# A watch-and-wait registry for blood precursor conditions found by chance

Source: https://onco.cc/ideas/idea-prev-blood-precursor-watch-registry/  
OnCo record `idea-prev-blood-precursor-watch-registry` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Blood tests increasingly find precursor conditions like MGUS and smouldering myeloma, but most never progress. A registry with clear rules would stop early treatment outside trials.

## Summary

Smouldering myeloma treatment trials prompt calls for early therapy, yet most patients would never progress; iStopMM (Iceland) shows population MGUS screening is feasible. Propose a national precursor registry (MGUS, smouldering myeloma, monoclonal B-cell lymphocytosis, CHIP) with risk stratification, no treatment outside trials, and patient-reported outcomes.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A stratified registry allows at least 80% of precursor patients to remain untreated over ten years while progression is detected before end-organ damage in at least 90% of those who progress.
- Rationale: The harm to avoid is treatment creep as detection expands.
- Proposed test: Registry with pre-specified progression monitoring; compare outcomes with treated cohorts.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- cancers: [Chronic lymphocytic leukaemia](https://onco.cc/cancers/cll/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)
- key papers: [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/)

---
JSON: https://onco.cc/api/v1/entities/idea-prev-blood-precursor-watch-registry.json