Genetic predictive testing for bowel cancer predisposition: the impact on the individual

When considering the impact of a genetic diagnosis of hereditary predisposi tion to colon cancer, there are many similarities to other predictive genet ic tests, but also many differences. The development and availability of su ch genetic diagnoses, and the concept of testing being linked to effective prevention, have advanced rapidly, opening up not only unique opportunities but also unique psychosocial situations for the affected families-and unus ual ethical issues far the professional. Compared to a diagnosis of sporadi c colorectal cancer for a patient, hereditary colorectal cancer requires an understanding of genetics, heredity, and the attendant mathematics of risk calculation, but, most importantly, there must be a belief that it is poss ible to remain healthy whilst having an increased risk. This paper outlines the possible impact of a genetic diagnosis of hereditary non-polyposis col orectal cancer (HNPCC) or familial adenomatous polyposis (FAP) on both the individual and the family and concludes that genetic testing should be acco mpanied by genetic counseling. Relevant ethical issues are also introduced, with the opinion presented suggesting that if primary considerations are a lways for the individual rather than the family or society, then unethical or eugenic decisions are likely to be avoided.