4 ms·

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/bene

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.
      - mikert89 1y ago
        this is medical gate keeping ("only the holy priests can practice medicine"), please take this attitude elsewhere
        lm28469 1y ago
        [flagged]
        rscho 1y ago
        Honestly, you don't have access to the necessary data to make rational decisions. That's not gatekeeping, it's logic. I don't have access to it either, although I'm indeed a healthcare pro. Screening strategies are a hyperspecialized domain and only experts somewhat understand what they're doing. It's just like making theories about what the CERN guys should be doing while not having passed physics 101 with no access to experimental data. That's why I'm just saying: you're certainly allowed to question, but you certainly can't make up assertions either.
        _coveredInBees 1y ago
        What a ridiculous statement to make. No wonder the US is in the state it is in. Lets let the ignorant and uninformed decide on policy rather than the scientific community and experts. What could possibly go wrong?
        surgical_fire 1y ago
        "my ignorance is as valid as your knowledge" The internet is a powerful tool of communication, but turns out some people don't have anything worthwhile to communicate.
  - terminalshort 1y ago
    How could the screening do you harm? (other than financial)
    - rscho 1y ago
      What are you gonna do if the screening test comes back positive?
      - terminalshort 1y ago
        Get treated for the cancer you will now survive because you just caught early. The answer is so obvious I think I may have misunderstood what you mean here.
        rscho 1y ago
        The fact that this answer is so obvious to you means you have to read up on diagnostic test performance and how screening works, because it's in fact not obvious at all. I mean that in the nicest way possible. Those companies offering expensive screening are not what they seem. Whether their offering is useful or whether they're just swindling you is a question that needs lots of time, money and sweat to answer.
        fragmede 1y ago
        What if it's just some lump that would not have developed into cancer? The surgery to get it removed isn't risk free.
- jmcgough 1y ago
  There's not a lot of evidence that full body MRIs are beneficial. A lot of people have pre-cancerous growths that may or may not become cancer in the future, so you may just be giving them unnecessary surgery, and surgeries are not risk-free. If you don't operate, they might develop an anxiety disorder. We do a lot of CT imaging in the emergency department and it sucks if we incidentally find an abnormal growth in a young patient's CT head. These are usually benign and often not worth performing brain surgery to get a biopsy.
  - ospray 1y ago
    I had one at detected at 5mm close to the amigdala and they just scanned again in 3-6 months on MRI to prove it wasn't growing. That was a decade ago.
  - lokrian 1y ago
    Why not just rescan them every few months to see if it's still growing? After all, you wouldn't have to rescan the full body, just the section where the growth is.
DiscourseFan 1y ago
Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up. The only people who would benefit from these screenings are already unhealthy and cancer might be just one of many potential conditions they could experience—the goal of healthcare is not to dedicate an inordinate amount of resources for procedures that may amount to not much of any long term benefit. People talk about the “immune system” but they are really referring to a number of systems the body uses to regulate itself, more or less successfully, around environmental pressures. The body is a system under tension, sometimes extreme tension leads to extreme success (success here being growth of power), sometimes it breaks the body, and sometimes the systems have been slowly failing for a while, and most treatments will not help. Medicine is only useful in the specific case where the power of the body would be promoted if not for one thing, that the body would be healthy, at least manageably so, without that issue.
- wetpaws 1y ago
  [dead]
- cogman10 1y ago
  > Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up Incorrect. There are tons of cancers that hide and mask with symptoms common to other symptoms. Kidney cancer, for example, presents pretty similarly to both kidney stones and UTIs. Even blood in the urine isn't proof positive that anything is wrong beyond either of those conditions. And, by the time blood is in the urine, it's often too late. Liver cancer is even worse. The first symptoms you get can be thought of as a simple pulled muscle, just a little ache in the back. By the time you have appreciable problems, like turning yellow, it's quite advanced and too late to really do much. There are common cancers like colon, skin, breast, and prostate that more fit your description of being mostly harmless so long as you get regular screenings and eat healthy. But, for every part of the body, a cancer can form and the symptoms are very often invisible. I'm unfortunately all too familiar with how cancer looks. My wife currently has stage 4 cancer that started as kidney cancer. She does not drink or smoke, gets enough rest, and is very active.
PaulHoule 1y ago
Or cancers that aren't clinically relevant. Many prostate cancers, for instance, are slow growing and won't kill you before something else does. If you try to take that kind of cancer out surgically or zap it with radiation or chemo the side effects could be severe.
- brudgers 1y ago
  Treatments for prostate cancer are consistently improving. And what makes sense when you are 55 might be different than what does at 75…like all health care issues.

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.
    - mikert89 1y ago
      this is medical gate keeping ("only the holy priests can practice medicine"), please take this attitude elsewhere
      - lm28469 1y ago
        [flagged]
      - rscho 1y ago
        Honestly, you don't have access to the necessary data to make rational decisions. That's not gatekeeping, it's logic. I don't have access to it either, although I'm indeed a healthcare pro. Screening strategies are a hyperspecialized domain and only experts somewhat understand what they're doing. It's just like making theories about what the CERN guys should be doing while not having passed physics 101 with no access to experimental data. That's why I'm just saying: you're certainly allowed to question, but you certainly can't make up assertions either.
      - _coveredInBees 1y ago
        What a ridiculous statement to make. No wonder the US is in the state it is in. Lets let the ignorant and uninformed decide on policy rather than the scientific community and experts. What could possibly go wrong?
      - surgical_fire 1y ago
        "my ignorance is as valid as your knowledge" The internet is a powerful tool of communication, but turns out some people don't have anything worthwhile to communicate.
- terminalshort 1y ago
  How could the screening do you harm? (other than financial)
  - rscho 1y ago
    What are you gonna do if the screening test comes back positive?
    - terminalshort 1y ago
      Get treated for the cancer you will now survive because you just caught early. The answer is so obvious I think I may have misunderstood what you mean here.
      - rscho 1y ago
        The fact that this answer is so obvious to you means you have to read up on diagnostic test performance and how screening works, because it's in fact not obvious at all. I mean that in the nicest way possible. Those companies offering expensive screening are not what they seem. Whether their offering is useful or whether they're just swindling you is a question that needs lots of time, money and sweat to answer.
      - fragmede 1y ago
        What if it's just some lump that would not have developed into cancer? The surgery to get it removed isn't risk free.
jmcgough 1y ago
There's not a lot of evidence that full body MRIs are beneficial. A lot of people have pre-cancerous growths that may or may not become cancer in the future, so you may just be giving them unnecessary surgery, and surgeries are not risk-free. If you don't operate, they might develop an anxiety disorder. We do a lot of CT imaging in the emergency department and it sucks if we incidentally find an abnormal growth in a young patient's CT head. These are usually benign and often not worth performing brain surgery to get a biopsy.
- ospray 1y ago
  I had one at detected at 5mm close to the amigdala and they just scanned again in 3-6 months on MRI to prove it wasn't growing. That was a decade ago.
- lokrian 1y ago
  Why not just rescan them every few months to see if it's still growing? After all, you wouldn't have to rescan the full body, just the section where the growth is.

DiscourseFan 1y ago

Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up. The only people who would benefit from these screenings are already unhealthy and cancer might be just one of many potential conditions they could experience—the goal of healthcare is not to dedicate an inordinate amount of resources for procedures that may amount to not much of any long term benefit. People talk about the “immune system” but they are really referring to a number of systems the body uses to regulate itself, more or less successfully, around environmental pressures. The body is a system under tension, sometimes extreme tension leads to extreme success (success here being growth of power), sometimes it breaks the body, and sometimes the systems have been slowly failing for a while, and most treatments will not help. Medicine is only useful in the specific case where the power of the body would be promoted if not for one thing, that the body would be healthy, at least manageably so, without that issue.

wetpaws 1y ago
[dead]
cogman10 1y ago
> Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up Incorrect. There are tons of cancers that hide and mask with symptoms common to other symptoms. Kidney cancer, for example, presents pretty similarly to both kidney stones and UTIs. Even blood in the urine isn't proof positive that anything is wrong beyond either of those conditions. And, by the time blood is in the urine, it's often too late. Liver cancer is even worse. The first symptoms you get can be thought of as a simple pulled muscle, just a little ache in the back. By the time you have appreciable problems, like turning yellow, it's quite advanced and too late to really do much. There are common cancers like colon, skin, breast, and prostate that more fit your description of being mostly harmless so long as you get regular screenings and eat healthy. But, for every part of the body, a cancer can form and the symptoms are very often invisible. I'm unfortunately all too familiar with how cancer looks. My wife currently has stage 4 cancer that started as kidney cancer. She does not drink or smoke, gets enough rest, and is very active.

PaulHoule 1y ago

Or cancers that aren't clinically relevant. Many prostate cancers, for instance, are slow growing and won't kill you before something else does. If you try to take that kind of cancer out surgically or zap it with radiation or chemo the side effects could be severe.

brudgers 1y ago
Treatments for prostate cancer are consistently improving. And what makes sense when you are 55 might be different than what does at 75…like all health care issues.