Ethical considerations in testing workers for the -Glu69 marker of genetic susceptibility to chronic beryllium disease.
OBJECTIVE
The most compelling real-world example of genetic testing for susceptibility to a workplace exposure involves those industries that process or fabricate beryllium. We examined ethical issues associated with testing for susceptibility to chronic beryllium disease.


METHODS
Using ethical and clinical criteria, we examined voluntary employer-sponsored testing programs in which individual results are reported directly to workers in a confidential manner.


RESULTS
Under reasonable assumptions, the longitudinal positive predictive value of the HLA-DPB1-Glu69 marker of susceptibility to beryllium disease is 12%. Interpretive challenges further limit the utility of the test and may inadvertently suggest a false sense of safety among workers. Concerns about confidential participation and pressures to be tested also must be addressed.


CONCLUSIONS
Difficulties surrounding the interpretation of the HLA-DPB1-Glu69 marker, lack of assurance regarding the protection of worker confidentiality, and the potential lowering of social barriers to the implementation of mandatory worker screening combine to make testing beryllium workers inappropriate at this time.
Silver
Ken
K
Department of Environmental Health, East Tennessee State University, Johnson City, Tennessee, USA.
Sharp
Richard R
RR
D001607:Berylliosis / Q000235:genetics*; D003219:Confidentiality / Q000941:ethics; D005819:Genetic Markers / Q000941:ethics / Q000235:genetics; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D005820:Genetic Testing / Q000941:ethics* / Q000379:methods; D006682:HLA-DP Antigens / Q000032:analysis*; D059868:HLA-DP beta-Chains; D006801:Humans; D009787:Occupational Medicine / Q000941:ethics; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000941:ethics; D035141:Voluntary Programs / Q000941:ethics
D005819:Genetic Markers; D006682:HLA-DP Antigens; D059868:HLA-DP beta-Chains; C071170:HLA-DPB1 antigen