Summer is coming: how to prevent and check for melanoma

Resource Post for May

In preparation for the summer season, there are health observances in May that are focusing on awareness about skin cancer.

May is Melanoma/Skin Cancer Detection and Prevention Month and May 4 was Melanoma Monday and sponsored by the American Academy of Dermatology (AAD).

Identifying melanoma

It is estimated that 1 million cases of skin cancer is diagnosed in the US each year. About one in five Americans will develop skin cancer in their lifetime. Of all types of skin cancers, melanoma is the most deadly, commonly affecting young adults aged 25 to 29 years of age.

Melanoma is characterized by pigment-producing cells that grow and reproduce uncontrollably. It may suddenly on the skin or may develop on an existing mole. According to researchers at St. Louis University, the identifying signs of melanoma are:

• Asymmetry - one half is unlike the other half
• Border - irregular, scalloped or poorly defined border
• Color - varied from one area to another; shades of tan and brown, black; sometimes white, red or blue
• Diameter - while melanomas are usually greater than 6 mm (the size of a pencil eraser) when diagnosed, they can be smaller
• Evolving - a mole or skin lesion that looks different from the rest or is changing in size, shape or color

Who is at risk of developing melanoma?

Current guidelines recommend regular screening for skin cancer, especially those at high risk for the disease. The risk factors include

• People older 40 years of age
• People with a fair complexion
• People who sunburn easily
• People who have many moles
• People with a personal or family history of skin cancer
• People who spend long periods of time exposed to the sun
• People exposed to UV radiation at recreation or the work place, e.g. use of tanning salons, sunbathing, etc.

However, just because you are of the dark-haired, dark-skinned type, and you never sunburn easily doesn’t mean you don’t have to worry about UV radiation. According to a study presented at the annual meeting of the American Association of Cancer Research (AACR), certain variants of the MC1R gene increase the melanoma risk of people who are normally of low risk profile by almost two-fold. The study was presented by researchers from the Pennsylvania University.

How do we prevent skin cancer?

Here are simple tips on skin cancer prevention.

Use sunblock. It is advisable to use sun protection, even in children. Regular use of sunblock during the first 18 years of one’s life can reduce the lifetime risk by 78%. Use sunscreens which blocks UV A as well as UV B radiation. For it to be effective, a sunscreen must have a minimum sun protection factor (SPF) of 15.

Stay out of the midday sun. UV radiation is strongest at midday. Enjoy th early morning or late afternoon sun instead.

Have regular skin cancer screenings. Free skin cancer screenings are being offered by health and advocacy groups. The American Academy of Dermatology (AAD) offers free screening all over the US. You can request a notification from the AAD when there is a scheduled screening within a 50-mile radius from where you live. You can also send an eCard to family and friends to help spread awareness on skin cancer and inform about free screenings.

Do a self-check for skin cancer. By using the abovementioned signs for melanoma, you can check yourself and your family for suspicious pigmentation. The AAD also gives us instructions on how to perform a skin self-exam.

• Examine your body front and back in the mirror, then right and left sides with arms raised.
• Bend elbows and look carefully at forearms, upper underarms and palms.
• Look at the backs of your legs and feet, the spaces between your toes and on the sole.
• Examine the back of your neck and scalp with a hand mirror. Part hair for a closer look.
• Finally, check your back and buttocks with a hand mirror.

Avoid suntanning beds. Even artificial UV rays from suntanning lamps and beds can cause skin cancer.

The latest research news on skin cancer

Researchers from St. Louis University report on the effectiveness of a topical cream in treating certain melanoma. The researchers used the cream imiquimod in treating lentigo maligna (LM) which the most common type of melanoma of the head and neck. LM is “a type of “melanoma-in- situ”, the earliest stage of melanoma [which] precedes the more invasive form, lentigo maligna melanoma (LMM).” Imiquimod was used in conjunction with surgery. Skin surgery removed the invasive area while the topical cream was applied in the surrounding area. The cream supposedly can supposedly limit the area of surgery as well as minimize disfigurement and the risk of recurrence.

According to lead researcher Dr. Scott Fosko, chairman of the department of dermatology at Saint Louis University School of Medicine

“As we’re seeing melanoma in younger and younger people, in their 30s and 40s, there is a longer window for the cancer to return and a greater desire to avoid disfiguring surgery…This subtype of melanoma is becoming more and more common, and can be one of the more challenging melanomas to manage”.

In lab tests, researchers at the M. D. Anderson Cancer Center demonstrated that that the yellow spice curcumin which is also found turmeric and curry powder seems to be able to block the pathway to melanoma development.

               

Denial can be deadly - participate in the National Alcohol Screening Day

April 9th is the 9^th Annual National Alcohol Screening Day (NASD). Have you even thought of taking a self-assessment for alcohol problems? Or are you in denial? You’d be surprised to know that the following may have some alcohol problems:

• Straight A college students
• Pregnant women
• Successful professionals
• Well-off retirees

And you could be one of these!

According to Dr. Ting-Kai Li, director of the National Institute on Alcohol Abuse and Alcoholism

“As many as one-third of Americans may engage in drinking practices that place them at heightened risk for the medical disorders alcohol dependence (alcoholism) and alcohol abuse.”

One fo the sponsors of NASD is the not-for-profit organization Screening for Mental Health (SMH).  SMH is offering a confidential and free screening for alcohol problems to help people find out whether a professional consultation is necessary. The screening can be done online and is designed for individuals aged 17 years old and older. It is anonymous and the privacy of the respondent is protected.

Many people think they have everything under control. “Other people have alcohol problems but not me“, is something that is heard often. However, denial can be deadly.

According to Charles G. Curie, administrator at the Substance Abuse and Mental Health Services Administration

“A truthful self-assessment about alcohol use may not be easy but denial can be devastating or even deadly. Too many Americans realize too late that alcohol misuse can lead to incredible losses: lost family and friends, lost jobs and opportunities, and lost lives. Especially during this stressful time, we urge all American adults to understand the effects of alcohol on health and learn their own risk levels. Doing so can change lives.”

Here are three scenarios that SMH describes to indicate whether you need to take the alcohol screening self-assessment or not:

Drink so much you forget what happened?

Tried to cut back but couldn’t?

Friends and family concerned about your drinking?

Alcohol screening.org is also offering another online self-assessment called “How much is too much?”

Many organizations have planned screening events to today to encourage people to be honest to themselves and go for screening. Colleges and universities across America are especially concerned by the rising incidence of binge drinking among college students and are therefore offering free screening and counseling today.

Also: check out addiction books in this site.

               

Think about your colon (even if you don’t want to talk about it)

The colon is an organ that people would rather not talk about. It is associated with waste and dirt, thus a subject matter that is almost taboo. Yet, cancer of the colon is a real problem that people should think, if not talk about.

Problems with the colon actually occur very often throughout a person’s life. However, these problems can add up with time, so that the incidence of colon cancer can be quiet high among the elderly. That is why current guidelines recommend for regular colon cancer screening starting at age 50. But how does it all start?

According to researchers at the University of Michigan

Regular wear and tear on the colon can cause little out-pockets called diverticula in one in three adults over the age of 65. They are sometimes more common when there is persistent constipation, which causes people to strain to pass stool that is too hard. The high pressure from straining causes the weak spots in the colon to bulge out and become diverticula.

Diverticuli are normally harmless. They usually form in areas where the blood vessels go through the intestinal muscle walls, making these areas weak. Diverticuli can get plugged up with waste and become infected by bacteria, resulting in a condition called diverticulitis. The older people get, the more diverticuli are formed in the colon, and the chances of plugging up, inflammation and infection go up.

It is said that 30% of adults aged at least 65 years old have diverticuli in their colon. By age 85, the incidence increases to 65%. Complications of diverticulitis can lead to colon cancer.

Colon cancer, however, is highly preventable. According to Dr. Kim Turgeon, a gastroenterologist in Internal Medicine at the University of Michigan Health System, it is important to keep the colon healthy and this can be done by

• Keeping the bowels moving with a high fiber diet
• Exercising regularly
• Drinking lots of fluids throughout the day

Previous recommendations about not eating nuts and seeds to avoid little particles plugging diverticuli are no longer valid, as recent research studies have shown. These food can in fact be beneficial as they are rich in fiber.

It is also important that adults above the age of 50 should be routine screened, for example, through colonoscopy. Even if you are healthy, and had no history of colon or bowel problems, screening is still recommended.

It can be embarrassing to talk about your colon to friends. So why not talk to your doctor about it?

               

April is National Cancer Control Awareness Month

April is the month to step up on cancer control awareness. So how can we help?

Several cancer research institutes in the US are actively campaigning during this month. And they give us some tips on how we can help.

Cancer Institute of New Jersey (CINJ)

As one of the nation’s 40 National Cancer Institute-designated Comprehensive Cancer Centres and the only one in New Jersey, The Cancer Institute of New Jersey (CINJ) delivers advanced comprehensive care to adults and children, and conducts cutting-edge cancer research. Their researchers and physicians transform discoveries into clinical practice and provide education and outreach regarding cancer prevention, detection and treatment.

CINJ is a Centre of Excellence of UMNDJ-Robert Wood Johnson Medical School. This April, the institute is highlighting its clinical trial programs and the importance of patients having access to quality information about these cancer studies right at their fingertips. It is with this objective in mind that the CINJ-operated, web-based New Jersey Cancer Trial Connect (NJCTC) website was set up. With NJCTC, patients can conduct research and match diseases and drugs with cancer clinical trials

Michigan Cancer Consortium (MCC)

Do you know that there are over 100 types of cancer? That 1 out of every 4 deaths in the US is caused by cancer? These are just a few facts and figures from the Michigan Cancer Consortium (MCC) in observance of the National Cancer Control Awareness Month. MCC “is a dedicated group of public, private, and voluntary organizations committed to reducing the human and economic impact of cancer in Michigan. MCC members are collaborating to address cancer control priorities in Michigan.” To highlight cancer control awareness and help spread the word, here are a few ideas from MCC:

• You can get involved as an individual or as an organization.
• Have a prerecorded phone message about cancer screening. You can use this on your private phone or in your business phone. The message, can for example run in lieu of music while the client is put oh hold.
• Get involved in disseminating the MCC Cancer Early Detection Recommendations.
• Include MCC Early Detection Guidelines in your newsletters, journals, or blogs.
• Share or distribute cancer resource materials to family, friends and colleagues.

All guidelines, resources and recommendations are available from the MCC website.

 

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Experts: routine depression screening for teenagers

It is a problem that many parents face: clinical depression among teenagers.

As many as two million American teenagers suffer from depression and most go undiagnosed, thus untreated according to the United States Preventive Services Task Force. The task force has recently came up with guidelines recommending primary health care practitioners to routinely screen teenage patients for clinical depression. The new recommendations have been published in the April issue of the journal Pediatrics.

The guidelines apply to adolescents aged 12 to 18 years old. However, the task force found there is insufficient evidence to show the benefits of screening younger children for clinical depression

Depression in young people can lead to

• poor health outcomes
• difficulties in school
• disruptions of family and social relationships
• lowerquality of life
• self-destructive behavior/suicide
• depression in adulhood

It is therefore necessary that clinical depression be diagnosed as early as possible.

“Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed,” said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. “It is important that adolescents are diagnosed and treated for clinical depression in order to improve their health and quality of life, especially if they have a family history of depression.”

However, screening for clinical depression should only be done “when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care.” Treatment of clinical depression among teenagers can be through by psychotherapy or by pharmacological means using selective serotonin reuptake inhibitors (SSRIs), or combined therapy (SSRIs plus psychotherapy). However, the prescription of anitdepressants SSRIs should be done with care as this class of drugs is associated with an increased risk of suicidality.

The new guidelines go further than the previous guideline issued by the Academy of Pediatrics which recommended pediatricians to ask their young patients questions about depression.

The new recommendarions cited using “two questionnaires that focus on depression tip-offs, like mood, anxiety, appetite and substance abuse.” The screening should be done by the family doctor or pediatrician who is known to the family and the patient.

Almost 6% of Amrican teenagers aged 13 to 18 are clinically depressed. A lot of cases do not show over symptoms and are therefore easily overlooked by parents and teachers. Suicide due to clinical depression is the 3^rd leading cause of death in US adolescents in the age range 15 to 24 years old.

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Screening for prostate cancer: the pros and the cons

Resource post for March

In almost all diseases, screening and early detection is the key to management and cure. What used to be fatal diagnoses of late stage breast and cervical cancer have now become uncommon as more and more cases are detected early by regular screening.

In men, prostate cancer is the third leading cause of cancer mortality. The Institute for Cancer Research (ICR) in the UK gives us the following statistics:

As many as 80% of men develop prostate cancer during their lifetime, but in most cases it does not cause any ill health. Around 6% of men experience symptoms of the disease, while 3% of men die of prostate cancer.

Screening for prostate cancer is done in two ways, namely:

PSA test. Prostate-specific antigen (PSA) is protein biomarker produced by prostate cells. PSA is normally present in blood in low amounts. Cancerous (malignant) prostate cells are expected to produce more PSA than noncancerous cells, leading to elevated PSA levels in the blood. PSA testing consists mainly of testing for levels of the antigen in a blood sample. If PSA levels are found to be high, other tests, including a prostate biopsy may be deemed necessary. Currently, the American Urologic Association, the American Cancer Society, and the National Comprehensive Cancer Network recommend that all men 50 years and older should have annual PSA tests. Men with high risk profiles (e.g. of African American heritage, family history of prostate cancer) are advised to get tested starting at the age of 40.

Digital rectal examination. This examination is performed by a doctor by inserting a lubricated finger through the rectum. Through the walls of the rectum, the doctor can feel for structural abnormalities (bumps, growths, enlargement) in the prostate.

The usefulness of the PSA test in screening for prostate cancer has always been a subject of controversy. Some studies have produced inconclusive results regarding its benefits as well as its side effects. Potential risks include, unnecessary invasive testing (biopsy), and unnecessary treatment with serious side effects, and unnecessary expense. However, 95% of male urologists and 78% of male primary care clinicians admit to having had a PSA test themselves. PSA gives the potential benefits of catching cancer at its early stages, with better prognosis.

In the March issue of the New England Journal of Medicine, results of two studies on PSA screening were presented: one study conducted in the US, and one study conducted in Europe. Unfortunately, instead of resolving the controversy once and for all, the two studies actually produced contradicting results.

The American study:

Mortality Results from a Randomized Prostate-Cancer Screening Trial
This study is part of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The study looked at 76,693 men from 1993 to 2001. About 50% of the participants had PSA screening every year for 6 years and digital rectal examination for 4 years. The other half did not undergo screening for prostate cancer. The PLCO results showed that after 7 to 10 years the incidence of prostate cancer was 116 per 10,000 person-years in the screening group and 95 in the control group. The incidence of death per 10,000 person-years was 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group. Statistically speaking, there was no difference in cancer incidence and mortality between the screened group and the unscreened group.

The European study:

Screening and Prostate-Cancer Mortality in a Randomized European Study
The European Randomized Study of Screening for Prostate Cancer (ERSPC) started in the 1990s and followed up 182,000 men aged between 50 and 74 years old for about 12 years. The study had also two groups. In one group, PSA screening way conducted on average, once a year. The other group did not undergo PSA screening. The study was conducted in 8 European countries, namely Belgium, Finland, France, Italy, Netherlands, Spain, Sweden and Switzerland The results of the study showed that

PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis

Both studies will now look into the cost effectiveness and overall quality of life of the PSA testing. Although PSA testing itself is non-invasive, the subsequent confirmatory tests such as biopsy can be invasive and present with risks.

About PSA testing

Many experts observe that PSA testing is not specific enough and has a 30% rate of false positives - e.g. cancers are non-aggressive and are indolent or slow-growing. It is sometimes difficult to decide which really cancer needs treatment which one doesn’t. While many would opt to be on the safe side and go for early treatment, the treatment comes with side effects such as impotence and incontinence.

A more conservative form of prostate cancer monitoring is called “Active Surveillance which aims to individualise the management of early prostate cancer by selecting only those men with significant cancers for curative treatment… Patients on active surveillance are closely monitored using PSA blood tests and repeat prostate biopsies. The choice between continued observation and curative treatment is based on evidence of disease progression during this monitoring.”

It seems that prostate cancer screening by PSA testing have its pros and cons. In the end, it is always a question whether the benefits outweigh the costs.

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March is Colorectal Cancer Awareness Month

March is the month to step up on awareness of colorectal cancer, the third leading cause of cancer mortality in the US, according to the American Gastroenterological Association (AGA). Approximately 149,000 new cases of colorectal cancer have been predicted for 2008. About 50,000 Americans die this disease every year

The good news is that colorectal cancer is preventable and treatable when detected at an early stage. And early detection is possible through screening.

The bad news is that, “even in the best economic environment, only half of the people who need colorectal cancer screening receive the life-saving test.” The low screening rate maybe due to a lot of causes. Screening is mainly done by colonoscopy, which involves gently inserting an intrument called colonoscope into the rectum and large intestine. The instrument enables the doctor examine the walls of the lower gastrointestinal tract. Unfortunately, many people find this screening method embarrassing and invasive. With the economic recession, it is expected that even more people will forego screening for colorectal cancer due to loss of health insurance and financial difficulties. In addition, there seem to be cultural and ethnic barriers that are also related to health insurance coverage. According to AGA, African Americans and Hispanics are less likely to be screened and are therefore more likely to die from colorectal cancer than other ethnic groups.

A study by the Lewin Group made public early this year predicts that there will be a shortage of actively practicing gastroenterologists in the US in the next ten years. This shortage will further lead to low screening rates.

Hopefully, legislation will help solve the issue. Texas Rep. Kay Granger reintroduced the Colorectal Cancer Early Detection, Prevention and Treatment Act in the US Congress in February, a bill whose aim is

“to amend the Public Health Service Act to establish a national screening program at the Centers for Disease Control and Prevention and to amend title XIX of the Social Security Act to provide States the option to provide medical assistance for men and women screened and found to have colorectal cancer or colorectal polyps.”

The bill can hopefully establish a life-saving program similar to the Breast and Cervical Cancer Screening Program. Screening for colorectal cancer is recommended for people between 50 and 64 years old but also those younger than 50 but have high risks profiles. The bill will also facilitate screening, follow-up, and treatment of those who do not have insurance coverage.

Risk factors for colorectal cancer (source: American Cancer Society) are:

• Age older than 50 years old
• Previous history of polyps and inflammatory bowel disease
• Family history of colorectal cancer
• Other hereditary diseases (Peutz-Jeghers syndrome, familial adenomatous polyposis, and Lynch syndrome).
• Racial and ethnic background
• Lifestyle-related factors including smoking, diet, lack of exercise, obesity, heavy alcohol consumption, and type 2 diabetes.

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Expert recommendations:heart patients should be screened for depression

Background

Time and time again, studies have shown that many patients become depressed after suffering from major cardiac events. This occurs even after successful surgery and interventions. The reasons for this depression are many and may differ depending on the age of the patients (see previous post).

With this knowledge in mind, the American Heart Association (AHA) issued a new science advisory endorsed by the American Psychiatric Association which recommends that primary health care physicians should routinely screen their cardiac patients for signs of clinical depression. This would include referring suspected cases to mental health specialists for assessment, monitoring, and therapy.

Depression in heart patients

According to Dr Viola Vaccarino

“Despite a long-standing popular belief that stress and emotions affect the cardiovascular system, it was not until the mid-1980s that the first studies linking depression to higher mortality after a myocardial infarction (MI) began to appear in the medical literature. Since then, scientific interest in the link between depression and heart disease has grown steadily over time, with an increasing number of research studies addressing depression as a prognostic factor in cardiac patients. There is now a sufficient consensus that depression is a risk factor for coronary heart disease (CHD), as well as an important prognostic factor in cardiac patients. It is also recognized that depression is a growing global problem. By 2030, depression is projected to be the second leading cause of disability worldwide (after HIV/AIDS) and the number one cause of disability in high-income countries.“

Screening methods

The recommended assessment for depression in cardiac patients is fast and easy. The patients only have to initially answer 2 questions. Longers questionnaires may be needed when further assessment is deemed necessary.

Experts believe that the recommended questionnaires

“are validated tools and an efficient, evidence-based way of finding possible cases and referring them on for further assessment and treatment.”

However, a big problem would be how the patients would accept the recommendations for screening and the diagnosis of depression. People with heart disease would not necessarily be happy (and they are already unhappy) when they hear they have another clinical problem to face.

Treatments

The AHA advisory recommends pharmacological treatment of depression. As first line of treatment, the selective serotonin reuptake inhibitors (SSRIs) sertraline and citalopram are recommended. Furthermore, AHA cautions that some antidepressant drugs may have some cardiotoxic effects that can worsen existing cardiovascular conditions.

For those who cannot tolerate antidepressant medications or prefer nonpharmacological treatments, cognitive behavior therapy is recommended. A combination of both psychotherapy and medications may also work for some patients. The important thing is to find the right therapeutic approach for patients.

               

Is skin cancer on the rise?

The incidence of skin cancer is increasing. And this increase is not only due to better screening and diagnostic techniques. The threat is real and not just an artefact of better technology, according to researchers at the Stanford University Medical Center in California.

This rise of skin cancer incidence has been reported both in the US and Europe. In the US, the increase is on average, 3.1% each year, from 1992 to 2004.

The Stanford researchers argue that improved screening methods will detect more skin tumors which are thinner and most likely to be benign, the kind that were easily missed before the new methods were introduced. However,

“after assessing 70,596 previously documented cases of cancer diagnosed between 1992 and 2004 in the United States, they found that there were significantly more cases of tumours of all thicknesses”.

Another indication of skin cancer increase is the fact that the rise is evident in all socioeconomic groups, not only among those who belong to higher income groups in the US and therefore have better access to health care and insurance coverage.

The findings of the two studies indicate that skin cancer is indeed on the rise.

Skin cancer incidence reports are quite controversial, because the disease is closely associated to exposure to the sun. In recent years, there is a rapid increase in vitamin D deficiency the world over because people tend to avoid sun exposure for fear of skin cancer. However, vitamin D deficiency has been linked to a variety to chronic conditions, including cardiovascular problems, osteoporosis, neurodegenerative disorders, as well as pregnancy complications.

According to lead researcher Eleni Linos

“Over the past 100 years, people are really changing the amount of time they spend in the sun, the clothes they wear, and whether their hobbies and work are indoor or outdoor.” This has been confounded by the thinning of the ozone layer which led to “increased exposure to ultraviolet light or a longer-term increase in the genetic susceptibility to cancer.”

According to the Medline Medical Encyclopedia,

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common.

• skin cancer commonly occurs in people who
• have light-colored skin, hair and eyes
• are older than 50 years old
• family history of skin cancer
• spend a lot of time outdoors in the sun.

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First baby preselected as “breast cancer gene-free” born in the UK

Resource post for January

It is not surprising that it happened in the UK first. After all, this is the country where the first in vitro fertilization baby was born 30 years ago. It is the country where last year, development of human-animal embryo hybrids for research was legalized as well as the conception of savior siblings.

Thus, it is no surprise that the first supposedly “breast cancer-free” baby way born in the UK a couple of days ago and took over the headlines and raised some ethical questions.

Prenatal and preimplantation diagnostics

Prenatal diagnostics is not new. Fetuses are screened for chromosomal aberrations such as Down Syndrome early in the gestation period by amniocentesis and chorionic villus sampling (CVS). Preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS) goes even further and tests for genetic aberrations that cause life-threatening disorders such cystic fibrosis, sickle-cell anemia, and Huntington’s disease before implantation of the embryo. Testing for the breast cancer susceptibility genes was approved by the UK’s Human Fertilisation and Embryology Authority in 2006.

The breast cancer susceptibility genes

The so-called breast cancer-free baby was conceived through in vitro fertilization. Several eggs from the mother were fertilized with the father’s sperm in the lab. The resulting embryos were then screened for mutations in the genes BRCA1 and BRCA2 which make them susceptible to breast cancer. Two of the embryos were declared free from these mutations and were implanted in the mother’s uterus. A healthy baby girl was born on a few days ago.

The parents deemed the genetic preselection of the embryos necessary because all of the father’s close female relatives had breast cancer, making him a most likely carrier of the breast cancer genes. Women with either faulty BRCA1 or BRCA2 are seven times more likely to develop breast cancer during her lifetime compared to those who do not have them. By making sure that their baby is free from these genes, the parents hoped to break the genetic chain that passes on the faulty genes to the next generation.

Dubbing the baby, however, as “breast cancer-free” as many newspapers have done is kind of premature, a misnomer in fact. The BRCA1 and BRCA2 mutations accounts only for about 5 to10% of cases of breast cancers. There is still a lot to know about the remaining 90 to 95% of cases, which may be caused by environmental factors as well as other yet unidentified genes. Thus, the baby is currently “breast cancer gene-free” or more accurately “BRCA1 and BRCA2-mutation-free.”

The ethical questions

However, regardless of how she is called, the baby will learn one day that the circumstances of her conception and birth triggered ethical debates the world over.

Some criticized the doctors and parents for “playing God” by using PGD.

Some claim this is the start of the “Gattaca era” recalling the 1997 science fiction movie of that title about a world populated by “genetically designed” individuals.

There are others, however, who sympathize with the parents, and feel they would do the same if they had the chance of “freeing” their offsprings from potentially deadly diseases. In the end, this type of prenatal selection is more justified than sexual preselection in favor of male embryos, which is commonly (though not openly) practiced.

Another ethical concern, an issue that is not unique to PGD alone but is true to the whole field of IVF and assisted reproduction techniques is the fate of the rejected embryos. The number of left over embryos from IVF procedures that are currently stored in deep freeze is quite high - 500,000 embryos in the US alone. And the question of their fate is something that that parents, doctors, and lawmakers cannot agree upon. A survey by Duke University researchers presented IVF parents the following options:

• indefinite freezing
• donation for research
• reproductive donation
• thawing and discarding

The most popular options were the first 2 whereas the last 2 were not acceptable. However, indefinite freezing is not a real solution and donation for research is not legal in many countries.

In the US, several states are considering legislation would recognize an embryo as a person. Thus, “abandoned” embryos may become wards of the stat and can even be put up for adoption.

The future of PGD

Doctors handling the case emphasize that PGD is not the answer to every genetic disorder problem nor is it a cure for cancer. PGD is also not suitable for all cases and all couples. Besides, the use of PGD in the UK is still highly regulated and is evaluated on a case to case basis. However, the case has definitely set a precedent that many would try to follow suit. Louise Brown, the first IVF baby was born a little over 30 years ago in the UK. Since then, millions of babies have been conceived through IVF. We would therefore expect that PGD in connection with breast cancer and other cancers with identified susceptibility genes will soon be a standard procedure in fertility clinics. Whether the ethical issues can be resolve soon is another matter.

So tell us, what is your take on PGD?

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