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Muller C, Gallacher L, Keogh L, McInerney-Leo A, Boughtwood T, Gleeson P, Barlow-Stewart K, Delatycki MB, Winship I, Nowak KJ, Otlowski M, Lacaze P, Tiller J. "Uninsurable because of a genetic test": a qualitative study of consumer views about the use of genetic test results in Australian life insurance. Eur J Hum Genet 2024; 32:827-836. [PMID: 38637700 PMCID: PMC11219861 DOI: 10.1038/s41431-024-01602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Genetic testing can provide valuable information to mitigate personal disease risk, but the use of genetic results in life insurance underwriting is known to deter many consumers from pursuing genetic testing. In 2019, following Australian Federal Parliamentary Inquiry recommendations, the Financial Services Council (FSC) introduced an industry-led partial moratorium, prohibiting life insurance companies from using genetic test results for policies up to $AUD500,000. We used semi-structured interviews to explore genetic test consumers' experiences and views about the FSC moratorium and the use of genetic results by life insurers. Individuals who participated in an online survey and agreed to be re-contacted to discuss the issue further were invited. Interviews were 20-30-min long, conducted via video conference, transcribed verbatim and analysed using inductive content analysis. Twenty-seven participants were interviewed. Despite the moratorium, concerns about genetic discrimination in life insurance were prevalent. Participants reported instances where life insurers did not consider risk mitigation when assessing risk for policies based on genetic results, contrary to legal requirements. Most participants felt that the moratorium provided inadequate protection against discrimination, and that government legislation regulating life insurers' use of genetic results is necessary. Many participants perceived the financial limits to be inadequate, given the cost-of-living in Australia. Our findings indicate that from the perspective of participants, the moratorium has not been effective in allaying fears about genetic discrimination or ensuring adequate access to life insurance products. Concern about genetic discrimination in life insurance remains prevalent in Australia.
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Affiliation(s)
| | - Lyndon Gallacher
- University of Melbourne, Parkville, VIC, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Aideen McInerney-Leo
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | | | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, VIC, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, VIC, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristen J Nowak
- Office of Population Health Genomics, Western Australia Department of Health, Perth, WA, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Tiller
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Australian Genomics, Melbourne, VIC, Australia.
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Oliva R, Grassi S, Marchetti C, Cazzato F, Marinelli R, Scambia G, Fagotti A. Medicolegal and insurance issues regarding BRCA1 and BRCA2 gene tests in high income countries. Int J Gynecol Cancer 2024; 34:935-941. [PMID: 38642925 DOI: 10.1136/ijgc-2023-005225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
Hereditary breast and ovarian cancer syndrome is an autosomal dominant cancer susceptibility syndrome mainly due to variants in BRCA1 or BRCA2 genes. Patients presenting with BRCA1 or BRCA2 gene mutations have a lifetime risk of developing breast or ovarian cancer (80% and 40%, respectively). Genetic testing to explore the predisposition to develop cancer represents a pivotal factor in such cases, and this review wants to explore the main implications in terms of medicolegal liability and insurance issues. Medicolegal issues related to these diagnostic processes include: (a) failure to recommend the test; (b) failure to properly interpret the test; (c) failure to correctly translate results into clinical practice; (d) lack of informed consent; and (e) failure to refer patients to specialized genetic counseling. Such errors may lead to compensation since the legal burden inherent in the efficacy of prophylactic interventions is a proof that requires the so-called 'preponderance of the evidence'. Concerning insurance issues, the carriers of such alleles without cancer are healthy because the genetic predisposition is not a disease per se but represents a (relevant) health risk. However, disclosure of these conditions can be impelled by insurers. It can lead to so-called 'genetic discrimination' because insurance companies might use genetic information to limit insurance options or increase their costs. Many private and public healthcare funders do not cover risk reducing surgeries, even when recommended as part of a risk reduction management plan for BRCA gene mutation carriers. Here, positions on these matters from different high income countries are discussed, stressing the importance of a common supranational or international regulatory framework to reach a trade-off between the economic interests of insurers and the rights of carriers not to disclose extremely sensitive information.
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Affiliation(s)
- Riccardo Oliva
- Department of Women's and Child Health and Public Health Sciences, Obstetrics and Gynecology, Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Italy
| | - Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, Firenze, Italy
| | - Claudia Marchetti
- Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Italy
- Department of Women's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Francesca Cazzato
- Section Legal Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Italy
| | - Roberta Marinelli
- Section Legal Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Italy
- Department of Women's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Anna Fagotti
- Università Cattolica del Sacro Cuore - Campus di Roma, Roma, Italy
- Department of Women's and Child Health and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Alarie S, Hagan J, Dalpé G, Faraji S, Mbuya-Bienge C, Nabi H, Pashayan N, Brooks JD, Dorval M, Chiquette J, Eloy L, Turgeon A, Lambert-Côté L, Paquette JS, Walker MJ, Lapointe J, Granados Moreno P, Blackmore K, Wolfson M, Broeders M, Knoppers BM, Chiarelli AM, Simard J, Joly Y. Risk-Stratified Approach to Breast Cancer Screening in Canada: Women's Knowledge of the Legislative Context and Concerns about Discrimination from Genetic and Other Predictive Health Data. J Pers Med 2021; 11:jpm11080726. [PMID: 34442372 PMCID: PMC8398750 DOI: 10.3390/jpm11080726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
The success of risk-stratified approaches in improving population-based breast cancer screening programs depends in no small part on women’s buy-in. Fear of genetic discrimination (GD) could be a potential barrier to genetic testing uptake as part of risk assessment. Thus, the objective of this study was twofold. First, to evaluate Canadian women’s knowledge of the legislative context governing GD. Second, to assess their concerns about the possible use of breast cancer risk levels by insurance companies or employers. We use a cross-sectional survey of 4293 (age: 30–69) women, conducted in four Canadian provinces (Alberta, British Colombia, Ontario and Québec). Canadian women’s knowledge of the regulatory framework for GD is relatively limited, with some gaps and misconceptions noted. About a third (34.7%) of the participants had a lot of concerns about the use of their health information by employers or insurers; another third had some concerns (31.9%), while 20% had no concerns. There is a need to further educate and inform the Canadian public about GD and the legal protections that exist to prevent it. Enhanced knowledge could facilitate the implementation and uptake of risk prediction informed by genetic factors, such as the risk-stratified approach to breast cancer screening that includes risk levels.
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Affiliation(s)
- Samuel Alarie
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
- Correspondence: ; Tel.: +1-(514)-398-8155
| | - Gratien Dalpé
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Sina Faraji
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Cynthia Mbuya-Bienge
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Hermann Nabi
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Université Laval Cancer Research Center, Quebec City, QC G1R 3S3, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London WC1E 6BT, UK;
| | - Jennifer D. Brooks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
| | - Michel Dorval
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Faculty of Pharmacy, Université Laval, Quebec City, QC G1V 4G2, Canada
- CISSS de Chaudière-Appalaches Research Center, Lévis, QC G6V 3Z1, Canada
| | - Jocelyne Chiquette
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- CHU de Québec-Université Laval, Quebec City, QC G1S 4L8, Canada
- Département de Médecine Familiale et de Médecine D’urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Laurence Eloy
- Québec Cancer Program, Ministère de la Santé et des Services Sociaux, Quebec City, QC G1S 2M1, Canada;
- Department of Social and Preventive Medicine, CISSS de Lanaudière-Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Annie Turgeon
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Laurence Lambert-Côté
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Jean-Sébastien Paquette
- Département de Médecine Familiale et de Médecine D’urgence, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | - Meghan J. Walker
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Ontario Health (Cancer Care Ontario), Toronto, ON M5G 2L3, Canada;
| | - Julie Lapointe
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
| | - Palmira Granados Moreno
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | | | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada;
| | - Mireille Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, 525 EZ Nijmegen, The Netherlands;
- Dutch Expert Centre for Screening, 6538 SW Nijmegen, The Netherlands
| | | | - Bartha M. Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
| | - Anna M. Chiarelli
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada; (J.D.B.); (M.J.W.); (A.M.C.)
- Department of Social and Preventive Medicine, CISSS de Lanaudière-Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Jacques Simard
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada; (C.M.-B.); (H.N.); (M.D.); (J.C.); (A.T.); (L.L.-C.); (J.L.); (J.S.)
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 4G2, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC H3A 0G1, Canada; (S.A.); (G.D.); (S.F.); (P.G.M.); (B.M.K.); (Y.J.)
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Wauters A, Van Hoyweghen I. Normalising life at risk of Huntington's disease. A qualitative study of backgrounds and coping strategies of fears of genetic discrimination. Eur J Hum Genet 2021; 29:940-948. [PMID: 33594260 PMCID: PMC8187417 DOI: 10.1038/s41431-021-00822-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 12/14/2022] Open
Abstract
Studies in the sociology of genetics have shown how living with a predisposition to a genetic disorder often comes with significant psycho-social burdens and struggles. One of these struggles is the fear of genetic discrimination. Despite genetic non-discrimination regulations, research shows people still worry about being subjected to genetic discrimination. This article adds to this existing body of literature by showing why people still worry about genetic discrimination and how they cope with these worries. Our findings derive from an analysis of semi-structured, in-depth interviews with individuals at risk for Huntington's disease (HD) in Belgium. Concerns of genetic discrimination are grounded in the participants' family backgrounds. Our participants, having witnessed numerous events in which symptomatic relatives suffered discrimination and stigmatisation, expressed heightened fears of facing genetic discrimination. Further, this article provides insight into the strategies participants use to cope with these fears. Two ways of normalising life were identified-while some persist in keeping their genetic risk a secret, other participants explicitly choose to be transparent about their genetic risk, desiring a level of openness. However, while they want to 'break' with their family background, participants who choose to be open are still held back by their worries about genetic discrimination by organisational actors. 'Normalising genetics' appears to be particularly challenging considering the remaining stereotypes and stigma surrounding genetic diseases.
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Affiliation(s)
- Annet Wauters
- Life Sciences & Society Lab, Centre for Sociological Research, KU Leuven, 45 - 3601, Parkstraat, Leuven, 3000, Belgium.
| | - Ine Van Hoyweghen
- Life Sciences & Society Lab, Centre for Sociological Research, KU Leuven, 45 - 3601, Parkstraat, Leuven, 3000, Belgium
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