title: Processes and preliminary outputs for identification of actionable genes as incidental findings in genomic sequence data in the Clinical Sequencing Exploratory Research Consortium.
abstract: As genomic and exomic testing expands in both the research and clinical arenas, determining whether, how, and which incidental findings to return to the ordering clinician and patient becomes increasingly important. Although opinion is varied on what should be returned to consenting patients or research participants, most experts agree that return of medically actionable results should be considered. There is insufficient evidence to fully inform evidence-based clinical practice guidelines regarding return of results from genome-scale sequencing, and thus generation of such evidence is imperative, given the rapidity with which genome-scale diagnostic tests are being incorporated into clinical care. We present an overview of the approaches to incidental findings by members of the Clinical Sequencing Exploratory Research network, funded by the National Human Genome Research Institute, to generate discussion of these approaches by the clinical genomics community. We also report specific lists of "medically actionable" genes that have been generated by a subset of investigators in order to explore what types of findings have been included or excluded in various contexts. A discussion of the general principles regarding reporting of novel variants, challenging cases (genes for which consensus was difficult to achieve across Clinical Sequencing Exploratory Research network sites), solicitation of preferences from participants regarding return of incidental findings, and the timing and context of return of incidental findings are provided.Genet Med 15 11, 860-867.Genetics in Medicine (2013); 15 11, 860-867. doi:10.1038/gim.2013.133.
authors.affiliation: 1] Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA [2] Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA [3] Center for Genomics and Society, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA [4] Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Berg
authors.forename: Laura M
authors.initials: LM
authors.lastname: Amendola
authors.forename: Christine
authors.initials: C
authors.lastname: Eng
authors.forename: Eliezer
authors.initials: E
authors.lastname: Van Allen
authors.forename: Stacy W
authors.initials: SW
authors.lastname: Gray
authors.forename: Nikhil
authors.initials: N
authors.lastname: Wagle
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Rehm
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: DeChene
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Dulik
authors.forename: Fuki M
authors.initials: FM
authors.lastname: Hisama
authors.forename: Wylie
authors.initials: W
authors.lastname: Burke
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Spinner
authors.forename: Levi
authors.initials: L
authors.lastname: Garraway
authors.forename: Robert C
authors.initials: RC
authors.lastname: Green
authors.forename: Sharon
authors.initials: S
authors.lastname: Plon
authors.forename: James P
authors.initials: JP
authors.lastname: Evans
authors.forename: Gail P
authors.initials: GP
authors.lastname: Jarvik
mesh_terms: D000328:Adult; D002648:Child; D059472:Exome; D005820:Genetic Testing; D014644:Genetic Variation; D005826:Genetics, Medical; D015894:Genome, Human; D023281:Genomics; D006801:Humans; D033162:Incidental Findings; D054560:National Human Genome Research Institute (U.S.); D057240:Patient Preference; D017422:Sequence Analysis, DNA; D014481:United States