London IDEAS Genetics Knowledge Park

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London IDEAS Genetics Knowledge Park
Effect of a breast cancer family history on life
insurance costs
Amy Hunter Manager London IDEAS Genetics
Knowledge Park a.hunter_at_ich.ucl.ac.uk
London IDEAS Genetics Knowledge Park
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Outline

• Introduction Genetics Knowledge Parks
• Revision! Predictive genetic tests and
  commercial insurance
• Survey on family history and insurance premiums

London IDEAS Genetics Knowledge Park
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GKP network
London IDEAS Genetics Knowledge Park
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GKP network

• Funded by Department of Health, and Department of
  Trade and Industry
• London IDEAS GKP consortium of university and
  NHS organisations in London, and Genetic
  Interest Group

London IDEAS Genetics Knowledge Park
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GKP network
Genetics and
lab research to improve genetics technologies in
NHS
building good ethical practice in NHS, contribute
to public debate e.g. insurance
training NHS professionals, new information
resources for public
cheap, efficient diagnostic tests for NHS labs
London IDEAS Genetics Knowledge Park
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Predictive and diagnostic tests
test taken to determine risk of developing
condition later in life e.g. cholesterol test for
risk of heart disease BRCA1/BRCA2 gene test for
breast cancer
Predictive
test taken to confirm diagnosis of existing
symptomatic condition e.g. angiogram for heart
disease, lump biopsy
Diagnostic
London IDEAS Genetics Knowledge Park
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Public and industry concerns

• privacy of medical information
• discrimination / increased premiums

Public Industry

• accurate risk assessment
• adverse selection

London IDEAS Genetics Knowledge Park
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Models of insurance

• Individuals contribute according to own risk
• Higher risk of future claim, higher premium
• UK life insurance, critical illness, income
  protection, travel insurance

Mutuality Solidarity

• Burden of risk shared by whole community
• UK National Health Service

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Current moratorium

• Industry cannot use adverse results of predictive
  genetic tests for policies below certain values
• cannot request test taken
• cannot request disclosure
• For high-value policies, use of tests only with
  GAIC approval (Huntingtons)
• Initially 2001 to 2006, extended to November 2011

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London IDEAS activities

• Education and information
• Research
• familial hypercholesterolaemia
• breast cancer

London IDEAS Genetics Knowledge Park
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Breast cancer and insurance

• GAIC expects revised applications in 2005 for use
  of BRCA1/2 for high value policies
• Life insurance
• Critical illness
• Income protection

• Possible wider use after moratorium unknown as
  yet

• NICE 2004 clinical guidelines approving testing
  more high risk women may take up testing

London IDEAS survey of industry practice data on
use of family history as baseline ahead of BRCA
testing
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Breast cancer and insurance
Mother 65, healthy except BC age 35
Father 68, healthy
Female applicant 35, asymptomatic

• 3-fold higher risk of BC mortality during 20-yr
  policy term
• 10 of 16 companies standard premium
• 6 of 16 companies higher premium (50 or 75 xs
  mortality)

London IDEAS Genetics Knowledge Park
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Breast cancer and insurance
Mother 65, healthy except BC age 35
Father 68, healthy
Female applicant 35, asymptomatic mammographic
screening programme

• 3-fold higher risk of BC mortality during 20-yr
  policy term
• 2 companies reduced their higher premium to
  standard

London IDEAS Genetics Knowledge Park
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Breast cancer and insurance
Mother 65, healthy except BC age 35
Father 68, healthy
Female applicant 35, asymptomatic prophylactic
breast and ovarian surgery

• at-risk tissue removed
• all companies bar one offered standard premium

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Breast cancer and insurance
Summary

• most companies offer standard premiums despite
  higher than average risk
• some companies charging higher premiums give
  credit for surveillance
• all companies charging higher premiums give
  credit for prophylactic surgery

Reassuring message for women with family
history Baseline snapshot before use of BRCA test
results
London IDEAS Genetics Knowledge Park
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London IDEAS Genetics Knowledge Park
Effect of a breast cancer family history on life
insurance costs
Amy Hunter Manager London IDEAS Genetics
Knowledge Park a.hunter_at_ich.ucl.ac.uk
London IDEAS Genetics Knowledge Park