Pre-implantation diagnosis and predispositions


On last 9th January, the first British baby selected by pre-implantation diagnosis (PID) for breast cancer predisposition was born. Its mother, 27 years old, decided to resort to PID so that her child does not carry BRCA1 gene which could have increased by 50% to 80% the risks she/he develops breast cancer. A few days before, the newspaper La Croix spread this first British birth of a "child whose genetic inheritance has been selected to avoid she/he develops such disease, which is generally successfully cured if it is diagnosed early enough".
 
Prenatal selection, where to go?
 
Initially, the PID was used to "prevent" serious and incurable diseases, or rather not to implant embryos carrying these diseases. But, since 2006, date at which the PID was used in USA to "prevent" a colon cancer predisposition, the question about the extension of the field of application of the PID comes up in a concrete manner. And this question is particularly worrying given that, according to British scientists, the future parents could, from now to next year, have a genetic test, the genetic MoT, which enables them to select in vitro their embryos free from any known genetic diseases or predispositions to cancers, diabetes, to some cardiovascular or neurodegenerative diseases. In theory, the genetic MoT could also enable selecting embryos according to the eye colours or other genetic criteria determining the size, the weight…, but the Human Fertilisation and Embryology Authority (HFEA), to which the test has to be submitted, should prohibit such use.
 
Still in Great Britain, associations of deaf people claim the "right" to give birth to deaf children via the PID. And this demand would not be isolated: 3% of American fertility clinics would have already resorted to PID to select and re-implant embryos carrying genetic anomalies.
 
Situation in France
 
French law in force stipulates that the PID can only concern "particularly serious" and "incurable" diseases at the time of the diagnosis. But a French team, managed by Pr. Stéphane Viville, director of the Institute of Genetics and Molecular and Cellular Biology of Strasbourg, recognised, in 2006, he practices the DPI to identify the embryos carrying genes predisposing to some cancers. According to him, the law did not list the pathologies concerned by the PID, "there is no need of change (…) to (…) treat the predisposition to some cancers". In those days, the director of the Agency of Biomedicine, Carine Camby, declared that, if "the law of bioethics had to be extensively construed", this could not be "the fact of a single centre" and called for a public debate.
 
In lieu of public debate, on 9th April 2008, the mission directed by Dr Dominique Stoppa-Lyonnet in which participated Pr Viville, concluded that "no modification of the law of bioethics" was "necessary so that this practice may continue". And, on last 26th December, the Agency of Biomedicine wanted to remind, with a press release, that the selection of embryos by PID in some cases of cancers was authorised in France. According to her, 22 PID associated to a risk of cancer were performed between January 2000 and June 2007, leading to the birth of 6 children free from inherited forms of cancers or associated diseases researched 1.
 
Nevertheless, the question should be treated during the next revision of the law of bioethics.
 
1- Bilan d’application de la loi de bioéthique du 6 août 2004, Agence de la biomédecine, octobre 2008