Race and Genomics in the Veterans Health Administration

Clinical implementation of genomic medicine is gaining momentum. Since 2003, there has been a 25% yearly increase in the number of genes linked to specific diseases or treatments. Genetic testing is quickly and steadily being incorporated into clinical practice guidelines across a wide range of health indications, including cancer, cardiology, infectious diseases, mental health, and primary care. Within the Veterans Health Administration (VHA), from 2011 through 2013, more than 80 000 veterans underwent at least 1 of 110 different genetic tests. Tests that have high levels of utilization within the VHA include Factor V Leiden gene to identify patients at risk for venous thrombosis, HLA-B*5701 to identify patients at risk for a hypersensitivity reaction to abacavir (a treatment for HIV), IL28B to evaluate potential responsiveness to peginterferon-α-2b treatment for HCV, and several tests to inform risk, prognosis, or treatment for cancer, including BCR-ABL1, FLT3, JAK2, BRAF, BRCA, c-KIT, EGFR, EML4-ALK, KRAS, MLH1, MSH2, MSH6, among others.