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Tutty E, Archibald AD, Downie L, Gaff C, Lunke S, Vears DF, Stark Z, Best S. Key informant perspectives on implementing genomic newborn screening: a qualitative study guided by the Action, Actor, Context, Target, Time framework. Eur J Hum Genet 2024:10.1038/s41431-024-01650-7. [PMID: 38907005 DOI: 10.1038/s41431-024-01650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/01/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024] Open
Abstract
Newborn screening (NBS) programmes are highly successful, trusted, public health interventions. Genomic sequencing offers the opportunity to increase the benefits of NBS by screening infants for a greater number and variety of childhood-onset conditions. This study aimed to describe who needs to do what, when, and for whom to deliver genomic newborn screening (gNBS) and capture perceived implementation barriers and enablers. 'Key informants' (individuals involved in the delivery of NBS) were interviewed. The Actor, Action, Context, Time and Target framework guided data collection and analysis. Participants (N = 20) identified new Actions required to deliver gNBS (educating healthcare providers, longitudinal psychosocial support), NBS Actions needing modification (obtaining consent) and NBS Actions that could be adopted for gNBS (prompt referral pathways). Obtaining consent in a prenatal Context was a source of some disagreement. The Time to disclose high chance results was raised as a key consideration in gNBS programme design. Genetic counsellors were identified as key Actors in results management, but workforce limitations may be a barrier. Online decision support tools were an enabler to offering gNBS. The implementation of gNBS will require behaviour changes from HCPs delivering NBS. Findings can inform how to deliver gNBS at population-scale.
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Affiliation(s)
- Erin Tutty
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Alison D Archibald
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Service, Melbourne, VIC, Australia
| | - Lilian Downie
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Service, Melbourne, VIC, Australia
| | - Clara Gaff
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
- WEHI, Melbourne, VIC, 3052, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Service, Melbourne, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
- Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danya F Vears
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne Law School, University of Melbourne, Melbourne, VIC, Australia
| | - Zornitza Stark
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Service, Melbourne, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | - Stephanie Best
- Australian Genomics, Melbourne, VIC, Australia.
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
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2
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Betzler IR, Hempel M, Mütze U, Kölker S, Winkler E, Dikow N, Garbade SF, Schaaf CP, Brennenstuhl H. Comparative analysis of gene and disease selection in genomic newborn screening studies. J Inherit Metab Dis 2024. [PMID: 38757337 DOI: 10.1002/jimd.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
Genomic newborn screening (gNBS) is on the horizon given the decreasing costs of sequencing and the advanced understanding of the impact of genetic variants on health and diseases. Key to ongoing gNBS pilot studies is the selection of target diseases and associated genes to be included. In this study, we present a comprehensive analysis of seven published gene-disease lists from gNBS studies, evaluating gene-disease count, composition, group proportions, and ClinGen curations of individual disorders. Despite shared selection criteria, we observe substantial variation in total gene count (median 480, range 237-889) and disease group composition. An intersection was identified for 53 genes, primarily inherited metabolic diseases (83%, 44/53). Each study investigated a subset of exclusive gene-disease pairs, and the total number of exclusive gene-disease pairs was positively correlated with the total number of genes included per study. While most pairs receive "Definitive" or "Strong" ClinGen classifications, some are labeled as "Refuted" (n = 5) or "Disputed" (n = 28), particularly in genetic cardiac diseases. Importantly, 17%-48% of genes lack ClinGen curation. This study underscores the current absence of consensus recommendations for selection criteria for target diseases for gNBS resulting in diversity in proposed gene-disease pairs, their coupling with gene variations and the use of ClinGen curation. Our findings provide crucial insights into the selection of target diseases and accompanying gene variations for future gNBS program, emphasizing the necessity for ongoing collaboration and discussion about criteria harmonization for panel selection to ensure the screening's objectivity, integrity, and broad acceptance.
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Affiliation(s)
- Isabel R Betzler
- Institute of Human Genetics, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Maja Hempel
- Institute of Human Genetics, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Mütze
- Centre for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kölker
- Centre for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Eva Winkler
- Section of Translational Medical Ethics, National Center for Tumour Diseases, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Nicola Dikow
- Institute of Human Genetics, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Sven F Garbade
- Centre for Child and Adolescent Medicine, Division of Child Neurology and Metabolic Medicine, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Christian P Schaaf
- Institute of Human Genetics, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
| | - Heiko Brennenstuhl
- Institute of Human Genetics, Heidelberg University and University Hospital Heidelberg, Heidelberg, Germany
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Spiekerkoetter U, Bick D, Scott R, Hopkins H, Krones T, Gross ES, Bonham JR. Genomic newborn screening: Are we entering a new era of screening? J Inherit Metab Dis 2023; 46:778-795. [PMID: 37403863 DOI: 10.1002/jimd.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Population newborn screening (NBS) for phenylketonuria began in the United States in 1963. In the 1990s electrospray ionization mass spectrometry permitted an array of pathognomonic metabolites to be identified simultaneously, enabling up to 60 disorders to be recognized with a single test. In response, differing approaches to the assessment of the harms and benefits of screening have resulted in variable screening panels worldwide. Thirty years on and another screening revolution has emerged with the potential for first line genomic testing extending the range of screening conditions recognized after birth to many hundreds. At the annual SSIEM conference in 2022 in Freiburg, Germany, an interactive plenary discussion on genomic screening strategies and their challenges and opportunities was conducted. The Genomics England Research project proposes the use of Whole Genome Sequencing to offer extended NBS to 100 000 babies for defined conditions with a clear benefit for the child. The European Organization for Rare Diseases seeks to include "actionable" conditions considering also other types of benefits. Hopkins Van Mil, a private UK research institute, determined the views of citizens and revealed as a precondition that families are provided with adequate information, qualified support, and that autonomy and data are protected. From an ethical standpoint, the benefits ascribed to screening and early treatment need to be considered in relation to asymptomatic, phenotypically mild or late-onset presentations, where presymptomatic treatment may not be required. The different perspectives and arguments demonstrate the unique burden of responsibility on those proposing new and far-reaching developments in NBS programs and the need to carefully consider both harms and benefits.
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Affiliation(s)
- Ute Spiekerkoetter
- Department of Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University Children's Hospital, Freiburg, Germany
| | | | | | | | - Tanja Krones
- URPP Human Reproduction Reloaded - H2R and Institute of Biomedical Ethics and History of Medicine, University Hospital/University of Zurich, Zurich, Switzerland
| | | | - James R Bonham
- International Society of Neonatal Screening, Maarssen, The Netherlands
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White S, Mossfield T, Fleming J, Barlow-Stewart K, Ghedia S, Dickson R, Richards F, Bombard Y, Wiley V. Expanding the Australian Newborn Blood Spot Screening Program using genomic sequencing: do we want it and are we ready? Eur J Hum Genet 2023; 31:703-711. [PMID: 36935418 PMCID: PMC10250371 DOI: 10.1038/s41431-023-01311-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/12/2022] [Accepted: 01/31/2023] [Indexed: 03/21/2023] Open
Abstract
Since the introduction of genome sequencing in medicine, the factors involved in deciding how to integrate this technology into population screening programs such as Newborn Screening (NBS) have been widely debated. In Australia, participation in NBS is not mandatory, but over 99.9% of parents elect to uptake this screening. Gauging stakeholder attitudes towards potential changes to NBS is vital in maintaining this high participation rate. The current study aimed to determine the knowledge and attitudes of Australian parents and health professionals to the incorporation of genomic sequencing into NBS programs. Participants were surveyed online in 2016 using surveys adapted from previous studies. The majority of parents (90%) self-reported some knowledge of NBS, with 77% expressing an interest in NBS using the new technology. This was significantly lower than those who would utilise NBS using current technologies (99%). Although, many health professionals (62%) felt that new technologies should currently not be used as an adjunct to NBS, 79% foresaw the use of genomic sequencing in NBS by 2026. However, for genomic sequencing to be considered, practical and technical challenges as well as parent information needs were identified including the need for accurate interpretation of data; pre-and post-test counselling; and appropriate parental consent and opt-out process. Therefore, although some support for implementing genomic sequencing into Australian NBS does exist, there is a need for further investigation into the ethical, social, legal and practical implications of introducing this new technology as a replacement to current NBS methods.
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Affiliation(s)
- Stephanie White
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Tamara Mossfield
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
- Genea, Sydney CBD, Sydney, NSW, Australia
| | - Jane Fleming
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Kristine Barlow-Stewart
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sondhya Ghedia
- Department of Clinical Genetics, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Rebecca Dickson
- Genea, Sydney CBD, Sydney, NSW, Australia
- Royal Hospital for Women, Sydney, NSW, Australia
| | - Fiona Richards
- Department of Clinical Genetics, Children's Hospital, Westmead, Sydney, NSW, Australia
| | - Yvonne Bombard
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Veronica Wiley
- NSW Newborn Screening Programme, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Gold NB, Adelson SM, Shah N, Williams S, Bick SL, Zoltick ES, Gold JI, Strong A, Ganetzky R, Roberts AE, Walker M, Holtz AM, Sankaran VG, Delmonte O, Tan W, Holm IA, Thiagarajah JR, Kamihara J, Comander J, Place E, Wiggs J, Green RC. Perspectives of Rare Disease Experts on Newborn Genome Sequencing. JAMA Netw Open 2023; 6:e2312231. [PMID: 37155167 PMCID: PMC10167563 DOI: 10.1001/jamanetworkopen.2023.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
Importance Newborn genome sequencing (NBSeq) can detect infants at risk for treatable disorders currently undetected by conventional newborn screening. Despite broad stakeholder support for NBSeq, the perspectives of rare disease experts regarding which diseases should be screened have not been ascertained. Objective To query rare disease experts about their perspectives on NBSeq and which gene-disease pairs they consider appropriate to evaluate in apparently healthy newborns. Design, Setting, and Participants This survey study, designed between November 2, 2021, and February 11, 2022, assessed experts' perspectives on 6 statements related to NBSeq. Experts were also asked to indicate whether they would recommend including each of 649 gene-disease pairs associated with potentially treatable conditions in NBSeq. The survey was administered between February 11 and September 23, 2022, to 386 experts, including all 144 directors of accredited medical and laboratory genetics training programs in the US. Exposures Expert perspectives on newborn screening using genome sequencing. Main Outcomes and Measures The proportion of experts indicating agreement or disagreement with each survey statement and those who selected inclusion of each gene-disease pair were tabulated. Exploratory analyses of responses by gender and age were conducted using t and χ2 tests. Results Of 386 experts invited, 238 (61.7%) responded (mean [SD] age, 52.6 [12.8] years [range 27-93 years]; 126 [52.9%] women and 112 [47.1%] men). Among the experts who responded, 161 (87.9%) agreed that NBSeq for monogenic treatable disorders should be made available to all newborns; 107 (58.5%) agreed that NBSeq should include genes associated with treatable disorders, even if those conditions were low penetrance; 68 (37.2%) agreed that actionable adult-onset conditions should be sequenced in newborns to facilitate cascade testing in parents, and 51 (27.9%) agreed that NBSeq should include screening for conditions with no established therapies or management guidelines. The following 25 genes were recommended by 85% or more of the experts: OTC, G6PC, SLC37A4, CYP11B1, ARSB, F8, F9, SLC2A1, CYP17A1, RB1, IDS, GUSB, DMD, GLUD1, CYP11A1, GALNS, CPS1, PLPBP, ALDH7A1, SLC26A3, SLC25A15, SMPD1, GATM, SLC7A7, and NAGS. Including these, 42 gene-disease pairs were endorsed by at least 80% of experts, and 432 genes were endorsed by at least 50% of experts. Conclusions and Relevance In this survey study, rare disease experts broadly supported NBSeq for treatable conditions and demonstrated substantial concordance regarding the inclusion of a specific subset of genes in NBSeq.
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Affiliation(s)
- Nina B. Gold
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital for Children, Boston
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sophia M. Adelson
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Ariadne Labs, Boston, Massachusetts
| | - Nidhi Shah
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine, Hanover, New Hampshire
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts
| | - Shardae Williams
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Ariadne Labs, Boston, Massachusetts
| | - Sarah L. Bick
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts
| | - Emilie S. Zoltick
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jessica I. Gold
- Division of Human Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alanna Strong
- Division of Human Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rebecca Ganetzky
- Division of Human Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Amy E. Roberts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology and Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Melissa Walker
- Division of Pediatric Neurology, Massachusetts General Hospital for Children, Boston
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Alexander M. Holtz
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts
| | - Vijay G. Sankaran
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ottavia Delmonte
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Weizhen Tan
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Nephrology, Massachusetts General Hospital for Children, Boston
| | - Ingrid A. Holm
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts
- Manton Center for Orphan Diseases Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Jay R. Thiagarajah
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Junne Kamihara
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Hematology/Oncology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jason Comander
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Emily Place
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Janey Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Robert C. Green
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Ariadne Labs, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Broad Institute, Boston, Massachusetts
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Farrell MH, Mooney KE, Laxova A, Farrell PM. Parental Preferences about Policy Options Regarding Disclosure of Incidental Genetic Findings in Newborn Screening: Using Videos and the Internet to Educate and Obtain Input. Int J Neonatal Screen 2022; 8:ijns8040054. [PMID: 36278624 PMCID: PMC9590039 DOI: 10.3390/ijns8040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Our objective was to develop and test a new approach to obtaining parental policy guidance about disclosure of incidental findings of newborn screening for cystic fibrosis (CF), including heterozygote carrier status and the conditions known as CFTR-related metabolic syndrome (CRMS) and/or cystic fibrosis screen positive inconclusive diagnosis, CFSPID. The participants were parents of infants up to 6 months old recruited from maternity hospitals/clinics, parent education classes and stores selling baby products. Data were collected using an anonymous, one-time Internet-based survey. The survey introduced two scenarios using novel, animated videos. Parents were asked to rank three potential disclosure policies-Fully Informed, Parents Decide, and Withholding Information. Regarding disclosure of information about Mild X (analogous to CRMS/CFSPID), 57% of respondents ranked Parents Decide as their top choice, while another 41% ranked the Fully Informed policy first. Similarly, when considering disclosure of information about Disease X (CF) carrier status, 50% and 43% gave top rankings to the Fully Informed and Parents Decide policies, respectively. Less than 8% ranked the Withholding Information policy first in either scenario. Data from value comparisons suggested that parents believed knowing everything was very important even if they became distressed. Likewise, parents preferred autonomy even if they became distressed. However, when there might not be enough time to learn everything, parents showed a slight preference for deferring decision-making. Because most parents strongly preferred the policies of full disclosure or making the decision, rather than the withholding option for NBS results, these results can inform disclosure policies in NBS programs, especially as next-generation sequencing increases incidental findings.
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Affiliation(s)
- Michael H. Farrell
- Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Katherine E. Mooney
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Anita Laxova
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Philip M. Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, CSC Room K4/948, 600 Highland Avenue, Madison, WI 53792, USA
- Correspondence: ; Tel.: +1-608-345-2308; Fax: +1-608-263-2820
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Bick D, Ahmed A, Deen D, Ferlini A, Garnier N, Kasperaviciute D, Leblond M, Pichini A, Rendon A, Satija A, Tuff-Lacey A, Scott RH. Newborn Screening by Genomic Sequencing: Opportunities and Challenges. Int J Neonatal Screen 2022; 8:40. [PMID: 35892470 PMCID: PMC9326745 DOI: 10.3390/ijns8030040] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/11/2022] Open
Abstract
Newborn screening for treatable disorders is one of the great public health success stories of the twentieth century worldwide. This commentary examines the potential use of a new technology, next generation sequencing, in newborn screening through the lens of the Wilson and Jungner criteria. Each of the ten criteria are examined to show how they might be applied by programmes using genomic sequencing as a screening tool. While there are obvious advantages to a method that can examine all disease-causing genes in a single assay at an ever-diminishing cost, implementation of genomic sequencing at scale presents numerous challenges, some which are intrinsic to screening for rare disease and some specifically linked to genomics-led screening. In addition to questions specific to routine screening considerations, the ethical, communication, data management, legal, and social implications of genomic screening programmes require consideration.
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Affiliation(s)
- David Bick
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Arzoo Ahmed
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Dasha Deen
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Alessandra Ferlini
- Medical Genetics Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | | | - Dalia Kasperaviciute
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Mathilde Leblond
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Amanda Pichini
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Augusto Rendon
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Aditi Satija
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Alice Tuff-Lacey
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
| | - Richard H. Scott
- Genomics England Ltd., Dawson Hall, Charterhouse Square, Barbican, London EC1M 6BQ, UK; (A.A.); (D.D.); (D.K.); (M.L.); (A.P.); (A.R.); (A.S.); (A.T.-L.); (R.H.S.)
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8
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Rahimzadeh V, Friedman JM, de Wert G, Knoppers BM. Exome/Genome-Wide Testing in Newborn Screening: A Proportionate Path Forward. Front Genet 2022; 13:865400. [PMID: 35860465 PMCID: PMC9289115 DOI: 10.3389/fgene.2022.865400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/27/2022] [Indexed: 11/20/2022] Open
Abstract
Population-based newborn screening (NBS) is among the most effective public health programs ever launched, improving health outcomes for newborns who screen positive worldwide through early detection and clinical intervention for genetic disorders discovered in the earliest hours of life. Key to the success of newborn screening programs has been near universal accessibility and participation. Interest has been building to expand newborn screening programs to also include many rare genetic diseases that can now be identified by exome or genome sequencing (ES/GS). Significant declines in sequencing costs as well as improvements to sequencing technologies have enabled researchers to elucidate novel gene-disease associations that motivate possible expansion of newborn screening programs. In this paper we consider recommendations from professional genetic societies in Europe and North America in light of scientific advances in ES/GS and our current understanding of the limitations of ES/GS approaches in the NBS context. We invoke the principle of proportionality-that benefits clearly outweigh associated risks-and the human right to benefit from science to argue that rigorous evidence is still needed for ES/GS that demonstrates clinical utility, accurate genomic variant interpretation, cost effectiveness and universal accessibility of testing and necessary follow-up care and treatment. Confirmatory or second-tier testing using ES/GS may be appropriate as an adjunct to conventional newborn screening in some circumstances. Such cases could serve as important testbeds from which to gather data on relevant programmatic barriers and facilitators to wider ES/GS implementation.
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Affiliation(s)
- Vasiliki Rahimzadeh
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA, United States
| | - Jan M. Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Guido de Wert
- Department of Health, Ethics and Society, Maastricht University, Maastricht, Netherlands
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9
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Jian M, Wang X, Sui Y, Fang M, Feng C, Huang Y, Liu C, Guo R, Guan Y, Gao Y, Wang Z, Li S, Cheng B, Sun L, Cui F, Guo J, Zhan Y, Zhang G, Zheng L, Su F, Xue W, Qian P, Gao S, Chen J, Guan L, Lu H, Kristiansen K, Jin X, Chen F, Zhao Y, Hammarström L, Jiang X, Liu J, Gao Y. A pilot study of assessing whole genome sequencing in newborn screening in unselected children in China. Clin Transl Med 2022; 12:e843. [PMID: 35665479 PMCID: PMC9167628 DOI: 10.1002/ctm2.843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Min Jian
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
- Department of BiologyUniversity of CopenhagenCopenhagenDenmark
| | | | - Yuanyuan Sui
- Maternal and Child Health and Family Planning Service Center of Huangdao DistrictQingdaoChina
| | - Mingyan Fang
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Chenchen Feng
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | | | - Chunhua Liu
- Maternal and Child Health and Family Planning Service Center of Huangdao DistrictQingdaoChina
| | - Ruidong Guo
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | | | - Yuxiao Gao
- Maternal and Child Health and Family Planning Service Center of Huangdao DistrictQingdaoChina
| | | | - Shuli Li
- Traditional Chinese Medical Hospital of Huangdao DistrictQingdaoChina
| | - Bochen Cheng
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Lina Sun
- BGI‐Qingdao, BGI‐ShenzhenQingdaoChina
| | - Fenghua Cui
- The Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Jia Guo
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Ying Zhan
- Qindgao West Coast New Area Central HospitalQingdaoChina
| | - Guohong Zhang
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Ling Zheng
- Traditional Chinese Medical Hospital of Huangdao DistrictQingdaoChina
| | - Fengxia Su
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Wei Xue
- The Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Puyi Qian
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Shaobo Gao
- Qindgao West Coast New Area Central HospitalQingdaoChina
| | - Jiayu Chen
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Lingyao Guan
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Haorong Lu
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
- Guangdong Provincial Key Laboratory of Genome Read and Write, BGI‐ShenzhenShenzhenChina
| | | | - Xin Jin
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Fang Chen
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
| | - Yuhuan Zhao
- Medical Career Development Center, Huangdao DistrictQingdaoChina
| | | | - Xiaojing Jiang
- Maternal and Child Health and Family Planning Service Center of Huangdao DistrictQingdaoChina
| | - Junnian Liu
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
- BGI‐Qingdao, BGI‐ShenzhenQingdaoChina
| | - Ya Gao
- BGI‐ShenzhenShenzhenChina
- China National GeneBank, BGI‐ShenzhenShenzhenChina
- Shenzhen Engineering Laboratory for Birth Defects ScreeningShenzhenChina
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10
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Genomics and Newborn Screening: Perspectives of Public Health Programs. Int J Neonatal Screen 2022; 8:ijns8010011. [PMID: 35225933 PMCID: PMC8883997 DOI: 10.3390/ijns8010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/05/2023] Open
Abstract
This study assesses the benefits and challenges of using genomics in Newborn Screening Programs (NBS) from the perspectives of State program officials. This project aims to help programs develop policies that will aid in the integration of genomic technology. Discussion groups were conducted with the NBS Program and Laboratory Directors in the seven HRSA Regional Genomics Collaboratives (August 2014-March 2016). The discussion groups addressed expected uses of genomics, potential benefits, and challenges of integrating genomic technology, and educational needs for parents and other NBS stakeholders: Twelve focus groups were conducted, which included participants from over 40 state programs. Benefits of incorporating genomics included improving screening modalities, supporting diagnostic procedures, and screening for a wider spectrum of disorders. Challenges included the costs of genomics, the ability to educate parents and health care providers about results, and the potential negative psychosocial impact of genomic information. Attempts to address the challenges of integrating genomics must focus on preserving the child welfare goals of NBS programs. Health departments will need to explore how genomics could be used to enhance programs while maintaining universal access to screening.
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11
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An Assessment of Traditional and Genomic Screening in Newborns and their Applicability for Africa. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Newborn screening with targeted sequencing: a multicenter investigation and a pilot clinical study in China. J Genet Genomics 2021; 49:13-19. [PMID: 34474183 DOI: 10.1016/j.jgg.2021.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022]
Abstract
Different newborn screening (NBS) programs have been practiced in many countries since the 1960s. It is of considerable interest whether next-generation sequencing is applicable in NBS. We have developed a panel of 465 causative genes for 596 early-onset, relatively high incidence, and potentially actionable severe inherited diseases in our Newborn Screening with Targeted Sequencing (NESTS) program to screen 11,484 babies in 8 Women and Children's hospitals nationwide in China retrospectively. The positive rate from preliminary screening of NESTS was 7.85% (902/11,484). With 45.89% (414/902) follow-up of preliminary positive cases, the overall clinically confirmative diagnosis rate of monogenic disorders was 12.07% (50/414), estimating an average of 0.95% (7.85% × 12.07%) clinical diagnosis rate, suggesting that monogenic disorders account for a considerable proportion of birth defects. The disease/gene spectrum varied in different regions of China. NESTS was implemented in a hospital by screening 3923 newborns to evaluate its clinical application. The turn-around time of a primary report, including the sequencing period of < 7 days, was within 11 days by our automatic interpretation pipeline. Our results suggest that NESTS is feasible and cost-effective as a first-tier NBS program, which will change the status of current clinical practice of NBS in China.
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13
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Abstract
IMPORTANCE Genomic newborn screening (gNBS) may optimize the health and well-being of children and families. Screening programs are required to be evidence based, acceptable, and beneficial. OBJECTIVES To identify what has been discovered following the reporting of the first gNBS pilot projects and to provide a summary of key points for the design of gNBS. EVIDENCE REVIEW A systematic literature review was performed on April 14, 2021, identifying 36 articles that addressed the following questions: (1) what is the interest in and what would be the uptake of gNBS? (2) what diseases and genes should be included? (3) what is the validity and utility of gNBS? and (4) what are the ethical, legal, and social implications? Articles were only included if they generated new evidence; all opinion pieces were excluded. FINDINGS In the 36 articles included, there was high concordance, except for gene disease inclusion, which was highly variable. Key findings were the need for equitable access, appropriate educational materials, and informed and flexible consent. The process for selecting genes for testing should be transparent and reflect that parents value the certainty of prediction over actionability. Data should be analyzed in a way that minimizes uncertainty and incidental findings. The expansion of traditional newborn screening (tNBS) to identify more life-threatening and treatable diseases needs to be balanced against the complexity of consenting parents of newborns for genomic testing as well as the risk that overall uptake of tNBS may decline. The literature reflected that the right of a child to self-determination should be valued more than the possibility of the whole family benefiting from a newborn genomic test. CONCLUSIONS AND RELEVANCE The findings of this systematic review suggest that implementing gNBS will require a nuanced approach. There are gaps in our knowledge, such as the views of diverse populations, the capabilities of health systems, and health economic implications. It will be essential to rigorously evaluate outcomes and ensure programs can evolve to maximize benefit.
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Affiliation(s)
- Lilian Downie
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Halliday
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - David J. Amor
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Royal Children’s Hospital, Melbourne, Victoria, Australia
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
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14
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Tanisawa K, Wang G, Seto J, Verdouka I, Twycross-Lewis R, Karanikolou A, Tanaka M, Borjesson M, Di Luigi L, Dohi M, Wolfarth B, Swart J, Bilzon JLJ, Badtieva V, Papadopoulou T, Casasco M, Geistlinger M, Bachl N, Pigozzi F, Pitsiladis Y. Sport and exercise genomics: the FIMS 2019 consensus statement update. Br J Sports Med 2020; 54:969-975. [PMID: 32201388 PMCID: PMC7418627 DOI: 10.1136/bjsports-2019-101532] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
Rapid advances in technologies in the field of genomics such as high throughput DNA sequencing, big data processing by machine learning algorithms and gene-editing techniques are expected to make precision medicine and gene-therapy a greater reality. However, this development will raise many important new issues, including ethical, moral, social and privacy issues. The field of exercise genomics has also advanced by incorporating these innovative technologies. There is therefore an urgent need for guiding references for sport and exercise genomics to allow the necessary advancements in this field of sport and exercise medicine, while protecting athletes from any invasion of privacy and misuse of their genomic information. Here, we update a previous consensus and develop a guiding reference for sport and exercise genomics based on a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis. This SWOT analysis and the developed guiding reference highlight the need for scientists/clinicians to be well-versed in ethics and data protection policy to advance sport and exercise genomics without compromising the privacy of athletes and the efforts of international sports federations. Conducting research based on the present guiding reference will mitigate to a great extent the risks brought about by inappropriate use of genomic information and allow further development of sport and exercise genomics in accordance with best ethical standards and international data protection principles and policies. This guiding reference should regularly be updated on the basis of new information emerging from the area of sport and exercise medicine as well as from the developments and challenges in genomics of health and disease in general in order to best protect the athletes, patients and all other relevant stakeholders.
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Affiliation(s)
- Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Guan Wang
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Jane Seto
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Ioanna Verdouka
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Richard Twycross-Lewis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Antonia Karanikolou
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Masashi Tanaka
- Department for Health and Longevity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Mats Borjesson
- Department of Neuroscience and Physiology, Center for Health and Performance, Goteborg University, Göteborg, Sweden
- Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
| | - Luigi Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Michiko Dohi
- Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Bernd Wolfarth
- Department of Sport Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - Jeroen Swart
- UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
| | | | - Victoriya Badtieva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
- Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- British Association of Sport and Exercise Medicine, Doncaster, UK
| | | | - Michael Geistlinger
- Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Salzburg, Austria
| | - Norbert Bachl
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Fabio Pigozzi
- Sport Medicine Unit, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Yannis Pitsiladis
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
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15
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Glenn AL. Using biological factors to individualize interventions for youth with conduct problems: Current state and ethical issues. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 65:101348. [PMID: 29673560 DOI: 10.1016/j.ijlp.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
A growing body of evidence suggests that biological factors such as genes, hormone levels, brain structure, and brain functioning influence the development and trajectory of conduct problems in youth. In addition, biological factors affect how individuals respond to the environment, including how individuals respond to programs designed to prevent or treat conduct problems. Programs designed to reduce behavior problems in youth would have the greatest impact if they were targeted toward youth who need it the most (e.g., who are mostly likely to demonstrate persistent behavior problems) as well as youth who may benefit the most from the program. Biological information may improve our ability to make decisions about which type or level of intervention is best for a particular child, thus maximizing overall effectiveness, but it also raises a number of ethical concerns. These include the idea that we may be providing fewer services to some youth based on biological factors, and that information about biological risk could potentially lead to discrimination or labeling. In this article, I discuss the risks and benefits of using biological information to individualize interventions for youth with conduct problems.
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Affiliation(s)
- Andrea L Glenn
- Center for the Prevention of Youth Behavior Problems, Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL 35487, USA.
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16
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Bilkey GA, Burns BL, Coles EP, Bowman FL, Beilby JP, Pachter NS, Baynam G, J. S. Dawkins H, Nowak KJ, Weeramanthri TS. Genomic Testing for Human Health and Disease Across the Life Cycle: Applications and Ethical, Legal, and Social Challenges. Front Public Health 2019; 7:40. [PMID: 30915323 PMCID: PMC6421958 DOI: 10.3389/fpubh.2019.00040] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/14/2019] [Indexed: 12/23/2022] Open
Abstract
The expanding use of genomic technologies encompasses all phases of life, from the embryo to the elderly, and even the posthumous phase. In this paper, we present the spectrum of genomic healthcare applications, and describe their scope and challenges at different stages of the life cycle. The integration of genomic technology into healthcare presents unique ethical issues that challenge traditional aspects of healthcare delivery. These challenges include the different definitions of utility as applied to genomic information; the particular characteristics of genetic data that influence how it might be protected, used and shared; and the difficulties applying existing models of informed consent, and how new consent models might be needed.
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Affiliation(s)
- Gemma A. Bilkey
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Belinda L. Burns
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Emily P. Coles
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - Faye L. Bowman
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
| | - John P. Beilby
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Nicholas S. Pachter
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - Gareth Baynam
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Genetic Services of Western Australia, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Crawley, WA, Australia
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Department of Health, Government of Western Australia, Subiaco, WA, Australia
- Centre for Child Health Research, The University of Western Australia and Telethon Kids Institute, Perth, WA, Australia
| | - Hugh J. S. Dawkins
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Sir Walter Murdoch School of Policy and International Affairs, Murdoch University, Murdoch, WA, Australia
- School of Public Health, Curtin University of Technology, Bentley, WA, Australia
| | - Kristen J. Nowak
- Office of Population Health Genomics, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, WA, Australia
| | - Tarun S. Weeramanthri
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, East Perth, WA, Australia
- Faculty of Health and Medical Sciences, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
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SPIEGEL ALLENM. THE JEREMIAH METZGER LECTURE: A BRIEF HISTORY OF EUGENICS IN AMERICA: IMPLICATIONS FOR MEDICINE IN THE 21 ST CENTURY. TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION 2019; 130:216-234. [PMID: 31516187 PMCID: PMC6736015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the first half of the 20th century, the US was swept up in a multifaceted movement to enhance the genetic makeup of the country's population. This eugenics movement, based on flawed scientific principles promulgated by Galton in the UK and Davenport in the US included legally mandated compulsory sterilization in 27 states in the US and sharply restricted immigration from many parts of the world. Compulsory sterilization legislation was upheld by the Supreme Court in 1927. The American eugenics movement was a model for the compulsory sterilization implemented by the Nazis after they took power in Germany in 1933. The movement waned in America only following World War II when the US public became aware of the full extent of the Nazi Aryan racial superiority program. With the advent of major advances in molecular and cellular biology that are already being applied to clinical medicine in the 21st century, we have entered a new eugenics era. It is critical that we learn the lessons of our earlier eugenics movement if we are to avoid making the same flawed decisions now.
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Affiliation(s)
- ALLEN M. SPIEGEL
- Correspondence and reprint requests: Allen M. Spiegel, MD, Albert Einstein College of Medicine,
Belfer 1003, 1300 Morris Park Avenue, Bronx, New York 10461929-246-6738
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18
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Kanungo S, Patel DR, Neelakantan M, Ryali B. Newborn screening and changing face of inborn errors of metabolism in the United States. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:468. [PMID: 30740399 DOI: 10.21037/atm.2018.11.68] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Newborn screening (NBS) in the United States helps each year diagnose, 1 in every 320 newborns (12,500 of the 4 million births), with a potentially severe or lethal condition prior to clinical symptoms manifestation. 10% of these are inborn errors of metabolism (IEM). Coordinated efforts of NBS program, primary care physicians, and metabolic centers can help with pre-symptomatic identification and interventions for such conditions to ameliorate or resolve associated morbidity and mortality. NBS in the United States is a successful public health program to improve short and long term health outcomes for newborns. Federal and State agencies provide the regulatory and funding framework to implement NBS programs, while professional societies provide medical guidelines to help identify and manage such conditions. However, each State independently organizes and administers its own NBS program. This article reviews the common NBS program workflow, federal regulatory framework, uniform screening panel recommendations, the testing processes and ethical considerations involved.
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Affiliation(s)
- Shibani Kanungo
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Dilip R Patel
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Mekala Neelakantan
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Brinda Ryali
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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19
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Including ELSI research questions in newborn screening pilot studies. Genet Med 2018; 21:525-533. [PMID: 30100612 DOI: 10.1038/s41436-018-0101-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 06/13/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The evidence review processes for adding new conditions to state newborn screening (NBS) panels rely on data from pilot studies aimed at assessing the potential benefits and harms of screening. However, the consideration of ethical, legal, and social implications (ELSI) of screening within this research has been limited. This paper outlines important ELSI issues related to newborn screening policy and practices as a resource to help researchers integrate ELSI into NBS pilot studies. APPROACH Members of the Bioethics and Legal Workgroup for the Newborn Screening Translational Research Network facilitated a series of professional and public discussions aimed at engaging NBS stakeholders to identify important existing and emerging ELSI challenges accompanying NBS. RESULTS Through these engagement activities, we identified a set of key ELSI questions related to (1) the types of results parents may receive through newborn screening and (2) the initiation and implementation of NBS for a condition within the NBS system. CONCLUSION Integrating ELSI questions into pilot studies will help NBS programs to better understand the potential impact of screening for a new condition on newborns and families, and make crucial policy decisions aimed at maximized benefits and mitigating the potential negative medical or social implications of screening.
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20
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Johnston J, Lantos JD, Goldenberg A, Chen F, Parens E, Koenig BA. Sequencing Newborns: A Call for Nuanced Use of Genomic Technologies. Hastings Cent Rep 2018; 48 Suppl 2:S2-S6. [PMID: 30133723 PMCID: PMC6901349 DOI: 10.1002/hast.874] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Many scientists and doctors hope that affordable genome sequencing will lead to more personalized medical care and improve public health in ways that will benefit children, families, and society more broadly. One hope in particular is that all newborns could be sequenced at birth, thereby setting the stage for a lifetime of medical care and self-directed preventive actions tailored to each child's genome. Indeed, commentators often suggest that universal genome sequencing is inevitable. Such optimism can come with the presumption that discussing the potential limits, cost, and downsides of widespread application of genomic technologies is pointless, excessively pessimistic, or overly cautious. We disagree. Given the pragmatic challenges associated with determining what sequencing data mean for the health of individuals, the economic costs associated with interpreting and acting on such data, and the psychosocial costs of predicting one's own or one's child's future life plans based on uncertain testing results, we think this hope and optimism deserve to be tempered. In the analysis that follows, we distinguish between two reasons for using sequencing: to diagnose individual infants who have been identified as sick and to screen populations of infants who appear to be healthy. We also distinguish among three contexts in which sequencing for either diagnosis or screening could be deployed: in clinical medicine, in public health programs, and as a direct-to-consumer service. Each of these contexts comes with different professional norms, policy considerations, and public expectations. Finally, we distinguish between two main types of genome sequencing: targeted sequencing, where only specific genes are sequenced or analyzed, and whole-exome or whole-genome sequencing, where all the DNA or all the coding segments of all genes are sequenced and analyzed. In a symptomatic newborn, targeted or genome-wide sequencing can help guide other tests for diagnosis or for specific treatment that is urgently needed. Clinicians use the infant's symptoms (or phenotype) to interrogate the sequencing data. These same complexities and uncertainties, however, limit the usefulness of genome-wide sequencing as a population screening tool. While we recognize considerable benefit in using targeted sequencing to screen for or detect specific conditions that meet the criteria for inclusion in newborn screening panels, use of genome-wide sequencing as a sole screening tool for newborns is at best premature. We conclude that sequencing technology can be beneficially used in newborns when that use is nuanced and attentive to context.
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Milko LV, Rini C, Lewis MA, Butterfield RM, Lin FC, Paquin RS, Powell BC, Roche MI, Souris KJ, Bailey DB, Berg JS, Powell CM. Evaluating parents' decisions about next-generation sequencing for their child in the NC NEXUS (North Carolina Newborn Exome Sequencing for Universal Screening) study: a randomized controlled trial protocol. Trials 2018; 19:344. [PMID: 29950170 PMCID: PMC6022715 DOI: 10.1186/s13063-018-2686-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/14/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Using next-generation sequencing (NGS) in newborn screening (NBS) could expand the number of genetic conditions detected pre-symptomatically, simultaneously challenging current precedents, raising ethical concerns, and extending the role of parental decision-making in NBS. The NC NEXUS (Newborn Exome Sequencing for Universal Screening) study seeks to assess the technical possibilities and limitations of NGS-NBS, devise and evaluate a framework to convey various types of genetic information, and develop best practices for incorporating NGS-NBS into clinical care. The study is enrolling both a healthy cohort and a cohort diagnosed with known disorders identified through recent routine NBS. It uses a novel age-based metric to categorize a priori the large amount of data generated by NGS-NBS and interactive online decision aids to guide parental decision-making. Primary outcomes include: (1) assessment of NGS-NBS sensitivity, (2) decision regret, and (3) parental decision-making about NGS-NBS, and, for parents randomized to have the option of requesting them, additional findings (diagnosed and healthy cohorts). Secondary outcomes assess parents' reactions to the study and to decision-making. METHODS/DESIGN Participants are parents and children in a well-child cohort recruited from a prenatal clinic and a diagnosed cohort recruited from pediatric clinics that treat children with disorders diagnosed through traditional NBS (goal of 200 children in each cohort). In phase 1, all parent participants use an online decision aid to decide whether to accept NGS-NBS for their child and provide consent for NGS-NBS. In phase 2, parents who consent to NGS-NBS are randomized to a decision arm or control arm (2:1 allocation) and learn their child's NGS-NBS results, which include conditions from standard (non-NGS) NBS plus other highly actionable childhood-onset conditions. Parents in the decision arm use a second decision aid to make decisions about additional results from their child's sequencing. In phase 3, decision arm participants learn additional results they have requested. Online questionnaires are administered at up to five time points. DISCUSSION NC NEXUS will use a rigorous interdisciplinary approach designed to collect rich data to inform policy, practice, and future research. TRIAL REGISTRATION clinicaltrials.gov, NCT02826694 . Registered on 11 July, 2016.
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Affiliation(s)
- Laura V. Milko
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Christine Rini
- Department of Biomedical Research, Hackensack University Medical Center, Hackensack, NJ 07601 USA
| | - Megan A. Lewis
- Center for Communication Science, RTI International, Research Triangle Park, NC 27709 USA
| | - Rita M. Butterfield
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599 USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ryan S. Paquin
- Center for Communication Science, RTI International, Research Triangle Park, NC 27709 USA
| | - Bradford C. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Myra I. Roche
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599 USA
| | - Katherine J. Souris
- Department of Heath Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Donald B. Bailey
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, NC 27709 USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Cynthia M. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599 USA
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Al-Mousa H, Al-Dakheel G, Jabr A, Elbadaoui F, Abouelhoda M, Baig M, Monies D, Meyer B, Hawwari A, Dasouki M. High Incidence of Severe Combined Immunodeficiency Disease in Saudi Arabia Detected Through Combined T Cell Receptor Excision Circle and Next Generation Sequencing of Newborn Dried Blood Spots. Front Immunol 2018; 9:782. [PMID: 29713328 PMCID: PMC5911483 DOI: 10.3389/fimmu.2018.00782] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/28/2018] [Indexed: 11/23/2022] Open
Abstract
Severe combined immunodeficiency disease (SCID) is the most severe form of primary immunodeficiency disorders (PID). T-cell receptor excision circle (TREC) copy number analysis is an efficient tool for population-based newborn screening (NBS) for SCID and other T cell lymphopenias. We sought to assess the incidence of SCID among Saudi newborn population and examine the feasibility of using targeted next generation sequencing PID gene panel (T-NGS PID) on DNA isolated from dried blood spots (DBSs) in routine NBS programs as a mutation screening tool for samples with low TREC count. Punches from 8,718 DBS collected on Guthrie cards were processed anonymously for the TREC assay. DNA was extracted from samples with confirmed low TREC count, then screened for 22q11.2 deletion syndrome by real-time polymerase chain reaction and for mutations in PID-related genes by T-NGS PID panel. Detected mutations were confirmed by Sanger sequencing. Sixteen out of the 8,718 samples were confirmed to have low TREC copy number. Autosomal recessive mutations in AK2, JAK3, and MTHFD1 were confirmed in three samples. Two additional samples were positive for the 22q11.2 deletion syndrome. In this study, we provide evidence for high incidence of SCID among Saudi population (1/2,906 live births) and demonstrate the feasibility of using T-NGS PID panel on DNA extracted from DBSs as a new reliable, rapid, and cost-effective mutation screening method for newborns with low TREC assay, which can be implemented as part of NBS programs for SCID.
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Affiliation(s)
- Hamoud Al-Mousa
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ghadah Al-Dakheel
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amal Jabr
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Fahd Elbadaoui
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Mohamed Abouelhoda
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Saudi Human Genome Project, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Mansoor Baig
- Department of Biostatistics, Epidemiology & Scientific Computing (BESC), King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Dorota Monies
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Saudi Human Genome Project, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Brian Meyer
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Saudi Human Genome Project, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Abbas Hawwari
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Majed Dasouki
- Department of Genetics, Research Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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23
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Ficicioglu C. New tools and approaches to newborn screening: ready to open Pandora's box? Cold Spring Harb Mol Case Stud 2017; 3:a001842. [PMID: 28487886 PMCID: PMC5411690 DOI: 10.1101/mcs.a001842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The landscape of newborn screening (NBS) is changing as new tools are developed. We must acknowledge that NBS is a very important and extraordinarily positive initiative especially for rare and serious inherited disorders; however, lessons learned from current NBS should guide the future of NBS as we enter the era of “omics” that will expand NBS for many other genetic disorders. In this article, I will first discuss new tools such as genomics and metabolomics for NBS. I will then turn to assessing how best to take advantage of new technical developments while considering the best interests of patients and the success of newborn screening.
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Affiliation(s)
- Can Ficicioglu
- Children's Hospital of Philadelphia (CHOP), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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24
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Bailey DB, Berry-Kravis E, Gane LW, Guarda S, Hagerman R, Powell CM, Tassone F, Wheeler A. Fragile X Newborn Screening: Lessons Learned From a Multisite Screening Study. Pediatrics 2017; 139:S216-S225. [PMID: 28814542 DOI: 10.1542/peds.2016-1159h] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Delays in the diagnosis of children with fragile X syndrome (FXS) suggest the possibility of newborn screening as a way to identify children earlier. However, FXS does not have a proven treatment that must be provided early, and ethical concerns have been raised about the detection of infants who are carriers. This article summarizes major findings from a multisite, prospective, longitudinal pilot screening study. METHODS Investigators in North Carolina, California, and Illinois collaborated on a study in which voluntary screening for FXS was offered to parents in 3 birthing hospitals. FXS newborn screening was offered to >28 000 families to assess public acceptance and determine whether identification of babies resulted in any measurable harms or adverse events. Secondary goals were to determine the prevalence of FMR1 carrier gene expansions, study the consent process, and describe early development and behavior of identified children. RESULTS A number of publications have resulted from the project. This article summarizes 10 "lessons learned" about the consent process, reasons for accepting and declining screening, development and evaluation of a decision aid, prevalence of carriers, father participation in consent, family follow-up, and maternal reactions to screening. CONCLUSIONS The project documented public acceptance of screening as well as the challenges inherent in obtaining consent in the hospital shortly after birth. Collectively, the study provides answers to a number of questions that now set the stage for a next generation of research to determine the benefits of earlier identification for children and families.
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Affiliation(s)
- Donald B Bailey
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, North Carolina;
| | | | - Louise W Gane
- MIND Institute, University of California at Davis, Sacramento, California; and
| | - Sonia Guarda
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Randi Hagerman
- MIND Institute, University of California at Davis, Sacramento, California; and
| | - Cynthia M Powell
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Flora Tassone
- MIND Institute, University of California at Davis, Sacramento, California; and
| | - Anne Wheeler
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, Research Triangle Park, North Carolina
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25
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Friedman JM, Cornel MC, Goldenberg AJ, Lister KJ, Sénécal K, Vears DF. Genomic newborn screening: public health policy considerations and recommendations. BMC Med Genomics 2017; 10:9. [PMID: 28222731 PMCID: PMC5320805 DOI: 10.1186/s12920-017-0247-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/14/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of genome-wide (whole genome or exome) sequencing for population-based newborn screening presents an opportunity to detect and treat or prevent many more serious early-onset health conditions than is possible today. METHODS The Paediatric Task Team of the Global Alliance for Genomics and Health's Regulatory and Ethics Working Group reviewed current understanding and concerns regarding the use of genomic technologies for population-based newborn screening and developed, by consensus, eight recommendations for clinicians, clinical laboratory scientists, and policy makers. RESULTS Before genome-wide sequencing can be implemented in newborn screening programs, its clinical utility and cost-effectiveness must be demonstrated, and the ability to distinguish disease-causing and benign variants of all genes screened must be established. In addition, each jurisdiction needs to resolve ethical and policy issues regarding the disclosure of incidental or secondary findings to families and ownership, appropriate storage and sharing of genomic data. CONCLUSION The best interests of children should be the basis for all decisions regarding the implementation of genomic newborn screening.
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Affiliation(s)
- Jan M. Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
| | - Martina C. Cornel
- Section Clinical Genetics, Department of Clinical Genetics, VU University Medical Center, Amsterdam, Holland
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Holland
| | - Aaron J. Goldenberg
- The Center for Genetic Research Ethics and Law, Department of Bioethics, Case Western Reserve University, Cleveland, OH USA
| | - Karla J. Lister
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia, Perth, Australia
| | - Karine Sénécal
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Canada
| | - Danya F. Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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26
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Berg JS, Agrawal PB, Bailey DB, Beggs AH, Brenner SE, Brower AM, Cakici JA, Ceyhan-Birsoy O, Chan K, Chen F, Currier RJ, Dukhovny D, Green RC, Harris-Wai J, Holm IA, Iglesias B, Joseph G, Kingsmore SF, Koenig BA, Kwok PY, Lantos J, Leeder SJ, Lewis MA, McGuire AL, Milko LV, Mooney SD, Parad RB, Pereira S, Petrikin J, Powell BC, Powell CM, Puck JM, Rehm HL, Risch N, Roche M, Shieh JT, Veeraraghavan N, Watson MS, Willig L, Yu TW, Urv T, Wise AL. Newborn Sequencing in Genomic Medicine and Public Health. Pediatrics 2017; 139:e20162252. [PMID: 28096516 PMCID: PMC5260149 DOI: 10.1542/peds.2016-2252] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/20/2022] Open
Abstract
The rapid development of genomic sequencing technologies has decreased the cost of genetic analysis to the extent that it seems plausible that genome-scale sequencing could have widespread availability in pediatric care. Genomic sequencing provides a powerful diagnostic modality for patients who manifest symptoms of monogenic disease and an opportunity to detect health conditions before their development. However, many technical, clinical, ethical, and societal challenges should be addressed before such technology is widely deployed in pediatric practice. This article provides an overview of the Newborn Sequencing in Genomic Medicine and Public Health Consortium, which is investigating the application of genome-scale sequencing in newborns for both diagnosis and screening.
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Affiliation(s)
| | - Pankaj B Agrawal
- Divisions of Newborn Medicine and
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Alan H Beggs
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Amy M Brower
- American College of Medical Genetics and Genomics, Bethesda, Maryland
| | - Julie A Cakici
- Rady Children's Institute for Genomic Medicine, San Diego, California
| | | | - Kee Chan
- Chicago School of Public Health, University of Illinois, Chicago, Illinois
| | | | - Robert J Currier
- Genetic Disease Screening Program, California Department of Public Health, Sacramento, California
| | - Dmitry Dukhovny
- Department of Pediatrics and Division of Neonatology, Oregon Health & Science University, Portland, Oregon
| | | | | | - Ingrid A Holm
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Galen Joseph
- Department of Anthropology, History, and Social Medicine
| | | | | | - Pui-Yan Kwok
- Institute for Human Genetics
- Cardiovascular Research Institute, and Department of Dermatology
| | - John Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Steven J Leeder
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Megan A Lewis
- RTI International, Research Triangle Park, North Carolina
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and
| | | | | | - Richard B Parad
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and
| | - Joshua Petrikin
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Cynthia M Powell
- Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Jennifer M Puck
- Department of Pediatrics, University of California, San Francisco, California
| | | | | | - Myra Roche
- Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Joseph T Shieh
- Institute for Human Genetics
- Department of Pediatrics, Benioff Children's Hospital, and
| | | | - Michael S Watson
- American College of Medical Genetics and Genomics, Bethesda, Maryland
| | - Laurel Willig
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Timothy W Yu
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tiina Urv
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
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27
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Yang L, Chen J, Shen B. Newborn Screening in the Era of Precision Medicine. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1005:47-61. [DOI: 10.1007/978-981-10-5717-5_3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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28
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Paquin RS, Peay HL, Gehtland LM, Lewis MA, Bailey DB. Parental intentions to enroll children in a voluntary expanded newborn screening program. Soc Sci Med 2016; 166:17-24. [PMID: 27526258 DOI: 10.1016/j.socscimed.2016.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/16/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Nearly all babies in the United States are tested at birth for rare, serious, and treatable disorders through mandatory state newborn screening (NBS). Recently, there have been calls for an expanded, voluntary model to facilitate early diagnosis and treatment of a wider range of disorders. We applied the reasoned action framework to examine parental intentions to participate in voluntary expanded screening. METHODS We recruited a national cohort of recent and expectant parents living in the U.S. who completed a self-administered online survey (N = 1001). Using a mixed-level fractional factorial experiment, we studied parental participation intentions and preferences for timing of consent, cost, consent format, and testing options. RESULTS We conducted a hierarchical regression analysis assessing parental intentions to participate in voluntary expanded NBS. Attitudes, perceived normative influence, and perceived behavioral control explained substantial variance in intention, with perceived normative influence emerging as the strongest predictor. We found no evidence that the manipulated program features altered mean levels of intention, but timing of parental permission, cost, and permission format moderated the relative importance of reasoned action constructs on intention. CONCLUSION Program design features may impact the psychological mechanisms underlying parental decision making for voluntary expanded screening. These results have important implications for parent education, outreach, and informed parental permission procedures.
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Affiliation(s)
- Ryan S Paquin
- Center for Communication Science, RTI International, Research Triangle Park, NC, United States.
| | - Holly L Peay
- Center for P-12 Education, RTI International, Research Triangle Park, NC, United States
| | - Lisa M Gehtland
- Center for P-12 Education, RTI International, Research Triangle Park, NC, United States
| | - Megan A Lewis
- Center for Communication Science, RTI International, Research Triangle Park, NC, United States
| | - Donald B Bailey
- Education and Workforce Development, RTI International, Research Triangle Park, NC, United States
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29
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Joseph G, Chen F, Harris-Wai J, Puck JM, Young C, Koenig BA. Parental Views on Expanded Newborn Screening Using Whole-Genome Sequencing. Pediatrics 2016; 137 Suppl 1:S36-46. [PMID: 26729702 PMCID: PMC4939888 DOI: 10.1542/peds.2015-3731h] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The potential application of whole-genome sequencing (WGS) to state-mandated standard newborn screening (NBS) challenges the traditional public health approach to NBS and raises ethical, policy, and clinical practice issues. This article examines the perspectives and values of diverse healthy pregnant women and parents of children diagnosed with a primary immunodeficiency disorder about traditional NBS and expanded NBS with the use of WGS. METHODS We conducted 4 focus groups (3 in English and 1 in Spanish) with socioeconomically and ethnically diverse pregnant women (n = 26), and a comparison group with parents of children diagnosed with a primary immunodeficiency disorder (n = 5). RESULTS Pediatric policy-relevant themes that emerged from our analysis of the focus group data are presented within 4 categories: (1) perspectives on traditional NBS, (2) informed consent, (3) return of results, and (4) storage and retrieval of results. Analyses indicate that study participants desired greater inclusion in the NBS process. Despite an optimistic orientation to the potential benefits and limited harms likely to result from genomic applications of NBS, parents voiced concerns about privacy and control over test results. Limited trust in the medical system and the state-run NBS program informed these concerns. CONCLUSIONS Expanded NBS with WGS for pediatricians may require management of more genetic conditions, including mutations that convey risk to both the child and parents for adult-onset disorders, and an informed-consent process to manage the genomic data and storage of blood spots. Attention to how these technologies are understood in diverse populations is needed for effective implementation.
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Affiliation(s)
- Galen Joseph
- Address correspondence to Galen Joseph, PhD, Department of Anthropology, History, and Social Medicine, Box 0128, UCSF, San Francisco, CA 94143-0128. E-mail:
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30
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Char DS. How should whole-genome sequencing be implemented in children? A consideration of the current limitations. Per Med 2016; 13:33-42. [DOI: 10.2217/pme.15.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In children, whole-genome sequencing (WGS) is envisioned as a tool to improve diagnosis of undiagnosed diseases and to improve population-based screening. Pilot applications have shown benefits: genomic information has been used as a diagnostic aid; pharmacogenomics can reduce medicine-related adverse events; advanced knowledge of the potential for later-onset disease can target tests and appropriate therapies. However, emerging technical, conceptual and ethical challenges may limit WGS from fulfilling the current vision for future applications. WGS platforms still struggle with reliability and accuracy. The role of the genome in long-term organismal function and disease is still being established. Ethical implications of WGS in both undiagnosed disease and population screening, particularly potential impacts of testing on children and their families are still unresolved.
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Affiliation(s)
- Danton S Char
- Department of Anesthesiology, Stanford University School of Medicine, Division of Pediatric Cardiac Anesthesia, H3580, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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31
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Lewis MA, Paquin RS, Roche MI, Furberg RD, Rini C, Berg JS, Powell CM, Bailey DB. Supporting Parental Decisions About Genomic Sequencing for Newborn Screening: The NC NEXUS Decision Aid. Pediatrics 2016; 137 Suppl 1:S16-23. [PMID: 26729698 PMCID: PMC4922487 DOI: 10.1542/peds.2015-3731e] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Advances in genomic sequencing technology have raised fundamental challenges to the traditional ways genomic information is communicated. These challenges will become increasingly complex and will affect a much larger population in the future if genomics is incorporated into standard newborn screening practice. Clinicians, public health officials, and other stakeholders will need to agree on the types of information that they should seek and communicate to parents. Currently, few evidence-based and validated tools are available to support parental informed decision-making. These tools will be necessary as genomics is integrated into clinical practice and public health systems. In this article we describe how the North Carolina Newborn Exome Sequencing for Universal Screening study is addressing the need to support parents in making informed decisions about the use of genomic testing in newborn screening. We outline the context for newborn screening and justify the need for parental decision support. We also describe the process of decision aid development and the data sources, processes, and best practices being used in development. By the end of the study, we will have an evidenced-based process and validated tools to support parental informed decision-making about the use of genomic sequencing in newborn screening. Data from the study will help answer important questions about which genomic information ought to be sought and communicated when testing newborns.
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Affiliation(s)
- Megan A. Lewis
- Center for Communication Science, and,Address correspondence to Megan A. Lewis, PhD, 3040 Cornwallis Rd, PO Box 12194, Research Triangle Park, NC 27709-2194. E-mail:
| | | | - Myra I. Roche
- Department of Pediatrics, and,Department of Genetics, and
| | | | - Christine Rini
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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32
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Howard HC, Knoppers BM, Cornel MC, Wright Clayton E, Sénécal K, Borry P. Whole-genome sequencing in newborn screening? A statement on the continued importance of targeted approaches in newborn screening programmes. Eur J Hum Genet 2015; 23:1593-600. [PMID: 25626707 PMCID: PMC4795188 DOI: 10.1038/ejhg.2014.289] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/20/2014] [Accepted: 12/02/2014] [Indexed: 11/24/2022] Open
Abstract
The advent and refinement of sequencing technologies has resulted in a decrease in both the cost and time needed to generate data on the entire sequence of the human genome. This has increased the accessibility of using whole-genome sequencing and whole-exome sequencing approaches for analysis in both the research and clinical contexts. The expectation is that more services based on these and other high-throughput technologies will become available to patients and the wider population. Some authors predict that sequencing will be performed once in a lifetime, namely, shortly after birth. The Public and Professional Policy Committee of the European Society of Human Genetics, the Human Genome Organisation Committee on Ethics, Law and Society, the PHG Foundation and the P3G International Paediatric Platform address herein the important issues and challenges surrounding the potential use of sequencing technologies in publicly funded newborn screening (NBS) programmes. This statement presents the relevant issues and culminates in a set of recommendations to help inform and guide scientists and clinicians, as well as policy makers regarding the necessary considerations for the use of genome sequencing technologies and approaches in NBS programmes. The primary objective of NBS should be the targeted analysis and identification of gene variants conferring a high risk of preventable or treatable conditions, for which treatment has to start in the newborn period or in early childhood.
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Affiliation(s)
- Heidi Carmen Howard
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Bartha Maria Knoppers
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Martina C Cornel
- Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
| | - Karine Sénécal
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Pascal Borry
- Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - endorsed by the European Society of Human Genetics; the P3G International Paediatric Platform; the Human Genome Organisation; and the PHG Foundation
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
- Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, TN, USA
- Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
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Beckmann JS. Can we afford to sequence every newborn baby's genome? Hum Mutat 2015; 36:283-6. [PMID: 25546530 DOI: 10.1002/humu.22748] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/17/2014] [Indexed: 01/19/2023]
Abstract
Whole-exome sequencing and whole-genome sequencing are gradually entering into the clinical arena. Drops in sequencing prices have led some to suggest that these analyses could be extended to the screening of whole populations or subsets thereof. Herein, we argue that this optimism is presently still unfounded. While cost estimates take into account the generation of sequence data, they fail to properly evaluate both the price of accurate and efficient interpretation and of the proper return of genomic information to the consulting individuals. Thus, short of inventing new, cost-effective ways of achieving these goals, the latter are likely to ruin our healthcare systems. We posit that due to lack of available resources, generalization of this practice remains, for the time being, unrealistic.
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Affiliation(s)
- Jacques S Beckmann
- Clinical Bioinformatics, SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
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Abstract
Whole-genome and whole-exome sequencing for clinical applications is now an integral part of medical genetics practice. The term newborn screening refers to public health programs designed to screen newborns for various treatable metabolic conditions, by measuring levels of circulating blood metabolites. The availability and significant decrease in sequencing costs has raised the question of whether metabolic newborn screening should be replaced by whole-genome or whole-exome sequencing. While newborn genome sequencing can potentially increase the number of disorders identified by newborn screening, the generalization of its practice raises a number of important ethical issues. This short article argues that there are medical, psychological, ethical and economic reasons why widespread dissemination of newborn screening is still premature.
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Miller FA, Hayeems RZ, Bombard Y, Cressman C, Barg CJ, Carroll JC, Wilson BJ, Little J, Allanson J, Chakraborty P, Giguère Y, Regier DA. Public Perceptions of the Benefits and Risks of Newborn Screening. Pediatrics 2015; 136:e413-23. [PMID: 26169426 DOI: 10.1542/peds.2015-0518] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Growing technological capacity and parent and professional advocacy highlight the need to understand public expectations of newborn population screening. METHODS We administered a bilingual (French, English) Internet survey to a demographically proportional sample of Canadians in 2013 to assess preferences for the types of diseases to be screened for in newborns by using a discrete choice experiment. Attributes were: clinical benefits of improved health, earlier time to diagnosis, reproductive risk information, false-positive (FP) results, and overdiagnosed infants. Survey data were analyzed with a mixed logit model to assess preferences and trade-offs among attributes, interaction between attributes, and preference heterogeneity. RESULTS On average, respondents were favorable toward screening. Clinical benefits were the most important outcome; reproductive risk information and early diagnosis were also valued, although 8% disvalued early diagnosis, and reproductive risk information was least important. All respondents preferred to avoid FP results and overdiagnosis but were willing to accept these to achieve moderate clinical benefit, accepting higher rates of harms to achieve significant benefit. Several 2-way interactions between attributes were statistically significant: respondents were willing to accept a higher FP rate for significant clinical benefit but preferred a lower rate for moderate benefit; similarly, respondents valued early diagnosis more when associated with significant rather than moderate clinical benefit. CONCLUSIONS Members of the public prioritized clinical benefits for affected infants and preferred to minimize harms. These findings suggest support for newborn screening policies prioritizing clinical benefits over solely informational benefits, coupled with concerted efforts to avoid or minimize harms.
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Affiliation(s)
- Fiona A Miller
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada;
| | - Robin Z Hayeems
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
| | - Yvonne Bombard
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Céline Cressman
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Carolyn J Barg
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | - Julian Little
- Departments of Epidemiology and Community Medicine and
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Pediatrics, University of Ottawa, Ottawa, Canada
| | - Pranesh Chakraborty
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada; Pediatrics, University of Ottawa, Ottawa, Canada
| | - Yves Giguère
- Department of Medical Biology, Centre Hospitalier Universitaire de Quebec, University of Laval, Quebec City, Canada
| | - Dean A Regier
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; and Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver, Canada
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Miller FA, Cressman C, Hayeems R. Governing population screening in an age of expansion: The case of newborn screening. Canadian Journal of Public Health 2015; 106:e244-8. [PMID: 26285197 DOI: 10.17269/cjph.106.4897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/01/2015] [Accepted: 02/12/2015] [Indexed: 11/17/2022]
Abstract
Newborn bloodspot screening is one of the most enduring and successful population screening initiatives. Yet technological innovation to permit simultaneous measurement of multiple biomarkers - and potentially, entire genomes - has spurred expansion and debate. Through a cross-jurisdictional comparison, we describe the varied roles and reach of screening-related governance structures in the United States, the United Kingdom, New Zealand and Canada, and highlight the distinct values and resources brought to bear by the genetics, public health and maternal-child health communities in adjudicating the benefits and burdens of expanded newborn screening. We call for the expansion of formal governance structures that are balanced in resources and perspective and mandated to ensure that the organization and delivery of newborn screening achieves optimal quality.
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Affiliation(s)
- Fiona Alice Miller
- Associate Professor of Health Policy, Institute of Health Policy, Management and Evaluation, University of Toronto Director, Health Policy & Ethics Division, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto.
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Affiliation(s)
| | - Lisa Gehtland
- RTI International, Research Triangle Park, North Carolina
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Nardini MD, Matthews AL, McCandless SE, Baumanis L, Goldenberg AJ. Genomic counseling in the newborn period: experiences and views of genetic counselors. J Genet Couns 2015; 23:506-15. [PMID: 24659383 DOI: 10.1007/s10897-014-9706-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/24/2014] [Indexed: 01/09/2023]
Abstract
As newborn screening (NBS) technology expands, genetic counselors will become more involved in counseling for NBS results, including those potentially generated from whole exome sequencing (WES) and eventually whole genome sequencing (WGS). Members of the National Society of Genetic Counselors (NSGC) responded to an online survey (n=208) regarding genomic counseling in the context of NBS. The majority of participants (82.1 %) did not feel prepared to counsel for WGS results from NBS. Counselors with previous WES/WGS counseling experience felt more prepared (p= 0.005) to counsel for WGS results from NBS than those without WES/WGS experience. Overall, counselors expressed ethical and practical concerns regarding WGS in NBS, as well as a need for additional training regarding this application of the technology before it is implemented. Based on the results of this study, genetic counselors voice caution to the larger genetics community regarding expansion of NBS to incorporate genomic sequencing and advocate for additional education prior to initiating WGS into NBS.
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Dodson DS, Goldenberg AJ, Davis MM, Singer DC, Tarini BA. Parent and public interest in whole-genome sequencing. Public Health Genomics 2015; 18:151-9. [PMID: 25765282 DOI: 10.1159/000375115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/12/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the baseline interest of the public in whole-genome sequencing (WGS) for oneself, parents' interest in WGS for their youngest children, and factors associated with such interest. METHODS A random sample of adults from a probability-based nationally representative online panel was surveyed. All participants were provided basic information about WGS and then asked about their interest in WGS for themselves. Those participants who were parents were additionally asked about their interest in WGS for their children. The order in which parents were asked about their interest in WGS for themselves and for their child was randomized. The relationship between parent/child characteristics and interest in WGS was examined. RESULTS The overall response rate was 62% (55% among parents). 58.6% of the total population (parents and nonparents) was interested in WGS for themselves. Similarly, 61.8% of the parents were interested in WGS for themselves and 57.8% were interested in WGS for their youngest children. Of note, 84.7% of the parents showed an identical interest level in WGS for themselves and their youngest children. Mothers as a group and parents whose youngest children had ≥2 health conditions had significantly more interest in WGS for themselves and their youngest children, while those with conservative political ideologies had considerably less. CONCLUSIONS While US adults have varying interest levels in WGS, parents appear to have similar interests in genome testing for themselves and their youngest children. As WGS technology becomes available in the clinic and private market, clinicians should be prepared to discuss WGS risks and benefits with their patients.
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Affiliation(s)
- Daniel S Dodson
- Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Mich., USA
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40
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Albert D, Belsky DW, Crowley DM, Latendresse SJ, Aliev F, Riley B, Sun C, Dick DM, Dodge KA. Can Genetics Predict Response to Complex Behavioral Interventions? Evidence from a Genetic Analysis of the Fast Track Randomized Control Trial. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2015; 34:497-518. [PMID: 26106668 PMCID: PMC4480598 DOI: 10.1002/pam.21811] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Early interventions are a preferred method for addressing behavioral problems in high-risk children, but often have only modest effects. Identifying sources of variation in intervention effects can suggest means to improve efficiency. One potential source of such variation is the genome. We conducted a genetic analysis of the Fast Track randomized control trial, a 10-year-long intervention to prevent high-risk kindergarteners from developing adult externalizing problems including substance abuse and antisocial behavior. We tested whether variants of the glucocorticoid receptor gene NR3C1 were associated with differences in response to the Fast Track intervention. We found that in European-American children, a variant of NR3C1 identified by the single-nucleotide polymorphism rs10482672 was associated with increased risk for externalizing psychopathology in control group children and decreased risk for externalizing psychopathology in intervention group children. Variation in NR3C1 measured in this study was not associated with differential intervention response in African-American children. We discuss implications for efforts to prevent externalizing problems in high-risk children and for public policy in the genomic era.
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Affiliation(s)
- Dustin Albert
- Center for Child and Family Policy at Duke University, Durham, NC 27708.
| | - Daniel W Belsky
- Social Science Research Institute at Duke University, Durham, NC 27708.
| | - D Max Crowley
- Center for Child and Family Policy at Duke University, Durham, NC 27708.
| | - Shawn J Latendresse
- Department of Psychology and Neuroscience at Baylor University, Baylor Sciences Building, Waco, TX 76798.
| | - Fazil Aliev
- Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University, Richmond, VA 23219, and Karabuk University, Turkey.
| | - Brien Riley
- Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University, Richmond, VA 23219.
| | - Cuie Sun
- Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University, Richmond, VA 23219.
| | - Danielle M Dick
- Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University, Richmond, VA 23219.
| | - Kenneth A Dodge
- Center for Child and Family Policy, and Duke University, Durham, NC 27708.
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Parents are interested in newborn genomic testing during the early postpartum period. Genet Med 2014; 17:501-4. [PMID: 25474344 PMCID: PMC4452417 DOI: 10.1038/gim.2014.139] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/28/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE We surveyed parents to ascertain interest in newborn genomic testing and determine whether these queries would provoke refusal of conventional state-mandated newborn screening. METHODS After a brief genetics orientation, parents rated their interest in receiving genomic testing for their healthy newborn on a 5-point Likert scale and answered questions about demographics and health history. We used logistic regression to explore factors associated with interest in genomic testing and tracked any subsequent rejection of newborn screening. RESULTS We queried 514 parents within 48 hours after birth while still in hospital (mean age (SD) 32.7 (6.4) years, 65.2% female, 61.2% white, 79.3% married). Parents reported being not at all (6.4%), a little (10.9%), somewhat (36.6%), very (28.0%), or extremely (18.1%) interested in genomic testing for their newborns. None refused state-mandated newborn screening. Married participants and those with health concerns about their infant were less interested in newborn genomic testing (P = 0.012 and P = 0.030, respectively). Degree of interest for mothers and fathers was discordant (at least two categories different) for 24.4% of couples. CONCLUSION Interest in newborn genomic testing was high among parents of healthy newborns, and the majority of couples had similar levels of interest. Surveying parents about genomic sequencing did not prompt rejection of newborn screening.Genet Med 17 6, 501-504.
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[Current methods in genetic analysis : an approach for genetics-based preventive medicine]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 58:113-20. [PMID: 25446309 DOI: 10.1007/s00103-014-2088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Modern genetic analysis methods such as DNA arrays (gene chips) or high-throughput DNA sequencing of the next generation (Next Generation Sequencing, NGS) have once again accelerated the pace of innovation that has been powered by genome research over the past 10 years of the "post-genomic era". The present paper introduces array and NGS methods as two important innovation driving methods and provides examples for their application in large-scale scientific projects. However, a broad application of these very powerful technologies for genetic screening for the purpose of disease prevention is currently not yet in sight. The complexity of the interaction of genes, gene products and the environment has so far exceeded all expectations, suggesting that reliable statements about the medical relevance of common genetic variants can presently only be made in a few areas such as pharmacogenetics and oncology. We also discuss ethical issues raised by genetic population screening. The aim of this paper is to provide a brief outline of the development of methods in molecular genetics to the now dominant modern technologies and present their applications in research, in the diagnosis of rare diseases, and in terms of screening approaches.
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Bombard Y, Miller FA, Hayeems RZ, Barg C, Cressman C, Carroll JC, Wilson BJ, Little J, Avard D, Painter-Main M, Allanson J, Giguere Y, Chakraborty P. Public views on participating in newborn screening using genome sequencing. Eur J Hum Genet 2014; 22:1248-54. [PMID: 24549052 PMCID: PMC4200434 DOI: 10.1038/ejhg.2014.22] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/17/2014] [Accepted: 01/22/2014] [Indexed: 01/28/2023] Open
Abstract
Growing discussion on the use of whole-genome or exome sequencing (WG/ES) in newborn screening (NBS) has raised concerns regarding the generation of incidental information on millions of infants annually. It is unknown whether integrating WG/ES would alter public expectations regarding participation in universal NBS. We assessed public willingness to participate in NBS using WG/ES compared with current NBS. Our secondary objective was to assess the public's beliefs regarding a parental responsibility to participate in WG/ES-based NBS compared with current NBS. We examined self-reported attitudes regarding willingness to participate in NBS using a cross-sectional national survey of Canadian residents recruited through an internet panel, reflective of the Canadian population by age, gender and region. Our results showed that fewer respondents would be willing to participate in NBS using WG/ES compared with NBS using current technologies (80 vs 94%, P<0.001), or perceived a parental responsibility to participate in WG/ES-based NBS vs current NBS (30 vs 48%, P<0.001). Our findings suggest that integrating WG/ES into NBS might reduce participation, and challenge the moral authority that NBS programmes rely upon to ensure population benefits. These findings point to the need for caution in the untargeted use of WG/ES in public health contexts.
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Affiliation(s)
- Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Robin Z Hayeems
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Barg
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Celine Cressman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - June C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Brenda J Wilson
- Department of Epidemiology and Community Medicine, University of Ottawa, Toronto, Ontario, Canada
| | - Julian Little
- Department of Epidemiology and Community Medicine, University of Ottawa, Toronto, Ontario, Canada
| | - Denise Avard
- Centre for Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Michael Painter-Main
- Department of Political Science, University of Toronto, Toronto, Ontario, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Yves Giguere
- Quebec Blood Newborn Screening Program, Department of Medical Biology, CHU de Quebec, Charlesbourg, Quebec, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology, University of Laval, Quebec, Quebec, Canada
| | - Pranesh Chakraborty
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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44
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Genetics professionals' opinions of whole-genome sequencing in the newborn period. J Genet Couns 2014; 24:452-63. [PMID: 25348082 DOI: 10.1007/s10897-014-9779-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 09/24/2014] [Indexed: 12/30/2022]
Abstract
Newborn screening (NBS) programs have been successful in identifying infants with rare, treatable, congenital conditions. While current programs rely largely on biochemical analysis, some predict that in the future, genome sequencing may be used as an adjunct. The purpose of this exploratory pilot study was to begin to characterize genetics professionals' opinions of the use of whole-genome sequencing (WGS) in NBS. We surveyed members of the American College of Medical Genetics and Genomics (ACMG) via an electronic survey distributed through email. The survey included questions about results disclosure, the current NBS paradigm, and the current criteria for adding a condition to the screening panel. The response rate was 7.3 % (n = 113/1549). The majority of respondents (85 %, n = 96/113) felt that WGS should not be currently used in NBS, and that if it were used, it should not be mandatory (86.5 %, n = 96/111). However, 75.7 % (n = 84/111) foresee it as a future use of WGS. Respondents felt that accurate interpretation of results (86.5 %, n = 83/96), a more extensive consent process (72.6 %, n = 69/95), pre- (79.2 %, n = 76/96) and post-test (91.6 %, n = 87/95) counseling, and comparable costs (70.8 %, n = 68/96) and turn-around-times (64.6 %, n = 62/96) to current NBS would be important for using WGS in NBS. Participants were in favor of disclosing most types of results at some point in the lifetime. However, the majority (87.3 %, n = 96/110) also indicated that parents should be able to choose what results are disclosed. Overall, respondents foresee NBS as a future use of WGS, but indicated that WGS should not occur within the framework of traditional NBS. They agreed with the current criteria for including a condition on the recommended uniform screening panel (RUSP). Further discussion about these criteria is needed in order to better understand how they could be utilized if WGS is incorporated into NBS.
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Nicholls SG, Wilson BJ, Etchegary H, Brehaut JC, Potter BK, Hayeems R, Chakraborty P, Milburn J, Pullman D, Turner L, Carroll JC. Benefits and burdens of newborn screening: public understanding and decision-making. Per Med 2014; 11:593-607. [PMID: 29758802 DOI: 10.2217/pme.14.46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this article we review the literature regarding the public understanding of the potential benefits and burdens of expanded newborn bloodspot screening. We draw attention to broadened notions of benefit that go beyond early identification of asymptomatic individuals and interventions to reduce morbidity or mortality, and include benefits gained by families through knowledge that may facilitate life choices, as well as gains generated by avoiding diagnostic delays. We also reflect on burdens such as increasing false-positive results and parental anxiety, together with risks of overdiagnosis when the natural history of a condition is poorly understood. We conclude that expanded notions of benefit and burden bring with them implications for parental consent and confidentiality and the secondary use of bloodspots.
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Affiliation(s)
- Stuart G Nicholls
- Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brenda J Wilson
- Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Holly Etchegary
- Clinical Epidemiology, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie C Brehaut
- Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Beth K Potter
- Department of Epidemiology & Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Hayeems
- Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada.,Institute of Health Policy Management & Evaluation, University of Toronto, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Jennifer Milburn
- Better Outcomes Registry & Network (BORN), Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Daryl Pullman
- Faculty of Medicine, Memorial University, St Johns, Newfoundland & Labrador, Canada
| | - Lesley Turner
- Eastern Health, St John's, Newfoundland & Labrador, Canada
| | - June C Carroll
- Department of Family & Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Mak CM, Lee HCH, Chan AYW, Lam CW. Inborn errors of metabolism and expanded newborn screening: review and update. Crit Rev Clin Lab Sci 2014; 50:142-62. [PMID: 24295058 DOI: 10.3109/10408363.2013.847896] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Inborn errors of metabolism (IEM) are a phenotypically and genetically heterogeneous group of disorders caused by a defect in a metabolic pathway, leading to malfunctioning metabolism and/or the accumulation of toxic intermediate metabolites. To date, more than 1000 different IEM have been identified. While individually rare, the cumulative incidence has been shown to be upwards of 1 in 800. Clinical presentations are protean, complicating diagnostic pathways. IEM are present in all ethnic groups and across every age. Some IEM are amenable to treatment, with promising outcomes. However, high clinical suspicion alone is not sufficient to reduce morbidities and mortalities. In the last decade, due to the advent of tandem mass spectrometry, expanded newborn screening (NBS) has become a mandatory public health strategy in most developed and developing countries. The technology allows inexpensive simultaneous detection of more than 30 different metabolic disorders in one single blood spot specimen at a cost of about USD 10 per baby, with commendable analytical accuracy and precision. The sensitivity and specificity of this method can be up to 99% and 99.995%, respectively, for most amino acid disorders, organic acidemias, and fatty acid oxidation defects. Cost-effectiveness studies have confirmed that the savings achieved through the use of expanded NBS programs are significantly greater than the costs of implementation. The adverse effects of false positive results are negligible in view of the economic health benefits generated by expanded NBS and these could be minimized through increased education, better communication, and improved technologies. Local screening agencies should be given the autonomy to develop their screening programs in order to keep pace with international advancements. The development of biochemical genetics is closely linked with expanded NBS. With ongoing advancements in nanotechnology and molecular genomics, the field of biochemical genetics is still expanding rapidly. The potential of tandem mass spectrometry is extending to cover more disorders. Indeed, the use of genetic markers in T-cell receptor excision circles for severe combined immunodeficiency is one promising example. NBS represents the highest volume of genetic testing. It is more than a test and it warrants systematic healthcare service delivery across the pre-analytical, analytical, and post-analytical phases. There should be a comprehensive reporting system entailing genetic counselling as well as short-term and long-term follow-up. It is essential to integrate existing clinical IEM services with the expanded NBS program to enable close communication between the laboratory, clinicians, and allied health parties. In this review, we will discuss the history of IEM, its clinical presentations in children and adult patients, and its incidence among different ethnicities; the history and recent expansion of NBS, its cost-effectiveness, associated pros and cons, and the ethical issues that can arise; the analytical aspects of tandem mass spectrometry and post-analytical perspectives regarding result interpretation.
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Affiliation(s)
- Chloe Miu Mak
- Chemical Pathology Laboratory, Department of Pathology, Princess Margaret Hospital , Hong Kong, SAR , China and
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Li A, Meyre D. Jumping on the Train of Personalized Medicine: A Primer for Non- Geneticist Clinicians: Part 3. Clinical Applications in the Personalized Medicine Area. CURRENT PSYCHIATRY REVIEWS 2014; 10:118-132. [PMID: 25598768 PMCID: PMC4287884 DOI: 10.2174/1573400510666140630170549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 12/17/2022]
Abstract
The rapid decline of sequencing costs brings hope that personal genome sequencing will become a common feature of medical practice. This series of three reviews aim to help non-geneticist clinicians to jump into the fast-moving field of personalized genetic medicine. In the first two articles, we covered the fundamental concepts of molecular genetics and the methodologies used in genetic epidemiology. In this third article, we discuss the evolution of personalized medicine and illustrate the most recent success in the fields of Mendelian and complex human diseases. We also address the challenges that currently limit the use of personalized medicine to its full potential.
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Affiliation(s)
| | - David Meyre
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON L8N 3Z5, Canada
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Graves KD, Sinicrope PS, Esplen MJ, Peterson SK, Patten CA, Lowery J, Sinicrope FA, Nigon SK, Borgen J, Gorin SS, Keogh LA, Lindor NM. Communication of genetic test results to family and health-care providers following disclosure of research results. Genet Med 2014; 16:294-301. [PMID: 24091800 PMCID: PMC4009372 DOI: 10.1038/gim.2013.137] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/29/2013] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Few studies have examined methods to promote communication following the return of DNA mismatch repair genetic test results obtained during research. The purpose of the present study was to evaluate a telephone protocol for returning research results of DNA mismatch repair gene testing to identify Lynch syndrome. METHODS We invited individuals with known DNA mismatch repair mutations in their family, who were enrolled in the Colon Cancer Family Registry at the Mayo Clinic, to participate in this study. Participants completed surveys before and 6 months after DNA mismatch repair test result disclosure. RESULTS Among 107 participants, 79% opted to learn their DNA mismatch repair test results; of these, 44 (41%) carried DNA mismatch repair mutations. After disclosure, 54% reported screening for any type of cancer. Among carriers, >74% reported communicating results to family; communication was predicted by baseline confidence in coping with the genetic test result (Z = 1.97; P = 0.04). Result disclosure to a physician was predicted by greater perceived cancer risk (Z = 2.08; P = 0.03) and greater intention to share results with family (Z = 3.07; P = 0.002). CONCLUSION Research versus clinically based gene disclosure presents challenges. A telephone disclosure process for the return of research-based results among Lynch syndrome families led to high rates of result uptake and participant communication of results to providers and family members.
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Affiliation(s)
- Harvey L Levy
- Division of Genetics and Genomics, Boston Children's Hospital Boston, Massachusetts ; Department of Pediatrics, Harvard Medical School Boston, Massachusetts
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Knoppers BM, Senecal K, Borry P, Avard D. Whole-Genome Sequencing in Newborn Screening Programs. Sci Transl Med 2014; 6:229cm2. [DOI: 10.1126/scitranslmed.3008494] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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