title: So rare we need to hunt for them: reframing the ethical debate on incidental findings.
abstract: Incidental findings are the subject of intense ethical debate in medical genomic research. Every human genome contains a number of potentially disease-causing alterations that may be detected during comprehensive genetic analyses to investigate a specific condition. Yet available evidence shows that the frequency of incidental findings in research is much lower than expected. In this Opinion, we argue that the reason for the low level of incidental findings is that the filtering techniques and methods that are applied during the routine handling of genomic data remove these alterations. As incidental findings are systematically filtered out, it is now time to evaluate whether the ethical debate is focused on the right issues. We conclude that the key question is whether to deliberately target and search for disease-causing variations outside the indication that has originally led to the genetic analysis, for instance by using positive lists and algorithms.
authors.affiliation: EURAT Project, Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schuol
authors.affiliation: Department of Medical Oncology, Program for Ethics and Patient Oriented Care, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schickhardt
authors.affiliation: Department of Molecular Genome Analysis, German Research Cancer Center (DKFZ), 69120 Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wiemann
authors.affiliation: Department of Human Genetics, University Hospital Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Claus R
authors.initials: CR
authors.lastname: Bartram
authors.affiliation: Department of Theology, University Heidelberg, 69117 Heidelberg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Tanner
authors.affiliation: Department of Theoretical Bioinformatics, German Research Cancer Center (DKFZ), 69120 Heidelberg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Eils
authors.affiliation: Department of Internal Medicine III, University Hospital Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Meder
authors.affiliation: Department of Translational Oncology, National Center for Tumor Diseases (NCT), German Research Cancer Center (DKFZ), 69120 Heidelberg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Richter
authors.affiliation: Department of Translational Oncology, National Center for Tumor Diseases (NCT), German Research Cancer Center (DKFZ), 69120 Heidelberg, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Glimm
authors.affiliation: Department of Translational Oncology, National Center for Tumor Diseases (NCT), German Research Cancer Center (DKFZ), 69120 Heidelberg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: von Kalle
authors.affiliation: Department of Medical Oncology, Program for Ethics and Patient Oriented Care, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, 69120 Heidelberg, Germany.
authors.forename: Eva C
authors.initials: EC
authors.lastname: Winkler