Molecular indolence classifiers bundled with every screening programme
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.
Overdiagnosis in prostate, thyroid, breast (DCIS) and low-dose CT lung screening leads to unnecessary surgery and anxiety and is the main argument against expanding screening. Molecular and imaging classifiers of indolence (genomic classifiers in prostate cancer, DCIS risk scores, radiomic and growth-rate models for lung nodules, ctDNA fragmentomics) are emerging but not integrated into programmes. The proposal is that every screening programme develops, validates and deploys an indolence classifier with a surveillance-first protocol for low-risk findings, and reports overdiagnosis as a monitored quality metric.
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
- Most lethal cancers are found late · Screening exists for only a few cancers. Pancreatic, ovarian, liver, oesophageal and most lung cancers are found when cure is unlikely.
- Biomarkers are not validated or standardised · Tests that decide who gets a drug are often not validated prospectively and are measured differently in every lab.