ideas

BRCA1 breast cancers seem to grow from cells driven by the RANK signal. Denosumab blocks it and is already used for bone. A trial is testing whether it prevents these cancers.

For some cancers, drugs and radiotherapy can now cure without removing the organ, sparing patients a stoma, a lost voice or a removed bladder. A dedicated programme would run the trials to prove where this is safe.

Set a legal limit: anyone referred with suspected cancer should be told within 28 days whether they have it. Publish how every hospital performs each month.

Blood tests can now find leftover cancer months before scans, but most patients who test positive have nothing to enrol in. One standing trial per country would fix that.

Every newly diagnosed patient gets a named person whose job is to get them through appointments, tests, paperwork and money problems. Insurers should pay for it because it prevents delays and dropouts.

Platform trials that test several companies' drugs against one shared control arm, such as I-SPY 2, Lung-MAP, GBM AGILE and STAMPEDE, are each built from scratch by determined individuals. A permanent non-profit sponsor holding the protocol, control arm, statistics and data, with a standard entry contract for companies, would cut the launch of a new platform from years to months.

Instead of starting a new trial for every drug pair, keep one always-open trial per cancer that new arms can join and leave, sharing the same control group.

Every cancer trial would have to publish a short, clear summary that patients can understand, within twelve months of results, in one public place.

No company will pay to find out whether six months of its drug works as well as twelve. A dedicated public fund would pay for those trials, which save patients side effects and health systems money.

Every attempt to drop radiotherapy from early Hodgkin lymphoma on the strength of a clear scan has cost people their remission. Changing the chemotherapy as well is the next attempt.

Some chemotherapy and antibody drugs damage the heart. Checking heart function before and during treatment and starting protective drugs early for those at risk could prevent much of that damage.

Rare cancers are often misdiagnosed, which sends patients down the wrong treatment path. Digital slide sharing could get every case to an expert within days.

Rather than building a new trial from scratch for every drug, keep one permanent trial open per cancer where new treatments can be slotted in and dropped out, sharing the same patients, control group and infrastructure.

A pill on a string collects cells from the food pipe and finds Barrett's oesophagus, a precursor of cancer. Offering it in pharmacies to people on long-term heartburn drugs would find it early.

Secure online workrooms where approved researchers can analyse cancer records without downloading them, with the data already cleaned and organised for cancer questions.

Papillary thyroid cancers under 1 cm almost never cause harm. Japanese hospitals have watched thousands safely. Make watching, not surgery, the default everywhere, with a registry.

A cancer patient with a fever or severe sickness during treatment should be seen quickly by a team that knows chemotherapy, not wait hours in a general emergency room.

Patients whose TNBC survives chemo-immunotherapy before surgery have a high relapse risk. Give them an ADC after surgery.

Radiation therapists, the staff who deliver daily treatment, can be trained to outline normal organs on scans and to review patients during treatment, work that oncologists now do.

Low-risk DCIS is a breast change that may never become cancer. Trials now show watching it is safe in the short term. The next step is a proper pathway and a name that does not say cancer.

When a prediction model says a patient has a high chance of dying within a year, their team is prompted to have a structured conversation about what matters to them, while there is still time to act on it.

Most cancer drug approvals depend on a handful of facts already in the chart, such as the diagnosis, biomarker and line of therapy; sending those automatically in a standard format would return most decisions before the patient leaves the room.

Copies of biological cancer drugs are still required to run large trials that rarely change the answer. Dropping them would cut years and tens of millions from each biosimilar.

Anyone with ovarian, pancreatic, metastatic prostate or mismatch-repair-deficient colorectal cancer should be tested for inherited mutations, yet testing rates fall well short. Making it an automatic, opt-out laboratory step triggered by pathology, as reflex mismatch-repair testing already is, would close the gap.

Palliative care given from the start of treatment for advanced cancer improves quality of life and may extend it. Instead of waiting for an oncologist to remember, the system should refer automatically when the diagnosis is recorded.

When a cancer drug is approved for more uses, the company sells far more of it but the price stays the same. Japan cuts prices automatically when sales balloon; others should too.

Connect the cancer registry to death records, pharmacy records and scan reports automatically every week, so we always know what happened to every patient without anyone filling in a form.

Sunbeds cause melanoma, especially when used young. Australia and Brazil have banned them. Other countries should follow and measure the effect.

Cheaper copies of biological cancer drugs exist but are used far less in some countries than others. Making them the default choice saves billions with no loss of benefit.

Nasopharyngeal cancer is common in southern China and is caused by a virus. A blood test for viral DNA finds it early, and a large study showed better survival. Scale it up.

Travel and time off work are among the biggest costs families face; if consultations happen by video, blood tests locally and oral drugs by mail, most routine visits need no journey at all.

Pay hospitals a single amount for a whole course of cancer treatment, with extra for following the evidence, rather than paying per visit and per drug, which rewards fragmentation.

Most people do not know alcohol causes seven cancers. Ireland is putting cancer warnings on bottles; other countries should follow and measure the effect on drinking.

Treatment abandonment is the leading cause of treatment failure for childhood cancer in much of the low- and middle-income world, driven by bus fares, lost income and the cost of food and lodging. Conditional cash, transport vouchers and family accommodation have cut abandonment sharply in Central America, East Africa and India, and should be funded in every curative protocol.

Giving chemotherapy before the operation is standard when the tumour is borderline operable, but for tumours that can be removed straight away two trials have failed to show it beats operating first. Two more, one Dutch and one American, are directly comparing chemotherapy before and after surgery with chemotherapy after alone; the proposal is to wait for them and to pool them.

Gallbladder cancers found by chance often come back within six months of the second operation, usually far from the gallbladder, which suggests the disease was already in the bloodstream. Two randomised trials are testing chemotherapy first; one closed small, the other reports in 2028.

The HPV vaccine prevents most cervical cancer, but false safety claims have cut uptake in several countries. Rebuild confidence locally and deliver the vaccine in schools.

Since 2016 England's Cancer Drugs Fund has paid a confidential discounted price for cancer drugs whose benefit is plausible but unproven, collected outcome data for two or three years, then had NICE decide for good; most drugs that entered were later recommended. Other systems could use the same managed-access deal instead of a yes-or-no at launch.

Radiotherapy trials need physicists to check every plan and central review of every target drawn, which nobody pays for. Fund that infrastructure permanently so trials are faster and results are trustworthy.

Radiotherapy machines that adapt to the tumour each day cost far more than standard ones and their benefit is unproven. Payers would fund them only within registries and trials that measure whether they help.

Use a blood test after surgery to decide who gets chemotherapy: spare the negatives, and find something that actually works for the positives.

Hepatitis C is now curable in weeks. Testing and treating where it is concentrated, and keeping those with scarring in surveillance afterwards, would cut liver cancer.

Fewer than half of patients starting treatment that can damage fertility have a documented fertility discussion or referral, with worse rates for women, minorities and patients outside academic centres. An order-set trigger that refers every patient under 40 to reproductive medicine unless they actively decline would make the conversation routine and timely.

Companies now have to file a plan for enrolling a representative mix of patients. If the trial misses the plan, the label should say so and the company should be required to fill the gap after approval.

About one in eight cancers is caused by an infection we can vaccinate against, cure or eradicate. A concerted global programme could make those cancers rare within a generation.

Scotland and Wales put a floor under the price of alcohol. Deaths from liver disease have already fallen. Cancer takes longer to show, so someone has to keep measuring for a decade.

Lung screening is a teachable moment. Giving cessation medicine and support by default at every scan, unless the person opts out, roughly doubles quit rates.

At diagnosis, people would be asked a single question: may we contact you about research that fits your cancer? Those who say yes would be findable by trial teams without repeated cold approaches.

Outside US Medicare and Medicaid, joining a trial can leave the patient or hospital paying for the ordinary care that goes with it, and billing uncertainty blocks participation in middle-income countries. Requiring every insurer and public system to cover routine care costs removes a hidden barrier.

Offer the complementary approaches that have evidence (acupuncture for nausea and pain, exercise, mindfulness, yoga) inside the cancer centre, so patients do not seek them, and worse, elsewhere.

If a practice's requests are approved almost every time, asking again wastes everyone's money; gold-card rules give such practices automatic approval and audit them instead.

Instead of picking the dose by how much patients can tolerate, measure drug levels in blood and relate them to both benefit and harm across patients, then choose the dose that hits the sweet spot.

Stomach cancer is largely caused by a bacterium that spreads in households. Testing and treating whole families, not individuals, would stop reinfection and prevent cancer.

Everyone of reproductive age about to have treatment that can cause infertility is offered egg, sperm or tissue freezing, paid for, before treatment starts.

Several treatments now work without chemotherapy, but most are given until the disease comes back. Giving them for a fixed time and stopping is the version patients would choose.

Getting fitter and better nourished before an operation reduces complications and speeds recovery. It is cheap, but only a few hospitals do it.

Health systems would pay for a $400,000 cell therapy only if it works. If the cancer has not responded by three months, the company refunds the price.

Losing hair is one of the most distressing side-effects of chemotherapy and can often be prevented with a cooling cap. Make it routinely available and paid for.

Most cancer patients are over 65, yet treatment is chosen by age and guesswork and trials exclude them. Assess fitness properly and design trials that include real older patients.

A short structured check of memory, mobility, nutrition and medicines before treatment cuts serious side effects in older patients without reducing benefit. It should be automatic, not optional.