{"entity":{"id":"rejuv-agenda-screening-without-a-trial","kind":"bottleneck","name":"No randomised trial shows that any survivorship screening programme reduces death","aka":[],"tldr":"Survivors are screened for second cancers on the strength of how large their risk is, not on the strength of a trial showing that screening them saves lives. For most organs there is no programme at all.","summary":"This is the sharpest gap the second-cancers facet of this round found, and it stated it in one sentence: no randomised trial has shown that any survivorship screening programme reduces death from a second cancer.\n\nWhere a programme exists, it rests on inference. The United Kingdom's very high risk breast screening protocol offers annual magnetic resonance imaging to women irradiated to the chest when young; the case for it is the size of the measured risk, the youth of the women, and general evidence that magnetic resonance imaging finds breast cancer earlier in high-risk women. It is not a trial in irradiated survivors, and, as the paediatric facet put it, there will not be one. That is a defensible decision rather than an oversight: the population is small, the latency is decades, and randomising a woman with a measured several-fold risk to no surveillance is not something an ethics committee would approve.\n\nWhere no programme exists, the reasoning has never been done at all. No country screens for lung cancer on the basis of having had chest radiotherapy, even though measured second-primary lung cancer rates in some survivor groups exceed the rate in the control arm of the trial that established that lung screening saves lives. No country screens survivors' skin as a programme. There is no bladder screening for people who have had cyclophosphamide anywhere. For adults treated as adults there is no organised colonoscopy programme after abdominal or pelvic radiotherapy in the United Kingdom, the United States or Europe. For thyroid cancer after neck radiotherapy the international guideline panel compared ultrasound against feeling the neck, found neither superior, and published a decision aid instead of a recommendation.\n\nThe reason this matters more than it looks is that a survivor cannot tell the difference between a gap and a decision. Being told there is no programme sounds like reassurance. On several of these organs it is not reassurance, it is an unanswered question, and the records on this front say which is which.","asOf":"2026-10-02","links":[{"label":"Oeffinger et al., Chronic health conditions in adult survivors of childhood cancer (NEJM 2006;355:1572-1582)","url":"https://doi.org/10.1056/NEJMsa060185"},{"label":"NHS England: very high risk breast screening protocol","url":"https://www.gov.uk/government/publications/breast-screening-very-high-risk-women-surveillance-protocols"}],"tags":["rejuvenation","survivorship","open-problem","screening","second-cancers"],"related":["rejuv-second-screening-after-treatment-compared","rejuv-second-uk-very-high-risk-breast-screening","second-primary-lung-after-chest-radiotherapy","second-primary-skin-cancer-after-cancer-treatment","second-primary-thyroid-after-neck-radiotherapy","second-primary-bowel-after-abdominal-radiotherapy","second-primary-bladder-after-cyclophosphamide","rejuv-paed-breast-after-chest-radiotherapy","idea-rejuv-registry-randomised-screening-in-survivors","rejuvenation-roadmap"],"cancers":["hodgkin-lymphoma","breast-cancer"],"sections":["rejuvenation","supportive-care"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"stage":"prevention-detection","severity":"major","metrics":[{"label":"Randomised trials showing a survivorship screening programme reduces death from a second cancer","value":"None","source":"OnCo second-cancers facet, 2 October 2026","url":"https://doi.org/10.1056/NEJMsa060185"},{"label":"Organs with an organised survivor screening programme in any country, among those with a measured excess risk on this front","value":"Breast after chest radiotherapy given young; none for lung, skin, bladder, bowel in adults","source":"NHS England very high risk breast screening protocol and the second-cancer records on this front"}],"causes":["Latency between treatment and a second cancer is often two to four decades, longer than a screening trial can run.","Each survivor group is small, so a trial powered for mortality would need international recruitment nobody is funding.","Randomising people with a known elevated risk to no surveillance is difficult to justify to an ethics committee.","Screening programmes are organised by population risk factors such as age and smoking, and treatment history is not a field those programmes can query.","Radiotherapy fields and doses are frequently not recorded anywhere a survivor or a general practitioner can reach, so risk cannot be computed even where it is known."],"currentEfforts":["NHS England runs a very high risk breast screening protocol for women irradiated to the chest when young, and names total body irradiation as a group it will review for eligibility.","The Children's Oncology Group Long-Term Follow-Up Guidelines and the International Guideline Harmonization Group define risk-based surveillance after childhood cancer by exposure rather than diagnosis.","Registry-linked cohorts, including the Childhood Cancer Survivor Study and the British Childhood Cancer Survivor Study, continue to measure the risks that any programme would be built on."],"successLooksLike":"At least one survivorship surveillance programme has been evaluated against an outcome that matters, by registry-based randomisation or by a cohort with a contemporaneous unscreened comparison, and the organs where no programme exists have an explicit, published reason rather than a silence."},"route":"/bottlenecks/rejuv-agenda-screening-without-a-trial/","neighbours":{"term":[{"id":"second-primary-bladder-after-cyclophosphamide","kind":"term","name":"Bladder cancer after cyclophosphamide","route":"/terms/second-primary-bladder-after-cyclophosphamide/"},{"id":"second-primary-bowel-after-abdominal-radiotherapy","kind":"term","name":"Bowel cancer after abdominal and pelvic radiotherapy","route":"/terms/second-primary-bowel-after-abdominal-radiotherapy/"},{"id":"second-primary-lung-after-chest-radiotherapy","kind":"term","name":"Lung cancer after chest radiotherapy and after alkylating chemotherapy","route":"/terms/second-primary-lung-after-chest-radiotherapy/"},{"id":"rejuv-second-screening-after-treatment-compared","kind":"term","name":"Screening survivors: where the UK, American and European answers differ","route":"/terms/rejuv-second-screening-after-treatment-compared/"},{"id":"second-primary-skin-cancer-after-cancer-treatment","kind":"term","name":"Skin cancer after cancer treatment","route":"/terms/second-primary-skin-cancer-after-cancer-treatment/"},{"id":"rejuv-second-uk-very-high-risk-breast-screening","kind":"term","name":"The UK very high risk breast screening protocol after chest radiotherapy","route":"/terms/rejuv-second-uk-very-high-risk-breast-screening/"},{"id":"second-primary-thyroid-after-neck-radiotherapy","kind":"term","name":"Thyroid cancer after neck radiotherapy, and whether to look for it","route":"/terms/second-primary-thyroid-after-neck-radiotherapy/"}],"technology":[{"id":"rejuv-paed-breast-after-chest-radiotherapy","kind":"technology","name":"Breast cancer after chest radiotherapy in childhood, and the screening that follows","route":"/technologies/rejuv-paed-breast-after-chest-radiotherapy/"}],"idea":[{"id":"idea-rejuv-registry-randomised-screening-in-survivors","kind":"idea","name":"Ask whether survivorship screening saves lives, using registry-based randomisation","route":"/ideas/idea-rejuv-registry-randomised-screening-in-survivors/"}],"roadmap":[{"id":"rejuvenation-roadmap","kind":"roadmap","name":"Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it","route":"/roadmaps/rejuvenation-roadmap/"}],"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}]}}