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ACOEM GUIDANCE STATEMENT
Genetic Screening in the Workplace
ACOEM Task Force on Genetic Screening in the Workplace
The mapping and sequencing of the hu-man genome has resulted in
an explo-sion of information that may ultimatelylead to improved
capability for detectingdiseases or increased susceptibility to
dis-ease, treatment of a wide range of diseases,and the
identification of individuals atincreased risk for adverse
reactions to phar-maceuticals and environmental or work-
place chemicals. Some genetic tests arealready commercially
available, eg, testswhich screen for variations in genes
thatmetabolize certain pharmaceuticals andothers that identify
individuals at increased
risks of specific types of cancer. Geneticscreening offers the
prospect of a new erafor prevention and treatment and a
growingarray of effective new interventions. (In thefollowing
discussion, the term geneticscreening and genetic testing refer
tothe evaluation of genotype (ie, tests thatspecifically
characterize gene or chromo-somal structure), not tests that
characterize
phenotype or evaluate function.)Genetic screening has also been
ac-
companied by some misunderstanding,mistrust, and fear that it
could be usedinappropriately. Indeed, certain previoususes of
genetic screening have been incon-
sistent with good ethical standards andsound scientific practice
and have led someto advocate that genetic screening betreated as a
separate category with specialsafeguards. The passage of the
GeneticInformation Nondiscrimination Act (GINA)of 2008 formalized
many of these con-cerns, thereby establishing strict restric-tions
and guidelines for the use of suchtesting in occupational
settings.
Historically, the American Collegeof Occupational and
Environmental Medi-cine (ACOEM) has taken the position thatgenetic
screening was not conceptually dif-
ferent from other types of medical testingor screening and that
adherence to existingethical standards, good scientific
practices,and laws regulating medical confidentiality
protected the rights of the individual appro-priately, while
allowing the new informa-tion to be used to further safeguard
thehealth of individuals in the workplace andelsewhere. The
adoption of GINA neces-
sarily changes that position. From a scien-tific perspective,
ACOEM still regards ge-netic screening as conceptually similar
toother types of medical screening. However,from a legal
perspective, ACOEM recog-nizes that many of the potential uses
ofgenetic screening for workplace safety pro-grams are now legally
prohibited in numer-ous jurisdictions. Genetic screening may
beoffered only on a voluntary basis and testresults may not be used
to determine work
practices or conditions of employment.It is imperative that
practitioners of
occupational and environmental medicine
be well grounded in the relevant ethical,legal, social, and
scientific considerationsand be prepared to offer sound advice
toemployees, employers, insurance compa-nies, and regulatory
agencies. For example,GINA permits voluntary testing
(geneticmonitoring) that provides informationabout the biological
effects of toxic sub-stances in the workplace. Similarly, GINA
permits voluntary testing for genetic infor-mation in otherwise
appropriate research
programs, so long as the resulting geneticinformation is not
used in a manner thatimpacts the tested individuals conditionsof
employment.
Although the application of geneticscreening in the workplace
has been lim-ited to date (and is now severely restricted),the
ethical considerations of such testing inthe workplace (and
elsewhere) have beenextensively examined. ACOEM endorsesthe
following guiding principles:
Y Genetic screening must be conducted inaccordance with the law,
medical ethicalstandards, and good scientific practices.
Y Until extensively validated, geneticscreening is a form of
human investiga-tion and subject to the appropriate ethi-cal and
scientific controls.
Y Due consideration should be given to thequality and
reliability of the screening testsand the predictive value of the
results.
Y Caution should be exercised in the useand interpretation of
screening tests.
Y If performed, genetic screening shouldalways be accompanied by
an opportu-nity to discuss the meaning of the resultswith an
appropriately trained health pro-fessional.
When consulted by employees aboutdecisions to have genetic
testing performed(or seeking explanations of results per-formed
apart from the workplace), occupa-
tional physicians should candidly share, inline with these
principles, the limitations oftesting and the uncertainties
regarding in-terpretation of results.
ACOEM also notes that GINA maycomplicate ethical considerations
for occu-
pational physicians and others committedto the health and safety
of workers andworkplaces. It seems reasonable to expectthat in the
future, some forms of genetictesting will provide a basis for more
effec-tive methods to ensure the health of indi-vidual workers but
that preventive actionstaken on the basis of such testing might
violate GINA. In such situations, both act-ing on the basis of
genetic information to
better protect the workerand not actingon that information, and
thereby failing to
protect the workerwould violate stan-dards of ethical conduct.
ACOEM hopesthat such potential conflicts can be preemp-tively
resolved without recourse to litiga-tion and the federal court
system.
ACKNOWLEDGMENTS
This ACOEM statement was devel-oped by ACOEMs Task Force on
GeneticScreening in the Workplace under the aus-
pices of the Council of Scientific Advisors.Task Force members
were Drs. Paul
Brandt-Rauf, David C. Deubner, BenjaminF. Withers, T. Warner
Hudson, andJonathan Borak. This statement was peerreviewed by the
Council and was approvedby the ACOEM Board of Directors on May1,
2010. This statement updates ACOEMs2005 genetic screening
statement.
REFERENCES
Brandt-Rauf PW, Brandt-Rauf SI. Genetic testing inthe workplace:
ethical, legal, and social implica-tions. Annu Rev Public Health.
2004;25:139
153.British Medical Association. Population Screening
and Genetic Testing: A Briefing on Current Pro-grammes and
Technologies. London: BritishMedical Association; 2005.
Genetic Information Nondiscrimination Act of 2008(Public Law
110233). 122 STAT. 881922.Available at:
www.gpo.gov/fdsys/pkg/PLAW-110publ233/pdf/PLAW-110publ233.pdf.
AccessedMay 21, 2008.
Greely HT. Banning genetic discrimination. N EnglJ Med.
2005;353:865867.
NIOSH. Genetics in the Workplace: Implicationsfor Occupational
Safety and Health (DHHS[NIOSH] Publication Number 2010-101).
Wash-ington, DC: Department of Health and HumanServices; 2009.
Address correspondence to: ACOEM at [email protected].
Copyright 2010 by American College of Occu-pational and
Environmental MedicineDOI: 10.1097/JOM.0b013e3181ebac98
JOEM Volume 52, Number 7, July 2010 763
