Acceptance of Genetic Counseling and Testing in a Hospital-Based Series of Patients with Gynecological Cancer

Referral of patients with endometrial (EC) and/or ovarian cancer (OC) for genetic counseling is based on age at diagnosis and family history. Many patients with hereditary cancers are missed by following this strategy. We determined acceptance and mutation detection rate of offering genetic counseling and testing to unselected EC and OC patients. Therefore, in 2007, EC and OC patients were invited for genetic counseling and testing. Patients were asked for their reasons to accept or decline. Nineteen out of fifty-two EC patients (36 %) and twenty-two out of thirty-five OC patients (63 %) accepted genetic counseling, mainly to receive risk assessment for themselves and relatives. Counseling was declined mainly because patients did not want more tests or had no relatives for whom it was relevant. Eighteen out of nineteen EC patients (95 %) and twenty out of twenty-two OC patients (91 %) underwent genetic testing. One EC patient carried an MSH6 mutation (mutation detection rate: 6 %). BRCA1/2 mutations were found in two out of twenty OC patients (10 %). Eleven patients (29 %) received surveillance recommendations for themselves and their relatives. Finally, family history recorded by the gynecologist was compared to that taken by the clinical geneticist. Gynecologists reported family history in ten out of forty-one participants (24 %). In conclusion, genetic counseling and testing are acceptable to patients with OC and/or EC. The 10 % BRCA1/2 mutation detection rate and underreporting of family history by gynecologists warrant referral for genetic counseling for all OC patients, followed by BRCA1/2 testing if indicated. We recommend that microsatellite instability and immunohistochemical analysis be performed in all EC patients, followed by genetic counseling if appropriate. These strategies will lead to better cancer prevention in gynecological cancer patients and their relatives.     

Humean laws,explanatory circularity,and the aim of scientific explanation

Philosophical Studies - One of the main challenges confronting Humean accounts of natural law is that Humean laws appear to be unable to play the explanatory role of laws in scientific practice....     

Evidence: A Guide for the Uncertain

Assume that it is your evidence that determines what opinions you should have. I argue that since you should take peer disagreement seriously, evidence must have two features. (1) It must sometimes warrant being modest: uncertain what your evidence warrants, and (thus) uncertain whether you’re rational. (2) But it must always warrant being guided: disposed to treat your evidence as a guide. It is surprisingly difficult to vindicate these dual constraints. But diagnosing why this is so leads to a proposal—Trust—that is weak enough to allow modesty but strong enough to yield many guiding features. In fact, I argue that Trust is the Goldilocks principle—for it is necessary and sufficient to vindicate the claim that you should always prefer to use free evidence. Upshot: Trust lays the foundations for a theory of disagreement and, more generally, an epistemology that permits self-doubt—a modest epistemology.     

There is no measurement problem for Humeans

The measurement problem concerns an apparent conflict between the two fundamental principles of quantum mechanics, namely the Schrödinger equation and the measurement postulate. These principles describe inconsistent behavior for quantum systems in so-called “measurement contexts.” Many theorists have thought that the measurement problem can only be resolved by proposing a mechanistic explanation of (genuine or apparent) wavefunction collapse that avoids explicit reference to “measurement.” However, I argue here that the measurement problem dissolves if we accept Humeanism about laws of nature. On a Humean metaphysics, there is no conflict between the two principles, nor is there any inherent problem with the concept of “measurement” figuring into the account of collapse.