Population germline screening for hereditary cancer genes with cascade testing
Most people carrying a high-risk cancer gene do not know it until someone in the family gets cancer. Offer testing to all adults so carriers can be protected before that happens.
Family-history-based testing misses about half of BRCA and Lynch carriers. Population screening pilots (Ashkenazi BRCA programmes, Geisinger MyCode, Healthy Nevada) identify carriers efficiently and studies suggest cost-effectiveness at current sequencing prices. The proposal is national population screening for a defined panel of actionable hereditary cancer genes offered to all adults at a set age, with automated cascade testing offers to relatives, standardised risk-reducing pathways (enhanced surveillance, chemoprevention, risk-reducing surgery) and long-term outcome tracking.
- Inherited risk is mostly unidentified · Most people who carry a high-risk cancer gene do not know it until they or a relative gets cancer.
- Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.
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