The Impact of Known Breast Cancer Polygenes on Critical Illness Insurance

Genetic studies indicate that the inherited risk of breast cancer is mediated by the well-studied major genes BRCA1 and BRCA2, and a polygenic component, probably with many genes each making a small contribution. Recently, seven polygenes have been found (Pharoah et al., 2008) contributing an estimated 3.6% of all familial risk (Easton et al., 2007) This suggests that the polygenic component may involve well over 100 genetic loci. We extrapolate these new results into a polygenic model with 147 genetic loci and simulate lifetimes of families to calculate the premium ratings appropriate for a family history of breast or ovarian cancer. We model the adverse selection costs arising from restricting the use of genetic test information in critical illness insurance underwriting in light of new European legislation banning the use of gender for insurance underwriting. In this setting we confirm the overall conclusion of Macdonald & McIvor (2009) that the polygene confers higher adverse selection risk than the BRCA genes. We establish that their three-gene polygenic model does not overly inflate the insurance costs attributable to a polygenic component of breast cancer risk under a model with 147 polygenes.