# Let clinics contact relatives directly when a cancer gene is found

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

## TL;DR

When someone tests positive for a BRCA or Lynch mutation, relatives are told only if the patient passes the message on. Most do not. Letting clinics contact relatives directly, with consent, could double testing.

## Summary

Cascade testing uptake is 20-40%. Trials of health-system-initiated direct contact (with proband consent) in the Netherlands and Australia show higher uptake. Propose direct contact as the default, with digital family letters, telegenetic counselling, and free mail-in testing for relatives regardless of their insurer.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Direct contact doubles cascade testing uptake in first-degree relatives within 12 months.
- Rationale: The proband-mediated model fails because of family dynamics and low health literacy; direct contact is standard in other public health settings such as contact tracing.
- Proposed test: RCT of direct versus proband-mediated contact across five genetics services.
- Maturity: early-clinical
- Actor: clinic

## 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

- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/)
- targets: [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/)
- terms: [Germline vs somatic mutations](https://onco.cc/terms/germline-vs-somatic/)
- bottlenecks: [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/)
- 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/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/)

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