11 ms·

Utterly wrong. You are conflating current technology like MRIs and CT scans that only detect lumps, to blood tests that detect CANCER. Yes, if every lump were

Utterly wrong. You are conflating current technology like MRIs and CT scans that only detect lumps, to blood tests that detect CANCER. Yes, if every lump were treated and excised then it would be problematic. But CANCER is different. The only cancer that you might be able to leave alone is prostate because it grows so slowly. Everything else is a risk. And if we can treat cancer at early stage 1, then maybe people won’t be as afraid of it because it has such a high rate of cure. We don’t know that until we do it.

TaupeRanger 5y ago
You say "utterly wrong" and yet you clearly have no idea what you're talking about and have never even approached the field of health policy. Screening has to PROVE that it makes people live longer or better, just like any other intervention. It is not the case that screening is automatically good, otherwise we would be giving 20 year olds colonoscopies. Just because you find something, doesn't mean you've helped the patient, as anyone with a modicum of understanding in this field knows. Read this and learn something: https://www.bmj.com/content/352/bmj.h6080 https://www.bmj.com/content/352/bmj.h6080
- plank_time 5y ago
  We don’t give colonoscopies to 20 years olds because it’s an expensive, invasive test with a low rate of cancer. We don’t give mammograms to under 40 year olds these days because the same and it’s notoriously inaccurate. We give blood glucose level tests and cholesterol tests to everyone every year at the physical because they are cheap and easy to administer. Even though the effects of both may take decades to have any effect and have no correlation to ultimate death. It’s about trade off of cost and convenience. If you detect pancreatic or colon cancer in a 20 year old patient via $1 blood test, that is immediately actionable. Cancer is ALWAYS actionable unless you’re talking about prostrate which grows slowly. But even in a 20 year old, you would want to treat that but maybe not a 70 year old. And we’ve never had the ability to detect stage 1 cancer of the deadliest types of cancer. Imagine the new treatments that might save lives if we could. Honestly, the number of people here who think they know better and citing unrelated research is bordering on anti-maskers parroting the surgeon general saying masks don’t work when they do.
  - rwmj 5y ago
    But this isn't the argument. The argument is about all the false positives you get when you mass-screen everyone. All those people then need to be further examined, overwhelming the medical system and causing distress for the individuals (who are, remember, perfectly well). I agree if we had a test that was 100% accurate (literally never gave a false result either way), only detected dangerous cancers, and cost $1 then that would be a game-changer, but the screening and tests so far are not that.
  - rackjack 5y ago
    > It correctly identified when cancer was present in 51.5% of cases, across all stages of the disease, and wrongly detected cancer in only 0.5% of cases. If all 300 million Americans get blood tested each year, that is 1 and a half MILLION people who are falsely told they have CANCER. One and a half MILLION people whose life gets turned upside down, WRONGLY, due to a blood test -- at least, until they take a second one. Or a third one. Or maybe they get unlucky never learn they don't have cancer, and mess up their life treating a disease they don't have. Now, OBVIOUSLY not all 300 million Americans are going to get tested each year. But you are completely ignoring the ethical concerns surrounding telling literally .5% of those who don't have cancer that they have cancer, and the non-insignificant proportion of people who will never learn they don't have cancer (we NEED to consider even the "miniscule" probabilities at this scale), and that makes you seem like somebody who "think[s] they know better".
    - JumpCrisscross 5y ago
      > One and a half MILLION people whose life gets turned upside down, WRONGLY, due to a blood test Culture adapts. Getting a cancer diagnosis today is a huge deal because testing is infrequent, usually in response to a problem, and the diagnosis tends to be late and accurate. If 1.5mm healthy people get a false positive every year, the general response will be stress until a second test confirms a false positive. The lack of public trust in health policy doctrine, and the support for start-ups that can operate outside those channels, comes in large part from this type of thinking.
      - 5y ago
- bluGill 5y ago
  That this test is approved implies that it to some extent at least makes people live longer. There are a number of cancers that are easily treatable in stage one - but they have no symptoms then, and so often kill people because by the time it is discovered it is too late. False positives are a concern, but one that is manageable. People should get regular checkups, if something comes up we just do more testing as needed.
  - rwmj 5y ago
    It's approved to be rolled out to a medical trial. You can read what the journal says here: https://www.annalsofoncology.org/article/S0923-7534(21)02046-9/fulltext https://www.annalsofoncology.org/article/S0923-7534(21)02046...
    - bluGill 5y ago
      I'll stand corrected. Though that makes this discussion completely worthless - without trial results we have no idea if it is a useful test. Once we have those results we will know something about how useful/useless might be.
- jcims 5y ago
  Your replies to folks in this thread contain the same hubris as the content of your message, which in turn is consistent with the hubris I've encountered in the medical community over the past five years. My wife went to urgent care twice in three months because of a pain in her side. She was turned away with cough medicine. She finally went to the ER where a CT scan revealed massive tumors in her abdomen that had gone undetected for likely years. Genetic and semi-annual CA125 screening could yield quite a few false positives, but combined with her physical symptoms she may have had more cause to press at an incomplete conclusion and possibly could have had a different outcome. She underwent nearly $2M in medical procedures over the course of 26 months and died at 45 years old last year. A few years prior to that I was spring cleaning one day and found a glucose test kit at the house. I had the whole family test their blood glucose. My youngest was 240mg/dL. We waited a day and tested again, same thing. We took her into the hospital and they actually admitted her for two days because they had no idea what to do with a child presenting with Type 1 diabetes that hadn't gone into full DKA. That's harmful, gross, and embarrassing. And this is a major children's hospital that was recently in the top ten in the nation for endocrinology. In both of these situations, preventative screening could have or did have positive outcomes. I don't disagree with the effect that has been observed, but the conclusion being drawn from it is revolting to me. People should be permitted to make their own decisions about their level of knowledge of the state of their body. We only get one trip as far as we know, and I just find it unacceptable that people are willing to categorically deny diagnostic technology or bemoan its development because they they don't know how to support people trying to navigate the information it brings.
  - plank_time 5y ago
    Exactly. Also my sincerest condolences to you and your family. The level of arrogance in these responses parroting what they’ve read in a paragraph online approaches that with what we saw early in the pandemic with masks. “Masks don’t work! Fauci said so!” And the level of confidence they said it was shocking along with the self-righteousness. Yes, maybe people can’t put on N95 masks properly... but maybe we can teach them? Is that so mind blowing? We teach people how to wash hands for 20 seconds, is it not so hard to believe you can’t teach people to wear masks properly? Maybe make masks that are easier to put on? It’s sad how people with no vision are Karen’ing people to not think ahead or think of the future. It’s scary that it’s happening on hacker news.
deleted 5y ago
[deleted]
fnord77 5y ago
cells turn cancerous all the time and usually the body eliminates them without issue. this blood test is still going to hit all sorts of "false" positives, where it detects some cell that has gone cancerous that would have been eliminated anyway.
- jghn 5y ago
  I'm far from expert but I don't think this would be a large concern. My understanding of CTCs (circulating tumor cells) is that they are shed by a growing tumor. A random weird cell doesn't seem likely to be turned up in a test like this. You need some amount of quantity to set off the proverbial alarm bells
fortran77 5y ago
My father died from metastasized prostate cancer.
ska 5y ago
> ke MRIs and CT scans that only detect lumps, to blood tests that detect CANCER. You mean like the PSA test? It's pretty bad, in the scale of these things. It's used because there isn't a better screen, not because it is more specific.

TaupeRanger 5y ago

You say "utterly wrong" and yet you clearly have no idea what you're talking about and have never even approached the field of health policy. Screening has to PROVE that it makes people live longer or better, just like any other intervention. It is not the case that screening is automatically good, otherwise we would be giving 20 year olds colonoscopies. Just because you find something, doesn't mean you've helped the patient, as anyone with a modicum of understanding in this field knows. Read this and learn something: https://www.bmj.com/content/352/bmj.h6080 https://www.bmj.com/content/352/bmj.h6080

plank_time 5y ago
We don’t give colonoscopies to 20 years olds because it’s an expensive, invasive test with a low rate of cancer. We don’t give mammograms to under 40 year olds these days because the same and it’s notoriously inaccurate. We give blood glucose level tests and cholesterol tests to everyone every year at the physical because they are cheap and easy to administer. Even though the effects of both may take decades to have any effect and have no correlation to ultimate death. It’s about trade off of cost and convenience. If you detect pancreatic or colon cancer in a 20 year old patient via $1 blood test, that is immediately actionable. Cancer is ALWAYS actionable unless you’re talking about prostrate which grows slowly. But even in a 20 year old, you would want to treat that but maybe not a 70 year old. And we’ve never had the ability to detect stage 1 cancer of the deadliest types of cancer. Imagine the new treatments that might save lives if we could. Honestly, the number of people here who think they know better and citing unrelated research is bordering on anti-maskers parroting the surgeon general saying masks don’t work when they do.
- rwmj 5y ago
  But this isn't the argument. The argument is about all the false positives you get when you mass-screen everyone. All those people then need to be further examined, overwhelming the medical system and causing distress for the individuals (who are, remember, perfectly well). I agree if we had a test that was 100% accurate (literally never gave a false result either way), only detected dangerous cancers, and cost $1 then that would be a game-changer, but the screening and tests so far are not that.
- rackjack 5y ago
  > It correctly identified when cancer was present in 51.5% of cases, across all stages of the disease, and wrongly detected cancer in only 0.5% of cases. If all 300 million Americans get blood tested each year, that is 1 and a half MILLION people who are falsely told they have CANCER. One and a half MILLION people whose life gets turned upside down, WRONGLY, due to a blood test -- at least, until they take a second one. Or a third one. Or maybe they get unlucky never learn they don't have cancer, and mess up their life treating a disease they don't have. Now, OBVIOUSLY not all 300 million Americans are going to get tested each year. But you are completely ignoring the ethical concerns surrounding telling literally .5% of those who don't have cancer that they have cancer, and the non-insignificant proportion of people who will never learn they don't have cancer (we NEED to consider even the "miniscule" probabilities at this scale), and that makes you seem like somebody who "think[s] they know better".
  - JumpCrisscross 5y ago
    > One and a half MILLION people whose life gets turned upside down, WRONGLY, due to a blood test Culture adapts. Getting a cancer diagnosis today is a huge deal because testing is infrequent, usually in response to a problem, and the diagnosis tends to be late and accurate. If 1.5mm healthy people get a false positive every year, the general response will be stress until a second test confirms a false positive. The lack of public trust in health policy doctrine, and the support for start-ups that can operate outside those channels, comes in large part from this type of thinking.
    - 5y ago
bluGill 5y ago
That this test is approved implies that it to some extent at least makes people live longer. There are a number of cancers that are easily treatable in stage one - but they have no symptoms then, and so often kill people because by the time it is discovered it is too late. False positives are a concern, but one that is manageable. People should get regular checkups, if something comes up we just do more testing as needed.
- rwmj 5y ago
  It's approved to be rolled out to a medical trial. You can read what the journal says here: https://www.annalsofoncology.org/article/S0923-7534(21)02046-9/fulltext https://www.annalsofoncology.org/article/S0923-7534(21)02046...
  - bluGill 5y ago
    I'll stand corrected. Though that makes this discussion completely worthless - without trial results we have no idea if it is a useful test. Once we have those results we will know something about how useful/useless might be.
jcims 5y ago
Your replies to folks in this thread contain the same hubris as the content of your message, which in turn is consistent with the hubris I've encountered in the medical community over the past five years. My wife went to urgent care twice in three months because of a pain in her side. She was turned away with cough medicine. She finally went to the ER where a CT scan revealed massive tumors in her abdomen that had gone undetected for likely years. Genetic and semi-annual CA125 screening could yield quite a few false positives, but combined with her physical symptoms she may have had more cause to press at an incomplete conclusion and possibly could have had a different outcome. She underwent nearly $2M in medical procedures over the course of 26 months and died at 45 years old last year. A few years prior to that I was spring cleaning one day and found a glucose test kit at the house. I had the whole family test their blood glucose. My youngest was 240mg/dL. We waited a day and tested again, same thing. We took her into the hospital and they actually admitted her for two days because they had no idea what to do with a child presenting with Type 1 diabetes that hadn't gone into full DKA. That's harmful, gross, and embarrassing. And this is a major children's hospital that was recently in the top ten in the nation for endocrinology. In both of these situations, preventative screening could have or did have positive outcomes. I don't disagree with the effect that has been observed, but the conclusion being drawn from it is revolting to me. People should be permitted to make their own decisions about their level of knowledge of the state of their body. We only get one trip as far as we know, and I just find it unacceptable that people are willing to categorically deny diagnostic technology or bemoan its development because they they don't know how to support people trying to navigate the information it brings.
- plank_time 5y ago
  Exactly. Also my sincerest condolences to you and your family. The level of arrogance in these responses parroting what they’ve read in a paragraph online approaches that with what we saw early in the pandemic with masks. “Masks don’t work! Fauci said so!” And the level of confidence they said it was shocking along with the self-righteousness. Yes, maybe people can’t put on N95 masks properly... but maybe we can teach them? Is that so mind blowing? We teach people how to wash hands for 20 seconds, is it not so hard to believe you can’t teach people to wear masks properly? Maybe make masks that are easier to put on? It’s sad how people with no vision are Karen’ing people to not think ahead or think of the future. It’s scary that it’s happening on hacker news.

deleted 5y ago

[deleted]

fnord77 5y ago

cells turn cancerous all the time and usually the body eliminates them without issue. this blood test is still going to hit all sorts of "false" positives, where it detects some cell that has gone cancerous that would have been eliminated anyway.

jghn 5y ago
I'm far from expert but I don't think this would be a large concern. My understanding of CTCs (circulating tumor cells) is that they are shed by a growing tumor. A random weird cell doesn't seem likely to be turned up in a test like this. You need some amount of quantity to set off the proverbial alarm bells

fortran77 5y ago

My father died from metastasized prostate cancer.

ska 5y ago

> ke MRIs and CT scans that only detect lumps, to blood tests that detect CANCER. You mean like the PSA test? It's pretty bad, in the scale of these things. It's used because there isn't a better screen, not because it is more specific.