ideasIdea
Automatic germline testing for every cancer type where it changes care
Anyone with ovarian, pancreatic, metastatic prostate or mismatch-repair-deficient cancer should be tested for inherited mutations, but many are not. Make it an automatic, opt-out lab step.
Guidelines recommend germline testing in these groups but rates are often under 50%. Propose reflex testing triggered by pathology (as reflex MMR/MSI testing already is), mainstreamed by oncologists with genetics support only for positives.
Hypothesis
Reflex opt-out testing raises germline testing to at least 90% in eligible groups and increases cascade testing of relatives proportionally.
Rationale
Reflex mismatch-repair testing succeeded, and mainstreaming trials show oncologists can consent patients.
What would test it
Health-system implementation with monthly testing-rate dashboards.
Maturity
being tested at scale
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.