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. Author manuscript; available in PMC: 2017 Oct 18.
Published in final edited form as: Semin Oncol. 2016 Oct 18;43(5):615–622. doi: 10.1053/j.seminoncol.2016.10.002

Table 3.

2020 Foresight: Future Paradigms for Clinical Cancer Genomics

If you would be willing to anonymously reply to this opinion survey online, please go to https://www.surveymonkey.com/r/6XHXS5J. Results may be posted in the future.
In your opinion, which response best characterizes the future state of predictive cancer genomics:
  1. In 2020, most germline cancer genetic testing will be delivered
    1. By cancer genetic health care professionals using traditional forms of genetic counseling
    2. By a variety of health care professionals ordering tests on-line, with blood or saliva samples sent and results received online or in person, and reimbursed by carriers.
    3. By individuals via direct-to-consumer testing, largely self-paid, with results discussed with a health care provider only if initiated by the consumer
    4. In the context of treatment selection, limited by third party payers, and with results delivered as any other medical test.
  2. By 2020, the assessment of the patient newly diagnosed with cancer, for largest number of cases, will include
    1. Tumor only testing for mutations that are shown to target therapies
    2. Tumor-normal testing including germline risk assessment at the same time
    3. Tumor-normal exome/genome/transcriptome testing with reporting of all inherited findings, including non cancer risks
  3. By 2020, pre-implantation genetic diagnosis for cancer predisposition
    1. Will be used at about the same frequency as today
    2. Will be used much more often and reimbursed by carriers
    3. Will begin to be impacted by direct germline “editing,” prohibited in the U.S, but obtained abroad.
    4. Will be routinely included as part of “fitness” screens offered to all reproductive age couples, with defined indications for reimbursement by carriers
  4. By 2020, pharmaco-genomic testing for cancer drug and dose selection
    1. Will be utilized uncommonly as drug choices and dosing will be based on other factors
    2. Will be routinely performed as part of pretreatment assessment of the cancer patient
    3. Will be performed commonly but after initiation of treatment in the assessment of severe toxicity in selected cancer patients