From the patient to the population: Use of genomics for population screening

Chloe Mighton; Salma Shickh; Vernie Aguda; Suvetha Krishnapillai; Ella Adi-Wauran; Yvonne Bombard

doi:10.3389/fgene.2022.893832

From the patient to the population: Use of genomics for population screening

Front Genet. 2022 Oct 24:13:893832. doi: 10.3389/fgene.2022.893832. eCollection 2022.

Authors

Chloe Mighton^{1

2}, Salma Shickh^{1

2}, Vernie Aguda^{1

3}, Suvetha Krishnapillai^{1

2}, Ella Adi-Wauran^{1

2}, Yvonne Bombard^{1

2}

Affiliations

¹ Genomics Health Services Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
³ Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom.

Abstract

Genomic medicine is expanding from a focus on diagnosis at the patient level to prevention at the population level given the ongoing under-ascertainment of high-risk and actionable genetic conditions using current strategies, particularly hereditary breast and ovarian cancer (HBOC), Lynch Syndrome (LS) and familial hypercholesterolemia (FH). The availability of large-scale next-generation sequencing strategies and preventive options for these conditions makes it increasingly feasible to screen pre-symptomatic individuals through public health-based approaches, rather than restricting testing to high-risk groups. This raises anew, and with urgency, questions about the limits of screening as well as the moral authority and capacity to screen for genetic conditions at a population level. We aimed to answer some of these critical questions by using the WHO Wilson and Jungner criteria to guide a synthesis of current evidence on population genomic screening for HBOC, LS, and FH.

Keywords: familial hypercholestelemia; genetic testing; hereditary breast and ovarian cancer (HBOC); lynch syndrome; population screening; tier 1 conditions.