#165 Sequencing for Cancer Risk with Sandra Balladares
In this week’s episode, our host, Kira Dineen, is joined by Dr. Sandra Balladares to explore utilizing Illumina’s sequencing technology to assess inherited cancer risk.
Dr. Balladares is currently the HLA Typing Franchise Leader at Thermo Fisher Scientific. She formerly held positions at Illumina, most recently as Staff Segment Marketing Manager Oncology. Sandra holds a Ph.D. in molecular biomedicine, is a mother of two young children, and breast cancer survivor who advocates for genetic testing in developing countries and among ethnic minorities.
The Illumina mission is to improve human health by unlocking the power of the genome. With Illumina’s sequencing-by-synthesis technology, they have only just begun to discover the true impact of genomics in areas including oncology, reproductive health, genetic disease, agriculture, microbiology, and beyond. Knowing the discoveries that lie ahead is what inspires Illumina to push the boundaries of their imagination and constantly drive innovation. To learn more, visit illumina.com.
On This Episode We Discuss:
Sandra’s personal experience with breast cancer
Utilizing Illumina’s technology for genetic sequencing
The difference between Sanger Sequencing and Next Generation Sequencing
Sequencing versus genotyping
Various number of genes on a hereditary cancer panel
How the availability and accessibility of genetic testing differ around the world
Do you have patients with Primary Mitochondrial Myopathy? There is a new clinical study looking for people with PMM to enroll. People with Primary Mitochondrial Myopathy can experience muscle weakness or exercise intolerance. This study is assessing the efficacy and safety of a drug to help patients walk further by improving their muscle function. Find out about the study for Primary Mitochondrial Myopathy and how your patients can participate by going to pmmstudy.com.
Do you work in a lab? Want to receive rewards when you order supplies? Check out Thermo Fisher Scientific’s Aspire program, it’s a rewards program created with scientists, like you, in mind. All members receive a free full size trial product every year. Points are earned every time you use or purchase products. Rewards include science themed apparel like a zip up DNA hoodie! Check it out at ThermoFisher.com/aspire-DNAtoday and for a limited time receive 500 bonus points.
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Unfortunately, there is an underrepresentation of people of Non-European descent in genetic studies. We’ve explored this in multiple episodes of DNA Today. Allelica is also very aware of this issue and how polygenic risk scores developed for people who are of European descent cannot be applied to other ancestries without further validations. To directly address this, Allelica developed new models to improve predictive power in Non-European people. Allelica validated their polygenic risk scores in Non-Europeans population to provide ancestry specific genetic risk assessment. Interested in learning more? Visit Allelica.com. Allelica: Empowering the next generation of clinical genomics.
Stay tuned for the next new episode of DNA Today in the new year on January 7th, 2022! We’ll be joined by genetic counselor and patient advocate Radhika Sawh to discuss Thalassemia and blood donor awareness. New episodes are released on the first and third Friday of the month. In the meantime, you can binge over 165 other episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Today”. All episodes in 2021 are also recorded with video which you can watch on our YouTube channel.
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Have you heard of the new app Wisdom? It’s a social audio app for open access to mentorship. You can talk live with experts about anything. Our host, Kira Dineen, will be giving her first wisdom talk on January 5th at 5:30pmET / 2:30pmPT. You can tune in live by downloading the Wisdom app, then following me @DNAtoday. That way when she goes live on January 5th you will get a notification and can jump in. Podcasts can be very one way, whereas Wisdom allows us to chat. She wants to answer your questions about genetics, genetic counseling including grad school, or the podcast. It will be a live QnA! We can’t wait to talk to you then!
Transcript
Please note that this transcript was automatically generated and may not be 100% accurate.
Hello, you're listening to DNA Today, a genetics podcast asked and radio show. I'm your host, Kira Dineen. I'm also a certified genetic counselor practicing in the prenatal space. On this show, we explore genetics impact on our health through conversations with leaders in genetics. These are experts like fellow genetic counselors, researchers, doctors and patient advocates. In this episode, we are exploring how to utilize sequencing to assess inherited cancer risk. Joining me for this discussion is Dr. Sandra Balladares. She is currently the HLA typing franchise leader at Thermo Fisher Scientific, and she formally held positions at Alumina most recently as staff, segment marketing manager and oncology. Thank you so much for joining us on the show here. Thank you very much. It's a great pleasure to have the opportunity to share my story. Yes. And let's start with that. I'd love to hear about your personal experience with breast cancer and just sharing with our audience of that patient angle that you're also coming from. Yes, sure. Well, everything started in May 10. Obviously, nobody expects to be diagnosed with cancer, but in my case, being a scientist and with a family history of breast cancer, for me, it was less than expected, less expected. I was getting ready on the morning of maintain to go for breakfast. It was Mother's Day and Maintain in 23 when I was getting a shower and suddenly I felt this loan for my left breast. I got kind of worried. And as soon as I got to breakfast, I asked my sister, who is an Ob Gyn to go with me to the pressure. I couldn't really wait to have her exploring me. And after she explored me, she told me, well, after breakfast, you have to come with me to my office. So I was extremely nervous. I was the mom of two babies. They were one and three years old. And during that time I was working as sales manager for Life Technologies. It was a very interesting point of time because a precision medicine personalized medicine was kind of emerging. And during that time, kind of the goal standard for sequencing was finger sequencing. Next generation sequencing was in its infancy. It was kind of being developed but not yet adopted for clinical testing. So that is important as part of my story that is related to genetic testing. So I was well diagnosed and well, four important things that are critical for patients survival are that you want to be diagnosed in early stage. Do you want to get the right treatment for your type of cancer? And third, do you want to make sure that you survive the treatment because the treatment is also extremely toxic. And number four, do you want to make sure that if there is any records that you are aware about the potential chances of records? In your case, genetic testing will play an important role. First of all, with the first one. I think that I was lucky because I was diagnosed with a stage one, a type of cancer. So the higher the stage means that it is more spread in your body. In my case, it was a very small lump regardless. Well, the size of the lump. I require mastectomy and also cycles of chemotherapy, four cycles of epidural plus four cycles of taxotaire plus twelve cycles of septic because one of the actual biomarkers was her two positive. Unfortunately, there's an underrepresentation of people of nonEuropean descent in genetic studies. We've explored this in multiple episodes of DNA today. Aluca is also very aware of this issue and how polygenic risk scores develop for people who are of European descent cannot be applied to other ancestors without further validations. To directly address this, Alilca developed new models to improve predictive power in nonEuropean people. Alelca validated their polygenic risk scores in nonEuropean populations to provide ancestry specific genetic risk assessment. Interested in learning more visit alelica. Com alelica Empowering the next generation of clinical genomics. Do you like science themed apparel? If you follow us on Instagram at DNA radio, you've seen how much I love genetic shirts, jewelry, masks, you name it. That's why I want to tell you about Thermo Fisher's Aspire program. It's a rewards program created with scientists like you in mind. Points earned every time you use or purchase lab products. Then you can redeem those points for fun. Science seemed apparel, career and educational items and more. One of my friends in the program got a DNA hoodie and it was clearly designed by a genetics nerd because you zip up the base fares. Here's a bonus. As a Thermo Fisher Aspire member, you will receive a free full size trial product every year. You can also use points to get full size products from their catalog that you haven't tried before with over 1000 kits, reagents antibodies and other products to select from, you'll be sure to find many valuable options for your research. Best of all, you'll get a full size products, not just samples, so you'll have enough to really experiment with anyone can join. You don't need to be a purchaser, so check it out at ThermoFisher. Com aspiredna to cash in those 500 bonus points. Again, that's ThermoFisher com. Aspiredna for 500 bonus points, see the show notes for terms and conditions and that link. Do you have patients with primary mitochondrial myopathy? There's a new clinical study looking for people with PM to enroll people with primary mitochondrial myopathy can experience muscle weakness or exercise intolerance this study is assessing the efficacy and safety of a drug to help patients walk further by improving their muscle function. Find out about the study for primary mitochondrial myopathy and how your patients can participate by going to Pmmstudy.com. The link is also available in the Show notes and at Dnapodcast. Com. Part of the genetic testing that you did was not right away when you were diagnosed but it was a couple of years later, right. Of your first round of genetic testing. What were you offered at that time in terms of genetic testing? Well, do you know what actually that's kind of part of my fundamental part in my story of breast cancer, because when I was diagnosed, I was 36 years old. According to the National Cancer Guidelines, any patient who is diagnosed before 50 is candidate for genetic testing. I was only 36 years old. I was living in Mexico City, and unfortunately, nobody recommended me any genetic testing. When I was diagnosed, it was until again, as I was listing the four critical stages for cancer survival. So I got diagnosed, I received the treatment, and then it was until the end, when I was kind of wondering, what are my chances of recording is that I learn about genetic testing, and that obviously I needed to know what was my genetic makeup in order to identify what was the risk for future cancers. So Unfortunately, I couldn't really get genetic testing anywhere in Mexico when I was diagnosed because genetic testing didn't exist. There was only kind of some labs that were doing genetic testing for research purposes, but not really for providing clinical guidance to healthcare professionals for risk assessment. So that was kind of unfortunate. Yes. And you bring up a good point of other areas of the world, genetic testing isn't always readily available. I practice in the US, so I have more of that perspective. But I think it's important to realize that everywhere is going to be a little bit different, especially we're talking about ten years ago. So just where genetic testing was ten years ago is a long time in genetics. But you also got further genetic testing later on. So when did that happen? So my genetic testing, actually, I got broken gene sequences. I think that it was in 2011, and that was kind of a courtesy of a collaborator. So when I got diagnosed and given that I was working myself in this biotech company, really pushing for genomics, enjoying genomics and all the change of paradigm that genomics was bringing into the clinical space. So that was for me, an opportunity to make something to make an impact. So I decided that okay. In my personal story, in my personal case, I decided to get a double mastectomy. And I think my doctor also recommended eventually, double mastectomy because there were some signs of other lumps in my second breast. But for me, I was fine. So I was thinking that I was getting rid of all the additional susceptibility for getting a second cancer. But you know what? Again, I think that my position was critical, knowing that I knew as a patient that genetic testing was important and that it could save other patients having a second recurrence of cancer, breast cancer or ovarian cancer. So I decided to make a change. And I traveled at the end of my chemotherapy. I travel it to Orlando to attend a CF for first time. So my goal was to identify who was doing genetic testing and invite the person to do an awareness campaign about genetic testing. So that person was Dr. Jeffrey Weiker from City of Hope. During that time, he was the director of the Cancer Genomics Center. And he did a super wonderful work on really well helping to create awareness around genetic testing and also create in bridges between different labs in Mexico and his lab in a city of hobby in order to enable genetic testing in Latin America. So that was a key. And as part of that collaboration is that I got genetic testing. Interesting. It was really wonderful at the end, but I didn't get it until kind of one year or two years after my diagnosis. My genetic testing for BRCA one and two came back negative, but obviously different things. Actually, many things have changed since that time right now. It's not only BRCA one and BRCA two, it is many different genes that are associated with breast cancer. Yeah. You bring a good point that it used to be with breast cancer. We would only test for those two genes, BRCA one and two. But now, if we're looking at patients listening to this and they're saying, Well, I think I do have this family history, maybe similar to yours of other people in the family having cancers, maybe early ages, similar cancers. How many genes should they be looking at on a panel to say, okay, this is a full panel. This is a good test that's really comprehensive to do. Is there a ballpark number that you would advise? I would say that the size of panels and the different providers have different contents of jeans. I would say that something that is critically important is that the jeans that are included in the panel will, at minimum, the genes that are recommended by guyline. So since a few years ago, NCCN is recommending to use now panels instead of versus one single gene. And the reason is that there are different phenotypes of breast cancer, and for those phenotypes of breast cancers, there are different syndromes associated to the development of breast cancer. So there is an overlap between some of the features in the different types of syndrome related to breast cancer. And because of that, now, NCCN guidelines and other guidelines recommend to use multigene testing versus one single gene. Again, I think that it is important that at minimum, all the genes that are recommended are included in those panels oncology that expands also to genetic testing for germline susceptibility to increase chances is changing every day. And there are everyday or frequently new genes that are added to those lists, and also the variants that are identified with increase in risk to different types of cancer, not only breast. Yeah. That's a really good point that people should be checking in to say, well, I had genetic testing years ago. It's probably changed. And maybe there's more genes that should be looked at, especially for someone in your case where had genetic testing but didn't find there to be a pathogenic variance or a change in the gene that makes the gene not work, and that protection for cancer is lower. If that gene is not working along with the variance, there can also be variants where we say, Well, we see there's a difference in the gene, but we don't know what that means. Does that make the gene not work? Does it mean that? No, it doesn't affect the gene at all. And it's just human diversity. How do we handle what we call these variants of unknown significance or vus is how do we deal with this when it comes up with data from sequencing? Well, obviously, as you expand the search of potential pathogenic variants, like one single gene to multiple genes, you get a lot of background data, background noise that could be potentially related or could be not related. So obviously, in order to confirm any Association, it is important to perform additional studies. I would say that perhaps right now we are living this case and control studies like on real time where all different variants are added into the databases. And there are studies in real time performed to identify if those are in the pathogenic or not pathogenic. I would say that for variants of certain significance, it is important. Number one, healthcare practitioners and labs don't take really any medical advice based on purely having a bus. And it is important for patients to follow up on those with their health care professionals. So usually the labs or the healthcare professionals. As soon as new evidence is added into guidelines, they look into their databases and identify patients who fall into a category where the US change from the US to pathogenic burial and they will actively contact the patients. But if not, I think that is important that patients follow up with their doctors and check if something has changed. And when we've talked about this genetic testing and sequencing, we're talking about reading the genes and saying, okay, let's read the entire genes, see if there's any spelling differences there than we expect to see. There's two main ways of sequencing. Can you go over, like the Sanger sequencing versus the next generation sequencing? Yes, of course. And that's why when I was adding that it was a very important moment in 2010 because next generation sequencing was amazing and really like technology for reading things during that time in the clinical space was anger sequencing. I would say that the main difference is the amount of sequencing data that you are generating for that I want to actually use the example of BRCA one and two. So during 2010, when I knew that I was not going to be able to get my gene sequencer in Mexico, I was thinking, oh, I work in less technologies. I have access to sequencers. I have access to reagents. I have access. I know I have a protocol. I can do it myself, but obviously there was this pressure of time. And obviously I was not really allowed or I didn't have the time to do that because basically in 2010 to do the sequencing of BRCA one and two. So the genes have large genes. So in total. So we are talking about two genes. But we are talking about 50 axons that basically to analyze all those excellence for the two genes. During that time, it was needed to do 80 PCRs and then to sequence those AP single PCR reactions forward and reverse with anchor sequencing. So at the end, it was 160 sequencing reactions. And in total, like, turnaround time. That will take, like from four weeks to eight weeks, depending, like what sequencers you have one single capillar or 96 capillar. So obviously it would be faster. But it was kind of the time to turn around time to sequence two genes. Ngs, as I said, was emerging during that time. Ngs was used only, like for research project. But I kind of saw. Okay, at one day this is going to be done with next generation sequencing. And right now it's really impressive because you can do not only BRCA one and two, but you can add, like, 50 more genes in order to interrogate for other genes that are associated to cancer syndrome. And you can do all of that in 6 hours. Like the library prep you sequence overnight, and next day you have all the results. So as you are sequencing massively, a large amount of data DNA, whether it is multiple samples or multiple genes for fewer samples. So it's really kind of the capacity of doing massively amount of sequencing simultaneously in parallel. The turnaround time is just crazy. I mean, you're talking about weeks compared to just like one day overnight to be able to do this testing. I mean, that's just remarkable. Exactly. Yeah. It's just amazing how fast this technology changes. And if we're comparing sequencing to genotyping, how is sequencing superior to genotyping? Because now most testing is doing sequencing. Genotyping isn't happening as much anymore. That is correct. I will say that if we refer to genotyping as only interrogating specific positions in the genes or in the genome. So obviously it has limited discovery power because you are just limited to interrogate those positions based on the information that has been published about those positions. Whereas with next generation sequencing, if you are doing sequencing, you are interrogating that position. But you are interrogating every single position in the gym, which means that you have the discovery power to identify other variations polymorphins between different individuals. So right now, that's kind of the right approach to do sequencing, because again, cancer is so variable is mutating all the time. And also, there is a lot of variation in the human population that has not been fully characterized. So it's really important to use an open approach that has a discovery power to interrogate and find new variants. Yeah, it's a good point. And just going back to the vus and why those come up more now because we're sequencing, we're not just looking at the hot spots on the gene. We're looking at the entire gene saying, okay, is there any differences in this gene that we should be looking more into on the flip side with sequencing? Is there anything that is a limitation that we're not able to learn about genes with the approach of sequencing? Do you know what that's actually very interesting, because next generation sequencing has been evolved a lot and at the beginning for me, well, I have been kind of seated in the first row looking at how genetic testing has been varying from moving from Sanker sequencing to next generation sequencing with only one gene, multiple genes, but also different types of variants. Because also at the beginning, labs were using two approaches to determine the different types of DNA variants. They were using next generation sequencing to determine SMB single nucleotide variation or small insertions and deletions, and the last we're using other technologies based on fragment analysis as MLPA in order to determine copy number of specific regions, large regions of the genes, or even copy number of the whole gene. So at the beginning, kind of the old labs were doing two techniques next generation sequencing for only the small variants and MLPA for determining copper variants. So that has changed also, because right now there are newer library prep methods that can actually deliver a very good uniformity of coverage across the different genes versus PCR based technologies. So that really well, let's determine how many correlated number of reads per reading, two units of a copy number, which is really great. And also there has been an evolution in the bioinformatic tools that paired with these advances in laboratory are now enabling to determine copy number variation. Also with next generation sequencing, which is really great. Do you work in a lab? Want to receive rewards? When you order supplies? Check out Thermo Fisher Scientific Aspire program. It's a rewards program created with scientists like you and Mind. All members receive a free, full size trial product every year. Points are earned every time you use or purchase products. Rewards include sciencethemed apparel like a zip up DNA hoodie. Check it out at ThermoFisher com aspiredna today, for a limited time, you can receive 500 bonus points. Again, that's ThermoFisher com. Aspirehyphenday for 500 bonus points, see the show notes for terms and conditions and that link. Did you know you can get actionable results from polygenic risk scores? Polygenic risk scores allow health care providers to more effectively help patients lower their risk of lifethreatening common diseases. However, since this is a new application, it's easy for healthcare providers to misuse and misinterpret polygenic risk scores. That's where Alilica is key. Alilica has developed polygenic risk scores that provide risk for conditions based on established guidelines. Their software allows healthcare providers to simply upload genotyped data and receive a clinical grade polygenic risk score report. Alilica makes it clear that the percentile of a polygenic risk score is useless. Rather, it's the relative or absolute risk that matters. Alilca assesses the absolute risk and provides a lifetime or a ten year risk depending on the guideline of each disease. This leads to easier interpretation for healthcare providers and better care for patients. Learn more in our upcoming episode with Alelika in January, but if you can't wait to find out more, head over to Alelica. Com allelica empowering the next generation of clinical genomics. If you have patients with primary mitochondrialmyopathy, please let them know about a new clinical study looking for participants. Primary mitochondrialmyopathy leads to debilitating symptoms of muscle weakness and fatigue, which means there's an urgent need to find an effective treatment. That's why the study was started. It's a new clinical study to test the efficacy and safety of a drug for people with PMM. During the study, participants will be administered daily medication. The objective of the study is to see if people can walk further and complete other exercise tests better. After 24 weeks of treatment, you can connect with a patient advocate MPMM today to learn more about the study, including how your patients can participate. Also, stay tuned for a full episode of DNA today about mitochondrial disorders, including this study on February 4. To learn more about the study, you can visit pmmstudy. Com. This link is also available in the Show Notes and at Dnapodcast. Com. You can also learn more about other clinical studies for genetic disorders through no rare. Com. There are studies for sickle cell echondroplasia, cystic fibrosis and more. Again, that's norer. Com and another term that's thrown around with sequencing is like depth of coverage. What does that mean in terms of sequencing? Why is it important to look at death of coverage when looking at a test or a panel? As we've been talking about. Basically, when you are doing sequencing, you want to make sure that whatever you are reporting. If there is a variant, that variants is true and it's not a background noise. So different labs have established different kind of parameters about this signal. Usually it is considered that it is needed 100 X of coverage in order to call with good accuracy Gemline variants, but that will also vary from lab to lab and also from some of the regulatory bodies. They could have also different thresholds for detecting variants versus noise. So it all kind of depends on what that depth of coverage is. There's no real standard yet. I would say that the kind of low bar is said like at 100. And however, I know lapse that they like to prefer a higher coverage in order to have a higher rate of accuracy and reporting what they consider? That is true with a good level of accuracy. And are there other aspects that labs should be considering when deciding what type of sequencing they're using and what types of panels are there other on the more like lab side that we've been talking about, factors that should be considered when looking at testing and looking at this data. I think that it's important to consider what is the base of accuracy when it comes to the sequencing platform, when it comes to the content of the panel, where, again, you want to make sure that you have actionable jeans recommended by guidelines. At minimum, you want to make sure that the test is sensitive, that the test is sensitive and reproducible. But you also want to make sure that there is a full solution, because analyzing like that vast amount of data is not really something easy. So it is important to have secondary analysis in the value informatic side to analyze all the data and tertiary analysis in order to interpret like Alta data after secondary analysis and to get a biological interpretation of what is that you are getting from the sequencer. And another topic that I wanted to kind of go back to is when we were talking about your own genetic testing and that there's germline testing to see if what you're born with your genetics versus somatic testing of possibly variance mutations that people have acquired over time. So with cancer, like, okay, what's different about the cancer genetics compared to a person's genetics? So when we're looking at testing for this, usually when people are talking about genetic testing, they're talking about germline, they're talking about anything that's been inherited. What did they get from mom or maternal sample and their paternal or dad's sample? Do you see that? Somatic testing is expanding that this is happening much more than it used to be? Like, what are the changes that you've seen in terms of somatic testing being used in health care and used to help with, like, treatment. You said for yourself of looking at genetic testing, and that helped with one of the treatments that you had for your own breast cancer. Absolutely. And I think that's kind of one of the paradigms that has changed with the advance of next generation sequencing. So cancer is a disease of the gene. So we are basically accumulating mutations. So really, next generation sequencing is kind of the best technology to address identify what are those changes that are happening as a result of the Maline growth in the cancer cells? In that case, yes. We are talking about a second type of genome because it's not the germline genome where we look for Association to increase risk to cancer. So in this Somatic genome, we are looking at the two more cells and all those changes that are driving, like, all the cancer itself. Yeah. Absolutely. To identify all those mutations. Yeah. I can see this happening much more in the future, too, of just like everybody that it's standard that everybody that has cancer that has somatic testing done and comparing it to germline, because, as you said, for breast cancer, you could have a BRCA mutation. But that's not something you were born with. That's just isolated in the cancer, which I think is something that a lot of people don't know of. They just hear of the RCA and they think, oh, I was either born with it or not, but there's a whole other level to it in terms of the cancer, genetics there and everything, something else that I would like to add and is that unfortunately, genetic testing is not really widely adopted yet there is an opportunity in order to include populations. There are disparities, and not all the populations are really very well studied. So it is unfortunate that there are some gap access related to availability of the test. So I can tell you it's still ten years when I was not really recommended genetic testing, and I can tell you that still, like now, eleven years after that, I know that there are cases where genetic testing is not recommended in some of the developing countries, so it's really super important to work and enable access to genetic testing in those populations. So I think that we need big effort in order to make the test accessible to patients. Health care providers still increase awareness around genetic testing because it is again, super important and it will save lives and prevent other types of cancer. But it's really critical that there is awareness and there is still a lot of work to do in that there. Yeah, I agree. And I think the more healthcare providers that are aware of how important the genetic testing is. As we've talked about today, I think that's going to lead to more people offering this testing, more insurance coverage, more hospitals offering that as, oh, you can get your blood drawn here for genetic test and bring that up so that patients know that not only is it an option, but it's a really important one to be considering and could change treatment and everything. So I think you really highlighted a lot of important aspects of genetic testing and not just of, like, okay, looking at how we're doing this and which is the best, but just like, we need to have it in general. So I think that that's really important to really drive home. Exactly. And people can learn more about using sequencing to assess inherited cancer risk by visiting alumina. Com. You can learn more about the show by heading over to Dnapodcast.com and you can connect with us on Twitter, Instagram, YouTube, Facebook. The video for this episode, the video interview is available on our YouTube and any questions for us, you can send it to info at dnapodcast.com. We'd really appreciate rating review on Apple. Have you heard of the new app called Wisdom. It's a social audio app for open access to mentorship. You can talk live with experts about anything. I'll be giving my first Wisdom talk on January 5 at 05:30 p.m.. Eastern. 02:30 p.m.. Pacific you can tune in live by downloading the Wisdom app, then follow me at DNA today. That way when I go live on January 5, you'll get a notification and can jump in. Podcasts can be very one way. Whereas Wisdom allows us to actually chat back and forth and I want to answer your questions about genetics, genetic counseling, including Grad school or the podcast. So it will be a live Q and A and again I'll be live on January 5 at 05:30 p.m.. Eastern on the wizard map. Just follow me at DNA today. Can't wait to talk to you then join us next time to learn. Discover new advances in the world of genetics.
