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There's a related problem when you can diagnose a cancer really early -- it's that you wind up, technically, living with cancer for a longer time. Early diagnos
by VeninVidiaVicii 5y ago
There's a related problem when you can diagnose a cancer really early -- it's that you wind up, technically, living with cancer for a longer time. Early diagnosis makes treatments look like they're working better and better, when they might not be.
Newer treatments might actually be worse, but early diagnosis makes them look more effective.
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- nradov 5y agoAlmost every elderly person has cancer. It's just that many people die from something else first before those tiny malignancies grow large enough to cause significant clinical symptoms.
- inglor_cz 5y agoCancers are very diverse in this regard. Prostate cancer is quasi-normal in men over 70 and usually grows so slowly that it does not influence their lifespan. Pancreatic cancer is deadly at any age and its treatment would profit a lot from very early detection.
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- est31 5y agoThe rule of thumb with cancer is that the earlier you diagnose it, the more treatable it is. So yes, please detect cancers as early as possible.
- the_af 5y agoI don't have a firm opinion but tend to agree with you, however... ...an article linked to here on HN many years ago argued that sometimes early detection can lead to downgraded quality of life. The examples they provided were of middle-age men diagnosed with very early stage prostate cancer, which sometimes led to surgery with debilitating complications (like erectile dysfunction, incontinence, and others). The article argued many of those cancers were effectively harmless, that those men would have died of something else after a long life without ever realizing they had cancer, and that the treatment was considerably worse than the disease. Of course, it could be argued that knowing is always better: that the mistake in those cases was to perform unnecessary surgery.
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- mlyle 5y ago> The rule of thumb with cancer is that the earlier you diagnose it, the more treatable it is. So yes, please detect cancers as early as possible. No one argues this is true. But there's mounting evidence that this is less true than one would have believed a couple of decades ago. * First, as the parent to your post says: if a cancer takes 3 years to go from stage 1 to stage 4, detecting the cancer at stage 1 will increase measured survival by 3 years even if your treatments do nothing. * Second, the stage at detection is also a measure of how aggressive the cancer is. That is, if you screen every year, and find 100 stage 4 cancers and 100 stage 1 cancers in your population... odds are the stage 4 cancers are much faster growing and more likely to become malignant. You didn't necessarily find them "earlier".
- zarzavat 5y agoIs it not possible to normalise "survival" so that we can compare cancers detected at different times?
- mlyle 5y agoHow do you know when this guy's stage 1 cancer would become a stage 4 without treatment so that you can line up the data series? Maybe it's stage 1 because you got lucky and saw it early. Maybe it's stage 1 because it grows really slowly and will be stage 1 still in 5 years. Only way you could know is to not treat and watch what happens... Everything else is a fudge.
- cbsmith 5y agoExcept when you are analyzing treatments, you would want to control for when & how the diagnosis was made...