Genomic Justice as Reproductive Justice: Universal Coverage for Preimplantation Genetic Testing for Hereditary Breast and Ovarian Cancer Syndrome.

With increasing limitations on reproductive choice in the past several years, reproductive rights-often relegated to abortion access and contraception-have become a critical consideration for American clinicians and patients. We implore the medical community to expand its understanding of reproductive autonomy by illuminating an overlooked community: those with hereditary breast and ovarian cancer syndrome. For those with pathogenic/likely pathogenic variants in cancer susceptibility genes that carry a 50% inheritance pattern, such as BRCA, preimplantation genetic testing for monogenic disorders offers a life-altering technology that provides the option to halt the generational legacy of cancer. This service, however, is cost-prohibitive. These financial barriers create disparities that not only directly impact the immediate offspring but also have the potential to form entire generational shifts in future gene pools based on socioeconomic status. This form of healthcare injustice is unacceptable, for which the medical community can and should advocate for urgent solutions. We posit that genomic justice, specifically within the framework of reproductive justice, demands that all communities have the ability to choose whether and how they will use genomic technologies to align with their reproductive goals and values.