# Tailored screening for second cancers in survivors with known high-risk exposures

Source: https://onco.cc/ideas/idea-acc-tailored-second-cancer-screening/  
OnCo record `idea-acc-tailored-second-cancer-screening` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Survivors who had chest radiotherapy as young women, or certain chemotherapies, have much higher risks of specific second cancers. They should be screened like people with inherited risk, and today most are not.

## Summary

Women treated with chest radiotherapy before 30 have breast cancer risks comparable to BRCA carriers and are recommended annual MRI; survivors of Hodgkin lymphoma have elevated lung and gastrointestinal cancer risks; alkylating agents raise leukaemia risk. Uptake of recommended surveillance is low because survivors and their doctors do not know the exposures. Registry-driven identification and invitation to tailored screening, as is done for hereditary syndromes, would apply existing evidence.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Registry-driven invitation will raise adherence to recommended second-cancer surveillance among high-risk survivors from under 40% to above 75%, and will shift second cancers to earlier stage at diagnosis.
- Rationale: Organised invitation is what makes population screening work; high-risk survivors are a defined, findable population with strong evidence for surveillance.
- Proposed test: A randomised trial of registry-driven invitation versus usual care among 5,000 high-risk survivors with adherence and stage at second-cancer diagnosis as endpoints.
- Maturity: early-clinical
- Actor: clinic

## Sources

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

## Connected records

- cancers: [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- technologies: [Breast cancer after chest radiotherapy in childhood, and the screening that follows](https://onco.cc/technologies/rejuv-paed-breast-after-chest-radiotherapy/), [MRI](https://onco.cc/technologies/mri/), [Second cancers after childhood cancer: the risk by treatment, and why it is falling](https://onco.cc/technologies/rejuv-paed-second-cancers/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- ideas: [Ask whether survivorship screening saves lives, using registry-based randomisation](https://onco.cc/ideas/idea-rejuv-registry-randomised-screening-in-survivors/)
- 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/)

---
JSON: https://onco.cc/api/v1/entities/idea-acc-tailored-second-cancer-screening.json