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Droin-Mollard M, de Montgolfier S, Gimenez-Roqueplo AP, Flahault C, Petit A, Bourdeaut F, Julia S, Rial-Sebbag E, Coupier I, Simaga F, Brugières L, Guerrini-Rousseau L, Claret B, Cavé H, Strullu M, Hervouet L, Lahlou-Laforêt K. Psychological and ethical issues raised by genomic in paediatric care pathway, a qualitative analysis with parents and childhood cancer patients. Eur J Hum Genet 2024:10.1038/s41431-024-01653-4. [PMID: 38997469 DOI: 10.1038/s41431-024-01653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/27/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
In paediatric oncology, genomics raises new ethical, legal and psychological issues, as somatic and constitutional situations intersect throughout the care pathway. The discovery of potential predisposition in this context is sometimes carried out outside the usual framework. This article focuses on the views of children, adolescents, and young adults (AYA) with cancer and their parents about their experience with genomic testing. Forty-eight semi-structured interviews were performed with children or AYAs with cancer and one of their parents, before and/or after receiving the genetic test results. The interviews were fully transcribed, coded and thematically analysed using an inductive method. This analysis revealed several themes that are key issues: perceived understanding and consenting, apprehension about the test outcomes (expectations and fears), perception and attitude towards incidental findings. The main expectation was an aetiological explanation. Children and AYAs also emphasised the altruistic meaning of genetic testing, while parents seemed to expect a therapeutic and preventive approach for their child and the rest of the family. Parents were more concerned about a family risk, while patients were more afraid of cancer relapse or transmission to their descendants. Both groups suggested possible feelings of guilt concerning family transmission and imaginary representations of what genomics may allow. Incidental findings were not understood by patients, while some parents perceived the related issues and hesitated between wanting or not to know. A multidisciplinary approach would be an interesting way to help parents and children and AYAs to better grasp the complexity of genetic and/or genomic testing.
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Affiliation(s)
- Marion Droin-Mollard
- UF of Psychology and Liaison and Emergency Psychiatry, DMU Psychiatry and Addictology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
| | - Sandrine de Montgolfier
- IRIS Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (UMR 8156 CNRS-997 INSERM-EHESS-UPSN), Campus Condorcet, Aubervilliers, France.
- University of Paris Est Créteil, Créteil, France.
- Aix Marseille Universite, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Anne-Paule Gimenez-Roqueplo
- Département de Médecine Génomique des Tumeurs et des Cancers, Consultation d'oncogénétique Multidisciplinaire des Cancers Rares, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Université Paris Cité, PARCC, INSERM, Paris, France
| | - Cécile Flahault
- UF of Psychology and Liaison and Emergency Psychiatry, DMU Psychiatry and Addictology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé UR4057, Paris, France
| | - Arnaud Petit
- Service d'Hématologie et d'Oncologie Pédiatrique, Hôpital Armand Trousseau, APHP, Sorbonne Université, Paris, France
| | - Franck Bourdeaut
- SIREDO Pediatric Oncology Center, Laboratory of Translational Research in Pediatric Oncology-INSERMU830, Institut Curie, Paris Sciences Lettres Research University, Paris, France
- Université Paris-Cité, Paris, France
| | - Sophie Julia
- UMR 1027 INSERM, University of Toulouse & Toulouse University Hospital, Toulouse, France
- Medical Genetics Department, Purpan Hospital, Toulouse, France
| | - Emmanuelle Rial-Sebbag
- UMR 1027 INSERM, University of Toulouse & University Toulouse III-Paul Sabatier, Toulouse, France
| | - Isabelle Coupier
- CHU Montpellier, Hôpital Arnaud de Villeneuve Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France
- INSERM896, CRCM Val d'Aurelle, Montpellier, France
| | | | - Laurence Brugières
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Léa Guerrini-Rousseau
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- Molecular Predictors and New Targets in Oncology, Inserm U981 Team "Genomics and Oncogenesis of Pediatric Brain Tumors", Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Béatrice Claret
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
- Psycho-Oncology Unit, Supportive Care Department, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Hélène Cavé
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Département de Génétique, Paris, France
- INSERM UMR_S1131, Institut de Recherche Saint-Louis, Université Paris-Cité, Paris, France
| | - Marion Strullu
- INSERM UMR_S1131, Institut de Recherche Saint-Louis, Université Paris-Cité, Paris, France
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Service d'Hémato-Immunologie Pédiatrique, Paris, France
| | - Lucile Hervouet
- IRIS Institut de Recherche Interdisciplinaire sur les Enjeux Sociaux (UMR 8156 CNRS-997 INSERM-EHESS-UPSN), Campus Condorcet, Aubervilliers, France
| | - Khadija Lahlou-Laforêt
- UF of Psychology and Liaison and Emergency Psychiatry, DMU Psychiatry and Addictology, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Département de Médecine Génomique des Tumeurs et des Cancers, Consultation d'oncogénétique Multidisciplinaire des Cancers Rares, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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Capalbo A, de Wert G, Mertes H, Klausner L, Coonen E, Spinella F, Van de Velde H, Viville S, Sermon K, Vermeulen N, Lencz T, Carmi S. Screening embryos for polygenic disease risk: a review of epidemiological, clinical, and ethical considerations. Hum Reprod Update 2024:dmae012. [PMID: 38805697 DOI: 10.1093/humupd/dmae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/25/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The genetic composition of embryos generated by in vitro fertilization (IVF) can be examined with preimplantation genetic testing (PGT). Until recently, PGT was limited to detecting single-gene, high-risk pathogenic variants, large structural variants, and aneuploidy. Recent advances have made genome-wide genotyping of IVF embryos feasible and affordable, raising the possibility of screening embryos for their risk of polygenic diseases such as breast cancer, hypertension, diabetes, or schizophrenia. Despite a heated debate around this new technology, called polygenic embryo screening (PES; also PGT-P), it is already available to IVF patients in some countries. Several articles have studied epidemiological, clinical, and ethical perspectives on PES; however, a comprehensive, principled review of this emerging field is missing. OBJECTIVE AND RATIONALE This review has four main goals. First, given the interdisciplinary nature of PES studies, we aim to provide a self-contained educational background about PES to reproductive specialists interested in the subject. Second, we provide a comprehensive and critical review of arguments for and against the introduction of PES, crystallizing and prioritizing the key issues. We also cover the attitudes of IVF patients, clinicians, and the public towards PES. Third, we distinguish between possible future groups of PES patients, highlighting the benefits and harms pertaining to each group. Finally, our review, which is supported by ESHRE, is intended to aid healthcare professionals and policymakers in decision-making regarding whether to introduce PES in the clinic, and if so, how, and to whom. SEARCH METHODS We searched for PubMed-indexed articles published between 1/1/2003 and 1/3/2024 using the terms 'polygenic embryo screening', 'polygenic preimplantation', and 'PGT-P'. We limited the review to primary research papers in English whose main focus was PES for medical conditions. We also included papers that did not appear in the search but were deemed relevant. OUTCOMES The main theoretical benefit of PES is a reduction in lifetime polygenic disease risk for children born after screening. The magnitude of the risk reduction has been predicted based on statistical modelling, simulations, and sibling pair analyses. Results based on all methods suggest that under the best-case scenario, large relative risk reductions are possible for one or more diseases. However, as these models abstract several practical limitations, the realized benefits may be smaller, particularly due to a limited number of embryos and unclear future accuracy of the risk estimates. PES may negatively impact patients and their future children, as well as society. The main personal harms are an unindicated IVF treatment, a possible reduction in IVF success rates, and patient confusion, incomplete counselling, and choice overload. The main possible societal harms include discarded embryos, an increasing demand for 'designer babies', overemphasis of the genetic determinants of disease, unequal access, and lower utility in people of non-European ancestries. Benefits and harms will vary across the main potential patient groups, comprising patients already requiring IVF, fertile people with a history of a severe polygenic disease, and fertile healthy people. In the United States, the attitudes of IVF patients and the public towards PES seem positive, while healthcare professionals are cautious, sceptical about clinical utility, and concerned about patient counselling. WIDER IMPLICATIONS The theoretical potential of PES to reduce risk across multiple polygenic diseases requires further research into its benefits and harms. Given the large number of practical limitations and possible harms, particularly unnecessary IVF treatments and discarded viable embryos, PES should be offered only within a research context before further clarity is achieved regarding its balance of benefits and harms. The gap in attitudes between healthcare professionals and the public needs to be narrowed by expanding public and patient education and providing resources for informative and unbiased genetic counselling.
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Affiliation(s)
- Antonio Capalbo
- Juno Genetics, Department of Reproductive Genetics, Rome, Italy
- Center for Advanced Studies and Technology (CAST), Department of Medical Genetics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Guido de Wert
- Department of Health, Ethics & Society, CAPHRI-School for Public Health and Primary Care and GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Liraz Klausner
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Edith Coonen
- Departments of Clinical Genetics and Reproductive Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands
| | - Francesca Spinella
- Eurofins GENOMA Group Srl, Molecular Genetics Laboratories, Department of Scientific Communication, Rome, Italy
| | - Hilde Van de Velde
- Research Group Genetics Reproduction and Development (GRAD), Vrije Universiteit Brussel, Brussel, Belgium
- Brussels IVF, UZ Brussel, Brussel, Belgium
| | - Stephane Viville
- Laboratoire de Génétique Médicale LGM, Institut de Génétique Médicale d'Alsace IGMA, INSERM UMR 1112, Université de Strasbourg, France
- Laboratoire de Diagnostic Génétique, Unité de Génétique de l'infertilité (UF3472), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Karen Sermon
- Research Group Genetics Reproduction and Development (GRAD), Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Todd Lencz
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Departments of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Mazel B, Bertolone G, Baurand A, Cosset E, Sawka C, Robert M, Gautier E, Lançon A, Réda M, Favier L, Dérangère V, Richard C, Binquet C, Boidot R, Goussot V, Albuisson J, Ghiringhelli F, Faivre L, Nambot S. Advancing precision oncology through systematic germline and tumor genetic analysis: The oncogenetic point of view on findings from a prospective multicenter clinical trial of 666 patients. Cancer Med 2023; 12:18786-18796. [PMID: 37694493 PMCID: PMC10557826 DOI: 10.1002/cam4.6498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/07/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION With the emergence of targeted therapies, there is a need to accurately identify more tumor biomarkers. The EXOMA trial was designed to offer tumor and germline exome sequencing (ES) to patients with solid malignant tumors and facing therapeutic failure. As hereditary cancer predispositions could be identified, with genetic counseling and health management implications, a genetic consultation was systematically established. This design needs to be discussed as genetic human resources are limited and indication of theranostic tests will increase. METHODS Genetic counseling was conducted within 15 days following inclusion in the study for patients recruited between December 2015 and July 2019. In silico analyses from theranostic ES were limited to 317 genes involved in oncogenesis, from both tumor and blood DNA. RESULTS Six hundred and sixty six patients had a genetic consultation before ES. In 65/666 patients, 66 germline pathogenic or likely pathogenic (P/LP) variants were identified in 16 actionable genes and seven non-actionable genes according to French guidelines. 24/65 patients had previously received genetic analysis for diagnostic purposes, and for 17 of them, a P/LP variant had already been identified. Among the 48/65 remaining cases for which the EXOMA protocol revealed a previously unknown P/LP variant, only 19 met the criteria for genetic testing for inherited cancer risk after familial survey. These criteria had not been identified by the oncologist in 10 cases. In 21/65 cases, the variant was considered incidental. DISCUSSION In 7.4% of patients, an undiagnosed hereditary genetic predisposition was identified, whether or not related to the clinical presentation, and germline analysis impacted oncological management for only 6.3% of the cohort. This low percentage should be weighed against the burden of systematic genetic consultation and urgent circuits. Information or training tools to form oncologists to the prescription of germline genetic analyses should be explored, as well as information supports and patient preferences.
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Affiliation(s)
- Benoit Mazel
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- INSERM UMR 1231 GAD, Génétique des Anomalies du Développement, Université Bourgogne Franche‐ComtéDijonFrance
| | - Geoffrey Bertolone
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Amandine Baurand
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Elodie Cosset
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Caroline Sawka
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Marion Robert
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Elodie Gautier
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
| | - Allan Lançon
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Manon Réda
- Département d'Oncologie MédicaleCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Laure Favier
- Département d'Oncologie MédicaleCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Valentin Dérangère
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Corentin Richard
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
| | - Christine Binquet
- INSERM, CIC1432, Module Epidémiologie Clinique, Dijon, France; Centre Hospitalier Universitaire Dijon‐Bourgogne, Centre d'Investigation Clinique, module Epidémiologie clinique/essais cliniquesDijonFrance
| | - Romain Boidot
- Unité de Biologie MoléculaireCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Institut de Chimie Moléculaire de l'Université de Bourgogne, UMR CNRS 6302DijonFrance
| | - Vincent Goussot
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
- Unité de Biologie MoléculaireCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Juliette Albuisson
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
- Unité de Biologie MoléculaireCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - François Ghiringhelli
- Département d'Oncologie MédicaleCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
| | - Laurence Faivre
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- INSERM UMR 1231 GAD, Génétique des Anomalies du Développement, Université Bourgogne Franche‐ComtéDijonFrance
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
| | - Sophie Nambot
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- INSERM UMR 1231 GAD, Génétique des Anomalies du Développement, Université Bourgogne Franche‐ComtéDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
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Wolf SM, Green RC. Return of Results in Genomic Research Using Large-Scale or Whole Genome Sequencing: Toward a New Normal. Annu Rev Genomics Hum Genet 2023; 24:393-414. [PMID: 36913714 PMCID: PMC10497726 DOI: 10.1146/annurev-genom-101122-103209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
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Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
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5
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Ungar WJ, Hayeems RZ, Marshall CR, Gillespie MK, Szuto A, Chisholm C, James Stavropoulos D, Huang L, Jarinova O, Wu V, Tsiplova K, Lau L, Lee W, Venkataramanan V, Sawyer S, Mendoza-Londono R, Somerville MJ, Boycott KM. Protocol for a Prospective, Observational Cost-effectiveness Analysis of Returning Secondary Findings of Genome Sequencing for Unexplained Suspected Genetic Conditions. Clin Ther 2023; 45:702-709. [PMID: 37453830 DOI: 10.1016/j.clinthera.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Although costly, genome-wide sequencing (GWS) detects an extensive range of variants, enhancing our ability to diagnose and assess risk for an increasing number of diseases. In addition to detecting variants related to the indication for testing, GWS can detect secondary variants in BRCA1, BRCA2, and other genes for which early intervention may improve health. As the list of secondary findings grows, there is increased demand for surveillance and management by multiple specialists, adding pressure to constrained health care budgets. Secondary finding testing is actively debated because some consider it opportunistic screening for future health risks that may not manifest. Given the economic implications of secondary finding testing and follow-up and its unproven clinical utility, the objective is to assess the incremental cost-effectiveness of secondary finding ascertainment per case detected and per unit of improved clinical utility in families of children with unexplained suspected genetic conditions undergoing clinical GWS. METHODS Those undergoing trio genome or exome sequencing are eligible for the study. Positive secondary finding index cases will be matched to negative controls (1:2) based on age group, primary result(s) type, and clinical indication. During the 2-year study, 71 cases and 142 matched controls are expected. Health service use will be collected in patients and 1 adult family member every 6 months. The per-child and per-dyad total cost will be determined by multiplying use of each resource by a corresponding unit price and summing all cost items. Costs will be estimated from the public and societal payer perspectives. The mean cost per child and per dyad for secondary finding-positive and secondary finding-negative groups will be compared statistically. If important demographic differences are observed between groups, ordinary least-squares regression, log transformation, or other nonparametric technique will be used to compare adjusted mean costs. The ratio of the difference in mean cost to the secondary finding yield will be used to estimate incremental cost-effectiveness. In secondary analyses, effectiveness will be estimated using the number of clinical management changes due to secondary findings or the Clinician-Reported Genetic Testing Utility Index (C-GUIDE) score, a validated measure of clinical utility. Sensitivity analysis will be undertaken to assess the robustness of the findings to variation in key parameters. IMPLICATIONS This study generates key evidence to inform clinical practice and funding allocation related to secondary finding testing. The inclusion of family members and a new measure of clinical utility represent important advancements in economic evaluation in genomics.
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Affiliation(s)
- Wendy J Ungar
- Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Robin Z Hayeems
- Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christian R Marshall
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meredith K Gillespie
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Anna Szuto
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Caitlin Chisholm
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - D James Stavropoulos
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lijia Huang
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Olga Jarinova
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Vercancy Wu
- Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Kate Tsiplova
- Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Lynnette Lau
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Whiwon Lee
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Viji Venkataramanan
- Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Sarah Sawyer
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin J Somerville
- Genome Diagnostics, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Notini L, Gaff C, Savulescu J, Vears DF. Offering and Returning Secondary Findings in the Context of Exome Sequencing for Hearing Loss: Clinicians' Views and Experiences. AJOB Empir Bioeth 2023; 14:74-83. [PMID: 36595590 DOI: 10.1080/23294515.2022.2160507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is ongoing debate regarding whether and under which circumstances secondary findings (SF) should be offered in the pediatric context. Although studies have examined patient perspectives on receiving SF, little research has been conducted examining the experiences of clinicians offering SF to parents of newborns receiving genomic sequencing for a recently diagnosed medical condition. METHODS To address this, we conducted qualitative interviews exploring the views and experiences of 12 clinicians who offered SF to parents of infants who had diagnostic exome sequencing (ES) to identify the cause of their hearing loss. Interviews explored clinicians' accounts of parents' choices and decision-making about receiving SF, their views on whether and when to offer SF, their experiences returning SF, and any ethical challenges they encountered. Interviews were audio-recorded, transcribed and analyzed using inductive content analysis. RESULTS Clinicians reported parents who declined all SF often felt finding out about future conditions unrelated to their child's hearing loss may be unhelpful, or even harmful, or were overwhelmed by their child's diagnosis. Clinicians also reported that some parents chose SF because they felt obliged to, even if they did not want to receive them. They explained that while some parents experienced decision-making regarding SF as positive, for others, this process was challenging or distressing. While clinicians generally agreed SF should be offered, mainly to promote parental choice, most felt SF should be offered after disclosing diagnostic results, primarily to avoid overwhelming parents. Clinicians encountered several ethical challenges, including balancing parental autonomy with non-maleficence, wanting to report or not report certain SF, and questioning whether parents can make an autonomous choice regarding SF. CONCLUSIONS Our findings, which are novel as they relate to parents of young infants with a recent diagnosis of hearing loss, add new insights into clinicians' and parents' decision-making regarding SF in pediatrics.
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Affiliation(s)
- Lauren Notini
- University of Melbourne, Carlton, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia
| | - Clara Gaff
- Genomics in Society, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Melbourne Genomics Health Alliance, Parkville, Australia
| | - Julian Savulescu
- University of Melbourne, Carlton, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia.,Chen Su Lan Centennial Professor in Medical Ethics, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Danya F Vears
- University of Melbourne, Carlton, Australia.,Biomedical Ethics Research Group, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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7
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Expectations, concerns, and attitudes regarding whole-genome sequencing studies: a survey of cancer patients, families, and the public in Japan. J Hum Genet 2022; 68:281-285. [PMID: 36509867 PMCID: PMC10040335 DOI: 10.1038/s10038-022-01100-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
Whole-genome sequencing (WGS) is being used in research and clinical settings in cancer genomics. Studies show that cancer patients generally have positive attitudes toward tumor profiling tests; however, few works revealed their attitudes toward WGS. This study clarifies the expectations, concerns, and result preferences of cancer patients (CPs), family members (FMs) and general adults (GAs) regarding WGS study in Japan. We conducted an anonymous survey with 1204 CPs, 5968 FMs, and 2915 GAs in 2021. Despite low awareness of the WGS studies, CPs had the highest expectations for it. FMs had a higher level of concern than CPs and GAs; feeling anxious by knowing the results, being treated unfavorably if germline findings were detected. Both the FMs and CPs were highly concerned about the protection of genetic information. CPs preferred results with actionability, however, only half preferred to know germline findings. Given the possibility of detecting variants across multidisciplinary diseases and the long-term continuity of WGS research, a system is needed in which study participants can consult and receive decision-making support at any time according to their needs.
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8
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Perspectives and preferences regarding genomic secondary findings in underrepresented prenatal and pediatric populations: A mixed-methods approach. Genet Med 2022; 24:1206-1216. [PMID: 35396980 DOI: 10.1016/j.gim.2022.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Patients undergoing clinical exome sequencing (ES) are routinely offered the option to receive secondary findings (SF). However, little is known about the views of individuals from underrepresented minority pediatric or prenatal populations regarding SF. METHODS We explored the preferences for receiving hypothetical categories of SF (H-SF) and reasons for accepting or declining actual SF through surveying (n = 149) and/or interviewing (n = 47) 190 families undergoing pediatric or prenatal ES. RESULTS Underrepresented minorities made up 75% of the probands. In total, 150 families (79%) accepted SF as part of their child/fetus's ES. Most families (63%) wanted all categories of H-SF. Those who declined SF as part of ES were less likely to want H-SF across all categories. Interview findings indicate that some families did not recall their SF decision. Preparing for the future was a major motivator for accepting SF, and concerns about privacy, discrimination, and psychological effect drove decliners. CONCLUSION A notable subset of families (37%) did not want at least 1 category of H-SF, suggesting more hesitancy about receiving all available results than previously reported. The lack of recollection of SF decisions suggests a need for alternative communication approaches. Results highlight the importance of the inclusion of diverse populations in genomic research.
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9
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Kruse J, Mueller R, Aghdassi AA, Lerch MM, Salloch S. Genetic Testing for Rare Diseases: A Systematic Review of Ethical Aspects. Front Genet 2022; 12:701988. [PMID: 35154238 PMCID: PMC8826556 DOI: 10.3389/fgene.2021.701988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Genetic testing is associated with many ethical challenges on the individual, organizational and macro level of health care systems. The provision of genetic testing for rare diseases in particular requires a full understanding of the complexity and multiplicity of related ethical aspects. This systematic review presents a detailed overview of ethical aspects relevant to genetic testing for rare diseases as discussed in the literature. The electronic databases Pubmed, Science Direct and Web of Science were searched, resulting in 55 relevant publications. From the latter, a total of 93 different ethical aspects were identified. These ethical aspects were structured into three main categories (process of testing, consequences of the test outcome and contextual challenges) and 20 subcategories highlighting the diversity and complexity of ethical aspects relevant to genetic testing for rare diseases. This review can serve as a starting point for the further in-depth investigation of particular ethical issues, the education of healthcare professionals regarding this matter and for informing international policy development on genetic testing for rare diseases.
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Affiliation(s)
- Judith Kruse
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Regina Mueller
- Institute of Ethics and History of Medicine, Medical Faculty, University Tübingen, Tübingen, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | | | - Sabine Salloch
- Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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10
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Claret B. Être psychologue au sein d’une équipe d’oncogénétique : défis, enjeux et limites autour de la place du « psy ». PSYCHO-ONCOLOGIE 2022. [DOI: 10.3166/pson-2021-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le développement des séquençages génétiques tumoraux et constitutionnels, lié aux progrès technologiques récents, a permis d’améliorer les connaissances en oncogénétique et d’ouvrir de multiples champs de recherche de nouvelles mutations génétiques prédisposant aux cancers pédiatriques. Cet article questionne la place du psychologue au sein d’une équipe d’oncogénétique en pédiatrie, tant auprès des familles concernées par ces problématiques qu’auprès des soignants, mettant en avant la nécessité d’une pensée groupale et transdisciplinaire.
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11
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Haga SB. Revisiting Secondary Information Related to Pharmacogenetic Testing. Front Genet 2021; 12:741395. [PMID: 34659361 PMCID: PMC8517135 DOI: 10.3389/fgene.2021.741395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Incidental or secondary findings have been a major part of the discussion of genomic medicine research and clinical applications. For pharmacogenetic (PGx) testing, secondary findings arise due to the pleiotropic effects of pharmacogenes, often related to their endogenous functions. Unlike the guidelines that have been developed for whole exome or genome sequencing applications for management of secondary findings (though slightly different from PGx testing in that these refer to detection of variants in multiple genes, some with clinical significance and actionability), no corresponding guidelines have been developed for PGx clinical laboratories. Nonetheless, patient and provider education will remain key components of any PGx testing program to minimize adverse responses related to secondary findings.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomic and Precision Medicine, Duke University School of Medicine, Durham, NC, United States
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12
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Saelaert M, Mertes H, Moerenhout T, Van Cauwenbergh C, Leroy BP, Devisch I, De Baere E. A qualitative study among patients with an inherited retinal disease on the meaning of genomic unsolicited findings. Sci Rep 2021; 11:15834. [PMID: 34349199 PMCID: PMC8339116 DOI: 10.1038/s41598-021-95258-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/05/2021] [Indexed: 12/30/2022] Open
Abstract
Exome-based testing for genetic diseases can reveal unsolicited findings (UFs), i.e. predispositions for diseases that exceed the diagnostic question. Knowledge of patients’ interpretation of possible UFs and of motives for (not) wanting to know UFs is still limited. This lacking knowledge may impede effective counselling that meets patients’ needs. Therefore, this article examines the meaning of UFs from a patient perspective. A qualitative study was conducted and an interpretative phenomenological analysis was made of 14 interviews with patients with an inherited retinal disease. Patients assign a complex meaning to UFs, including three main components. The first component focuses on result-specific qualities, i.e. the characteristics of an UF (inclusive of actionability, penetrance, severity and age of onset) and the consequences of disclosure; the second component applies to a patient’s lived illness experiences and to the way these contrast with reflections on presymptomatic UFs; the third component addresses a patient’s family embedding and its effect on concerns about disease prognosis and genetic information’s family relevance. The complex meaning structure of UFs suggests the need for counselling procedures that transcend a strictly clinical approach. Counselling should be personalised and consider patients’ lived illness experiences and family context.
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Affiliation(s)
- Marlies Saelaert
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium.
| | - Heidi Mertes
- Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Ghent, Belgium
| | - Tania Moerenhout
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium.,Bioethics Centre, University of Otago, Dunedin, New Zealand.,Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
| | - Caroline Van Cauwenbergh
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Bart P Leroy
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.,Department of Head and Skin, Ghent University, Ghent, Belgium.,Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium.,Division of Ophthalmology & Center for Cellular & Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Philosophy of Medicine and Ethics Research Group, Ghent University, Campus Heymans (UZ Gent), Corneel Heymanslaan 10 - Building 6K3, 9000, Ghent, Belgium
| | - Elfride De Baere
- Center for Medical Genetics Ghent (CMGG), Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
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13
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Cléophat JE, Dorval M, El Haffaf Z, Chiquette J, Collins S, Malo B, Fradet V, Joly Y, Nabi H. Whether, when, how, and how much? General public's and cancer patients' views about the disclosure of genomic secondary findings. BMC Med Genomics 2021; 14:167. [PMID: 34174888 PMCID: PMC8236159 DOI: 10.1186/s12920-021-01016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/16/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data on the modalities of disclosing genomic secondary findings (SFs) remain scarce. We explore cancer patients' and the general public's perspectives about disclosing genomic SFs and the modalities of such disclosure. METHODS Sixty-one cancer patients (n = 29) and members of the public (n = 32) participated in eight focus groups in Montreal and Quebec City, Canada. They were asked to provide their perspectives of five fictitious vignettes related to medically actionable and non-actionable SFs. Two researchers used a codification framework to conduct a thematic content analysis of the group discussion transcripts. RESULTS Cancer patients and members of the public were open to receive genomic SFs, considering their potential clinical and personal utility. They believed that the right to know or not and share or not such findings should remain the patient's decision. They thought that the disclosure of SFs should be made mainly in person by the prescribing clinician. Maintaining confidentiality when so requested and preventing genetic discrimination were considered essential. CONCLUSION Participants in this study welcomed the prospect of disclosing genomic SFs, as long as the right to choose to know or not to know is preserved. They called for the development of policies and practice guidelines that aim to protect genetic information confidentiality as well as the autonomy, physical and psychosocial wellbeing of patients and families.
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Affiliation(s)
- Jude Emmanuel Cléophat
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada.,Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada.,Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Laval University Cancer Research Center, Quebec City, QC, Canada.,Research Center of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada
| | - Zaki El Haffaf
- Division of Genetics, Department of Medicine, Hospital Center of the University of Montreal, Montreal, QC, Canada.,Oncology Division, Research Center of the Hospital Center of the University of Montreal, Montreal, QC, Canada
| | - Jocelyne Chiquette
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | | | - Benjamin Malo
- Infectious and Immune Diseases Division, Research center of the Quebec City University Hospital, Quebec City, QC, Canada
| | - Vincent Fradet
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada.,Laval University Cancer Research Center, Quebec City, QC, Canada.,Department of Surgery, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Yann Joly
- Center of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Hermann Nabi
- Oncology Division, Research Center of the CHU de Québec-Laval University, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada. .,Laval University Cancer Research Center, Quebec City, QC, Canada. .,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
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14
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Recommendations for reporting of secondary findings in clinical exome and genome sequencing, 2021 update: a policy statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2021; 23:1391-1398. [PMID: 34012069 DOI: 10.1038/s41436-021-01171-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
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15
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Maron JL, Kingsmore SF, Wigby K, Chowdhury S, Dimmock D, Poindexter B, Suhrie K, Vockley J, Diacovo T, Gelb BD, Stroustrup A, Powell CM, Trembath A, Gallen M, Mullen TE, Tanpaiboon P, Reed D, Kurfiss A, Davis JM. Novel Variant Findings and Challenges Associated With the Clinical Integration of Genomic Testing: An Interim Report of the Genomic Medicine for Ill Neonates and Infants (GEMINI) Study. JAMA Pediatr 2021; 175:e205906. [PMID: 33587123 PMCID: PMC7885094 DOI: 10.1001/jamapediatrics.2020.5906] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE A targeted genomic sequencing platform focused on diseases presenting in the first year of life may minimize financial and ethical challenges associated with rapid whole-genomic sequencing. OBJECTIVE To report interim variants and associated interpretations of an ongoing study comparing rapid whole-genomic sequencing with a novel targeted genomic platform composed of 1722 actionable genes targeting disorders presenting in infancy. DESIGN, SETTING, AND PARTICIPANTS The Genomic Medicine in Ill Neonates and Infants (GEMINI) study is a prospective, multicenter clinical trial with projected enrollment of 400 patients. The study is being conducted at 6 US hospitals. Hospitalized infants younger than 1 year of age suspected of having a genetic disorder are eligible. Results of the first 113 patients enrolled are reported here. Patient recruitment began in July 2019, and the interim analysis of enrolled patients occurred from March to June 2020. INTERVENTIONS Patient (proband) and parents (trios, when available) were tested simultaneously on both genomic platforms. Each laboratory performed its own phenotypically driven interpretation and was blinded to other results. MAIN OUTCOMES AND MEASURES Variants were classified according to the American College of Medical Genetics and Genomics standards of pathogenic (P), likely pathogenic (LP), or variants of unknown significance (VUS). Chromosomal and structural variations were reported by rapid whole-genomic sequencing. RESULTS Gestational age of 113 patients ranged from 23 to 40 weeks and postmenstrual age from 27 to 83 weeks. Sixty-seven patients (59%) were male. Diagnostic and/or VUS were returned for 51 patients (45%), while 62 (55%) had negative results. Results were concordant between platforms in 83 patients (73%). Thirty-seven patients (33%) were found to have a P/LP variant by 2 or both platforms and 14 (12%) had a VUS possibly related to phenotype. The median day of life at diagnosis was 22 days (range, 3-313 days). Significant alterations in clinical care occurred in 29 infants (78%) with a P/LP variant. Incidental findings were reported in 7 trios. Of 51 positive cases, 34 (67%) differed in the reported result because of technical limitations of the targeted platform, interpretation of the variant, filtering discrepancies, or multiple causes. CONCLUSIONS AND RELEVANCE As comprehensive genetic testing becomes more routine, these data highlight the critically important variant detection capabilities of existing genomic sequencing technologies and the significant limitations that must be better understood.
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Affiliation(s)
- Jill L. Maron
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts
| | | | - Kristen Wigby
- Rady Children’s Institute for Genomic Medicine, San Diego, California,Department of Pediatrics, University of California, San Diego, San Diego
| | - Shimul Chowdhury
- Rady Children’s Institute for Genomic Medicine, San Diego, California
| | - David Dimmock
- Rady Children’s Institute for Genomic Medicine, San Diego, California
| | - Brenda Poindexter
- Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Kristen Suhrie
- Perinatal Institute, Cincinnati Children’s Hospital, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jerry Vockley
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas Diacovo
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annemarie Stroustrup
- Department of Pediatrics, Cohen Children’s Medical Center, New Hyde Park, New York, New York
| | - Cynthia M. Powell
- University of North Carolina Children’s Research Institute, University of North Carolina Health Children’s Hospital, Chapel Hill
| | - Andrea Trembath
- University of North Carolina Children’s Research Institute, University of North Carolina Health Children’s Hospital, Chapel Hill
| | - Matthew Gallen
- Athena Diagnostics/Quest Diagnostics, Marlborough, Massachusetts
| | - Thomas E. Mullen
- Athena Diagnostics/Quest Diagnostics, Marlborough, Massachusetts
| | | | - Dallas Reed
- Department of Obstetrics and Gynecology, Tufts Medical Center Boston, Boston, Massachusetts,Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Anne Kurfiss
- Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Jonathan M. Davis
- Department of Pediatrics, The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts,The Tufts Clinical and Translation Science Institute, Tufts University School of Medicine, Boston, Massachusetts
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16
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Nambot S, Sawka C, Bertolone G, Cosset E, Goussot V, Derangère V, Boidot R, Baurand A, Robert M, Coutant C, Loustalot C, Thauvin-Robinet C, Ghiringhelli F, Lançon A, Populaire C, Damette A, Collonge-Rame MA, Meunier-Beillard N, Lejeune C, Albuisson J, Faivre L. Incidental findings in a series of 2500 gene panel tests for a genetic predisposition to cancer: Results and impact on patients. Eur J Med Genet 2021; 64:104196. [PMID: 33753322 DOI: 10.1016/j.ejmg.2021.104196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
With next generation sequencing, physicians are faced with more complex and uncertain data, particularly incidental findings (IF). Guidelines for the return of IF have been published by learned societies. However, little is known about how patients are affected by these results in a context of oncogenetic testing. Over 4 years, 2500 patients with an indication for genetic testing underwent a gene cancer panel. If an IF was detected, patients were contacted by a physician/genetic counsellor and invited to take part in a semi-structured interview to assess their understanding of the result, the change in medical care, the psychological impact, and the transmission of results to the family. Fourteen patients (0.56%) were delivered an IF in a cancer predisposition gene (RAD51C, PMS2, SDHC, RET, BRCA2, CHEK2, CDKN2A, CDH1, SUFU). Two patients did not collect the results and another two died before the return of results. Within the 10 patients recontacted, most of them reported surprise at the delivery of IF, but not anxiety. The majority felt they had chosen to obtain the result and enough information to understand it. They all initiated the recommended follow-up and did not regret the procedure. Information regarding the IF was transmitted to their offspring but siblings or second-degree relatives were not consistently informed. No major adverse psychological events were found in our experience. IF will be inherent to the development of sequencing, even for restricted gene panels, so it is important to increase our knowledge on the impact of such results in different contexts.
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Affiliation(s)
- S Nambot
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France.
| | - C Sawka
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - G Bertolone
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - E Cosset
- CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - V Goussot
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France
| | - V Derangère
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France
| | - R Boidot
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France; CNRS, 6302 Unit, Dijon, France
| | - A Baurand
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - M Robert
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France
| | - C Coutant
- Département de Chirurgie, Centre Georges François Leclerc, F-21000, Dijon, France
| | - C Loustalot
- Département de Chirurgie, Centre Georges François Leclerc, F-21000, Dijon, France
| | - C Thauvin-Robinet
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France
| | - F Ghiringhelli
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France; Département D'oncologie Médicale, Centre Georges François Leclerc, Dijon, France; Centre de Recherche INSERM LNC-UMR123, Université de Bourgogne Franche-Comté, F-21000, Dijon, France
| | - A Lançon
- CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France
| | - C Populaire
- Service Génétique et Biologie Du Développement-Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - A Damette
- Service Génétique et Biologie Du Développement-Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - M A Collonge-Rame
- Service Génétique et Biologie Du Développement-Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - N Meunier-Beillard
- INSERM, CIC1432, Module épidémiologie Clinique, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Centre D'investigation Clinique, Module épidémiologie Clinique/essais Cliniques, Dijon, France
| | - C Lejeune
- Centre de Recherche INSERM LNC-UMR123, Université de Bourgogne Franche-Comté, F-21000, Dijon, France; INSERM, CIC1432, Module épidémiologie Clinique, Dijon, France; Centre Hospitalier Universitaire Dijon-Bourgogne, Centre D'investigation Clinique, Module épidémiologie Clinique/essais Cliniques, Dijon, France
| | - J Albuisson
- Platform of Transfer in Cancer Biology, Department of Biology and Pathology of Tumours, Centre Georges-François Leclerc, Unicancer, F-21000, Dijon, France; Centre de Recherche INSERM LNC-UMR123, Université de Bourgogne Franche-Comté, F-21000, Dijon, France
| | - L Faivre
- Centre de Génétique, FHU TRANSLAD, Institut GIMI, CHU Dijon, F-21000, Dijon, France; CGFL, Unité D'oncogénétique et Institut GIMI, F-21000, Dijon, France.
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Stakeholder views on opportunistic genomic screening in the Netherlands: a qualitative study. Eur J Hum Genet 2021; 29:949-956. [PMID: 33619333 DOI: 10.1038/s41431-021-00828-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 11/08/2022] Open
Abstract
Genome sequencing can be used to actively search for genetic variants unrelated to the initial clinical question. While such 'opportunistic genomic screening' (OGS) has been proposed in the USA, a European discussion on the ethics of OGS is only starting. Should testing for selected 'secondary findings' be offered to patients who need genetic sequencing? Using focus groups and interviews, we explored views on OGS in adults and minors from three perspectives: policy experts (n = 9), health professionals (n = 8) and patient representatives (n = 7). A thematic approach was used to analyze the data. There was consensus that OGS should be evaluated in terms of the classical 'screening' framework, rather than as a form of 'good patient care'. Accordingly, stakeholders agreed that professionals do not have a 'fiduciary duty' to look for secondary findings. Adding screening to clinical care was only conceivable with the patient's informed consent. In general, stakeholders were reluctant towards OGS. Arguments for regarding OGS being premature included lack of evidence regarding its clinical utility, also in view of uncertainties regarding general population penetrance, and concerns about both its psychosocial impact and respect for autonomy. All groups agreed that OGS means unequal access, which was seen as problematic. Yet, despite their concerns, stakeholders felt that offering screening for certain actionable pathogenic variants with known high penetrance could potentially be valuable in certain contexts for both adults and minors. Pharmacogenetic variants were regarded as a category by itself, for which OGS could potentially be beneficial.
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Brown EE, Sturm AC, Cuchel M, Braun LT, Duell PB, Underberg JA, Jacobson TA, Hegele RA. Genetic testing in dyslipidemia: A scientific statement from the National Lipid Association. J Clin Lipidol 2020; 14:398-413. [DOI: 10.1016/j.jacl.2020.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022]
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