- 100,000 Genomes Project
- Resources for patients
- How to get involved
Many of the differences in our DNA – known as variants – have no impact, but there are some that can affect our health. Variants may cause a genetic condition, such as sickle cell anaemia, or could influence our predisposition to develop a condition, such as breast cancer.
We can now sequence and analyse genomic information to inform healthcare. A person’s genomic information can sometimes be used to diagnose a condition, predict and prevent disease, and offer personalised treatment.
Most people have heard of genetics in relation to healthcare. Genetics is the study of genes and their roles in inheritance – the way certain traits or conditions are passed down in genes from one generation to the next. In healthcare, genetics has typically focused on variations in a single gene when determining the cause of a health condition.
Genomics is an all-encompassing term that takes into account all the DNA in a person’s or organism’s genome – both the genes that code for proteins and those that do not, the non-coding regions. Genes account for just 1-5% of our complete set of genomic information, our genome. Genomics looks at how genes are expressed and the interplay between different genes.
Genetic testing involves the investigation of a single piece of genetic information for specific bits of DNA that have a known function. Through this, scientists can isolate the underlying causes of the specific genetic variant in question. Genomic testing involves the investigation of larger sections of genetic material and information. It's scope is broader and without a specific target.
Your healthcare professional may order a genomic test for several different reasons:
Diagnostic testing – to confirm a diagnosis of a particular cancer or rare disease
- when you display relative symptoms – ‘clinical presentation’
- a yes/no test
- can be used to confirm an initial diagnosis or alternatively to rule out a possible cause of the symptoms
Clinical predictive testing – to assess your risks of developing a genetic condition and to guide preventative care
- before you display any symptoms
- usually when a family member has been diagnosed with a genetic condition
- for a gene that is associated with a condition that is ‘actionable’ – it can be treated or the risk can be reduced with lifestyle changes and/or regular screening
- for a condition that is not actionable but is sufficiently severe that you may want to know about it before making major life decision (such as starting a family)
Pharmacogenetic testing – to test how your genome affects your response to medication
- can include whether a particular medicine will be effective or ineffective, and how likely the medicine is to cause particular side-effects
Tumour testing – to identify gene mutations present in the tumour cells that are either actionable (meaning targeted treatment can be offered), or warrant further study
- comparing the genomes of a patient’s tumour cells with those of the patient’s healthy cells can also help in identifying genes that are actionable in other ways, e.g. identify new research targets such as genes that are seen to be ‘driving’ cancers to develop and spread
Genomic testing usually requires samples of your blood, saliva or tissue. The DNA is extracted from these samples and sequenced at your local Genomic Laboratory Hub, where specific areas or all of your genome is then analysed.
Depending on what the test is for, results may take days, weeks or sometimes months to be reviewed and finalised and fed back to you. You may also be referred for genetic counselling depending on the results.
We inherit half of our DNA from our mother and half from our father. There are different ways that genetic conditions can be inherited (passed down) in a family. Sometimes a child only needs to inherit one copy of a gene variant to have a condition or increased risk for a condition. This is known as dominant inheritance. Other conditions such as cystic fibrosis (CF) are recessive. If both parents carry a variant, there is a 25 out of 100 (25%) chance for a child to have CF. There are also other forms of inheritance such as X-linked. Sometimes the genetic variant is new in a child and is not present in either parent.
Genomic tests can help to understand what variants are present, and then the clinical and scientific teams work together to understand what the variant means for a person and their family.
100,000 Genomes Project
Rare Disease patients
and their families recruited
in our region
Cancer patients recruited
in our region
Rare Disease and Cancer results
reported back to clinicians
We are sorry for the significant delay in receiving your 100,000 Genomes Project results. We are aware that many families have waited much longer than the expected 18-24 months to receive results. We are sorry that we have not been able to keep all families up to date with the delay. Every family is important to us and we are working hard to try and get your results to you as quickly as possible. The primary findings have been prioritised to ensure every family receives their main results as soon as possible.
When you donated your samples to the Project they were sent to Genomics England for sequencing and analysis before being returned to us here at the South London GMC for further analysis and reporting. For more information on all the stages that your family’s samples go through from recruitment to report, please visit this link to Genomics England’s ‘results journey’ process: www.genomicsengland.co.uk/information-for-participants/results-the-journey/
Participants of the 100,000 Genomes Project are able to track their sample online using the Genomics England “Track My Sample” service. However, please note that once sequencing and the initial analysis at Genomics England has been completed, the results still need to be confirmed back at their GMC and reported to the healthcare professional who referred you to the project. Neither Genomics England nor the hospital where you took part will be able tell you exactly when your results will be back.
Your referring healthcare professional (such as your GP or specialist) will let you know when they have received the report. You will be contacted about your test results just as you would be for any other test results – usually by letter or phone.
If you require any further information or help, please contact the South London GMC project team:
A main finding is one relevant to the condition that led someone to join the Project. These findings are changes, or variants, in a person’s genomic sequence. The changes could be relevant to the
- diagnosis or
- treatment of a person’s rare disease or cancer.
Main findings can also be called ‘pertinent’ or primary findings. Any main findings will be fed back to the NHS clinical team to confirm the result. The referring health professional will then give the results to the participant.
According to Genomics England, an estimated quarter of participants with a rare disease could receive a diagnosis in their results, and approximately half of participants with cancer are projected to receive information that could open up possibilities for clinical trials or targeted therapies.
This also means for many participants, no clear answer will be found at first. Your clinical team will tell you if nothing has been found. This is just the initial analysis though. Your data will also go into a research database. As our knowledge grows, researchers will continue to analyse your data. We will let your clinical team know if we find anything in the future that could be important for your, or your family’s, health.
Further information for 100,000 Genomes Participants can be found on the Genomics England website where they have a dedicated section on the project, including FAQs and information about participant data.
Participants can decide if we should look for ‘additional findings’ in their genome. These are not related to the cancer or rare disease that led them to take part. We only look for these changes if a participant wants us to.
These are genomic changes that are known to cause serious, life threatening conditions. The changes we look for are in certain genes, and they may cause an increased risk of certain genetic diseases. These diseases can often can be prevented or reduced by NHS treatment. These conditions are quite rare. We expect that about 1 in 100 people who take part will have one of these conditions.
Additional findings will be returned later, separately to any findings related to a participant’s main condition. Participants who decide to receive additional findings may get results several years later, as new genomic changes get added to the list.
Participants can change their mind about whether they want to receive these additional findings at any time. Participants can contact their referring clinical team or the GMC that they were recruited, at any time to either opt in or opt out to receive additional findings. Forms can be found in our Patient Resources.
The list of additional findings we look for will change over time. This is because new evidence becomes available about the role of the genes in disease. We only feedback information where there is strong scientific evidence that the changes can cause a disease.
Any participant who was initially consented to the project below the age of 16, will be contacted once they turn 16 to confirm whether they would like to remain in the project or not. If the patient would like to continue on the project as an adult, a consent conversation would need to take place again to sign a new consent form. This can be done either by telephone or via a clinic appointment.
Any participants that do not have capacity to sign for themselves, a consultee/parent will be able to make this decision and sign the form on their behalf.
- Withdrawal information and form – for adult or child participants (6a)
- Consultee declaration of advice regarding adult participant withdrawal information – for consultees (withdrawal) (6b)
Opting in/out forms for additional findings:
Resources for patients
When your clinician discusses genomic testing as part of your care, you will also be asked if you want to donate your sample, genome sequence and health data for research. If you agree to take part, your samples will be stored securely and your data will be added to the National Genomic Research Library – a secure national database of de-identified genomic and health data managed by Genomics England.
Approved researchers can use the samples and data to study diseases and look for new treatments. Their research might help you and others now or in the future.
Whole Genome Sequencing (WGS)
Episode 43 “Cracking the genetics of rare diseases through crowdsourcing” – Hear about how Genomics England is calling on experts around the world to help in the diagnosis of rare diseases.
Episode 62 “Unlocking the genetic mysteries of rare diseases” – Listen to an interview with the director of the US National Institutes of Health’s Center for Mendelian Genomics to find out why funding for genome sequencing is significant for understanding rare diseases.
Episode 105 “Helping patients with the same undiagnosed genetic condition find each other” – Listen to find out more about the importance of patients with undiagnosed rare diseases being able to find each other.
Episode 275 “Targeting the regulatory genome to treat rate blood diseases” – Listen to find out more about Sickle Cell disease, Beta Thalassaemia and other genetic blood diseases. The host talks with Syros Pharmaceuticals Chief Medical Officer to find out more about their research into treating these conditions by targeting the genome.
A story of twin sisters, two cultures, and two new chances at life. Inspired by their 2007 memoir, “The Power Of Two” offers an intimate portrayal of the bond between half-Japanese twin sisters Anabel Stenzel and Isabel Stenzel Byrnes, their battle with the fatal genetic disease cystic fibrosis (CF) and miraculous survival through double lung transplants. Defying all odds, Ana and Isa have emerged as authors, athletes and global advocates for organ donation, and their connection to the CF and transplant communities provides rare insight into the struggles — and overlooked joys — of chronic illness.
This short documentary takes us through the lives of women and men who have the BRCA 1 and 2 genetic mutations and and how these mutations put both women and men at risk for developing numerous cancers. The trailer is available to watch on Vimeo.
Other websites with genomics related resources
How can you get involved?
Why should you get involved?
If you live in South London, Kent, Surrey or Sussex you are one of our patients. Even if you don’t currently use our services, you or your family may need to in the future. By getting involved you can tell us what you think of the services we provide and use your experience and skills to help us improve what we are doing.
Why is Patient and Public Engagement important to us?
We care about the communities we serve and want to be providing the best services we can, meeting everyone’s needs. To ensure that we are able to do this, and to make sure the patient perspective is always at the centre of what we do, we are committed to involving patients and the public at every step. We have set up a number of ways for members of the public to be involved and to have a say in the implementation of our services.
There are several ways that patients, family members and the public can get involved with the South East Genomic service. These include:
Who are Genomic Patient Ambassadors?
Genomic Patient Ambassadors are volunteers who are enthusiastic about genetics and genomics. They may have previously been involved in the 100,000 Genomes Project, be a previous or current patient, or a carer or member of the public. People from all backgrounds and all abilities are welcome.
Genomic Patient Ambassadors play a leading role in working with the GLH leads to help ensure patient and public involvement is embedded in the planning and delivery of the new genomic service.
No previous experience is necessary, we just ask that you are able to commit to a small number of hours per month.
What can Genomic Patient Ambassadors do?
Genomic Patient Ambassadors work together to actively shape their own work and responsibilities so you can decide how best to contribute your skills and experience.
Due to our vast geographical region much of the work will take place online, but provisions will be made for those who are unable (for whatever reason) to use digital means of communication.
Here are some of the activities Genomic Patient Ambassadors can be involved with: