The SG100K_Cancer and Aging Workgroup: Developing risk models for cancer associations
Main Applicant – Dr Joanne Ngeow, Lee Kong Chian School of Medicine, Nanyang Technological University (NTU)

Globally, cancer is a leading cause of death in people <70 years old with ~19.3 million new cases, and 10 million deaths in 2020 alone. In Singapore, >50% of common cancers are detected only in advanced stages, with poor uptake of current age-based cancer screening.

Early cancer detection by screening improves cancer treatment and control. Yet, due to rapidly aging populations in Asia, screening by age will add tremendous pressure on healthcare systems. Therefore, screening recommendations based solely on age and gender irrespective of ethnicity, family history, lifestyle, clinical and other biomarkers/genomic factors, is non-optimal.

Precision medicine advocates for discriminative clinical risk models. Polygenic risk scores (PRSs), which incorporate information about inherited genetic risk for cancer from common genetic variants in the population shows promise but, its robustness for cancer prediction is debatable. Other risk prediction models also suggest improvements in risk stratification when common polygenic risk burdens are jointly modelled with rare, coding defects as well as lifestyle and clinical risk factors.

We hypothesize that improved risk models for common cancers could be developed through the joint evaluation of common variant PRSs, rare coding genetic defects, established ageing biomarkers associated with cancers, lifestyle and behavioral data and clinical biomarkers.