We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Mandatory Extended Searches in All Genome Sequencing “Incidental Findings,” Patient Autonomy, and Shared Decision Making

Lainie Friedman Ross, MD, PhD1; Mark A. Rothstein, JD2; Ellen Wright Clayton, MD, JD3
[+] Author Affiliations
1Department of Pediatrics, University of Chicago, Chicago, Illinois
2Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, Louisville, Kentucky
3Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, Tennessee
JAMA. 2013;310(4):367-368. doi:10.1001/jama.2013.41700.
Text Size: A A A
Published online


Should incidental findings discovered with whole-genome sequencing or testing be sought and reported to ordering clinicians and to patients (or their surrogates)? —No.

An incidental finding occurs when a medical test or procedure directed at one condition unexpectedly reveals a separate finding. An example would be when a radiologist notices a chest mass on abdominal computed tomography. By contrast, the American College of Medical Genetics and Genomics (ACMG) statement proposes that whenever genome sequencing is ordered in the clinical setting, laboratories have a mandatory duty to analyze 57 genes (revised to 56 genes) and to report the results to the clinicians and patients, regardless of the patient’s age or medical condition.1 Any positive findings from these additional analyses are hardly incidental; they are the results of a new recommendation for mandatory testing beyond the scope of the original request that will require a significant amount of time, effort, and resources.2 This approach is similar to requiring a laboratory to test every blood sample for human immunodeficiency virus, hemoglobin A1c level, and 54 other tests for which early treatment can reduce morbidity or mortality, even if the physician had only ordered, and the patient had only consented to, a cholesterol measurement.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

39 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles