PRESYMPTOMATIC GENETIC TESTING FOR CANCER
A guide to counselling patients about their risks

Tara E. Power, LLB, PhD and John Robinson, PhD, RPsych

From the time of Hippocrates, the medical practitioner’s credo to has been primum non nocere: do no harm. Recognizing that some medical treatments may do harm, and that the patient should be the one who decides whether the potential harm of a treatment is worth the potential benefit, the ethical principle of informed consent has become a standard in medicine. To be fully informed, the patient needs to understand both the physical and psychosocial aspects of the situation.

 

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Top-line summary
People facing the decision of whether or not to undergo presymptomatic genetic testing for cancer gene mutations often begin their quest for knowledge with their primary care practitioner — who is accustomed to helping patients who need information about all aspects of a medical decision. Here, Oncology Exchange describes the psychosocial, ethical and legal issues facing those considering this question, prior to seeking more indepth information from specialists and genetic counsellors. The article introduces the drivers of patient interest in testing and suggests ways to help them appreciate the limitations of genetic testing for satisfying these drives. The potential legal and psychosocial outcomes of testing are then outlined, to guide practitioners in fully informing patients of the possible harms and benefits of choosing or foregoing these investigations. While intended primarily for primary care practitioners, this information is also relevant to oncologists and other members of the oncology team when counselling patients and families about options for close relatives of people with cancer.
 
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