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It's not silly. Look at how the mammogram guidelines are set. If the scans are too frequent, the harm done from false positives (unnecessary surgeries and risks
by bagels 4y ago
It's not silly. Look at how the mammogram guidelines are set. If the scans are too frequent, the harm done from false positives (unnecessary surgeries and risks from those surgeries) can become too great. The standards were relaxed to include fewer scans in the last few years because of this.
Apply this to more invasive exploratory surgeries, and you see people dying from internal surgery complications for benign cysts and lumps.
- derefr 4y agoThat's because single datapoints are used to trigger intervention. We should be intervening based on growth trends from time-series data. Time-series data which can only be collected by... frequent scans.
- Sebb767 4y agoDon't discount psychological stress. "You have something growing in your breast which might be cancer, just wait a few months and we'll scan again" is not something that gives people a good nights sleep.
- derefr 4y agoSo don't tell them. Like I said, a single datapoint by itself is meaningless — so you wouldn't bring it to the patient's attention. Heck, the software shouldn't flag it for the doctor's attention. (Think: metrics-based alerting thresholds in software systems.)
- lazyasciiart 4y agoWe do have time series data for mammograms. You may think it doesn't meet whatever standard you are setting, but it is objectively false to say it isn't there.
- derefr 4y agoMy standard is "doing it for everything, rather than for one thing"; and more importantly, not acting upon data about chronic disease progression, if it isn't a time-series. In science, you don't call one datapoint "data." You call it an anecdote. Outside of emergency medicine/urgent care, medical practice should be the same.
- lazyasciiart 4y agoI honestly can't imagine how you believe breast cancer is diagnosed and treated, but it's clearly inaccurate. So is the cute phrase about "in science".
- derefr 4y agoYou didn't understand what I said. Breast cancer screening is the "one thing" I referred to that we're doing right. But who cares if we're doing one thing right? We're doing screening for literally every other cancer wrong. And not getting any less wrong over time. We — the medical profession in general — are aware of the proven effectiveness of time-series analysis of regular mammograms as a screening technique. However, we have failed utterly to spread this "obvious" knowledge out from the specialty that understands it and has proven its effectiveness, to literally anywhere else. We've been doing regular mammograms for decades now, but that hasn't sparked (wide) adoption of regular scans + time-series-based screening for any other cancer. There is a certain moral culpability in that. A certain negligence of duty / not seeing the forest for the trees in what it means to be saving lives. (I hypothesize that doctors in at least some specialties, could save more lives over the course of their career by dropping their practice and instead turning into advocates for wide adoption of periodic-scans + time-series-analysis-based screens. Somewhat like would have been true of a doctor in the 1800s quitting doctoring to instead become an advocate for hand-washing before surgery.)
- lazyasciiart 4y agoYou're right, I had absolutely no idea that you thought we were doing breast cancer screening right. And I don't know if you're now failing to communicate your awareness of regular screening for prostate and cervical cancer, or skin cancer in higher risk locations, or if that doesn't count somehow, or what. I also don't know if you have any evidence for the existence of these other tests that we could be doing on everyone and the risk-benefit profile that shows we should be doing them, or if you're assuming such tests and evidence exists, or complaining that we haven't invented the tests that must be theoretically possible.