Re-evaluating the Benefits of Cancer Screening 253
uncleO writes "An article in the NY Times describes two studies that weigh the harm caused by cancer screenings against the benefits they provide. From the article, 'Two recent clinical trials of prostate cancer screening cast doubt on whether many lives — or any — are saved. And it said that screening often leads to what can be disabling treatments for men whose cancer otherwise would never have harmed them. A new analysis of mammography concluded that while mammograms find cancer in 138,000 women each year, as many as 120,000 to 134,000 of those women either have cancers that are already lethal or have cancers that grow so slowly they do not need to be treated. ... In recent years, researchers have found that many, if not most, cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated — they are harmless."
indolent (Score:2)
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We need someone to do an emergency homestectomy! Someone call the US air force nuclear medicine department, we'll need a few tons of radioisotopes to ensure we can do a sucessful thermoablative intervention.
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His haircut has already metastasized onto teenaged losers everywhere.
And, for no good reason, onto this dude [draftdaysuit.com], who currently defines "winner" in a way not made so clear since Joe Namath and James Bond were peaking.
Re:indolent (Score:4, Interesting)
I thought that was insolent.
OK, here are the things that can happen in a cancer screening:
1. You find a cancer that will eventually kill you AND that particular cancer has a treatment that works better when started earlier. (True Positive result)
2. You don't find a cancer that you don't have. (True Negative result)
3. You find a cancer or something that looks like a cancer however it will grow so slowly or regress so it won't cause any harm, but then you don't really know which is which so you elect to be treated for same with some morbidity or mortality. (False Positive result)
4. You don't find the cancer that existed and goes off to knock you off just before you design the next iPad killer. (False negative result).
Only #1 and #2 are unequivocally good. #3 might be a bit of a problem - say a lumpectomy for Ductal carcinoma in situ (DCIS) - which is painful and maybe slightly disfiguring but doesn't really change your overall health or it might be a radical prostatectomy for an indolent prostate cancer that would never kill you but now your are incontinent and impotent (a relatively common outcome). #4 is only bad if you would have been helped by earlier detection which is a theory often proposed but often doesn't hold up to scrutiny.
Right now the biggest noise is around breast cancer which unfortunately has problems with all four potential outcomes. You can miss aggressive cancers on mammography. It is not at all clear that getting aggressive cancers early affects any change in outcome. There are many, many false positives. There are a number of breast cancers (DCIS for example) that left alone, typically don't do anything.
So the 'preventative medicine' bandwagon needs to be taken down a notch or two. It is not helped at all that most of the bigger players in cancer research and therapy stand to gain by aggressive detection treatment strategies.
Patients, not so much.
Re:indolent (Score:5, Interesting)
You're leaving out #5:
You find a cancer that is so aggressive that it will kill you no matter what, but you still treat it and the treatment kills you faster or reduces the quality of your remaining life.
At least then you get a choice (Score:3)
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Then there's a particularly nasty subset of #3, you find an essentially harmless cancer like object and treat it aggressively. As a result of long term damage to your immune system and genetic damage from harsh chemo, you develop a lethal cancer that can't be treated. Or you just spend the rest of your shortened life in relatively poor health.
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That #6 is #1 in GP's list...
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We need better detection methods, to both detect and differentiate.
We need better treatment. Jumping the shark with the scalpel is old fashioned. Cancer vaccines(tailored based on sampled cancer from patient itself) would be a fantastic method if proved efficient. Although general sweeping anti-canc
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But what's the alternative? Just wait until someone's sick enough to warrant a cancer screening?
Or, to be more direct, the problem isn't the _testing_, it the _reaction_. The view of cancer is too binary... You either don't have cancer or you have ZOMG CANCER. It seems to me that by making a third category of 'mostly harmless' we could really do away with #3 altogether. How could we determine that? Early detection and study. Exactly what abandoning screens would make impossible.
Really, this is just ab
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Absolutely! If the statistics show that we're better off without early screening in terms of health outcomes, by all means! We should be doing something else with our time and money than to spend them on ineffective screening.
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First, no doctor is going to volunteer "this is cancer, but it doesn't look dangerous so we'll just monitor the situation"
This is not universally correct. For a run-of-the-mill prostatic adenocarcinoma (your garden variety prostate cancer) there is actually the concept of active surveillance, where the patient gets yearly biopsies to track any progression. If the biopsies show cancer involving more than it should (where should is defined by a variety of factors) then treatment becomes more aggressive (r
Re:indolent (Score:4, Informative)
I've lost loved ones to cancer as well, but if early detection doesn't help you, and false positives can really hurt you, then cancer screenings are doing more harm than good and costing society dearly.
I've been growing more wary of early detection, and not just cancer, but all sorts of things. False positives are everywhere in medicine, more commonplace than we'd like to think. It's better to educate people on symptoms, screen only for things that don't have any symptoms (until it's too late), and generally people should live their lives normally and only see a doctor when they actually get sick. Annual check-ups are good for people who are uninformed about their health, or have questions they need answered, but what do they actually do for healthy people? Nothing. What do they do for sick people? Well, those sick people should've made a special appointment when they realized they were sick, not based on an arbitrary annual check-up schedule.
If something hurts, is bleeding, or isn't working right, by all means, go see a doctor, ideally a specialist who knows all about it. If there's nothing wrong, though, you're more likely to become sick going to a doctor's office or hospital than if you just stayed home. Either you'll catch something from another patient who's there legitimately, or you'll become a victim of malpractice or treatment for false positives.
While emergency medicine is based on worst case scenario, the rest of our medical system is all based on probabilities. The same three symptoms could mean you have x, y, or z, but you're treated for y because it's most likely. Only if treatment fails do we consider x or z. It's not a perfect system, but it's the best system for the most number of people, until we devise better tests to differentiate x and z from y. By all means, we should use cold hard statistics to weigh the pros and cons of screening. If the probability of harm is greater than the probability of benefit, regardless of the dangers of untreated cancer, we must advocate less screening.
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It is not at all clear that getting aggressive cancers early affects any change in outcome.
5 year breast cancer survival rates:
Detected at stage 1: 88%
Detected at stage 4: 15%
Source: http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-survival-by-stage [cancer.org]
You're right, dunno why we bother screening.
However, it is not at all clear that those detected at stage 1 are all the same types as those detected at stage 4. If a significant fraction of those detected at stage one would NEVER progress beyond stage one lets call them "type A", with the aggressive ones called "type B", then it is at least possible that "type A" has a 15% survival rate no matter what stage it is detected, and is responsible for much of the 12% death rate in the early detection pool, as well as the 85% death rate in the later detectio
Big implications for public health across world (Score:3)
And the UK is now reviewing the entire breast screening programme it runs to see whether the evidence continues to show that, on balance, good outweighs harm. Tough decisions for all concerned, and an excellent demonstration of just why science is hard to do right.
Among the options:
1) Continue as-is
2) Use more selective screening with (hopefully) greater specificity -- eg familial history, gene markers, etc
3) Stop screening
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The problem is that the corner cases (those with no family history) whose cancer was caught by the screening are humans, and they will be very, very vocal about their desire to continue living. And over here one of our political parties will point at you and say something like, "See? In government-run health care they want to stop the screenings that saved the lives of Mrs. A and Ms. B and Mrs. C! Isn't that horrible!" And then nothing is accomplished.
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No, you do the research and then use that to inform the design of the screening including selection criteria. I think you'll find that the designers of such screening programmes are pretty eminent medical scientists dealing with very difficult problems. Triviaising it does not favours to anyone.
Blood tests (Score:4, Interesting)
I'm curious why blood tests aren't peformed regularly. You can certainly request Alpha-fetoprotein (AFP) any time you like, but it is not commonly recommended on a regular basis. AFP can indicate tumors growing in the body. Very high levels of AFP can indicate advanced cancer. In the case of a co-worker who was found to have advanced cancer, on first diagnosis, why not have this marker checked every 6 months?
I've been told a normal reading is about 100-120. Values over 10,000 should be investigated. Lance Armstrong, had levels of over 100,000 when he was diagnosed, with tumors spread throughout his body.
It seems a low impact test, why is it not advised as part of a standard checkup? We'll look for chelesterol, why not Alpha-fetoprotein?
Re:Blood tests (Score:4, Interesting)
I'm curious why blood tests aren't peformed regularly. You can certainly request Alpha-fetoprotein (AFP) any time you like, but it is not commonly recommended on a regular basis. AFP can indicate tumors growing in the body. Very high levels of AFP can indicate advanced cancer. In the case of a co-worker who was found to have advanced cancer, on first diagnosis, why not have this marker checked every 6 months?
I've been told a normal reading is about 100-120. Values over 10,000 should be investigated. Lance Armstrong, had levels of over 100,000 when he was diagnosed, with tumors spread throughout his body.
It seems a low impact test, why is it not advised as part of a standard checkup? We'll look for chelesterol, why not Alpha-fetoprotein?
Because, AFP is a crummy screening test [wikimedia.org].
We look for cholesterol because heart disease is one of the major killers of society. Testicular cancer isn't. It is also not terribly sensitive, not very specific and it isn't clear that early treatment helps. You need various qualities of all three aspects for something to be a good screening test.
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I'm curious why blood tests aren't peformed regularly. You can certainly request Alpha-fetoprotein (AFP) any time you like, but it is not commonly recommended on a regular basis. AFP can indicate tumors growing in the body. Very high levels of AFP can indicate advanced cancer. In the case of a co-worker who was found to have advanced cancer, on first diagnosis, why not have this marker checked every 6 months?
I've been told a normal reading is about 100-120. Values over 10,000 should be investigated. Lance Armstrong, had levels of over 100,000 when he was diagnosed, with tumors spread throughout his body.
It seems a low impact test, why is it not advised as part of a standard checkup? We'll look for chelesterol, why not Alpha-fetoprotein?
Because, AFP is a crummy screening test [wikimedia.org].
We look for cholesterol because heart disease is one of the major killers of society. Testicular cancer isn't. It is also not terribly sensitive, not very specific and it isn't clear that early treatment helps. You need various qualities of all three aspects for something to be a good screening test.
Another link by way of Lance Armstrong, the blood doping tests for athletes now are sophisticated enough to establish a Base Line for certain concentrations of hormones, red count, etc. Catching a tumor on the first blood test is probably not good, but establishing norms for an individual can help identify when something is happening, by looking for spikes or dips in readings.
Re:Blood tests (Score:5, Informative)
Your link shows no evidence that "AFP is a crummy screening test". Were you hoping that nobody clicked the link, and just took your word that it was correct?
My impression is that ColdWetDog was hoping whoever clicked the link would follow Wikipedia's explanation of how the statistics of screening tests work, and using that explanation, understand the logic of why AFP is not used as a general cancer screen by filling in the blanks themselves.
But that's ok, maybe you didn't understand him, so let me elaborate a bit in steps. The "Specificity [wikipedia.org]" of the AFP test is the percentage of True Negatives (patients without cancer), divided by Reported Negatives (AFP tested negative). Now, the specificity of the AFP assay varies with the laboratory, cut-off criteria used, and particular cancer -- but something like 90% is reasonable for an AFP test (better for some cancers, worse for others, not applicable for many). That sounds good, right?
Well, next step is figuring out your Positive Predictive Value [wikipedia.org]. The interesting thing about this parameter, is it varies with Prevalence. If you define your tested population as a group in which you already have reason to suspect cancer, you can get a pretty decent PPV. Now, elevated AFPs are rare in the healthy general population. Thing is -- while it might not seem that way emotionally -- statistically, cancer is also considered a rare health condition (from an epidemiological standpoint). The net result is most tumor biomarkers applied to the general population, end up with low PPVs [wikipedia.org] -- even tests with specificities of 90+% can end up with PPVs in the single digits or less.
While I don't have a specific link for AFP, the general state of population-wide cancer biomarker screening is not good: http://www.nature.com/news/2011/110323/full/471428a.html [nature.com]
but perhaps you are a genuine "shill" for one of the big pharmaceutical companies.
Oh, you were just shitposting. Carry on then.
Re:Blood tests (Score:5, Insightful)
Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives. Keep in mind, when you start talk about putting everyone through a screening, whether it be for cancer or HIV or terrorism, your screen had better be crazily accurate. Imagine there's a (really exceptionally good) false positive rate of 0.1% on your hypothetical test, if you give it to every person in the US twice a year you're going to produce 74,000 false positives a year. Or to put it another way, more false negatives than there are cancer deaths.
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That's 740,000 false positives, not 74,000. Sorry for the double post.
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Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives.
More importantly, it's important that if you screen positive, the confirmatory tests and treatment yield a better outcome than doing nothing would have. Lots of people can point to a friend or relative for whom early detection treatment saved their life; however, if someone dies from the treatment of a cancer that would never have killed them, how will you ever know?
Cancer is dangerous, but it's important to remember that cancer treatments are dangerous as well. People can and do die from complications from
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Exactly, we went through this on day is a stats course I took years ago.
it seems counter intuitive but it is not a good idea to test for medical problems without a lot of thought put into the +es and -es involved.
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But what about drug tests? Big employers give everybody drug tests.
Cancer - i'ts not as bad as you think. (Score:2)
Deaths caused by cancer (US numbers, 2009): 562,875
Deaths caused by heart disease (US, 2009): 616,067
We know more about Heart Disease, but it gets less press - mainly because the treatments for it are not as painful.
You know, I bet if someone created a painful, dramatic, balding cure for Heart Disease that in 10 years we would cure it entirely.
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Anyway, I meant to say that cancer gets way too much press simply because our treatments for it are nasty. We should base funding on that are nasty, not ones that have nasty cures.
Re:Cancer - i'ts not as bad as you think. (Score:5, Insightful)
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Your correct. The scary thing about heart disease is how much we really don't know about it even if it is relatively 'simple'.
Good medical research is very, very hard to do. Humans are just absolutely horrid research subjects. They live too long, they are expensive to keep, they are genetically and environmentally diverse and the every time you get an Institutional Review Board involved you are in for years of meetings and paperwork.
Better for us if we were hamsters. Or Paramecium.
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Better for us if we were hamsters. Or Paramecium.
I wish I were a zebrafish. You cut a piece out of a zebrafish's heart, it grows right back.
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Hundreds of different types, but they boil down to three or four deviations from proper operation of the DNA/RNA system. The different types do matter, though. The tissue affected initially can determine what treatments can be used, and what other tissues might be affected if it spreads.
And the thing about there being multiple types of heart disease is actually important as well, since not making the distinction means people can feel one thing, think it might be heart related, then read the symptoms for t
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Heart Disease gets lots of press, it just isn't all labeled "Heart Disease", whereas anything about prostate cancer is pretty unambiguous.
Anything relating to cholesterol, "heart health", cardio anything, "eating right", etc., is ultimately about heart disease.
I also don't know why you think the treatments for heart disease are less painful than for cancer. Nothing is more painful than people digging around in your chest cavity running new pipe or replacing the pump. Chemo is pretty nasty, but compared wi
Seen this article everywhere now. (Score:3, Insightful)
Seems like someone is driving a huge PR campaign for "let's not have people visit doctors and get cancer screening". It's likely actually just costing a group of HMO insurers more money to have lots of people treat cancers early and undergo lengthy treatment, and then survive, rather than have a smaller number of people detect it too late, do a short treatment, and then just die.
After all, health services are a business. We understand. You can't just have insured people liviing a long time and making businesses lose money.
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Re:Seen this article everywhere now. (Score:5, Insightful)
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Which is why sane people realize that the proper course of action isn't to replace the money grubbing bureaucrats with apathetic ones (note that there is a big difference) and instead attempt to do away with them altogether. We could break apart the back room collective bargaining and price fixing and actually make health care something that people actually pay for, like car insurance and automotive services. That way, at least, we can see some competition for price and maybe people will even understand t
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At least get rid of the laws that prohibit doctors and dentists from publishing the price list.
Re:Seen this article everywhere now. (Score:5, Insightful)
We could break apart the back room collective bargaining and price fixing and actually make health care something that people actually pay for, like car insurance and automotive services. That way, at least, we can see some competition for price and maybe people will even understand the resources they waste every time they go to the doctor about a cold. (Well, at least after they paid $80 to hear the doc say "It's a cold, drink some juice and get some rest" they'll think twice before doing it again.)
This is a common fallacy -- that the costs of going to doctors for minor discretionary ailments are a significant part of health care costs. As the economist Paul Krugman has explained, the major expenses in health care aren't $80 visits to the doctor, but $50,000 and $100,000 cancers, $20,000 a year lifelong treatments for diabetes, $50,000 a year lifelong treatments for multiple sclerosis, $50,000 and $100,000 heart bypass operations.
Actually, there have been many studies over at least 40 years to see whether charging patients more would produce better -- or even cheaper -- care. They all failed. Look up the Rand Health Insurance Experiment in Wikipedia. Patients who had greater copayments put off necessary care, like blood pressure medication (probably the most cost-efficient intervention we have).
U.S. corporations like IBM tried imposing co-payments on their employees, and they ended those policies when they found that they wound up spending *more* money. Patients with asthma put off maintenance care, and wound up going to the hospital more.
Health insurance isn't like car insurance. If your car is damaged, you know what the problem is and you know what's going on. If your doctor tells you that you have a disease you never heard of, and that you have to treat it right away, you don't know what's going on. It will take you more than a day of Google searches to find out.
If a nurse tells you, "You should go to the hospital right away. It could be life-threatening," what are you going to do? Look it up on the Internet?
Making health care decisions is like a graduate-level exam with questions you're unlikely to understand, and if you get one question wrong, you die.
It would also help the problems with cancer screening: once people see a $10,000+ price tag on treating that maybe-dangerous tumor they'll definitely give waiting and seeing a thought.
Ridiculous. The main thing a cancer patient wants to know is whether (or how long) he's going to live. The only concern about treating a tumor is (1) whether it really is a tumor that has to be treated and (2) what the best treatment is.
Cancer chemotherapy causes heart failure and other cancers. Is the risk of death from treatment greater than the risk of death from no treatment? Nobody takes doxorubicin just because they can get it free.
I know people who are doing watchful waiting, because their doctors think it's one of those false positives. I've talked about the decisions with them.
$10,000 doesn't enter into the decision. How much is your life worth?
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Take it from someone that was there this year, your life changes when you hear it is an 80% chance of being cancer, the only way to know for sure is to remove it, and if it is cancer even if removed has a 50% chance to come back, and a 0% 5 year survival rate if not treated. Thankfully I was in the 20%,
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The studies you quote were all performed within the broken system. It's quite hard to extrapolate their results to fundamentally different circumstances. For instance the RAND study had people paying 95%, which would almost certainly be higher than what they would pay with reduced demand and lack of health insurance overhead. Even the 50% is questionable.
No, it was 0%, 25%, 50% or 95% http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment [wikipedia.org]
25% is close to the 20% that Medicare charges. This was designed covering the full range.
What do you mean, "broken system"? That's the system we've got, and we're trying to figure out ways to improve it.
Other countries have copayments, and they don't work either. I read a series of articles, pro and con, on the Swiss health care system, in JAMA. Their copayments don't work either. For serious diseases, they quickly e
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Instead of being handled by a government agency overseen by elected officials, you are beholden to a for-profit organization who wants everyone to pay in more than they draw out.
Your faith in the State's benevolence is duly noted, and downright cute.
doc
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Holding costs down is just as important if you pay out of pocket, as if you have insurance or national healthcare.
Ignoring cost there is another important factor here, quality of life.
There is little point in killing 70 year olds on the operating table to attempt to remove a cancer that would not have killed them for another 40 years.
Re:Seen this article everywhere now. (Score:4, Insightful)
Sure. If in your fantasy world nobody in government had any sort of ethics at all, and the government doesn't pass laws enforcing ethics standards.
But here, in the real world, government workers are generally more ethical than private-sector businesses, and are bound by strict ethics regulations.
So stop buying Fox News propaganda. The dysfunction of American healthcare is due to fractionation and greed in the system. Making it one system, with one set of standards and little opportunity for gouging people who are suffering, will make it far, far better. Not worse.
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Seems like we have our tin foil hat on just a little too tight.
Not everything is an Illuminati conspiracy.
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Even if health care was completely not for profit, it would still make sense to be aware of false positives on cancer screens.
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Even if health care was completely not for profit, it would still make sense to be aware of false positives on cancer screens.
Search the news and find articles saying pre-screening is bad for some reason, in prostrate, breast, and cervical cancer - that I have seen so far.
Yes, false positives are bad, and could be the real issue here. And greedy insurance companies could be the issue too. We haven't get the evidence or research to prove either issue yet.
But I can't see the logic of dealing with false positives by eliminating testing altogether, especially via news articles, and frases such as "cancer screening is pointless and co
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You mean as opposed to the private bureaucratic triage that happens now coupled with the really ugly economic triage that makes lower income people die on average 10 years early?
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Someone who catches cancer early and has 2 years of treatment is going to have a much smaller bill on average than someone who catches their cancer at stage 2 or 3 and has a 2 year death spiral of expensive, invasive, and life destroying (figuratively if not literally) treatments. Chemo and radiation is expensive, but it's a lot less so than surgery, rehab, months in the ICU, and, eventually, hospice care.
And for gods sakes people, do you really live in a world where you believe every single persons in a d
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And someone who doesn't needlessly get treated for something that was going to just go away saves HUGE amounts of money and quality of life.
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People eventually die. So just because someone dies earlier expensively doesn't mean that the person who didn't die sooner would be cheaper in the long run, especially if it's all paid by socialized healthcare/welfare.
Lastly it's quality AND length of life that matters. You want to live longer not merely survive longer.
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There are these things in Slashdot discussions called threads, where someone responds to someone else's post. Sometimes, their response only makes sense in light of what they are responding to. In this case, I was responding to someone trying to claim that this was something sinister being done by the insurance companies or the government to reduce healthcare costs at the expense of lives. My post was the point out the failures of logic in the OPs post, not argue for or against anything in the article.
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Dead people don't pay premiums. People with "cured" conditions pay higher premiums.
Re:Seen this article everywhere now. (Score:4, Insightful)
Dead people don't pay premiums.
1. Healthy people pay premiums.
2. Sick people pay premiums and collect benefits.
3. Dead people pay no premiums and collect no benefits.
The private insurance industry only wants #1. If you become #2, they will do everything in their power to help you progress to #3. There will always be a fresh supply of #1 (young/healthy) to replace "retired" customers.
If this sounds cynical, it comes from personal experience with private health insurance and a talk with someone whose job with a private health insurer was to comb through records of people costing "too much" money and find any excuse to rescind a person's coverage. He was amazingly successful in helping customers reach #3.
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No, it's just one of those things that people who work in cancer research are aware of and, eventually, that awareness leaks into the public and the press realizes that the research community knows something the uneducated public would find astounding.
Let me give you a human example of the cost of screening. I was sitting in a mammography waiting room once when a women came in for her screening. The receptionist informed her that she could get screened, but the radiologist was out and she would have to wait
Re:Seen this article everywhere now. (Score:5, Informative)
When evaluating what works and what doesn't, you have to tread very carefully. Sure, most people^Wgeeks know about double blind studies, but that's just the tip of the iceberg. The second edition of Testing Treatments [testingtreatments.org] came out recently (available as a free pdf on the website, although I bought it to support the authors) that explains the problems in an understandable language while not dumbing down the issues. The book comes with the recommendation of well known epidemiologists like Ben Goldacre, of Bad Science.net fame [badscience.net].
To talk about the specifics of screening, check out Chapter 4. To recap the main points there, for screening to be worthwhile you have to look at several factors:
The problem with lots of screening is that on the level of the population it can lead to more harm than good overall for a lot of different diseases, because of false positives, because of our psychological makeup that we'd prefer surgery for even harmless varieties of lumps in our bodies, etc. (see detailed examples in the book). In a lot of cases it happened that screening was introduced before the effectiveness of screening was established in a trial, then later trials showed that the screening was ineffective in reducing deaths or harm.
The bottom line is that well designed trials should be conducted and based on the systemic review of those trials it should be decided whether to conduct screening or not, based on whether it's improving health outcomes or not. A lot of trials don't improve outcomes.
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Are you sure it's the HMOs driving this? I don't think so. If you take a look at the recommendations [nytimes.com] this group has given in the past, many of those recommendations would go against the interests of HMOs, so I do not see any particular pattern emerging one way or another.
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I always thought it would be better to combine life insurance and health insurance. That way the interests of you and the company are both the same, your well being. Right now as a 40 year old guy I am ten years into a twenty year term policy for a million dollars. You would think if I get cancer my life insurer wouldn't mind paying a couple hundred grand to make sure I make it to the end of my policy.
Or they could do MORE frequent screenings. (Score:2)
Another approach is to find an imaging technique that is cheap and harmless enough that you could image someone's whole body every week. Then you could compare week to week to monitor growth and spread of the tumors, and only target tumors that are fast growing, or persist beyond a certain threshold size.
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Depends what your definition of harmless is I suppose.
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Two reasons that won't work. Restrict the discussion to breast/prostate cancer for simplicity. Both are highly treatable if they haven't mutated enough to have the ability to metastasize. You can't make an imaging technique that checks every cancer cell to see if even one(!) has gained the ability to metastasize.
Second, the vast majority of people will INSIST on surgery if they know they have cancer. I used to try to explain to people that most of us have already (if we've got grey hair) thyroid cancer, but
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You can, however, tell if cancer has metastasized or not. You can see whether or not it is spreading.
Most people are unreasonably afraid of dying. Pathologically afraid, really. People need to accept that the question is how you're going live, not whether you're going to die.
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How do you plan to make a home without any metal objects?
How cheap do you think liquid hydrogen/helium are?
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And who reads the results? How accurate are the readings?
What about treatments that prolong life? (Score:5, Insightful)
as many as 120,000 to 134,000 of those women either have cancers that are already lethal or
There are a lot of cancers that are incurable, but can still be controlled for a while. Statements like this make it sound as though catching these cancers early and controlling them for a while is a worthless endeavor.
My wife is one year into a battle with a cancer that she has only roughly a 25% chance of surviving with treatment. Without treatment, she would have been dead a few weeks after diagnosis. She is grateful to have spent the past year alive instead of dead, and of course the children and I are also grateful. I guess the point that I'm trying to make here is that treating a cancer that will most likely be lethal still has significant value. None of us would have been very happy if some government bureaucrat had told us that since the cancer was so likely to kill her, they wouldn't bother treating.
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This has nothing to do with government bureaucrats, nor does it matter for your wife. No one wants to take away healthcare, they just want to know if on the whole it is worth it to keep going down this track.
The reality is treating someone who will die no matter what, if the treatment does not extend life by much is not medically worth it. If treatment adds only a month of life, a painful puking near death month, why bother? On the flipside, how many people are being treated and just did not need to be? Qua
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You are lucky. My brother's insurance company bureaucrat did the "government bureaucrat's" part in denying his treatment.
You're correct; we are fortunate. Our insurance provider has not given us too much grief over her treatment. I know that that's not to be taken for granted.
Including the line about government, I think, set a lot of people off. As you say, it doesn't matter which payer is doing the denying. A denial from a private insurer is still a denial, although it's much easier to fight a private insurer, in my experience.
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But that is a whole lot different then if she had a 0% chance of survival, but she could be kept alive for 6 months longer in constant severe discomfort and pain in a hospital bed.
Blame the "cure" as much as the diagnostic (Score:2)
Some diagnostic tests (breast cancer screening, for example) increase the risk of contracting the disease you are screening for.
In the case of the prostate cancer study, it seems that treatment of detected, but actually benign, tumors was causing more mortality than just living in ignorance of them.
Better Tests Are Needed (Score:2)
People read these articles and too many come away with "we shouldn't be screening for cancer". That's not what it's saying at all. It's saying "we shouldn't rely on our current screening tests". That's the key. Screening isn't a problem. Early detection isn't a problem. Inaccurate screening tests that encourage treatment when none would be necessary is the problem. That's what the US Preventive Services Task Force is trying to say: shitty tests create shitty outcomes.
It's like trying to use just a th
It's their decision. (Score:2)
The risk of false positives outweight the risks... (Score:2)
The change in policy stems from good mathematics, namely good statistics. Where the number of people who are subjected to a test may suffer from one of two failures,
a) false negative - that is the test fails to detect the presence of a disease and thus incorrectly reports a negative results, and
b) false positive, the test incorrectly reports a positive result, but the disease is not actually present.
The problem is that with a large pool of test population and a small affected sub-population, the misleading
See no evil? (Score:2)
Let's see if I have this right:
When people receive bad news about their health, they often make poor decisions about treatment.
Solution: Stop screening and therefore, there won't be any bad news to report.
What? Unless the testing itself is a hazard, we shouldn't be cutting off a potentially life saving source of information. We should be working on improving the decision making process. If most prostate cancers should not be treated then recognize this and develop an alternative response. Perhaps more e
Fallacy? (Score:2)
Hard to be objective here (Score:4)
My colonoscopy at 53 (3 years late) detected the start of malignant cancer. My gastro guy described my situation as "having *just* missed being hit by the bus. Without treatment, I'd have been dead in less than 5 years, give or take a year.
So, better safe than sorry has become my new motto. The social and economic cost, in the scheme of things, is trivial (That is, if you have health insurance. If you don't, unofficial government policy is the usual de facto homicide applied to the poor).
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The issue here -- even if your case were typical -- is that a colonoscopy is probably much more accurate and reliable for identifying treatable terminal cancers than the screening test for prostrate cancer. Again, the argument isn't "don't screen" it's "screening sucks if the tests suck". The screening tests for many cancers currently suck.
How would you have felt if you found out after treatment that your cancer would have killed you in about 150 years instead of 5? How would your family have felt if you
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"have cancers that are already lethal"
--> People that have lethal cancer can be treated nevertheless.
--> how do you know if a persons cancer will be lethal or not?
Well, you'll find out sooner or later, right?
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So ... what kind of idiot wrote that pretentious article
One who understands that cost/benefit calculations have to, you know, include the costs as well as the benefits?
If attempting to treat supposed cancers causes debilitating harm to thousands of people but benefits another few thousand people, then it's far from clear whether treatment is beneficial to the majority.
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Government care would be cheaper, for evidence look around the world.
This is about not torturing people with pointless treatments, not saving a couple bucks.
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Bzzt, wrong.
The USA has one of the shortest life expectancies in the first world.
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One who understands that the government cannot afford the level of care we have become accustomed to, but wants the government to pay for everybody's health care anyway.
We cannot afford the level of care we have been accustomed to, period. Medicare OR through private insurance.
Health care premiums doubled between 1996 and 2006. I dare you to blame Obamacare for that.
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If the cancer kills you anyway, then you went through a whole lot of pain and trouble for nothing. I'd rather not be put through all that for nothing.
You wait until they've died from it. Then you mark in your notes that the cancer was lethal. Pretty simple really. But only useful for generating statistics.
Again, you wait until they die, t
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I know in the case of prostate cancers, there are fast-growing tumors and there are slow-growing tumors. My father-in-law was diagnosed with a slow-growing tumor in his mid-70s and his doctor advised him to basically live with it, because something else would kill him first, and six or seven years later he died after a stroke.
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And then there's hyperplasia, this only insults you by increasing the duration of the average urination by ~1000%, and UTI rate by similar numbers.
The problematic part is that there's a relationship between hyperplasia and malignitiy, and for prostates this is an eternal headache.
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Genetic damage accumulates _all_ the time, however you have DNA-repair mechanisms of rather amazing complexity that constantly patch things back into their original shape, and in the case they fail they still face down the checkpoints in the mitotic cycle that halts cell divison until damage is either repair or the self-destruct/apoptosis kicks in.
And there's more, if a cell starts to produce foreign proteins these will appear in fragments on its surface, which the
Re:Often wondered (Score:5, Informative)
I guess the question is how do you tell the ones that need treatment from the ones that don't before it it too late to treat the ones that do
Histology at the moment. What a trained pathologist can tell from a slide of stained cells is incredible. In the near future, genomic sequencing is what experts seem to be saying. [ted.com] You find a tumor, you get a biopsy, look at it under the microscope and also sequence the DNA of the cancer. Between what the cells look like and the DNA sequence, they'll be able to tell how likely it is to kill you.
There are a number of well-characterized things a cancer cell must do to be really bad, and genomic sequencing will allow a good diagnosis as to what a cancer is doing exactly. If it's just that the cells are growing more than they should, but are otherwise playing by the rules (IE, unlikely to metastasize or start increasing the bloodflow to the tumor, and not in a critical location) keep an eye on it but it may not become a problem ever. If it is expressing several genes that will allow the cells to get into the bloodstream and take root elsewhere, chemotherapy now. Chances are much better that it will spread to critical areas like your lungs or brain and kill you.
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They rob pharmaceutical companies of revenue streams that are rightfully theirs.
Well, if cancer is found during the screening, chances are all kinds of products made by pharmaceutical companies will be unleashed onto the patient full-force.
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You can blame this on Obamacare IFF you can prove without a doubt your exact same exact scenario would NOT happen in the era immediately preceding Obamacare (you know, the Golden Age of Private Insurance.)
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You really think "Obamacare" is driving this? It would be happening regardless, driven by the insurance companies.
But people were complaining recently that health insurers drive people to have too many tests and unneccesary treatments, so that they can push up premiums.
Then today they're not paying for enough.
Seems they're damned either way.
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booth my father and uncle have had prostate cancer treated and survived, guess that its a pretty good bet I am likely to have it at some point as well. I think i'll have the screening it's recommended for over 50's so in a few years it will be one of those things i'll have to put up with as i'd rather live to a reasonable age.
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Actually, some of the studies on the prostate cancer are not saying "you are diagnosed too late", they are saying that "you are diagnosed too early to tell if it's a real cancer" and that detecting one risk factor and starting treatment based on just that is probably going to have more nasty consequences than doing nothing for most of them.
Men are "pretreated" for their cancer and thus, men that maybe would never have a cancer (because a bigger percentage of men are treated than the average of prostate canc
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Screening test are not as important as we thought. WRONG. If anything this points to MORE FREQUENT screening of assorted cancers.
Assuming, of course, that your test will detect cancer before its too late. I remember reading a study on mammograms which concluded they were a waste of time because cancers that were going to metastasize had already done so by the time you can detect them on a mammogram. More screening is then just a waste of time, and in fact is counterproductive because repeatedly bombardi