Population cancer screening incorporating genomic data – ethical considerations
As the costs of genomic testing has fallen, and our understanding of genetic susceptibility to cancers has grown, there has been increasing interest in incorporating testing for cancer susceptibility genes (CSGs), and polygenic risk estimates (PRS), into population cancer screening. A growing body of evidence suggests that this would be both clinically and cost-effective. The evidence for acceptability of screening for CSGs is positive to date. Several recent trials have suggested public support for population genetic testing for CSGs or screening stratified by PRS. However, a consequent reduction in screening for low risk groups has been a concern to those questioned. Thus is seems unlikely that this approach would gain public approval, and this may prove a barrier to maximising the efficacy and cost-effectiveness of such programmes.
Population screening for genetic risk in cancer shifts the focus from diagnostics to prognostication, and has wider implications for personal and familial health than existing screening programmes. Development of effective and acceptable population screening programmes should be informed by best available evidence and the values of the population concerned. Whilst the scientific and economic evidence is accruing, an understanding of the underpinning values of populations regarding stratification of screening programmes is lacking.
RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING
This project will involve empirical bioethics methods, which combine philosophical and ethical analysis with empirical research. It will provide a range of training opportunities in empirical bioethics research methods, including literature review, conceptual ethical analysis, qualitative research, data analysis.
FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING
This project will involve a literature and policy review to determine the current landscape of the population and institutional culture, processes and values underpinning the assessment of need, design and implementation of UK NHS population screening programmes with specific reference to cancer screening. This will be followed by an empirical study, to gather qualitative data from key stakeholders (e.g members of UK National Screening Committee, Public Health England Population Screening Committee members, members of the public, cancer patients, local screening coordinators and local public health teams).
This project would suit a candidate with a background in social sciences, public health or health policy wishing to develop expertise in the field of empirical bioethics with an interest in population and public health, new technologies, and health care.