Incidental Findings From Treatment Response Monitoring in Oncological Care: Ethical Reflections

The question of how to handle incidental findings in medicine has attracted a lot of attention in the bioethics literature. The most widely discussed examples come from genetics (e.g., next generation sequencing) and medical imaging (e.g., neuroimaging). While incidental findings in medical imaging research have sparked much debate, the way incidental findings arising from medical imaging are handled in clinical practice is taken to be relatively uncontentious. However, in this paper, I will challenge how incidental findings arising from treatment response monitoring in oncological care are handled. At present, oncological patients' consent is not obtained before disclosing incidental findings that arise during treatment response monitoring. Rather, all and only incidental findings that are taken to be clinically relevant are disclosed. Using treatment response monitoring in metastatic breast cancer care as an illustration throughout the paper, I will challenge the more general practice of not offering oncological patients the possibility to refuse being informed about incidental findings that arise during treatment response monitoring. Ultimately, I will argue for the introduction of a tiered-layered-staged consent regarding the disclosure of incidental findings before the initiation of treatment response monitoring in oncological care for much the same reasons as it has been advocated for in genetics.