4 ms·

I had a CT scan of a fracture taken when I was a child, and doctors coincidentally discovered a tumour. My mum discovered she had breast cancer through a routin

by strken 3y ago

I had a CT scan of a fracture taken when I was a child, and doctors coincidentally discovered a tumour. My mum discovered she had breast cancer through a routine mammogram. Early detection of growths is great because it saves lives and lets patients get treatment when it's more effective. The framing of expanded early detection as "Silicon Valley's quest to live forever" seems uncharitable.

iancmceachern 3y ago
Agreed. I'm not really things like that tech bro who goes to great lengths to reduce aging, but regular diagnostic screenings, like mri, save lives. Additionally, MRI doesn't have the radiation side effects that other forms of imaging do
epicureanideal 3y ago
> The framing of expanded early detection as "Silicon Valley's quest to live forever" seems uncharitable. Totally agree. Also, we should be encouraging those with the means to spend on medical technology! It'll bring down the cost for everyone over time.
hnboringman 3y ago
[flagged]
ackbar03 3y ago
Isn't there a saying that the benefits of regular checkup are a myth? Since they lead to over intervention or something? I know some places encourage regular health checkups whilst other places actually actively say it's a bad idea. Any doctor can chime in on this?
- q1w2 3y ago
  It's too broad of a statement. Take a look at individual tests to see if they make sense. A PSA urine test, for example, is insanely cheap and catches many expensive prostate cancers in early stages. Mammograms are the similar (less cheap, but still life saving). For those specific tests, the evidence is clear.
andreareina 3y ago
> Early detection of growths is great because it saves lives and lets patients get treatment when it's more effective. It also gets people treatment when none was required: https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni... ETA: this is the page I was looking for actually: https://sciencebasedmedicine.org/the-early-detection-of-cancer-and-improved-survival-more-complicated-than-most-people-think/ https://sciencebasedmedicine.org/the-early-detection-of-canc...
hellotheretoday 3y ago
I’ve seen people bring up the whole “increased false positive rate” which is totally understandable but I don’t get how this couldn’t be a potential preventative diagnostic tool to be combined with annual physicals. Eg that unless something is obviously wrong you wouldn’t action based on any findings from a full body scan; instead you would retain the record and repeat the scan 12-24 months later. Compare anything notable for growth or other irregular change, rinse and repeat. I would imagine that would greatly decrease the amount of pointless imaging and biopsy done. There would certainly still be some done but is that not the case now? I would imagine this is downplayed because us insurance companies are generally not huge fans of expensive preventative care procedures with little evidence base (and to the last point, fair). And additionally I’d imagine physicians and radiologists have some worry about the potential liability of things being incorrectly being labeled as benign or to be monitored and turning into malpractice claims. So the evidence base gets established by rich people who can afford to cut insurance out of the equation and hire physicians that are open to these kinds of procedures. Unfair and something I’ll be very bitter about if I ever die of a cancer that could have been detected earlier if I was lucky enough to get imaged in the area for whatever reason.
- KingMachiavelli 3y ago
  > I would imagine this is downplayed because us insurance companies are generally not huge fans of expensive preventative care procedures... Sure this but also: the evidence does exist and it will be a huge expensive, inconvenience, and maybe dangerous unnecessary tests/surgery for >90% of the population. Really someone has to do the math to determine the inflection point; X% of people will get some early cancer/positive result found early, Y% will get a false-positive and undergo expensive and unnecessary procedures, and Z% will still get a false result but have cost some amount of money and time. From a public health perspective, this is unlikely to be the best-next-thing because so many people die from more preventable diseases/things or lack access to health care at all. Is it a obvious service for the upper class in SF? Certainly, because the market thinks they are 5-30x more valuable than the average person so 2.5k is nothing to be extra certain of their survival. Does that sound weirdly dystopian? Sure, but it is just moving your chance of living (for the next year as our unit) by 0.00001% or less. Most people would not spend 2.5k on a 1/100k outcome.
arcticbull 3y ago
> I had a CT scan of a fracture taken when I was a child, and doctors coincidentally discovered a tumour. > My mum discovered she had breast cancer through a routine mammogram. These two are not the same thing. We do mammograms, and only in women over a certain age, because they're a high risk population. CT scans, especially chest CT scans, expose you to huge amounts of radiation. The odds that you randomly stumble on a super low-incidence tumor is dwarfed by the fact you're exposing people - especially children in your case - to large doses of ionizing radiation. A chest CT scan smacks you with 7 mSv which is about the same as spending an hour at Chernobyl, or 7X the EPA annual dose limit for radiation exposure. [1] Lest we not forget Bayes theorem. We only do tests on people who are likely to have the condition otherwise the risks associated with a false positive outweigh the benefits of early detection. [1] https://xkcd.com/radiation/ https://xkcd.com/radiation/
- strken 3y ago
  I'm not suggesting that, at all. I just don't like the framing that any new screening process must be part of a "quest to live forever" instead of a quest to e.g. live long enough to go to your kid's wedding.
  - arcticbull 3y ago
    I think the point is more that rich tech folks (like many people) think doing more testing must be good even if there's no scientific evidence to support that conclusion - the difference is rich tech folks can afford it anyways, and they're going to be very loud about it.
- MikusR 3y ago
  Just don't eat bananas for a month to offset it.
  - lm28469 3y ago
    People should stop with these bananas stories every time we talk about radiations > while average Computer Tomography (CT) scan would equal to 105 BED or one hundred thousand eaten bananas https://etn.redmud.org/banana-equivalent-dose/#:~:text=The%20medical%20exposure%20to%20radiation,one%20hundred%20thousand%20eaten%20bananas https://etn.redmud.org/banana-equivalent-dose/#:~:text=The%2....

by strken 3y ago

iancmceachern 3y ago

Agreed. I'm not really things like that tech bro who goes to great lengths to reduce aging, but regular diagnostic screenings, like mri, save lives. Additionally, MRI doesn't have the radiation side effects that other forms of imaging do

epicureanideal 3y ago

> The framing of expanded early detection as "Silicon Valley's quest to live forever" seems uncharitable. Totally agree. Also, we should be encouraging those with the means to spend on medical technology! It'll bring down the cost for everyone over time.

hnboringman 3y ago

[flagged]

ackbar03 3y ago

Isn't there a saying that the benefits of regular checkup are a myth? Since they lead to over intervention or something? I know some places encourage regular health checkups whilst other places actually actively say it's a bad idea. Any doctor can chime in on this?

q1w2 3y ago
It's too broad of a statement. Take a look at individual tests to see if they make sense. A PSA urine test, for example, is insanely cheap and catches many expensive prostate cancers in early stages. Mammograms are the similar (less cheap, but still life saving). For those specific tests, the evidence is clear.

andreareina 3y ago

> Early detection of growths is great because it saves lives and lets patients get treatment when it's more effective. It also gets people treatment when none was required: https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni... ETA: this is the page I was looking for actually: https://sciencebasedmedicine.org/the-early-detection-of-cancer-and-improved-survival-more-complicated-than-most-people-think/ https://sciencebasedmedicine.org/the-early-detection-of-canc...

hellotheretoday 3y ago

I’ve seen people bring up the whole “increased false positive rate” which is totally understandable but I don’t get how this couldn’t be a potential preventative diagnostic tool to be combined with annual physicals. Eg that unless something is obviously wrong you wouldn’t action based on any findings from a full body scan; instead you would retain the record and repeat the scan 12-24 months later. Compare anything notable for growth or other irregular change, rinse and repeat. I would imagine that would greatly decrease the amount of pointless imaging and biopsy done. There would certainly still be some done but is that not the case now? I would imagine this is downplayed because us insurance companies are generally not huge fans of expensive preventative care procedures with little evidence base (and to the last point, fair). And additionally I’d imagine physicians and radiologists have some worry about the potential liability of things being incorrectly being labeled as benign or to be monitored and turning into malpractice claims. So the evidence base gets established by rich people who can afford to cut insurance out of the equation and hire physicians that are open to these kinds of procedures. Unfair and something I’ll be very bitter about if I ever die of a cancer that could have been detected earlier if I was lucky enough to get imaged in the area for whatever reason.

KingMachiavelli 3y ago
> I would imagine this is downplayed because us insurance companies are generally not huge fans of expensive preventative care procedures... Sure this but also: the evidence does exist and it will be a huge expensive, inconvenience, and maybe dangerous unnecessary tests/surgery for >90% of the population. Really someone has to do the math to determine the inflection point; X% of people will get some early cancer/positive result found early, Y% will get a false-positive and undergo expensive and unnecessary procedures, and Z% will still get a false result but have cost some amount of money and time. From a public health perspective, this is unlikely to be the best-next-thing because so many people die from more preventable diseases/things or lack access to health care at all. Is it a obvious service for the upper class in SF? Certainly, because the market thinks they are 5-30x more valuable than the average person so 2.5k is nothing to be extra certain of their survival. Does that sound weirdly dystopian? Sure, but it is just moving your chance of living (for the next year as our unit) by 0.00001% or less. Most people would not spend 2.5k on a 1/100k outcome.

arcticbull 3y ago

> I had a CT scan of a fracture taken when I was a child, and doctors coincidentally discovered a tumour. > My mum discovered she had breast cancer through a routine mammogram. These two are not the same thing. We do mammograms, and only in women over a certain age, because they're a high risk population. CT scans, especially chest CT scans, expose you to huge amounts of radiation. The odds that you randomly stumble on a super low-incidence tumor is dwarfed by the fact you're exposing people - especially children in your case - to large doses of ionizing radiation. A chest CT scan smacks you with 7 mSv which is about the same as spending an hour at Chernobyl, or 7X the EPA annual dose limit for radiation exposure. [1] Lest we not forget Bayes theorem. We only do tests on people who are likely to have the condition otherwise the risks associated with a false positive outweigh the benefits of early detection. [1] https://xkcd.com/radiation/ https://xkcd.com/radiation/

strken 3y ago
I'm not suggesting that, at all. I just don't like the framing that any new screening process must be part of a "quest to live forever" instead of a quest to e.g. live long enough to go to your kid's wedding.
- arcticbull 3y ago
  I think the point is more that rich tech folks (like many people) think doing more testing must be good even if there's no scientific evidence to support that conclusion - the difference is rich tech folks can afford it anyways, and they're going to be very loud about it.
MikusR 3y ago
Just don't eat bananas for a month to offset it.
- lm28469 3y ago
  People should stop with these bananas stories every time we talk about radiations > while average Computer Tomography (CT) scan would equal to 105 BED or one hundred thousand eaten bananas https://etn.redmud.org/banana-equivalent-dose/#:~:text=The%20medical%20exposure%20to%20radiation,one%20hundred%20thousand%20eaten%20bananas https://etn.redmud.org/banana-equivalent-dose/#:~:text=The%2....