Louise Slaughter (D-N.Y.), that would prohibit health insurers or employers from accessing the genetic information of patients or employees and considering it for hiring, firing and other business decisions, CQ Today reports (Armstrong, CQ Today , 4/25). The Senate Health, Education, Labor and Pensions Committee on Jan. 31 approved a similar bill (S 358), sponsored by Sen. Olympia Snowe (R-Maine). Snowe has said she introduced the legislation, called the Genetic Information Nondiscrimination Act of 2007, because some women have said they were reluctant to be tested for genetic alterations that indicate increased risk of developing breast cancer because they feared difficulty in acquiring health insurance if they tested positive ( Kaiser Daily Women's Health Policy Report, 2/15). Sen. Tom Coburn (R-Okla.) has placed a hold on the Senate legislation. According to CQ Today , Coburn said that he and his staff were working on several objections to the measure but would not give more details. Sen. Edward Kennedy (D-Mass.), chair of the HELP committee, said he thought Coburn's concerns could be addressed ( CQ Today , 4/25). Business groups, such as the U.S. Chamber of Commerce, have lobbied against such measures, saying that federal law on the issue is not needed because state laws already provide protection against such discrimination (Kaiser Daily Women's Health Policy Report, 2/15). Michael Eastman, executive director of labor policy at the chamber, said the bill would impose more medical privacy regulations that are inconsistent with current law. He added that the law would allow states to set their own, and perhaps, different rules and would allow for excessive lawsuit damages. The White House in a statement said, "The administration wants to work with Congress to further perfect this legislation and to make genetic discrimination illegal and provide individuals with fair, reasonable protections against improper use of their genetic information." The House bill now goes to the Senate (Dunham, Reuters, 4/25).

This article is republished with kind permission from our friends at the The Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery of in-depth coverage of health policy developments, debates and discussions. The Kaiser Daily Health Policy Report is published for Kaisernetwork, a free service of The Henry J. Kaiser Family Foundation. 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Based on the model, clinicians can compute a patient's ordinal risk score and absolute chance a patient has of developing lung cancer within a year. The patient then can be classified into high-, moderate-, or low-risk groups. Examples of key risk factors found in the targeted groups include:

in never smokers: exposure to secondhand smoke and family history of cancer; in both current and former smokers: emphysema; exposure to dust and no history of hay fever; in former smokers: age they stopped smoking and family history of cancer; and in current smokers: asbestos exposure, intensity of smoking and family history of a smoking-related cancer. Spitz and Etzel say that the most striking finding was the strong impact of a prior history of emphysema as a risk factor in both current and former smokers. In contrast, hay fever worked as a protective agent against lung cancer in both groups.

The study is not without limitations. One major drawback is that the model focuses only on Caucasians, due to the fact that there were not enough minority patients in the cohort to build and validate the model. "We are currently working with other institutions to combine our numbers and build a model specifically for Mexican Americans and African Americans. In preliminary testing, already we are finding that while some of the risk factors are common to both groups, there are different levels of risk, so the model for Caucasians would likely not be as predictive for other populations," says Etzel.

Also, cases and controls were paired based on smoking status - perhaps masking the importance of smoking as a risk factor, though adjustment factors were included for this limitation.

Currently, the researchers are developing a Web-based version of this lung cancer assessment model, in hopes of soon making the tool accessible to clinicians.

mdanderson