5 ms·

> No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life. Prostate

> No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life. Prostate cancer is considered one of the most treatable forms of cancer. It's lethal if not treated. But given the proper intervention, a person can live for literally years (if not decades). The treatment isn't fun, but it's very effective, and most people consider it better than, you know, death. As of a few years ago, the survival rate for people with prostate cancer was over 90% in the US. People are actually more likely to die from an unrelated cause than they are to die from prostate cancer after treatment. The UK, on the other hand, has an abysmal track record of treating prostate cancer - worse than every other OECD country, in fact. As of a few years ago, the survival rate was barely more than 50%. That is shameful , and it's ridiculous to dismiss that as "overdiagnosis".

DanBC 8y ago
Buit this is the point: The US appears to have better 5 year survival rates for prostate cancer because they massively over diagnos cancers thatwould otherwise not kill the patient. Once you've detected these cancers you don't need to provide any treatment at all, your 5 year survival rates increase. But when you do treat all these men you significantly decrease the quality of life for many of them without providing any benefit. https://academic.oup.com/jnci/article/94/13/981/2519795 https://academic.oup.com/jnci/article/94/13/981/2519795 > Background: Overdiagnosis of clinically insignificant prostate cancer is considered a major potential drawback of prostate-specific antigen (PSA) screening. Quantitative estimates of the magnitude of this problem are, however, lacking. We estimated rates of prostate cancer overdiagnosis due to PSA testing that are consistent with the observed incidence of prostate cancer in the United States from 1988 through 1998. Overdiagnosis was defined as the detection of prostate cancer through PSA testing that otherwise would not have been diagnosed within the patient's lifetime. > Methods: We developed a computer simulation model of PSA testing and subsequent prostate cancer diagnosis and death from prostate cancer among a hypothetical cohort of two million men who were 60–84 years old in 1988. Given values for the expected lead time—that is, the time by which the test advanced diagnosis—and the expected incidence of prostate cancer in the absence of PSA testing, the model projected the increase in population incidence of prostate cancer associated with PSA testing. By comparing the model-projected incidence with the observed incidence derived from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry data, we determined the lead times and corresponding overdiagnosis rates that were consistent with the observed data. > Results: SEER data on prostate cancer incidence from 1988 through 1998 were consistent with overdiagnosis rates of approximately 29% for whites and 44% for blacks among men with prostate cancers detected by PSA screening. > Conclusions: Among men with prostate cancer that would be detected only at autopsy, these rates correspond to overdiagnosis rates of, at most, 15% in whites and 37% in blacks. The observed trends in prostate cancer incidence are consistent with considerable overdiagnosis among PSA-detected cases. However, the results suggest that the majority of screen-detected cancers diagnosed between 1988 and 1998 would have presented clinically and that only a minority of cases found at autopsy would have been detected by PSA testing. That's a lot of people being put through unpleasant surgery that has considerable side effects for no benefit. See also this: https://scienceblog.cancerresearchuk.org/2018/03/06/overdiagnosis-when-finding-cancer-can-do-more-harm-than-good/ https://scienceblog.cancerresearchuk.org/2018/03/06/overdiag...
- chimeracoder 8y ago
  > Buit this is the point: The US appears to have better 5 year survival rates for prostate cancer because they massively over diagnos cancers thatwould otherwise not kill the patient. The methodology of that study is highly suspect, but even if we took it at face value - the magnitude of the effect that they propose is nowhere near enough to explain the difference in survival rates by overdiagnosis alone. It's a drop in the bucket.

DanBC 8y ago

Buit this is the point: The US appears to have better 5 year survival rates for prostate cancer because they massively over diagnos cancers thatwould otherwise not kill the patient. Once you've detected these cancers you don't need to provide any treatment at all, your 5 year survival rates increase. But when you do treat all these men you significantly decrease the quality of life for many of them without providing any benefit. https://academic.oup.com/jnci/article/94/13/981/2519795 https://academic.oup.com/jnci/article/94/13/981/2519795 > Background: Overdiagnosis of clinically insignificant prostate cancer is considered a major potential drawback of prostate-specific antigen (PSA) screening. Quantitative estimates of the magnitude of this problem are, however, lacking. We estimated rates of prostate cancer overdiagnosis due to PSA testing that are consistent with the observed incidence of prostate cancer in the United States from 1988 through 1998. Overdiagnosis was defined as the detection of prostate cancer through PSA testing that otherwise would not have been diagnosed within the patient's lifetime. > Methods: We developed a computer simulation model of PSA testing and subsequent prostate cancer diagnosis and death from prostate cancer among a hypothetical cohort of two million men who were 60–84 years old in 1988. Given values for the expected lead time—that is, the time by which the test advanced diagnosis—and the expected incidence of prostate cancer in the absence of PSA testing, the model projected the increase in population incidence of prostate cancer associated with PSA testing. By comparing the model-projected incidence with the observed incidence derived from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry data, we determined the lead times and corresponding overdiagnosis rates that were consistent with the observed data. > Results: SEER data on prostate cancer incidence from 1988 through 1998 were consistent with overdiagnosis rates of approximately 29% for whites and 44% for blacks among men with prostate cancers detected by PSA screening. > Conclusions: Among men with prostate cancer that would be detected only at autopsy, these rates correspond to overdiagnosis rates of, at most, 15% in whites and 37% in blacks. The observed trends in prostate cancer incidence are consistent with considerable overdiagnosis among PSA-detected cases. However, the results suggest that the majority of screen-detected cancers diagnosed between 1988 and 1998 would have presented clinically and that only a minority of cases found at autopsy would have been detected by PSA testing. That's a lot of people being put through unpleasant surgery that has considerable side effects for no benefit. See also this: https://scienceblog.cancerresearchuk.org/2018/03/06/overdiagnosis-when-finding-cancer-can-do-more-harm-than-good/ https://scienceblog.cancerresearchuk.org/2018/03/06/overdiag...

chimeracoder 8y ago
> Buit this is the point: The US appears to have better 5 year survival rates for prostate cancer because they massively over diagnos cancers thatwould otherwise not kill the patient. The methodology of that study is highly suspect, but even if we took it at face value - the magnitude of the effect that they propose is nowhere near enough to explain the difference in survival rates by overdiagnosis alone. It's a drop in the bucket.