Expanded carrier screening in China: a focused narrative review and conceptual implementation framework

Expanded carrier screening (ECS) is increasingly used in China, but implementation remains heterogeneous across regions, laboratories, and reproductive-care settings. This focused narrative review synthesizes Chinese evidence on population variation, panel design, analytical methods, variant interpretation, couple-level reproductive risk, and health-system delivery. The review was informed by a reproducible PubMed search through 29 July 2026, supplemented by targeted identification of Chinese empirical studies and professional guidance. Chinese studies demonstrate substantial variation in carrier frequencies and screening yield across populations, while reported carrier and at-risk couple (ARC) rates are strongly influenced by panel composition, analytical methods, and variant-reporting criteria, particularly the inclusion of low-penetrance variants. Technical limitations at structurally complex loci and uneven access to genetic counseling and laboratory resources further affect implementation. On this basis, we propose a review-derived conceptual framework centered on universal minimum access, core screening principles, population-informed content adaptation, separation of variant-level classification from couple-level reproductive-risk assessment, and health-system support. Regional epidemiology and founder variants may inform panel content but should not determine screening eligibility. The framework also emphasizes partner testing, counseling and referral pathways, quality assurance, reimbursement, and measurable implementation outcomes. It is intended to organize current evidence and support future consensus development rather than function as a validated clinical guideline. Prospective multicenter evaluation, stakeholder consensus, and China-specific health-economic analyses are needed before national practice recommendations can be established.