5 ms·

They are conflating cancer survival rates with longevity. When has someone claimed that treating cancer would increase life expectancy above the average? This

by Clent 3y ago

They are conflating cancer survival rates with longevity. When has someone claimed that treating cancer would increase life expectancy above the average? This is a dangerous article. People don't need more reasons to avoid cancer screenings.

amanaplanacanal 3y ago
It looks like they were comparing a group that got screening vs a group that didn’t get screening. If the group that got screening didn’t live longer than the group that didn’t get screening, that seems like a lot of wasted dollars.
- throwway120385 3y ago
  Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. What if some people in the group that didn't get screening had fewer high-quality years? It might simply be that the last 5 years of life for people who are screened positive early on and who subsequently receive treatment is a better 5 years than the last 5 years of life for people who aren't screened positive early on and who subsequently have to undergo brutal hail mary treatments at the last minute.
  - pessimizer 3y ago
    > Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. Claiming that there are missing elements that could possibly turn the equation in favor of screening is cause for further research and analysis. You can't just claim that they fall in your favor; some diagnostic and exploratory processes due to false positives are painful and/or dangerous in and of themselves. > What if "What if" is right. You can't just conjure these people into existence to justify current policies, you have to find them and do the statistics.
    - throwway120385 3y ago
      Given that screening is arguably benign for most people, you could argue that we continue screening while we gather more information. But you do whatever you want to do. I'm just pointing out that it's really premature to cancel all of your screenings based on the idea that it doesn't add any years to your life. That may be true, but there's more to a life than how long you live.
      - idopmstuff 3y ago
        > Given that screening is arguably benign for most people You're 100% wrong here, this is not a given. Prostate cancer screenings, which are very common, can have both false positives as well as findings of cancer that is and would remain completely benign. These can both lead to unnecessary treatments that cause serious negative health effects, including incontinence and erectile dysfunction. https://www.cdc.gov/cancer/prostate/basic_info/benefits-harms.htm https://www.cdc.gov/cancer/prostate/basic_info/benefits-harm...
        Gibbon1 3y ago
        Also read that death rates from thyroid cancer hasn't changed in 50 years. Despite huge numbers of thyroid screenings and treatment. An ultrasound of the thyroid often leads to finding a nodule. Which leads to a biopsy. Which comes out indeterminate. Which leads to a thyroidectomy and life long dependence on thyroid hormones. Another one is ductal carcinoma in situ. Read somewhere there is a 1% chance that will evolve into cancer. And yet you have women having double mastectomies and chemo for it.
        haldujai 3y ago
        Absolutely no one is getting a bilateral mastectomy or chemotherapy for DCIS. This is by far the most inaccurate medical claim I've ever seen on HN. Where on earth did you get this from? The whole point of diagnosing DCIS on screening mammography is that it avoids systemic therapy and mastectomy. It also wouldn't be bilateral.
  - dudeofea 3y ago
    I'm going to start with one assumption that I believe is true: higher mental and physical stress will kill you faster. If two statistical people both get cancer, one gets screened and potentially treated, and the other doesn't and they both live to 80, I would rather be the person that doesn't get treated. A regular schedule of treatments is only better than a hail mary if you actually get more longevity from it, otherwise it's just more pain for the patient. At least with the hail mary, I only spend a short time feeling horrible before dying. This is most likely why doctors don't opt for treatment more than the average. https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...
  - kirkni 3y ago
    There are attempts to address this, “The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions.” See: https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year
  - vc8f6vVV 3y ago
    There is another consideration: 1. You have an aggressive (i.e. non-treatable) cancer, maybe you feel slightly off, but you go on with your life, until you finally got worse and die. Or you performed screening, focus on treatment, bankrupt your family and ... die anyway, 2. You have a slow growing cancer (e.g. prostate), live your life and die of some other causes. Or you performed screening, got surgery, got tons of problems and die of myocardial infarction (yes, that's one of complications after prostate surgery). If you read the original JAMA publication you would notice that there is a research on quality of life metric. That metric for breast cancer is higher among non-screened women.
- DennisP 3y ago
  Yes but as someone else mentioned, it's like an insurance policy. Buying insurance doesn't make you richer on average, it makes the insurance company richer. But you aren't guaranteed the average outcome, so it's still rational to get the insurance, to cover the cases where you'd otherwise have a catastrophic loss. As with gambling, it's not just about expected value. You also have to consider risk of ruin.
  - pessimizer 3y ago
    False positives can be debilitating or fatal.
    - DennisP 3y ago
      But at what rate? The study doesn't say.
- lowbloodsugar 3y ago
  FTA: "Overall cancer mortality worldwide has decreased significantly, falling 33% since 1991, in part due to early detection as well as advances in treatment and declines in smoking."
rdedev 3y ago
I think the consensus on cancer screening is stil not fully there? Came across this video by a cardiologist a long time ago https://youtu.be/yNzQ_sLGIuA?si=fUttSVFQjsrIqc-p https://youtu.be/yNzQ_sLGIuA?si=fUttSVFQjsrIqc-p I guess the main gist is that screening is not completely benign and a positive screen might lead to more interventions for what in the end could just be a benign tumor. Then there's the other point of detecting it late in life. Like treatment for cancer might not make much sense if you are already 89 years old
- haltingproblem 3y ago
  This is the negative expectation part of most medical screening that most analyses miss. - Medical screenings themselves have iatrogenic effects, - the false positives interventions resulting from screenings have further negative effects and - finally the true positive interventions don't necessarily prolong life. All in all very difficult (confounding) tradeoffs that are impossible to quantify and understand especially when the cultural pressure is to do something.
  - arisAlexis 3y ago
    Do you really believe your third point? That most medical interventions for cancer do not prolong life? Or the word necessarily means your argument is null like "not all interventions prolong life". Yeah , we knew that already. It's never 100%.
    - NoZebra120vClip 3y ago
      I'd rather die of cancer than die of chemotherapy.
      - newaccount74 3y ago
        A friend of mine had a pretty agressive cancer at age 16. He suffered through chemotherapy, a bone marrow transplant, and another round of chemo a year later. I think it sucked pretty bad. I visited him once in hospital, they made me wear a full body suit to prevent any infections. But that was 20 years ago. He lives a normal life now and has a family. I'm pretty sure chemo was worth it.
aeturnum 3y ago
Why would it be dangerous for people to avoid cancer screenings if those screenings do not impact life expectancy? You might want to know if you have cancer, but doesn't this suggest that...there's no baseline argument to suggest that all people undergo those screenings?
- arisAlexis 3y ago
  They do impact life expectancy. The English language is a bit confusing to some mixed with statistics. They do not make life greater than average but they do make you closer to the average than if you die earlier.

by Clent 3y ago

amanaplanacanal 3y ago

It looks like they were comparing a group that got screening vs a group that didn’t get screening. If the group that got screening didn’t live longer than the group that didn’t get screening, that seems like a lot of wasted dollars.

throwway120385 3y ago
Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. What if some people in the group that didn't get screening had fewer high-quality years? It might simply be that the last 5 years of life for people who are screened positive early on and who subsequently receive treatment is a better 5 years than the last 5 years of life for people who aren't screened positive early on and who subsequently have to undergo brutal hail mary treatments at the last minute.
- pessimizer 3y ago
  > Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. Claiming that there are missing elements that could possibly turn the equation in favor of screening is cause for further research and analysis. You can't just claim that they fall in your favor; some diagnostic and exploratory processes due to false positives are painful and/or dangerous in and of themselves. > What if "What if" is right. You can't just conjure these people into existence to justify current policies, you have to find them and do the statistics.
  - throwway120385 3y ago
    Given that screening is arguably benign for most people, you could argue that we continue screening while we gather more information. But you do whatever you want to do. I'm just pointing out that it's really premature to cancel all of your screenings based on the idea that it doesn't add any years to your life. That may be true, but there's more to a life than how long you live.
    - idopmstuff 3y ago
      > Given that screening is arguably benign for most people You're 100% wrong here, this is not a given. Prostate cancer screenings, which are very common, can have both false positives as well as findings of cancer that is and would remain completely benign. These can both lead to unnecessary treatments that cause serious negative health effects, including incontinence and erectile dysfunction. https://www.cdc.gov/cancer/prostate/basic_info/benefits-harms.htm https://www.cdc.gov/cancer/prostate/basic_info/benefits-harm...
      - Gibbon1 3y ago
        Also read that death rates from thyroid cancer hasn't changed in 50 years. Despite huge numbers of thyroid screenings and treatment. An ultrasound of the thyroid often leads to finding a nodule. Which leads to a biopsy. Which comes out indeterminate. Which leads to a thyroidectomy and life long dependence on thyroid hormones. Another one is ductal carcinoma in situ. Read somewhere there is a 1% chance that will evolve into cancer. And yet you have women having double mastectomies and chemo for it.
        haldujai 3y ago
        Absolutely no one is getting a bilateral mastectomy or chemotherapy for DCIS. This is by far the most inaccurate medical claim I've ever seen on HN. Where on earth did you get this from? The whole point of diagnosing DCIS on screening mammography is that it avoids systemic therapy and mastectomy. It also wouldn't be bilateral.
- dudeofea 3y ago
  I'm going to start with one assumption that I believe is true: higher mental and physical stress will kill you faster. If two statistical people both get cancer, one gets screened and potentially treated, and the other doesn't and they both live to 80, I would rather be the person that doesn't get treated. A regular schedule of treatments is only better than a hail mary if you actually get more longevity from it, otherwise it's just more pain for the patient. At least with the hail mary, I only spend a short time feeling horrible before dying. This is most likely why doctors don't opt for treatment more than the average. https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...
- kirkni 3y ago
  There are attempts to address this, “The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions.” See: https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year
- vc8f6vVV 3y ago
  There is another consideration: 1. You have an aggressive (i.e. non-treatable) cancer, maybe you feel slightly off, but you go on with your life, until you finally got worse and die. Or you performed screening, focus on treatment, bankrupt your family and ... die anyway, 2. You have a slow growing cancer (e.g. prostate), live your life and die of some other causes. Or you performed screening, got surgery, got tons of problems and die of myocardial infarction (yes, that's one of complications after prostate surgery). If you read the original JAMA publication you would notice that there is a research on quality of life metric. That metric for breast cancer is higher among non-screened women.
DennisP 3y ago
Yes but as someone else mentioned, it's like an insurance policy. Buying insurance doesn't make you richer on average, it makes the insurance company richer. But you aren't guaranteed the average outcome, so it's still rational to get the insurance, to cover the cases where you'd otherwise have a catastrophic loss. As with gambling, it's not just about expected value. You also have to consider risk of ruin.
- pessimizer 3y ago
  False positives can be debilitating or fatal.
  - DennisP 3y ago
    But at what rate? The study doesn't say.
lowbloodsugar 3y ago
FTA: "Overall cancer mortality worldwide has decreased significantly, falling 33% since 1991, in part due to early detection as well as advances in treatment and declines in smoking."

rdedev 3y ago

I think the consensus on cancer screening is stil not fully there? Came across this video by a cardiologist a long time ago https://youtu.be/yNzQ_sLGIuA?si=fUttSVFQjsrIqc-p https://youtu.be/yNzQ_sLGIuA?si=fUttSVFQjsrIqc-p I guess the main gist is that screening is not completely benign and a positive screen might lead to more interventions for what in the end could just be a benign tumor. Then there's the other point of detecting it late in life. Like treatment for cancer might not make much sense if you are already 89 years old

haltingproblem 3y ago
This is the negative expectation part of most medical screening that most analyses miss. - Medical screenings themselves have iatrogenic effects, - the false positives interventions resulting from screenings have further negative effects and - finally the true positive interventions don't necessarily prolong life. All in all very difficult (confounding) tradeoffs that are impossible to quantify and understand especially when the cultural pressure is to do something.
- arisAlexis 3y ago
  Do you really believe your third point? That most medical interventions for cancer do not prolong life? Or the word necessarily means your argument is null like "not all interventions prolong life". Yeah , we knew that already. It's never 100%.
  - NoZebra120vClip 3y ago
    I'd rather die of cancer than die of chemotherapy.
    - newaccount74 3y ago
      A friend of mine had a pretty agressive cancer at age 16. He suffered through chemotherapy, a bone marrow transplant, and another round of chemo a year later. I think it sucked pretty bad. I visited him once in hospital, they made me wear a full body suit to prevent any infections. But that was 20 years ago. He lives a normal life now and has a family. I'm pretty sure chemo was worth it.

aeturnum 3y ago

Why would it be dangerous for people to avoid cancer screenings if those screenings do not impact life expectancy? You might want to know if you have cancer, but doesn't this suggest that...there's no baseline argument to suggest that all people undergo those screenings?

arisAlexis 3y ago
They do impact life expectancy. The English language is a bit confusing to some mixed with statistics. They do not make life greater than average but they do make you closer to the average than if you die earlier.