Pregnancy. Marriage. A cancer diagnosis. A sick child. A family tragedy. Too often, something must happen before we start asking what our DNA might tell us.
It shouldn’t. Genetic screening and education should become a more normal and accessible part of preventive health care, available before a life event or health crisis makes the information urgent.
We already practice prevention. We check blood pressure before a stroke. We measure cholesterol before a heart attack. We ask about family history because we know what runs in a family can matter.
But what happens when we don’t know our family history or don’t know enough of it? Someone may not know a biological parent. Families may not talk about diagnoses. A relative may have died without a clear diagnosis. We may know “Grandma had cancer,” but not what kind, at what age, or whether anyone else had it. If inherited risk matters enough for us to ask about it, shouldn’t people also have greater access to understanding what their own DNA may reveal?
Real physician voices, twice a week
Free, and one click to unsubscribe.
In Nigeria, that “something” can be marriage. Health advocates have called for mandatory genotype screening before marriage to help reduce sickle cell disease. The goal is understandable: Knowing whether two people carry sickle cell trait can help them understand potential risks to their children.
But why should marriage be the moment we finally decide it is important to know? Health experts in Nigeria have raised that same concern. In reporting by Premium Times, health professionals argued that genotype education should begin much earlier through schools, adolescent health programs, and routine reproductive care. The same reporting highlighted gaps in newborn screening and access to early diagnosis.
I confronted the other side of that question during my global health fellowship in Kenya. Newborn screening for sickle cell disease is not yet universally implemented nationwide, despite national efforts to expand screening. Whether a baby is screened can still depend on where that child is born and whether testing is available. Without early identification, opportunities for awareness, preventive care, monitoring, and informed decisions can be missed long before a health crisis occurs.
In Nigeria, one debate is whether to know your genotype before marriage. In Kenya, the question can begin much earlier: What happens when we don’t even know which babies are born with the disease? Those babies grow into children and adults who may still not know. That is what stayed with me.
Different circumstances, same fundamental problem: You cannot act on information you do not have. And this is much bigger than sickle cell.
In 2026, Mayo Clinic researchers reported genome-sequencing results from 484 seemingly healthy adults. About 13 percent had a serious genetic risk they previously did not know about, including risks associated with hereditary cancers and cardiovascular conditions.
That does not mean everyone needs every genetic test. DNA is not destiny, and more information does not always mean clearer answers. Genetic testing can raise legitimate concerns about uncertainty, privacy, discrimination, cost, and anxiety. But those concerns should shape how we provide genetic information, not make us wait until a crisis to discuss it.
That shift may already be beginning. An NIH-funded Population Genomic Screening Network is studying how screening for certain actionable hereditary conditions could be incorporated into primary care. That is the direction we should be moving: making conversations about genetic risk part of prevention, education, counseling, and informed choice rather than something reserved for after disease appears.
Yet relatively few Americans have received this kind of genetic information. A recent national study found that only 8.4 percent of U.S. adults had received genetic testing for cancer risk. Among those who had not been tested, 40.7 percent were interested in testing. More than 9 in 10 of those interested said knowing their risk would affect their health care decisions.
There is also an equity question. Precision medicine promises increasingly personalized health care. But how equitable can it be if access to useful genetic information depends on income, insurance, geography, access to specialists, or simply knowing enough to ask?
Marriage should not have to make genetics relevant. Neither should pregnancy, cancer, a sick child, or a family tragedy. We should have the opportunity to know earlier, when that knowledge can still inform prevention, care, and the choices we make.
Our DNA cannot tell us our future. But knowing more about it can help us make informed choices before life makes those choices urgent.
Keelee Moseley is a health care executive.
