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The big secret is that they could detect cancer very early in most people, but the health care companies don't want to pay for the screening. You can pay out of

The big secret is that they could detect cancer very early in most people, but the health care companies don't want to pay for the screening. You can pay out of pocket for these procedures. I was told this by a cancer researcher EDIT: Adding these caveats: 1. There is a ton of nuance in the diagnosis, since most people have a small amount of cancer in their blood at all times 2. The screenings are 5-10k + follow up appointments to actually see if its real cancer 3. All in cost then could be much higher per person 4. These tests arent something that are currently produced to be used at mass scale

melling 1y ago
Probably not true. It’s much cheaper to catch cancer early than to treat advanced cancer later
- mikert89 1y ago
  Nope, the cost is 5-10k maybe more, and there is alot of nuance and follow ups to those detections
- HPsquared 1y ago
  That's true in the case someone actually does have cancer, but what about paying for all the negative tests?
- vasco 1y ago
  Yeah but then you'd go through life having biopsies all the time. If all people did a full body MRI almost everyone would have weird lumps that doctors would have to biopsy to be really sure, and then what do you do? Do you biopsy yourself every time some weird tissue appears? Most of those will be nothing and you'll be going through the complications of surgeries and anesthesia all the time just to always make sure.
  - rwmj 1y ago
    Assuming some future MRI technology which was very cheap, wouldn't you have MRIs at fairly regular intervals, to first see if the lump was growing or changing shape? And if this was being done at population scale, you'd train up an AI on the known outcomes, to have it flag up problems for a human to review.
  - cogman10 1y ago
    Assuming MRIs weren't exorbitantly expensive, then the answer would probably be to simply rescan a month or 2 later and biopsy the lumps that don't go away.
deadbabe 1y ago
Wrong. The usual story is that you’re just better off not knowing because you’ll end up doing more harm than good chasing every little suspicious diagnosis. Cancer happens all the time, but many times doesn’t lead to anything.
delfinom 1y ago
Health insurers would absolutely pay for the screennig if the sum spent on screening everyone was cheaper than long term cancer care. It's the same reason they pay for annual physicals in the first place.
- mikert89 1y ago
  Nah the tests can go up to 10k per person
  - graeme 1y ago
    >if the sum spent on screening everyone was cheaper than long term cancer care
doctoring 1y ago
The not so big secret is that we can detect cancer early in a lot of people, but we also would detect a lot of not-cancer. We don't currently know the cost/benefit of that tradeoff for all these new types of screening, and therefore insurers and health systems are reluctant to pay the cost of the both screening and the subsequent workup. This is not just a financial consideration, though the financial part is a big part -- the workup for those that end up as not-cancer has non-negligible risks for the patients as well (I have had patients of mine suffer severe injury and even die from otherwise routine biopsies), and on top of that, some actual cancers may not really benefit from early discovery in the first place. This is not to downplay the potential benefit of early cancer detection... which is huge. And in the US/UK anyway, there are ongoing large trials to try to figure some of this stuff out in the space of blood-based cancer screening, as part of the path to convincing regulatory bodies and eventual reimbursement for certain tests. As mentioned, you can currently at least get the Galleri test out of pocket (<$1k, not cheap, but not exorbitant either), as well as whole body MRIs (a bit more expensive, ~$2-5k).
- mikert89 1y ago
  Yeah, after a detection there is alot of work to determine if what they detected should be worried about. But this doesnt take away from the fact that cancer can be detected very early, and these screenings could easily save your life
  - rscho 1y ago
    ... or could do you harm, which is an important point.
    - ospray 1y ago
      To clarify is the harm that many healthy people would stress while it was confirmed the detection was not cancer?
      - rscho 1y ago
        No, the potential harm comes from follow-up tests. That's why screening strategies are designed by professionals. It's a pretty complex field, and all the people here fielding their opinions on how we should proceed about tests don't have a single idea about the implications of their theories.
agumonkey 1y ago
But what could we expect as fair price if mass scale production happens ?
daedrdev 1y ago
Doing this could be actively worse for you and society based on the false positive rate. Testing and accidental unneeded treatment carry very real risks that could lead to net suffering and more death or damage if enough people are tested.
- mikert89 1y ago
  This is a collectivist opinion on something which is very personal
  - rscho 1y ago
    It's not personal, it's perfectly rational statistics, i.e. epidemiology. Designing screening strategies is not an amateur's game.
  - daedrdev 1y ago
    Would you take a test if doing so statistically increases your probability of death? Is it moral for a doctor to give a test they think is going to increase someone's chance of death.
    - twothreeone 1y ago
      That's just wrong. Taking a test doesn't do anything to the data-generating process, your chance of death is 100%. The test merely informs your posterior about the timing of the event.
      - rscho 1y ago
        The timing is pretty important to most people, and is actually the whole point of taking the test in the first place so the generating process and the test are not independent. See ?! What you said is just wrong too ! ;-)
  - surgical_fire 1y ago
    Public healthcare policy is absolutely not something personal. It involves costs of healthcare for all people involved, workload on health professionals, hospital occupancy, etc and so forth. If the rate of false positives in these tests are too high, people that need treatment for their actual illnesses might be on a waiting list because too many are doing follow-up screening and biopsies for non-issues. And to address your silly "collectivist" fear-mongering, your hyper-individualist mentality is a societal disease. We could do with some more collectivism, in the sense that people have a better understanding of the constraints and conditions of the society they are inserted in.
andsoitis 1y ago
> The big secret is that they could detect cancer very early in most people, but the health care companies don't want to pay for the screening. thanks for adding the caveats; they suggest that there are good reasons why it isn't clear cut that health care companies should pay.

melling 1y ago

Probably not true. It’s much cheaper to catch cancer early than to treat advanced cancer later

mikert89 1y ago
Nope, the cost is 5-10k maybe more, and there is alot of nuance and follow ups to those detections
HPsquared 1y ago
That's true in the case someone actually does have cancer, but what about paying for all the negative tests?
vasco 1y ago
Yeah but then you'd go through life having biopsies all the time. If all people did a full body MRI almost everyone would have weird lumps that doctors would have to biopsy to be really sure, and then what do you do? Do you biopsy yourself every time some weird tissue appears? Most of those will be nothing and you'll be going through the complications of surgeries and anesthesia all the time just to always make sure.
- rwmj 1y ago
  Assuming some future MRI technology which was very cheap, wouldn't you have MRIs at fairly regular intervals, to first see if the lump was growing or changing shape? And if this was being done at population scale, you'd train up an AI on the known outcomes, to have it flag up problems for a human to review.
- cogman10 1y ago
  Assuming MRIs weren't exorbitantly expensive, then the answer would probably be to simply rescan a month or 2 later and biopsy the lumps that don't go away.

deadbabe 1y ago

Wrong. The usual story is that you’re just better off not knowing because you’ll end up doing more harm than good chasing every little suspicious diagnosis. Cancer happens all the time, but many times doesn’t lead to anything.

delfinom 1y ago

Health insurers would absolutely pay for the screennig if the sum spent on screening everyone was cheaper than long term cancer care. It's the same reason they pay for annual physicals in the first place.

mikert89 1y ago
Nah the tests can go up to 10k per person
- graeme 1y ago
  >if the sum spent on screening everyone was cheaper than long term cancer care

doctoring 1y ago

The not so big secret is that we can detect cancer early in a lot of people, but we also would detect a lot of not-cancer. We don't currently know the cost/benefit of that tradeoff for all these new types of screening, and therefore insurers and health systems are reluctant to pay the cost of the both screening and the subsequent workup. This is not just a financial consideration, though the financial part is a big part -- the workup for those that end up as not-cancer has non-negligible risks for the patients as well (I have had patients of mine suffer severe injury and even die from otherwise routine biopsies), and on top of that, some actual cancers may not really benefit from early discovery in the first place. This is not to downplay the potential benefit of early cancer detection... which is huge. And in the US/UK anyway, there are ongoing large trials to try to figure some of this stuff out in the space of blood-based cancer screening, as part of the path to convincing regulatory bodies and eventual reimbursement for certain tests. As mentioned, you can currently at least get the Galleri test out of pocket (<$1k, not cheap, but not exorbitant either), as well as whole body MRIs (a bit more expensive, ~$2-5k).

mikert89 1y ago
Yeah, after a detection there is alot of work to determine if what they detected should be worried about. But this doesnt take away from the fact that cancer can be detected very early, and these screenings could easily save your life
- rscho 1y ago
  ... or could do you harm, which is an important point.
  - ospray 1y ago
    To clarify is the harm that many healthy people would stress while it was confirmed the detection was not cancer?
    - rscho 1y ago
      No, the potential harm comes from follow-up tests. That's why screening strategies are designed by professionals. It's a pretty complex field, and all the people here fielding their opinions on how we should proceed about tests don't have a single idea about the implications of their theories.

agumonkey 1y ago

But what could we expect as fair price if mass scale production happens ?

daedrdev 1y ago

Doing this could be actively worse for you and society based on the false positive rate. Testing and accidental unneeded treatment carry very real risks that could lead to net suffering and more death or damage if enough people are tested.

mikert89 1y ago
This is a collectivist opinion on something which is very personal
- rscho 1y ago
  It's not personal, it's perfectly rational statistics, i.e. epidemiology. Designing screening strategies is not an amateur's game.
- daedrdev 1y ago
  Would you take a test if doing so statistically increases your probability of death? Is it moral for a doctor to give a test they think is going to increase someone's chance of death.
  - twothreeone 1y ago
    That's just wrong. Taking a test doesn't do anything to the data-generating process, your chance of death is 100%. The test merely informs your posterior about the timing of the event.
    - rscho 1y ago
      The timing is pretty important to most people, and is actually the whole point of taking the test in the first place so the generating process and the test are not independent. See ?! What you said is just wrong too ! ;-)
- surgical_fire 1y ago
  Public healthcare policy is absolutely not something personal. It involves costs of healthcare for all people involved, workload on health professionals, hospital occupancy, etc and so forth. If the rate of false positives in these tests are too high, people that need treatment for their actual illnesses might be on a waiting list because too many are doing follow-up screening and biopsies for non-issues. And to address your silly "collectivist" fear-mongering, your hyper-individualist mentality is a societal disease. We could do with some more collectivism, in the sense that people have a better understanding of the constraints and conditions of the society they are inserted in.

andsoitis 1y ago

> The big secret is that they could detect cancer very early in most people, but the health care companies don't want to pay for the screening. thanks for adding the caveats; they suggest that there are good reasons why it isn't clear cut that health care companies should pay.