5 ms·

I get what you're saying: it's a bit of an apples-to-oranges comparison since better screening means we're comparing cancers of different severities. I don't ne

by nluken 4y ago

I get what you're saying: it's a bit of an apples-to-oranges comparison since better screening means we're comparing cancers of different severities. I don't necessarily see that as a problem, though, since a lot of these earlier screened cancers would have become more advanced cancers down the line. If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no?

jagraff 4y ago
The thing we don't know is which early cancers actually progress to advanced cancer. It's possible that we detect more things that look like cancer, but that would not have ever progressed into full blown metastatic cancer (at least, not before the patient died of something else). So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer.
- chimeracoder 4y ago
  > So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer. No, because the death rate is measured at the population level, not at the incidence level. Fewer people are dying today of cancer than 30 years ago. The only way that detection bias could impact that outcome is if you make the argument that a large number of terminal cancer cases were going undetected in 1991 at the time of death.
pasquinelli 4y ago
> If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no? no. being able to detect cancer doesn't mean people are getting tested twice a year for their whole life. for example, you wouldn't have routine cancer screenings for children, but sometimes they get cancer, and on those occasions it'd be nice to have better treatment options.
- nluken 4y ago
  > it'd be nice to have better treatment options. No disagreement with you there. By "perfect screening" I assumed a "perfect" patient set where problems brought up at annual checkups lead directly to tests which lead to detection, but perhaps that's a naïve assumption to the point of uselessness. Still, I think it's easy to write off screening advances as skewing the data set vs. actually saving lives, when they do in fact help people that otherwise could have been much sicker.
- tshaddox 4y ago
  We wouldn’t normally even consider talking about these things as if they’re in any way mutually exclusive, would we? Like normally we would all understand that it’s good for cars to get safer and for trauma care to get better.
- kragen 4y ago
  if cancer screenings for children were painless, lower risk than the cancer, and cost five dollars, you would totally have routine cancer screenings for children i mean maybe not in the usa but in sane places
  - HWR_14 4y ago
    They would have them in the US as well, but only for people in the Gold tier of insurance
    - tshaddox 4y ago
      And only children of parents who were members of whichever political party had decided the scans aren't an evil hoax.
timerol 4y ago
The "US Cancer Death Rate" talked about in the article is measured in deaths per 100,000 population, not deaths per detected cancer. So we are comparing apples to apples, but finding and treating cancers earlier could be helping to result in fewer deaths.
- londons_explore 4y ago
  Or it could simply mean that another cause of death has increased. Like heart disease/diabetes from ever increasing obesity rates. A person can't die twice, so if heart disease gets them first, then they won't die of cancer.
  - chimeracoder 4y ago
    > Or it could simply mean that another cause of death has increased. Like heart disease/diabetes from ever increasing obesity rates. You could hardly have picked a worse counterexample. Deaths from heart disease have fallen dramatically over that time period, even faster than cancer deaths have dropped. Deaths from strokes - which at one point equalled deaths from all cancers combined - have fallen as well, although much of that drop occurred before the time period in question. Deaths from diabetes are actually quite few in number compared to heart disease and cancer. They've sort of plateaued over this time interval, which isn't good news, but hardly the alternate explanation for the reduction in cancer deaths. Now, there is one big cause of death which we haven't addressed: COVID-19, which causes about 3x the number of deaths as diabetes, and over half the number of deaths as all cancers combined. But that only began in 2020, and this data shows a decrease across the entire interval, so it's not relevant here.
    - TylerE 4y ago
      Diabetes is almost never the direct cause of death, but it’s damn hard in the body. Hurts circulation, hurts your nerves, hurts your organs… and it can flare badly in reaction to some medications. So, the cause of death won’t be “diabetes”, it’ll be heart attack, stroke, chronic infection, something like that. Similar to AIDS in that it doesn’t kill you directly (not that we know that juvenile diabetes is a thing, and we routinely test for it), it just makes any other health challenge much dicier.

by nluken 4y ago

jagraff 4y ago

The thing we don't know is which early cancers actually progress to advanced cancer. It's possible that we detect more things that look like cancer, but that would not have ever progressed into full blown metastatic cancer (at least, not before the patient died of something else). So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer.

chimeracoder 4y ago
> So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer. No, because the death rate is measured at the population level, not at the incidence level. Fewer people are dying today of cancer than 30 years ago. The only way that detection bias could impact that outcome is if you make the argument that a large number of terminal cancer cases were going undetected in 1991 at the time of death.

pasquinelli 4y ago

> If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no? no. being able to detect cancer doesn't mean people are getting tested twice a year for their whole life. for example, you wouldn't have routine cancer screenings for children, but sometimes they get cancer, and on those occasions it'd be nice to have better treatment options.

nluken 4y ago
> it'd be nice to have better treatment options. No disagreement with you there. By "perfect screening" I assumed a "perfect" patient set where problems brought up at annual checkups lead directly to tests which lead to detection, but perhaps that's a naïve assumption to the point of uselessness. Still, I think it's easy to write off screening advances as skewing the data set vs. actually saving lives, when they do in fact help people that otherwise could have been much sicker.
tshaddox 4y ago
We wouldn’t normally even consider talking about these things as if they’re in any way mutually exclusive, would we? Like normally we would all understand that it’s good for cars to get safer and for trauma care to get better.
kragen 4y ago
if cancer screenings for children were painless, lower risk than the cancer, and cost five dollars, you would totally have routine cancer screenings for children i mean maybe not in the usa but in sane places
- HWR_14 4y ago
  They would have them in the US as well, but only for people in the Gold tier of insurance
  - tshaddox 4y ago
    And only children of parents who were members of whichever political party had decided the scans aren't an evil hoax.

timerol 4y ago

The "US Cancer Death Rate" talked about in the article is measured in deaths per 100,000 population, not deaths per detected cancer. So we are comparing apples to apples, but finding and treating cancers earlier could be helping to result in fewer deaths.

londons_explore 4y ago
Or it could simply mean that another cause of death has increased. Like heart disease/diabetes from ever increasing obesity rates. A person can't die twice, so if heart disease gets them first, then they won't die of cancer.
- chimeracoder 4y ago
  > Or it could simply mean that another cause of death has increased. Like heart disease/diabetes from ever increasing obesity rates. You could hardly have picked a worse counterexample. Deaths from heart disease have fallen dramatically over that time period, even faster than cancer deaths have dropped. Deaths from strokes - which at one point equalled deaths from all cancers combined - have fallen as well, although much of that drop occurred before the time period in question. Deaths from diabetes are actually quite few in number compared to heart disease and cancer. They've sort of plateaued over this time interval, which isn't good news, but hardly the alternate explanation for the reduction in cancer deaths. Now, there is one big cause of death which we haven't addressed: COVID-19, which causes about 3x the number of deaths as diabetes, and over half the number of deaths as all cancers combined. But that only began in 2020, and this data shows a decrease across the entire interval, so it's not relevant here.
  - TylerE 4y ago
    Diabetes is almost never the direct cause of death, but it’s damn hard in the body. Hurts circulation, hurts your nerves, hurts your organs… and it can flare badly in reaction to some medications. So, the cause of death won’t be “diabetes”, it’ll be heart attack, stroke, chronic infection, something like that. Similar to AIDS in that it doesn’t kill you directly (not that we know that juvenile diabetes is a thing, and we routinely test for it), it just makes any other health challenge much dicier.