Seminars in Oncology 2016 1. The Future of Clinical Cancer Genomics I Table 3 Question Title * 1. In 2020, most germline cancer genetic testing will be delivered By cancer genetic health care professionals using traditional forms of genetic counseling By a variety of health care professionals ordering tests online, with blood or saliva samples sent and results received online or in person, and reimbursed by carriers By individuals via direct-to-consumer testing, largely self-paid, with results discussed with a health care provider only if initiated by the consumer In the context of treatment selection, limited by third party payers, and with results delivered as any other medical test Question Title * 2. By 2020, the assessment of the patient newly diagnosed with cancer, for largest number of cases, will include Tumor only testing for mutations that are shown to target therapies Tumor-normal testing including germline risk assessment at the same time Tumor-normal exome/genome/transcriptome testing with reporting of all inherited findings, including non cancer risks Question Title * 3. By 2020, pre-implantation genetic diagnosis for cancer predisposition Will be used at about the same frequency as today Will be used much more often and reimbursed by carriers Will begin to be impacted by direct germline “editing,” prohibited in the U.S, but obtained abroad. Will be routinely included as part of “fitness” screens offered to all reproductive age couples, with defined indications for reimbursement by carriers Question Title * 4. By 2020, pharmaco-genomic testing for cancer drug and dose selection Will be utilized uncommonly as drug choices and dosing will be based on other factors Will be routinely performed as part of pretreatment assessment of the cancer patient Will be performed commonly but after initiation of treatment in the assessment of severe toxicity in selected cancer patients Done