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> Cancer is not rare. Early detection heavily skews the odds on one's side. Depends on the cancer and even the doctors are torn. Most breast tumors and prostat
by BeetleB 3y ago
> Cancer is not rare. Early detection heavily skews the odds on one's side.
Depends on the cancer and even the doctors are torn. Most breast tumors and prostate tumors will not kill you or affect your life much. Treating them likely will (especially for prostate). Depending on the model, the overall health of the population is actually reduced by early detection because in most of these tumors treatment is worse than the disease.
One of my doctors is a strong believer in periodic prostate exams after 40. The other recommends only if there are other symptoms. You can guess which is the older one and which is the younger one.
Years ago there was the whole Gardasil controversy. What was often excluded in the noise was that if it were mandated for all girls as some states were recommending, it would be so expensive that funding for other health programs would need to be reduced. The studies were showing that this kind of preventative approach would again reduce the health of the state's population.
Preventive medicine is good - to an extent. Beyond that it is bad.
- gusgus01 3y agoI'm interested in those studies. Do you have them handy or will I need to resort to some Google fu?
- BeetleB 3y agoHere's a related one : https://www.npr.org/sections/health-shots/2014/09/02/345200586/double-mastectomies-dont-increase-cancer-survival-rates https://www.npr.org/sections/health-shots/2014/09/02/3452005... It mentions Angelina Jolie as a good example of how fear can lead to drastic actions. Probably better to find an article talking about the general problem to find more references.
- BeetleB 3y agoWikipedia has this: The Cochrane collaboration (2013) states that the best quality evidence neither demonstrates a reduction in cancer specific, nor a reduction in all cause mortality from screening mammography. When less rigorous trials are added to the analysis there is a reduction in mortality due to breast cancer of 0.05% (a decrease of 1 in 2000 deaths from breast cancer over 10 years or a relative decrease of 15% from breast cancer). Screening over 10 years results in a 30% increase in rates of over-diagnosis and over-treatment (3 to 14 per 1000) and more than half will have at least one falsely positive test. This has resulted in the view that it is not clear whether mammography screening does more good or harm. Cochrane states that, due to recent improvements in breast cancer treatment, and the risks of false positives from breast cancer screening leading to unnecessary treatment, "it therefore no longer seems beneficial to attend for breast cancer screening" at any age. Whether MRI as a screening method has greater harms or benefits when compared to standard mammography is not known.
- moralestapia 3y ago>it is not clear whether mammography screening does more good or harm
- BeetleB 3y ago> the best quality evidence neither demonstrates a reduction in cancer specific, nor a reduction in all cause mortality from screening mammography.
- moralestapia 3y agoBut you are arguing that regular screening is bad. You forgot your lines, man!
- BeetleB 3y ago> Depending on the model...
- moralestapia 3y ago>it would be so expensive that funding for other health programs would need to be reduced But that's a different thing. I'm sorry, I will not talk about that.
- BeetleB 3y ago> But that's a different thing. I'm sorry, I will not talk about that. For people setting policies (and that includes doctors) cost is absolutely not a different thing. If you can afford to pay for everything without involving insurance, by all means do whatever tests you want. If you're a doctor you don't want to maybe help Betty while definitely hiring Veronica.
- moralestapia 3y ago>I'm sorry, I will not talk about that.
- loloquwowndueo 3y agoI can’t guess. Which is the older one?
- BeetleB 3y agoThe one recommending it for everyone over 40. They pushback against too much screening is relatively recent, and thus younger doctors are more likely to adopt it.
- randallsquared 3y agoI also couldn't guess. There are equally plausible stories the other way: "obviously the older one is the one who doesn't recommend, since they're more experienced and have seen over thousands of patients how often it doesn't help...".
- Retric 3y agoUntreated detectable cancers still kill relatively quickly, the only time they’re not a major concern is when people have other major medical issues. For perspective even with all the advances in modern medicine in 2020 and thus a pandemic, cancer was still the #2 killer in the US after heart disease. It killed over 600,000 Americans in 2020 and that’s a 27% improvement over what it was doing as recently as 2001. That said, there’s currently believed to be a long undetectable period where the body fights off most pre cancers. We’re approaching the ability to detect cancers below 0.5mm which we don’t have much clinical data on.
- fortran77 3y agoUntrue wrt prostate cancer. Since the average date it’s detected is 70 and 2/3rds of the population is obese, then of course most people will die of something else. If you are non-obese and in good shape, then get aggressive treatment.
- BeetleB 3y agoThat aggressive treatment may leave you incontinent before you turn 50, and likely would not have killed you if untreated.
- cyberax 3y ago> Most breast tumors and prostate tumors will not kill you or affect your life much. This is yet another fallacy. A prostate cancer takes about 10 years to kill you. If you're 80, then it's probably not worth pursuing aggressive treatment. You're likely to die of something else. However, if you're 40 then it's another story entirely.
- cyberax 3y ago> What was often excluded in the noise was that if it were mandated for all girls as some states were recommending, it would be so expensive that funding for other health programs would need to be reduced. This is an argument from scarcity. If you have a severely limited amount of a resource, it makes sense to sacrifice some people, so that more people can receive life-saving care. If the resource is not scarce, then this simply doesn't apply. These days HPV vaccine (in Europe) is around $30, so it makes sense to just vaccinate everybody. > Preventive medicine is good - to an extent. Beyond that it is bad. Nope. It's always good, but sometimes it's too expensive.
- BeetleB 3y ago> These days HPV vaccine (in Europe) is around $30, so it makes sense to just vaccinate everybody. These days it's likely a very different from 2007 when it was being debated. There argument wasn't that no one should get Gardasil. Just that it would hurt the health of the society if it was mandated for all. Obviously if you had the money it's good to get it
- cyberax 3y agoYes, and this argument indeed holds in the case of extra MRI screenings. We simply don't have enough MRI units to screen everybody every year. On the other hand, the quantity of MRI units is not fixed. We can always build more, they are just inherently very expensive. And if you can afford an MRI scan from your personal disposable income, then what's the problem?