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Webber EM, Hunter JE, Biesecker LG, Buchanan AH, Clarke EV, Currey E, Dagan-Rosenfeld O, Lee K, Lindor NM, Martin CL, Milosavljevic A, Mittendorf KF, Muessig KR, O'Daniel JM, Patel RY, Ramos EM, Rego S, Slavotinek AM, Sobriera NLM, Weaver MA, Williams MS, Evans JP, Goddard KAB. Evidence-based assessments of clinical actionability in the context of secondary findings: Updates from ClinGen's Actionability Working Group. Hum Mutat 2019; 39:1677-1685. [PMID: 30311382 PMCID: PMC6211797 DOI: 10.1002/humu.23631] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/19/2018] [Accepted: 08/23/2018] [Indexed: 12/31/2022]
Abstract
The use of genome-scale sequencing allows for identification of genetic findings beyond the original indication for testing (secondary findings). The ClinGen Actionability Working Group's (AWG) protocol for evidence synthesis and semi-quantitative metric scoring evaluates four domains of clinical actionability for potential secondary findings: severity and likelihood of the outcome, and effectiveness and nature of the intervention. As of February 2018, the AWG has scored 127 genes associated with 78 disorders (up-to-date topics/scores are available at www.clinicalgenome.org). Scores across these disorders were assessed to compare genes/disorders recommended for return as secondary findings by the American College of Medical Genetics and Genomics (ACMG) with those not currently recommended. Disorders recommended by the ACMG scored higher on outcome-related domains (severity and likelihood), but not on intervention-related domains (effectiveness and nature of the intervention). Current practices indicate that return of secondary findings will expand beyond those currently recommended by the ACMG. The ClinGen AWG evidence reports and summary scores are not intended as classifications of actionability, rather they provide a resource to aid decision makers as they determine best practices regarding secondary findings. The ClinGen AWG is working with the ACMG Secondary Findings Committee to update future iterations of their secondary findings list.
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Affiliation(s)
- Elizabeth M Webber
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Adam H Buchanan
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - Elizabeth V Clarke
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Erin Currey
- Division of Genomics and Society, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Kristy Lee
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina
| | - Noralane M Lindor
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Christa Lese Martin
- Autism & Developmental Medicine Institute, Geisinger, Danville, Pennsylvania
| | | | | | - Kristin R Muessig
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Julianne M O'Daniel
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina
| | - Ronak Y Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Erin M Ramos
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Shannon Rego
- Institute for Human Genetics, University of California, San Francisco, San Francisco, California
| | - Anne M Slavotinek
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Nara Lygia M Sobriera
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meredith A Weaver
- American College of Medical Genetics and Genomics, Bethesda, Maryland
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania
| | - James P Evans
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina
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