Cancer Screening, Risk Stratification and the Ethics of Apt Categorisation: A Case Study

Abstract

This paper considers an under-explored topic in Public Health Ethics, the “ethics of apt categorization” by means of a case study of recent proposals that genetic data might be used in breast cancer screening programmes. The paper first outlines some of the obvious ethical concerns about replacing current age-based categorisation schemes with genetic-based ones for purposes of calculating breast cancer risk: about relative costs, about age discrimination, and about genetic discrimination. It then suggests that such a scheme also raises a further, separate problem, about which categorization schemes are apt in public policy. The paper argues that these problems cannot be resolved by appeal to purely scientific considerations, before proposing four axes along which schemes should be assessed: their “epistemic robustness”; their “knock-on effects”; whether they perpetuate or endorse past or ongoing injustice; and their intelligibility. The final section argues that, considered along the four axes, an age-based categorization scheme is preferable to a genetic-based scheme for purposes of breast cancer screening.