GenomicsNew

Goal

Improve health and prevent harm through valid and useful genomic tools in clinical and public health practices.

Overview

The new Genomics topic area and objectives for 2020 reflect the increasing scientific evidence supporting the health benefits of using genetic tests and family health history to guide clinical and public health interventions. This decade begins with recommendations from independent panels on genetic testing based on thorough reviews of scientific evidence.

The 1st recommendation is from the U.S. Preventive Services Task Force (USPSTF):

Women with certain high-risk family health history patterns for breast and ovarian cancer could benefit from receiving genetic counseling to learn about genetic testing for BRCA1/2. For women with BRCA1/2 mutations, surgery could potentially reduce the risk of breast and ovarian cancer by 85 percent or more.1

The 2nd recommendation is from the Evaluation of Genomic Applications in Practice and Prevention Working Group:

All people who are newly diagnosed with colorectal cancer should receive counseling and educational materials about genetic testing. Family members could benefit from knowing whether the colorectal cancer in their family is a hereditary form called Lynch syndrome.2 Screening interventions could potentially reduce the risk of colorectal cancer among men and women with Lynch syndrome by 60 percent.3

Why Is Genomics Important?

Genomics plays a role in 9 of the 10 leading causes of death, including:

• Heart disease
• Cancer
• Stroke
• Diabetes
• Alzheimer’s disease

For people who are at increased risk for hereditary breast and ovarian, or hereditary colorectal cancer, genetic tests may reduce their risk by guiding evidence-based interventions.1, 2 Genetic tests for other leading causes of death and disability are becoming available. New recommendations are expected as the scientific evidence on which tests and interventions have health benefits is strengthened.

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Understanding Genomics

Traditionally, public health applications of genomics have focused on rare diseases, such as those identified through newborn screening programs. Much of the future promise of genomics rests on its application to common diseases.

More than 1,700 genetic tests are currently available, including many available directly to consumers.4 Genetic tests have the potential to improve health in a variety of ways by informing disease:

• Diagnosis
• Prognosis
• Risk prediction
• Prevention
• Treatment, including choice of medication and dosage

On the other hand, genetic tests that are not valid or useful have the potential to cause harm by prompting inappropriate changes in medical care based on incomplete or incorrect information.

Family health history is an important risk factor for common diseases, independent from traditional risk factors. More than 50 percent of the population is at increased risk of diabetes, cancer, or heart disease because they have close relatives with 1 or more of these diseases. Family health history has the potential to improve health by finding people who are at risk for disease in the future or who are already sick but have not been diagnosed.5

Although the field of genomics is rapidly producing discoveries, there are a limited number of evidence-based recommendations for genetic tests and family health history tools. The existing recommendations, after translating them into practice, have the potential for improving health. In addition, more evaluation of the potential benefits and harms from the use of genomics is needed to guide the development of new recommendations.

Emerging Issues in Genomics

As genomics discoveries lead to new opportunities to improve health through the use of genetic tests and family health history tools, 2 important challenges need to be addressed.

1. It is becoming increasingly difficult for evidence-based, independent review panels to evaluate quickly and thoroughly the proposed health benefits and harms of the fast-growing number of genetic tests and family health history tools.
2. As the number of recommended genetic tests increases, valid and reliable national data are needed to establish baseline measures and track progress toward targets. Many tests are recommended for use in small subpopulations, making it difficult for most national health information systems, such as the National Health Interview Survey (NHIS), to monitor progress. In addition, traditional administrative data sources in the health care system typically do not capture the use of genetic tests and family health history tools. For example, current procedural terminology (CPT) codes do not allow tracking of specific genetic tests in billing records.

The development of new Healthy People objectives in genomics may be hindered by the limited availability of both evidence-based practice recommendations and national data to monitor progress.

The Future of Genomics in Public Health

Many opportunities and challenges for realizing the promise of genomics to improve health outcomes lie ahead, including:

• Creating and evaluating scientific evidence to support valid and useful genetic tests and family health history tools.
• Developing evidence-based practice recommendations that evaluate the net health benefit of genetic tests and family health history tools.
• Conducting research on how to translate recommendations into practice.
• Facilitating the use of valid and useful genetic tests and family health history tools to guide clinical practice, policy, and national, State, and local programs to find people who are at risk for disease, make diagnoses, and provide appropriate interventions.
• Monitoring the use of genetic tests and family health history in populations, the health outcomes related to their use, and disparities in use and outcomes.
• Adding genomic information and clinical decision support tools to electronic health records.
• Incorporating health-related genomics education in primary, secondary, undergraduate, and graduate curricula.
• Assuring the privacy and confidentiality of genomic information.

Addressing these issues will require the coordinated and collaborative efforts of both the public and private sectors.

References

1US Preventive Services Task Force. Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: Recommendation statement. Ann Intern Med. 2005 Sep 6;143(5):355-61.

2Evaluation of Genomics Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: Genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives. Genet Med. 2009 Jan;11(1):35-41.

3Stupart DA, Goldberg PA, Algar U, et al. Surveillance colonoscopy improves survival in a cohort of subjects with a single mismatch repair gene mutation. Colorectal Dis. 2009 Feb;11(2):126-30.

4GeneTests: Medical genetics information resource [Internet]. Seattle, WA, and Bethesda, MD: University of Washington and National Institutes of Health, National Library of Medicine, National Center for Biotechnology; c1993–2010 [cited 2010 May 11]. Available from: http://www.ncbi.nlm.nih.gov/sites/GeneTests/?db=GeneTests

5Valdez R, Yoon PW, Qureshi N, et al. Family history in public health practice: A genomic tool for disease prevention and health promotion. Annu Rev Public Health. 2010 Apr 21;31:69-87.

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