What if some people in the group that didn't get screening had fewer high-quality years? It might simply be that the last 5 years of life for people who are screened positive early on and who subsequently receive treatment is a better 5 years than the last 5 years of life for people who aren't screened positive early on and who subsequently have to undergo brutal hail mary treatments at the last minute.
Claiming that there are missing elements that could possibly turn the equation in favor of screening is cause for further research and analysis. You can't just claim that they fall in your favor; some diagnostic and exploratory processes due to false positives are painful and/or dangerous in and of themselves.
> What if
"What if" is right. You can't just conjure these people into existence to justify current policies, you have to find them and do the statistics.
1. You have an aggressive (i.e. non-treatable) cancer, maybe you feel slightly off, but you go on with your life, until you finally got worse and die. Or you performed screening, focus on treatment, bankrupt your family and ... die anyway,
2. You have a slow growing cancer (e.g. prostate), live your life and die of some other causes. Or you performed screening, got surgery, got tons of problems and die of myocardial infarction (yes, that's one of complications after prostate surgery).
If you read the original JAMA publication you would notice that there is a research on quality of life metric. That metric for breast cancer is higher among non-screened women.
If two statistical people both get cancer, one gets screened and potentially treated, and the other doesn't and they both live to 80, I would rather be the person that doesn't get treated.
A regular schedule of treatments is only better than a hail mary if you actually get more longevity from it, otherwise it's just more pain for the patient. At least with the hail mary, I only spend a short time feeling horrible before dying. This is most likely why doctors don't opt for treatment more than the average.
https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...
