11 ms·

For those not keeping up, we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation

For those not keeping up, we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation patterns. They can identify over 50 types of cancer, have a specificity of 99.5% and can accurately predict the cancer’s origin. The biggest push-back from the medical profession is diagnosing cancers that are not clinically relevant and treatable (eg. A cancer may be detected 15 years before clinically relevant in some cases to my understanding). There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable. Detection is being solved in some incredible ways. To my understanding moonshot catch all treatments are mostly a pipe dream given the diversity of disease under the “cancer” umbrella, and lifestyle based prevention is proving a way bigger factor than historically acknowledged - an inconvenient challenge in addressing the issue societally. It is an endlessly interesting field to keep a track of, and I believe more entrepreneurs should be working on prevention topics!

bankcust08385 2y ago
The best reactive, futile, end-of-life medical procedures and bankruptcies money can buy rather than reducing suffering with prophylaxis and individualized care identifying root causes sooner. And the ostensible demands for prior evidence to shutdown discussion.
aquafox 2y ago
> The biggest push-back from the medical profession is diagnosing cancers that are not clinically relevant and treatable [...]. There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable. One major driver in not screening for everything that can be screened for is the base rate fallacy [1]: We usually screen for things that are rare in the general population and in that case a large fraction of positive tests are false positives. But each positive test has to be followed up and potentially causes harm (because of invasive biopsies, psychological burden etc.). [1] https://en.m.wikipedia.org/wiki/Base_rate_fallacy https://en.m.wikipedia.org/wiki/Base_rate_fallacy
whoitwas 2y ago
This is really detached from reality in the USA. In USA, health care is not important. Insurance companies decide which treatments should be given to patients, not doctors. There should theoretically be incentive to pretend to care about people and keep them alive, but no one has time to pretend. One way to break the cycle killing everyone is to remove "health" insurance companies from the system.
- s1artibartfast 2y ago
  That is more of a politically driven position than a rational one. Healthcare is important in the US. We spend more on it than any other country on the planet. There are tons of European countries that have highly functional Healthcare and private insurance.
- billy99k 2y ago
  "insurance companies decide which treatments should be given to patients, not doctors" In counties that have universal health-care, the government gets to decide which treatments are given to patients. "One way to break the cycle killing everyone is to remove "health" insurance companies from the system." I agree with you here. We should only have insurance for surgeries that won't benefit from competition (IE: are really expensive and don't happen that often). The rest should be paid for directly without insurance. This would reduce the cost quickly, as doctors and hospitals need to get paid and remove the middleman inflating all of our prices. Lasik eye surgery is a good example of this working in practice. It's not covered by most health insurance and was $50,000 a decade ago. It's now less than $3000 now.
  - whoitwas 2y ago
    Doctors and patients should dictate health care, not a third party. Insurance obviously creates misaligned demand at least as consumer and doctor's demand is ignored. Being from the US, anything would be better as it's impossible to get health care here as the system is centered around insurance.
    - 2y ago
bsder 2y ago
> for example lowering the prescribed age for breast screening would save lives This is not true. The problem is that breast screening also flags lots of benign things. These benign flags then need to be followed up and those procedures have health implications which may harm the patient worse than not learning about something benign. My friend's wife got a screen that flagged "something". During the time between "something" and the result of the biopsy (which has its own complication rate), her blood pressure went soaring due to anxiety and she had to significantly increase her blood pressure medication. Medicine is conservative and sometimes has odd incentives but the vast majority of the profession really does try to adhere to "First, do no harm."
- resource_waste 2y ago
  >"First, do no harm." Nah. First follow the corporate policy. Second keep them in your hospital network. Third always have follow up visits. "Do no harm" is just branding for the Physician Cartel.
- devonsolomon 2y ago
  Yes, no doubt there are inverse consequences: I mean on an individual level, would catch cancers and potentially save those people’s lives. I believe breast cancer in pre-screening populations are often caught later.
silverquiet 2y ago
> lifestyle based prevention is proving a way bigger factor than historically acknowledged Can you elaborate? As far as I know, abstinence from smoking and drinking as well as maintaining a healthy weight have long been the most important factors in cancer prevention. I don't think that's controversial, but that doesn't make them easy obviously.
- DataDive 2y ago
  Being active for example correlates with massive health benefits. Is an active lifestyle easy? Well, it is easy if you like being active, and extremely hard if you hate it.
  - digitalsushi 2y ago
    There are many people who would love to live an active lifestyle but their bodies do not allow them to express what their minds desire.
  - jerlam 2y ago
    It's more than just personal preference. There are environments that make it easier to get some kind of physical activity, and others that make it very hard. Weather, proximity to parks/recreational areas, convenient public transit, and dense neighborhoods can contribute to increasing physical activity without someone actually wanting to "like being active". There are local/regional/national differences in physical activity and health that are not merely explained by personal preference.
    - throwaway22032 2y ago
      Where you live is personal preference for the vast majority of Western individuals, at least barring visa issues. It's more of a prioritisation thing e.g. some people will live in New York even though they hate it because they get paid well there. Or they'll live in Arizona because family is there.
- marcuskane2 2y ago
deleted 2y ago
[deleted]
BaculumMeumEst 2y ago
> The biggest push-back from the medical profession is diagnosing cancers that are not clinically relevant and treatable (eg. A cancer may be detected 15 years before clinically relevant in some cases to my understanding). There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable. I've watched two people who waited for too long to seek treatment become eaten alive, quite literally, so I would have to imagine that at least on an individual level it would be a good idea to seek this out. Just to make sure I understand, are you saying that the problem is that people essentially get a very early warning of a diagnosis, so they start coming in for regular checks to see if it has become treatable, but it has not, but they come in fairly frequently, and those frequent visits use a lot of time and thus this process would not scale to the general population?
- devonsolomon 2y ago
  Exactly. The argument also goes that some cancers may never become clinically relevant, or in the case of the sick, vulnerable or elderly other causes of death will get you before the cancer does - And so detection in these cases may cause “unnecessary” treatment, patient worry and burden on society.
  - AnimalMuppet 2y ago
    I would really like to know: 1. What is the average number of cancers per person as a function of age? 2. How many of those cancers are clinically relevant now? 3. How many will become clinically relevant in the future? Then we can have an informed discussion about the trade-offs. Unfortunately, I suspect that nobody actually knows those numbers. (So maybe we have to start doing the scanning, at least on a study population, in order to find out...)
    - caeril 2y ago
      I read a medical article some time back stating that cancer (and tumors in general) occur all the time in basically everybody, but in the vast majority of cases, the immune system kills them. I've experienced this personally, and visibly. I've had a few moles appear on my skin, then subsequently a white ring would appear around it (presumably my body was killing ALL melanocytes in that region?) while the mole slowly shrank over the span of a few months. I have a few dozen other moles that my body never bothered doing anything about. And this is just the skin. I'm not sure I want to know what's gone on in the other 90% of my biomass.
nickfromseattle 2y ago
> For those not keeping up, we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation patterns. Can you share some types of test / brands doing these testing?
- devonsolomon 2y ago
  The one I’ve read up on is called GRAIL. I believe this is the leading lab in terms of commercialization.
theGnuMe 2y ago
>There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable. That's not really justifiable imho.
dmitrygr 2y ago
> we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation patterns Where?
- devonsolomon 2y ago
  Google GRAIL Gallery
  - dmitrygr 2y ago
    Did. You have a strange definition of "available". I see no sign up or way to pay.
    - devonsolomon 2y ago
      I have the dictionary definition of available: https://www.galleri.com/patient/complete-your-blood-draw https://www.galleri.com/patient/complete-your-blood-draw
AtlasBarfed 2y ago
Yeah I think the cancer cure endeavor is still hampered by trying to find the one-pill-to-fix-them-all, or at least the pill popping drug complex's desire for one. I think cancer will be "cured" with detailed genetic mechanism detection that feeds into a "cookbook" knowledge base that specifically targets immunotherapy and other custom-targeted treatments. That is probably labor intensive, something of course modern business hates and doesn't lead to their stock market bonanza price margins. IMO to cure cancer-the-umbrella-disease involves us focusing first on doing medicine, and less on the embarrassingly high profit margins of drug/device conglomerates. It will probably take a different kind of company.

bankcust08385 2y ago

The best reactive, futile, end-of-life medical procedures and bankruptcies money can buy rather than reducing suffering with prophylaxis and individualized care identifying root causes sooner. And the ostensible demands for prior evidence to shutdown discussion.

aquafox 2y ago

> The biggest push-back from the medical profession is diagnosing cancers that are not clinically relevant and treatable [...]. There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable. One major driver in not screening for everything that can be screened for is the base rate fallacy [1]: We usually screen for things that are rare in the general population and in that case a large fraction of positive tests are false positives. But each positive test has to be followed up and potentially causes harm (because of invasive biopsies, psychological burden etc.). [1] https://en.m.wikipedia.org/wiki/Base_rate_fallacy https://en.m.wikipedia.org/wiki/Base_rate_fallacy

whoitwas 2y ago

This is really detached from reality in the USA. In USA, health care is not important. Insurance companies decide which treatments should be given to patients, not doctors. There should theoretically be incentive to pretend to care about people and keep them alive, but no one has time to pretend. One way to break the cycle killing everyone is to remove "health" insurance companies from the system.

s1artibartfast 2y ago
That is more of a politically driven position than a rational one. Healthcare is important in the US. We spend more on it than any other country on the planet. There are tons of European countries that have highly functional Healthcare and private insurance.
billy99k 2y ago
"insurance companies decide which treatments should be given to patients, not doctors" In counties that have universal health-care, the government gets to decide which treatments are given to patients. "One way to break the cycle killing everyone is to remove "health" insurance companies from the system." I agree with you here. We should only have insurance for surgeries that won't benefit from competition (IE: are really expensive and don't happen that often). The rest should be paid for directly without insurance. This would reduce the cost quickly, as doctors and hospitals need to get paid and remove the middleman inflating all of our prices. Lasik eye surgery is a good example of this working in practice. It's not covered by most health insurance and was $50,000 a decade ago. It's now less than $3000 now.
- whoitwas 2y ago
  Doctors and patients should dictate health care, not a third party. Insurance obviously creates misaligned demand at least as consumer and doctor's demand is ignored. Being from the US, anything would be better as it's impossible to get health care here as the system is centered around insurance.
  - 2y ago

bsder 2y ago

> for example lowering the prescribed age for breast screening would save lives This is not true. The problem is that breast screening also flags lots of benign things. These benign flags then need to be followed up and those procedures have health implications which may harm the patient worse than not learning about something benign. My friend's wife got a screen that flagged "something". During the time between "something" and the result of the biopsy (which has its own complication rate), her blood pressure went soaring due to anxiety and she had to significantly increase her blood pressure medication. Medicine is conservative and sometimes has odd incentives but the vast majority of the profession really does try to adhere to "First, do no harm."

resource_waste 2y ago
>"First, do no harm." Nah. First follow the corporate policy. Second keep them in your hospital network. Third always have follow up visits. "Do no harm" is just branding for the Physician Cartel.
devonsolomon 2y ago
Yes, no doubt there are inverse consequences: I mean on an individual level, would catch cancers and potentially save those people’s lives. I believe breast cancer in pre-screening populations are often caught later.

silverquiet 2y ago

> lifestyle based prevention is proving a way bigger factor than historically acknowledged Can you elaborate? As far as I know, abstinence from smoking and drinking as well as maintaining a healthy weight have long been the most important factors in cancer prevention. I don't think that's controversial, but that doesn't make them easy obviously.

DataDive 2y ago
Being active for example correlates with massive health benefits. Is an active lifestyle easy? Well, it is easy if you like being active, and extremely hard if you hate it.
- digitalsushi 2y ago
  There are many people who would love to live an active lifestyle but their bodies do not allow them to express what their minds desire.
- jerlam 2y ago
  It's more than just personal preference. There are environments that make it easier to get some kind of physical activity, and others that make it very hard. Weather, proximity to parks/recreational areas, convenient public transit, and dense neighborhoods can contribute to increasing physical activity without someone actually wanting to "like being active". There are local/regional/national differences in physical activity and health that are not merely explained by personal preference.
  - throwaway22032 2y ago
    Where you live is personal preference for the vast majority of Western individuals, at least barring visa issues. It's more of a prioritisation thing e.g. some people will live in New York even though they hate it because they get paid well there. Or they'll live in Arizona because family is there.
marcuskane2 2y ago

deleted 2y ago

[deleted]

BaculumMeumEst 2y ago

> The biggest push-back from the medical profession is diagnosing cancers that are not clinically relevant and treatable (eg. A cancer may be detected 15 years before clinically relevant in some cases to my understanding). There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable. I've watched two people who waited for too long to seek treatment become eaten alive, quite literally, so I would have to imagine that at least on an individual level it would be a good idea to seek this out. Just to make sure I understand, are you saying that the problem is that people essentially get a very early warning of a diagnosis, so they start coming in for regular checks to see if it has become treatable, but it has not, but they come in fairly frequently, and those frequent visits use a lot of time and thus this process would not scale to the general population?

devonsolomon 2y ago
Exactly. The argument also goes that some cancers may never become clinically relevant, or in the case of the sick, vulnerable or elderly other causes of death will get you before the cancer does - And so detection in these cases may cause “unnecessary” treatment, patient worry and burden on society.
- AnimalMuppet 2y ago
  I would really like to know: 1. What is the average number of cancers per person as a function of age? 2. How many of those cancers are clinically relevant now? 3. How many will become clinically relevant in the future? Then we can have an informed discussion about the trade-offs. Unfortunately, I suspect that nobody actually knows those numbers. (So maybe we have to start doing the scanning, at least on a study population, in order to find out...)
  - caeril 2y ago
    I read a medical article some time back stating that cancer (and tumors in general) occur all the time in basically everybody, but in the vast majority of cases, the immune system kills them. I've experienced this personally, and visibly. I've had a few moles appear on my skin, then subsequently a white ring would appear around it (presumably my body was killing ALL melanocytes in that region?) while the mole slowly shrank over the span of a few months. I have a few dozen other moles that my body never bothered doing anything about. And this is just the skin. I'm not sure I want to know what's gone on in the other 90% of my biomass.

nickfromseattle 2y ago

> For those not keeping up, we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation patterns. Can you share some types of test / brands doing these testing?

devonsolomon 2y ago
The one I’ve read up on is called GRAIL. I believe this is the leading lab in terms of commercialization.

theGnuMe 2y ago

>There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable. That's not really justifiable imho.

dmitrygr 2y ago

> we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation patterns Where?

devonsolomon 2y ago
Google GRAIL Gallery
- dmitrygr 2y ago
  Did. You have a strange definition of "available". I see no sign up or way to pay.
  - devonsolomon 2y ago
    I have the dictionary definition of available: https://www.galleri.com/patient/complete-your-blood-draw https://www.galleri.com/patient/complete-your-blood-draw

AtlasBarfed 2y ago

Yeah I think the cancer cure endeavor is still hampered by trying to find the one-pill-to-fix-them-all, or at least the pill popping drug complex's desire for one. I think cancer will be "cured" with detailed genetic mechanism detection that feeds into a "cookbook" knowledge base that specifically targets immunotherapy and other custom-targeted treatments. That is probably labor intensive, something of course modern business hates and doesn't lead to their stock market bonanza price margins. IMO to cure cancer-the-umbrella-disease involves us focusing first on doing medicine, and less on the embarrassingly high profit margins of drug/device conglomerates. It will probably take a different kind of company.