OnCo
ideasIdea

A whole-population cancer interception programme: risk-stratify every adult, detect and intercept early

Instead of separate screening programmes for a few cancers, assess every adult's overall cancer risk and offer blood tests, imaging and preventive treatment tuned to that risk, all inside one system that learns.

Screening today covers a handful of cancers with organ-specific programmes and reaches a fraction of eligible people. Multi-cancer early detection blood tests (NHS-Galleri, PATHFINDER 2) and polygenic, exposure and imaging-based risk models make a unified approach conceivable: every adult over 40 receives a risk profile, a personalised detection schedule, and where indicated interception (chemoprevention, vaccines, risk-reducing procedures), with all results feeding a national learning system that recalibrates the models. Overdiagnosis is controlled through molecular indolence classifiers and surveillance-first protocols.

Hypothesis
A unified risk-stratified programme reduces late-stage (III/IV) cancer incidence across all cancers by at least 20% within a decade at acceptable cost per life-year, without increasing overtreatment of indolent disease.
Rationale
Stage at diagnosis is the strongest determinant of survival, most cancers have no screening, and organ-by-organ programmes cannot scale to thirty diseases. Risk models and blood-based detection convert the problem into a systems problem.
What would test it
A regional cluster-randomised implementation of the programme versus standard screening with stage-shift, cancer-specific mortality and overdiagnosis metrics at five years, building on the NHS-Galleri infrastructure.
Maturity
speculative
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
10
Bottlenecks it attacks

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