ideasIdea
Modern autopsy studies to measure how much silent cancer people carry
Old autopsy studies found hidden prostate, thyroid and breast cancers in many people who died of other causes. Repeating them with modern methods would show how large the reservoir of harmless cancer is.
Overdiagnosis estimates depend on knowing the prevalence of indolent disease, yet the data is decades old and pre-dates modern pathology. Propose systematic autopsy series with whole-body imaging and standardised histology across ages and populations, quantifying the reservoir for prostate, thyroid, breast, kidney, lung and pancreas.
Hypothesis
Modern reservoir estimates show at least 30% prevalence of indolent cancers in adults over 60 for several organs, changing screening threshold calculations.
Rationale
MCED and imaging screening will find these lesions; we need to know how many there are before deciding what to call them.
What would test it
Fund 2,000 autopsies across five countries.
Maturity
speculative
Who has to act
research
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
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.
Pages like this
not linked directly; found by shared links- IdeaAn international body to rename indolent lesions so 'cancer' means something
Shares Overdiagnosis and false alarms, Thyroid cancer, Prostate cancer.
- IdeaStop biopsying small thyroid nodules and never screen the thyroid
- IdeaTest whether calling Gleason 6 'not cancer' changes what men choose
- TermBethesda category (thyroid cytology)
- IdeaActive surveillance as the default for tiny papillary thyroid cancers
- IdeaCertified decision aids required for every preference-sensitive cancer decision
- TrialPRECISION
- TermGleason score / Grade Group