ideasIdea
A ten-year cohort of incidental findings to calibrate follow-up guidelines
Scans find unexpected lumps in the adrenal, thyroid, pancreas and lung. Nobody knows how many matter. A national cohort following them for ten years would tell us whom to watch.
Incidentaloma guidelines rest on small retrospective series. Propose a national linked cohort enrolling all incidental findings flagged by structured radiology reporting, with registry follow-up, to estimate cancer risk by lesion type, size and patient factors, and to prune guidelines.
Hypothesis
For at least three common incidentaloma categories, ten-year cancer risk is low enough (under 1%) that current follow-up recommendations can be dropped, reducing follow-up imaging by at least 30%.
Rationale
Natural history data is the missing evidence; structured reporting makes capture feasible.
What would test it
Enrol via structured reporting in a national health system; interim analyses at three and five years.
Maturity
speculative
Who has to act
data
Cost to try
Medium ($1M to $50M)
Years to first evidence
5
Bottlenecks it attacks
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
- Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.