ELSIcon2022 Paper: Physician and patient perspectives on the role of the microbiome in the prevention and treatment of colorectal cancer: the ethics of uncertainty in emerging science

ELSIcon2022 • Paper • May 31, 2022

Juli Bollinger, Sara Glass, Sheethal Jose, Cynthia L. Sears, Gail Geller

Background: Research has found unique populations of bacteria in the gut microbiota of patients with colorectal cancer (CRC), including CRCs that are inherited. This suggests a possible role of host-microbe interactions in the origin, development, and treatment of inherited forms of colon cancer. However, questions remain regarding how patients and clinicians might react to this new information as well as the broader ethical and social implications of emerging science that may redefine the screening and treatment of CRC.

Methods: Semi-structured interviews with clinicians involved in the diagnosis and/or treatment of colorectal cancer and five patient focus groups: two groups of patients with inherited forms of CRC (familial adenomatous polyposis and hereditary non-polyposis colorectal cancer), one of patients with early-onset CRC (diagnosis < age 50), and two of healthy controls. Results: Ten physicians and thirty patients participated. All participants were interested in the potential for microbiome-based screening and therapeutics, but physicians and patients attached different meaning to the uncertainty raised by this early science. In general, patients were optimistic that the information could offer a greater sense of control while physicians were more guarded about their use of nascent discoveries in the absence of practice guidelines.

Conclusions: Similar to other patterns of adoption of emerging science, our data suggest patients’ enthusiasm for and potential use of microbiome information outpace physicians’ more cautious and constrained approach. This disconnect in the meaning that different stakeholder groups attach to uncertainty in emerging science raises ethical and social challenges for CRC prevention and treatment.