{"entity":{"id":"idea-prev-cascade-direct-contact-relatives","kind":"idea","name":"Let clinics contact relatives directly when a cancer gene is found","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Inherited risk is mostly unidentified): Childers et al., National estimates of genetic testing in women with breast or ovarian cancer (JCO 2017)","url":"https://doi.org/10.1200/JCO.2017.73.6314"}],"tags":[],"related":[],"cancers":[],"sections":["prevention"],"technologies":["germline-testing"],"targets":["brca"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["germline-vs-somatic"],"trials":[],"people":[],"bottlenecks":["b-hereditary-risk"],"keyPapers":["paper-childers-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"RCT of direct versus proband-mediated contact across five genetics services.","maturity":"early-clinical","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-prev-cascade-direct-contact-relatives/","neighbours":{"section":[{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"}],"target":[{"id":"brca","kind":"target","name":"BRCA1 / BRCA2 (HRD)","route":"/targets/brca/"}],"term":[{"id":"germline-vs-somatic","kind":"term","name":"Germline vs somatic mutations","route":"/terms/germline-vs-somatic/"}],"bottleneck":[{"id":"b-hereditary-risk","kind":"bottleneck","name":"Inherited risk is mostly unidentified","route":"/bottlenecks/b-hereditary-risk/"}],"paper":[{"id":"paper-childers-j-clin-oncol","kind":"paper","name":"National Estimates of Genetic Testing in Women With a History of Breast or Ovarian Cancer","route":"/key-papers/paper-childers-j-clin-oncol/"}],"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"}]}}