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Clinically Actionable Findings Derived From Predictive Genomic Testing Offered in a Medical Practice Setting

Published:October 21, 2020DOI:https://doi.org/10.1016/j.mayocp.2020.08.051

      Abstract

      Objective

      To assess the presence of clinically actionable results and other genetic findings in an otherwise healthy population of adults seen in a medical practice setting and offered “predictive” genomic testing.

      Patients and Methods

      In 2014, a predictive genomics clinic for generally healthy adults was launched through the Mayo Clinic Executive Health Program. Self-identified interested patients met with a genomic nurse and genetic counselor for pretest advice and education. Two genome sequencing platforms and one gene panel–based health screen were offered. Posttest genetic counseling was available for patients who elected testing. From March 1, 2014, through June 1, 2019, 1281 patients were seen and 301 (23.5%) chose testing. Uptake rates increased to 36.3% [70 of 193]) in 2019 from 11.8% [2 of 17] in 2014. Clinically actionable results and genetic findings were analyzed using descriptive statistics.

      Results

      Clinically actionable results were detected in 11.6% of patients (35 of 301), and of those, 51.7% (15 of 29) with a cancer or cardiovascular result = did not have a personal or family history concerning for a hereditary disorder. The most common actionable results were in the BCHE, BRCA2, CHEK2, LDLR, MUTYH, and MYH7 genes. A carrier of at least one recessive condition was found in 53.8% of patients (162 of 301). At least one variant associated with multifactorial disease was found in 44.5% (134 of 301) (eg, 25 patients were heterozygous for the F5 factor V Leiden variant associated with thrombophilia risk).

      Conclusion

      Our predictive screening revealed that 11.6% of individuals will test positive for a clinically actionable, likely pathogenic/pathogenic variant. This finding suggests that wider knowledge and adoption of predictive genomic services could be beneficial in medical practice, although additional studies are needed.

      Abbreviations and Acronyms:

      ACMG (American College of Medical Genetics and Genomics), AD (Alzheimer disease), FH (familial hypercholesterolemia), NAFLD (nonalcoholic fatty liver disease), NCCN (National Comprehensive Cancer Network), OR (odds ratio), PGS (predictive genomic services), sVUS (suspicious variant of uncertain significance)
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