8 ms·

Well, this is one side of the discussion. While I agree to some extent, the author should also answer the question whether he honestly thinks he would have been

Well, this is one side of the discussion. While I agree to some extent, the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast). You can of course take the stance that 90 years ago that cancer would have been misdiagnosed and left untreated and that 90 years ago he would have probably died of something else before that cancer would have got lethal. I personally rather prefer having the cancer cut out as soon as possible. Also some arguments are not honest. It's right that e.g. most dead men have some form of undiagnosed prostate cancer, which they didn't notice. But screening programs usually are not designed for e.g. 90 years old people for who it probably doesn't make that much of a difference whether an early stage cancer gets diagnosed. Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis.

hannob 7y ago
> Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis. You say "likely". But the problem is you don't have evidence. Noone has shown that these screening programs do have these benefits [1]. If they have I don't think anyone would argue with that. The tricky issue is: Actually showing the benefits of these screening programs is hard. It requires large-scale studies with longterm followup. It's expensive. But it nevertheless should be done. [1] https://www.bmj.com/content/352/bmj.h6080 https://www.bmj.com/content/352/bmj.h6080
- Retric 7y ago
  People have done studies like you propose, but long term studies always lag improvements in treatment. You can’t see 20 year mortality statistics for 2020’s cancer treatment options until 2040. CDC supports screening for breast, cervical, colorectal (colon), and lung cancers Screening for ovarian, pancreatic, prostate, testicular, and thyroid cancers has not been shown to reduce deaths from those cancers. The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for bladder cancer and oral cancer in adults without symptoms, and of visual skin examination by a doctor to screen for skin cancerexternal icon in adults. https://www.cdc.gov/cancer/dcpc/prevention/screening.htm https://www.cdc.gov/cancer/dcpc/prevention/screening.htm PS: Showing differences in overall mortality based on differences in treatment for an uncommon disease requires truly massive study’s. Failing to show a correlation is expected with noisy data and insufficient sample sizes.
  - stewbrew 7y ago
    The problem also is that diagnosis doesn't stop progressing. Today's opponents to cancer screening often argue with data from the 1990s. On the other hand proponents often refer to data of underpowered, badly designed trials. Also, there exists no real guideline as to what would be "sufficient evidence". How much better would the survival of screening participants would have to be? In exchange, how much pain may be inflicted on people who get false-positive results. This discussion is extremely difficult. And once you are in the situation that you or somebody close to you get's diagnosed with cancer, it becomes really difficult to deal with arguments like: "On average the whole population does not benefit from you having diagnosed your cancer early so that after some small surgery, you'll continue living as if nothing had happened."
throwawaylolx 7y ago
>the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast). No, the hypothetical situation in your question misses the gist of the article: the hypothetical situation should still be in present day but with much less funds having been spent on cancer research.
- stewbrew 7y ago
  You don't get good cancer diagnosis without funding. You don't get neoadjuvant therapies without funding.

hannob 7y ago

> Screening programs usually are for younger people who will most likely get old enough to benefit from an early diagnosis. You say "likely". But the problem is you don't have evidence. Noone has shown that these screening programs do have these benefits [1]. If they have I don't think anyone would argue with that. The tricky issue is: Actually showing the benefits of these screening programs is hard. It requires large-scale studies with longterm followup. It's expensive. But it nevertheless should be done. [1] https://www.bmj.com/content/352/bmj.h6080 https://www.bmj.com/content/352/bmj.h6080

Retric 7y ago
People have done studies like you propose, but long term studies always lag improvements in treatment. You can’t see 20 year mortality statistics for 2020’s cancer treatment options until 2040. CDC supports screening for breast, cervical, colorectal (colon), and lung cancers Screening for ovarian, pancreatic, prostate, testicular, and thyroid cancers has not been shown to reduce deaths from those cancers. The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening for bladder cancer and oral cancer in adults without symptoms, and of visual skin examination by a doctor to screen for skin cancerexternal icon in adults. https://www.cdc.gov/cancer/dcpc/prevention/screening.htm https://www.cdc.gov/cancer/dcpc/prevention/screening.htm PS: Showing differences in overall mortality based on differences in treatment for an uncommon disease requires truly massive study’s. Failing to show a correlation is expected with noisy data and insufficient sample sizes.
- stewbrew 7y ago
  The problem also is that diagnosis doesn't stop progressing. Today's opponents to cancer screening often argue with data from the 1990s. On the other hand proponents often refer to data of underpowered, badly designed trials. Also, there exists no real guideline as to what would be "sufficient evidence". How much better would the survival of screening participants would have to be? In exchange, how much pain may be inflicted on people who get false-positive results. This discussion is extremely difficult. And once you are in the situation that you or somebody close to you get's diagnosed with cancer, it becomes really difficult to deal with arguments like: "On average the whole population does not benefit from you having diagnosed your cancer early so that after some small surgery, you'll continue living as if nothing had happened."

throwawaylolx 7y ago

>the author should also answer the question whether he honestly thinks he would have been better off 90 years ago if some cancer got detected with him in, say, 2 weeks from now (such things usually happen really fast). No, the hypothetical situation in your question misses the gist of the article: the hypothetical situation should still be in present day but with much less funds having been spent on cancer research.

stewbrew 7y ago
You don't get good cancer diagnosis without funding. You don't get neoadjuvant therapies without funding.