How should we address the inevitable harms from non-negligent variant reclassification in predictive genetic testing?

J Genet Couns. 2023 Feb;32(1):18-30. doi: 10.1002/jgc4.1638. Epub 2022 Oct 19.

Abstract

The process of interpreting genetic variants, in which experts use all available evidence to determine whether an identified variant is associated with a current or future disease, is both scientific and nevertheless subjective. In this paper, we summarize the existing evidence that any given variant could be reclassified and that such a reclassification could lead to harm. Furthermore, the racial gap in genetic databases could lead to a higher likelihood of harm for non-white patients. We also review recent legal analyses indicating it is unlikely that an individual who sues for restitution would be successful, especially in the absence of evidence of lab negligence. We then propose a compensation program for medical genetic tests to ensure that individuals who experience demonstrable harm due to a variant reclassification can be made whole financially. We conclude by discussing outstanding questions that must be answered for such a program to be feasible.

Keywords: genetic testing; genetics; insurance; public health; variant classification; variant of uncertain significance; variant reclassification.

MeSH terms

  • Genetic Predisposition to Disease*
  • Genetic Testing
  • Genetic Variation*
  • Humans
  • Probability