1. Breast Cancer and Ethical Issues Regarding Insurance Coverage! By Jenn Butt Heidi Keefe Melissa Snyder Rachel Malinowski

2. What is the disease? n Familial Breast Cancer is Autosomal Dominant n Two genes are involved in inheritance (BRCA1, BRCA2) n These two genes are account for as much as 5-10% of all breast cancers.

3. An Example Pedegree

4. Who usually gets the disease n Women inheriting BRCA1 and BRCA2 have a 60-90% lifetime risk of developing breast cancer and a 20-60% risk for ovarian cancer. n Women above the age of 40 have a greater risk for developing the disease than those under 40, which is the reason that an insurance company will not pay for a mammogram for those under 40.

5. Who usually get the disease? (cont.) n 77% of women who are diagnosed with breast cancer are over the age of 50. n Women with a mother or a sister who developed breast cancer before menopause are twice as at risk as the general population. n Caucasian women are more likely to develop breast cancer, but African American woman are more likely to die from it.

6. Genetics of Breast Cancer n BRCA1 is found on chromosome 17 (17q21) n The entire sequence of the gene is known n BRCA2 is found on chromosome 13 (13q12.3)

7. Insurance Information n Legislation has been enacted to prevent insurance discrimination based on genetic test results since 1997. n In Case 11, the patient was dropped from the plan after her physician gave information about genetic predisposition to the insurance company and her preventative testing was no longer paid for.

8. Insurance Information (cont.) n Most major insurance companies understand the value of BRACAnalysis® for high risk women

9. References n http://www.familycancer.org/ n Our Textbook n http://www3.ncbi.nlm.nih.gov/Omim/

10. Health Insurance Portability and Accountability Act n Ensures that Americans have access to group insurance when they change jobs n It prevents medical information from genetic tests from being used to deny coverage n Kennedy Kasselbaum says that you cannot be dropped from a group plan, but you can be dropped from an individual plan