A CRISPR New World: Attitudes in the Public toward Innovations in Human Genetic Modification

Trust and Support for Cancer Research Biobanks: Insights from Cancer Patients in Poland

BACKGROUND Biobanks are legally regulated entities that acquire, store, prepare, preserve, test, analyze, and distribute defined biological material and related information and data from human sources. This study aimed to evaluate trust, support and willingness to donate personal data and tissue samples for biobanking from cancer patients attending oncology departments in Poznań, Poland. MATERIAL AND METHODS This study utilized data from questionnaire-based survey conducted from February to June 2023 among 548 patients from 2 Poznań hospitals equipped with oncology treatment units. The survey employed convenience sampling. Statistical analysis was carried out using JASP 0.18.3 and PQStat1.8.6., with significance levels set at 0.05. Descriptive statistics and logistic regression were utilized to present the results. RESULTS 92.2% of cancer patients supported the establishment of cancer research biobank in Poland, and 93.1% declared the willingness to share their cancer tissues for research purposes. Patients' willingness to donate was associated with biomedical research conducted by biobanks and types of biobank institutions. Most patients were willing to donate for research on cancer, genetic and autoimmune diseases or dementia, but were reluctant to participate in research on sexual identity, intelligence, aggression and for-profit research. Patients were willing to donate to biobanks managed by medical universities, public institutions, clinical hospitals and national biobanks but not to foreign and private biobanks. CONCLUSIONS Although patients' support for cancer biobank is high it is not unconditional as their willingness to participate in cancer-related research is associated with types of biomedical research conducted by biobanks and different types of biobank institutions.

The divide so wide: Public perspectives on the role of human genome editing in the US healthcare system

We report findings from two open-framed focus groups eliciting informed public opinion about the rapidly developing technology of human genome editing in the context of the US healthcare system. Results reveal that participants take a dim view of the present healthcare system, articulating extensive concerns about the accessibility and affordability of care. They feel that, unless these problems are resolved, they stand little chance of benefiting from any eventual human genome editing treatments. They prioritize improvement in healthcare access well above human genome editing development, and human genome editing regulation and oversight above human genome editing research. These results reveal substantial divergence between public perspectives and expert discourse on human genome editing. The latter attends primarily to the moral permissibility of technical categories of human genome editing research and how to treat human genome editing within existing regulatory and oversight systems rather than broader political-economic and healthcare access concerns. This divergence illustrates the importance of openly framed public engagement around emerging technologies.

What do people think about genetic engineering? A systematic review of questionnaire surveys before and after the introduction of CRISPR

The advent of CRISPR-Cas9 in 2012 started revolutionizing the field of genetics by broadening the access to a method for precise modification of the human genome. It also brought renewed attention to the ethical issues of genetic modification and the societal acceptance of technology for this purpose. So far, many surveys assessing public attitudes toward genetic modification have been conducted worldwide. Here, we present the results of a systematic review of primary publications of surveys addressing public attitudes toward genetic modification as well as the awareness and knowledge about the technology required for genetic modification. A total of 53 primary publications (1987-2020) focusing on applications in humans and non-human animals were identified, covering countries in four continents. Of the 53 studies, 30 studies from until and including 2012 (pre-CRISPR) address gene therapy in humans and genetic modification of animals for food production and biomedical research. The remaining 23 studies from after 2013 (CRISPR) address gene editing in humans and animals. Across countries, respondents see gene therapy for disease treatment or prevention in humans as desirable and highly acceptable, whereas enhancement is generally met with opposition. When the study distinguishes between somatic and germline applications, somatic gene editing is generally accepted, whereas germline applications are met with ambivalence. The purpose of the application is also important for assessing attitudes toward genetically modified animals: modification in food production is much less accepted than for biomedical application in pre-CRISPR studies. A relationship between knowledge/awareness and attitude toward genetic modification is often present. A critical appraisal of methodology quality in the primary publications with regards to sampling and questionnaire design, development, and administration shows that there is considerable scope for improvement in the reporting of methodological detail. Lack of information is more common in earlier studies, which probably reflects the changing practice in the field.

Biases in bioethics: a narrative review

Given that biases can distort bioethics work, it has received surprisingly little and fragmented attention compared to in other fields of research. This article provides an overview of potentially relevant biases in bioethics, such as cognitive biases, affective biases, imperatives, and moral biases. Special attention is given to moral biases, which are discussed in terms of (1) Framings, (2) Moral theory bias, (3) Analysis bias, (4) Argumentation bias, and (5) Decision bias. While the overview is not exhaustive and the taxonomy by no means is absolute, it provides initial guidance with respect to assessing the relevance of various biases for specific kinds of bioethics work. One reason why we should identify and address biases in bioethics is that it can help us assess and improve the quality of bioethics work.

Heterogeneous attitudinal profiles towards gene editing: Evidence from latent class analysis

Advances in gene-editing technology have important implications for the treatment and prevention of disease. Accordingly, it is important to understand public perceptions towards gene editing, as the public's willingness to endorse gene editing may be as important as technological breakthroughs themselves. Previous research has almost exclusively examined attitudes towards gene editing on specific issues, but has not addressed how attitudes towards gene editing across a range of issues coalesce in individuals: that is, the degree to which discrete, heterogeneous attitudinal profiles exist versus a simple support/oppose continuum. Here, we addressed this issue using latent class analysis on data from The Pew Research Center (N = 4726; US residents) across a wide range of gene-editing topics. We found that attitudes towards gene editing cohere into 10 distinct latent classes that showed some evidence of a support/oppose continuum, but also for clear qualitative differences between each class, even with support or oppose classes, on a number of issues. The most opposed classes significantly differed from the supporter classes in age, sex, political ideology and self-rated knowledge. These findings provide evidence that attitudes towards gene editing are heterogeneous and public discourse, as well as policy making need to consider a range of arguments when evaluating this technology.

Walking a Fine Germline: Synthesizing Public Opinion and Legal Precedent to Develop Policy Recommendations for Heritable Gene-Editing

Gene-editing technologies, such as CRISPR/Cas9, are internationally ethically fraught. In the United States, policy surrounding gene-editing has yet to be implemented, while the science continues to speed ahead. However, it is not enough that policy be implemented: in order for policy to establish limits for the technology such that benefits are possible while threats are kept at bay, such policy must be ethical. In turn, the ethics of gene-editing is a culturally determined field of inquiry. This piece presents a proposal for a study whose goal is to arrive at ethical policy recommendations for policymakers. To achieve this goal, this study proposes, what needs to be done is, first, to understand the full history and foundation of gene-editing by conducting a thorough legal, bioethical, and policy review for precedent assisted reproductive technologies and genetic reproductive technologies. Following this effort, an empirical study must be conducted involving careful surveys of key stakeholder groups on their knowledge and opinions of gene-editing. Such stakeholder groups must include bioethicists, medical geneticists, and lay persons, including those in the disability community.

An exploration of how gender, political affiliation, or religious identity is associated with comfort and perceptions of controversial topics in bioethics

Bioethics is an important aspect of understanding the relationship between science and society, but studies have not yet examined undergraduate student experiences and comfort in bioethics courses. In this study, we investigated undergraduate bioethics students' support of and comfort when learning three controversial bioethics topics: gene editing, abortion, and physician-assisted suicide (PAS). Furthermore, student identity has been shown to influence how students perceive and learn about controversial topics at the intersection of science and society. So, we explored how students' religious affiliation, gender, or political affiliation was associated with their support of and comfort when learning about gene editing, abortion, and PAS. We found that most students entered bioethics with moderated viewpoints on controversial topics but that there were differences in students' tendency to support each topic based on their gender, religion, and political affiliation. We also saw differences in student comfort levels based on identity: women reported lower comfort than men when learning about gene editing, religious students were less comfortable than nonreligious students when learning about abortion and PAS, and nonliberal students were less comfortable than liberal students when learning about abortion. Students cited that the controversy surrounding these topics and a personal hesitancy to discuss them caused discomfort. These findings indicate that identity impacts comfort and support in a way similar to that previously shown in the public. Thus, it may be important for instructors to consider student identity when teaching bioethics topics to maximize student comfort, ultimately encouraging thoughtful consideration and engagement with these topics.

The genetic technologies questionnaire: lay judgments about genetic technologies align with ethical theory, are coherent, and predict behaviour

Background

Policy regulations of ethically controversial genetic technologies should, on the one hand, be based on ethical principles. On the other hand, they should be socially acceptable to ensure implementation. In addition, they should align with ethical theory. Yet to date we lack a reliable and valid scale to measure the relevant ethical judgements in laypeople. We target this lacuna.

Methods

We developed a scale based on ethical principles to elicit lay judgments: the Genetic Technologies Questionnaire (GTQ). In two pilot studies and a pre-registered main study, we validated the scale in a representative sample of the US population.

Results

The final version of the scale contains 20 items but remains highly reliable even when reduced to five. It also predicts behaviour; for example, ethical judgments as measured by the GTQ predicted hypothetical donations and grocery shopping. In addition, the GTQ may be of interest to policymakers and ethicists because it reveals coherent and ethically justified judgments in laypeople. For instance, the GTQ indicates that ethical judgments are sensitive to possible benefits and harms (in line with utilitarian ethics), but also to ethical principles such as the value of consent-autonomy.

Conclusions

The GTQ can be recommended for research in both experimental psychology and applied ethics, as well as a tool for ethically and empirically informed policymaking.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00792-x.

Communicating CRISPR: Challenges and opportunities in engaging the public

CRISPR technologies are advancing at a dizzying pace, and emerging cultural, sociopolitical, ethical, and legal implications continue to pose new challenges for public engagement. Recent calls for public engagement and dialogue on CRISPR applications stress the importance of nuanced thinking and responsible communication. In this chapter, we review public opinion research and find that a comprehensive and clear picture of global views on CRISPR is missing but is necessary to build the foundation for effective public engagement programs. We recommend community-based-participatory research as an inclusive and effective framework for shared knowledge production and decision-making practices for scientific experts and science communicators to engage in genuine and meaningful dialogue with community members in making informed consideration for important value-laden decisions. In response to the politicization of science, this chapter offers strategic communication techniques that can help those facilitating public engagement of CRISPR-based technologies keep cognitive biases, such as identity protective cognition, motivated reasoning, and confirmation bias, at bay.

Toward Anticipatory Governance of Human Genome Editing: A Critical Review of Scholarly Governance Discourse

The rapid development of human genome editing (HGE) techniques evokes an urgent need for forward-looking deliberation regarding the aims, processes, and governance of research. The framework of anticipatory governance (AG) may serve this need. This article reviews scholarly discourse about HGE through an AG lens, aiming to identify gaps in discussion and practice and suggest how AG efforts may fill them. Discourse on HGE has insufficiently reckoned with the institutional and systemic contexts, inputs, and implications of HGE work, to the detriment of its ability to prepare for a variety of possible futures and pursue socially desirable ones. More broadly framed and inclusive efforts in foresight and public engagement, focused not only upon the in-principle permissibility of HGE activities but upon the contexts of such work, may permit improved identification of public values relevant to HGE and of actions by which researchers, funders, policymakers, and publics may promote them.

Disparities among infertility patients regarding genetic carrier screening, sex selection, and gene editing

PURPOSE

The purpose of this study is to evaluate the perspectives of infertility patients regarding genetic carrier screening, embryo sex selection, embryo research, and gene editing.

METHODS

An anonymous 32-question survey was distributed electronically to all patients who seen at a single academic fertility center for at least one visit between June 2018 and September 2019. Survey questions evaluated patient perspectives on genetic carrier screening, embryo sex selection, embryo research, and gene editing.

RESULTS

There were 1460 survey responses (32.0% response rate). There were significant differences in the proportion of respondents receiving genetic carrier screening between racial groups, 73.1% of White, 45.5% of Black, 49.4% of Hispanic, and 62.8% of Asian respondents. The likelihood of having genetic carrier screening was also significantly influenced by respondent income, insurance status, and religion. Religion significantly influenced the acceptance of embryonic research and embryonic sex selection. While only 8.9% felt that genetically modifying embryos for physical traits should be allowed, 74.1% felt that genetic modification to correct disease should be allowed.

CONCLUSION

Racial, religious, and socioeconomic factors significantly impacted respondents' likelihood to have genetic carrier screening and views on embryo sex selection, embryo research, and gene editing. These findings highlight the importance of tailoring genetic counseling to the individual, acknowledging individual and cultural differences in agreement with genetic testing and emerging genetic therapies.

Gene editing isn't just about food: comments from U.S. focus groups

In the United States, adult public perception of genetic modification has been well documented in the domain of agriculture and food; however, recent international news on gene editing in medical applications may present new challenges for science communicators who seek to proactively share benefits of emerging gene editing technology. While research traditionally considers perceptions of agricultural and medical applications separately, gene editing may bridge the gap between the two domains. We find that when asked about thoughts regarding gene editing, adult focus groups discussed medical applications more frequently and extensively than agricultural applications. Although, when examining the length of discussion about specific topics, designer babies, cures for disease, and food were discussed at similar lengths. Understanding audiences’ current perceptions of the technology is the first step in shaping strategic communication efforts to inform public opinion. A proper understanding of the benefits and risks of new technology is central to its application.

Attitudes of Indonesian Medical Doctors and Medical Students Toward Genome Editing

Purpose

This study aimed to measure the attitudes of Indonesian medical doctors and students toward new technology in genome editing.

Materials and Methods

Online questionnaires regarding attitudes toward genome editing on health and non-health conditions, both in somatic cells and embryo, were distributed through researcher networks, email and social media specific to medical doctors and students. The data of 1055 valid questionnaires were processed; descriptive and association analyses between sociodemographic factors and attitudes toward genome editing were performed. Email in-depth interview was performed to explore the respondents’ answers.

Results

The results showed that Indonesian medical doctors’ and students’ knowledge of genome editing was limited and correlated with gender, place of residence, religion, education, marital status, childbearing and experience abroad. More than half of respondents supported genome editing for the treatment of fatal and debilitating diseases both in somatic cells and embryos, implying their consent to edited gene inheritance. However, this approval decreased when applied to non-health-related aspects, such as physical appearance, intelligence and strength. Factors affecting their attitudes toward genome editing included their status as medical doctors or students, gender, age, education, religion, economic status and place of residence.

Conclusion

Increasing knowledge and awareness of Indonesian medical doctors and students regarding genome editing is important. Even though its application in health-related matter was supported by a majority of the respondents, discussion from ethical and religious perspectives is necessary to ensure the acceptance.

Regulating reproductive genetic services: dealing with spiral-shaped processes and techno-scientific imaginaries

PURPOSE

We have been inquiring into the diffusion process of reproductive genetic services (RGS) and the viability of geneticization in human reproduction.

METHOD

A 2-round modified-Delphi survey was applied amongst Israeli and Spanish experts to analyze regulatory attitudes and expectations about the future applications of RGS. We argue that an explanation of RGS diffusion based on a 'technology-push' impulse should be complemented by a 'demandpull' approach, which underscores the importance of regulatory frameworks and demand-inducing policies. The diffusion of RGS is advancing in a 'spiralshaped' process where technology acts as a cause and effect simultaneously, modulating social acceptance and redefining the notions of health and responsibility along the way.

RESULTS

We suggest that there is a 'grey-zone' of RGS regulations regarding four procedures: the use of germline genome modification (GGM) for severe monogenic disorders, preimplantation genetic testing (PGT) for detection of chromosomal abnormalities, PGT for multifactorial diseases, and PGT with whole-exome screening.

CONCLUSIONS

Although far from the geneticization of human reproduction, our findings suggest that, since techno-scientific imaginaries tend to shape regulations and thus favor the diffusion of RGS, policymakers should pay attention to those procedures by focusing on good practices and equity while providing sound information on potential risks and expected success rates. A broad and inclusive societal debate is critical for overcoming the difficulty of drawing a clear line between medical and non-medical uses of genetic selection and engineering while searching for the right balance between allowing reproductive autonomy and protecting the public interest.

Assessing Public Opinion on CRISPR-Cas9: Combining Crowdsourcing and Deep Learning

Background

The discovery of the CRISPR-Cas9–based gene editing method has opened unprecedented new potential for biological and medical engineering, sparking a growing public debate on both the potential and dangers of CRISPR applications. Given the speed of technology development and the almost instantaneous global spread of news, it is important to follow evolving debates without much delay and in sufficient detail, as certain events may have a major long-term impact on public opinion and later influence policy decisions.

Objective

Social media networks such as Twitter have shown to be major drivers of news dissemination and public discourse. They provide a vast amount of semistructured data in almost real-time and give direct access to the content of the conversations. We can now mine and analyze such data quickly because of recent developments in machine learning and natural language processing.

Methods

Here, we used Bidirectional Encoder Representations from Transformers (BERT), an attention-based transformer model, in combination with statistical methods to analyze the entirety of all tweets ever published on CRISPR since the publication of the first gene editing application in 2013.

Results

We show that the mean sentiment of tweets was initially very positive, but began to decrease over time, and that this decline was driven by rare peaks of strong negative sentiments. Due to the high temporal resolution of the data, we were able to associate these peaks with specific events and to observe how trending topics changed over time.

Conclusions

Overall, this type of analysis can provide valuable and complementary insights into ongoing public debates, extending the traditional empirical bioethics toolset.

Meaning of Ambiguity: A Japanese Survey on Synthetic Biology and Genome Editing

Synthetic biology and genome editing have become increasingly controversial issues, necessitating careful attention and engagement with the public. Our study examined ambiguity in public perception about emerging biotechnologies through the use of several intermediate response options in a survey. To understand the relationship between respondents' thoughts and attitudes, we also examined how respondents' indecision is related to their cognitive concept of "self" as well as their interpretation of "future generations." An online survey of 994 respondents living in Japan revealed that around 80% hold intermediate attitudes (two-sided, non-judgmental, or reserved attitudes) toward synthetic biology and genome editing. These results revealed that respondents who have a narrow self-concept tend to postpone decisions about the application of emerging technologies. In contrast, those with a broad self-concept tend to adopt an ambivalent attitude and are more short-sighted, but make judgments based on the impact of their decisions on current and future generations. This study thus demonstrates that public views are more diverse and nuanced than those obtained from conventional public surveys for policy making.

Ethical issues in human germline gene editing: a perspective from China

The ethical issues associated with germline gene modification and embryo research are some of the most contentious in current international science policy debates. In this paper, we argue that new genetic techniques, such as CRISPR, demonstrate that there is an urgent need for China to develop its own regulatory and ethical framework governing new developments in genetic and embryo research. While China has in place a regulatory framework, it needs to be strengthened to include better compliance oversight and explicit criteria for how different types of research should be reviewed by regulatory authorities. We also document a variety of opinions about the new technologies among the public, scholars, and policy makers. China needs to develop its own regulations in coordination with other countries; but it is unlikely that an international consensus will be achieved in this area, given the existing differences in regulations between countries. We should aim at harmonization, not necessarily complete consensus, and the perspective from China is vital when international norms are developed and harmonized. Chinese policy makers and researchers need to be aware of the international discussions, at the same time as the international community is aware of, and accommodates, Chinese positions on important policy options.

Predicting Public Attitudes Toward Gene Editing of Germlines: The Impact of Moral and Hereditary Concern in Human and Animal Applications

Background and Objective: New and more efficient methods of gene editing have intensified the ethical and legal issues associated with editing germlines. Yet no research has separated the impact of hereditary concern on public attitudes from moral concern. This research compares the impact these two concerns have on public attitudes across five applications including, the prevention of human disease, human and animal research, animals for the use of human food and the enhancement of human appearance. Methods: A sample of 1004 Australians responded to either a telephone (n = 501; randomly selected) or online survey (n = 503; sourced by Qualtrics). Both samples were representative in terms of States and Territories as well as gender (51% female), though the online sample was younger (M = 40.64, SD = 16.98; Range = 18-87) than the telephone sample (M = 54.79, SD = 18.13; Range = 18-96). A 5 (application) by 3 (type of cell) within groups design was utilized, where all respondents reported their level of approval with scientists editing genes across the 15 different contexts. Multilevel modeling was used to examine the impact of moral (embryo vs. germ) and hereditary (germ vs. somatic) concern on attitudes across all applications. Results: Australians were comfortable with editing human and animal embryos, but only for research purposes and to enhance human health. The effect of moral concern was stronger than hereditary concern, existing in all applications except for the use of animals for human purposes. Hereditary concern was only found to influence attitudes in two applications: improving human health and human research. Moral concern was found to be accentuated amongst, women, more religious individuals and those identifying as Australian, while hereditary concern was strongest amongst non-Australians, those with stronger trust in scientists, and more religious respondents. Conclusion: Moral and hereditary concerns are distinct, and require different approaches to public education, engagement and possibly regulation. Further research needs to explore hereditary concern in relation to non-human applications, and the reasons underlying cultural and gender differences.

Reasons for being in favour of or against genome modification: a survey of the Dutch general public

STUDY QUESTION

What are the general public's reasons for being in favour of or against the use of genome modification for five potential applications?

SUMMARY ANSWER

Overall, 43 reasons for being in favour, 45 reasons for being against as well as 26 conditional reasons for the use of genome modification were identified.

WHAT IS KNOWN ALREADY

Various applications of somatic genome modification are progressing towards clinical introduction and several recent studies have reported on germline genome modification. This has incited a debate on ethical and legal implications and acceptability. There is a growing plea to involve the general public earlier on in the developmental process of science and (bio)technology including genome modification.

STUDY DESIGN SIZE DURATION

In April 2016, a cross-sectional survey was launched online among the Dutch general public. A documentary on genome modification on public television and calls in social media invited viewers and non-viewers, respectively, to participate.

PARTICIPANTS/MATERIALS SETTING METHODS

The questionnaire introduced five potential future applications of genome modification: modified wheat for individuals with gluten intolerance; somatic modification for individuals with neuromuscular diseases; germline modification to prevent passing on a neuromuscular disease; germline modification to introduce resistance to HIV; and germline modification to increase intelligence. Participants were asked to indicate whether and why they would make use of genome modification in these scenarios. The reasons mentioned were analysed through content analysis by two researchers independently. The proportion of respondents that was willing to modify was described per scenario and associations with respondent characteristics were analysed.

MAIN RESULTS AND THE ROLE OF CHANCE

The survey was completed by 1013 participants. Forty-three reasons for being in favour, 45 reasons for being against as well as 26 conditional reasons for the use of genome modification were identified. These could be categorized into 14 domains: safety of the individuals concerned; effectiveness; quality of life of the individuals concerned; existence of a clinical need or an alternative; biodiversity and ecosystems; animal homo sapiens (i.e. relating to effects on humans as a species); human life and dignity; trust in regulation; justice; costs; slippery slope; argument of nature; parental rights and duties; and (reproductive) autonomy. Participants' willingness to use genome modification was dependent on the application: most participants would eat modified wheat if gluten intolerant (74%), would use genome modification to cure his/her own neuromuscular disease (85%) and would apply germline modification to prevent passing on this neuromuscular disease (66%). A minority would apply germline modification to introduce resistance to HIV (30%) or increase intelligence (16%). Being young (odds ratio (OR) = 0.98 per year increase), being male (OR = 2.38), and having watched the documentary (OR = 1.82) were associated with being willing to apply genome modification in more scenarios.

LIMITATIONS REASONS FOR CAUTION

Inquiring for reasons through open questions in a survey allowed for a larger sample size and intuitive responses but resulted in less depth than traditional face-to-face interviews. As the survey was disseminated through social media, the sample is not representative of the overall Dutch population, and hence the quantitative results should not be interpreted as such.

WIDER IMPLICATIONS OF THE FINDINGS

Further public consultation and a more in-depth ethical and societal debate on principles and conditions for responsible use of (germline) genome modification is required prior to future clinical introduction.

STUDY FUNDING/COMPETING INTERESTS

Funded by the University of Amsterdam and University Medical Centre Utrecht. No conflict of interest.

TRIAL REGISTRATION NUMBER

Not applicable.

Gene therapy clinical trials worldwide to 2017: An update

To date, almost 2600 gene therapy clinical trials have been completed, are ongoing or have been approved worldwide. Our database brings together global information on gene therapy clinical activity from trial databases, official agency sources, published literature, conference presentations and posters kindly provided to us by individual investigators or trial sponsors. This review presents our analysis of clinical trials that, to the best of our knowledge, have been or are being performed worldwide. As of our November 2017 update, we have entries on 2597 trials undertaken in 38 countries. We have analysed the geographical distribution of trials, the disease indications (or other reasons) for trials, the proportions to which different vector types are used, and the genes that have been transferred. Details of the analyses presented, and our searchable database are available via The Journal of Gene Medicine Gene Therapy Clinical Trials Worldwide website at: http://www.wiley.co.uk/genmed/clinical. We also provide an overview of the progress being made in gene therapy clinical trials around the world, and discuss key trends since the previous review, namely the use of chimeric antigen receptor T cells for the treatment of cancer and advancements in genome editing technologies, which have the potential to transform the field moving forward.