Prevent earlier, prevent better: precision medicine and public health from the first thousand days

Precision medicine is not only oncology or clinical genomics. It is also — and perhaps above all — prevention. It is the ability to intercept risks before they become disease, building personalised strategies based on each individual’s biological, environmental and social profile. This is the territory where Professor Antonella Agodi has worked for years: general and applied hygiene, molecular epidemiology, public health that uses the tools of genomics to do better what it has always done — protecting the health of all.

Who is precision medicine for?

«Precision medicine is aimed at the entire population, but with different approaches and goals. In the clinical setting, it mainly concerns patients — for example in therapeutic decision-making guided by precision biomarkers. From a public health perspective, however, it extends also to healthy individuals and to specific at-risk groups who can benefit from personalised prevention strategies built on their own biological, environmental and social profile.»

The key concept is the life course approach: precision medicine must accompany the individual throughout life, starting from what scientific research has identified as the most critical time window of all.

What are the “first thousand days” and why do they matter so much?

«These first thousand days — spanning from conception to the child’s second birthday — are critical for maintaining health not only during prenatal development and at birth, but throughout the entire life course. They shape the health potential that will unfold in the adolescent, the adult, the elderly person. Precision medicine must therefore be applied not to do more, but to do better. At the right time and for the people who benefit most from it.»

How does the HEAL project intervene concretely during this phase?

«We intercept the woman during pregnancy as soon as she attends her first check-up. Through a structured questionnaire, we collect information on her habits before and during pregnancy, her health status and her environmental exposures — everything that epidemiology refers to as the exposome, meaning the totality of exposures to which every individual is subject from conception throughout life. We also collect biological samples: maternal blood, stored for genome analysis, and — later — a cord blood sample to obtain comprehensive information on the child’s health.»

Women’s participation in these studies is, according to the group’s data, remarkably high. «Pregnancy is a moment when women are extremely open to taking part, precisely because they are aware of an offer of information and attention directed at their child’s health. A heritage of information that is important for the individual’s health development throughout life.»

From universal to stratified prevention: the BRCA example

For public health, the shift from universal medicine to precision medicine means learning to stratify risk: identifying the population subgroups that need more intensive pathways, and directing resources accordingly.

«A concrete model is the BRCA mutation, which increases the risk of breast and ovarian cancer. Today, public health offers all women a universal programme based on age group. But for higher-risk individuals — those identified by a hereditary familial cancer risk — something more is offered. A programme designed to be applied not to everyone, but to those who share that elevated risk. This is a precision concept that delivers a framework of equity, appropriateness and excellence in outcomes.»

What are the main concerns?

«An important concern involves the protection and sharing of data. Genetic information must be authorised by clear informed consent, and the governance of data management must be equally transparent. It is a real obstacle to research: one cannot assess genetic risk without the individual’s consent.»

But there is a second theme, even more central to Professor Agodi’s thinking: equity. «Genetic tests and personalised pathways must be guaranteed to all those who need them. There are inequalities that are social, linguistic, ethnic, gender-based. These issues must be addressed through outreaching, through information, through what we call health literacy. This is not a corollary: it is the foundation. Every individual is freer to make decisions the more aware and well-informed they are.»

The HEAL project and the IGEA project

Within the HEAL Italia project, Professor Agodi serves as scientific lead of Spoke 7 at the University of Catania. The aim is to identify the most effective prevention strategies that account for both the exposome and the genome. Task 4.2, developed jointly with the Istituto Superiore di Sanità, focuses on maternal exposure and health outcomes in pregnant women and their children.

The work continues with the IGEA project — Innovative Gender Medicine Approaches — established under ministerial decree 307 of 2025. «The gender-based approach integrates genomic data to identify molecular and immune signatures associated with increased oncological risk, with particular attention to the period of pregnancy. The goal is to reorganise preventive and clinical pathways in order to guarantee equitable access and improve the management of hereditary cancer risk in women of reproductive age.»

What will care look like in the future?

«The pregnant woman will be taken into care in a context where precision medicine is fully integrated into clinical practice. From the very first visit, alongside standard clinical parameters, information will be collected on nutritional profile, physical activity, environmental exposures and socioeconomic determinants. Through algorithms that integrate all this personalised information, the individual’s level of vulnerability will be defined. The care pathway — both therapeutic and preventive — will be modulated differently for high-risk cases compared to low-risk ones.»

A concrete example: «A high-risk woman might receive a home air purifier to reduce environmental exposures during pregnancy, or a smartwatch to monitor lifestyle habits and exposures more effectively. This approach maximises the preventive benefit, ensures sustainability — because prevention saves both suffering and costs — and maintains the balance between personalisation and equity: whatever is saved through appropriate targeting is reinvested in the health of those who need it most.»

What competencies will be indispensable?

«Alongside existing teams — doctors, nurses, healthcare professionals — experts with knowledge of genomics and gender medicine will be needed, capable of interpreting complex data and contextualising them in care practice. Biostatisticians, informaticians and data science specialists will be essential to integrate electronic health records, omic data and diverse sources into reliable predictive models. But equally necessary will be specific training in communicating genetic data to patients: counselling is not a competency acquired spontaneously. It requires method, to make complex concepts understandable and to build trust.»

A message to students

«I would encourage cultivating interdisciplinarity and methodological rigour. An integration between doctors, public health experts, communicators and humanists — intersectoral, not merely interdisciplinary — is pivotal for truly reaching everyone. And above all: consider equity as a criterion of scientific quality and of service. A technology is truly innovative only if it improves health without leaving anyone behind.»