Genetics and Public Health in the 21st Century: Using Genetic Information to Improve Health and Prevent Disease. Khoury MJ, Burke W, Thomson EJ, eds., New York: Oxford University Press, Inc., 2000 Aug; :203-219
Genetic information is information about genes, gene products, or inherited characteristics that may derive from an individual or family member. In the workplace, genetic information is usually the product of genetic screening or genetic monitoring, but may also be derived from a person's medical record. This chapter examines the use of genetic information in the occupational safety and health field in terms of practice, research, and regulation. In occupational health practice, genetic monitoring of workers exposed to various toxicants is analogous to biological monitoring for the presence or effects of any toxicant. Here the issue is to use genetic material or somatic or germline DNA to assess whether exposures or health effects are likely to have occurred. Genetic screening, in contrast, is rarely practiced but is aimed at identifying an asymptomatic person with a particular inherited genetic characteristic who is likely to develop a health effect related to work. For the most part, genetic screening related to occupational diseases involves hereditary characteristics that have an influence in conjunction with a particular exposure but which do not confer a risk on their own. At the present time, little scientific evidence has been found to support a link between unexpressed genetic factors and a person's ability to perform job functions. From a public health perspective, genetic monitoring and screening raise very different issues. Genetic monitoring has many of the same strengths and limitations of any type of toxic effect monitoring such as assessing blood lead, carboxyhemoglobin, or liver-function assays. In these situations, the genetic effect must be validated for the exposure or disease - that is, the relationship between the genetic effect and exposure or disease must be known before it is used. Moreover, as with all monitoring, attention needs to be given before the genetic monitoring is ascertaining whether a person's genetic material has been altered over time, thus indicating exposure or providing an early warning of possible health effects. Using changes in genetic materials as exposure indicators has been well studied. Not only has genetic monitoring been used to assess damage from occupational exposures, but also from other environmental exposures and lifestyle habits such as smoking. The benefits of a monitoring program include (1) identifying a risk for the exposed group as a whole or for individuals; (2) targeting work areas for evaluation of safety and health practices; and (3) detecting previously unknown hazards-thus possibly decreasing health costs for employers, insurance companies, and society in general. In an Office of Technology Assessment survey conducted in 1989 of Fortune 500 companies, only one company reported currently conducting genetic monitoring. Five companies reported past use of genetic monitoring and two companies reported future consideration of genetic monitoring.