Experience using conventional compared to ancestry-based population descriptors in clinical genomics laboratories

Various scientific and professional groups, including the American Medical Association (AMA), American Society of Human Genetics (ASHG), American College of Medical Genetics (ACMG), and the National Academies of Sciences, Engineering, and Medicine (NASEM), have appropriately clarified that certain population descriptors, such as race and ethnicity, are social and cultural constructs with no basis in genetics. Nevertheless, these conventional population descriptors are routinely collected during the course of clinical genetic testing and may be used to interpret test results. Experts who have examined the use of population descriptors, both conventional and ancestry based, in human genetics and genomics have offered guidance on using these descriptors in research but not in clinical laboratory settings. This perspective piece is based on a decade of experience in a clinical genomics laboratory and provides insight into the relevance of conventional and ancestry-based population descriptors for clinical genetic testing, reporting, and clinical research on aggregated data. As clinicians, laboratory geneticists, genetic counselors, and researchers, we describe real-world experiences collecting conventional population descriptors in the course of clinical genetic testing and expose challenges in ensuring clarity and consistency in the use of population descriptors. Current practices in clinical genomics laboratories that are influenced by population descriptors are identified and discussed through case examples. In relation to this, we describe specific types of clinical research projects in which population descriptors were used and helped derive useful insights related to practicing and improving genomic medicine.