# Use a polygenic risk score to set when screening starts

Source: https://onco.cc/ideas/idea-prev-prs-screening-start-age/  
OnCo record `idea-prev-prs-screening-start-age` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: Embedded trial in a national programme with PRS returned through an Our Future Health-style cohort.
- Maturity: early-clinical
- Actor: policy

## Sources

- Bottleneck evidence (Inherited risk is mostly unidentified): Childers et al., National estimates of genetic testing in women with breast or ovarian cancer (JCO 2017): https://doi.org/10.1200/JCO.2017.73.6314

## Connected records

- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/), [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- ideas: [Judge a prostate screening programme on metastatic presentation, not on incidence or mortality](https://onco.cc/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/)
- institutions: [The Institute of Cancer Research](https://onco.cc/institutions/icr-london/)
- terms: [Polygenic risk score (PRS)](https://onco.cc/terms/polygenic-risk-score/)
- bottlenecks: [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- key papers: [National Estimates of Genetic Testing in Women With a History of Breast or Ovarian Cancer](https://onco.cc/key-papers/paper-childers-j-clin-oncol/), [Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction](https://onco.cc/key-papers/paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021/)

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