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Low-risk patients often receive operations and radiotherapy they may not need, for example sentinel node biopsy in older women with favourable breast cancer or radiotherapy after breast-conserving surgery in genomically low-risk disease. Because no company will sponsor trials of leaving treatment out, health systems should fund them and keep the savings.
Payers and public funders sponsor randomised trials of omission or de-escalation of local therapy: omitting sentinel node biopsy in older women with favourable breast cancer (as SOUND and INSEMA tested), omitting radiotherapy after breast-conserving surgery in genomically low-risk disease, active surveillance instead of surgery in low-risk thyroid and prostate cancer, and shorter or lower-dose regimens. These trials save money, reduce harm and address overdiagnosis, but have no commercial sponsor. Genomic and imaging biomarkers now allow risk-adapted selection that makes omission trials ethically and statistically feasible.
Shares Payers fund trials of cheaper, shorter or lower-dose versions of expensive treatments, Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam).
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, HR-positive / HER2-negative breast cancer, Prostate cancer.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, HR-positive / HER2-negative breast cancer, Prostate cancer.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, Thyroid cancer, Toxicity and quality of life are undervalued.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Sentinel lymph node biopsy, Surgery and radiotherapy cure most, get least.
Shares Overdiagnosis and false alarms, Thyroid cancer, Prostate cancer.
Shares Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam), HR-positive / HER2-negative breast cancer, Prostate cancer.
Shares Global cancer surgery: delivering safe, affordable, and timely cancer surgery, Surgery and radiotherapy cure most, get least, Toxicity and quality of life are undervalued.