4 ms·

'60s but yes. The last innovation was the invention of chemotherapy, which I won't tell you about since it's not very pleasant but you can find the whole thing

'60s but yes. The last innovation was the invention of chemotherapy, which I won't tell you about since it's not very pleasant but you can find the whole thing in 'Tripping Over The Truth' by Travis Christofferson. If you look around your an find lots of graphs like this: http://medicine-opera.com/wp-content/uploads/2012/07/cancer-death-rates-males-2011.jpg http://medicine-opera.com/wp-content/uploads/2012/07/cancer-... which show that rates haven't really changed since 1930, give or take. The variance you see in the graph is things like lots more people smoking then not smoking any more, the prevention methodology of either finding cancer early or preventing high-risk people (e.g. mastectomies). But the actual chance of death hasn't really changed. Compare and contrast to things like surviving anything else (heart attack, stroke and so on) and it's night-and-day.

noam87 10y ago
> The last innovation was the invention of chemotherapy. Um.. immune therapies, targeted genetic therapies, TIL therapies... all kind of a big deal. Sorry, you don't know what you're talking about. And rates say nothing about efficacy / quality of treatment. (And even when new treatments are not more effective, often the side effects are much milder (to non-existent): getting an extra three years sick and in pain, vs getting them as your normal self is a huge difference) Edit: what I mean by that is that rates of incidence say nothing about how effective the treatments are. It can both be true that rates are going up (say, due to air pollution) and that treatments are more effective. --- Reply to comment below: again, you are wrong. Jesus, stop. One example: Ipilimumab and PD-1 inhibitors have a ~20% effectiveness rate against melanoma, a cancer that was considered a sure death sentence just 15 years ago. Some patients have not had any recurrence in a decade, they seem cured, which was unheard of before. And targeted drugs like dabrafenib buy most patients an extra 6-18 months, almost side effect free. With more of these coming out, it seems like soon it'll be possible to cycle patients even longer (some combos already are known to extend their effect). This doesn't qualify as "major"? The ability to reprogram our immune system to kill cancer cells, or to reprogram pathways in faulty cells?
- SteveCoast 10y ago
  I'm sorry I should have said the last _major_ innovation that made any difference. All the things you mention are innovations, they just haven't really changed average mortality numbers, which is what I care about. Edit: the parent post changed their argument to being about 'efficacy' or quality of care. Personally, I prefer a cure to a high-quality and effective 3 months in hospital then death. Thus I focus on the mortality statistics. Edit again: quote: > This doesn't qualify as "major"? The ability to reprogram our immune system to kill cancer cells, or to reprogram pathways in faulty cells? I'd define major as some large change to average mortality from cancer. The same way heart attacks are now vastly more survivable, or we don't get them in the first place. For example, in another comment, someone linked to the NIH's numbers https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=75 https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid... They show from 1975 to 2007 incidence of cancer going from 400 per 100k to 461 (e.g. up). I'd define a major improvement as that going to 200 or 100 per 100k people (e.g. down). The 5-year survivability has gone up for the same reason incidence went up, early detection. Yes, there are specific therapies that improve things 20% here or there for certain very targeted groups. I hope I am in one of those groups if I ever get cancer, but again the averages haven't changed much at all, especially when compared to other chronic disease.
hyperpape 10y ago
Are you sure that graph shows what you're saying? Say overall lifespans increase, and several other causes of death decline (infectious diseases, preventable accidents), and most cancers hit people who are older. Then you'd have more people getting cancer, which means that stable death rates imply that people are surviving longer while they have cancer. Am I confused?
- SteveCoast 10y ago
  I think that's a fair interpretation but that we can make others. It was just the nicest looking of the graphs I found on google images for 'cancer mortality over time' or some query like that. The central point I'm trying to make, which was a surprise to me as much as others, is that there hasn't been some dramatic decline in cancer like I expected. If you look at graphs for other things we see amazing gains in prevention and treatment that don't particularly occur in cancer. To pick one at random, the pancreatic cancer line on the graph above is basically flat. And so, if it isn't changing a whole lot, why is that? The standard theory is that cancer is really complicated and it's DNA. The alternative theory is that it's the mitochondria(l DNA). I'm not in some crusade against medicine, it just seems to make more sense to me and explains the lack of progress. As Feynman said, the easiest person to fool is yourself, so who knows, maybe I'm wrong. But then I also worry about the story of the doctor who invented washing hands between procedures, and the story of the doctor who discovered the cause of stomach ulcers.
  - sergiosgc 10y ago
    > To pick one at random, the pancreatic cancer line on the graph above is basically flat. Pancreatic cancer mortality is heavily correlated with age. What happened is that people now live longer, and when older people get pancreatic cancer, they have a lot more probability to die. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer/mortality#heading-One http://www.cancerresearchuk.org/health-professional/cancer-s...

noam87 10y ago

> The last innovation was the invention of chemotherapy. Um.. immune therapies, targeted genetic therapies, TIL therapies... all kind of a big deal. Sorry, you don't know what you're talking about. And rates say nothing about efficacy / quality of treatment. (And even when new treatments are not more effective, often the side effects are much milder (to non-existent): getting an extra three years sick and in pain, vs getting them as your normal self is a huge difference) Edit: what I mean by that is that rates of incidence say nothing about how effective the treatments are. It can both be true that rates are going up (say, due to air pollution) and that treatments are more effective. --- Reply to comment below: again, you are wrong. Jesus, stop. One example: Ipilimumab and PD-1 inhibitors have a ~20% effectiveness rate against melanoma, a cancer that was considered a sure death sentence just 15 years ago. Some patients have not had any recurrence in a decade, they seem cured, which was unheard of before. And targeted drugs like dabrafenib buy most patients an extra 6-18 months, almost side effect free. With more of these coming out, it seems like soon it'll be possible to cycle patients even longer (some combos already are known to extend their effect). This doesn't qualify as "major"? The ability to reprogram our immune system to kill cancer cells, or to reprogram pathways in faulty cells?

SteveCoast 10y ago
I'm sorry I should have said the last _major_ innovation that made any difference. All the things you mention are innovations, they just haven't really changed average mortality numbers, which is what I care about. Edit: the parent post changed their argument to being about 'efficacy' or quality of care. Personally, I prefer a cure to a high-quality and effective 3 months in hospital then death. Thus I focus on the mortality statistics. Edit again: quote: > This doesn't qualify as "major"? The ability to reprogram our immune system to kill cancer cells, or to reprogram pathways in faulty cells? I'd define major as some large change to average mortality from cancer. The same way heart attacks are now vastly more survivable, or we don't get them in the first place. For example, in another comment, someone linked to the NIH's numbers https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=75 https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid... They show from 1975 to 2007 incidence of cancer going from 400 per 100k to 461 (e.g. up). I'd define a major improvement as that going to 200 or 100 per 100k people (e.g. down). The 5-year survivability has gone up for the same reason incidence went up, early detection. Yes, there are specific therapies that improve things 20% here or there for certain very targeted groups. I hope I am in one of those groups if I ever get cancer, but again the averages haven't changed much at all, especially when compared to other chronic disease.

hyperpape 10y ago

Are you sure that graph shows what you're saying? Say overall lifespans increase, and several other causes of death decline (infectious diseases, preventable accidents), and most cancers hit people who are older. Then you'd have more people getting cancer, which means that stable death rates imply that people are surviving longer while they have cancer. Am I confused?

SteveCoast 10y ago
I think that's a fair interpretation but that we can make others. It was just the nicest looking of the graphs I found on google images for 'cancer mortality over time' or some query like that. The central point I'm trying to make, which was a surprise to me as much as others, is that there hasn't been some dramatic decline in cancer like I expected. If you look at graphs for other things we see amazing gains in prevention and treatment that don't particularly occur in cancer. To pick one at random, the pancreatic cancer line on the graph above is basically flat. And so, if it isn't changing a whole lot, why is that? The standard theory is that cancer is really complicated and it's DNA. The alternative theory is that it's the mitochondria(l DNA). I'm not in some crusade against medicine, it just seems to make more sense to me and explains the lack of progress. As Feynman said, the easiest person to fool is yourself, so who knows, maybe I'm wrong. But then I also worry about the story of the doctor who invented washing hands between procedures, and the story of the doctor who discovered the cause of stomach ulcers.
- sergiosgc 10y ago
  > To pick one at random, the pancreatic cancer line on the graph above is basically flat. Pancreatic cancer mortality is heavily correlated with age. What happened is that people now live longer, and when older people get pancreatic cancer, they have a lot more probability to die. http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer/mortality#heading-One http://www.cancerresearchuk.org/health-professional/cancer-s...