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Not convinced the Grail approach is safe and effective for low-risk cohorts given the false-positive rate. Follow-up diagnostics are not risk-free.

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The non-invasive followup for people with positive test results would knock out a lot of the false-positives. At least, thats what I understand of "the usual result of a positive test result for a serious illness, is that a repeat test does not confirm it"

That said, at what level of risk of follow up diagnostic would you baulk? Any procedure which requires a general is bad news, and if you are over 70 its a lot more bad.

Their advertised sensitivity and specificity put them in the ballpark of what other liquid biopsies advertise. The ones I know of target high-risk cohorts where the benefits of other screenings already outweigh the risks of taking them. It doesn't make sense for the average person to be getting periodic full chest CT scans for instance, but it might for a decades-long smoker.

Sure, that's a concern. But for screenings like this the ultimate metric is all-cause mortality (perhaps adjusted for costs and quality of life). It will take several years before we have a clear signal on that.

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