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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

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.
  - rackjack 5y ago
    > 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. Getting a cancer diagnosis is a "huge deal" because getting cancer is one of the worst experiences a human can go through. Getting cancer carries the weight of imminent death, obviously. But some cancers can be cured with high survival rate, so what's the big deal? The deal is that these cures are often brutal chemotherapy or radiotherapy or whatever treatments that destroy your body, your sleep, your appetite, your ability to go to the bathroom yourself, your ability to do chores by yourself, your ability to do anything a normal human being can do. They DESTROY you. THAT'S the "huge deal". NOT the frequency. Cancer RUINS YOUR LIFE for the period you get treated, IF you survive the treatment at all, let ALONE the cancer. And you are proposing we tell sub-1.5 million people EACH YEAR that they might have to go through that, while STILL ignoring the proportion of the population that will never learn they have a false positive because they got unlucky (which, AGAIN, we need to consider, since even miniscule probabilities matter at this scale.) So until the day we figure out a way to make getting rid of cancer as easy as popping a pill (we're getting closer thanks to gene therapy, but patients may still receive the destructive treatments in the meantime), culture will not "adapt", it will remain a "huge deal", and we will keep "this type of thinking".
    - JumpCrisscross 5y ago
      > these cures are often brutal Heart disease is a huge deal. It ruins your life. (Maybe not in all caps.) Nevertheless, we regularly test for it, including with techniques with high rates of false positives. Few panic because almost everyone knows someone who got a false positive and didn't promptly keel over and die. If healthy adults are screened for cancer, there will be cultural memory of people who got a false positive. The response to a positive test result won't be chemo. It will be further testing, if non-invasive, or suggestions of lifestyle changes and increased monitoring of the suspected system. People aren't too stupid to understand an early test with a high false positive rate. People with family histories of cancer don't wake up every morning screaming. Some may. But barring everyone because some people will overreact is why orthodox health policy is losing public trust.
fortran77 5y ago
My father died from metastasized prostate cancer.
tnel77 5y ago
For every genuinely smart person on HN, there’s a handful of Google warriors who hardly know what they are talking about. I guess that’s not unique to HN, but it can be aggravating just how many commenters can be so “know-it-all” with their comments.
- TaupeRanger 5y ago
  Try making an actual argument rather than simply attacking the attitude or character of the person you're responding to.
  - tnel77 5y ago
    I was trying to agree with a comment I saw, but it appears I replied to the wrong comment.

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.
- rackjack 5y ago
  > 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. Getting a cancer diagnosis is a "huge deal" because getting cancer is one of the worst experiences a human can go through. Getting cancer carries the weight of imminent death, obviously. But some cancers can be cured with high survival rate, so what's the big deal? The deal is that these cures are often brutal chemotherapy or radiotherapy or whatever treatments that destroy your body, your sleep, your appetite, your ability to go to the bathroom yourself, your ability to do chores by yourself, your ability to do anything a normal human being can do. They DESTROY you. THAT'S the "huge deal". NOT the frequency. Cancer RUINS YOUR LIFE for the period you get treated, IF you survive the treatment at all, let ALONE the cancer. And you are proposing we tell sub-1.5 million people EACH YEAR that they might have to go through that, while STILL ignoring the proportion of the population that will never learn they have a false positive because they got unlucky (which, AGAIN, we need to consider, since even miniscule probabilities matter at this scale.) So until the day we figure out a way to make getting rid of cancer as easy as popping a pill (we're getting closer thanks to gene therapy, but patients may still receive the destructive treatments in the meantime), culture will not "adapt", it will remain a "huge deal", and we will keep "this type of thinking".
  - JumpCrisscross 5y ago
    > these cures are often brutal Heart disease is a huge deal. It ruins your life. (Maybe not in all caps.) Nevertheless, we regularly test for it, including with techniques with high rates of false positives. Few panic because almost everyone knows someone who got a false positive and didn't promptly keel over and die. If healthy adults are screened for cancer, there will be cultural memory of people who got a false positive. The response to a positive test result won't be chemo. It will be further testing, if non-invasive, or suggestions of lifestyle changes and increased monitoring of the suspected system. People aren't too stupid to understand an early test with a high false positive rate. People with family histories of cancer don't wake up every morning screaming. Some may. But barring everyone because some people will overreact is why orthodox health policy is losing public trust.

fortran77 5y ago

My father died from metastasized prostate cancer.

tnel77 5y ago

For every genuinely smart person on HN, there’s a handful of Google warriors who hardly know what they are talking about. I guess that’s not unique to HN, but it can be aggravating just how many commenters can be so “know-it-all” with their comments.

TaupeRanger 5y ago
Try making an actual argument rather than simply attacking the attitude or character of the person you're responding to.
- tnel77 5y ago
  I was trying to agree with a comment I saw, but it appears I replied to the wrong comment.