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Cancer Control Research

Abstract

DESCRIPTION: (Applicant's Abstract) This study will analyze how knowledge of genetic test results for the BRCA1 gene influences consumer behaviors and attitudes regarding life insurance coverage. The current proposal complements a larger, on-going research project, "Behavioral and Psychosocial Effects of BRCA1 Testing," (R01-CA- 63681), that focuses on psychological, familial, and risk behavior changes associated with the receipt of genetic test results. The current study will look specifically at how the receipt of genetic test results for the BRCA1 gene affects choices about life insurance coverage and consumers' attitudes regarding if insurers should have access to genetic test results. Particular attention will be given to assessing the potential for adverse selection that is created by such genetic testing procedures. The research specific questions that will be addressed are: (1) Does the receipt of information that one is a BRCA1 gene carrier lead women to increase their life insurance coverage above levels of coverage purchased by (a) women who test negative for the BRCA1 gene, (b) women who have a known family history of breast/ovarian cancer but who are not tested, and/or (c) women in the general public who have no family history of breast/ovarian cancer? (2) Are those who test negative for the BRCA1 gene more likely to share their test results voluntarily with insurers than those who test positive? (3) Do these four groups differ in their opinions regarding the need to balance life, health, and disability insurers' need to know the results of genetic tests and consumers' right to privacy? Survey data on life insurance coverage and attitudes will be gathered from four groups of women: (a) those who test positive for the BRCA1 gene, (b) those who test negative for the BRCA1 gene, (c) those who have a family history of breast/ovarian cancer but who are not tested for the BRCA1 gene, and (d) those who have no family history of breast/ovarian cancer. A two-equation, multivariate system that corrects for selectivity bias will be used to ascertain if knowledge of genetic test results creates a threat of adverse selection in the insurance market. Separate mulitvariate analyses will also examine (a) the factors that affect the probability that consumers voluntarily share test results with insurers, and (b) the factors that affect public opinion regarding the consumer's right to privacy versus the insurance industry's need to know genetic test results. The findings of this study will provide information that is critical for the conduct of human genetic research, the design of appropriate counseling protocols, and the development of public policies that relate to the possible use of genetic test results by the insurance industry.