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Registry-based randomised MCED trial: a million people, no study visits

Randomise people through the national health system, post the blood kit, and read cancer deaths off the registry. That is ten times cheaper per participant than a classic trial.

Swedish registry-based RCTs (TASTE, DETO2X) showed pragmatic randomisation at national scale at a fraction of usual cost. Propose an MCED trial that randomises through screening call/recall, draws blood at existing phlebotomy or mobile units, and uses cancer registry and death-certificate linkage for endpoints, with no in-person study visits.

Hypothesis
A registry-based RCT of at least one million adults aged 50-79 can detect a 15% relative reduction in cancer mortality within eight years at under $50 per participant-year.
Rationale
MCED effects on all-cancer mortality will be modest and need very large samples; only registry-linked pragmatic designs make that affordable.
What would test it
Feasibility pilot in a Nordic country or NHS region (100,000 invitations, mailed kits; uptake and linkage completeness as endpoints), then scale.
Maturity
speculative
Who has to act
research
Cost to try
Large (over $50M)
Years to first evidence
8
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