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Three different ways a cancer stops killing someone: stop it before it starts, remove every last cell, or hold it in check for life. Each needs different technology.
Cure is not one goal. Interception prevents a cancer from forming or removes it while it is still precancerous. Eradication removes every malignant cell, which is what surgery plus adjuvant therapy already achieves in early disease and what cell therapy achieves in some leukaemias. Control converts advanced cancer into a managed chronic condition, which is what endocrine therapy in breast cancer and TKIs in CML already do for many patients.
Separating them matters because they have different endpoints, different evidence requirements, and different technologies. An interception vaccine needs decades of follow-up in healthy people; an eradication strategy needs a sensitive measure of residual disease; a control strategy needs sequencing, tolerability, and resistance management rather than depth of response.
HPV and hepatitis B vaccination, tobacco control, screening with removal of precancerous lesions, risk-reducing surgery in carriers, and tamoxifen or aspirin chemoprevention are the interventions that have measurably reduced incidence. Almost every future interception technology is competing against, or adding to, this list, and none of it is glamorous.
Shared-neoantigen vaccines in Lynch syndrome and BRCA carriers, multi-cancer blood tests, and breath analysis all aim to act before or at the very beginning of disease. The bar is high: a healthy person accepts risk today for a probabilistic benefit later, so safety must be near-perfect and trials must run for years with surrogate endpoints. A positive interception vaccine trial would be the single largest change on this roadmap.
Surgery with adjuvant systemic therapy cures a large fraction of early cancers; CAR-T and transplant cure a minority of advanced haematologic malignancies. What has changed is measurement: ctDNA-based residual disease testing turns 'we think it is gone' into a testable claim, and the first ctDNA-guided approval arrived in bladder cancer in 2026.
Micrometastatic disease is where alpha and Auger emitters, in situ vaccination, and logic-gated cell therapy should have their advantage, because each kills single cells rather than bulk. The pairing to watch is a sensitive residual-disease test that says who still has disease, and a single-cell-selective therapy that can clear it, which is the explicit design of several ongoing trials.
Endocrine therapy in hormone-driven breast cancer, androgen-pathway therapy in prostate cancer, BTK and BCL-2 inhibitors in CLL, and TKIs in CML already keep many people alive for years or decades. Control depends less on depth of response than on tolerability, sequencing, and managing resistance, which is why supportive care and cardio-oncology belong in this row.
If a cancer cannot be eradicated, the goal becomes keeping the sensitive clone dominant. Adaptive dosing, timing treatment to the body clock, payload switching guided by resistance biomarkers, and treating the host environment all aim at that. Cachexia therapy belongs here too: patients who keep weight and function tolerate more lines of treatment.
Every path above assumes measurement improves faster than the cancer adapts: interception needs a test that finds disease while it is still local, eradication needs one that proves nothing is left, control needs one that spots the resistant clone before it takes over. Technology that measures is therefore upstream of technology that treats, which is an unfashionable conclusion but the one the evidence supports.
Every era's records, trial outcomes and papers, and every watch item, as JSON.
Probability ranges are named estimates that the claim is borne out on roughly a five-year horizon. They are meant to be argued with: propose a revision with your name and reasoning via a pull request to src/data/confidence.ts.
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Shares Senolytics and senescence-directed therapy, Chronotherapy: timing treatment to the body clock, Auger-electron therapy, Breath and volatile-organic-compound detection.
Shares Chemoprevention & risk-reducing surgery, Hormonal therapy roadmap: removing the ovaries → tamoxifen → oral degraders switched by a blood test, Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers, Endocrine therapy (SERMs, AIs, SERDs).
Shares Off-the-shelf cancer vaccines, Chemoprevention & risk-reducing surgery, Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers, Germline (hereditary) testing.
Shares Risk-reducing and opportunistic salpingectomy, Chemoprevention & risk-reducing surgery, Germline (hereditary) testing.
Shares Senolytics and senescence-directed therapy, Continuous and near-continuous ctDNA monitoring, MRD / molecular residual disease testing, Small-molecule kinase inhibitors.
Shares Continuous and near-continuous ctDNA monitoring, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment, MRD / molecular residual disease testing.
Shares cfDNA fragmentomics, ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment, MRD / molecular residual disease testing.
Shares Cardio-oncology, Geriatric assessment, Exercise & lifestyle oncology.