HFEA approves embryo tests for hereditary cancer
Dr Jess Buxton
Progress Educational Trust16 May 2006
The UK's fertility treatment regulator has given the go-ahead for couples to test embryos to avoid passing on hereditary cancer. At its open meeting held on 10 May in Belfast, the Human Fertilisation and Embryology Authority (HFEA) accepted a recommendation from its ethics and law committee to allow licences to be granted for such procedures. People who know they have inherited genetic mutations that would confer a high risk of breast, ovarian or bowel cancer on their children will now be permitted to undergo preimplantation genetic diagnosis (PGD) treatment, to enable them to select IVF embryos that do not have the faulty gene.
Last November, the HFEA launched a public debate on testing embryos for 'lower penetrance', late onset genetic disorders. The discussion paper, entitled 'Choices and Boundaries', focused both on genetic tests currently available, such as that for hereditary breast cancer, and possible future developments, such as tests for inherited forms of Alzheimer's disease. The recommendations approved recently refer to just three genes: BRCA1 and BRCA2, which are both linked to hereditary breast and ovarian cancer, and HNPCC gene mutations, which confer a very high risk of colon cancer.
PGD involves taking a single cell from a 2-4 day old embryo, performing a genetic or chromosome test on that cell, and then returning one or two unaffected embryos to the womb. In the UK, the use of PGD is regulated by the HFEA, which licenses the procedure on a case-by-case basis. Previously, it has only permitted the use of PGD for fully 'penetrant' gene mutations that always result in a serious illness, usually in childhood. In contrast, women with mutations in the genes BRCA1 or BRCA2 face up to an 85 per cent chance of developing cancer in their lifetime, often in their thirties or forties. With HNPCC, 90 per cent of men and 70 per cent of women who have a gene mutation will get some form of cancer by the age of 70.
The decision to extend the use of PGD in this way has attracted criticism from some quarters. Josephine Quintavalle, of pro-life pressure group Comment on Reproductive Ethics (Core) said that 'PGD is currently nothing more than a weapon of destruction, aimed at the ruthless elimination of any embryo which does not conform to eugenic concepts of perfection'. However, scientists and clinicians have welcomed the policy change. Dr Simon Fishel, managing director of the UK's Care Fertility Group, said that 'we are talking about serious disorders here, and where there is major cost too to the NHS for treatment and radical approaches', adding 'until there is an easier option for cure, we have got an option here for prevention'.
Baroness Ruth Deech, former head of the HFEA, also agreed with the decision. 'Nothing is going to be forced on anybody, but for a tiny handful who feel that they would find this burden insupportable I feel that they should be allowed to do what their instincts tell them would be best for their children', she told BBC News Online.
In a press release, Dame Suzi Leather, current Chair of the HFEA, said that PGD can still only be used for 'a minority of people if there is a clear history of cancer across generations of a family'. She also stressed that the broad approach decided by the Authority 'will not limit the discretion of an HFEA Licence Committee to consider the individual circumstances of each case - assessing applications on a case-by-case basis will remain at the heart of HFEA decision-making'.
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.