Genomics and Justice: A Multi-Country Distributional Cost-Effectiveness Analysis of Hereditary Breast and Ovarian Cancer Screening

Expected Outcomes and Impact:

1. Public Health Impact: HBOC (BRCA-related cancer risk) is a suitable target for population prevention. Approximately 0.2–0.3% of women carry BRCA mutations​, so population screening could identify thousands of at-risk women who would otherwise remain undiagnosed. Early identification enables prevention of numerous breast and ovarian cancers, substantially reducing disease burden in each country.
2. Clinical Impact: For individuals, a positive BRCA result unlocks effective preventive options – enhanced MRI/mammography surveillance or prophylactic surgery – that can dramatically reduce cancer incidence and mortality​. Implementing screening and follow-up will improve quality-adjusted survival for high-risk women.
3. Health Policy Impact: This study will inform whether and how to implement genomic screening at scale. If population-wide BRCA screening is found cost-effective and pro-equity, it would strongly support broad implementation (e.g. adding BRCA testing to national screening programs or insurance coverage). If it is cost-effective but inequitable (disproportionately benefiting higher-SES groups), then additional interventions – such as subsidized testing and outreach in low-income communities – will be needed to ensure genomic screening does not exacerbate disparities. In either scenario, the evidence will guide policymakers in balancing efficiency with justice in precision health.