3 ms·

Yeah cancer is the big killer nowadays. Survival rates for stage 4 cancer still poor after many decades of research. Worse yet, in many instances there are no

Yeah cancer is the big killer nowadays. Survival rates for stage 4 cancer still poor after many decades of research. Worse yet, in many instances there are no obvious risk factors, such as people in their 30s or 40s who get colon cancer and were not eligible for screening .

yieldcrv 1y ago
that’s to be expected, after we do the adequate screening for one older population and mitigate many of the advanced versions of that, then the previously edge case becomes more prevalent amongst all cases there is still a limited resource for the screening at this point, so that’s a friction to expanding screening
- zahlman 1y ago
  It's not just a question of scaling up the screening effort. Doctors are also concerned with potential harms caused by false positives.
  - greedo 1y ago
    What false positive would come out of a colonoscopy? You are visually looking for masses, and removing suspect polyps that are sent in for evaluation. The major potential harm of a colonoscopy is a bowel perforation. Serious complications occur roughly 0.3% of the time.
    - Someone 1y ago
      > Serious complications occur roughly 0.3% of the time. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html https://www.cancer.org/cancer/types/colon-rectal-cancer/abou..., “the lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 26 for women.” So, it’s a 4% lifetime risk versus a 0.3% per colonoscopy risk. The outcomes for the two risks also are different, but I would think that for many healthy people (e.g. those under 40 years old), the risk of doing such a check are greater than that of not taking it. Reading https://en.wikipedia.org/wiki/Colorectal_cancer#Screening https://en.wikipedia.org/wiki/Colorectal_cancer#Screening, that’s one of the reasons frequent colonoscopies aren’t advised.
      - greedo 1y ago
        As you said, the outcomes are wildly different. A 0.3% risk of colonoscopy complications vs missing out on catching a mass when it's relatively easy to treat.
accrual 1y ago
> not eligible for screening Is this a thing? I thought I could walk into my PCP's office and schedule a screening any time, provided I may need to pay more out of pocket or something.
- BobbyTables2 1y ago
  PCP is certainly not going to be the one doing the colonoscopy. maybe they’d do the stool sample or some silly blood test if you are extremely insistent and can somehow demonstrate a risk factor. I’ve dealt with a few PCPs and they seem less informed about their own area than a 30 sec google search. They’re basically L6 tech support…
  - exhilaration 1y ago
    I read here (on Hacker News) that the stool test is actually really valuable and cheap enough to pay out of pocket prior to trying to justify an out-of-schedule colonoscopy.
    - OptionOfT 1y ago
      Not to mention the prepare for a colonoscopy is not pleasant.
      - SoftTalker 1y ago
        And colonoscopies are invasive procedures that have their own risks. Perforated bowel can turn this "routine" procedure into an emergency.
    - yen223 1y ago
      Gentle reminder for Australian folks here, you can get a bowel screening test kit for free, if you're between 45 - 74 years of age. https://www.health.gov.au/our-work/national-bowel-cancer-screening-program/doing-a-bowel-screening-test/who-should-do-the-bowel-screening-test https://www.health.gov.au/our-work/national-bowel-cancer-scr...
    - 1y ago
tonyedgecombe 1y ago
Would screening improve the outcomes or just create more patients getting unnecessary treatment?
- greedo 1y ago
  Catching colorectal cancer at an early stage improves survival rates tremendously. You have to weigh the risk of complications from the colonoscopy (primarily bowel perforation) with the improved outcomes. There's a cost element as well, since colonoscopies (without complications) can be several thousand dollars.
  - naijaboiler 1y ago
    That's the calculations that go into screening guidelines. It's a lot of weighing now much benefit early detection provides vs how much harm testing and false positives do.
    - greedo 1y ago
      Guidelines do change however. When I first was diagnosed at age 41, my doctors were all pretty surprised due to my age. Not shocked, just surprised. Five years later, they were all pretty consistent in their views that the age guidelines should be lower, and that viewing colorectal cancer as something primarily limited to 50+ was outdated.
- deleted 1y ago
  [deleted]
- ak217 1y ago
  Yes, colorectal cancer screening is estimated to reduce colorectal cancer mortality by 50% to 73%. https://pmc.ncbi.nlm.nih.gov/articles/PMC10093633/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10093633/ https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 Progressive screening using non-invasive assays like Cologuard and FIT is a valuable screening mode. The non-invasive assays are not perfect but they are improving.
dogmatism 1y ago
No, heart disease still #1 (it's closer, like 680K vs 600K deaths)

yieldcrv 1y ago

that’s to be expected, after we do the adequate screening for one older population and mitigate many of the advanced versions of that, then the previously edge case becomes more prevalent amongst all cases there is still a limited resource for the screening at this point, so that’s a friction to expanding screening

zahlman 1y ago
It's not just a question of scaling up the screening effort. Doctors are also concerned with potential harms caused by false positives.
- greedo 1y ago
  What false positive would come out of a colonoscopy? You are visually looking for masses, and removing suspect polyps that are sent in for evaluation. The major potential harm of a colonoscopy is a bowel perforation. Serious complications occur roughly 0.3% of the time.
  - Someone 1y ago
    > Serious complications occur roughly 0.3% of the time. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html https://www.cancer.org/cancer/types/colon-rectal-cancer/abou..., “the lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 26 for women.” So, it’s a 4% lifetime risk versus a 0.3% per colonoscopy risk. The outcomes for the two risks also are different, but I would think that for many healthy people (e.g. those under 40 years old), the risk of doing such a check are greater than that of not taking it. Reading https://en.wikipedia.org/wiki/Colorectal_cancer#Screening https://en.wikipedia.org/wiki/Colorectal_cancer#Screening, that’s one of the reasons frequent colonoscopies aren’t advised.
    - greedo 1y ago
      As you said, the outcomes are wildly different. A 0.3% risk of colonoscopy complications vs missing out on catching a mass when it's relatively easy to treat.

accrual 1y ago

> not eligible for screening Is this a thing? I thought I could walk into my PCP's office and schedule a screening any time, provided I may need to pay more out of pocket or something.

BobbyTables2 1y ago
PCP is certainly not going to be the one doing the colonoscopy. maybe they’d do the stool sample or some silly blood test if you are extremely insistent and can somehow demonstrate a risk factor. I’ve dealt with a few PCPs and they seem less informed about their own area than a 30 sec google search. They’re basically L6 tech support…
- exhilaration 1y ago
  I read here (on Hacker News) that the stool test is actually really valuable and cheap enough to pay out of pocket prior to trying to justify an out-of-schedule colonoscopy.
  - OptionOfT 1y ago
    Not to mention the prepare for a colonoscopy is not pleasant.
    - SoftTalker 1y ago
      And colonoscopies are invasive procedures that have their own risks. Perforated bowel can turn this "routine" procedure into an emergency.
  - yen223 1y ago
    Gentle reminder for Australian folks here, you can get a bowel screening test kit for free, if you're between 45 - 74 years of age. https://www.health.gov.au/our-work/national-bowel-cancer-screening-program/doing-a-bowel-screening-test/who-should-do-the-bowel-screening-test https://www.health.gov.au/our-work/national-bowel-cancer-scr...
  - 1y ago

tonyedgecombe 1y ago

Would screening improve the outcomes or just create more patients getting unnecessary treatment?

greedo 1y ago
Catching colorectal cancer at an early stage improves survival rates tremendously. You have to weigh the risk of complications from the colonoscopy (primarily bowel perforation) with the improved outcomes. There's a cost element as well, since colonoscopies (without complications) can be several thousand dollars.
- naijaboiler 1y ago
  That's the calculations that go into screening guidelines. It's a lot of weighing now much benefit early detection provides vs how much harm testing and false positives do.
  - greedo 1y ago
    Guidelines do change however. When I first was diagnosed at age 41, my doctors were all pretty surprised due to my age. Not shocked, just surprised. Five years later, they were all pretty consistent in their views that the age guidelines should be lower, and that viewing colorectal cancer as something primarily limited to 50+ was outdated.
deleted 1y ago
[deleted]
ak217 1y ago
Yes, colorectal cancer screening is estimated to reduce colorectal cancer mortality by 50% to 73%. https://pmc.ncbi.nlm.nih.gov/articles/PMC10093633/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10093633/ https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 https://www.nejm.org/doi/full/10.1056/NEJMoa2208375 Progressive screening using non-invasive assays like Cologuard and FIT is a valuable screening mode. The non-invasive assays are not perfect but they are improving.

dogmatism 1y ago

No, heart disease still #1 (it's closer, like 680K vs 600K deaths)