Our genes, our selves: hereditary breast cancer and biological citizenship in Norway

The concept ‘hereditary breast cancer’ is commonly used to delineate a group of people genetically at risk for breast cancer—all of whom also having risk for other cancers. People carrying pathogenic variants of the BRCA1 and BRCA2 genes are often referred to as those having predisposition for ‘hereditary breast cancer’. The two genes, however, are when altered, associated with different risks for and dying from breast cancer. The main risk for dying for carriers of both genes is from ovarian cancer. These biological facts are of philosophical interest, because they are the facts underlying the public debate on BRCA1/2 genetic testing as a model for the discussion of how to implement genetic knowledge and technologies in personalized medicine. A contribution to this public debate describing inherited breast cancer as ‘biological citizenship’ recently printed in Med Health Care and Philos illustrated how fragmented and detached from the biological and socio-political facts this debate sometimes is. We here briefly summarize some of the biological facts and how they are implemented in today’s healthcare based on agreed philosophical, ethical and moral principles. The suggestion of a ‘biological citizenship’ defined by hereditary breast cancer is incorrect and ill-advised. ‘Identity politics’ focusing hereditary breast cancer patients as a group based on a bundle of ill-defined negative arguments is well known, but is supported neither by scientific nor philosophical arguments. To those born with the genetic variants described, the philosophical rule of not doing harm is violated by unbalanced negative arguments.