Qualitative review finds governance gaps limit feasibility of lifelong genomic medicine in US health systems

Background. A vision of lifelong genomic medicine, in which stored genomic data can inform a lifetime of care, has long animated the field of genomic medicine. Component pieces of this vision are being researched or are already in clinical practice, including dozens of projects around the world sequencing healthy newborns, along with reanalysis of stored genomic data. Whether lifelong genomic medicine is desirable, and, if so, whether it is feasible, has not been explored in the literature. Methods. We conducted and thematically analyzed interviews with over 50 US-based healthcare professionals, including clinical geneticists, genetic counselors, primary care clinicians, laboratory personnel, and those who have implemented genomic screening in health systems. Results. We found broad endorsement of the value of lifelong genomic medicine across groups. Perceived clinical value stemmed from the existence of genomic information relevant at multiple stages of life, the ability to query the genome if an individual's medical circumstances change, and the ability to inform patients about relevant evolving scientific advances. Participants also articulated an efficiency argument for reanalyzing stored genomic data rather than retesting. The clinical value was contested by a few participants, who argued for more targeted testing for the clinical situation and disputed the efficiency argument. Many participants viewed the model as inevitable, with operational precedent already established for many component activities. The feasibility of lifelong genomic medicine was limited not by scientific barriers but by governance gaps spanning delivery models, consent, data stewardship, recontact, and the pediatric-to-adult transition. These gaps have equity implications that are cumulative and mutually reinforcing. Conclusions. The concept of lifelong genomic medicine was widely viewed as acceptable and desired. However, until the governance infrastructure is established, including accountability, funding, data stewardship, and recontact mechanisms, population-scale genomic sequencing risks proceeding faster than the frameworks needed to make it responsible.