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In the UK the NHS don't do screening for breast cancer for under 50s because it's believed that it would do more harm than good by leading to unnecessary treatm

In the UK the NHS don't do screening for breast cancer for under 50s because it's believed that it would do more harm than good by leading to unnecessary treatment for cancers that would never have actually caused any harm, and even where no treatment is carried out it causes great distress. Though there are arguments that the age cut off is too high, and should be set at 40. The above is with regard to a well-funded and regulated screening program that presumably has much better precision/recall than this website. I wonder what the cut off age is for this website before the diagnoses cause more harm than good? 60? 70? This is getting lots of upvotes because it's confirmation bias for the large segment of HN readers who believe that problems would easily be solved by a small number of brilliant technologists, if only it weren't for governments and big organisations with all their rules and regulations.

laingc 4y ago
A lot of people, including myself, don’t believe that central health authorities have the right to make that call. Moreover, I personally don’t have confidence in their ability to make those kinds of decisions, and I believe the abysmal performance of the NHS supports my view.
- ramraj07 4y ago
  I share your disdain for a central authority in making these judgement calls, but I have even less confidence in the majority of people who think they can solve everything with AI. Signed, a data scientist with a PhD in biomedical engineering.
- Gatsky 4y ago
  The NHS has finite resources. They have to decide if implementing a screening program is worthwhile or not, versus spending the money elsewhere. You can still go to your doctor and get a mammogram (or even a more useful test) if you have other reasons why this might be justified in your situation. They aren’t ‘banning’ mammograms for young women.
  - KennyBlanken 4y ago
    It's not just a matter of finite resources. Any sort of treatment is invasive. Almost all form of medical treatment has side effects and risks. Finding out you have "cancer" is traumatic and extremely emotional, though breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Putting these tools in the hands of medical professionals is one thing. Putting them in the hands of the general public is beyond irresponsible. People physically assaulted doctors and nurses for not being given ivermectin; imagine how insufferable people will get when some website examined their mammogram and said they have cancer.
    - johnday 4y ago
      > ...breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Extremely weird take. Not least because the survival rates for breast cancer and prostate cancer are very similar.
- Waterluvian 4y ago
  I think central authorities absolutely must make that call. Who else is going to decide how to dole out a scarce social resource? Americanizing healthcare is obviously not a good choice given how much worse it does overall by basically every measure (unless you're rich and don't give a toss about other people). I certainly agree that central authorities can be better. But that's kind of a truism. What alternative options do you have in mind? Admittedly I'm short on alternative ideas.
  - civilized 4y ago
    I understand why people don't want money to completely decide who gets health care. But I don't think it should be a complete non-factor either. If I've worked hard and saved diligently for an emergency, and an emergency arrives, I feel I should be able to tell a doctor "will you treat me? I have money". But if you insist upon perfect equality of health care access, I guess it can't be. Some central authority has to decide if anyone is allowed to treat you, regardless of what you've saved for the eventuality.
    - Waterluvian 4y ago
      Medical tourism will always be a thing for the rich. But I personally do not see an argument for driving a social service, even if only slightly, with capitalism. Perhaps that’s part of my developing thought on the matter: the public system paid by tax dollars should be equitable to all. But by all means, take your credit card to Pepsi Presents: For Profit Medical Centre and get a full work up.
      - civilized 4y ago
        What makes the cut of a "social service"? Wouldn't it be anything people really need? Basic food staples, for example? China tried socializing food production, and it worked terribly. Production tripled when they re-privatized it and let farmers grow for themselves. People do a better job when they get to keep the rewards. US health care isn't capitalist in this sense of rewarding a good job. It's the worst of both worlds: a system whose regulations are superbly adapted to optimize profit for the administrative class at the expense of both doctors and patients.
- nivenkos 4y ago
  Yeah, just look at their disastrous handling of Covid for example.
  - pas 4y ago
    the real problem is that we still don't have combined vaccines for all the new variants (+ influenza) and it's completely ridiculous why there isn't a public/government project to do this.
- barry-cotter 4y ago
  > A lot of people, including myself, don’t believe that central health authorities have the right to make that call. That’s absolutely fine. You’re free to spend your money on preventative healthcare that’s been determined to fail a cost benefit test. Organizations that have to save as many lives as possible or prolong healthspan as long as possible within a limited budget must make decisions somehow.
- poirot2 4y ago
  Misunderstanding here. The question is at what age is the base rate in the population sufficiently high that a test with a certain sensitivity and specificity useful net risks. Multiple studies have shown that these screening programmes don’t have a huge impact on mortality - excluding lead time bias etc. and noting the c. 10 in 100k extra cases of cancer caused by the screening. Here’s a review for prostate screening that’s even more damning about its usefulness - https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-screening.pdf https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-...
  - pas 4y ago
    would it be possible to use MRI for screening?
    - manarth 4y ago
      MRI scans take longer, are often more uncomfortable for the patient (being in an enclosed, noisy machine), require much larger capital investment than an X-ray (and therefore supply is more limited), and have a higher cost per exam than an X-ray. It almost certainly would be possible to use MRI for screening, but the impact would be a reduction in availability and a higher cost.
- deleted 4y ago
  [deleted]
webmobdev 4y ago
Thanks for the different perspective. What did you mean by "unnecessary treatment" though? If you have cancer, doesn't it need to be treated? Doesn't cancer anywhere always cause harm to the body?
- latortuga 4y ago
  Breast cancer for example is diagnosed by increasing levels of invasiveness. First a mammogram, then possibly a 3D mammogram, then an ultrasound, then a biopsy. There are possibilities for false positives all along this path and increasing levels of possible complications when performing procedures. If a false positive gets to a biopsy and you get an infection from it, you would not have ever gotten that infection if they didn't start testing you so young. False positives are very common with breast cancer screening.
  - markdown 4y ago
    Not to mention the fact that getting a biopsy can cause the cancer to spread all over the body where it might never have grown beyond its original position had it been left untouched.
    - adamredwoods 4y ago
      Highly contested, and there is no evidence. Link to this published research: https://gut.bmj.com/content/64/7/1105.abstract https://gut.bmj.com/content/64/7/1105.abstract
  - feanaro 4y ago
    Wait, how is an ultrasound more invasive than a mammogram, an X-ray based technique?
    - webmobdev 4y ago
      I guess they are physically more invasive - you have to undress and the gel has to be applied on the body part to get the ultrasound scan.
adamredwoods 4y ago
NHS recommendations: https://www.cancerresearchuk.org/about-cancer/breast-cancer/getting-diagnosed/screening/breast-screening https://www.cancerresearchuk.org/about-cancer/breast-cancer/... Anecdotally, I know (directly and indirectly) many, many women who had breast cancer before 50 years of age.
bayareabadboy 4y ago
Your solution to anxiety derived from lack of medical knowledge is more bureaucracy between a patient and their healthcare provider?
- reubens 4y ago
  I think the suggestion was more along the lines of “screening programmes have their place, but their variables should be optimised”
mchusma 4y ago
This is absurd logic. If the next step for a test like is a procedure with a lot of risk, change the next step. We need to be able to work in a world with frequent, imperfect, low cost diagnostic tools. Cancer is almost completely survivable if caught early enough. So working to figure out early detection is effectively the "cure" for cancer we have been looking for.
- ip26 4y ago
  As I recall the actual logic was after decades of early & frequent screening, allegedly the data showed a greatly increased rate of mass discovery and treatment, but no improvement in mortality at the population level. This suggested despite a lot of activity, we may not have accomplished anything.
  - pas 4y ago
    but that means that instead of treatment the correct next step after discovery is monitoring of those masses, no? also it's quite possible that (just as with COVID tests) we would benefit from more testing even if that test is not that reliable. (so there's an argument for developing fast non-ionizing radiation imaging machines, eg. a fast stand-in MRI)
morelish 4y ago
The NHS is massive bureaucracy. What it does or doesn’t do is peering inside the belly of a Byzantine whale. The article is a misnomer calling him an ‘amateur’. Its a click bait title. He’s shown himself to a world leading researcher in the application of AI to cancer screening. Plenty of managers in the NHS can’t even do simple math.
mateo1 4y ago
I'm always surprised with the "just close your eyes" attitude of medical policies. I mean, this way we essentially choose when to get women misdiagnosed? Isn't the solution to get a better idea of how common it is for non-cancerous masses to appear and adjust the risk predictions? Or to actually improve the diagnostic methods?

laingc 4y ago

A lot of people, including myself, don’t believe that central health authorities have the right to make that call. Moreover, I personally don’t have confidence in their ability to make those kinds of decisions, and I believe the abysmal performance of the NHS supports my view.

ramraj07 4y ago
I share your disdain for a central authority in making these judgement calls, but I have even less confidence in the majority of people who think they can solve everything with AI. Signed, a data scientist with a PhD in biomedical engineering.
Gatsky 4y ago
The NHS has finite resources. They have to decide if implementing a screening program is worthwhile or not, versus spending the money elsewhere. You can still go to your doctor and get a mammogram (or even a more useful test) if you have other reasons why this might be justified in your situation. They aren’t ‘banning’ mammograms for young women.
- KennyBlanken 4y ago
  It's not just a matter of finite resources. Any sort of treatment is invasive. Almost all form of medical treatment has side effects and risks. Finding out you have "cancer" is traumatic and extremely emotional, though breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Putting these tools in the hands of medical professionals is one thing. Putting them in the hands of the general public is beyond irresponsible. People physically assaulted doctors and nurses for not being given ivermectin; imagine how insufferable people will get when some website examined their mammogram and said they have cancer.
  - johnday 4y ago
    > ...breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Extremely weird take. Not least because the survival rates for breast cancer and prostate cancer are very similar.
Waterluvian 4y ago
I think central authorities absolutely must make that call. Who else is going to decide how to dole out a scarce social resource? Americanizing healthcare is obviously not a good choice given how much worse it does overall by basically every measure (unless you're rich and don't give a toss about other people). I certainly agree that central authorities can be better. But that's kind of a truism. What alternative options do you have in mind? Admittedly I'm short on alternative ideas.
- civilized 4y ago
  I understand why people don't want money to completely decide who gets health care. But I don't think it should be a complete non-factor either. If I've worked hard and saved diligently for an emergency, and an emergency arrives, I feel I should be able to tell a doctor "will you treat me? I have money". But if you insist upon perfect equality of health care access, I guess it can't be. Some central authority has to decide if anyone is allowed to treat you, regardless of what you've saved for the eventuality.
  - Waterluvian 4y ago
    Medical tourism will always be a thing for the rich. But I personally do not see an argument for driving a social service, even if only slightly, with capitalism. Perhaps that’s part of my developing thought on the matter: the public system paid by tax dollars should be equitable to all. But by all means, take your credit card to Pepsi Presents: For Profit Medical Centre and get a full work up.
    - civilized 4y ago
      What makes the cut of a "social service"? Wouldn't it be anything people really need? Basic food staples, for example? China tried socializing food production, and it worked terribly. Production tripled when they re-privatized it and let farmers grow for themselves. People do a better job when they get to keep the rewards. US health care isn't capitalist in this sense of rewarding a good job. It's the worst of both worlds: a system whose regulations are superbly adapted to optimize profit for the administrative class at the expense of both doctors and patients.
nivenkos 4y ago
Yeah, just look at their disastrous handling of Covid for example.
- pas 4y ago
  the real problem is that we still don't have combined vaccines for all the new variants (+ influenza) and it's completely ridiculous why there isn't a public/government project to do this.
barry-cotter 4y ago
> A lot of people, including myself, don’t believe that central health authorities have the right to make that call. That’s absolutely fine. You’re free to spend your money on preventative healthcare that’s been determined to fail a cost benefit test. Organizations that have to save as many lives as possible or prolong healthspan as long as possible within a limited budget must make decisions somehow.
poirot2 4y ago
Misunderstanding here. The question is at what age is the base rate in the population sufficiently high that a test with a certain sensitivity and specificity useful net risks. Multiple studies have shown that these screening programmes don’t have a huge impact on mortality - excluding lead time bias etc. and noting the c. 10 in 100k extra cases of cancer caused by the screening. Here’s a review for prostate screening that’s even more damning about its usefulness - https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-screening.pdf https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-...
- pas 4y ago
  would it be possible to use MRI for screening?
  - manarth 4y ago
    MRI scans take longer, are often more uncomfortable for the patient (being in an enclosed, noisy machine), require much larger capital investment than an X-ray (and therefore supply is more limited), and have a higher cost per exam than an X-ray. It almost certainly would be possible to use MRI for screening, but the impact would be a reduction in availability and a higher cost.
deleted 4y ago
[deleted]

webmobdev 4y ago

Thanks for the different perspective. What did you mean by "unnecessary treatment" though? If you have cancer, doesn't it need to be treated? Doesn't cancer anywhere always cause harm to the body?

latortuga 4y ago
Breast cancer for example is diagnosed by increasing levels of invasiveness. First a mammogram, then possibly a 3D mammogram, then an ultrasound, then a biopsy. There are possibilities for false positives all along this path and increasing levels of possible complications when performing procedures. If a false positive gets to a biopsy and you get an infection from it, you would not have ever gotten that infection if they didn't start testing you so young. False positives are very common with breast cancer screening.
- markdown 4y ago
  Not to mention the fact that getting a biopsy can cause the cancer to spread all over the body where it might never have grown beyond its original position had it been left untouched.
  - adamredwoods 4y ago
    Highly contested, and there is no evidence. Link to this published research: https://gut.bmj.com/content/64/7/1105.abstract https://gut.bmj.com/content/64/7/1105.abstract
- feanaro 4y ago
  Wait, how is an ultrasound more invasive than a mammogram, an X-ray based technique?
  - webmobdev 4y ago
    I guess they are physically more invasive - you have to undress and the gel has to be applied on the body part to get the ultrasound scan.

adamredwoods 4y ago

NHS recommendations: https://www.cancerresearchuk.org/about-cancer/breast-cancer/getting-diagnosed/screening/breast-screening https://www.cancerresearchuk.org/about-cancer/breast-cancer/... Anecdotally, I know (directly and indirectly) many, many women who had breast cancer before 50 years of age.

bayareabadboy 4y ago

Your solution to anxiety derived from lack of medical knowledge is more bureaucracy between a patient and their healthcare provider?

reubens 4y ago
I think the suggestion was more along the lines of “screening programmes have their place, but their variables should be optimised”

mchusma 4y ago

This is absurd logic. If the next step for a test like is a procedure with a lot of risk, change the next step. We need to be able to work in a world with frequent, imperfect, low cost diagnostic tools. Cancer is almost completely survivable if caught early enough. So working to figure out early detection is effectively the "cure" for cancer we have been looking for.

ip26 4y ago
As I recall the actual logic was after decades of early & frequent screening, allegedly the data showed a greatly increased rate of mass discovery and treatment, but no improvement in mortality at the population level. This suggested despite a lot of activity, we may not have accomplished anything.
- pas 4y ago
  but that means that instead of treatment the correct next step after discovery is monitoring of those masses, no? also it's quite possible that (just as with COVID tests) we would benefit from more testing even if that test is not that reliable. (so there's an argument for developing fast non-ionizing radiation imaging machines, eg. a fast stand-in MRI)

morelish 4y ago

The NHS is massive bureaucracy. What it does or doesn’t do is peering inside the belly of a Byzantine whale. The article is a misnomer calling him an ‘amateur’. Its a click bait title. He’s shown himself to a world leading researcher in the application of AI to cancer screening. Plenty of managers in the NHS can’t even do simple math.

mateo1 4y ago

I'm always surprised with the "just close your eyes" attitude of medical policies. I mean, this way we essentially choose when to get women misdiagnosed? Isn't the solution to get a better idea of how common it is for non-cancerous masses to appear and adjust the risk predictions? Or to actually improve the diagnostic methods?