# A survivor biobank to find who will develop late effects before they do

Source: https://onco.cc/ideas/idea-acc-survivor-biobank-late-effect-prediction/  
OnCo record `idea-acc-survivor-biobank-late-effect-prediction` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Two people can have identical treatment and only one develops heart failure or a second cancer years later. Collecting blood and genetic data from survivors could reveal who is at risk and who can be reassured.

## Summary

Genetic variants (for instance in anthracycline cardiotoxicity), clonal haematopoiesis, and circulating biomarkers may predict late effects, but studies are small and scattered. A prospective survivor biobank with baseline and serial samples linked to treatment exposures and long-term outcomes would allow discovery and validation of predictive markers, enabling risk-adapted surveillance and preventive therapy.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Within six years the biobank will validate at least one biomarker or polygenic score that stratifies late cardiotoxicity or second-cancer risk with sufficient discrimination to change surveillance intensity.
- Rationale: Pharmacogenomic predictors of toxicity have been found where cohorts were large enough; late effects have never had such a resource.
- Proposed test: Enrol 20,000 survivors with samples at end of treatment and five years, linked to registry outcomes, with pre-registered discovery and validation analyses.
- Maturity: speculative
- Actor: research

## Sources

- Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics: https://cancercontrol.cancer.gov/ocs/statistics

## Connected records

- technologies: [Cardio-oncology](https://onco.cc/technologies/cardio-oncology/), [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [How much illness childhood cancer survivors carry, and at what age](https://onco.cc/technologies/rejuv-paed-chronic-disease-burden/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/)
- roadmaps: [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/)

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