Ethics and Diagnosis of Breast Cancer

Posted on: January 13th, 2012 by admin

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Fifteen years ago the National Institutes of Health in the USA convened a panel to reach consensus on whether regular mammograms should be recommended for women in their forties. Amid vitriol and animosity, no consensus was reached and the meeting was later described in the journal Science as a “breast-screening brawl.” We might question the ethics of the person who described the actions of Daniel Kopans, the eminent Harvard radiologist and breast-screening proponent, as “intellectual terrorism.”

Then there is Kopans himself, accusing two San Francisco epidemiologists of having “manipulated data in a fashion that borders on scientific fraud.” Was he behaving ethically, given that a later investigation showed there was no substance to his charges? 

A statue of Aristotle, one of the greatest thinkers in history and among the first to apply ethical reasoning.
A statue of Aristotle, one of the greatest thinkers in history and among the first to apply ethical reasoning.

The meaning of ethics can be hard to pin down and many people will have their own views on the subject. However, ethics is a branch of philosophy with a long history, reaching back over two thousand years to the early Greek philosophers like Socrates and Aristotle. Ethics refers to well-founded standards of what constitutes right and wrong and that prescribe how humans ought to behave, especially in terms of their obligations and benefits to society.

Margaret Somerville, founding director of the Centre for Medicine, Ethics and Law at McGill University, has recently asked: Is the decision to recommend reduced breast cancer screening ethical? Her question followed the Canadian government’s recommendation in late 2011 that routine screening be abandoned or reduced in frequency for younger women. Somerville argued, “But the benefits and harms of the changes in screening will not accrue to the same persons, which makes the situation more complex ethically. Those who would have benefited from finding their cancer earlier will be harmed; those who avoid false positives and unnecessary interventions, unfounded worry, and the costs screening involves, will be benefited.”

At CapeRay we are regularly confronted with decisions involving ethics. This week, in collaboration with our partners at the Medical Imaging Research Unit, we have submitted a protocol to the Human Research Ethics Committee of the University of Cape Town. This will enable us to begin the clinical testing of our PantoScanner Soteria system on patients. Ethics requires us first “to do no harm” and, where possible, “to do good.”


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