DNA Answers is a community health research program offered by St. Luke’s University Health Network and co-sponsored by our partners at Helix to help improve the health of the patients and the community we serve. Through no-cost genetic screening, the research program looks at how your DNA could impact your health. The information we gain may help us improve personalized healthcare and support new research discoveries.

DNA Answers aims to enroll up to 100,000 participants in this community health research program.

• You may be able to participate in the DNA Answers study if you are:
  • 18 years or older at time of enrollment

• You are not eligible to participate in the DNA Answers study if you are:
  • The recipient of a donor bone marrow transplant
  • The recipient of a donor stem cell transplant

No. Participation is at no cost to you and health insurance is not required. The genetic testing provided will not be billed to you or your health insurance. If test results returned to you indicate an increased health risk, you will be contacted directly regarding your results and be offered a genetic counseling session at no cost with a licensed genetic counselor from St. Luke’s to discuss your individual results.

No. Participants will not receive any payment or other compensation for participating or for any inventions and/or patents developed, or other discoveries made from the research.

No. Research studies include only people who choose to participate. It is your choice whether or not you want to take part in this study and your decision will not impact your care at St. Luke’s University Health Network or any other provider.

We want to make sure you understand what is involved in the study so you can make an informed decision about your participation in the research. Signing up is easy and something you can do from home. If you decide to participate, we will ask you to answer a few questions to confirm you are eligible to participate. You will then be provided a link to review and sign the DNA Answers research consent form which provides confirmation of your informed consent.

The consent process:

1. Create a MyChart account, if you don't already have one.
   • You can find instructions at https://www.slhn.org/mychart/information
2. Click on the “Join Now” button on this website. This will bring you to the enrollment website from our partner, Helix. You will be asked to confirm your identity on the next step by logging into your MyChart account.
   • If you received an invite to join DNA Answers in your MyChart account, you may also click the link in that message to take you to the enrollment website.
3. After the login to your MyChart account is complete, some of your contact and personal information will be shared with Helix to assist with the enrollment process. You will then visit Helix’s enrollment website where you can learn more information about DNA Answers and proceed to start the enrollment process by answering questions to see if you are eligible.
4. Once your eligibility is confirmed, the research consent form will be available to you for review. It is important to read over the consent form carefully. If you have any questions about the study or the form, you can contact a member of the DNA Answers study team by phone at 484-658-6300 or email at DNAanswers@sluhn.org.
5. Once you are ready and all of your questions have been answered, sign the consent form. You will be sent a copy of your signed consent for your records via email and it will be available in your medical record. You will then receive a MyChart message with next steps for providing your DNA sample at a St. Luke’s lab in Pennsylvania or New Jersey.

Please note: The information provided before informed consent is signed may be stored by St. Luke’s University Health Network and/or Helix to keep track of potential participants and may be used to contact those who are interested. Only those who are eligible may sign an informed consent form to participate.

Once your sample is received at Helix, they will complete a DNA analysis, also known as sequencing. Sequencing reads the code contained within the DNA so that it can be used for research. You will also receive an email from Helix offering you the opportunity to create an optional Helix account. The turnaround time on your DNA results could take up to 12 weeks.

Yes. You will receive health results that will indicate if you have inherited certain risk factors in your DNA, meaning that the risk may have been passed from generation to generation in your family. Your family history alone, and standard medical screening tests, do not always identify risks for these conditions. Specifically, the test will tell you about your genetic risk for the following three conditions:

• Familial hypercholesterolemia (FH): A hereditary form of very high cholesterol that causes heart disease at an earlier age than the general population
• Hereditary breast and ovarian cancer (HBOC): A hereditary form of breast (male and female) and ovarian cancer, specifically linked with abnormalities in the 2 most common genes (BRCA1 and BRCA2)
• Lynch syndrome: The most common cause of hereditary colorectal (colon) cancer, people with Lynch syndrome have higher risks for colorectal, ovarian, and uterine cancers. People with Lynch syndrome are more likely to get these cancers at a younger age.

In addition, if you sign up for a Helix Health account, you’ll receive information about your genetic ancestry and how your DNA may influence certain traits, such as your caffeine metabolism and sleep patterns.

You will receive health results from the genetic screening that will indicate if you have inherited certain risk factors in your DNA, which will be shared with the study team, your St. Luke’s healthcare provider through your MyChart account, and which you may share with any healthcare provider at any facility. About 1-2% (1 to 2 people out of 100) will be found to have a risk for one of the inherited cancer or heart conditions that are part of this study. If your results show you are at an increased risk for certain conditions, a member of the St. Luke’s University Health Network study team will contact you about your results and you will be able to schedule a genetic counseling appointment at no cost to you or your insurance.

Your healthcare provider may refer you to a specialist for more information, genetic counseling, and/or additional screenings, if needed. You are free to share and discuss your results with any healthcare provider for consultation or care. Your healthcare provider does not have to be affiliated with St. Luke’s and seeking consultation or care with another healthcare provider will not in any way impact the care you receive at St. Luke’s. You will be responsible for additional charges related to follow-up care.

St. Luke’s patients: Your results will be available to you in your MyChart account and to your healthcare team in the St. Luke’s electronic medical record. You may also share your results with any other provider at any facility, as described below.

Non-St. Luke’s patients: Your results will be available to you in your MyChart account. There are several options for you to share these results with your preferred healthcare team, as described below.

Sharing Results:

• Epic, Care Everywhere: If your current healthcare provider is a St. Luke’s provider or in the Epic Care Everywhere network, you can notify them of these results, and they will be able to locate them through this platform.
• Request Medical Records: You can always request a copy of your medical record from St. Luke’s to share with your current healthcare provider.
  • MyChart: Within your St. Luke’s MyChart account you can use the “Request Medical Records” feature to request a formal copy of your health record to be sent directly to you.
  • Contact St. Luke’s Medical Records: To request a copy of your medical record sent directly to your healthcare provider or to another individual, contact Medical Records at:
    • Phone: 484-526-4719 (Monday-Friday 8am-4:30pm)
    • Fax: 833-932-1185
    • Email: releaseofinformation@sluhn.org
    • Website: https://www.slhn.org/patients-visitors/medical-record

The process takes about 12 weeks, from Helix receiving your blood sample to the time you receive your health test results. Typically, your ancestry and traits results are ready within 8 weeks of the Helix lab receiving your sample if you have created an optional Helix account. It may take an additional 4 weeks before your health results are ready to view, as extra steps are taken to ensure your health results are accurate.

Our partner, Helix, performs Exome+ sequencing on participant samples. This testing reads the DNA sequence of most genes (plus many other regions of the DNA). An individual's DNA sequence is also called their genetic information. Through involvement in this study, participants will receive DNA test results for three medical conditions. These conditions include a genetic form of breast cancer, colon cancer and high cholesterol. There are no additional genetic test results planned for return through this research program at this time. This may change in the future if additional medical conditions become appropriate for general population screening. Participants will be notified of any updates before receiving new results.

Helix will store participants’ DNA sequence results for an unlimited time. Since participants’ genetic information has been sequenced and stored, it will be possible to use that information for future clinical genetic testing. Helix is actively working with St. Luke’s and other partnering healthcare institutions to offer opportunities for patients to learn more about their genetic information in the future. Such future clinical testing would only be performed at the request of an ordering healthcare provider and with the consent and payment of the patient.

You may withdraw from the study at any time. Your decision to withdraw will not result in any penalty or loss of benefits and will not affect the medical care or benefits to which you are otherwise entitled.

To withdraw, please send an email to the DNA Answers study team at DNAanswers@sluhn.org. Include your name as it appears on your medical record and your date of birth with a statement that you are withdrawing from the DNA Answers study. Please also indicate if you would like your data deleted. If your data is deleted, it cannot be used for any future clinical use and your Helix account will be closed if you have created one. If you withdraw, whether or not your data is deleted, any data that identifies you will not be used for any future research studies.

If you withdraw from the study, you will no longer receive any emails or other communication as part of the study. Any information that has already been added to your medical record will remain in your medical record. However, no new information from the research study will go into your medical record. Your withdrawal from the project will be appropriately noted in your medical record.

Genetic variations linked to ancestry and traits occur throughout the genome. They are responsible for the natural genetic diversity among people. These genetic variants estimate the most likely ancestry or traits that a person will have. They are not definitive and do not guarantee the occurrence of specific ancestry or traits. Sometimes, the ancestry and traits we express do not match what is expected based on DNA testing. There are a few reasons for this. First, Helix testing may not include all of the genetic variants linked to a specific trait or ancestry. Also, there may be interactions between genes that are not yet fully understood. Genetic traits are often influenced by multiple genes making it difficult to predict precise outcomes. Finally, genetic traits can be influenced by the environment or other factors. These factors can interact with your genetic makeup and contribute to differences between the traits you express and the traits expected based on your DNA testing. Any questions about ancestry and/or traits should be directed to Helix since St. Luke's University Health Network does not have access to ancestry and/or trait information. Helix customer support: (844) 430-0468// support@helix.com // Online form: https://support.helix.com/s/contactsupport

No. The results of your ancestry and traits may be different from what you understand to be true about yourself. This does not mean the information provided to you about these results or your health results is inaccurate. It is important to understand that traits and ancestry results are estimates based on DNA patterns rather than definitive information. These results give insights into a person's genetic origins or predispositions. They do not guarantee the occurrence of specific ancestry or traits. While some traits are easy to predict based on genetic information, other traits are more complex and therefore more challenging to predict based on genetic data alone. Trait and ancestry results are different from Helix Health results. Helix Health testing looks for the presence or absence of specific genetic variants. Such variants have extensive evidence from the medical community linking them to risk for disease.

If you have a personal or family history of a condition covered by this test, it is important to know the results of this test do not change a previous diagnosis or any family history risk you might have. This is because there are other causes of cancer and heart disease that were not evaluated as part of this test. For example, lifestyle, family history, environment, personal medical history, and other genetic conditions all contribute to your overall health and personal risk for disease. In addition, the screening test provided as part of DNA Answers does not evaluate all genes associated with cancer and heart disease. Also, this test may not identify all DNA variants in the genes that were tested.

You may want to speak with a genetic counselor or your healthcare provider at any facility about the results of this test and whether additional or different genetic testing and general screening may be appropriate for you. In particular, participants with a negative genetic test and a clinical diagnosis of one of the conditions screened for by this test are recommended to consider a diagnostic genetics consultation to identify whether additional genetic testing or screening recommendations are indicated. A genetic counselor is a medical professional specifically trained to help you understand how your genetic information may impact your health and the health of your family members, discuss medical recommendations, and discuss how you can approach sharing any important information with others. Those communications would be separate from DNA Answers.

After your consent is signed, it will be sent to your St. Luke’s medical record and will prompt a lab order to be placed. Your order will be placed in your medical record within 1-3 business days. You will then receive a message in MyChart letting you know that your order is ready. Once your lab order is ready, you can proceed to any SLUHN lab location. You do not need to print out your lab order or fast.

If it has been longer than 3 business days, please login to MyChart to see if you have a message in your inbox. If you have not received a message, please contact the study team at DNAanswers@sluhn.org.

Currently, the study materials are only available in English. However, we are actively working on adding more languages soon. We strive to support our community members who do not read or speak English. Thus, your patience is appreciated while we prepare non-English language study materials.

If you have previously had diagnostic genetic testing through Helix or another laboratory, you may still participate in DNA Answers. If your diagnostic genetic testing was completed through Helix, you may be able to participate in DNA Answers without providing another sample since Helix is also our research partner for DNA Answers.

The results returned to you through DNA Answers may be different from those received from a diagnostic genetic test. This is because diagnostic genetic testing may test different or more genes and may provide a more detailed review of your DNA through use of additional methods or data review.

If you have additional questions about how diagnostic genetic testing and screening genetic testing are different. Please see the FAQ below.

While both tests examine DNA, there are important differences between a genetic screening test and a diagnostic genetic test.

Genetic screening tests are offered to a broad group of people. The goal of this testing is to identify those with a high risk for developing a disease. This allows for prevention or early detection of disease. Genetic screening tests include a limited set of genes. They do not report variants of uncertain significance.

Diagnostic genetic testing is ordered when there is a suspicion of a genetic condition. Diagnostic testing targets a set of genes and reads the DNA of those genes at a deeper level with the goal of diagnosing a disease.

Please contact your health care provider or the DNA Answers study team if you have additional questions.

The Genetic Information Nondiscrimination Act of 2008 (GINA) is a federal law that makes it illegal for health insurance companies, group health plans, and most employers to discriminate against you based on your genetic information. However, this law doesn’t protect you against genetic discrimination by companies when they consider selling you life insurance, disability insurance, or long-term care insurance. These companies must still abide by GINA when it comes to health insurance.

The information you contribute to DNA Answers will be used by researchers to study a wide range of questions around how DNA can impact health. The databases created in this research program will be used for future research by our genomics partner Helix, by us, and by other members of the Helix Research Network. That means, by agreeing to participate in the study, you are agreeing to have your information included in future research projects that are approved by us and by Helix.

Researchers outside of the Helix Research Network may also study your coded information and samples but will not have access to information that directly identifies you. These researchers may work for health systems, universities, government agencies, companies like drug companies and other foundations or groups interested in research. Any sharing of information outside of the Helix Research Network will be carefully reviewed and approved to make sure it is ethical, secure, and protects your privacy.

We may share discoveries that are made by St. Luke’s University Health Network researchers through our website and newsletters.

Your privacy is very important to us, and we take many steps to ensure it is protected, such as:

• Your information (your genetic information and health records) will be stored in secure databases.
• We limit and closely monitor who can access your data.
• We limit who is allowed to see information that could identify you, like your name or contact information.
• Researchers who have access to your data must be trained and certified to work with this type of research data.
• You can choose to withdraw and stop sharing your information at any time.

With few exceptions, GINA prohibits employers from discriminating against their employees on the basis of genetic information in any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoffs, training, fringe benefits, or any other term or condition of employment. The law similarly prohibits labor organizations from excluding, expelling, or otherwise discriminating against an individual based on genetic information.

Importantly, GINA’s employment protections do not extend to all employees or in all circumstances. Most notably, these protections do not apply to employees at companies with fewer than 15 employees or to active members of the U.S. military.

No. Your decision to participate in, decline, or withdraw from the research study is completely voluntary and not required by St. Luke’s University Health Network because of your employment. In making your voluntary decision, we encourage you to carefully review the above-referenced FAQ’s which, along with the Informed Consent form, more fully explain the research study and summarize risks and benefits of participating in this study, along with other important information, including your rights under the Genetic Information Nondiscrimination Act (GINA). Your voluntary decision will not be included in your St. Luke’s employment record (or be accessible to your manager(s)), nor will any results of your participation in the study (should you choose to participate). Your voluntary decision will not affect your compensation, benefits, job performance evaluation or any other decision related to your employment. A voluntary decision not to participate in this study will not result in any penalty or loss of employment and will not affect the medical care or benefits you receive and to which you are otherwise entitled.

Currently, federal, Pennsylvania, and New Jersey state laws protections against discrimination based on genetic information by health insurers do not extend to providers of life, disability, and long-term care insurance. That means companies offering these kinds of insurance may request access to genetic information in your medical record as part of the insurance application process (including information generated as part of your participation in this study) and may legally consider this information in deciding whether to extend your coverage or in determining the price they charge you.

If you already have an existing life insurance, disability insurance, or long-term care insurance policy, new information about your health (including genetic information) generally may not be used to deny your continuing coverage under those policies. However, the terms of individual policies vary significantly, and you should read your policy carefully to understand how results could impact your coverage or insurance rates.

If you decide to participate in the DNA Answers study, your information will be stored in databases that are maintained and monitored by a team of IT and security professionals who are committed to safeguarding the information stored in those systems. These systems include numerous technical, physical, and administrative safeguards that meet, and in some cases exceed, industry best privacy and cybersecurity practices, including standards established by the National Institutes of Science and Technology (“NIST”), the Association of International Certified Professional Accountants (“AICPA”), and applicable state and federal laws, such as Health Insurance Portability and Accountability Act (“HIPAA”). Some of the technical safeguards we’ve implemented include rigorous identification, authorization and access controls, audit and logging procedures, configuration management, system and communication protections, and endpoint monitoring, data loss prevention systems, encryption of data at rest and in transit, and vendor risk management procedures. Although we generally do not share the details of how these controls and safeguards have been configured, we can share that our privacy and security programs are reviewed annually by third-party auditors to ensure our safeguards are operating as expected and in a manner consistent with industry standards.

DNA Answers Study Team
Phone: 484-658-6300
Email: DNAanswers@sluhn.org

For questions related to the informed consent process and using the informed consent website (including updates to email and phone number), or creating or accessing an optional Helix account, please contact Helix customer support by phone, email or by filling out an online request: (844) 211-2070// support@helix.com // Online form: https://support.helix.com/s/contactsupport

This FAQ is being provided in light of the recent news about a data breach impacting user accounts at a genetic testing company that is not affiliated with Helix. Based on information that is publicly available, several factors contributed to this incident: (1) lack of multi-factor authentication; (2) password vulnerability to credential stuffing (a type of attack where credentials from a data breach on one service are used to log into another unrelated service); and (3) a specific service that allowed users to automatically share their results with others. In contrast, all Helix Accounts that are created for Helix Research Network (HRN), including accounts that are created through MyChart, require multi-factor authentication. Helix enforces the use of CAPTCHAs to prevent credential stuffing attacks and Helix’s product does notenable automatic sharing of results. All participant information that St. Luke’s shares with Helix as part of HRN is stored in secure databases. Helix uses advanced security monitoring tools and measures to ensure this data is secure. Access rights to this data are based on the principle of “least privilege” and “audit trails”, and logs are closely monitored on a regular basis. “Least privilege” means that employee access rights to sensitive information is limited. “Audit trails” provide a step-by-step record for tracing who has accessed information.