The increasing clinical use of next generation sequencing in genetic testing, especially whole exome and whole genome, continues to be a hot topic. The ability to contribute to diagnosis, clinical utility, incidental findings and whether insurance will cover next-gen sequencing are all changing.

A Nature Medicine article lays out a lot of the emerging business issues on next-gen sequencing. On the topic of incidental findings, Buzzfeed science editor Virginia Hughes last week reported stories of women who receive a cancer diagnosis as a result of having a prenatal genetic test.

“These cases, though extremely rare, are raising ethical questions about the unregulated and rapidly evolving genetic-testing industry,” Buzzfeed says.

At a recent Department of Pediatrics seminar, Emory geneticist Michael Gambello described examples of how whole exome sequencing, performed to diagnose intellectual disability or developmental problems in a child, can uncover cancer or neurodegenerative disease risk mutations in a parent. The question becomes, whether to notify the parent for something that may or may not be actionable. This is why Emory Genetics Laboratory’s whole exome sequencing service has an extensive opt-in/opt-out consent process.

Emory Genetics Laboratory executive director Madhuri Hegde, working with the Association of Molecular Pathology, has been a leader in pushing genetic testing laboratories to adopt best practices.

“Patients have a choice whether or not to receive additional information that may be available as a result of a genetic test that looks across an entire genome of DNA,” she says in an AMP press release. “In most cases, patients are interested in learning more, but it’s critical that we educate them, as well as the ordering physician, about their options and what can and cannot be reported.”

Hegde was a panelist at the February FDA workshop on regulation of new genetic tests. The FDA has announced plans to regulate this area more, and in February approved a 23andMe test, which industry watchers think is a sign of the future.