lunes, 7 de mayo de 2012

Genomics|Genetic Testing|Tier 1-3

Genomics|Genetic Testing|Tier 1-3

Genetic Testing

Genomic Tests by Levels of Evidence

The CDC Office of Public Health Genomics provides the following list of genomic tests and applications in practice according to three levels of evidence based on the paper by Khoury et alExternal Web Site Icon. This list is provided only for informational purposes to researchers, providers, public health programs and others. For additional information on this list, read our accompanying blog.
Tier 1 genomic applications are recommended for clinical use by evidence-based panels based on a systematic review of analytic validity, clinical validity and utility for specific clinical scenarios

Test/Application Scenario Evidence-based recommendation
Newborn screening panel of 31 core conditions Screening all newborns at birth through public health programs Secretary's Advisory Committee on Heritable Diseases of Newborns and ChildrenExternal Web Site Icon (2011)
BRCA1/2 analysis for hereditary breast and ovarian cancer Genetic counseling of women with specific family history patterns of breast or ovarian cancer US Preventive Services Task ForceExternal Web Site Icon (2005)
Lynch syndrome testing Screening newly diagnosed cases of colorectal cancer for Lynch syndrome and cascade testing of relatives of affected Lynch syndrome cases Evaluation of Genomic Applications in Practice and Prevention Working Group (2009)
Familial Hypercholesterolemia Cascade cholesterol testing with/without DNA analysis among relatives of affected persons with familial hypercholesterolemia UK National Institute for Clinical ExcellenceExternal Web Site Icon (2008)
HLA testing for abacavir sensitivity Testing HIV patients before starting abacavir to reduce adverse effects and inform drug choice DHHS Advisory Committee on HIV treatment Adobe PDF file [PDF 2.86 MB]External Web Site Icon (2008)
HER2 mutation testing in breast cancer Routine testing for HER2 mutations in patients with invasive breast cancer to target therapy ASCO/CAP evidence-based panelExternal Web Site Icon (2007)

Tier 2 genomic applications have demonstrated analytic and clinical validity; hold promise for clinical utility but evidence-based panels have not examined their use or found insufficient evidence for their use. Such applications may provide information for informed decision making by providers and patients

Test/Application Scenario Evidence-based recommendation
Breast cancer gene expression profiles To estimate risk of recurrence of breast cancer and target therapy EGAPP found insufficient evidenceExternal Web Site Icon (2009)
Family history for common diseases Collecting family history in primary care for risk assessment of common diseases NIH state-of science panel found insufficient evidenceExternal Web Site Icon (2009)
Pharmacogenomic testing Use of pharmacogenomics tests to inform safety and effectiveness of existing medications Pharmacogenomics information on labels of more than 80 FDA approved drugsExternal Web Site Icon; The Clinical Pharmacogenetics Implementation ConsortiumExternal Web Site Icon issues guidelines to help clinicians understand how available genetic test results should be used to optimize drug therapy, rather than whether  tests should be ordered.
Single gene disorders and chromosomal abnormalities Molecular, cytogenetic biochemical and other tests available for the diagnosis, management and carrier testing for these disorders More than 2500 geneticExternal Web Site Icon conditions affect millions of individuals. Diagnosis and management of these conditions may require use of genetic tests even without formal evidence synthesis and reviews by evidence panels. The NIH Genetic Testing RegistryExternal Web Site Icon has
updated information on genetic tests in practice.

Tier 3 genomic applications have not demonstrated adequate analytic validity, clinical validity, or clinical utility. This also includes applications for which evidence-based panels have recommended against their use based on the synthesis of the balance of benefits and harms. Such applications are not ready for routine practice, but may be considered in clinical and population research.

Test/Application Scenario Evidence-based recommendation
Genetic risk factors for common diseases Risk assessment and disease prevention Multiple panels have recommended against use of genetic risk factors testing. EGAPP made specific recommendations against testing for factor V LeidenExternal Web Site Icon and cardiogenomic profilesExternal Web Site Icon
Emerging genomic tests found in the CDC's GAPP FinderExternal Web Site Icon of the GAPP Knowledge BaseExternal Web Site Icon More than 400 genomic tests for various intended uses captured through horizon scanning Almost all of these applications (except when listed above) have insufficient information on analytic or clinical validity, or clinical utility
Next Generation Sequencing/ Whole Genome Sequence Emerging tools to help with diagnosis of rare familial diseases and provide information for assessing risk for common diseases Rapidly evolving landscape; gaps in knowledge exist for analytic validity, clinical validity and clinical utility

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