OnCo
ideasIdea

Offer everyone at 30 a test for the cancer genes that matter

Most people with BRCA or Lynch mutations do not know until they get cancer. Testing everyone once for a short list of high-impact genes would find them in time to prevent it.

Population screening for CDC Tier 1 conditions (BRCA1/2, Lynch syndrome, familial hypercholesterolaemia) has been piloted in Geisinger MyCode, the Healthy Nevada Project, and Jewish BRCA programmes, finding that most carriers would not meet family-history criteria. Propose a national programme at age 30 with tiered disclosure and linked prevention pathways.

Hypothesis
Population screening identifies at least half of carriers who would otherwise be missed by family-history criteria, at a cost per QALY under $50,000.
Rationale
Family-history criteria miss about half of carriers, and test costs have fallen below cost-effectiveness thresholds in UK and US modelling.
What would test it
Regional pilot in 100,000 people with uptake, carrier yield, and prevention uptake as endpoints.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks

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