The argument for screening programs in previvors with Li-Fraumeni syndrome.

Introduction: Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome caused by pathogenic/likely pathogenic germline TP53 variants. Core cancers include sarcomas, brain tumors, adrenocortical carcinoma and breast cancer. Surveillance with whole-body MRI (WBMRI) and other modalities is used for early cancer detection, regardless of the individual's personal cancer history. With the increasing use of diagnostic multigene panels in oncology, more diverse phenotypic presentations have emerged, and subsequent cascade testing identifies more asymptomatic cancer-free individuals - 'previvors.'

Areas covered: This review analyzes aspects of early cancer detection screening programs in asymptomatic germline TP53 variant carriers including current guidelines, specific founder variant populations, health economics and emerging strategies including liquid biopsies and wearable devices. A literature search with PubMed included publications in English until April 2025.

Expert opinion: Current guidelines recommend WBMRI in all LFS individuals, regardless of their prior cancer history, due to its demonstrated survival advantage. Guidelines for use of other modalities such as endoscopy, ultrasound or laboratory tests are less well-established. Therefore, longitudinal prospective studies including all these modalities and their cancer detection rates are needed. In the future, a one-size-fits-all approach toward surveillance will be replaced by more precise patient-centered tailor-made screening programs incorporating noninvasive methods.