Sure, of course you would make practical decisions about what kinds of tests to administer, and not proactively administer the tests that have significant negative side effects.
For the other point, personally I don’t really buy the argument of “it’s better not to know you have cancer X, because it might end up being low impact.” If we had excellent regular screening, yes detection of low impact cancers would become a lot more common, but I think people’s perception of them would change too. If it became a common thing for cancers to be detected, but the detection could reliably say “this is likely low impact, we should just keep an eye on it but not treat it”, this would be a lot less scary. It would become normalized IMO. Cancer diagnoses are partly so scary right now because we’re often mostly catching cancers that have progressed and are causing symptoms, so the public perception is rightly “cancer diagnosis = very scary.”
> Sure, of course you would make practical decisions about what kinds of tests to administer, and not proactively administer the tests that have significant negative side effects.
The harm is from investigating the screening test result and not the test itself.
> If it became a common thing for cancers to be detected, but the detection could reliably say “this is likely low impact, we should just keep an eye on it but not treat it”, this would be a lot less scary
This is already the case for some like prostate cancer and certain lymphomas.
> Cancer diagnoses are partly so scary right now because we’re often mostly catching cancers that have progressed and are causing symptoms
The most aggressive cancers are also the least likely ones to be diagnosed by screening due to growth rates, screening intervals and diagnostic test limitations.
The harm can be from the initial screening too. The lifetime risk for complications from routine colonoscopy is around 1.6%. The lifetime risk of colo-rectal cancer is 4-5%.
So already before investigating the result, there's a very real consideration whether increasing the number of colonoscopies is likely to be a net benefit.
Colonoscopy is confusing because it is both screening and diagnostic/investigating.
Most if not all of the complication/risk (perforation and major bleeding being the ones of note) is from the polypectomy / biopsy part of the colonoscopy.
The path to being able to say "low impact, don't worry" will be quite rocky and possibly involve a lot of painful treatment for patients. If you have a very different detection surface, you would not initially know what is all low impact, for example.
For the other point, personally I don’t really buy the argument of “it’s better not to know you have cancer X, because it might end up being low impact.” If we had excellent regular screening, yes detection of low impact cancers would become a lot more common, but I think people’s perception of them would change too. If it became a common thing for cancers to be detected, but the detection could reliably say “this is likely low impact, we should just keep an eye on it but not treat it”, this would be a lot less scary. It would become normalized IMO. Cancer diagnoses are partly so scary right now because we’re often mostly catching cancers that have progressed and are causing symptoms, so the public perception is rightly “cancer diagnosis = very scary.”