ABSTRACT
In the mid-1990s, the cloning of two major breast cancer genes, BRCA1 and BRCA2, became a harbinger for a new era in genetic medicine. Despite the complexities,
uncertainties, and potential risks associated with predictive genetic testing, over 100,000
individuals have undergone testing for breast cancer susceptibility (1). By far, most of the
information available to clinicians about the attitudes of those undergoing testing and the
impact of testing has been gathered in the context of comprehensive research programs.
But as genetic testing diffuses into mainstream clinical practice, it is important that we
continue to examine and address the ethical, legal, and social issues that are part and
parcel of this new technology. In this chapter, we begin by providing a general framework
for examining ethical issues in clinical cancer genetics. Then, we present a detailed
analysis of some common themes that arise in this field, such as provider roles and
service delivery issues, informed consent, genetic discrimination, family communication
and duty to warn, predictive testing in children, and preimplantation and prenatal testing.
Each section will conclude with some pointers for anticipating and addressing these
issues in clinical practice.
