{"entity":{"id":"idea-prev-incidentaloma-natural-history-cohort","kind":"idea","name":"A ten-year cohort of incidental findings to calibrate follow-up guidelines","aka":[],"tldr":"Scans find unexpected lumps in the adrenal, thyroid, pancreas and lung. Nobody knows how many matter. A national cohort following them for ten years would tell us whom to watch.","summary":"Scans find unexpected lumps in the adrenal, thyroid, pancreas and lung, and nobody knows how many matter, so this idea enrols every incidental finding flagged by structured radiology reporting into a national linked cohort followed for ten years. Incidentaloma guidelines rest on small retrospective series; natural history data is the missing evidence, and structured reporting makes capture feasible. The cohort would estimate cancer risk by lesion type, size and patient factors and allow follow-up recommendations to be pruned where risk is very low. The test is enrolment in a national health system with interim analyses at three and five years. Speculative in maturity, it addresses the bottlenecks Overdiagnosis and false alarms and Weak real-world evidence and registries.","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":[],"sections":["early-detection","imaging"],"technologies":["ct","mri"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis","b-real-world-evidence"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"For at least three common incidentaloma categories, ten-year cancer risk is low enough (under 1%) that current follow-up recommendations can be dropped, reducing follow-up imaging by at least 30%.","rationale":"Natural history data is the missing evidence; structured reporting makes capture feasible.","test":"Enrol via structured reporting in a national health system; interim analyses at three and five years.","maturity":"speculative","actor":"data","cost":"medium","horizonYears":5},"route":"/ideas/idea-prev-incidentaloma-natural-history-cohort/","neighbours":{"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"ct","kind":"technology","name":"CT (computed tomography)","route":"/technologies/ct/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"}],"bottleneck":[{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"},{"id":"b-real-world-evidence","kind":"bottleneck","name":"Weak real-world evidence and registries","route":"/bottlenecks/b-real-world-evidence/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}