Cancer Genomics and Impact:
Genomic testing is increasingly recommended to inform clinical diagnosis and treatment decision-making in oncology particularly in breast and/or ovarian cancer.1–5 Genomic testing includes germline testing for inherited cancers, somatic tumor testing and/or paired tumor and germline samples. Testing modalities vary from single gene testing, multi-gene panel tests, whole exome, and genome sequencing, to novel genomic biomarkers such as tumor mutational burden. Interpreting of genomic alterations identified from sequencing is key in determining eligibility for targeted therapies. Rapid advances in cancer genomic technologies not only affected testing and treatment but also have resulted in innumerable possibilities for research. CRISPR/Cas9 which is a gene editing technology has emerged and advanced rapidly as a stable, efficient, simple technology that may lead to further breakthroughs in the field of precision oncology. 6
Ethical issues of cancer genomics raised in clinical practice:
Integrating genomics into clinical oncology raises several ethical issues include inequitable access to services, voluntary versus mandatory testing and screening, full disclosure of information ensured by an informed consent, confidentiality versus duties to relatives at genetic risk, privacy of genetic information, return of results issues and ethical issues related to gene therapy and consequently gene editing.7–9
Ethical issues of cancer genomics raised in Research:
While clinical practice seeks to improve health outcomes for cancer patients, research pursues generalizable knowledge. The difference between clinical practice and research leads to differences in legal obligations, ethical duties, and governing regulations covering clinicians and researchers, as well as separate sets of rights and protections owed to patients and research subjects.10
The increasingly blurred boundary between cancer genomics research and clinical practice, which have historically been kept clear. Recently they have sometimes been integrated raising questions about what ethical principles should govern this practice; those of clinical care or those of research?11
Oncologists’ education:
As involved oncologists face complex decisions regarding genomic testing, interpretation of results, treatment decisions based on the clinical actionability of genomic results,12 genomics research and gene therapy, so involved oncologists should have sufficient knowledge and skills in cancer genomics.13
Many options have become available to fill gaps in physician knowledge e.g., organizations have been formed to support genomic education for physicians, websites have been developed to provide webinars on various genomics topics and resources for educating physicians,14,15 data repositories, interprofessional education, and even emails are being used to disseminate genomic information to physicians.16,17
Competency-based curriculum development in medical education was first introduced by WHO, influenced by the need for medical education to better meet public health needs in both developed and developing nations.18 Recently, van Melle et al defined and delineated the core components of CBME.19
The National Comprehensive National Network (NCCN) clinical practice guidelines in oncology issued breast, ovarian and/or pancreatic cancer genetic assessment and genetic/familial high-risk assessment: colorectal as well as including the genetic testing and impact on treatment decision for different other cancers in other clinical practice guidelines. The NCCN elaborated indications of genetic testing, interpretation of genetic results and subsequent management decisions.20,21
This study was conducted to assess the current knowledge of clinical cancer genomics, cancer genomics research, their related ethical considerations among oncologists and their perception of cancer genomics impact for the next five years, to help direct tailored pedagogy and training for curriculum development to meet the growing demand for precision oncology, genomics testing and targeted therapy in clinical practice and research.