Navigating the Bioethical Crossroads of Cancer Genetic Testing in Low-Resource Regions in Africa – What Do We Need to Consider?

Implementing modern medical technologies in diverse, low-resource areas helps reduce global health disparities and promote justice and inclusion. However, there are important bioethical challenges. As part of an ongoing cancer genetic testing initiative in Rwanda, we conducted select literature reviews and interviews with local professionals in Rwanda, Tunisia, and Nigeria. Our goals are to examine ethical dilemmas to effectively implement genetic testing in these low-resource regions in a safe and just manner.

Cancer genetic testing can identify high-risk individuals for hereditary cancers. This raises ethical considerations regarding clinical utility and medical actionability in low-resource areas due to limited access to appropriate care. After identifying cancer gene mutations, inequities in long-term resource availability and follow-up may create different global standards of care and fairness. Investigators have historically exploited marginalized populations, so current health programs must work inclusively and build community trust.

We must also understand cultural factors for patients to be fully informed about electing testing and prevention. We must consider the uniqueness and diversity of communities in how various strategies will be adopted and received. This requires community engagement and consideration of genomic data, privacy, and informed consent to prevent harm and exploitation while respecting vulnerable populations.

Effective strategies to reduce cancer in global low-resource regions must consider cultural values while working to improve fair resource access. Engaging communities and further research of international genomics can facilitate inclusive public conversations and exchange knowledge and opinions between interdisciplinary fields to guide resolving ethical dilemmas facing cancer genetics implementation in Sub-Saharan Africa.

Timothy Rebbeck, PhD – Professor of Cancer Prevention, Division of Population Sciences, Harvard TH Chan School of Public Health and Dana-Farber Cancer Institute; Yosr Hamdi, PhD – Assistant Professor, Institut Pasteur Tunis, Laboratory of Biomedical Genomics and Oncogenetics; Annette Uwineza, MD, PhD – Associate Professor, The School of Medicine and Pharmacy, University of Rwanda; Temidayo Fadelu, MD, MPH – Instructor in Medicine, Center for Global Cancer Medicine, Dana-Farber Cancer Institute; Kaitlyn P. Lew, BS – HMS Center for Bioethics and the Division of Population Sciences – Harvard Medical School and Dana-Farber Cancer Institute