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The International Journal of the Royal Society of Thailand
Volume XI - 2019

prophylactic surgery can also be recommended. When these cancers are detected
at the earlier state, life expectancy can be extended for these cancer patients.
The better survival rate based on earlier cancer detection, are likely cost-effective

health interventions. Since the mutation rates are usually lower than 1%,
applying the advance screening technology in these number of populations
are likely a cost-effective strategy. The opening of advance technology service
platform in the health system also enable the health service system development.
The screening services development and implementation is the opportunity for
health service delivery development, especially for the aging populations.

Excellent in management shall by applied to deliver the seamless
integration of genomics medicine from primary care to tertiary care. Family
health history (FHH) is new tool for screening family at risk for familial cancer,
the FHH collection process is usually time-consuming steps for routine clinical
services, but this can be introduced widely due to the primary care cluster
established in Thailand from 2017. This personalized screening program not
only vital for cancers prevention in this family. The next generation sequencing
technology is enabled the liquid biopsy, potentially identify tumors and types
of tumors even before the clinically detectable stage of cancer. Two of the
interventions that ready for clinical implementation such as 1) Screening
program for hereditary breast and ovarian cancer to detect BRCA1/BRCA2
mutations (King et al., 2003) 2) Screening program for hereditary nonpolyposis
colorectal cancer or Lynch syndrome to detect mutations in MLH1, MSH2, MSH6,
PMS2 (Giardiello et al., 2014).

In near future, when the sequencing cost reduced further, it is possible
to provide screening for larger groups at risk, this mean that the screening
program can included other high-risk populations, and eventually accessible

to all population.
For cancers that caused by oncovirus infection, detection of virus is the
risk stratification to identify high risk groups for cancer, one prominent example
is HPV DNA testing in samples from urogenital tract, that identify patients with
high risk HPV genotype infection. Further investigation can be offered to those
with high risk HPV genotype infection, so that cervical cancer will be detected

at the early stage. The HPV DNA test is a better screening test because of its
better sensitivity, when compared with conventional cytology-based test such as
“Pap smear”, that looking for abnormal cells from cervix area. Due to the higher

92 Precision Medicine: Preventive aspect

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