtreated) precisely because their father was. Twenty years into the PSA revolution, its generational consequences have not been discussed in the medical literature. (shrink)

Epigenetic markers could potentially be used for risk assessment in risk-stratified population-based cancer screening programmes. Whereas current screening programmes generally aim to detect existing cancer, epigenetic markers could be used to provide risk estimates for not-yet-existing cancers. Epigenetic risk-predictive tests may thus allow for new opportunities for risk assessment for developing cancer in the future. Since epigenetic changes are presumed to be modifiable, preventive measures, such as lifestyle modification, could be used to reduce the risk (...) of cancer. Moreover, epigenetic markers might be used to monitor the response to risk-reducing interventions. In this article, we address ethical concerns related to personal responsibility raised by epigenetic risk-predictive tests in cancer population screening. Will individuals increasingly be held responsible for their health, that is, will they be held accountable for bad health outcomes? Will they be blamed or subject to moral sanctions? We will illustrate these ethical concerns by means of a Europe-wide research programme that develops an epigenetic risk-predictive test for female cancers. Subsequently, we investigate when we can hold someone responsible for her actions. We argue that the standard conception of personal responsibility does not provide an appropriate framework to address these concerns. A different, prospective account of responsibility meets part of our concerns, that is, concerns about inequality of opportunities, but does not meet all our concerns about personal responsibility. We argue that even if someone is responsible on grounds of a negative and/or prospective account of responsibility, there may be moral and practical reasons to abstain from moral sanctions. (shrink)