Health: Genetic Testing — Knowing Less than We Think We Know

Two papers appearing today raise interesting questions about genetic testing.

  1. The first raises the question about insurer access to genetic testing records.
  2. The second states that some people who are genetically disposed to breast cancer don’t in fact get it — due to another genetic factor not previously considered.

In the first case, health and life insurers want access to genetic information in order to estimate more precisely the claims they are likely to face in providing insurance for a specific individual.

In fact, that approach violates the original logic of insurance — that insurance is sharing risks among a group of individuals, not writing a custom policy for a particular person.

Be that as it may, the second paper shows that what we know about genetics is still incomplete. That paper shows that persons with the BRCA mutation that disposes them to breast cancer don’t necessarily ever develop that cancer. The absence of cancer in these people may be linked to a COMT genetic variation. Right now, all that is know is that people with BRCA who don’t develop cancer tend to have the COMT variation; how it works isn’t known.

So, were an insurer to raise rates based just on the BRCA factor, the insurer could be getting an unnecessary, windfall profit on people with COMT.

Prudence says that we don’t know enough about the relationship of certain genetic factors and disease to make a universal case for inclusion of genetics in underwriting (pricing insurance). For some illnesses, maybe.  For all, no. That begs the question of whether inclusion of these factors fundamentally changed the definition of what insurance is.


  1. Mercedeh Movassagh, Prakriti Mudvari, Anelia Horvath. Co-Occurrence of COMT and BRCA1/2 Variants in a Population. New England Journal of Medicine, 2017; 376 (21): 2090 DOI: 10.1056/NEJMc1701592
  2. European Society of Human Genetics. “Balancing rights and responsibilities in insurers’ access to genetic test results.” ScienceDaily. ScienceDaily, 25 May 2017. <>.

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