All of these considerations should be incorporated into an incidental or secondary results report that provides clinicians with a clear summary of the analysis that was performed, the depth of coverage and other quality metrics, and any findings. We estimate from limited amount of published data33 that approximately 1% of sequencing reports will include an incidental variant from the Table. As recommended in the ACMG policy statement on clinical sequencing, the clinician ordering these tests is responsible for providing or ensuring the provision of pretest counseling so that the patient is aware of not only the implications and limitations of the primary testing, but also the analysis that is being performed for incidental findings. The clinician should also provide post-test counseling and medical follow-up as described in the prior ACMG policy statement on Clinical Application of Genomic Sequencing.15 The informed consent process for clinical sequencing should follow the forthcoming guideline from the ACMG.
