Exome and genome sequencing (collectively referred to in this paper as clinical sequencing) are rapidly being integrated into the practice of medicine,1,2 The falling price of sequencing, coupled with advanced bioinformatics capabilities, is creating opportunities to use sequencing in multiple medical situations, including the molecular characterization of rare diseases, the individualization of treatment (particularly in cancer), pharmacogenomics, preconception/prenatal screening and population screening for disease risk.3,4 In all of these applications, there is potential for the recognition and reporting of incidental (or secondary) findings, which are results that are not related to the indication for ordering the sequencing but that may nonetheless be of medical value or utility to the ordering physician and the patient. Considerable literature discusses the utility and ethics of reporting incidental findings discovered in the course of research,5–9 but relatively little has been written about doing so in the clinical context.10–14 Last year, the American College of Medical Genetics and Genomics (ACMG) published a policy statement related to clinical sequencing15 that emphasized the importance of secondary or incidental results in pretest patient discussions, clinical testing, and reporting
