Is There a Demand for PGD and/or PND Among Healthy BRCA1/2 Carriers at a Reproductive Age? A Contingent Valuation Survey.

Breast cancer is one of the most common neoplasms in women and 2-5% are due to high-risk penetrance genes, such as BRCA1/2. Carriers have a higher risk of developing breast and ovarian cancer at a younger age. Few options are available to avoid transferring their mutation (risk=50%): adopting, ovum/sperm donation, preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND). In France PGD and PND are allowed based on the severity and non curability of a condition, however no authorization has yet been reported. The national GENEPSO cohort gives us the opportunity to elicit preferences toward access to PGD and PND using the contingent valuation method. Eligible subjects were carriers of a BRCA1/2 mutation and unaffected by cancer. Among the 460 respondents 28% declared that, in the context of a next pregnancy, they would wish to beneficiate neither from PGD nor from PND. Among the remaining 330 respondents, 64% have given a value to PGD or PND (1952€ vs. 1808€). WTP PGD increases with income, acceptability of therapeutic ToP, knowledge of the risk of transmission and certainty of wishing to beneficiate from PGD. WTP PGD decreases when maternity project was not influenced by the test and when ToP was experienced. WTP PND was determined by WTP PGD , but also increases with income, being a male and certainty of wishing to beneficiate from PND. Debate around PGD/PND came from the fact that a mutation “only” predisposes to cancer. Our survey shows that BRCA carriers support the availability of access to PGD/PND and challenges the recommendations to be made to onco-geneticians.