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No randomised trial has shown that screening survivors for a second cancer reduces death from it. A registry-based randomised trial, which invites rather than enrols, is the only design that could answer this at an affordable cost.
Survivors of chest radiotherapy given young are offered breast surveillance in the United Kingdom on the strength of their measured risk. Survivors of the same treatment are offered nothing for lung, skin, bowel or bladder, despite measured excess risks, and the reason is not that anyone decided against it. A conventional trial here is impossible: the latency is decades, each survivor group is small, and consenting people to no surveillance when their risk is known is not acceptable.
A registry-based randomised design, as used in cardiology and in screening research, changes the economics. Eligible survivors are identified from a registry linkage, randomised to be invited or not invited to a surveillance pathway, and followed through the same registry for cancer incidence, stage at diagnosis and death. Nobody is denied care they would otherwise have had, because the comparator is the current default of no programme. The marginal cost is the invitation and the pathway, not a trial infrastructure.
The honest limits are that this answers the invitation question rather than the test question, that contamination from private screening would dilute the effect, and that mortality from a specific second cancer needs very large numbers or very long follow-up. Stage shift and interval cancers are the realistic interim endpoints.
Shares No randomised trial shows that any survivorship screening programme reduces death, Screening survivors: where the UK, American and European answers differ, The hardest cancers are found late, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, screening.
Shares The UK very high risk breast screening protocol after chest radiotherapy, Screening survivors: where the UK, American and European answers differ, The hardest cancers are found late, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, screening.
Shares No randomised trial shows that any survivorship screening programme reduces death, Screening survivors: where the UK, American and European answers differ, The hardest cancers are found late, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, screening.
Shares Registries count diagnoses and deaths, and not what treatment left behind, 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 and the tags rejuvenation, survivorship, open-problem.
Shares Tailored screening for second cancers in survivors with known high-risk exposures, No randomised trial shows that any survivorship screening programme reduces death, The hardest cancers are found late, Survivorship and late effects are neglected and the tags rejuvenation, survivorship.
Shares Registries count diagnoses and deaths, and not what treatment left behind, 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 and the tags rejuvenation, survivorship, open-problem.
Shares 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 and the tags rejuvenation, survivorship, open-problem.
Shares 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 and the tags rejuvenation, survivorship, open-problem.