Inherited Susceptibility to Cancer: Clinical, Predictive, and Ethical Perspectives (review)

Inherited Susceptibility to Cancer: Clinical, Predictive, and Ethical Perspectives. Edited by William D. Foulkes and Shirley V. Hodgson. New York: Cambridge Univ. Press, 1998. Pp. 464. $95.00.

Inherited Susceptibility to Cancer is an invaluable addition to the literature on cancer genetics. The editors have assembled articles from an internationally diverse group of researchers from many disciplines. In the first part, the authors address the ethical, legal, and social issues raised by genetic testing, screening, and counseling, and explore the science and epidemiology of gene and mutation detection. In the second part, the authors detail current knowledge regarding the inheritance patterns of many different forms of cancer.

The first half of the book is what makes this book so valuable for clinicians from many different backgrounds. The book begins with a very clear, simple overview of the inherited basis of cancer co-authored by one of the editors, and continues with chapters that address the social, ethical, and legal issues surrounding screening, cancer susceptibility, and public expectations. These issues resurface in the fifth and sixth chapters, which deal with genetic counseling and the role of primary care givers in genetic cancer screening and education. The section concludes with two chapters on gene and mutation detection, the second of which is quite technical.

Overall, these chapters are well written and comprehensive. They not only serve those who are in need of a primer or refresher course in oncology, genetics, and epidemiology, but they address many of the ethical, psychosocial, and legal issues raised by genetics. While it is impossible to flesh out all of these issues in a few chapters, the authors do an excellent job of raising the reader's consciousness regarding the ethical, legal, and psychosocial implications of genetic susceptibility testing. My objections to the content in these chapters are minor, although one is worth noting. In Chapter 3 the authors go too far in concluding that human genetics would be served by expanding the standard four ethical principles of medical ethics (autonomy, beneficence, non-maleficence, and justice) to include three additional principles (reciprocity, mutuality, and solidarity). Their conclusions are not based on any arguments in their text. While genetics highlights many of the ethical issues raised by innovative medical technology and science, many ethicists argue that these issues are not unique. The authors do not provide sound arguments to dispute this view.

One of the most important lessons is raised in Chapters 2 and 4. In Chapter 2, Professor Cuckle explores the issues raised by screening, particularly with respect to genetic susceptibility to cancer. He is concerned that these decisions are not being made rationally. Ruefully, Cuckle acknowledges that his goal of "proper evaluation . . . may be difficult to achieve in the face of public demand, clinical freedom and the need to allay anxiety," but he encourages his colleagues to "practice restraint" (p. 28). This warning is made more concrete in Chapter 4, in which Professor Nelkin explores the "themes and images that pervade reports and representations of the gene in popular culture" (p. 57). Nelkin notes that the media is having a great impact on public understanding and uptake of genetic tests and may be creating "unrealistic expectations as to what the geneticist can provide" (p. 46). Taken together, these chapters affirm that all who practice and research the genetic basis of cancer susceptibility have an obligation to ensure that science and not popular opinion is the basis for future health policy.

The second half of the book is a comprehensive review of the hereditary component of cancer by specific organ systems and for special groups. It provides a broad, in-depth account of the myriad ways that genetics and the environment interact in the development of virtually all the different forms of cancer. All of the chapters are up-to-date, with extensive citations from the world literature. The final chapter, by the editors, describes developments in many of...