8:14
5G
CaseNex · admit
case-001 intake · MSMC Miami Beach · ER → Floor
45F
Patient
Bi-BR T2N1
Presentation
<0.2%
Caribbean + Sephardic gap
Patient brief · case-001 · admit packet★ ADMIT
PMHx
45F · mixed Caribbean (Trinidadian) + Sephardic ancestry Bilateral breast masses on self-exam · 4cm R + 2.5cm L · presents to ER · admitted to floor · BMI 24.8
T+0
FHx
Mother d. ovarian ca age 52 · maternal aunt breast ca age 38 · maternal grandmother breast ca age 41 3-generation pedigree confirms autosomal dominant pattern · genetics consult ordered · daughter age 22 at-risk
FH+
DX
Imaging: bilateral BIRADS-5 · core-needle bx pending USS R: 4.2cm irregular hypoechoic · USS L: 2.5cm spiculated · MRI ordered for staging · CA-125 elevated 87 U/mL
BIRADS-5
RX
Initial orders: Illumina TruSight Hereditary Cancer panel · referral to Onc + GenCounseling Cascade-screening protocol opened for daughter · PARP-i candidacy pending variant call · CMI initial $0 copay (Florida Blue HMO)
ORDERED
GAP
Caribbean + Sephardic admixture cohort: <0.2% in BRCA1/2 trial cohorts Hadley Lab "Sparse Matrix" paper · medRxiv 2026-05-05 · Allana et al. · case-001 fills the gap on publish
UNDER
LLAUDE0.1.0(2)
S
Sarah · PGY-2
45F bilateral breast, Caribbean ancestry, strong family hx — any precedent?
L
LAUDE
Pulling three published cases. Closest match: case-001 (BRCA1 c.5266dupC, 45F bilateral, Caribbean ancestry) — peer-signed by @adrienne + @anil, evidence tier 1A.
S
Sarah · PGY-2
what's the cohort coverage on this variant?
L
LAUDE
3 Caribbean + Sephardic carriers documented in 14 months. You're about to be the 4th. The Sparse Matrix paper says <0.2% representation in BRCA1/2 trials — CaseNex is the operational answer.
Order the Illumina TruSight panel?
C
A 45-year-old Caribbean + Sephardic woman presents with bilateral breast masses.
Family history of early ovarian + breast cancer. She belongs to a cohort with <0.2% representation in BRCA1/2 trials. case-001 is about to be authored on her admission.
SLIDE ?? / ??
Resident · PGY-2 · 8:14am · MSMC Floor

case-001 walks in.
Caribbean. Bilateral. Underrepresented.

01
Real patient, real variant, real cohort gap
45F Caribbean + Sephardic admixture · BRCA1 c.5266dupC founder variant · <0.2% representation in published BRCA1/2 trial cohorts.
02
LAUDE finds precedent in seconds
Sarah types one line. LAUDE pivots to case-001 (peer-signed by @adrienne + @anil), surfaces ACMG criteria, flags the Caribbean cohort coverage gap.
03
CaseNex is the operational answer to the paper
Hadley Lab "Sparse Matrix" paper (medRxiv 2026-05-05) showed ≥40% under-representation. CaseNex bundles the patients who don't exist in published cohorts — until you publish them.
04
The case walks the whole system
Same case-001 reaches Marcus (MS3), Adrienne (FACMG), Anil (PM attending), the OncoNex tumor board, the Caribbean cascade. One artifact, five tiers.
CANONIC Nexus
case-001 · BRCA1 c.5266dupC · 45F Caribbean + Sephardic · MSMC Miami Beach
LEDGER · CASE_PUBLISHED · CASENEX_CASE_UTILITY_SIGNAL