That's generally exactly what we do, which if we need to follow 2x or 10x incidental lesions in the population, leads to cost and availability problems. A lymphoma patient in remission needs follow up scans too, and I don't want them to have to wait 3 months because thousands of people are now following up their benign adrenal adenomas.

This is definitely a part of standard follow up for small findings and part of the guidance for incidentally detected lung nodules smaller than <8mm.

I think mammography is a great example. Many people are quite surprised to hear that the Positive Predictive Value of a screening mammography is only in 10-15% range. This despite mammography being a pretty sensitive test. This is because despite good test performance characteristics, applied across a large population of relatively health people, the 2-5% false positive rate is a large number of people.

Statistically overdetection leads to poorer outcomes because interventions have a risk as well. That's why everyone doesn't get a yearly full body CT scan, for example. The current guidelines are based on optimizing for maximum good, and believe it or not some things are best not known about because the risk of dying from it is about the same as the risk of the treatment.

Because people discovering "Incidentalomas" will be too freaked out to wait "just to see how things develop".

Cost, time, and for things like CT's, trying to limit your radiation exposure