{"entity":{"id":"idea-prev-blood-precursor-watch-registry","kind":"idea","name":"A watch-and-wait registry for blood precursor conditions found by chance","aka":[],"tldr":"Blood tests increasingly find precursor conditions like MGUS and smouldering myeloma, but most never progress. A registry with clear rules would stop early treatment outside trials.","summary":"Smouldering myeloma treatment trials prompt calls for early therapy, yet most patients would never progress; iStopMM (Iceland) shows population MGUS screening is feasible. Propose a national precursor registry (MGUS, smouldering myeloma, monoclonal B-cell lymphocytosis, CHIP) with risk stratification, no treatment outside trials, and patient-reported outcomes.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":["multiple-myeloma","cll"],"sections":["early-detection"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"A stratified registry allows at least 80% of precursor patients to remain untreated over ten years while progression is detected before end-organ damage in at least 90% of those who progress.","rationale":"The harm to avoid is treatment creep as detection expands.","test":"Registry with pre-specified progression monitoring; compare outcomes with treated cohorts.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":6},"route":"/ideas/idea-prev-blood-precursor-watch-registry/","neighbours":{"cancer":[{"id":"cll","kind":"cancer","name":"Chronic lymphocytic leukaemia","route":"/cancers/cll/"},{"id":"multiple-myeloma","kind":"cancer","name":"Multiple myeloma","route":"/cancers/multiple-myeloma/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}