{ "@context": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/context/doc", "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069", "id": "CG-AC:AC069", "type": "ClinicalActionabilityReport", "metadata": { "schemaLabel": "AC-Sepio.Beta-1 (Unofficial)", "contentVersionId": "29506", "producedAtUTC": "Thu, 10 Sep 2026 19:39:12 -0000", "note": "DISCLAIMER: The SEPIO-inspired schema presented here is an initial prototype for Clinical Actionability curation summaries and has not been reviewed nor finalized by the ClinGen Data Exchange Modeling Team. We expect it to differ significantly from the final schema." }, "description": "JSON-LD representation of ClinGen Actionability Stage 2 report modeled with SEPIO. The hierarchically structured document will include:\n1. Contextual & topic information, such as the **conditions/diseases** and the **genes**.\n2. Categorized **evidence narratives**, with references.\n\t* This content corresponds to the texts within the *Actionability Summary Report*\n4. **Outcome & Intervention** pairs, with **consensus scoring** in 5 dimensions:\n\t1. Outcome Severity\n\t2. Outcome Likelihood\n\t3. Intervention Effectiveness\n\t4. Nature of the Intervention\n\t5. Total (Overall) Score\n\n*( Note: The summary report does not include the **Screening Survey** which led to preparation of the actionability report. )", "condition": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/co", "id": "CG-AC:AC069/co", "type": "GeneticCondition", "label": "Lynch Syndrome", "description": "- Increased risk of colon cancer and cancers of the endometrium, ovary, stomach, small intestine, hepatobiliary tract, urinary tract, brain, and skin\n- Associated with microsatellite instability (MSI)" }, "outcome": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ou/Colorectal%20cancer", "id": "CG-AC:AC069/ou/Colorectal cancer", "type": "Outcome", "label": "Colorectal cancer" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ou/Endometrial%20Cancer", "id": "CG-AC:AC069/ou/Endometrial Cancer", "type": "Outcome", "label": "Endometrial Cancer" } ], "intervention": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/intv/Surveillance", "id": "CG-AC:AC069/intv/Surveillance", "type": "Intervention", "label": "Surveillance" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/intv/Surveillance", "id": "CG-AC:AC069/intv/Surveillance", "type": "Intervention", "label": "Surveillance" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/intv/Risk%20Reducing%20Surgery", "id": "CG-AC:AC069/intv/Risk Reducing Surgery", "type": "Intervention", "label": "Risk Reducing Surgery" } ], "clinicalActionabilityProfile": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/cap", "id": "CG-AC:AC069/cap", "type": "Assertion", "assertionMethod": "The ClinGen AWG developed a standardized protocol to generate evidence-based profiles of clinical actionability of genes and associated disorders in the form of summary reports and semiquantitative metric (SQM) scores.", "releaseDate": "Wed, 28 Jun 2023 00:00:00 -0000", "releaseNum": "1.1.5" }, "evidenceStatements": { "evidenceNarratives": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/en/potgd", "id": "CG-AC:AC069/en/potgd", "type": "EvidenceNarrative", "narrative": "Currently in the US, roughly 1,154,000 people are living with CRC while 600,000 women are living with endometrial cancer. LS is the most common heritable CRC and accounts for 1-5% of all CRC cases and 2% of all endometrial cancer cases.", "evidenceDomainTag": "Nature of the Threat.Prevalence of the Genetic Disorder", "publication": [ "CG-AC:RF000106", "CG-AC:RF000107", "CG-AC:RF000325", "CG-AC:RF000017", "CG-AC:RF000109", "CG-AC:RF000110" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/en/cf", "id": "CG-AC:AC069/en/cf", "type": "EvidenceNarrative", "narrative": "LS is characterized by an increased risk of CRC and other cancers including endometrial, ovarian, and gastric. Cancers typically develop at an early age and individuals may develop multiple cancers. The majority (>90%) of LS-associated CRC tumors show microsatellite instability indicating the malfunction or loss of mismatch repair gene products.", "evidenceDomainTag": "Nature of the Threat.Clinical Features", "publication": [ "CG-AC:RF000106", "CG-AC:RF000107", "CG-AC:RF000325", "CG-AC:RF000109", "CG-AC:RF000110", "CG-AC:RF000111", "CG-AC:RF000112" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/en/nh", "id": "CG-AC:AC069/en/nh", "type": "EvidenceNarrative", "narrative": "The average age at diagnosis is 44-61 years for CRC, 48-62 years for endometrial cancer, 42 years for ovarian cancer, and later for other LS-associated cancers. The most common LS-associated cancer is CRC, which is not associated with polyposis and typically arises from a single colorectal lesion, advances more rapidly from adenoma to carcinoma than sporadic CRC, and is most common on the right side of the colon. The lifetime risk of cancer varies with the gene mutated and sex, with males having a higher risk of developing CRC compared to females. Recurrence of CRC is common. However, patients with LS-associated CRC and endometrial cancer have improved survival compared to patients with sporadic tumors.", "evidenceDomainTag": "Nature of the Threat.Natural History", "publication": [ "CG-AC:RF000107", "CG-AC:RF000325", "CG-AC:RF000110", "CG-AC:RF000111", "CG-AC:RF000112" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/en/ACMI2789", "id": "CG-AC:AC069/en/ACMI2789", "type": "EvidenceNarrative", "narrative": "Autosomal Dominant", "evidenceDomainTag": "Threat Materialization Chances.Modes of Inheritance" } ], "tieredEvidenceNarratives": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ten/NOI2963", "id": "CG-AC:AC069/ten/NOI2963", "type": "TieredEvidenceNarrative", "narrative": "Endoscopic surveillance can be burdensome for individuals. (Tier 2)\\nIn addition, colonoscopy is associated with risks, including pain, nausea, bleeding, perforation, and death. (Tier 3)", "evidenceDomainTag": "Acceptability of Intervention.Natures of Intervention", "publication": [ "CG-AC:RF000106", "CG-AC:RF000111" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ten/PGM2929", "id": "CG-AC:AC069/ten/PGM2929", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "3", "narrative": "LS has an estimated prevalence of 1/440 in the general population.", "evidenceDomainTag": "Threat Materialization Chances.Prevalences of the Genetic Mutation", "publication": [ "CG-AC:RF000325" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ten/EN3014", "id": "CG-AC:AC069/ten/EN3014", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "Not provided", "narrative": "Information in variable expressivity was not available.", "evidenceDomainTag": "Threat Materialization Chances.Expressivity Notes" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ten/ACPE4404", "id": "CG-AC:AC069/ten/ACPE4404", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "3", "narrative": "Cumulative risks of cancer in LS by age 70: colorectal =25-70% , endometrial =30-70%, gastric=1-9%, small bowel=1-4%, biliary tract=1-2%, pancreas=1-4%, urinary tract =2-8%, upper urinary tract=6%, bladder=2-16%, ovarian=6-14%, brain =3.5%, prostate=9-30%, breast=5-14%. Risk may vary by MMR gene. Carriers of EPCAM deletions have a similar risk of CRC but a lower risk of endometrial cancer (12% by age 70).", "evidenceDomainTag": "Threat Materialization Chances.Penetrances", "publication": [ "CG-AC:RF000109" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ten/REC2152", "id": "CG-AC:AC069/ten/REC2152", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "3", "narrative": "By definition, cases of Lynch Syndrome are due to a defect in one of the mismatch repair genes.", "evidenceDomainTag": "Threat Materialization Chances.Prevalences of the Genetic Mutation", "publication": [ "CG-AC:RF000107" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ten/RR2724", "id": "CG-AC:AC069/ten/RR2724", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "1", "narrative": "Males have a roughly 2.1- to 2.3-fold risk of prostate cancer.", "evidenceDomainTag": "Threat Materialization Chances.Relative Risks", "publication": [ "CG-AC:RF000116" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/ten/CDEC2982", "id": "CG-AC:AC069/ten/CDEC2982", "type": "TieredEvidenceNarrative", "evidenceSourceTier": "4", "narrative": "LS-associated CRC has a lower average age of onset and advances at a more rapid rate compared to sporadic CRC and an increased risk of endometrial cancer, making it likely that these patients would escape detection using surveillance recommendations for average risk populations as screening for CRC is recommended in older populations and endometrial cancer screening is not recommended for the general population at all.", "evidenceDomainTag": "Condition Escape Detection.Chances to Escape Clinical Detection", "publication": [ "CG-AC:RF000111" ] } ], "tieredRecommendations": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACPM6272", "id": "CG-AC:AC069/tr/ACPM6272", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "Health professionals should be aware of potential psychosocial problems associated with genetic testing and surveillance, and patients experiencing psychological distress should be offered referral to a clinical psychologist.", "evidenceDomainTag": "Effectiveness of Intervention.Patient Managements", "publication": [ "CG-AC:RF000109" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACPM6275", "id": "CG-AC:AC069/tr/ACPM6275", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "Regular aspirin significantly reduces LS cancer incidence. Evidence from a randomized controlled trial indicated regular aspirin reduced the incidence of CRC and other LS-associated cancers by 60%.", "evidenceDomainTag": "Effectiveness of Intervention.Patient Managements", "publication": [ "CG-AC:RF000107", "CG-AC:RF000109", "CG-AC:RF000110", "CG-AC:RF000099" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACPM6274", "id": "CG-AC:AC069/tr/ACPM6274", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "Prophylactic hysterectomy and salpingo-oophorectomy have been shown to reduce the risk to develop endometrial and ovarian cancer associated with LS, and should be discussed as an option to mutation carriers once child-bearing is complete and after age 35-40. A retrospective study showed an absence of gynecological cancers among women who underwent prophylactic hysterectomy and/or bilateral salpingo-oophorectomy, compared to 33% and 5% incidence of endometrial and ovarian cancer, respectively, among women who did not have surgery.", "evidenceDomainTag": "Effectiveness of Intervention.Patient Managements", "publication": [ "CG-AC:RF000107", "CG-AC:RF000109", "CG-AC:RF000110", "CG-AC:RF000111", "CG-AC:RF000112", "CG-AC:RF000113" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACPM6273", "id": "CG-AC:AC069/tr/ACPM6273", "type": "TieredRecommendation", "evidenceSourceTier": "Not provided", "recommendation": "The American College of Medical Genetics and Genomics (ACMG) has developed ACT sheets to help clinical decision-making when one or more pathogenic variants in LS genes are identified as secondary findings and for people with a family history of colon cancer: \nSecondary Findings ACT sheet: https://www.acmg.net/PDFLibrary/Lynch-Syndrome.pdf\nFamily History ACT Sheet: https://www.acmg.net/PDFLibrary/Colon-Cancer.pdf", "evidenceDomainTag": "Effectiveness of Intervention.Patient Managements" }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACSU3919", "id": "CG-AC:AC069/tr/ACSU3919", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "To screen for cancers of the urinary tract, individuals with LS should undergo urinalysis on an annual basis beginning at age 25-35 years.", "evidenceDomainTag": "Effectiveness of Intervention.Surveillances", "publication": [ "CG-AC:RF000110", "CG-AC:RF000112" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACSU3916", "id": "CG-AC:AC069/tr/ACSU3916", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "Individuals with LS should undergo esophagogastroduodenoscopy to screen for gastric cancer, though the age to start screening and the frequencies varies across recommendations, from age 30-25 to age 50 and from twice a year to every 2-3 years, respectively. However, there was no evidence provided that this surveillance reduces mortality.", "evidenceDomainTag": "Effectiveness of Intervention.Surveillances", "publication": [ "CG-AC:RF000110", "CG-AC:RF000112", "CG-AC:RF000023", "CG-AC:RF000115" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACSU3917", "id": "CG-AC:AC069/tr/ACSU3917", "type": "TieredRecommendation", "evidenceSourceTier": "1", "recommendation": "Transvaginal ultrasound with endometrial biopsy may detect cancers and premalignant lesions of the endometrium, though interval endometrial carcinomas still occur and no subsequent improvement in survival has been demonstrated.", "evidenceDomainTag": "Effectiveness of Intervention.Surveillances", "publication": [ "CG-AC:RF000111" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACSU3918", "id": "CG-AC:AC069/tr/ACSU3918", "type": "TieredRecommendation", "evidenceSourceTier": "1", "recommendation": "Regular colonoscopic surveillance has been shown to lead to significant reduction of LS CRC incidence, detection of CRC cases at an earlier stage, and reduction in CRC-associated mortality. Individuals with LS should undergo colonoscopy every 1-3 years starting at age 20-25 years. Five out of six studies found a significantly reduced incidence rate of CRC with surveillance (OR estimates ranged from 0.11 to 0.35), while the sixth study reporting an OR of 0.93 was not significant. Two out of four studies have shown a significant reduction in CRC-related mortality with surveillance (OR estimates range from 0.04 to 0.17), while three of the four studies reported no mortality in the study arm with surveillance.", "evidenceDomainTag": "Effectiveness of Intervention.Surveillances", "publication": [ "CG-AC:RF000111", "CG-AC:RF000114" ] }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/tr/ACCA3622", "id": "CG-AC:AC069/tr/ACCA3622", "type": "TieredRecommendation", "evidenceSourceTier": "2", "recommendation": "Smoking and high BMI are associated with an increased risk of adenomas and CRC in LS, thus patients are advised to stay within the normal weight range and refrain from cigarette smoking.", "evidenceDomainTag": "Effectiveness of Intervention.Circumstances to Avoid", "publication": [ "CG-AC:RF000109" ] } ] }, "evidenceCategory": { "outcomeEvidenceItem": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei", "id": "CG-AC:AC069/oei", "type": "EvidenceItem", "natureOfTheThreat": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/nott", "id": "CG-AC:AC069/oei/nott", "type": "EvidenceLine", "prevalenceOfTheGeneticDisorder": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/pgd", "id": "CG-AC:AC069/oei/pgd", "type": "EvidenceItem", "keyText": "Unknown", "sourceOfPopulation": "Other", "evidenceNarrative": { "@id": "CG-AC:AC069/en/potgd" } }, "clinicalFeatures": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/cf", "id": "CG-AC:AC069/oei/cf", "type": "EvidenceItem", "evidenceNarrative": { "@id": "CG-AC:AC069/en/cf" } }, "naturalHistory": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/nh", "id": "CG-AC:AC069/oei/nh", "type": "EvidenceItem", "evidenceNarrative": { "@id": "CG-AC:AC069/en/nh" } } }, "threatMaterializationChances": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/tmc", "id": "CG-AC:AC069/oei/tmc", "type": "EvidenceLine", "modeOfInheritance": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/moi", "id": "CG-AC:AC069/oei/moi", "type": "EvidenceItem", "keyText": "Autosomal Dominant", "evidenceNarrative": { "@id": "CG-AC:AC069/en/ACMI2789" } }, "prevalenceOfTheGeneticMutation": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/pgm", "id": "CG-AC:AC069/oei/pgm", "type": "EvidenceItem", "keyText": "1-2 in 500", "sourceOfPopulation": "Other", "tieredEvidenceNarrative": { "@id": "CG-AC:AC069/ten/REC2152" } }, "penetrance": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/pe/ACPE4404", "id": "CG-AC:AC069/oei/pe/ACPE4404", "type": "EvidenceItem", "keyText": ">= 40 %", "tieredEvidenceNarrative": { "@id": "CG-AC:AC069/ten/ACPE4404" } } ], "relativeRisk": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/rr/RR2724", "id": "CG-AC:AC069/oei/rr/RR2724", "type": "EvidenceItem", "keyText": "2-3", "tieredEvidenceNarrative": { "@id": "CG-AC:AC069/ten/RR2724" } } ], "expressivity": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/oei/ex/EN3014", "id": "CG-AC:AC069/oei/ex/EN3014", "type": "EvidenceItem", "tieredEvidenceNarrative": { "@id": "CG-AC:AC069/ten/EN3014" } } ] } }, "interventionEvidenceItem": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei", "id": "CG-AC:AC069/iei", "type": "EvidenceItem", "acceptabilityOfIntervention": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/aoi", "id": "CG-AC:AC069/iei/aoi", "type": "EvidenceLine", "natureOfIntervention": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/noi/NOI2963", "id": "CG-AC:AC069/iei/noi/NOI2963", "type": "EvidenceItem", "tieredEvidenceNarrative": { "@id": "CG-AC:AC069/ten/NOI2963" } } ] }, "effectivenessOfIntervention": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/eoi", "id": "CG-AC:AC069/iei/eoi", "type": "EvidenceLine", "patientManagement": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/pm/ACPM6273", "id": "CG-AC:AC069/iei/pm/ACPM6273", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACPM6273" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/pm/ACPM6274", "id": "CG-AC:AC069/iei/pm/ACPM6274", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACPM6274" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/pm/ACPM6275", "id": "CG-AC:AC069/iei/pm/ACPM6275", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACPM6275" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/pm/ACPM6272", "id": "CG-AC:AC069/iei/pm/ACPM6272", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACPM6272" } } ], "circumstanceToAvoid": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/cta/ACCA3622", "id": "CG-AC:AC069/iei/cta/ACCA3622", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACCA3622" } } ], "surveillance": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/su/ACSU3918", "id": "CG-AC:AC069/iei/su/ACSU3918", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACSU3918" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/su/ACSU3917", "id": "CG-AC:AC069/iei/su/ACSU3917", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACSU3917" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/su/ACSU3916", "id": "CG-AC:AC069/iei/su/ACSU3916", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACSU3916" } }, { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/su/ACSU3919", "id": "CG-AC:AC069/iei/su/ACSU3919", "type": "EvidenceItem", "tieredRecommendation": { "@id": "CG-AC:AC069/tr/ACSU3919" } } ] }, "conditionEscapeDetection": { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/ced", "id": "CG-AC:AC069/iei/ced", "type": "EvidenceLine", "chanceToEscapeDetection": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/AC069/iei/cted/CDEC2982", "id": "CG-AC:AC069/iei/cted/CDEC2982", "type": "EvidenceItem", "tieredEvidenceNarrative": { "@id": "CG-AC:AC069/ten/CDEC2982" } } ] } } }, "references": [ { "@id": "https://actionability.clinicalgenome.org/ac/Adult/api/sepio/doc/RF000017", "id": 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