Cancer risk assessment and management. An ethical perspective.

We explored ethical issues in cancer risk assessment and management. Although literature about risk assessment and management is increasing, few attempts have been made to address directly either their ethical aspects or implications. We have compared ethical considerations raised at the community level with those classically considered in the physician-patient setting. Established principles of autonomy, beneficence, nonmaleficence, and distributive justice are shown not to be easily applicable at the societal level. Available information about the safety of exposures often is too scanty to allow decisional autonomy; beneficence is considered from the societal viewpoint rather than from that of the individual; and equity is frequently violated. Ethics require careful consideration when defining what is acceptable to society; the simple mathematical formulations used for risk-benefit evaluations cannot be applied directly to individuals. Further development and integration of these ideas are necessary.