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Miner SA, Similuk M, Jamal L, Sapp J, Berkman BE. Genomic tools for health: Secondary findings as findings to be shared. Genet Med 2022; 24:2220-2227. [PMID: 35980380 PMCID: PMC9643624 DOI: 10.1016/j.gim.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Whether and how to disclose secondary finding (SF) information to children is ethically debated. Some argue that genetic testing of minors should be limited to preserve the child's future autonomy. Others suggest that disclosure of SFs can occur if it is in the best interests of the child. However, the ways that parents conceptualize and weigh their child's future autonomy against the interests of their child and other family members are unknown. METHODS To explore how parents understand SF disclosure in the context of their child and other family members' lives, we conducted semistructured interviews with 30 families (40 parents in total). All parents had children who were enrolled in a genetic sequencing protocol that returned results by default. RESULTS We found that parents did not routinely conceptualize SFs as distinctive health information. Rather parents saw this information as part of their child's overall health. To make decisions about disclosure, parents weighed their child's ability to understand the SF information and their other family member's need to know. CONCLUSION Because most families desired SF information, we argue that disclosure of SF be reconceptualized to reflect the lived experiences of those who may receive this information.
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Affiliation(s)
- Skye A Miner
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD; Department of Medical Humanities and Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Morgan Similuk
- Centralized Sequencing Program, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Leila Jamal
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD; NHGRI/NCI/JHU Genetic Counseling Training Program, National Human Genome Research Insitute, Bethesda, MD
| | - Julie Sapp
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD; Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Benjamin E Berkman
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD; Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.
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Goddard KAB, Lee K, Buchanan AH, Powell BC, Hunter JE. Establishing the Medical Actionability of Genomic Variants. Annu Rev Genomics Hum Genet 2022; 23:173-192. [PMID: 35363504 PMCID: PMC10184682 DOI: 10.1146/annurev-genom-111021-032401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Actionability is an important concept in medicine that does not have a well-accepted standard definition, nor is there a general consensus on how to establish it. Medical actionability is often conflated with clinical utility, a related but distinct concept. This lack of clarity contributes to practice variation and inconsistent coverage decisions in genomic medicine, leading to the potential for systematic bias in the use of evidence-based interventions. We clarify how medical actionability and clinical utility are distinct and then discuss the spectrum of actionability, including benefits for the person, the family, and society. We also describe applications across the life course, including prediction, diagnosis, and treatment. Current challenges in assessing the medical actionability of identified genomic variants include gaps in the evidence, limited contexts with practice guidelines, and subjective aspects of medical actionability. A standardized and authoritative assessment of medical actionability is critical to implementing genomic medicine in a fashion that improves population health outcomes and reduces health disparities. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Katrina A B Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA; .,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; , .,Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA; .,Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA;
| | - Kristy Lee
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA; .,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; , .,Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA; .,Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA;
| | - Adam H Buchanan
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA; .,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; , .,Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA; .,Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA;
| | - Bradford C Powell
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA; .,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; , .,Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA; .,Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA;
| | - Jessica Ezzell Hunter
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA; .,Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; , .,Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA; .,Genomics, Ethics, and Translational Research Program, RTI International, Research Triangle Park, North Carolina, USA;
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3
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Tosin KCF, Legal EF, Pianovski MAD, Ibañez HC, Custódio G, Carvalho DS, Figueiredo MMO, Hoffmann Filho A, Fiori CMCM, Rodrigues ALM, Mello RG, Ogradowski KRP, Parise IZS, Costa TEJ, Melanda VS, Watanabe FM, Silva DB, Komechen H, Laureano HA, Carboni EK, Kuczynski AP, Luiz GCF, Lima L, Tormen T, Gerber VKQ, Anegawa TH, Avilla SGA, Tenório RB, Mendes EL, Fachin Donin RD, Souza J, Kozak VN, Oliveira GS, Souza DC, Gomy I, Teixeira VB, Borba HHL, Kiesel Filho N, Parise GA, Ribeiro RC, Figueiredo BC. Newborn Screening for the Detection of the TP53 R337H Variant and Surveillance for Early Diagnosis of Pediatric Adrenocortical Tumors: Lessons Learned and Way Forward. Cancers (Basel) 2021; 13:cancers13236111. [PMID: 34885220 PMCID: PMC8656743 DOI: 10.3390/cancers13236111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Adrenocortical tumor (ACT) is rare in children and fatal if not detected early. Children who inherit a mutation of the TP53 gene tend to develop ACT early in life. In the 1990s, scientists revealed that a TP53 variant (R337H) was frequent in South Brazil. Therefore, the incidence of ACT in children is 20 times higher in this region than in other countries. We reviewed the records of 16 children with ACT treated in a pediatric hospital in Parana state (southern Brazil) and 134 children registered in the state public registry data. We found a high number of cases with advanced disease, leading to an unacceptable number of deaths. These observations contradict newborn R337H screening and surveillance data, showing that surgical intervention in early cases of ACT is associated with a 100% cure. Newborn screening/surveillance should be implemented in regions with a high frequency of the R337H variant. Abstract The incidence of pediatric adrenocortical tumors (ACT) is high in southern Brazil due to the founder TP53 R337H variant. Neonatal screening/surveillance (NSS) for this variant resulted in early ACT detection and improved outcomes. The medical records of children with ACT who did not participate in newborn screening (non-NSS) were reviewed (2012–2018). We compared known prognostic factors between the NSS and non-NSS cohorts and estimated surveillance and treatment costs. Of the 16 non-NSS children with ACT carrying the R337H variant, the disease stages I, II, III, and IV were observed in five, five, one, and five children, respectively. The tumor weight ranged from 22 to 608 g. The 11 NSS children with ACT all had disease stage I and were alive. The median tumor weight, age of diagnosis, and interval between symptoms and diagnosis were 21 g, 1.9 years, and two weeks, respectively, for the NSS cohort and 210 g, 5.2 years, and 15 weeks, respectively, for the non-NSS cohort. The estimated surveillance/screening cost per year of life saved is US$623/patient. NSS is critical for improving the outcome of pediatric ACT in this region. Hence, we strongly advocate for the inclusion of R337H in the state-mandated universal screening and surveillance.
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Affiliation(s)
- Karina C. F. Tosin
- Departamento de Saúde Coletiva, Federal University of Paraná, Rua Padre Camargo, 260, Centro, Curitiba 80.060-240, PR, Brazil; (K.C.F.T.); (D.S.C.)
| | - Edith F. Legal
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Mara A. D. Pianovski
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Humberto C. Ibañez
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Gislaine Custódio
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Denise S. Carvalho
- Departamento de Saúde Coletiva, Federal University of Paraná, Rua Padre Camargo, 260, Centro, Curitiba 80.060-240, PR, Brazil; (K.C.F.T.); (D.S.C.)
| | - Mirna M. O. Figueiredo
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Anselmo Hoffmann Filho
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Carmem M. C. M. Fiori
- Hospital do Câncer, UOPECCAN, R. Itaquatiaras, 769, Santo Onofre, Cascavel 85.806-300, PR, Brazil;
| | - Ana Luiza M. Rodrigues
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Rosiane G. Mello
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
| | - Karin R. P. Ogradowski
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
| | - Ivy Z. S. Parise
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Tatiana E. J. Costa
- Hospital Infantil Joana de Gusmão, R. Rui Barbosa, 152, Agronômica, Florianópolis 88.025-301, SC, Brazil; (T.E.J.C.); (D.B.S.)
| | - Viviane S. Melanda
- Secretaria do Estado da Saúde do Paraná, R. Piquiri, 170, Rebouças, Curitiba 80.230-140, PR, Brazil;
| | - Flora M. Watanabe
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Denise B. Silva
- Hospital Infantil Joana de Gusmão, R. Rui Barbosa, 152, Agronômica, Florianópolis 88.025-301, SC, Brazil; (T.E.J.C.); (D.B.S.)
| | - Heloisa Komechen
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Henrique A. Laureano
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Edna K. Carboni
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Ana P. Kuczynski
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Gabriela C. F. Luiz
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Leniza Lima
- Oncologia Pediátrica, Hospital de Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181, Alto da Glória, Curitiba 80.060-900, PR, Brazil; (L.L.); (T.T.)
| | - Tiago Tormen
- Oncologia Pediátrica, Hospital de Clínicas da Universidade Federal do Paraná, R. Gen. Carneiro, 181, Alto da Glória, Curitiba 80.060-900, PR, Brazil; (L.L.); (T.T.)
| | - Viviane K. Q. Gerber
- Departamento de Enfermagem, Universidade Estadual do Centro-Oeste, UNICENTRO, Rua Padre, R. Salvatore Renna, 875-Santa Cruz, Guarapuava 85.015-430, PR, Brazil;
| | - Tania H. Anegawa
- Oncologia Pediátrica, Campus Universitário, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid—Pr 445 Km 380, Londrina 86.057-970, PR, Brazil;
| | - Sylvio G. A. Avilla
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Renata B. Tenório
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Elaine L. Mendes
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Rayssa D. Fachin Donin
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Josiane Souza
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Vanessa N. Kozak
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Gisele S. Oliveira
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Deivid C. Souza
- Oncologia Pediátrica, Hospital Erasto Gaertner, R. Dr. Ovande do Amaral, 201, Jardim das Américas, Curitiba 81.520-060, PR, Brazil; (M.A.D.P.); (A.L.M.R.); (V.N.K.); (G.S.O.); (D.C.S.)
| | - Israel Gomy
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Vinicius B. Teixeira
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
| | - Helena H. L. Borba
- Departamento de Ciências Farmacêuticas, Federal University of Paraná, Av. Prefeito Lothário Meissner, 632-Jardim Botanico, Curitiba 80.210-170, PR, Brazil;
| | - Nilton Kiesel Filho
- Hospital Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (F.M.W.); (E.K.C.); (A.P.K.); (G.C.F.L.); (S.G.A.A.); (R.B.T.); (E.L.M.); (J.S.); (N.K.F.)
| | - Guilherme A. Parise
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
| | - Raul C. Ribeiro
- Leukemia and Lymphoma Division, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA
- Correspondence: (R.C.R.); or (B.C.F.)
| | - Bonald C. Figueiredo
- Departamento de Saúde Coletiva, Federal University of Paraná, Rua Padre Camargo, 260, Centro, Curitiba 80.060-240, PR, Brazil; (K.C.F.T.); (D.S.C.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Silva Jardim, 1532, Curitiba 80.250-060, PR, Brazil; (E.F.L.); (H.C.I.); (A.H.F.); (R.G.M.); (K.R.P.O.); (I.Z.S.P.); (H.K.); (H.A.L.); (V.B.T.)
- Centro de Genética Molecular e Pesquisa do Câncer em Crianças (CEGEMPAC-APACN), Avenida Agostinho Leão Jr., 400, Curitiba 80.030-110, PR, Brazil; (G.C.); (M.M.O.F.); (R.D.F.D.); (G.A.P.)
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Rebouças, Curitiba 80.230-020, PR, Brazil;
- Correspondence: (R.C.R.); or (B.C.F.)
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Mannette R. Navigating a world of genes: A conceptual analysis of gene fetishism, geneticization, genetic exceptionalism and genetic essentialism. Eur J Med Genet 2021; 64:104232. [PMID: 33974995 DOI: 10.1016/j.ejmg.2021.104232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
Genetics, as a discipline, is an essential part of the modern world. However, analyzing the interaction between genetics and society can be complex. Therefore, terminology has arisen from diverse fields to better understand genetics and its relation to other domains. Nevertheless, the diverse origins of many of these terms, as well as a lack of clarity in their definitions, have led to differences in use. This paper focuses on four such terms: genetic fetishism, geneticization, genetic essentialism, and genetic exceptionalism. By clarifying what each term means, the fields that utilize them will be helped. Furthermore, these terms can have specific value to bioethics in analyzing ethical issues that arise from genetics and the interaction with the socio-cultural world. While these terms may not always be applicable, a more careful analysis of their meaning can cultivate a more scientific and rigorous analysis of the ways genetics impacts and is understood by humanity.
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Affiliation(s)
- Ruel Mannette
- Department of Philosophy, University of Hawaii at Manoa, Honolulu, HI, USA.
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5
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Savatt JM, Wagner JK, Joffe S, Rahm AK, Williams MS, Bradbury AR, Davis FD, Hergenrather J, Hu Y, Kelly MA, Kirchner HL, Meyer MN, Mozersky J, O'Dell SM, Pervola J, Seeley A, Sturm AC, Buchanan AH. Pediatric reporting of genomic results study (PROGRESS): a mixed-methods, longitudinal, observational cohort study protocol to explore disclosure of actionable adult- and pediatric-onset genomic variants to minors and their parents. BMC Pediatr 2020; 20:222. [PMID: 32414353 PMCID: PMC7227212 DOI: 10.1186/s12887-020-02070-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Exome and genome sequencing are routinely used in clinical care and research. These technologies allow for the detection of pathogenic/likely pathogenic variants in clinically actionable genes. However, fueled in part by a lack of empirical evidence, controversy surrounds the provision of genetic results for adult-onset conditions to minors and their parents. We have designed a mixed-methods, longitudinal cohort study to collect empirical evidence to advance this debate. METHODS Pediatric participants in the Geisinger MyCode® Community Health Initiative with available exome sequence data will have their variant files assessed for pathogenic/likely pathogenic variants in 60 genes designated as actionable by MyCode. Eight of these genes are associated with adult-onset conditions (Hereditary Breast and Ovarian Cancer Syndrome (HBOC), Lynch syndrome, MUTYH-associated polyposis, HFE-Associated Hereditary Hemochromatosis), while the remaining genes have pediatric onset. Prior to clinical confirmation of results, pediatric MyCode participants and their parents/legal guardians will be categorized into three study groups: 1) those with an apparent pathogenic/likely pathogenic variant in a gene associated with adult-onset disease, 2) those with an apparent pathogenic/likely pathogenic variant in a gene associated with pediatric-onset disease or with risk reduction interventions that begin in childhood, and 3) those with no apparent genomic result who are sex- and age-matched to Groups 1 and 2. Validated and published quantitative measures, semi-structured interviews, and a review of electronic health record data conducted over a 12-month period following disclosure of results will allow for comparison of psychosocial and behavioral outcomes among parents of minors (ages 0-17) and adolescents (ages 11-17) in each group. DISCUSSION These data will provide guidance about the risks and benefits of informing minors and their family members about clinically actionable, adult-onset genetic conditions and, in turn, help to ensure these patients receive care that promotes physical and psychosocial health. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03832985. Registered 6 February 2019.
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Affiliation(s)
| | - Jennifer K Wagner
- Center for Translational Bioethics and Health Care Policy, Geisinger, Danville, PA, USA
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Angela R Bradbury
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - F Daniel Davis
- Center for Translational Bioethics and Health Care Policy, Geisinger, Danville, PA, USA
| | - Julie Hergenrather
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | | | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Michelle N Meyer
- Center for Translational Bioethics and Health Care Policy, Geisinger, Danville, PA, USA
| | - Jessica Mozersky
- Bioethics Research Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sean M O'Dell
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, USA
- Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Josie Pervola
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Andrea Seeley
- Department of Pediatrics, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
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6
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Garrett JR, Lantos JD, Biesecker LG, Childerhose JE, Chung WK, Holm IA, Koenig BA, McEwen JE, Wilfond BS, Brothers K. Rethinking the "open future" argument against predictive genetic testing of children. Genet Med 2019; 21:2190-2198. [PMID: 30894702 PMCID: PMC6754817 DOI: 10.1038/s41436-019-0483-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
Professional consensus has traditionally discouraged predictive genetic testing when no childhood interventions can reduce future morbidity or mortality. However, advances in genome sequencing and accumulating evidence that children and families cope adequately with predictive genetic information have weakened this consensus. The primary argument remaining against testing appeals to children's "right to an open future." It claims that the autonomy of the future adult is violated when others make an irreversible choice to obtain or disclose predictive genetic information during childhood. We evaluate this argument and conclude that children's interest in an open future should not be understood as a right. Rather an open future is one significant interest to weigh against other important interests when evaluating decisions. Thus, predictive genetic testing is ethically permissible in principle, as long as the interests promoted outweigh potential harms. We conclude by offering an expanded model of children's interests that might be considered in such circumstances, and present two case analyses to illustrate how this framework better guides decisions about predictive genetic testing in pediatrics.
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Affiliation(s)
- Jeremy R Garrett
- Children's Mercy Bioethics Center, Children's Mercy Kansas City, Kansas City, MO, USA.
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Leslie G Biesecker
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Janet E Childerhose
- Division of Pediatric Clinical and Translational Research, University of Louisville School of Medicine, Louisville, KY, USA
| | - Wendy K Chung
- Departments of Medicine and Pediatrics, Columbia University, New York, NY, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, and Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Barbara A Koenig
- UCSF Bioethics, University of California San Francisco, San Francisco, CA, USA
| | - Jean E McEwen
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Benjamin S Wilfond
- Treuman Katz Bioethics Center, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kyle Brothers
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
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7
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Warby M, Wakefield CE, Vetsch J, Tucker KM. Families' and health care professionals' attitudes towards Li-Fraumeni syndrome testing in children: A systematic review. Clin Genet 2019; 95:140-150. [PMID: 30191952 DOI: 10.1111/cge.13442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 01/18/2023]
Abstract
Li-Fraumeni syndrome (LFS) is a highly penetrant cancer predisposition syndrome caused by germline TP53 mutations. Genetic testing is not routinely offered in asymptomatic children at risk of the condition as the benefits are debatable and the attitudes of families and health care professionals (HCPs) may vary. This review assessed the attitudes of families and HCPs towards offering genetic testing to children for LFS, with a focus on perceived advantages and disadvantages and involvement of children in the decision-making process. We searched three key databases (Medline, PsycINFO and EMBASE) to identify quantitative and qualitative studies. We screened 729 articles identifying eight studies for detailed review. Most parents perceived TP53 genetic testing to be beneficial in childhood, despite previous lack of surveillance guidelines. Parents raised some concerns, including decreased insurability and diminishing the child's autonomy. Most children tested reported no negative emotional concerns after testing, even if tested positive. Despite generally positive interest clinicians remain hesitant. Most families saw the value in involving children in decision-making. Families' acceptance of TP53 testing in childhood was high. This review highlights the need for research on the long-term psychosocial impacts of testing and the attitudes of families to be reflected in professional guidelines.
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Affiliation(s)
- Meera Warby
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
- Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Katherine M Tucker
- Hereditary Cancer Centre, Department of Oncology and Haematology, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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8
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9
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Manzini A, Vears DF. Predictive Psychiatric Genetic Testing in Minors: An Exploration of the Non-Medical Benefits. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:111-120. [PMID: 29230699 PMCID: PMC5897476 DOI: 10.1007/s11673-017-9828-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
Predictive genetic testing for susceptibility to psychiatric conditions is likely to become part of standard practice. Because the onset of most psychiatric diseases is in late adolescence or early adulthood, testing minors could lead to early identification that may prevent or delay the development of these disorders. However, due to their complex aetiology, psychiatric genetic testing does not provide the immediate medical benefits that current guidelines require for testing minors. While several authors have argued non-medical benefits may play a crucial role in favour of predictive testing for other conditions, little research has explored such a role in psychiatric disorders. This paper outlines the potential non-medical benefits and harms of psychiatric genetic testing in minors in order to consider whether the non-medical benefits could ever make such testing appropriate. Five non-medical themes arise in the literature: psychological impacts, autonomy/self-determination, implications of the biomedical approach, use of financial and intellectual resources, and discrimination. Non-medical benefits were prominent in all of them, suggesting that psychiatric genetic testing in minors may be appropriate in some circumstances. Further research needs to empirically assess these potential non-medical benefits, incorporate minors in the debate, and include normative reflection to evaluate the very purposes and motivations of psychiatric genetic testing in minors.
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Affiliation(s)
- Arianna Manzini
- Neuroscience, Ethics & Society Team, Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Ln, Oxford, OX3 7JX UK
| | - Danya F. Vears
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium
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10
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De Rechter S, Kringen J, Janssens P, Liebau MC, Devriendt K, Levtchenko E, Bergmann C, Jouret F, Bammens B, Borry P, Schaefer F, Mekahli D. Clinicians' attitude towards family planning and timing of diagnosis in autosomal dominant polycystic kidney disease. PLoS One 2017; 12:e0185779. [PMID: 28961265 PMCID: PMC5621697 DOI: 10.1371/journal.pone.0185779] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/19/2017] [Indexed: 12/14/2022] Open
Abstract
Several ethical aspects in the management of Autosomal Dominant Polycystic Kidney Disease (ADPKD) are still controversial, including family planning and testing for disease presence in at-risk individuals. We performed an online survey aiming to assess the opinion and current clinical practice of European pediatric and adult nephrologists, as well as geneticists. A total of 410 clinicians (53% male, mean (SD) age of 48 (10) years) responded, including 216 pediatric nephrologists, 151 adult nephrologists, and 43 clinical geneticists. While the 3 groups agreed to encourage clinical testing in asymptomatic ADPKD minors and adults, only geneticists would recommend genetic testing in asymptomatic at-risk adults (P<0.001). Statistically significant disagreement between disciplines was observed regarding the ethical justification of prenatal genetic diagnosis, termination of pregnancy and pre-implantation genetic diagnosis (PGD) for ADPKD. Particularly, PGD is ethically justified according to geneticists (4.48 (1.63)), whereas pediatric (3.08 (1.78); P<0.001) and adult nephrologists (3.66 (1.88); P<0.05) appeared to be less convinced. Our survey suggests that most clinicians support clinical testing of at-risk minors and adults in ADPKD families. However, there is no agreement for genetic testing in asymptomatic offspring and for family planning, including PGD. The present data highlight the need for a consensus among clinicians, to avoid that ADPKD families are being given conflicting information.
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Affiliation(s)
- Stéphanie De Rechter
- Department of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Jonathan Kringen
- University of New Haven, New Haven, CT, United States of America
| | - Peter Janssens
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Nephrology, University Hospital of Brussels, Brussels, Belgium
| | - Max Christoph Liebau
- Department of Pediatrics and Center for Molecular Medicine, University Hospital of Cologne, Cologne, Germany
| | - Koenraad Devriendt
- Department of Genetics, KU Leuven—University Hospital of Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Carsten Bergmann
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
- Department of Medicine, University Hospital of Freiburg, Freiburg, Germany
| | - François Jouret
- Division of Nephrology, University of Liège Hospital (ULg CHU), Liège, Belgium
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Bert Bammens
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Franz Schaefer
- Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, Heidelberg, Germany
| | - Djalila Mekahli
- Department of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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11
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Niemiec E, Kalokairinou L, Howard HC. Current ethical and legal issues in health-related direct-to-consumer genetic testing. Per Med 2017; 14:433-445. [PMID: 29754566 DOI: 10.2217/pme-2017-0029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A variety of health-related genetic testing is currently advertized directly to consumers. This article provides a timely overview of direct-to-consumer genetic testing (DTC GT) and salient ethical issues, as well as an analysis of the impact of the recently adopted regulation on in vitro diagnostic medical devices on DTC GT. DTC GT companies currently employ new testing approaches, report on a wide spectrum of conditions and target new groups of consumers. Such activities raise ethical issues including the questionable analytic and clinical validity of tests, the adequacy of informed consent, potentially misleading advertizing, testing in children, research uses and commercialization of genomic data. The recently adopted regulation on in vitro diagnostic medical devices may limit the offers of predisposition DTC GT in the EU market.
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Affiliation(s)
- Emilia Niemiec
- Interdepartmental Centre for Research in the History, Philosophy, and Sociology of Law and in Computer Science and Law, University of Bologna, 40121 Bologna, Italy.,Department of Law, University of Turin, 10153 Turin, Italy.,Centre for Ethics & Law in the Life Sciences, Institute of Philosophy, Leibniz University Hannover, D 30159 Hannover, Germany
| | - Louiza Kalokairinou
- Centre for Biomedical Ethics & Law, Department of Public Health & Primary Care, KU Leuven, 3000 Leuven, Belgium
| | - Heidi Carmen Howard
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, SE-751 22 Uppsala, Sweden
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12
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Vears DF, Sénécal K, Borry P. Reporting practices for unsolicited and secondary findings from next-generation sequencing technologies: Perspectives of laboratory personnel. Hum Mutat 2017; 38:905-911. [PMID: 28512758 DOI: 10.1002/humu.23259] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/27/2017] [Accepted: 05/11/2017] [Indexed: 12/31/2022]
Abstract
While next-generation sequencing (NGS) has enormous potential to identify genetic causes of disease, the nature of the technology means that it can also identify additional information about the individual receiving sequencing that is unrelated to the original rationale for testing. Reporting these unsolicited findings (UF) to clinicians, and subsequently to patients, could lead to potentially lifesaving interventions. Most international guidelines provide limited specific recommendations as to whether these UF should be reported. Little research has been conducted exploring which of these variants are reported in practice. Twenty-six interviews were conducted with 27 laboratory personnel, representing 24 laboratories in Europe (12), Canada (five), and Australasia (Seven) to explore their reporting practices. There is considerable variation between laboratories in the reporting of UF. While some limit their reporting to findings that are relevant to the clinical question, others report UF to varying degrees. In addition, most laboratory personnel interviewed said that their laboratories do not actively search for secondary findings in disease-causing genes unrelated to the clinical question, such as those suggested by the American College of Medical Genetics and Genomics. Our study highlights that laboratories are still grappling with decisions about which UF to report from NGS and are calling for more guidance.
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Affiliation(s)
- Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Leuven Institute for Human Genomics and Society, KU Leuven, Leuven, Belgium
| | - Karine Sénécal
- Centre of Genomics and Policy, McGill University, Montreal, Canada
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Leuven Institute for Human Genomics and Society, KU Leuven, Leuven, Belgium
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13
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Lim Q, McGill BC, Quinn VF, Tucker KM, Mizrahi D, Patenaude AF, Warby M, Cohn RJ, Wakefield CE. Parents' attitudes toward genetic testing of children for health conditions: A systematic review. Clin Genet 2017; 92:569-578. [PMID: 28170090 DOI: 10.1111/cge.12989] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 12/13/2022]
Abstract
This review assessed parents' attitudes toward childhood genetic testing for health conditions, with a focus on perceived advantages and disadvantages. We also evaluated the factors that influence parents' attitudes toward childhood genetic testing. We searched Medline, Medline In-Process, EMBASE, PsycINFO, Social Work Abstracts and CINAHL. We screened 945 abstracts and identified 21 studies representing the views of 3934 parents. Parents reported largely positive attitudes toward childhood genetic testing across different genetic tests with varying medical utility. Parents perceived a range of advantages and disadvantages of childhood genetic testing. Childhood genetic testing was viewed by most as beneficial. Parents' education level, genetic status, sex and sociodemographic status were associated with reported attitudes. This yielded some conflicting findings, indicating the need for further research. Genetic counseling remains essential to support this population in making well-informed decisions. Targeted interventions tailored to specific families with different sociodemographic characteristics may be useful. Further research on the long-term impact of childhood genetic testing on families is warranted.
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Affiliation(s)
- Q Lim
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - B C McGill
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - V F Quinn
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - K M Tucker
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - D Mizrahi
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - A F Patenaude
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - M Warby
- Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - R J Cohn
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - C E Wakefield
- School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.,Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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14
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De Rechter S, Breysem L, Mekahli D. Is Autosomal Dominant Polycystic Kidney Disease Becoming a Pediatric Disorder? Front Pediatr 2017; 5:272. [PMID: 29326910 PMCID: PMC5742347 DOI: 10.3389/fped.2017.00272] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) affects 1 in 400 to 1,000 live births, making it the most common monogenic cause of renal failure. Although no definite cure is available yet, it is important to affect disease progression by influencing modifiable factors such as hypertension and proteinuria. Besides this symptomatic management, the only drug currently recommended in Europe for selected adult patients with rapid disease progression, is the vasopressin receptor antagonist tolvaptan. However, the question remains whether these preventive interventions should be initiated before extensive renal damage has occurred. As renal cyst formation and expansion begins early in life, frequently in utero, ADPKD should no longer be considered an adult-onset disease. Moreover, the presence of hypertension and proteinuria in affected children has been reported to correlate well with disease severity. Until now, it is controversial whether children at-risk for ADPKD should be tested for the presence of the disease, and if so, how this should be done. Herein, we review the spectrum of pediatric ADPKD and discuss the pro and contra of testing at-risk children and the challenges and unmet needs in pediatric ADPKD care.
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Affiliation(s)
- Stéphanie De Rechter
- PKD Lab, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Luc Breysem
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Djalila Mekahli
- PKD Lab, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium
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15
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Sénécal K, Thys K, Vears DF, Van Assche K, Knoppers BM, Borry P. Legal approaches regarding health-care decisions involving minors: implications for next-generation sequencing. Eur J Hum Genet 2016; 24:1559-1564. [PMID: 27302841 PMCID: PMC5110060 DOI: 10.1038/ejhg.2016.61] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/26/2016] [Accepted: 04/12/2016] [Indexed: 12/03/2022] Open
Abstract
The development of next-generation sequencing (NGS) technologies are revolutionizing medical practice, facilitating more accurate, sophisticated and cost-effective genetic testing. NGS is already being implemented in the clinic assisting diagnosis and management of disorders with a strong heritable component. Although considerable attention has been paid to issues regarding return of incidental or secondary findings, matters of consent are less well explored. This is particularly important for the use of NGS in minors. Recent guidelines addressing genomic testing and screening of children and adolescents have suggested that as 'young children' lack decision-making capacity, decisions about testing must be conducted by a surrogate, namely their parents. This prompts consideration of the age at which minors can provide lawful consent to health-care interventions, and consequently NGS performed for diagnostic purposes. Here, we describe the existing legal approaches regarding the rights of minors to consent to health-care interventions, including how laws in the 28 Member States of the European Union and in Canada consider competent minors, and then apply this to the context of NGS. There is considerable variation in the rights afforded to minors across countries. Many legal systems determine that minors would be allowed, or may even be required, to make decisions about interventions such as NGS. However, minors are often considered as one single homogeneous population who always require parental consent, rather than recognizing there are different categories of 'minors' and that capacity to consent or to be involved in discussions and decision-making process is a spectrum rather than a hurdle.
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Affiliation(s)
- Karine Sénécal
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Kristof Thys
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Kristof Van Assche
- Research Group on Personality Rights and Property Rights, Faculty of Law, University of Antwerp, Antwerp, Belgium
| | - Bartha M Knoppers
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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16
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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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17
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Godino L, Turchetti D, Jackson L, Hennessy C, Skirton H. Impact of presymptomatic genetic testing on young adults: a systematic review. Eur J Hum Genet 2015; 24:496-503. [PMID: 26173961 DOI: 10.1038/ejhg.2015.153] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 11/09/2022] Open
Abstract
Presymptomatic and predictive genetic testing should involve a considered choice, which is particularly true when testing is undertaken in early adulthood. Young adults are at a key life stage as they may be developing a career, forming partnerships and potentially becoming parents: presymptomatic testing may affect many facets of their future lives. The aim of this integrative systematic review was to assess factors that influence young adults' or adolescents' choices to have a presymptomatic genetic test and the emotional impact of those choices. Peer-reviewed papers published between January 1993 and December 2014 were searched using eight databases. Of 3373 studies identified, 29 were reviewed in full text: 11 met the inclusion criteria. Thematic analysis was used to identify five major themes: period before testing, experience of genetic counselling, parental involvement in decision-making, impact of test result communication, and living with genetic risk. Many participants grew up with little or no information concerning their genetic risk. The experience of genetic counselling was either reported as an opportunity for discussing problems or associated with feelings of disempowerment. Emotional outcomes of disclosure did not directly correlate with test results: some mutation carriers were relieved to know their status, however, the knowledge they may have passed on the mutation to their children was a common concern. Parents appeared to have exerted pressure on their children during the decision-making process about testing and risk reduction surgery. Health professionals should take into account all these issues to effectively assist young adults in making decisions about presymptomatic genetic testing.
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Affiliation(s)
- Lea Godino
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Daniela Turchetti
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Leigh Jackson
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Catherine Hennessy
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Heather Skirton
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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"Both Sides of the Wheelchair": The Views of Individuals with, and Parents of Individuals with Friedreich Ataxia Regarding Pre-symptomatic Testing of Minors. J Genet Couns 2015; 24:732-43. [PMID: 25592143 DOI: 10.1007/s10897-014-9801-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 11/24/2014] [Indexed: 12/28/2022]
Abstract
Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disorder characterized by variable age of onset, with no treatment proven to alter its natural history. Siblings of individuals with FRDA have a 25 % risk of developing the condition, raising issues around genetic testing of asymptomatic minors. There is a lack of professional consensus and limited empirical evidence to support provision or refusal of testing. This study aimed to ascertain the opinions of individuals with and parents of individuals with FRDA regarding pre-symptomatic testing of minors. A qualitative research approach using semi-structured interviews and thematic analysis was employed. Interviews with ten individuals with FRDA, and ten parents of individuals with FRDA were conducted, recorded, transcribed and analyzed. Four findings emerged. First, a number of arguments for and against testing minors were identified. Second, strong support existed from parents about the parental right to test their at-risk immature children, but individuals with FRDA were of mixed opinions. Third, participants felt it was not the clinician's role to make a final decision about whether testing occurs. Finally, a specific issue of concern regarding testing was what and when to tell at-risk children about the test result. The findings highlight a dilemma of how to manage the desires of some individuals and families affected by FRDA to access testing, when there is a lack of professional consensus due to differing opinions regarding autonomy, confidentiality and risk of harm. Research regarding the impact of testing and the views of at-risk individuals and clinicians is required so an appropriate framework for dealing with this contentious issue is developed.
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Anderson JA, Hayeems RZ, Shuman C, Szego MJ, Monfared N, Bowdin S, Zlotnik Shaul R, Meyn MS. Predictive genetic testing for adult-onset disorders in minors: a critical analysis of the arguments for and against the 2013 ACMG guidelines. Clin Genet 2014; 87:301-10. [PMID: 25046648 DOI: 10.1111/cge.12460] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/28/2014] [Accepted: 07/15/2014] [Indexed: 12/21/2022]
Abstract
The publication of the ACMG recommendations has reignited the debate over predictive testing for adult-onset disorders in minors. Response has been polarized. With this in mind, we review and critically analyze this debate. First, we identify long-standing inconsistencies between consensus guidelines and clinical practice regarding risk assessment for adult-onset genetic disorders in children using family history and molecular analysis. Second, we discuss the disparate assumptions regarding the nature of whole genome and exome sequencing underlying arguments of both supporters and critics, and the role these assumptions play in the arguments for and against reporting. Third, we suggest that implicit differences regarding the definition of best interests of the child underlie disparate conclusions as to the best interests of children in this context. We conclude by calling for clarity and consensus concerning the central foci of this debate.
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Affiliation(s)
- J A Anderson
- Department of Bioethics, The Hospital for Sick Children, Toronto, Canada; Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Toronto, Canada
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20
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Borry P, Shabani M, Howard HC. Is There a Right Time to Know? The Right Not to Know and Genetic Testing in Children. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2014; 42:19-27. [PMID: 26767473 DOI: 10.1111/jlme.12115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The increasing implementation of next-generation sequencing technologies in the clinical context and the expanding commercial offer of genetic tests directly-toconsumers has increased the availability of previously inaccessible genetic information. A particular concern in both situations is how the volume of novel information will affect the processing of genetic and genomic information from minors. For minors, it is argued that in the provision of genetic testing, their "right not to know" should be respected as much as possible. Testing a minor early in life eliminates the possibility for the minor to make use of his or her "right not to know." The article discusses the theoretical underpinnings of the right not know, analyzes reasons why various direct-to-consumer companies process samples from minors, and discusses the right not to know in relation to common complex disorders in a pediatric population.
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Affiliation(s)
- Pascal Borry
- Assistant Professor of Bioethics at the Centre for Biomedical Ethics and Law (University of Leuven, Belgium)
| | - Mahsa Shabani
- Ph.D. researcher at the Center for Biomedical Ethics and Law (University of Leuven, Belgium)
| | - Heidi Carmen Howard
- Assistant Professor at Radboud University Medical Centre in Nijmegen, the Netherlands
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Wade CH, Tarini BA, Wilfond BS. Growing up in the genomic era: implications of whole-genome sequencing for children, families, and pediatric practice. Annu Rev Genomics Hum Genet 2013; 14:535-55. [PMID: 23875800 DOI: 10.1146/annurev-genom-091212-153425] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Whole-genome sequencing (WGS) has advanced to a point where it is beginning to be integrated into pediatric practice. With little consensus on how to maximize the benefits of WGS for children, there is a growing need for focused efforts that connect researchers, clinicians, and families to chart a path forward. To illustrate relevant concerns, two contrasting applications of pediatric WGS are explored: clinical use with children who have undiagnosed conditions, and population-based screening. Specific challenges for health care services, policy development, and the well-being of children are discussed in light of current research. In the interest of ensuring evidence-based pediatric WGS, strategies are identified for advancing our understanding of what it means for children to grow up with WGS results guiding their health care.
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Affiliation(s)
- Christopher H Wade
- Nursing and Health Studies Program, University of Washington Bothell, Bothell, Washington 98011;
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22
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Skirton H, Goldsmith L, Jackson L, Tibben A. Quality in genetic counselling for presymptomatic testing--clinical guidelines for practice across the range of genetic conditions. Eur J Hum Genet 2013; 21:256-60. [PMID: 22892534 PMCID: PMC3573206 DOI: 10.1038/ejhg.2012.174] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/25/2012] [Accepted: 07/06/2012] [Indexed: 01/15/2023] Open
Abstract
Presymptomatic testing (PST) is the performance of a genetic test on an asymptomatic individual at risk of a condition to determine whether the person has inherited the disease-causing mutation. Although relevant guidelines exist for specific diseases, there is no overarching protocol that can be adapted to any disorder or clinical setting in which such testing is offered. The objective of this European project was to develop a set of coherent guidelines for PST (for adult-onset monogenic conditions) for use by health professionals working in a range of disciplines, countries or contexts. To ensure the guidelines were appropriate and practice based, we organised a workshop attended by an expert group of practitioners with relevant health professional backgrounds from 11 countries. Models of service for offering PST were presented, the group then discussed different aspects of testing and the standard of care required to ensure that patients were prepared to make decisions and deal with results and consequences. After the workshop, several rounds of consultation were used with a wider group of professionals to refine the guidelines. The guidelines include general principles governing the offer of testing (eg, autonomous choice of the patient), objectives of genetic counselling in this context (eg, facilitation of decision making), logistical considerations (eg, use of trained staff) and topics to be included during counselling discussion with the patient (eg, consequences of both positive and negative outcomes). We recommend the adoption of these guidelines to provide an equitable structure for those seeking PST in any country.
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Affiliation(s)
- Heather Skirton
- Faculty of Health, Education and Society, Plymouth, University, Taunton, UK.
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23
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Bradbury AR, Patrick-Miller L, Egleston BL, Olopade OI, Daly MB, Moore CW, Sands CB, Schmidheiser H, Kondamudi PK, Feigon M, Ibe CN, Daugherty CK. When parents disclose BRCA1/2 test results: their communication and perceptions of offspring response. Cancer 2012; 118:3417-25. [PMID: 22231763 DOI: 10.1002/cncr.26471] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND BRCA1/2 testing is not recommended for children, as risk reduction measures and screening are not generally recommended before 25 years old (YO). Little is known about the prevalence and predictors of parent communication to offspring and how offspring respond to this communication. METHODS Semi-structured interviews were conducted with parents who had BRCA1/2 testing and at least 1 child <25 YO. Logistic regressions were utilized to evaluate associations with communication. Framework analysis was utilized to analyze open-ended responses. RESULTS A total of 253 parents completed interviews (61% response rate), reporting on 505 offspring. Twenty-nine percent of parents were BRCA1/2 mutation carriers. Three hundred thirty-four (66%) offspring learned of their parent's test result. Older offspring age (P ≤ .01), offspring gender (female, P = .05), parents' negative test result (P = .03), and parents' education (high school only, P = .02) were associated with communication to offspring. The most frequently reported initial offspring responses were neutral (41%) or relief (28%). Thirteen percent of offspring were reported to experience concern or distress (11%) in response to parental communication of their test results. Distress was more frequently perceived among offspring learning of their parent's BRCA1/2 positive or variant of uncertain significance result. CONCLUSIONS Many parents communicate their BRCA1/2 test results to young offspring. Parents' perceptions of offspring responses appear to vary by offspring age and parent test result. A better understanding of how young offspring respond to information about hereditary risk for adult cancer could provide opportunities to optimize adaptive psychosocial responses to risk information and performance of health behaviors, in adolescence and throughout an at-risk life span.
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Affiliation(s)
- Angela R Bradbury
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111-2497, USA.
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Abstract
Genetics has fascinated societies since ancient times, and references to traits or behaviors that appear to be shared or different among related individuals have permeated legends, literature, and popular culture. Biomedical advances from the past century, and particularly the discovery of the DNA double helix, the increasing numbers of links that were established between mutations and medical conditions or phenotypes, and technological advances that facilitated the sequencing of the human genome, catalyzed the development of genetic testing. Genetic tests were initially performed in health care facilities, interpreted by health care providers, and included the availability of counseling. Recent years have seen an increased availability of genetic tests that are offered by companies directly to consumers, a phenomenon that became known as direct-to-consumer genetic testing. Tests offered in this setting range from the ones that are also provided in health care establishments to tests known as ‘recreational genomics,’ and consumers directly receive the test results. In addition, testing in this context often does not involve the availability of counseling and, when this is provided, it frequently occurs on-line or over the phone. As a field situated at the interface between biotechnology, biomedical research, and social sciences, direct-to-consumer genetic testing opens multiple challenges that can be appropriately addressed only by developing a complex, inter-disciplinary framework.
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Abstract
Genetic testing holds many promises in movement disorders, but also pitfalls that require careful consideration for meaningful results. These include the primary indication for testing in the first place, concerns regarding the implications of symptomatic, presymptomatic, and susceptibility testing, the mutation frequency in the gene of interest, the general lack of neuroprotective treatment options for neurodegenerative movement disorders, the prognosis of the condition diagnosed, and patient confidentiality concerns. Furthermore, new technical achievements and the available technical expertise, feasibility of specific gene testing, and its coverage through a health insurance carrier should be considered. Guidelines for testing have been established by some disease societies to advise clinicians and in parallel legal regulations are being adjusted at a national and international level. We review these and other critical points and recent developments regarding genetic testing in the field of movement disorders.
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Andersen J, Sandberg S, Raaheim M, Gjengedal E. Psychosocial aspects of predictive genetic testing for acute intermittent porphyria in norwegian minors. JIMD Rep 2011; 1:1-7. [PMID: 23430820 PMCID: PMC3509828 DOI: 10.1007/8904_2011_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 12/16/2010] [Accepted: 12/22/2010] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The Norwegian Porphyria Centre routinely offers genetic counselling and predictive genetic testing in families diagnosed with porphyria. The aim of this study was to investigate the subjective experiences of adolescents and young adults who were genetically tested for acute intermittent porphyria (AIP) as minors. What were the psychosocial consequences and how were these handled? METHODS Qualitative interviews of ten Norwegians aged 16-21 years were performed and analysed based on interpretive description. All participants were initially predictively tested for AIP as minors, but three had subsequently developed manifest disease. RESULTS The participants considered early diagnosis and lifestyle moderation advantageous, but finding motivation for precaution was difficult. AIP inflicted few psychosocial challenges and was a small part of the participants' identity, but risk of manifest disease was, nevertheless, a cause for concern for two participants with latent AIP. The participants were content with their present level of knowledge and they felt capable of obtaining relevant information when needed. AIP was experienced as a vague condition, and participants and their relatives attributed a variety of symptoms to the disease. CONCLUSION AND IMPLICATIONS Being genetically tested as a minor was experienced as useful and entailed relatively few adverse psychosocial consequences, although there was a potential for concern. Appropriate and individually tailored genetic counselling and written consent is subsequently advised. What constitutes a suitable age for testing will differ from individual to individual, but these results suggest that parents in collaboration with their children may be suited to decide what age is appropriate.
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Affiliation(s)
- Janice Andersen
- The Norwegian Porphyria Centre (NAPOS), Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, 5021, Norway,
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Howard HC, Avard D, Borry P. Are the kids really all right? Direct-to-consumer genetic testing in children: are company policies clashing with professional norms? Eur J Hum Genet 2011; 19:1122-6. [PMID: 21629297 DOI: 10.1038/ejhg.2011.94] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The genetic testing of minors within the direct-to-consumer (DTC) genetic testing (GT) context has been given relatively little attention. The issue of testing healthy children for diseases that would only develop in adulthood raises many important ethical, legal and social issues. As genetic testing is now available outside of the traditional health care system, often without even the intermediate of a health care professional, we surveyed 37 DTC GT companies regarding their policies for testing in children. Although the response rate is relatively low (35%, 13/37), our findings reveal that a clear majority of companies do perform genetic testing in minors. As such, companies testing for adult onset diseases are acting in contradiction of established professional guidelines, which state, among others, that, for predictive genetic testing, the availability of therapeutic or preventive measures is necessary for testing to be performed in asymptomatic minors. The community of stakeholders in children's health care and genetic testing should, therefore, decide which standards need to be upheld by DTC GT companies and ensure that these are met.
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Affiliation(s)
- Heidi Carmen Howard
- Centre for Biomedical Ethics and Law, Katholieke Universiteit Leuven, Kapucijnenvoer 35, Leuven, Belgium.
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28
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Patrick-Miller L, Bradbury AR, Terry MB. Controversies in communication of genetic screening results for cancer: a report from the American Society of Preventive Oncology's Screening Special Interest Group (ASPO's 33rd Annual Meeting, March 8 to 10, 2009, Tampa, Florida). Cancer Epidemiol Biomarkers Prev 2010; 19:624-7. [PMID: 20142257 DOI: 10.1158/1055-9965.epi-19-2-aspo01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Mackenzie A, Patrick-Miller L, Bradbury AR. Controversies in communication of genetic risk for hereditary breast cancer. Breast J 2009; 15 Suppl 1:S25-32. [PMID: 19775327 DOI: 10.1111/j.1524-4741.2009.00800.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Increased availability and heightened consumer awareness of "cancer genes" has increased consumer interest in, and demand for breast cancer risk assessment, and thus a pressing need for providers to identify effective, efficient methods of communicating complicated genetic information to consumers and their potentially at-risk relatives. With increasing direct-to-consumer and -physician marketing of predictive genetic tests, there has been considerable growth in web- and telephone-based genetic services. There is urgent need to further evaluate the psychosocial and behavioral outcomes (i.e., risks and benefits) of telephone and web-based methods of delivery before they become fully incorporated into clinical care models. Given the implications of genetic test results for family members, and the inherent conflicts in health care providers' dual responsibilities to protect patient privacy and to "warn" those at-risk, new models for communicating risk to at-risk relatives are emerging. Additional controversies arise when the at-risk relative is a minor. Research evaluating the impact of communicating genetic risk to offspring is necessary to inform optimal communication of genetic risk for breast cancer across the lifespan. Better understanding the risks and benefits associated with each of these controversial areas in cancer risk communication are crucial to optimizing adherence to recommended breast cancer risk management strategies and ensuring psycho-social well-being in the clinical delivery of genetic services for breast cancer susceptibility.
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Affiliation(s)
- Amy Mackenzie
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
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30
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Regniault A, Kupecz A, Gavey M, Mignolet O, De Carlo P, Meyer P, Bailey S. Legal and ethical concerns in personalized medicine: a European perspective. Per Med 2009; 6:517-528. [PMID: 29783304 DOI: 10.2217/pme.09.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Expectations in the integration of pharmacogenomics into clinical practice remain high in a number of therapeutic areas. This review focuses on the key legal and ethical issues concerning personalized medicine that have given rise to debate, law-making and/or Court decisions in Europe, especially involving: trial subject stratification during clinical trials; the protection of innovation in pharmacogenomics through intellectual property rights; the regulation of access to genetic testing; the regulatory framework for genetic testing devices; gene-based discrimination; legal duties and liabilities resulting from 'tailored' medicine; and confidentiality issues with respect to family members. This article explains these issues and identifies some of the difficulties encountered in seeking to build a harmonized legal framework within Europe.
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Affiliation(s)
| | | | | | | | | | | | - Sarah Bailey
- Simmons & Simmons, 5, boulevard de la Madeleine, F-75001 Paris, France.
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31
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Gilbar R. Genetic testing of children for familial cancers: a comparative legal perspective on consent, communication of information and confidentiality. Fam Cancer 2009; 9:75-87. [PMID: 19609725 DOI: 10.1007/s10689-009-9268-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 07/03/2009] [Indexed: 11/24/2022]
Abstract
Genetic testing of children is the subject of ethical and legal debate. On the one hand, the literature emphasises the personal interests and rights of the individual child. On the other, the interests of the parents and the family as a whole are discussed. English law relies by and large on a patient-centred approach where the child has some say about his/her medical care. The view reflected in Anglo-American guidelines, more specifically, is that testing is potentially harmful and may compromise the child's autonomy and confidentiality. This explains the reluctance to submit children to predictive genetic testing. An analysis of Israeli law, however, reflects a different approach, where the benefit to the child is defined more widely. This accords with the general communitarian position adopted by Israeli law, a legal position that reflects the duality of Israeli society in simultaneously promoting both fundamental human rights and family ethics. In practice, however, there may be little difference, as children in both jurisdictions have access to similar genetic services.
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Affiliation(s)
- Roy Gilbar
- School of Law, Queen Mary College, University of London, Mile End Road, London, E1 4NS, UK.
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Borry P, Evers-Kiebooms G, Cornel MC, Clarke A, Dierickx K. Genetic testing in asymptomatic minors: background considerations towards ESHG Recommendations. Eur J Hum Genet 2009; 17:711-9. [PMID: 19277061 PMCID: PMC2947094 DOI: 10.1038/ejhg.2009.25] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Although various guidelines and position papers have discussed, in the past, the ethical aspects of genetic testing in asymptomatic minors, the European Society of Human Genetics had not earlier endorsed any set of guidelines exclusively focused on this issue. This paper has served as a background document in preparation of the development of the policy recommendations of the Public and Professional Committee of the European Society of Human Genetics. This background paper first discusses some general considerations with regard to the provision of genetic tests to minors. It discusses the concept of best interests, participation of minors in health-care decisions, parents' responsibilities to share genetic information, the role of clinical genetics and the health-care system in communication within the family. Second, it discusses, respectively, the presymptomatic and predictive genetic testing for adult-onset disorders, childhood-onset disorders and carrier testing.
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Affiliation(s)
- Pascal Borry
- Research Fund Flanders, Centre for Biomedical Ethics and Law, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
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