WP leader: Scientific Institute of Public Health, Belgium (Marc Van den Bulcke)

Cancer control is a major public health issue. The pathology is strongly driven by genetic modifications in the genome DNA. A new era in science has emerge in the last decade, the so-called ‘genomics’ study field wherein we try to better understand health through integrating broad information on the genome with data on the impact of environmental factors such as nutrition, physical fitness but also disease. When studied at population scale this branch is generally designated as ‘Public health genomics’ (PHG).1 In addition, ‘public health genomics’ or ‘precision health’ is to be mirrored to the medical use of genomic information in personalized medicines, both fields being intimately intertwined through the very common denominator, the genome. Healthcare around the world is at a crossroads, with financial pressures undermining the sustainability of healthcare systems. It requires a shift from treatment of established disease to early diagnosis and disease prevention and relies on the need to engage citizens to take greater responsibility for their health in order to establish a more participatory healthcare model.

However, claims and counterclaims about the role that genomics might play in improving population health and patient care have been raised. On the one hand, genomics is viewed as the harbinger of a brave new world in which health care is transformed by virtue of earlier diagnosis, more effective prevention programs and more precise targeting of therapies to ever more narrowly specified diseases. On the other hand, genomic medicine is seen as promoting a vision of health care that encourages individualism rather than collectivism, creates the risk of further fragmenting the risk pooling that underpins social solidarity, and increases the scope for stigmatization and discrimination. Amid these competing visions of the advances that genomic science might entail, there is a critical need for an appropriate policy response.

Here, we wish to develop practical guidance for member states on four important aspects in successful integrating genomics in the health care system:

  1. As it is imperative that the population is actively supporting this paradigm shift in healthcare, a societal debate on ethical, legal and privacy issues on the use of genome information in healthcare is needed
  2. While considered as a promising future development, stratified screening by genetic testing of high-risk cancer patients requires evidence-based decisions and strict regulation of any enrolled initiative
  3. Implementing precision genomics in medical care may have profound impact on health professionals work experience, on data registration management systems and national healthcare budgets if not introduced in a carefully planned stepwise approach,
  4. It is necessary to jointly develop a strategy how to deal with ‘Direct to Consumer’ testing within the healthcare system
  5. Education and training on genomics of health professionals, policy makers and the citizens is a key element to full success of this new paradigm in healthcare