Women with a family history of breast cancer could be allowed to use IVF to have children free of the disease. These new proposals that is due to be discussed by the government's fertility watchdog tomorrow for approval. // WOMEN with inherited forms of breast cancer will be allowed to select embryos free from genes that can cause the disease.
This landmark ruling from the Human Fertilisation and Embryology Authority (HFEA) would permit thousands of women who carry the BRCA1 and BRCA2 genes to spare their daughters a genetic inheritance that confers an 80 per cent lifetime risk of developing breast cancer. The move, which also applies to a third gene that predisposes to bowel cancer, has also won the backing of the watchdog’s ethics and law committee, and is expected to be confirmed at a meeting in Belfast.
People who know that they have the BRCA1, BRCA2 or HNPCC colon cancer genes will be able to seek IVF treatment, during which a single cell is removed from the embryos for testing. Then only the embryos without those genes would be used for fertility.
This decision is expected to deepen the already existing controversy over “designer babies”, as it now significantly extends over the inherited conditions that can be prevented by “cherry-picking” the embryos. The screening procedure, known as pre-implantation genetic diagnosis (PGD), is at present approved only for mutations that lead to at least a 90 per cent chance of developing a disease.
The genes that are covered by the recommendations carry a lifetime cancer risk of 80%, which can be substantially reduced by preventive surgeries like double mastectomy, that is chosen by many women who test positive for BRCA1 or BRCA2.
Many critics feel that the move has marked a further step down a “slippery slope”, which was permitting screening for ever less serious genetic traits. Patient groups, however, welcomed the recommendation as a measure that would help fami
lies that have suffered genetic disease in several generations. Expecting the first application for a licence to perform PGD for breast cancer, Paul Serhal, of University College Hospital in London, has already seen ten patients with BRCA genes who want the procedure, and other clinics are also ready to conduct it.
The Times had in 2004 disclosed that Mr Serhal had won the first HFEA licence to screen embryos for a form of bowel tumour that affects 90% of those who inherit the gene. He has also received a licence to screen for the eye cancer retinoblastoma. He said that it would be hard for the HFEA to justify refusing permission to screen for the BRCA and HNPCC genes, given its earlier decisions. He explained that this procedure has the potential to reduce the incidence of serious diseases and also reduce the costs as far as ongoing medical care is concerned.
Extending this to look for the breast cancer genes would be a significant step for three reasons. First the genes are not an automatic death sentence: each results in an 80% risk of developing breast cancer. But unlike cystic fibrosis, breast cancer is treatable and can be prevented by mastectomy. And it kills much later - in a woman's 30s or 40s - so an embryo that is destroyed might have lived until then.
Stating that medicine is about caring not about killing, Josephine Qintavalle of the lobby group Comment on Reproductive Ethics, which opposes all uses of PGD stated that the right approach would be to learn more about the cancer and how to curing it.
The fertility doctors were quick to disagree. Simon Fishel, managing director of CARE, a group of fertility clinics stated that if families would wish to eliminate the threat of serious cancer from their family they should be at liberty to do so. Joan Finlayson, 47, from Arbroath, who finished nine months of excruciating treatment in September involving chemotherapy, radiotherapy and surgery. She stated that she w
ould do absolutely anything to prevent her daughter from having to go through what she went through.
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