Molecular diagnostics is set to change the way we treat patients and populations, said Dr Johnathan Lancaster at the APAC Forum 2016 podium.
The keynote speaker at the 5th annual forum told delegates at Sydney’s opulent State Theatre that in future we will be able to able to do pre-conception genotyping for genetic risk assessment and establish disease risk quantification and long-term wellness plans at birth. Our lives will be mapped out with lifetime plans for dietary, behavioural, preventive and therapeutic optimisation, as well as vocational and educational paths based on genetically-determined, predicted skillsets and strengths.
We will be able to understand medication efficacy and toxicity for individual patients. Implanted nano-detectors will monitor health parameters and give alarms at initial detection of disease markers. We will be able to identify genes that increase the risk of criminal behaviour and possibly intervene, and we will even be able to test for the likelihood of divorce based on genetics.
“It’s not an if it is a when,” Dr Lancaster said, noting the technology already exists today in some form or another.
The use of molecular diagnostics or precision medicine in oncology illustrates the extent that the technology can be used to transform lives.
The patient’s genome affects the likelihood of cancer developing. For example, women with inherited BRCA1 and BRCA2 genetic mutations are much more likely than the general population to develop breast or ovarian cancer.
In 2007, a new technology called Next-Gen Sequencing was developed that transformed the world of genetics. It enabled geneticists to measure genome-wide changes quickly, efficiently, accurately and cost-effectively. With this technology, the concept of gene panels was born, enabling us to look at hundreds of genes in a single sample almost immediately. This made pan-cancer panels possible. Pan-cancer panels show large numbers of genes that affect a person’s risk of developing cancer, making cancer risk assessments far more accurate. They have transformed our understanding of cancer genetics.
In the future Dr Lancaster says we all have access at some level to our own genome. Next-Gen Sequencing has brought the cost of sequencing a genome down to $1000 per person. However, we will need to consider who should receive these genomes and at what age, as well as how to deal with operational challenges, such as consent, confidentiality and data management. Financial considerations are also important when considering the use of molecular genetics or precision medicine.
Dr Lancaster noted that insurance companies are typically reluctant to fund genetic testing because of the high cost of these tests and the perception that they effectively serve to save costs for future competitors.
Echoing Professor Gray’s earlier keynote, arguing that Great Care Everywhere is possible and necessary, Dr Lancaster said precision medicine, carefully considered, will be part of this new healthcare landscape.
Dr Lancaster’s presence at APAC Forum was covered in the New Zealand media.