OnCo
ideasIdea

Use a polygenic risk score to set when screening starts

Common gene variants shift a person's cancer risk several-fold. A one-time genetic score could tell each person when to start breast, bowel or prostate screening.

Polygenic scores reclassify risk for breast, prostate, and colorectal cancer, and BARCODE1 showed PRS-selected prostate screening finds clinically significant disease. Propose national programmes assigning screening start age by PRS plus family history, with a pragmatic trial comparing PRS-tailored to age-based invitation.

Hypothesis
PRS-tailored start ages detect the same number of cancers with at least 15% fewer screening tests and earlier detection in the top PRS decile.
Rationale
Risk in the top polygenic decile at 40 roughly equals population risk at 50; screening efficiency scales with risk.
What would test it
Embedded trial in a national programme with PRS returned through an Our Future Health-style cohort.
Maturity
early clinical
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
6
Bottlenecks it attacks

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