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In Reply

Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY

Shelly Cummings, Melody White

Cancer Risk Clinic, Department of Medicine, University of Chicago Medical Center, Chicago, IL

Michal Sagi

Department of Human Genetics, Hadassah-Hebrew University Hospital, Jerusalem, Israel

Jessica G. Davis

Division of Human Genetics, Department of Pediatrics, New York-Presbyterian Hospital, New York, NY

As stated in our article, we agree that preimplantation genetic diagnosis for common cancer syndromes "has not been incorporated into common practice,"¹ and will not be appropriate in some cases for psychological or other personal reasons. However, increasing physician awareness of assisted reproductive technologies (ART) is not synonymous with imposing discussion of these options on every individual. Without communicating availability of these options to reproductive-age patients, how can they make truly informed decisions? For example, such discussions will come up in the setting of patients of reproductive age with newly diagnosed cancer who may consider ART for fertility preservation, or infertile individuals with cancer predisposing mutations who seek to utilize in vitro fertilization to achieve pregnancy. Oncologists can recognize those instances when ART may be of potential interest to a couple at risk for hereditary cancer, and then make referrals to professionals who can reliably discuss reproductive options with sensitivity to the emotional aspects and ethical issues. In an effort to guide clinicians and policy makers as they attempt to distinguish circumstances for which discussions of preimplantation genetic diagnosis may be appropriate for families affected by cancer, we have recently provided an analytic framework.² This framework takes into consideration: the age at onset of the disorder, the penetrance of the syndrome, the severity of the syndrome, the means available to decrease genetically acquired cancer risk, the availability of assisted reproduction options and the potential risks of preimplantation genetic diagnosis itself (eg, exposure to exogenous hormones). A broader discussion of the medical aspects, as well as ethical challenges of assisted reproduction will ensure its most responsible transition to clinical practice.

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The authors indicated no potential conflicts of interest.

REFERENCES

1. Offit K, Kohut K, Clagett B, et al: Cancer genetic testing and assisted reproduction. J Clin Oncol 2006 24:4775-4782[Abstract/Free Full Text]

2. Offit, K, Sagi M, Hurley, K: Commentary: Preimplantation genetic diagnosis for cancer syndromes: A new challenge for preventive medicine. JAMA 296:2727-2730, 2006[Free Full Text]

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This Article Full Text (PDF) Erratum (v26,p1018) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Offit, K. Articles by Davis, J. G. Search for Related Content PubMed Articles by Offit, K. Articles by Davis, J. G. Social Bookmarking                            What's this?