6 ms·

Is early-onset cancer an emerging global epidemic? (2022)

22 points by divbzero 3y ago

strogonoff 3y ago
I recall reading at some point that at any given time a person can have multiple mini-cancers coming and going, not resulting in anything. Could the early-onset cancer epidemic be an effect of detecting cancers earlier, and/or the consequences of the resulting stress (higher levels of inflammation, etc.)? A kind of “if you’re measuring it, you’re altering it”. Perhaps as we lower detection thresholds we should take care of handling measuring outcomes more carefully.
- Zenzero 3y ago
  To some degree you are correct, but you are conflating processes that occur at different scales. And important part of a functional immune system is checkpointing and surveillance of cells. Cells with errors in transcription in theory are flagged for destruction. Cell surface signaling is another way that the immune system jumps in to attack abnormal cells. This process is happening continuously, so in a technical sense if you wish to define cancer at the level of a single cell with proliferative potential, then sure, cancer is popping up all the time. As a result it is also why immunosuppressives carry warnings about increased risk of cancer, because they are downregulating a critical safeguard. Cancer detection is still predominantly at the level of macroscopic disease, at which point it has far surpassed the point of failure on a cellular level. While a rise in cancer diagnoses are to be expected with improved screening, a hypothetical situation where cancers are coming and going does not occur at a clinically detectable level.
  - strogonoff 3y ago
    I appreciate the insight. That said, you seem to imply that detected cancer does not resolve without modern medicinal treatment? Small sample, but I personally know one case where it did. Also, do you believe that ongoing stress (after receiving what is widely considered a death sentence or one way road to constant treatment) has no influence the outcome?
    - tsoukase 3y ago
      Not GP. Clinico-laboratory detected cancer will never resolve without treatment and will lead to death, fast or slow. I do not understand the second point. Anticancer treatment is very stressful and damaging in many ways (middle ages' level of technology...) but care is taken that its side effects are less than the desired ones
      - MrYellowP 3y ago
        > (middle ages' level of technology...) Star Trek reference?
        tsoukase 3y ago
        Modern available therapies: 1. Resect the cancer with healthy tissue without knowing the actual borders 2. Pour poisons until just before the patient surrenders and hope for the best 3. Bombard with ionising radiation (Hippocrates: if all therapies fail, apply cauterization) Actually it is Ancient technology.
      - naveen99 3y ago
        Cancers are not all deadly. even big ones.
        Zenzero 3y ago
        I think the problem is that this conversation is lacking in precision of language. Amongst doctors the word cancer carries minimal value. Describing a mass as (in simple terms) a locally invasive carcinoma or an encapsulated adenoma gives a much better idea of expectations and a basis for factual claims. In fact the entire point of a histopath report is to give descriptive language that sufficiently grounds the findings in a usable level of detail for treatment/prognosis/etc. Saying "cancers are X" will just invite anecdotal comments that refer to completely dissimilar processes.
      - strogonoff 3y ago
        https://www.wsj.com/health/wellness/prostate-cancer-low-risk-treatment-rename-185b6e3f https://www.wsj.com/health/wellness/prostate-cancer-low-risk... > It’s an unexpected question that has stirred the world of cancer treatment in recent years, most notably now with prostate cancer. A growing number of doctors are advocating what might seem like an unusual position: That low-grade prostate cancers that grow very slowly or not at all shouldn’t be called cancer or carcinoma. > The reason, they say, is that those words scare men, their families and sometimes even their doctors into seeking more aggressive treatment than patients need—leaving men with debilitating side effects—rather than pursuing a carefully monitored wait-and-see approach.

22 points by divbzero 3y ago

I recall reading at some point that at any given time a person can have multiple mini-cancers coming and going, not resulting in anything. Could the early-onset cancer epidemic be an effect of detecting cancers earlier, and/or the consequences of the resulting stress (higher levels of inflammation, etc.)? A kind of “if you’re measuring it, you’re altering it”. Perhaps as we lower detection thresholds we should take care of handling measuring outcomes more carefully.

Zenzero 3y ago
To some degree you are correct, but you are conflating processes that occur at different scales. And important part of a functional immune system is checkpointing and surveillance of cells. Cells with errors in transcription in theory are flagged for destruction. Cell surface signaling is another way that the immune system jumps in to attack abnormal cells. This process is happening continuously, so in a technical sense if you wish to define cancer at the level of a single cell with proliferative potential, then sure, cancer is popping up all the time. As a result it is also why immunosuppressives carry warnings about increased risk of cancer, because they are downregulating a critical safeguard. Cancer detection is still predominantly at the level of macroscopic disease, at which point it has far surpassed the point of failure on a cellular level. While a rise in cancer diagnoses are to be expected with improved screening, a hypothetical situation where cancers are coming and going does not occur at a clinically detectable level.
- strogonoff 3y ago
  I appreciate the insight. That said, you seem to imply that detected cancer does not resolve without modern medicinal treatment? Small sample, but I personally know one case where it did. Also, do you believe that ongoing stress (after receiving what is widely considered a death sentence or one way road to constant treatment) has no influence the outcome?
  - tsoukase 3y ago
    Not GP. Clinico-laboratory detected cancer will never resolve without treatment and will lead to death, fast or slow. I do not understand the second point. Anticancer treatment is very stressful and damaging in many ways (middle ages' level of technology...) but care is taken that its side effects are less than the desired ones
    - MrYellowP 3y ago
      > (middle ages' level of technology...) Star Trek reference?
      - tsoukase 3y ago
        Modern available therapies: 1. Resect the cancer with healthy tissue without knowing the actual borders 2. Pour poisons until just before the patient surrenders and hope for the best 3. Bombard with ionising radiation (Hippocrates: if all therapies fail, apply cauterization) Actually it is Ancient technology.
    - naveen99 3y ago
      Cancers are not all deadly. even big ones.
      - Zenzero 3y ago
        I think the problem is that this conversation is lacking in precision of language. Amongst doctors the word cancer carries minimal value. Describing a mass as (in simple terms) a locally invasive carcinoma or an encapsulated adenoma gives a much better idea of expectations and a basis for factual claims. In fact the entire point of a histopath report is to give descriptive language that sufficiently grounds the findings in a usable level of detail for treatment/prognosis/etc. Saying "cancers are X" will just invite anecdotal comments that refer to completely dissimilar processes.
    - strogonoff 3y ago
      https://www.wsj.com/health/wellness/prostate-cancer-low-risk-treatment-rename-185b6e3f https://www.wsj.com/health/wellness/prostate-cancer-low-risk... > It’s an unexpected question that has stirred the world of cancer treatment in recent years, most notably now with prostate cancer. A growing number of doctors are advocating what might seem like an unusual position: That low-grade prostate cancers that grow very slowly or not at all shouldn’t be called cancer or carcinoma. > The reason, they say, is that those words scare men, their families and sometimes even their doctors into seeking more aggressive treatment than patients need—leaving men with debilitating side effects—rather than pursuing a carefully monitored wait-and-see approach.