Idea rankings

For each cancer type, agree the set of stains and tests that are always needed, and have the lab run them automatically on diagnosis rather than waiting for someone to ask.

Cancer treatment often damages sexual function and intimacy, and almost nobody asks. Make it a routine question with a clinic to refer to.

A majority of people of West African ancestry carry the Duffy-null variant, which lowers baseline neutrophil counts without raising infection risk. Trials apply a single neutrophil cut-off that wrongly labels them unfit, so protocols should use Duffy-specific thresholds; Duffy status is a cheap blood test.

Not every survivor needs to see an oncologist every six months for years. Sort people by recurrence risk, send low-risk survivors back to their family doctor with a clear plan, and guarantee rapid return if something changes.

Up to a fifth of people with advanced solid tumours have cancer in the brain and are usually barred from trials. Letting in those whose brain disease is treated, stable or symptom-free would widen trials and tell us whether drugs work in the brain.

There are too few genetic counsellors to see every patient who should have an inherited-risk test. Let the cancer team order the test with a short consent script, and use video counsellors for those with results that matter.

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.

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.

A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.

Funders would publish how their spending compares with deaths and years of life lost per cancer, and commit to shift a fixed share of money each year towards the biggest gaps.

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.

Choices like mastectomy versus lumpectomy, or whether to have chemotherapy after surgery, depend on what matters to the patient. Good decision aids exist but are rarely used; building them into the clinic workflow would change that.

One week of breast radiotherapy in five doses works as well as three weeks in fifteen, but clinics paid per dose lose money by switching; paying one price per course removes the penalty.

Hospitals are paid for each radiotherapy session, so a proven five-session course earns less than an unproven twenty-five-session one. Paying per course removes the reason to give more treatment than needed.

Giving radiotherapy in five larger doses over one week instead of 15 to 25 smaller doses is non-inferior for cancer control and late toxicity in breast and prostate cancer, and triples the number of patients each machine can treat. The barriers are guideline inertia and payment per fraction, not hardware.

Hospitals usually keep one piece of a removed tumour. Keeping three pieces from different parts would show how varied the tumour is, at almost no extra cost.

Millions of people have had weight-loss surgery or now take weight-loss drugs. Linking those records to cancer registries would show, cancer by cancer, how much reversing obesity prevents, for almost no cost.

A cheap gene test for DPYD, UGT1A1 and TPMT or NUDT15 before fluoropyrimidines, irinotecan or thiopurines identifies people at risk of severe or fatal toxicity so their dose can be lowered. The EMA has recommended DPD testing since 2020; US uptake remains partial.

Protons cost more than shaped X-ray beams. They are worth it when the extra punch where the beam stops, and the missing exit dose, widen the gap between killing the tumour and harming late-reacting tissue: an alpha/beta and RBE question, not a machine question.

A drug that improves appetite and lean weight in cancer wasting is approved in Japan but almost nowhere else. Reviewing the existing evidence could widen access quickly.

Millions of community health workers already visit homes for vaccines and maternal care. Training them to recognise cancer warning signs, guide patients through the system and support home pain care would reach people no hospital does.

A few weeks of exercise, nutrition and mental preparation before a big operation helps older patients recover faster and with fewer complications. It costs little and should be routine.

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.

Hormone-blocking treatments for prostate and breast cancer, taken for years, raise the risk of diabetes, heart disease and bone fractures. Survivors on these drugs should get the same preventive care as diabetics.

When a scan shows most tumours shrinking but one growing, that odd lesion holds the escape mechanism. Sampling it, and treating it locally, should be routine.

Resistance mutations often exist in a tiny fraction of cells before treatment starts. Error-corrected sequencing that detects variants below 0.01 percent allele fraction could find them at diagnosis and prompt a mechanism-matched combination from day one.

Building a genetically engineered mouse for a specific cancer takes years. Editing genes directly in an adult mouse's organ can produce the same tumour in weeks.

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.

A large trial showed that palliative care delivered by video works as well as in person for people with advanced lung cancer. Payers should cover it so that distance from a hospital no longer decides who gets it.

Gut bacteria appear to influence whether immunotherapy works, and diet and antibiotics shape gut bacteria. Yet almost no drug trial records what patients ate or which antibiotics they took. Recording it would cost almost nothing.

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.

Screening finds cancers that would never have caused harm alongside dangerous ones. Pair every screening test with a test that says which is which, so people with harmless findings can safely watch and wait.

Millions of people have had weight-loss surgery or now take weight-loss drugs. Linking those records to cancer registries would show, cancer by cancer, how much reversing obesity prevents, for almost no cost.

Protons cost more than shaped X-ray beams. They are worth it when the extra punch where the beam stops, and the missing exit dose, widen the gap between killing the tumour and harming late-reacting tissue: an alpha/beta and RBE question, not a machine question.

Half of patients take antioxidant vitamins during chemotherapy. One good observational study suggests they raise recurrence by 40%. Patients deserve a definitive answer, and it can be obtained cheaply by adding supplement tracking to trials already running.

Funders would publish how their spending compares with deaths and years of life lost per cancer, and commit to shift a fixed share of money each year towards the biggest gaps.

Cancer treatment often damages sexual function and intimacy, and almost nobody asks. Make it a routine question with a clinic to refer to.

For each cancer type, agree the set of stains and tests that are always needed, and have the lab run them automatically on diagnosis rather than waiting for someone to ask.

Malnutrition is the commonest untreated complication in cancers of the gut, throat and pancreas. Putting a dietitian in the meeting where treatment is decided means it is seen and treated before chemotherapy starts, not after weight has been lost.

Common gene variants shift a person's cancer risk several-fold. A one-time genetic score could tell each person when to start breast, bowel or prostate screening.

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.

A fifth of patients with solid tumours develop brain metastases and are usually excluded from trials. This would fund a programme that studies and treats them as a disease in their own right.

Most cancer drugs cannot cross into the brain. Combine ultrasound that briefly opens the barrier with drugs engineered to be carried across, and make this a standard platform for every brain tumour and brain metastasis.

Metastasis causes about nine in ten cancer deaths but gets a small slice of research money. This would ring-fence a tenth of national cancer research budgets for the biology and trials of spread itself.

Resistance mutations often exist in a tiny fraction of cells before treatment starts. Error-corrected sequencing that detects variants below 0.01 percent allele fraction could find them at diagnosis and prompt a mechanism-matched combination from day one.

Around four in ten cancers are preventable with tools that exist now. This would fund the hard, unglamorous work of getting vaccines, screening and tobacco control to everyone, paid on results.

Trials usually take only patients who are up and about most of the day. Those who spend more time resting, a common group in real clinics, are excluded, so nobody knows how to treat them. A dedicated group in each trial would answer that.

Some people have only a few sites of spread and can be treated at each one; others have further deposits not yet visible, and counting lesions cannot tell them apart. A signature built from tumour DNA levels, microRNA classifiers and clonal diversity across lesions would define the biology and spare futile ablation.

Hundreds of millions of CT scans are done each year for other reasons. Software could check each one for early lung, kidney, liver and pancreas changes, but only if a follow-up system exists.

Give drug combinations before surgery and measure how much tumour remains at resection; that answer arrives in months. A standing neoadjuvant platform with a shared control arm, as I-SPY 2 runs in breast cancer, would test combinations quickly in lung, bladder, melanoma, head and neck and oesophago-gastric cancer.

A large trial showed a structured exercise programme improved survival after bowel cancer. Almost no health system pays for it, so almost no patient gets it.

The CHALLENGE trial showed a supervised exercise programme improves survival in colon cancer. Extend it to breast, prostate, and lung cancer with the same rigour.

Cheap old drugs such as aspirin, statins, metformin and beta-blockers show hints of cancer benefit but no company will pay for the trials. Create a public fund and a way to update their labels.

Patients join a long-term cohort once and agree in advance that they may be offered new treatments as they appear, while others in the cohort serve as the comparison group. No new trial has to start from zero.

Not every survivor needs to see an oncologist every six months for years. Sort people by recurrence risk, send low-risk survivors back to their family doctor with a clear plan, and guarantee rapid return if something changes.

A positive blood test tells you cancer is back but not where. Combining whole-body MRI with modern PET tracers may find a single spot that can be zapped.

Immunotherapy works in tumours that immune cells can enter and ignores those that shut them out. Systematically test ways to open up the shut-out tumours, measured with spatial maps.

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.

A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.

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.

Governments and foundations would pool a prize of about a billion dollars into an escrowed fund, paid only when a treatment is shown in a well-controlled registration cohort to keep most patients with a currently incurable metastatic cancer, such as pancreatic adenocarcinoma or glioblastoma, disease-free for five years. The winner keeps its patent but accepts a price ceiling.

Governments and philanthropists commit large payments for whoever achieves a verified jump in ten-year cure rates for a specific cancer, however they do it.

No single company will spend a decade on a target that might be impossible. A shared, openly published effort across the twenty hardest targets spreads that risk.

A second cancer after radiotherapy can take forty years to appear. Checkpoint inhibitors and antibody-drug conjugates have been in first-line use for a few, so nobody can say anything about their late effects, and nobody is building the thing that could.

Metastasis causes about nine in ten cancer deaths but gets a small slice of research money. This would ring-fence a tenth of national cancer research budgets for the biology and trials of spread itself.

Build a drug company that does not need profits, modelled on the ones that developed new tuberculosis and sleeping-sickness drugs, to take on rare, paediatric and undruggable cancers.

No company can profit from a drug for a cancer that affects a few hundred people. A guaranteed payment for success would change that calculation.

Design a radiotherapy machine from scratch for hospitals with patchy electricity, heat and few engineers, and publish the design so several companies can build it cheaply.

For people at very high cancer risk, install a small population of engineered immune cells that live for years and destroy cells showing early cancer signals before a tumour forms.

Payers would promise in advance to buy a set number of doses at a set price for any drug that meets a defined bar in a rare or childhood cancer, so companies know the market exists before they invest.

Cancer kills more people in poorer countries than HIV, TB and malaria combined, but has no global fund. A pooled fund for diagnosis, essential medicines and radiotherapy would change what ministries can afford to build.

Companies could choose to sell a new cancer drug at cost worldwide and instead be paid from a pooled fund according to how much health it actually delivers.

Instead of a new trial for each resistance mechanism, one continuous trial could sort patients into arms based on the reason their last treatment failed.

A supportive-care ARPA would be a well-funded, milestone-driven agency that develops drugs for nausea, nerve damage, mouth sores, fatigue and brain fog from cancer treatment, which the market has largely ignored.

A public investment fund would match private money in the riskiest early trials of truly new cancer drugs, taking a small share of future royalties so that taxpayers gain when the bets pay off.

Many relapses come from cancer cells that hid dormant for years. Find drugs that either force them awake so chemotherapy kills them, or keep them asleep for life.

Copy the model that transformed HIV, TB and malaria care: a pooled international fund that pays for radiotherapy machines, pathology labs and essential cancer medicines where there are none.

Countries buying radiotherapy machines one at a time pay high prices and get poor service. A single global buyer negotiating for dozens of machines a year could cut prices and demand long-term support.

Build the shared software, legal templates and data standards that let any hospital in the world join a cancer trial in weeks instead of years, the way the internet let any computer join the network.

No randomised trial has shown that screening survivors for a second cancer reduces death from it. A registry-based randomised trial, which invites rather than enrols, is the only design that could answer this at an affordable cost.

Several agents have been tried for thymic recovery after transplant and none is in routine use. The blocker is as much the missing endpoint as the missing drug.

Newborn sequencing programmes exclude adult cancer genes because babies cannot consent. Storing those results and offering them at 18 would preserve choice and give a lifetime of prevention.

Oral cancer drugs under Part D now have a yearly cap of $2,100, but infused drugs under Part B still carry 20% coinsurance with no limit; a Part B cap would close the biggest hole left in Medicare cancer coverage.

Metastasis causes most cancer deaths, yet no drug is developed to stop cells spreading. Create a formal approval route for drugs that prevent metastasis, tested in people at high risk of it.

For cancers too rare or too poor to attract companies, run drug discovery in the open, the way neglected tropical diseases are tackled, and take candidates to first human trials with public money.

Governments promised in advance to buy vaccines that did not yet exist, and they got made. The same promise could be made for a drug against a target everyone has given up on.

To prove a leftover-cancer test works you need blood taken years before relapse. Collecting and freezing yearly samples now makes every future test testable.

Build a computer model of each patient's cancer and body that simulates how different treatments would go, and prove in a proper trial that choosing treatment with the model helps.

Give a small number of scientists a decade of guaranteed funding to work on a single hard problem such as dormant cancer cells, with no pressure to publish quickly.

Resistance often arrives as the same few mutations. Teaching the immune system to recognise them in advance could remove the escaping cells while they are still rare.

The first drug against the KRAS protein nearly doubled survival in pancreatic cancer in 2026, but on its own it holds the disease for months, not years. Trials are now testing it in combination with a second RAS drug and with chemotherapy, and earlier in the disease; the open questions are which combination, in which order, and what works when the tumour escapes.

Immunotherapy is often given for two years or until it stops working, but responses can last long after stopping. Trials that randomly assign responders to stop or continue would show whether the extra year is needed.

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.

Taking 250 mg of abiraterone with a low-fat breakfast gives the same PSA response and testosterone suppression as the standard 1,000 mg fasting, because food increases absorption several-fold, so a quarter of the drug treats each man. The label still says fasting and no company promotes the food-effect dose, so adoption is patchy.

Use a whole-body TROP2 scan instead of a single tissue stain to decide which patients get a TROP2 ADC, which one, and when to switch.

One RAS mutation can now be drugged because it offers a reactive handle. Most RAS mutations do not, so new chemistry is needed to grab other amino acids.

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

Half of rectal cancer patients given all their chemotherapy and radiotherapy first can keep their rectum. Nobody has ever randomised that against having the operation, so the trade-off between avoiding a stoma and the risk of the cancer regrowing is still guesswork.

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.

Immunotherapy antibodies stay active in the body for weeks, yet are often given every two or three weeks. After a few months, spacing doses out to every two or three months might work as well, with fewer hospital visits and much lower cost.

Stool transplants from immunotherapy responders have rescued some non-responders in melanoma. If defined bacterial cocktails work as well, every immunotherapy patient could get one.

If most tumours escape a drug by the same back-up route, blocking that route from the start may prevent resistance rather than chase it.

Almost every pancreatic cancer shares one of a handful of KRAS mutations. A pre-made vaccine against them could be given to every patient after surgery.

After pre-surgery chemotherapy leaves tumour behind, a blood test for tumour DNA triples the risk of distant relapse when positive. The one trial that acted on it found the DNA usually appeared too late. A trial that tests at surgery with a tumour-informed assay, escalates positives to an antibody-drug conjugate and observes negatives has not been run.

Two thirds of women treated on the KEYNOTE-522 regimen have no tumour left at surgery and about 92 percent of them are alive without relapse at five years, yet all receive nine more cycles of pembrolizumab. Trials are now testing whether the best responders can stop early, skip the anthracycline, or in lymphocyte-rich stage I tumours skip chemotherapy altogether.

The first lymph node cancer reaches is also where the immune system learns to fight it. Injecting immunotherapy into that node before surgery, instead of removing it blindly, may work better.

Bursting tumour cells with light releases their contents to the immune system; adding immunotherapy might turn a local treatment into a body-wide one.

Use immunotherapy to shrink liver cancer enough for a transplant, and find the safe gap between the last dose and surgery so the new liver is not rejected.

Three antibody-drug conjugates now used in triple-negative breast cancer carry the same kind of chemotherapy warhead, a topoisomerase inhibitor. Nobody has randomised which to give first or whether the second works after the first; small series suggest it often does not. With two now approved first line, the question decides what a patient gets for the rest of her life.

A randomised trial at Tata Memorial added nivolumab at 20 mg every three weeks, about one-twelfth of the standard dose, to cheap metronomic chemotherapy for head and neck cancer patients who could not afford full-dose immunotherapy, and they lived longer. Checkpoint inhibitors saturate their target far below approved doses, so publicly funded trials should test low doses in common cancers.

Track FGFR2 resistance mutations in blood and switch to the next-generation inhibitor that still covers them, before the scan shows progression.

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.

Rather than giving the same dose until the cancer grows, measure tumour DNA in blood every few weeks and let a validated algorithm raise, lower, pause or switch drugs to keep the cancer suppressed for longer.

Several studies found patients infused with checkpoint inhibitors earlier in the day lived longer. If a randomised trial confirms it, it is a free improvement available everywhere tomorrow.

Ninety-five percent of bowel cancers ignore immunotherapy. Combinations that heat the tumour up (targeted drugs, radiation, new checkpoints) are the main hope.

About one man in eight with prostate cancer that has spread carries an inherited DNA repair fault, and about one in five has one in the tumour. The drugs for those faults have moved to the beginning of treatment, but the test is still usually done near the end, when it is too late to use the result.

Academic hospitals can already make CAR-T cells for a fraction of the commercial price. A public network would scale that so more patients can be treated for less.

Use an ultra-sensitive blood test after two cycles to decide who needs more than R-CHOP and who can stop early.

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.

Giving a targeted drug in pulses rather than continuously might slow the emergence of resistant cells and reduce side effects. Early results are mixed, so this needs careful trials with clear rules for when to try it.

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.

Why it is pickedThe tools already exist (vaccines, cures, eradication) and the cancers they prevent are among the commonest in the world; the missing piece is coordinated delivery.

Most cancer drugs cannot cross into the brain. Combine ultrasound that briefly opens the barrier with drugs engineered to be carried across, and make this a standard platform for every brain tumour and brain metastasis.

Why it is pickedBrain tumours and brain metastases share one obstacle, the blood-brain barrier, so a platform that solves delivery once would serve several cancers at the same time.

Common gene variants shift a person's cancer risk several-fold. A one-time genetic score could tell each person when to start breast, bowel or prostate screening.

Why it is pickedA one-time genetic score could personalise the start of breast, bowel and prostate screening, so fewer tests find the same cancers earlier in the people most at risk.

Cheap old drugs such as aspirin, statins, metformin and beta-blockers show hints of cancer benefit but no company will pay for the trials. Create a public fund and a way to update their labels.

Why it is pickedCheap old drugs with hints of benefit go untested because nobody profits from the answer; a public fund and a label pathway fix the incentive rather than the science.

Some cancers reach the brain in up to a quarter of patients. Prevention trials could aim specifically at stopping that, instead of treating it once it has happened.

Why it is pickedPrevention trials aimed only at brain metastasis would attack the event patients fear most, and the idea already has trials and treatments linked to it.

Surgeons often cannot see where a tumour ends. Fluorescent dyes and AI-read imaging in the operating theatre can show them, cutting repeat operations. Make this routine everywhere.

Why it is pickedSurgeons cannot see where a tumour ends; fluorescence and AI-read imaging in the theatre cut repeat operations, and low-cost versions could travel to any hospital.

The wasting that kills many cancer patients has had no effective drug. New antibodies against GDF-15 restored weight in early trials. Combine them with exercise and nutrition and test properly.

Why it is pickedCachexia kills many patients and has had no effective drug; combining new GDF-15 antibodies with exercise and nutrition is a testable bundle for pancreatic and lung cancer.

Focused ultrasound, histotripsy, heat and electric-field ablation can destroy tumours without an incision, but each maker runs its own small study. Publicly-funded trials would compare them fairly against surgery.

Why it is pickedIncisionless ablation is tested maker by maker in small studies; device-agnostic public trials against surgery would settle whether it works and for whom.

Dozens of countries have no radiotherapy machine at all. Combine long-term finance with a machine designed to be cheap, robust and maintainable where power and engineers are scarce.

Why it is pickedDozens of countries have no radiotherapy machine at all; pairing long-term finance with a cheap, robust linac targets one of the widest treatment gaps on earth.

Radiotherapy is given to half of all cancer patients but few new drugs are tested alongside it. A permanent trial platform would test drug-plus-radiation pairs systematically.

Why it is pickedHalf of all patients receive radiotherapy but few new drugs are tested alongside it; a standing platform would test drug-plus-radiation pairs systematically.

Obesity raises the risk of 13 cancers, and GLP-1 weight-loss drugs are already in routine use for diabetes and obesity. Observational data hint that they cut obesity-related cancers but confounding is severe, so a randomised trial in adults aged 50 to 70 with a BMI of 30 or more should make cancer the primary outcome.

Why it is pickedGLP-1 drugs are already in routine use and observational data hint at fewer obesity-related cancers; only a randomised trial with cancer as the primary outcome can settle it.

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.

Why it is pickedMinimum unit pricing is already in force in Scotland and Wales, so measuring cancer incidence over the next decade costs little and answers a population-scale question.