title: Management of Incidental Findings in the Era of Next-generation Sequencing.
abstract: Next-generation sequencing (NGS) technologies allow for the generation of whole exome or whole genome sequencing data, which can be used to identify novel genetic alterations associated with defined phenotypes or to expedite discovery of functional variants for improved patient care. Because this robust technology has the ability to identify all mutations within a genome, incidental findings (IF)- genetic alterations associated with conditions or diseases unrelated to the patient's present condition for which current tests are being performed- may have important clinical ramifications. The current debate among genetic scientists and clinicians focuses on the following questions: 1) should any IF be disclosed to patients, and 2) which IF should be disclosed - actionable mutations, variants of unknown significance, or all IF? Policies for disclosure of IF are being developed for when and how to convey these findings and whether adults, minors, or individuals unable to provide consent have the right to refuse receipt of IF. In this review, we detail current NGS technology platforms, discuss pressing issues regarding disclosure of IF, and how IF are currently being handled in prenatal, pediatric, and adult patients.
authors.affiliation: Integrative Cardiac Health Program, Windber Research Institute, Windber, PA USA;
authors.forename: Heather L
authors.initials: HL
authors.lastname: Blackburn
authors.affiliation: Clinical Breast Care Project, Windber Research Institute, Windber, PA, USA;
authors.forename: Bradley
authors.initials: B
authors.lastname: Schroeder
authors.affiliation: Clinical Breast Care Project, Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Clesson
authors.initials: C
authors.lastname: Turner
authors.affiliation: Clinical Breast Care Project, Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.affiliation: Integrative Cardiac Health Program, Windber Research Institute, Windber, PA USA;
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Ellsworth
authors.affiliation: Clinical Breast Care Project, Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Ellsworth
keywords: ACMG.; Disclosure; Incidental findings; Next-generation sequencing