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Hassel NC, Gilbert AD, Bejjani BA. COVID-19 and the adaptive evolution of genetic counseling. J Genet Couns 2022; 31:832-835. [PMID: 35304788 PMCID: PMC9088315 DOI: 10.1002/jgc4.1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/12/2022] [Accepted: 02/27/2022] [Indexed: 11/09/2022]
Abstract
Emerging diseases such as the Coronavirus Disease (COVID-19) have exposed severe weaknesses in the United States and global health. Healthcare systems have struggled and are still severely challenged and strained by this pandemic. It is clear that additional resources are needed to support healthcare providers in managing this and future pandemics. Genetic counselors can play an important supporting role in this fragile ecosystem because their comprehensive and broad training makes them uniquely qualified to meet many of the challenges that arise when healthcare workers and patients are faced with novel diseases. This paper describes the recent involvement of a telegenetic counseling company (Metis Genetics) in communicating and explaining COVID-19 serum antibody results to patients and physicians. This experience demonstrates how genetic counselors may be called upon to play a vital supporting role in the management of infectious disease pandemics. From May 2020 to July 2020, our genetic counseling telegenetics team was asked to provide support to more than 1,580 patients who underwent serum COVID-19 antibody testing and to educate their healthcare providers on the performance properties of this new test. The genetic counselors were able to utilize their expertise to convey test results, information on Center for Disease Control and Prevention (CDC) recommendations, COVID-19 fact-based evidence, to provide psychological support and reassurance to patients, and to respond to providers questions about the test. This experience suggests that the genetic counselors' skillset that has allowed the profession to continuously evolve can also be used in the management of pandemics by communicating directly with the public, supporting other healthcare workers, and assisting individual patients and families navigate the many medical and psychological issues caused by such events.
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Affiliation(s)
| | - Adel D Gilbert
- Metis Genetics, Addison, Texas, USA.,Wake Forest University Graduate School of Arts and Sciences, Winston-Salem, North Carolina, USA
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Ehsan L, Waheed MT, Akbar F, Siddiqui Z, Sattar AK, Kirmani S. Challenges and opportunities in the establishment of a hereditary breast cancer clinic at an academic medical center in a low-middle income country. J Genet Couns 2022; 31:998-1002. [PMID: 35099095 DOI: 10.1002/jgc4.1555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 01/24/2023]
Abstract
It is now standard of care to offer genetic testing to patients at risk of hereditary breast cancer and make management decisions based on these results. Although great strides have been made in ensuring access to genetic testing and genetic counseling by establishing hereditary breast cancer clinics in well-resourced countries, these are essentially non-existent in low-middle income countries like Pakistan. We established a hereditary breast cancer clinic involving a multidisciplinary team, including a medical geneticist and a genetic counselor. Our efforts were based on consensus guidelines and included educating medical providers about the importance of genetic testing in breast cancer care and the mandatory presence of a genetics team member at the weekly Breast Tumor Board meeting. This resulted in an increase in the number of referrals of breast cancer patients for genetic testing. In this report, we describe the challenges we faced in setting up such a system in Pakistan and the measures to overcome them. There is a need to establish such hereditary breast cancer clinics, which can also be replicated at other centers in low-resource settings, to improve standardized assessment and management of the patients with hereditary breast cancer according to consensus guidelines.
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Affiliation(s)
- Lubaina Ehsan
- Medical College, Aga Khan University, Karachi, Pakistan.,Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | | | - Fizza Akbar
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Abida K Sattar
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Salman Kirmani
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
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Hochstenbach R, Liehr T, Hastings RJ. Chromosomes in the genomic age. Preserving cytogenomic competence of diagnostic genome laboratories. Eur J Hum Genet 2021; 29:541-552. [PMID: 33311710 PMCID: PMC8115145 DOI: 10.1038/s41431-020-00780-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/26/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Participation of clinical genetic laboratories in External Quality Assessment schemes (EQAs) is a powerful method to ascertain if any improvement or additional training is required in the diagnostic service. Here, we provide evidence from recent EQAs that the competence in recognizing and interpreting cytogenetic aberrations is variable and could impact patient management. We identify several trends that could affect cytogenomic competence. Firstly, as a result of the age distribution among clinical laboratory geneticists (CLGs) registered at the European Board of Medical Genetics, about 25-30% of those with experience in cytogenetics will retire during the next decade. At the same time, there are about twice as many molecular geneticists to cytogeneticists among the younger CLGs. Secondly, when surveying training programs for CLG, we observed that not all programs guarantee that candidates gather sufficient experience in clinical cytogenomics. Thirdly, we acknowledge that whole genome sequencing (WGS) has a great attraction to biomedical scientists that wish to enter a training program for CLG. This, with a larger number of positions available, makes a choice for specialization in molecular genetics logical. However, current WGS technology cannot provide a diagnosis in all cases. Understanding the etiology of chromosomal rearrangements is essential for appropriate follow-up and for ascertaining recurrence risks. We define the minimal knowledge a CLG should have about cytogenomics in a world dominated by WGS, and discuss how laboratory directors and boards of professional organizations in clinical genetics can uphold cytogenomic competence by providing adequate CLG training programs and attracting sufficient numbers of trainees.
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Affiliation(s)
- Ron Hochstenbach
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Clinical Genetics, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - Thomas Liehr
- University Clinic Jena, Institute of Human Genetics, Am Klinikum 1, 07747, Jena, Germany
| | - Rosalind J Hastings
- GenQA, Level 1, The Women's Centre, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
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Kurnat-Thoma E. Educational and Ethical Considerations for Genetic Test Implementation Within Health Care Systems. NETWORK AND SYSTEMS MEDICINE 2020; 3:58-66. [PMID: 32676590 PMCID: PMC7357722 DOI: 10.1089/nsm.2019.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: The precision medicine (PM) era presents unprecedented proliferation of genetic/genomic initiatives, information, and bioinformatic tools to enhance targeted molecular diagnosis and therapeutic treatments. As of February 29, 2020, the National Institutes of Health (NIH) National Center for Biotechnology Information (NCBI) Genetic Testing Registry contained 64,860 genetic tests for 12,268 conditions and 18,686 genes from 560 laboratories, and the Food and Drug Administration had 404 entries for pharmacogeneomic biomarkers used in drug labeling. Population-based research initiatives including NIH's All of Us and Veterans Affairs' Million Veteran Program, and the UK Biobank, combine use of genomic biorepositories with electronic medical records (i.e., National Human Genome Research Institute's [NHGRI's] electronic Medical Records and Genomics [eMERGE] Network). Learning health care systems are implementing clinical genomics screening programs and precision oncology programs. However, there are insufficient medical geneticists, nurse geneticists, and genetics counselors to implement expanding number of clinical genetic tests that are required for PM implementation. Methods: A scoping review of current (2014-2019) trends in U.S. genomic medicine translation, PM health care provider workforce education and training resources, and genomic clinical decision support (CDS) implementation tools was conducted. Results: Health care delivery institutions and systems are beginning to implement genetic tests that are driving PM, particularly in the areas of oncology, pharmacogenetics, obstetrics, and prenatal diagnostics. To ensure safe adoption and clinical translation of PM, health care systems have an ethical responsibility to ensure their providers and front-line staff are adequately prepared to order, use, and interpret genetic test information. Conclusion: There are a number of high-quality evidenced-based educational resources and CDS tools available. Strong partnerships between health care system leaders, front-line providers and staff coupled with reasonable goal setting can help drive PM translation interests.
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Affiliation(s)
- Emma Kurnat-Thoma
- Department of Intramural Research, DHHS/NIH/NINR, Bethesda, Maryland, USA
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, USA
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Adashek JJ, Leonard A, Roszik J, Menta AK, Genovese G, Subbiah V, Msaouel P. Cancer Genetics and Therapeutic Opportunities in Urologic Practice. Cancers (Basel) 2020; 12:cancers12030710. [PMID: 32197306 PMCID: PMC7140104 DOI: 10.3390/cancers12030710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 01/02/2023] Open
Abstract
This article aims to summarize the current literature on genetic alterations related to tumors of the genitourinary tract. Novel associations have recently been reported between specific DNA alterations and genitourinary malignancies. The most common cause of chromosome 3p loss in clear cell renal cell carcinoma is a chromothripsis event, which concurrently generates a chromosome 5q gain. Specific patterns of clear cell renal cell carcinoma metastatic evolution have been uncovered. The first therapy targeting a specific molecular alteration has now been approved for urothelial carcinoma. Germline mutations in DNA damage repair genes and the transcription factor HOXB13 are associated with prostate cancer and may be targeted therapeutically. The genetic associations noted across different genitourinary cancers can inform potential screening approaches and guide novel targeted treatment strategies.
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Affiliation(s)
- Jacob J. Adashek
- Department of Internal Medicine, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33606, USA;
| | - Alex Leonard
- Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA;
| | - Jason Roszik
- Departments of Genomic Medicine and Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Arjun K. Menta
- The University of Texas at Austin, Austin, TX 78712, USA;
| | - Giannicola Genovese
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: (V.S.); (P.M.); Tel.: +1-713-563-1930 (V.S.); +1-713-563-4585 (P.M.); Fax: +1-713-792-0334 (V.S.); +1-713-745-0422 (P.M.)
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- Correspondence: (V.S.); (P.M.); Tel.: +1-713-563-1930 (V.S.); +1-713-563-4585 (P.M.); Fax: +1-713-792-0334 (V.S.); +1-713-745-0422 (P.M.)
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Greely HT. The Future of DTC Genomics and the Law. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:151-160. [PMID: 32342782 PMCID: PMC7394665 DOI: 10.1177/1073110520917003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Direct-to-Consumer ("DTC") genomics has been a controversial topic for over a decade. Much work has been done on the legal issues it raises. This article asks a different question: What will DTC genomics and its legal issues look like in ten to twenty years? After discussing the five current uses of DTC genomics, it describes three current legal issues: medical uses, privacy of genomic information, and privacy in collection and analysis of human DNA. It then suggests that changes in human genomics and how it is used will make the first of those DTC genomics legal issues less important in the future, but that the third will be increasingly significant.
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Affiliation(s)
- Henry T Greely
- Henry T. Greely, J.D., is the Deane F. and Kate Edelman Johnson Professor of Law, Professor by Courtesy of Genetics, and Director of the Center for Law and the Biosciences at Stanford University
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Affiliation(s)
- Maximilian Muenke
- National Human Genome Research InstituteNational Institutes of HealthBethesdaMDUSA
| | - Suzanne Hart
- National Human Genome Research InstituteNational Institutes of HealthBethesdaMDUSA
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Regier DS, Ferreira CR, Hart S, Hadley DW, Muenke M. Medical genetics and genomic medicine in the United States. Part 2: Reproductive genetics, newborn screening, genetic counseling, training, and registries. Mol Genet Genomic Med 2017; 5:621-630. [PMID: 29178644 PMCID: PMC5702569 DOI: 10.1002/mgg3.343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 01/10/2023] Open
Abstract
Review of genetics in the United States with emphasis on the prenatal, metabolic, genetic counseling, and training aspects of the field.
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Affiliation(s)
- Debra S Regier
- Rare Disease Institute, Children's National Health System, Washington, DC, USA
| | - Carlos R Ferreira
- Rare Disease Institute, Children's National Health System, Washington, DC, USA.,National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Suzanne Hart
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Donald W Hadley
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maximilian Muenke
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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