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> 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 accura

> 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.
- rackjack 5y ago
  I don't enough about heart disease treatment to comment on the degree it ruins your life. People already get further testing. People already get second opinions. In the time you are changing your lifestyle (a good option for helping treatment, I agree) and increasing monitoring you could already be progressing beyond treatability. You can argue about whether it's alright to tell sub-1.5 million people each year who don't have cancer that they have cancer (I don't think it is, but whatever). But again you can't disregard the non-insignificant number of people who get false positives. edit: Actually, not "whatever". You probably shouldn't tell sub-1.5 million people each year who don't have cancer that they have cancer.
  - burnished 5y ago
    Hey, I can see this is emotional for you, but have you considered a world in which it is not telling this vast body of people "you definitely have cancer"? Something more like "we detected XXppm of [marker] which indicates we might need to do some more testing, can we talk about [risk factors]?". It just doesn't need to be as dire as what you are projecting.
  - UnFleshedOne 5y ago
    > In the time you are changing your lifestyle (a good option for helping treatment, I agree) and increasing monitoring you could already be progressing beyond treatability. That's actually a very good argument for early testing. And needlessly scaring a some people into eating better and exercising more is about as bad as not screening them at all to avoid needless anxiety.
tnel77 5y ago
>Getting a cancer diagnosis is a "huge deal" because getting cancer is one of the worst experiences a human can go through. I’ve never been given a cancer diagnosis, but I’d imagine it’s much, much worse to be told you have stage 4 cancer versus stage 1. As the other person stated, the culture would adapt and people would learn to not immediately sell their house and go on a Vegas bender just because a yearly preventative test said they might, possibly, perhaps have stage 1 cancer. If you are one of the people with a false positive, you schedule a follow-up and move on accordingly. Your position is anti-progress just for the sake of being against accidentally scaring a few people. Indeed, we should let more people develop cancer and discover it at a later stage due to a small amount of false positives. Not scaring a small amount of people is more important than revolutionizing cancer screenings.
- rackjack 5y ago
  > I’ve never been given a cancer diagnosis, but I’d imagine it’s much, much worse to be told you have stage 4 cancer versus stage 1. It's bad all the way. > If you are one of the people with a false positive, you schedule a follow-up and move on accordingly. People already do schedule follow-ups and additional tests and second opinions when they get a positive. > Your position is anti-progress just for the sake of being against accidentally scaring a few people. No, it is cautiously ethical because: 1. You probably shouldn't tell sub-1.5 million people who don't have cancer that they have cancer 2. There are more false positives than you think, if you are suggesting regular blood tests
  - ericd 5y ago
    My impression is that yours is the consensus view in the medical community. But I think that what all these people are telling you is that they'd much rather have a much higher chance of a false positive stage 1 diagnosis than even a much lower chance of false negative diagnosis until they're at stage 4. And any positive result from this would obviously be couched in a doctor consult saying "if you have cancer, which this test doesn't definitively show, it's still very early, we're just going to keep an eye on it, we didn't get any confirmation from a chest x-ray or CT", etc And having a memento mori can be a positive thing.
mahkeiro 5y ago
Most stage 1 can be treated successfully with surgery alone, it's getting a late diagnosis that force you to go through a brutal treatment. If all cancer were detected in phase 1 it would not be seen as a "huge deal" anymore.

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.

rackjack 5y ago
I don't enough about heart disease treatment to comment on the degree it ruins your life. People already get further testing. People already get second opinions. In the time you are changing your lifestyle (a good option for helping treatment, I agree) and increasing monitoring you could already be progressing beyond treatability. You can argue about whether it's alright to tell sub-1.5 million people each year who don't have cancer that they have cancer (I don't think it is, but whatever). But again you can't disregard the non-insignificant number of people who get false positives. edit: Actually, not "whatever". You probably shouldn't tell sub-1.5 million people each year who don't have cancer that they have cancer.
- burnished 5y ago
  Hey, I can see this is emotional for you, but have you considered a world in which it is not telling this vast body of people "you definitely have cancer"? Something more like "we detected XXppm of [marker] which indicates we might need to do some more testing, can we talk about [risk factors]?". It just doesn't need to be as dire as what you are projecting.
- UnFleshedOne 5y ago
  > In the time you are changing your lifestyle (a good option for helping treatment, I agree) and increasing monitoring you could already be progressing beyond treatability. That's actually a very good argument for early testing. And needlessly scaring a some people into eating better and exercising more is about as bad as not screening them at all to avoid needless anxiety.

tnel77 5y ago

>Getting a cancer diagnosis is a "huge deal" because getting cancer is one of the worst experiences a human can go through. I’ve never been given a cancer diagnosis, but I’d imagine it’s much, much worse to be told you have stage 4 cancer versus stage 1. As the other person stated, the culture would adapt and people would learn to not immediately sell their house and go on a Vegas bender just because a yearly preventative test said they might, possibly, perhaps have stage 1 cancer. If you are one of the people with a false positive, you schedule a follow-up and move on accordingly. Your position is anti-progress just for the sake of being against accidentally scaring a few people. Indeed, we should let more people develop cancer and discover it at a later stage due to a small amount of false positives. Not scaring a small amount of people is more important than revolutionizing cancer screenings.

rackjack 5y ago
> I’ve never been given a cancer diagnosis, but I’d imagine it’s much, much worse to be told you have stage 4 cancer versus stage 1. It's bad all the way. > If you are one of the people with a false positive, you schedule a follow-up and move on accordingly. People already do schedule follow-ups and additional tests and second opinions when they get a positive. > Your position is anti-progress just for the sake of being against accidentally scaring a few people. No, it is cautiously ethical because: 1. You probably shouldn't tell sub-1.5 million people who don't have cancer that they have cancer 2. There are more false positives than you think, if you are suggesting regular blood tests
- ericd 5y ago
  My impression is that yours is the consensus view in the medical community. But I think that what all these people are telling you is that they'd much rather have a much higher chance of a false positive stage 1 diagnosis than even a much lower chance of false negative diagnosis until they're at stage 4. And any positive result from this would obviously be couched in a doctor consult saying "if you have cancer, which this test doesn't definitively show, it's still very early, we're just going to keep an eye on it, we didn't get any confirmation from a chest x-ray or CT", etc And having a memento mori can be a positive thing.

mahkeiro 5y ago

Most stage 1 can be treated successfully with surgery alone, it's getting a late diagnosis that force you to go through a brutal treatment. If all cancer were detected in phase 1 it would not be seen as a "huge deal" anymore.