ideasIdea
Let clinics contact relatives directly when a cancer gene is found
When someone tests positive for a BRCA or Lynch mutation, relatives are told only if the patient passes the message on. Most do not. Letting clinics contact relatives directly, with consent, could double testing.
Cascade testing uptake is 20-40%. Trials of health-system-initiated direct contact (with proband consent) in the Netherlands and Australia show higher uptake. Propose direct contact as the default, with digital family letters, telegenetic counselling, and free mail-in testing for relatives regardless of their insurer.
Hypothesis
Direct contact doubles cascade testing uptake in first-degree relatives within 12 months.
Rationale
The proband-mediated model fails because of family dynamics and low health literacy; direct contact is standard in other public health settings such as contact tracing.
What would test it
RCT of direct versus proband-mediated contact across five genetics services.
Maturity
early clinical
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- 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.