The genetics of breast and ovarian cancer IV: a model of breast cancer progression

Gui et al. (2006), in Part III of a series of papers, proposed a dynamic family history model of breast cancer (BC) and ovarian cancer in which the development of a family history was represented explicitly as a transition between states, and then applied this model to life insurance and critical illness insurance. In this study, we extend the model to income protection insurance. In this paper, Part IV of the series, we construct and parameterise a semi-Markov model for the life history of a woman with BC, in which events such as diagnosis, treatment, recovery and recurrence are incorporated. In Part V, we then show: (a) estimates of premium ratings depending on genotype or family history; and (b) the impact of adverse selection under various moratoria on the use of genetic information.