Ethical Considerations in Testing Workers for the -Glu69 Marker of Genetic Susceptibility to Chronic Beryllium Disease

Abstract

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.

Genetic susceptibility testing for beryllium: Worker knowledge, beliefs, and attitudes

“…This social dynamic could cause a workplace susceptibility-testing program to backfire, especially if: (a) the genetic marker is present in a minority of the work force; and (b) the test is not highly sensitive. These conditions are nearly satisfied by the Glu69 marker: its allelic frequency is about 30-40% among ethnic groups common to the United States, and it is absent from up to 28% of workers with CBD [Silver and Sharp, 2006]. So even voluntary removal of 100% of the individuals deemed ''susceptible'' would not create a safe environment for those with continued exposure.…”

“…The range of responses we report here could be helpful in developing guidelines to be used in a voluntary genetic testing program, laying out the implications of selfdisclosing to various actors [Silver and Sharp, 2006].…”

“…Beryllium is the first industrial toxicant for which a valid genetic susceptibility test may soon be available [Silver and Sharp, 2006]. Initially, a glutamic acid substitution for lysine or arginine in position 69 of the HLA-DPB1-0201 allele of the major histocompatibility complex (''Glu69'') was found to be associated with elevated risk of chronic beryllium disease (CBD) [Saltini, 1995].…”

Considerations for Designing a Prototype Genetic Test for Use in Translational Research

“…Health conditions were expected to have a substantial public health impact, as measured by prevalence, severity, and healthcare costs. For example, health conditions such as chronic beryllium disease may be addressed by genetic susceptibility testing for those who have an environmental exposure to beryllium [45]. However, chronic beryllium disease is uncommon, affecting ∼1% of a distinct group, generally industrial metal workers exposed to beryllium dust [45].…”

“…For example, health conditions such as chronic beryllium disease may be addressed by genetic susceptibility testing for those who have an environmental exposure to beryllium [45]. However, chronic beryllium disease is uncommon, affecting ∼1% of a distinct group, generally industrial metal workers exposed to beryllium dust [45]. Thus, while genetic testing might be appropriate for this targeted group, chronic beryllium disease was excluded from consideration for a research genetic susceptibility test that is focused on the general population.…”