title: Is uptake of genetic testing for colorectal cancer influenced by knowledge of insurance implications?
abstract: OBJECTIVE
  To assess whether knowledge of insurance implications influenced uptake of genetic testing by participants in a research study of the causes of colorectal cancer.
  
  
  METHODS
  Analysis of uptake of genetic testing by participants in the population-based Victorian Colorectal Cancer Family Study during two periods: from 1999 to 2003, when participants were not informed of any potential effect of genetic testing conducted during the study on their eligibility for new insurance policies; and from 2003 to 2006, when the protocol was changed to provide participants with information on the potential effect of genetic testing on insurance eligibility.
  
  
  METHODS
  Uptake of genetic testing for germline mutations in DNA mismatch repair (MMR) genes at a family cancer clinic.
  
  
  RESULTS
  The proportion of participants who declined genetic testing among those informed of insurance implications was more than double the proportion among those without this knowledge (29/59 [49%] v 9/47 [19%]; P = 0.002). This difference could not be explained statistically by adjusting for measured putative predictors.
  
  
  CONCLUSIONS
  Identification of people with a mutation in an MMR gene has clinical importance, and such screening may be a cost-effective way to reduce the burden of colorectal cancer in the community. If people are choosing not to obtain genetic information because of how it will affect their eligibility for insurance, reforms to existing insurance practices are indicated.
authors.affiliation: Key Centre for Women's Health in Society, University of Melbourne, Melbourne, VIC.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Keogh
authors.forename: Christine M
authors.initials: CM
authors.lastname: van Vliet
authors.forename: David M
authors.initials: DM
authors.lastname: Studdert
authors.forename: Judith A
authors.initials: JA
authors.lastname: Maskiell
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
authors.forename: D James
authors.initials: DJ
authors.lastname: St John
authors.forename: Clara L
authors.initials: CL
authors.lastname: Gaff
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Young
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Southey
authors.forename: Graham G
authors.initials: GG
authors.lastname: Giles
authors.forename: Doreen A
authors.initials: DA
authors.lastname: Rosenthal
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
authors.forename: Mark A
authors.initials: MA
authors.lastname: Jenkins
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000235:genetics; D004273:DNA, Neoplasm / Q000032:analysis*; D005260:Female; D005821:Genetic Techniques / Q000191:economics*; D005820:Genetic Testing / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007348:Insurance, Health / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D014739:Victoria
chemical_list: D004273:DNA, Neoplasm