Witness Statement – 2/11/2025
Name: Jay Carlson, DO, MS
Position: Medical Director for Oncology, Clinical Chair of Mercy Research, and founding member of Mercy’s Center for Precision Medicine.
Thank you for having me here today. My name is Jay Carlson, and I’m a gynecologic oncologist with Mercy Health System in St. Louis. I oversee our Oncology services and lead research efforts. Additionally, I helped start Mercy’s Center for Precision Medicine (CPM).
Mercy is a large, community-focused health system, primarily in Missouri, but we also serve parts of Illinois, Kansas, Oklahoma, and Arkansas. We have around 5,000 healthcare providers and take care of nearly 3.6 million people, just in Missouri alone.
One of our main goals is to find patients at risk for cancer as early as possible. To achieve this, we use advanced genomic testing and artificial intelligence. The CPM plays a crucial role in this by guiding our genomic testing and implementing the latest screening technologies.
We have a program that focuses on hereditary cancer risks. Many hereditary conditions follow an autosomal dominant pattern, meaning a child has a 50% chance of inheriting a mutation from an affected parent. Some of these mutations can increase cancer risks significantly, with a lifetime risk of 40-80%. To identify who should be tested, we follow the National Comprehensive Cancer Network (NCCN) guidelines. Most insurance plans cover the testing for those who meet these criteria. For patients found to have harmful mutations, we can recommend increased surveillance or even preventive measures to lower their cancer risk. Unfortunately, many health systems do not coordinate these efforts well, leaving high-risk patients without proper care.
To improve our screening efforts, we created a website that helps patients access hereditary cancer screenings. This tool allows us to connect at-risk patients with the CPM team. We also send text messages to guide patients back to this tool. Those identified with harmful mutations receive counseling and further testing from the CPM team before returning to their primary care providers.
We have streamlined the process by integrating a vendor for genomic tests. This makes it easier for our doctors to order and follow up on results. Over the past two years, our oncologists have tripled the number of genomic tests they order, moving towards more targeted therapies instead of just standard chemotherapy.
We’ve also rolled out an early detection test for multiple types of cancer (MCED). While many of you are familiar with this test, I will focus on how we’ve implemented it. Our hospitals are near communities with higher cancer rates linked to industrial waste, so we aim to provide this valuable tool there. We also target high-risk groups like firefighters and veterans. Successful deployment required training for our providers and support from the CPM team.
We held virtual meetings to explain the science behind the MCED test. We designed easy-to-navigate websites for patients and a separate section for provider education. Additionally, we used AI to find high-risk patients and encourage them to get tested. In the last two years, this has led to approximately 3,000 provider referrals and over 9,000 patient self-referrals, with about a third moving forward with testing. For those who tested positive, we offer a same-day review to develop a diagnostic plan.
The screening tests we currently use have been around for years and are well integrated into medical practice. However, we anticipate future tests will be more complex and often involve AI and various genomic assessments. Many providers may be unfamiliar with these new tools, but the CPM team helps bridge this gap, acting as experts to support our staff. This collaborative approach could serve as a model for other health systems.
In conclusion, Mercy is dedicated to advancing how we use genomic science and AI to enhance patient screenings, accurate diagnoses, and tailored treatments. This work aims to improve the quality and value of the care we offer.
I’m open to any questions you may have.
