Public health implications from COGS and potential for risk stratification and screening : Nature Genetics : Nature Publishing Group
Focus on cancer risk
Public health implications from COGS and potential for risk stratification and screening
- Nature Genetics
- Published online
The PHG Foundation led a multidisciplinary program, which used results from COGS research identifying genetic variants associated with breast, ovarian and prostate cancers to model risk-stratified prevention for breast and prostate cancers. Implementing such strategies would require attention to the use and storage of genetic information, the development of risk assessment tools, new protocols for consent and programs of professional education and public engagement.
How can these studies be interpreted for their potential public health impact? Alongside the scientific work, the COGS program included an implementation work package (WP7) led by the Foundation for Genomics and Population Health (PHG Foundation) in Cambridge. This multidisciplinary public health–orientated group focused on how emerging findings of associations with these three hormone-related cancers could enhance disease prevention by enabling the stratification of risk and the fine-tuning of current screening programs according to risk. Self-evidently, this relies on having effective preventive interventions for these cancers. WP7 focused on secondary prevention of breast and prostate cancers by provision of a screening test that identifies early cancers and thereby reduces mortality and morbidity. The evidence for the benefits of mammography in breast cancer detection and of prostate-specific antigen (PSA) testing in prostate cancer detection is not without controversy, and there is currently no screening test for ovarian cancer. From a public health perspective, it would also be highly desirable to devise proven and acceptable primary prevention strategies aimed at reducing the risk of disease; in breast cancer, for example, all women should receive general preventive advice related to alcohol intake, exercise and obesity. Under a risk-stratified program, behavioral interventions might be more intense for those at higher risk, and other measures such as chemoprophylaxis might also be offered.