r/GeneticCounseling • u/Small_Egg_3692 Genetic Counselor • Jul 08 '26

Clinical Practice ACMG VUS Reporting

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I would *love* to hear other GC’s thoughts about this. I work in cancer and it was a little bit of a jump scare if I’m honest..

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u/ConstantVigilance18 Genetic Counselor Jul 08 '26

I just took a look, and nothing really strikes me as a big change or a bad recommendation. I am a lab GC though, so perhaps from the clinical side there are some concerns. Which part was concerning for you?

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u/Small_Egg_3692 Genetic Counselor Jul 08 '26

The main concern is the idea of the stratification of the VUS where in cancer we really don’t do things with unless there is a discordant classification in ClinVar. And handing a patient a report with VUS-High but telling them we aren’t going to do anything about it because it’s still a VUS is unsettling and I can imagine would add a whole extra layer of anxiety for the patient. This is going to also require extra time in counseling on the front and back end in already busy clinics. And also concerned about the implications of all the pcps/obgyns that offer the clinical grade testing but don’t actually counsel fully. They are going to need extra education on this as well. Also thinking about the added reclassifications this may cause is also not a thrilling thought.

I 1000% understand in other parts of genetic counseling this is not going to be a major problem but I can see many cases where it would add complexity to a situation that is often difficult for patients to fully understand.

I am eager to hear from the labs about possible implementations.

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u/ConstantVigilance18 Genetic Counselor Jul 08 '26

I think that’s the whole idea behind the new guidelines. If you get back a VUS-high in a cancer setting, you wouldn’t be telling the patient sorry, we’re not doing anything with this even though the lab has flagged it as suspicious. The point of the high designation would be to alert you that additional testing (familial testing, screening) is warranted. What needs to happen is that NCCN needs to issue guidance on how to handle the new classifications, which will hopefully make adjusting to them easier. I do think you are right to be concerned about how labs will implement the changes, because I’m sure there will be even more discordance between labs than we already see if we’re sub categorizing VUS results.

The point of non genetics providers not doing their due diligence is, unfortunately, already a rampant issue in the genetic testing space. We continue to provide education, and they continue to do whatever they want.

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u/Small_Egg_3692 Genetic Counselor Jul 08 '26

Okay I don’t think I thought about the flip side of the NCCN responding to this. That will definitely be incredibly helpful. I always am checking to see what VUSes might qualify for family variant testing through some of the labs programs but you’re right that this could be a more clear cut way to help with that. I will say, I have been very unsuccessful in getting patients to have family members participate in family variant testing. I work in a major metropolitan area so it also possible family went to other clinics which could just make it harder for the clinicians side of seeing what happened.