4 ms·

A benign tumor doesn’t spread and doesn’t warrant chemotherapy I believe? And if it’s actually cancer than I don’t understand how you would not want it gone as

A benign tumor doesn’t spread and doesn’t warrant chemotherapy I believe? And if it’s actually cancer than I don’t understand how you would not want it gone as soon as possible to avoid metastasis?

Fire-Dragon-DoL 2y ago
Well, this is talking specifically about the case where the cancer is benign. Of course you want a metastatic one gone. For the benign ones, that's going to hurt the person's body quite a bit
- jvanderbot 2y ago
  I think the jump from "protein blood test" to "Chemotherapy" is a bit of a stretch. There are almost surely additional screenings and diagnoses going on there. And I don't think anyone is going into chemo for benign tumors.
  - Fire-Dragon-DoL 2y ago
    Makes sense. Is it possible for the two types of cancer to be confused? Should also point out that tests will negatively affect your life seriously either way, especially if these benign cancers are common. Think of the time spent going to/from the doctor, the incredible stress (am I dying?), the tests itself: it is damaging the person's life. Detection is good, false positives are unacceptable though.
    - jvanderbot 2y ago
      I recently read Outlive, and he makes the claim that almost all of the increase in survivability for cancer comes from early detection. I think projects like this are extrapolating that out. I think a little heartache and worry is excusable if it means 10 years added to your life. Over time, we'll develop a callous there and take it in stride. e.g., My two friends who got early screening had a few false positives, and one true positive treated early. One later died of heart attack and one lived long enough to get dementia. My two friends who didn't get early screening, one died of heart attack and one died of cancer that could have been caught. Both died earlier than two above. Sadly, at this point, you want to die of cancer, but you want to do it when you're 85. It beats a sudden heart attack and it beats dementia. You just want to prolong the outcome.
      - steveBK123 2y ago
        Precisely. I don't know any "did early detection which lead to unnecessary chemo" stories.. I know people who died due to the lack of early detection. I also know people who survived due to accidental pre-symptomatic detection because of unrelated ER scans where they'd have been in stage 4 before having any symptoms. So more screenings for more types of cancer are absolutely needed. It's more treatable early, and you will have better outcomes. Patients might worry about lab results is not a good reason not to have early detection. Patients can self select if they are so sensitive.
        vidarh 2y ago
        How would you distinguish a necessary and unnecessary chemo after the fact? Nobody would give chemo if the tumor is known to benign, after all. An unnecessary chemo will be one where they couldn't tell, and the chemo ensures they wont tell. The only way you'll know is from aggregate mortality statistics not budging. The other aspect is that even if a tumour isn't, earlier detection is often not reducing mortality any more once you get to a decent baseline. The evidence often does not support early screening in general. Early screening for specific subsets of the population have better results, but are also not unambiguously helpful.
        wrycoder 2y ago
        Typically, you biopsy the tumor to determine appropriate treatment.
        vidarh 2y ago
        And that is 1) not risk free - though it's low risk, have too many false positives, and you do more harm than you prevent, 2) do enough biopsies and you will still get false positives.
    - robocat 2y ago
      > [costs:] the incredible stress I have seen a few people get benefits from a cancer scare: a refocus onto what matters in their lives. Agree: I would guess most people just get costs. Of my middle-aged friends with health scares only a few addressed the underlying cause (and even fewer are proactively avoiding health issues).
  - IG_Semmelweiss 2y ago
    i think you are severely underestimating the human species bias for action once the train leaves the station theres a lot of steam to go in 1 direction only
canes123456 2y ago
It’s more complex than this. There is a pretty narrow sweet spot where early detection actually helps. If the cancer is very fast growing, it could be too fast for treatment to help at all. Even if treatment helps there likely not a very long period of time before you develop symptoms that would have lead to treatment regardless. If it is very slow growing, you might outlive the cancer and it doesn’t require treatment. It is effectively but not actually a benign tumor. You also have to deal with false negative and positives, that could be an order of magnitude higher than the Goldilocks true postives that earlier detection actually made a difference. It’s easy to see how population results will not show much of a benefit.
- jajko 2y ago
  Probably the most famous slow growing tumor is prostate cancer. As per my friend who is urology surgeon, basically all men eventually catch it, unless they die young. But it goes so slowly and symptoms are rather mild in most cases no invasive treatment is done.
deleted 2y ago
[deleted]
dukeofdoom 2y ago
Prostate cancer. Lots of nerve endings there. The procedure to remove it can lead you to be incontinent. Let's say you treat the cancer but get damaged by the procedure and can't be as active. Your seditary life style leads to a blood clot and an early death ...in the end you may have lowered your life expectancy as prostate cancer is slow growing
- vharuck 2y ago
  Prostate cancer also came to my mind first. Doctors generally stop screening for prostate cancer after a certain age (70 and older is the recommended cutoff from the US Preventative Services Task Force), because, if the cancer wasn't causing symptoms, it's unlikely to impact quality of life or cause death before something else. The USPSTF references a lot of meta-analyses dealing with screening outcomes. They make decisions by whether a specific screening practice decreases mortality rates. They explicitly don't even include the financial cost of a screening practice.
  - deleted 2y ago
    [deleted]
IG_Semmelweiss 2y ago
yet, many a malignant tumor may not metastize until you are 90 and dead from other causes, either

Fire-Dragon-DoL 2y ago

Well, this is talking specifically about the case where the cancer is benign. Of course you want a metastatic one gone. For the benign ones, that's going to hurt the person's body quite a bit

jvanderbot 2y ago
I think the jump from "protein blood test" to "Chemotherapy" is a bit of a stretch. There are almost surely additional screenings and diagnoses going on there. And I don't think anyone is going into chemo for benign tumors.
- Fire-Dragon-DoL 2y ago
  Makes sense. Is it possible for the two types of cancer to be confused? Should also point out that tests will negatively affect your life seriously either way, especially if these benign cancers are common. Think of the time spent going to/from the doctor, the incredible stress (am I dying?), the tests itself: it is damaging the person's life. Detection is good, false positives are unacceptable though.
  - jvanderbot 2y ago
    I recently read Outlive, and he makes the claim that almost all of the increase in survivability for cancer comes from early detection. I think projects like this are extrapolating that out. I think a little heartache and worry is excusable if it means 10 years added to your life. Over time, we'll develop a callous there and take it in stride. e.g., My two friends who got early screening had a few false positives, and one true positive treated early. One later died of heart attack and one lived long enough to get dementia. My two friends who didn't get early screening, one died of heart attack and one died of cancer that could have been caught. Both died earlier than two above. Sadly, at this point, you want to die of cancer, but you want to do it when you're 85. It beats a sudden heart attack and it beats dementia. You just want to prolong the outcome.
    - steveBK123 2y ago
      Precisely. I don't know any "did early detection which lead to unnecessary chemo" stories.. I know people who died due to the lack of early detection. I also know people who survived due to accidental pre-symptomatic detection because of unrelated ER scans where they'd have been in stage 4 before having any symptoms. So more screenings for more types of cancer are absolutely needed. It's more treatable early, and you will have better outcomes. Patients might worry about lab results is not a good reason not to have early detection. Patients can self select if they are so sensitive.
      - vidarh 2y ago
        How would you distinguish a necessary and unnecessary chemo after the fact? Nobody would give chemo if the tumor is known to benign, after all. An unnecessary chemo will be one where they couldn't tell, and the chemo ensures they wont tell. The only way you'll know is from aggregate mortality statistics not budging. The other aspect is that even if a tumour isn't, earlier detection is often not reducing mortality any more once you get to a decent baseline. The evidence often does not support early screening in general. Early screening for specific subsets of the population have better results, but are also not unambiguously helpful.
        wrycoder 2y ago
        Typically, you biopsy the tumor to determine appropriate treatment.
        vidarh 2y ago
        And that is 1) not risk free - though it's low risk, have too many false positives, and you do more harm than you prevent, 2) do enough biopsies and you will still get false positives.
  - robocat 2y ago
    > [costs:] the incredible stress I have seen a few people get benefits from a cancer scare: a refocus onto what matters in their lives. Agree: I would guess most people just get costs. Of my middle-aged friends with health scares only a few addressed the underlying cause (and even fewer are proactively avoiding health issues).
- IG_Semmelweiss 2y ago
  i think you are severely underestimating the human species bias for action once the train leaves the station theres a lot of steam to go in 1 direction only

canes123456 2y ago

It’s more complex than this. There is a pretty narrow sweet spot where early detection actually helps. If the cancer is very fast growing, it could be too fast for treatment to help at all. Even if treatment helps there likely not a very long period of time before you develop symptoms that would have lead to treatment regardless. If it is very slow growing, you might outlive the cancer and it doesn’t require treatment. It is effectively but not actually a benign tumor. You also have to deal with false negative and positives, that could be an order of magnitude higher than the Goldilocks true postives that earlier detection actually made a difference. It’s easy to see how population results will not show much of a benefit.

jajko 2y ago
Probably the most famous slow growing tumor is prostate cancer. As per my friend who is urology surgeon, basically all men eventually catch it, unless they die young. But it goes so slowly and symptoms are rather mild in most cases no invasive treatment is done.

deleted 2y ago

[deleted]

dukeofdoom 2y ago

Prostate cancer. Lots of nerve endings there. The procedure to remove it can lead you to be incontinent. Let's say you treat the cancer but get damaged by the procedure and can't be as active. Your seditary life style leads to a blood clot and an early death ...in the end you may have lowered your life expectancy as prostate cancer is slow growing

vharuck 2y ago
Prostate cancer also came to my mind first. Doctors generally stop screening for prostate cancer after a certain age (70 and older is the recommended cutoff from the US Preventative Services Task Force), because, if the cancer wasn't causing symptoms, it's unlikely to impact quality of life or cause death before something else. The USPSTF references a lot of meta-analyses dealing with screening outcomes. They make decisions by whether a specific screening practice decreases mortality rates. They explicitly don't even include the financial cost of a screening practice.
- deleted 2y ago
  [deleted]

IG_Semmelweiss 2y ago

yet, many a malignant tumor may not metastize until you are 90 and dead from other causes, either