Make skipping radiotherapy the default for very low-risk breast cancer
Trials show older women with the lowest-risk breast cancers gain almost nothing from radiotherapy after lumpectomy. Yet most still get it. Track and reward omission.
LUMINA, PRIME II, and IDEA show low local recurrence without radiotherapy in luminal A tumours in women over 55-65. Propose a quality metric and default-omission pathway (with genomic confirmation where needed), with omission rate and five-year local recurrence as measures.
- 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.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
- Incentives reward me-too drugs and marginal gains · The system pays the same for a drug that adds two months as for a cure, so companies race to copy rather than to cure.
Pages like this
not linked directly; found by shared links- IdeaEvery screening programme must publish its overdiagnosis rate each year
Shares Overdiagnosis and false alarms, Incentives reward me-too drugs and marginal gains.
- InstitutionUNC Lineberger Comprehensive Cancer Center
Shares PAM50 / intrinsic subtypes, Toxicity and quality of life are undervalued, HR-positive / HER2-negative breast cancer.
- IdeaAfter the COMET trial: surveillance pathways and a new name for low-risk DCIS
Shares Overdiagnosis and false alarms, HR-positive / HER2-negative breast cancer.
- IdeaCertified decision aids required for every preference-sensitive cancer decision
Shares Overdiagnosis and false alarms, HR-positive / HER2-negative breast cancer.
- IdeaProstate active surveillance without scheduled biopsies: MRI and blood tests decide
Shares Overdiagnosis and false alarms, Toxicity and quality of life are undervalued.
- IdeaProspective arm-volume surveillance to catch and reverse lymphoedema early
Shares Toxicity and quality of life are undervalued, HR-positive / HER2-negative breast cancer.
- IdeaHormone tablets instead of surgery for small breast cancers in the frail over-80s
Shares Overdiagnosis and false alarms, HR-positive / HER2-negative breast cancer.
- IdeaA public fund for trials that test less treatment
Shares Incentives reward me-too drugs and marginal gains, Toxicity and quality of life are undervalued.