Preparing for the Era of Multiple Primary Cancers: A Prevention-Centered Model for Survivorship Medicine

The number of cancer survivors is increasing rapidly, and the development of multiple primary cancers (MPCs) is becoming a foreseeable consequence of long-term survival. However, MPC detection remains fragmented. Clinical information is often scattered across institutions, and long-term follow-up is not always consistent. Early warning signs that appear outside oncology settings are also not always linked to a patient's prior cancer history. As the number of cancer survivors increases, these gaps can have important clinical consequences. This Perspective presents a prevention-centered framework that complements existing survivorship care by recognizing the development of MPCs as an expected event during long-term survivorship. I outline a framework integrating longitudinal genetic and multi-omics risk stratification with artificial intelligence-assisted risk modeling and interoperable health records for continuous monitoring. Extending surveillance beyond oncology clinics to settings such as emergency medicine, primary care, and dentistry, may help detect secondary malignancies earlier. Survivorship medicine should shift from episodic detection to more coordinated, lifelong prevention. Further studies are needed to evaluate this framework across diverse healthcare settings and to determine its potential to improve earlier detection and long-term outcomes for cancer survivors.