Multigene Panel Testing in Oncology Practice

netic resonance imaging for PALB2 as for BRCA1/2 mutation carriers)?Proposed modifications to the clinician-patient encounter, including a streamlined counseling approach guided by clinical relevance, are being tested in important clinical trials.7 Amid this uncertainty, a point of clarity emerges: that expertise in cancer genetics, always endorsed by the American Society of Clinical Oncology, National Comprehensive Cancer Network, and others, 4 is more critical now than ever before.We recommend referral to expert clinicians for test selection, pretest and posttest counseling whenever possible.The existing workforce is insufficient, and thus we urge a societal investment in training for genomics and precision medicine, both of genetic counselors and of interested physicians in oncology and other specialties.The growing accessibility of genomic sequencing has a dazzling potential to transform oncology and medicine.However, the imperative to do no harm mandates that we exercise careful judgment in (1) the patients we select for multigene panel testing; (2) the number and identity of genes we sequence, with custom gene selection a rational alternative to prefabricated panels; and (3) the cancer screening and prevention strategies we advise.Practice guidelines are evolving with emerging evidence, but it is important to maintain a clear separation between routine care and research, 4 particularly for comprehensive strategies such as wholegenome sequencing.Patient care should be guided by the family cancer history when a less-studied mutation is detected, and participation in well-designed trials of testing, communication, and intervention strategies (Table ) should be strongly encouraged.