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

Source: https://onco.cc/ideas/idea-moon-universal-sequencing-learning-system/  
OnCo record `idea-moon-universal-sequencing-learning-system` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: 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
- Actor: policy

## Sources

- AACR Project GENIE: https://www.aacr.org/professionals/research/aacr-project-genie/
- Genomics England: https://www.genomicsengland.co.uk/

## Connected records

- technologies: [Comprehensive genomic profiling](https://onco.cc/technologies/cgp/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [Whole-exome & whole-genome sequencing](https://onco.cc/technologies/wes-wgs/)
- institutions: [American Association for Cancer Research (AACR)](https://onco.cc/institutions/aacr/)
- terms: [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/), [Real-world evidence](https://onco.cc/terms/real-world-evidence/)
- bottlenecks: [Data silos](https://onco.cc/bottlenecks/b-data-silos/), [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [Weak real-world evidence and registries](https://onco.cc/bottlenecks/b-real-world-evidence/)
- roadmaps: [Diagnostics roadmap: stains → gene panels → blood tests that decide treatment](https://onco.cc/roadmaps/diagnostics-roadmap/)

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