# Offer everyone at 30 a test for the cancer genes that matter

Source: https://onco.cc/ideas/idea-prev-population-germline-screening-at-30/  
OnCo record `idea-prev-population-germline-screening-at-30` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Most people with BRCA or Lynch mutations do not know until they get cancer. Testing everyone once for a short list of high-impact genes would find them in time to prevent it.

## Summary

Population screening for CDC Tier 1 conditions (BRCA1/2, Lynch syndrome, familial hypercholesterolaemia) has been piloted in Geisinger MyCode, the Healthy Nevada Project, and Jewish BRCA programmes, finding that most carriers would not meet family-history criteria. Propose a national programme at age 30 with tiered disclosure and linked prevention pathways.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Population screening identifies at least half of carriers who would otherwise be missed by family-history criteria, at a cost per QALY under $50,000.
- Rationale: Family-history criteria miss about half of carriers, and test costs have fallen below cost-effectiveness thresholds in UK and US modelling.
- Proposed test: Regional pilot in 100,000 people with uptake, carrier yield, and prevention uptake as endpoints.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- Healthy Nevada Project: https://healthynv.org
- Our Future Health: https://ourfuturehealth.org.uk

## 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/)
- bottlenecks: [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/)
- key papers: [PROSE consortium: preventive surgery lowers cancer and death in BRCA1 and BRCA2 carriers](https://onco.cc/key-papers/paper-brca-risk-reducing-surgery-jama-2010/)
- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/)

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