OnCo
ideasIdea

Universal tumour and germline sequencing at diagnosis feeding a shared learning system

Sequence every cancer at diagnosis, along with the patient's inherited genes, and pool the results with treatments and outcomes so every patient teaches the system how to treat the next.

Comprehensive genomic profiling reaches a minority of patients even in rich countries, and results rarely rejoin outcome data. Genomics England, AACR Project GENIE and national programmes in the Netherlands and Denmark show what pooled genomics plus outcomes can do. The proposal is universal whole-genome or comprehensive panel sequencing plus germline testing at diagnosis as a funded standard, with mandatory return of de-identified genomic, treatment and outcome data to a federated national learning system that publishes evidence for rare variants, drug response and hereditary risk.

Hypothesis
Within five years the learning system produces at least ten practice-changing findings not obtainable from trials (rare variant actionability, real-world resistance patterns) and increases the fraction of patients receiving matched therapy or hereditary cascade testing.
Rationale
Genomic actionability grows with the number of observed cases, and rare events only become interpretable at population scale; the marginal cost of sequencing is now small relative to treatment.
What would test it
National programme in one health system with sequencing coverage, matched therapy rates, cascade testing and time to new actionable findings 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
  • Data silos · Records, scans, genomes and outcomes sit in separate systems that cannot talk. Every patient's experience is lost to the next.
  • Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.
  • 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.

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