{"entity":{"id":"idea-prev-prs-screening-start-age","kind":"idea","name":"Use a polygenic risk score to set when screening starts","aka":[],"tldr":"Common gene variants shift a person's cancer risk several-fold. A one-time genetic score could tell each person when to start breast, bowel or prostate screening.","summary":"Polygenic scores reclassify risk for breast, prostate, and colorectal cancer, and BARCODE1 showed PRS-selected prostate screening finds clinically significant disease. Propose national programmes assigning screening start age by PRS plus family history, with a pragmatic trial comparing PRS-tailored to age-based invitation.","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":["prostate-roadmap","idea-prostate-metastatic-presentation-as-the-screening-endpoint"],"cancers":["breast-hr-positive","prostate","colorectal","early-onset-colorectal"],"sections":["prevention","early-detection"],"technologies":["germline-testing"],"targets":[],"drugs":[],"companies":[],"institutions":["icr-london"],"pathways":[],"terms":["polygenic-risk-score"],"trials":[],"people":[],"bottlenecks":["b-hereditary-risk","b-early-detection"],"keyPapers":["paper-childers-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"PRS-tailored start ages detect the same number of cancers with at least 15% fewer screening tests and earlier detection in the top PRS decile.","rationale":"Risk in the top polygenic decile at 40 roughly equals population risk at 50; screening efficiency scales with risk.","test":"Embedded trial in a national programme with PRS returned through an Our Future Health-style cohort.","maturity":"early-clinical","actor":"policy","cost":"large","horizonYears":6},"route":"/ideas/idea-prev-prs-screening-start-age/","neighbours":{"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"},{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"idea":[{"id":"idea-prostate-metastatic-presentation-as-the-screening-endpoint","kind":"idea","name":"Judge a prostate screening programme on metastatic presentation, not on incidence or mortality","route":"/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"early-onset-colorectal","kind":"cancer","name":"Early-onset colorectal cancer (under 50)","route":"/cancers/early-onset-colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"}],"institution":[{"id":"icr-london","kind":"institution","name":"The Institute of Cancer Research","route":"/institutions/icr-london/"}],"term":[{"id":"polygenic-risk-score","kind":"term","name":"Polygenic risk score (PRS)","route":"/terms/polygenic-risk-score/"}],"bottleneck":[{"id":"b-hereditary-risk","kind":"bottleneck","name":"Inherited risk is mostly unidentified","route":"/bottlenecks/b-hereditary-risk/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"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/"},{"id":"paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021","kind":"paper","name":"Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction","route":"/key-papers/paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021/"}]}}