ONCO: A Tumor Board Without Borders
Dexter Hadley, MD/PhD (Penn) · CANONIC Foundation
title: ONCO: A Tumor Board Without Borders date: 2026-05-12 author: Dexter Hadley, MD/PhD (Penn) · CANONIC Foundation tags: [nex, abopm, onconex, oncology, tumor-board, caribbean-governance] scope: BLOGS _generated: true generator: gen-nex-fleet-doc (do_not_edit) — _generated by gen-nex-fleet-doc
Cancer-care discussion that does not stop at the hospital door. A breast-cancer staging debate begins in San Francisco at seven in the morning. By eleven, an oncologist in Trinidad has joined. Before lunch, a fellow in Madrid is in the thread. The case at the centre of the debate is a 38-year-old woman with HER2-low disease and a BRCA1 variant whose interpretation is still being worked out by the team that handles her care. The obvious reading is that a tumor board belongs to one hospital, one oncology service, one credentialing track. The working reading is that the cases worth the most discussion cross institutions, time zones, and credentialing boundaries — and the only board that can hold that discussion is one without borders.
What the App Is
This is ONCO, a tumor board built around the same principles as a hospital tumor board — but unbounded by which hospital. Threads are organised by cancer type, stage, biomarker, and trial eligibility. Oncologists, pathologists, and genetic counsellors post the cases. The same patient-identity protection that governs CASE governs ONCO; every case discussed has had identifiers removed.
What makes ONCO new is not that it lets clinicians talk across institutions. What makes it new is that it lets the talk be anchored. When a thread references a variant, the matching interpretation can be pulled in from OMICS without leaving the conversation. When a thread references a flashcard, the matching ANKI card is one tap away. When the talk converges on a published case, that case lives in CASE with its faculty signatures intact.
It is the difference between a corridor conversation and a corridor conversation that leaves a citable trail.
ANKI, CASE, ONCO, and OMICS are the four apps a candidate uses to prepare for board certification in precision medicine. The figure is rebuilt from the same source files that drive the apps themselves.
Who Built It
Practising oncologists, pathologists, and genetic counsellors post the threads. Credentialing is checked against board status and institutional affiliation. Centres in the United States, Spain, and the Caribbean are already contributing.
What Is Verified About the Content
Each post carries its author, their institution, and the evidence anchors they cite — NCCN guidelines, ClinicalTrials.gov identifiers, peer-reviewed references. Cases referenced in a thread come from CASE, with the same two-faculty sign-off and patient identity removed.
Where It Fits in Board Certification
ONCO contributes to the oncology and Caribbean-governance tracks of the ABOPM Foundation curriculum. The tracks are described in the chapters on each track inside the ABOPM book.
What It Costs and How to Use It
Reading is free. Posting requires board credentialing. The first author credit is expected to be paid during Breast Cancer Awareness Month in October.
What Is Next
Open for tumor-board discussion now. The first author credit is expected during Breast Cancer Awareness Month.
Where This Matters
Where this matters is the case nobody at one hospital has seen before — a young woman with HER2-low disease and a variant without consensus interpretation. The real tumor board is the one that brings San Francisco, Trinidad, and Madrid into the same thread, on the same day, with their evidence attached.
The Wider Picture
ANKI, CASE, ONCO, and OMICS share one permanent record. A flashcard, a case, a tumor-board thread, and a variant interpretation all sit on the same trail of evidence a candidate, a reviewer, or a board member can audit. For the full architecture, see Chapter 16 — Four Apps for Board Preparation.
ONCO is the tumor board that holds the discussion the field actually needs, with the citable trail attached.
Sources
| Claim | Source | Ref |
|---|---|---|
| HER2-low breast cancer is a clinically distinct entity established by the DESTINY-Breast04 trial | Modi et al. — Trastuzumab Deruxtecan in HER2-Low Breast Cancer (NEJM) | www.nejm.org |
| BRCA1 variant interpretation against ACMG criteria informs surgical and systemic choices in young breast-cancer patients | BRCA Exchange | brcaexchange.org |
| NCCN guidelines on breast cancer underpin tumor-board decision making across institutions | NCCN Clinical Practice Guidelines in Oncology — Breast Cancer | www.nccn.org |
| ClinicalTrials.gov is the public registry that anchors trial-eligibility references in ONCO threads | ClinicalTrials.gov (NIH) | clinicaltrials.gov |
| De-identification of cases referenced in tumor-board discussion follows HIPAA safe-harbor | HHS HIPAA Privacy Rule guidance | www.hhs.gov |
| ABOPM oncology and Caribbean-governance curriculum tracks govern the ONCO scope | ABOPM book (CANONIC) | hadleylab.org |
| The first ONCO author credit is scheduled for Breast Cancer Awareness Month, October 2026 | ONCONEX governance (CANONIC) | hadleylab.org |
ONCO | ONCOLOGY | ABOPM | BLOGS