Cervical Cancer Just Got Much Deadlier -- Because Scientists Fixed a Math Error (arstechnica.com) 183
An anonymous reader quotes a report from Ars Technica: Cervical cancer is 77 percent more deadly for black women and 44 percent more deadly for white women than previously thought, researchers report today in the journal Cancer. But the lethal boosts aren't from more women actually dying than before -- they're from scientists correcting their own calculation error. In the past, their estimates didn't account for women who had undergone hysterectomies -- which almost always removes the cervix, and with it the risk of getting cervical cancer. We don't include men in our calculation because they are not at risk for cervical cancer and by the same measure, we shouldn't include women who don't have a cervix," Anne F. Rositch, the study's lead author and an epidemiologist at Johns Hopkins told The New York Times. For the study, the researchers looked at national cervical cancer mortality data collected between 2000 to 2012. They also looked into national survey data on the prevalence of hysterectomies. Then, they used those figures to adjust the number of women at risk of dying of cervical cancer. The researchers found that black women have a mortality rate of 10.1 per 100,000. For white women, the rate is 4.7 per 100,000. Past estimates had those rates at 5.7 and 3.2, respectively. The new death rate for black women in the US is on par with that of developing countries. Though the new study wasn't designed to address racial disparities, experts speculate that the large difference reflects unequal access to preventative medicine and quality healthcare.
Why wasn't this caught in peer review? (Score:3, Interesting)
Re:Why wasn't this caught in peer review? (Score:4, Insightful)
Uh, peer review ultimately found and corrected the error....
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Since the HPV virus can be spread by non-sexual contact (and usually is - that's why the vaccine is given in childhood) I can't see why there would be any stigma around it (and STD stigmas are idiotic anyway).
But the thing is: vaccines ARE preventative medicine so the prevalence of the virus is, itself, indicative of the availability of preventative medicine.
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Except that the guy that headed the development of the vaccine stated:
1. the link between HPV and cancer is tenuous at best as the sampling was done with high-risk women (aka hookers) and how it affects less at-risk women was not studied
2. The vaccine was rushed to market with inadequate testing to meet external pressures .
(looking for article but can't find anymore)
Re: Why wasn't this caught in peer review? (Score:2)
Cant find the article... but I swear it exists and sure you can do nothing to verify its veracity but just trust me okay... and the dozens of other studies showing a link, imcluding with other cancers are just a weird and lucky coincidence. No really. Trust me.
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Your comment is incorrect in every particular.
For starters, the person being quote-mined is a woman, Dr. Diane Harper.
She had (this was back in 2009) two concerns regarding the vaccine, namely the data about the persistence of immunity (data at the time showed it would last at least 5 years, but they didn't have data about past that) and the way the vaccine was being marketed (she was concerned that the way the vaccine was being advertised may lead to women forgoing screening tests such as pap smears as the
Both numbers are correct, I would say. Older more (Score:5, Interesting)
It seems to me both are true and useful. I would even go so far as to say the original number is more useful.
1 in X women die from cervical cancer. (old number)
Of women who did not have a hysterectomy (prior to cancer), 1 in Y die from cervical cancer. (new number)
Both are true. How might mortality rates be used? One important use is comparisons for policy making decisions:
10 in X women die from heart disease, 1 in X die from cervical cancer. Therefore, we should invest more prevention efforts toward heart disease.
Or:
X% of women die from alcoholism, Y% from cervical cancer. Therefore, we should spend the most money researching cures for ______ ?
For these policy, questions, we want to know how many people are affected. Period. It's not a useful comparison to say "of people who drink, X die from alcoholism, while of people who have a uterus, Y die from cervical cancer". Those numbers don't give us any useful comparison with which to make decisions. The useful numbers for decision making are "how many people could be helped by addressing this issue?"
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The useful numbers for decision making are "how many people could be helped by addressing this issue?"
No, the first and primary useful number consideration is, "Now that we're 20 TRILLION dollars in debt and most new jobs are low-paying junk that barely creates any tax revenue, and we have an exploding entitlement spending problem the mere interest on the debt for which will soon displace nearly all discretionary spending ... what can we afford to research?"
You want to address the X in Y cases of Z disease in given populations? Return to producing the sort of economic health and largess that allows us t
Don't disagree, where did I say "forced by govt"? (Score:2)
I don't disagree with your general conclusion when it comes to spending that politicians force on us. I don't think my post said anything about government spending, though.
Howard Hughes Medical Institute has $18 billion dollars, the Kellogg Foundation has $8 billion. Both spend on health / medical programs. I personally decide how to donate my money.
Re: Why wasn't this caught in peer review? (Score:3)
The first was as a grade-schooler: I was once taught that humans have forty-eight chromosomes, twenty-four pairs. Several years later it was forty-six chromosomes, twenty-three pairs. Inspection of the first researcher's data showed this clearly; apparently, the first researcher simply miscounted and nobody caught it at the time.
The second happened when I was in junior-high school. Research showed that men tend to survive much l
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Re: Why wasn't this caught in peer review? (Score:3)
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There's nothing "pretend" about actually repeating something. If your model is no good at anything then it needs to go in the rubbish bin with casting spells.
Re: Why wasn't this caught in peer review? (Score:2)
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I wasn't intentionally deceived or lied to - the instruction and data were considered accurate at the time - as was the fact that humans have forty-eight chromosomes in their genetic structure and that men tend to survive the death of a spouse better than women do. Both took several years to correct, but the scientific community did correct them.
And I'm famil
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People with cervical cancer are far more likely to get a hysterectomy, eliminating the possibility of death by cervical cancer.
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Hysterectomies were just a trendy surgery to have for awhile. Doctors did them "just because". A lot of them had nothing to do with cancers.
See? I always told everyone math kills! (Score:4, Funny)
Yes we can (Score:2, Insightful)
The new death rate for black women in the US is on par with that of developing countries.
In other news, insurance companies make record profits since Obamacare
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Oh, but according to Donald Trump, the ACA was bankrupting them, that's why they need relief from the oppression of burdensome regulations.
you mean "President Trump"*.
* that still makes me laugh
Overall rate for women unchanged (Score:2)
It sounds like they just divided women into two sub-groups, one of which has a zero risk of getting cervical cancer.
The overall risk of cancer for women is still the same.
Depending on what you are using the statistic for (e.g. assessing your own risk of getting cervical cancer, large-scale targeted prevention efforts, allocating government health-care funding based on overall population, etc.), you may find the new set of statistics more useful than the old one, or vice-versa.
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Just nitpicking, these are the stats for death by cervical cancer, not for getting it. If it was for just getting it, including women who've had hysterectomies would have had a far smaller effect as most women don't get a hysterectomy before they get cancer.
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Most women who get hysterectomies don't get it for cervical cancer. Cancer of the womb or ovaries are the usual reasons, that's why not all hysterectomies even remove the cervix. What this correction does is to take out of the calculation those women who, to prevent/treat a womb cancer had, had a procedure which also removed their risk of cervical cancer. Cervical cancer is often not detected in time for surgical responses, and when responded to surgically is usually not done with a hysterectomy. Why remov
If it helps any . . . (Score:5, Insightful)
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Cervical cancer didn't become deadlier, we've just become slightly better informed.
Nah, just ignore the facts and you'll be more safe! CEO's do it all the time. It really works I tell you! If you claim otherwise, you're just a pessimistic curmudgeon. Gotta stay positive!
Vitamin D (Score:2)
Before guessing the racial disparity is from unequal access, rule out Vitamin D. Low Vitamin D levels are associated with higher rates of some cancers. Darker skin causes slower Vitamin D production from exposure to sunlight.
Re:Vitamin D (Score:4, Insightful)
The racial disparity they're talking about in this case is that white women are more likely to get a hysterectomy after they get cervical cancer than black women are. They aren't talking about the overall higher death rate among black women, which could be affected by vitamin D.
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My reading of the data is that they are publishing the likelihood of any given individual contracting cervical cancer. By removing women without cervixes from the equation they calculated the new incidence among those at risk for the disease.
They were not looking at relapse rates status-post initial diagnosis and subsequent treatment (which is what you're addressing when you mention hysterectomy status-post initial diagnosis). So whether white women or black women get hysterectomies after their initial diag
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They're talking about the death rate, not the contraction rate.
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In full, they are talking about those who contract and THEN die. But they specifically are addressing that hysterectomies remove individuals from the denominator of the equation with regard to incidence and subsequent morality. The study has nothing to do with how the cervical cancer, once present, is treated.
One could hypothesize that the racial disparity has to do with how the african american patients are treated once diagnosed, but since I'm not willing to go through the paywall and see if they controll
Pure headline bait (Score:2)
Cervical cancer didn't get more deadly, statistics have nothing to do with whether or not a certain cancer is more lethal or less susceptible to treatment.
The statistics also no longer apply to 'just' women, they only apply to women who haven't (yet) had their cervix removed, it's a different subset of people. 1/3 of women get hysterectomies (2/3 of those are deemed to be unnecessary).
It's not necessarily true that you can't get cervical cancer after a hysterectomy, even with the cervix removed (not necessa
No no no no (Score:2, Insightful)
"Cervical Cancer Just Got Much Deadlier -- Because Scientists Fixed a Math Error"
No, it's just as deadly as it always was, it's just being measured more accurately now. The perception of the mortality value changed, but nothing else.
The headline would have you believe that scientists changed a physical property of the universe because they moved a decimal point or something.
That's a lot of hysterectomies (Score:5, Informative)
R_initial = n / N
R_adjusted = n / (N - h*N) = (n / N) * (1 / (1-h))
R_adjusted / R_initial = 1 / (1- h)
(1-h) = 1 / (R_adjusted / R_initial)
h = 1 - 1/(R_adjusted / R_initial)
For black women, R_adjusted / R_initial = 1.77, so
h = 1 - 1/1.77 = 0.435
43.5% of black women have had hysterectomies.
For white women, R_adjusted / R_initial = 1.44, so
h = 1 - 1/1.44 = 0.306
30.6% of white women have had hysterectomies.
According to this site [nwhn.org] over 1/3 of women over age 60 have had hysterectomies. Which seems to agree with the above calculated rates. I had no idea hysterectomies were that prevalent.
That's Not Deadlier. That's a Higher Incidence. (Score:2, Informative)
Exactly what the Subject says. Cervical cancer did not get deadlier. That would be an adjustment to the 1, 3, or 5 year mortality rates which are not addressed here. What they adjusted was the incidence of the disease, i.e. the likelihood that you will get the disease.
Their data is valid presumable, but this headline about "deadlier" is wholly inaccurate. Report what the study actually concluded, not clickbait.
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Their data is valid presumable
Presumably, you mean presumably! I wouldn't normally bother but it's a weird error I frequently make too. I know the correct spelling, y is not near e, and yet my muscle memory keeps on mistyping it. Do you frequently make this error? I'm glad it's not just me at any rate.
Brains are weird.
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No, it was a typo on my phone.
Also...moderation "off topic"? How is pointing out, and explaining why, that the study doesn't have the conclusion that the headline implies "off topic?"
Should I have made a butt joke? Is that on topic? Yeesh.
Speculation (Score:3)
experts speculate that the large difference reflects unequal access to preventative medicine and quality healthcare.
Which "experts"? Why dismiss all the other cultural and genetic possibilities?
If it is about "access", why do poor whites have better life expectancy, and why are Hispanics so healthy and long lived in the US?
Math is hard.. (Score:2)
..(and apparently harder than surgery).
Beginners boo boo? (Score:2)
First, praise for communicating the error!
Second, how does such a beginners boo boo slip into statistics? I understand forgetting females without a cervix. But beings that weren't conceived with one? It sort of leaves the impression of botched research. Perhaps the findings and interpretation were rushed out to appease patrons. What else brings back memories of Roquefort and needs a once over? Did they confine the research to humans or more generally to primates?
So many questions.
Strange (Score:2)
Experts? No (Score:2)
"Though the new study wasn't designed to address racial disparities, experts speculate that the large difference reflects unequal access to preventative medicine and quality healthcare."
This is very strange, because we are spending lots and lots of money trying to get every woman to attend the damn screening (which together with vaccination is the only way to prevent cervical cancer). Do you know how hard that is?
It's not because of unequal access, it's not because of "muh oppression", it's because we cannot do more than send out invitations, offer self-sampling that can be mailed in, send out a gyno-bus, or offer online/phone consultations. We cannot forcibly make them. Do you have any ot
That's not a math error. (Score:4, Interesting)
It's a classification error.
Reminds me of the autism "epidemic" (Score:2)
And the post about trusting government data? (Score:2)
We need not trust ANY data. Even our own. Verify.
Define (Score:2)
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You're a male? OMG, you're so racist!!
Re:So what can I, as a 30 YRO male, do? (Score:5, Insightful)
Ask your doctor about getting an HPV vaccination.
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Ask your doctor about getting an HPV vaccination.
Unless he's a 30 year old virgin it's probably too late for him to get....wait... this is /.
Yes, go get the HPV vaccination.
Re:So what can I, as a 30 YRO male, do? (Score:4, Insightful)
Make no mistake, HPV vaccinations are good for men to get too - even though they don't have cervices because the virus has been linked to other cancers - including throat and tongue cancer. Even if you argue those links are not really definitive yet, getting the vaccine prevents the risk of becoming a carrier and acting like a cervical cancer typhoid-Mary (now watch as the MRA's start demanding men not get the HPV vaccine because men shouldn't be expected to NOT kill women they have sex with).
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The US just elected to the presidency somebody who is clearly both.
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He's clearly come out anti-vax. Probably more to pander to the idiots, than for any personal belief, as his kids were vaccinated, but he's supported anti-vax.
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Also, your parenthetical is a really weird strawman that takes away from the rest of your comment.
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>Also, your parenthetical is a really weird strawman that takes away from the rest of your comment.
Have you SEEN what MRAs actually advocate ? How is it a strawman to make a joke like that, about people who have actually advocated that rape should be legal ?!?!?! If anything, it was euphemistic. The worst thing you can say about it, is that it was a bit off-topic for the post - but not for current events.
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There's a lot of confusion/apathy in the popular media about men's groups, and they usually end up lumping them all tog
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Well seeing as what the "reasonable" ones advocate for... are things feminists also advocate for, well I'll keep calling myself a feminist I think.
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Well, I speak as a male survivor of domestic violence. I got plenty of support from feminists... men (and especially MRAs) mostly called me a "pussy" and a "cuck'.
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I know there are some such politicians who claim to carry the mantle of feminist, but since their positions are flagrantly against the meaning of the word - the vast majority of feminists (of all genders) do not accept them as such. That they get a disproportionate level of influence is sadly true, much like whatever the Rust Belt thought they were voting for will definitely be taking second place to the reasons why the KKK voted for Trump.
The vast majority of feminists do support men's shelters. Indeed the
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I know what the movement's platform is; I'm saying they haven't done much to actually accomplish that part of it. I question how much "breaking down gender roles" is actually good for men; men shouldn't feel the need to be super "manly", I agree, but treating men like we're just defective women doesn't work either - that's one reason boys an
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Even more annoyingly, hint at issues with carbon-14 dating and you're a global warming denier, discuss climategate and you're a creationist.
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"Science-based beliefs are the new bible. One is either a Darwinist [...] There is no longer room for discussion or dissent."
About species evolution by means of natural selection? No, certainly there's no longer room for discussion or dissent. Just like it's the case about thermodynamics or, say, special relativity. No, ignoramus douchebags' rants don't count.
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what planet are you on?
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what planet are you on?
Look at the mods on my post. QED.
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This is completely wrong.
Science-based beliefs are the new bible. One is either a Darwinist global warmist or religious scum taking money from Big Oil. There is no longer room for discussion or dissent. Just hint at possible issues with carbon-14 dating and you're branded a creationist. Discuss the climategate and you're automatically a global warming denier.
It's just like the switch between Republicans and Democrats over the last century. Nowadays it's easier to have discussions with pro-lifes or intelligent designers than with "learned" people.
Maybe for you it is easier. Why have a discussion with someone who refuses to acknowledge facts and sticks their head in the dung pile? Seriously, the time for discussion is past on some portions of these topics, e.g., Are we pumping stored CO2 into the atmosphere? Yes. Does CO2 have the ability to raise temperatures? Yes. Is the world warming? Yes. Anything that refutes those statements requires backing scientific evidence of a degree that would indicate matter/energy can be destroyed, as the science behin
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Nowadays it's easier to have discussions with pro-lifes or intelligent designers than with "learned" people.
Sure, lucm, is that because all of the things you want to say are what they want to hear?
Notice how you didn't say anything to challenge them and their agenda.
One of my best friends is a Jehovah's witness. We've been arguing for over 15 years about the bible (I'm more on the atheist side) and we're still friends.
Re:Pretend this is slashdot (Score:5, Insightful)
Cancer might not be caused by lack of quality healthcare, but dying of cancer certainly can be. i.e. People who have access to quality cancer treatments are more likely to survive than people who don't.
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The biggest healthcare issue is lack of follow up and preventive care. For many type of cancers you can be determined if you are a risk or not, by genetic screening, auditing your life style, environmental conditions... So for many of these conditions if we had a strong healthcare infrastructure the focus will be far heavier on detecting and preventing then on curing or holding off.
The proble with this method it means we will need an infrastructure so it will require corporations and governments and the p
Actually it could be caused. (Score:3)
Cancer might not be caused by lack of quality healthcare,
Actually, in this case, lack of quality healthcare DOES rise the incidence of cancer:
Like several other types of cancer (e.g.: like colon cancer ; unlike pancreatic cancer), it's possible with a routine test to detect cellular anomalies long before those degenerate into an actual cervical cancer (the same way you can notice polyps on a scopy long before an actual cancer).
But for those early detection to be done, the woman needs to be able to afford going to a gynaecologist for said test to be done.
Otherwise
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There's a fun flipside: having access to high quality healthcare increases your chances of (not only being diagnosed with, but also) contracting cancer and other diseases - but, then the healthcare fixes you up, so, it's a net win - especially if you make money selling healthcare.
The healthcare itself doesn't (usually) cause your cancer, it's all the comorbid lifestyle factors.
Now, if you don't have access to healthcare or a healthy environment, then you're just screwed.
Re:Pretend this is slashdot (Score:5, Insightful)
This new number was created by explicitly removing women that do have quality healthcare by removing women from the study that had hysterectomies, a form of quality healthcare when cervical cancer is involved. What is left are women that do not have quality healthcare.
You do realize that a woman NOT having a hysterectomy does NOT mean they don't have access to quality healthcare, right?
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Given that this is all speculation, I think what they speculated on doesn't cover the bases, but was the most PC thing to suggest. For example if they suggested things like "higher rate of having sex with men with HPV" or "less condom use" then the blogosphere would be getting out its pitch forks.
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The study isn't looking at women who had cancer and DIDN'T get hysterectomies. It's looking at incidence of the disease...NEW DIAGNOSIS. To calculate incidence you take the population at risk for the disease and see how many develop it per year.
(XXX cases) / (People who can possibly get it) = Incidence
The study made the observation that:
(XXX cases) / (All women) = Incidence A ---> (XXX cases) / (All women WHO HAVEN'T HAD HYSTERECTOMY) = Incidence B
Because the denominator is smaller in the 2nd case and t
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When cancer is not removed leading to death? Yeah, that is NOT quality healthcare.
Spin your alternative facts all you want right? Anything to defend your worldview. Wouldn't want to face reality.
There are a number of reasons a woman may need to get a hysterectomy. This study excluded those who had, for whatever reason, had a hysterectomy from the total population of people who could get cervical cancer (since they would, by definition, not have a cervix anymore). That does not mean that all the women left in the study don't have access to quality healthcare just because they never had a hysterectomy. A hysterectomy isn't like getting a vaccine, it's something that every women with healthcare wil
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This new number was created by explicitly removing women that do have quality healthcare by removing women from the study that had hysterectomies
Cancer is not a driving factor in most hysterectomies. There is no basis for claiming that "women who have had hysterectomies" have higher quality healthcare than "women who have not had hysterectomies".
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There is no basis for claiming that "women who have had hysterectomies" have higher quality healthcare than "women who have not had hysterectomies".
Assumption1: Not all women have health care, by circumstance or choice.
Assumption2: Hysterectomies are solely the result of health care of some sort.
Discounting false positives leading to unneeded hysterectomies, in the set of women who have had hysterectomies, all of the women who have needed hysterectomies have received hysterectomies. In the set of women who have not had hysterectomies, there will be some women who have needed hysterectomies have not received hysterectomies. Therefore, "women who ha
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Nearly 90 percent of all women in the US never have hysterectomies. Pretty sure a lot of them have quality health care.
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Except it's not quite that simple. People like to forget that we actually do have public healthcare options. There may be a gap where the working poor fall through the cracks but those in serious poverty do have access to healthcare. It's called Medicaid.
Also personal choices do matter. Even if a pap smear or colonoscopy is free, you still have to go out and get it. People may still avoid doctors if services are free or if they are "wealthy" enough.
Also, pap smears are an annual ritual of those that choose
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Or aren't idiots:
...as if cancer is caused by either of those. Political alert!
Cervical cancer is deadly in the final stages when symptoms begin appear that force people to seek medical care. If it's caught early through routine exams it has an exponentially higher survival rate.
Re: Pretend this is slashdot (Score:3, Informative)
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HPV gets around, you're looking for virgins if you're going to get away from it.
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Cervical cancer actually IS caused by BOTH those. Because Cervical cancer is preventable with a vaccine. Now do you think access to preventative care may increase somebody's ability to get a vaccine ? Those two sentences are practically the same thing.
More-over, the lethality of ALL cancers is directly linked to preventative care. The quicker a cancer is detected, the higher your odds of survival - preventative care is the number one way to detect the damn tumour BEFORE It metastasises - i.e. while you can
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Though the new study wasn't designed to address racial disparities, experts speculate that the large difference reflects unequal access to preventative medicine and quality healthcare.
But, but, everyone is supposed to have affordable, quality health insurance! It's required!
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A lot of these people with "poor access" are probably on Medicaid. So this politically motivated proposition may ultimately and ironically resolve into "socialized medicine sucks".
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Surely the fact that the two numbers are so different proves it is important?
The same reason you split data by age, gender and social class. All these categories can matter in medicine.
No just for epidemiology, but in deciding treatment or risk for an individual.
The more specific the data the better, but you need a statistically significant sample size.
Race is a statistical cluster of genetic factors, and genetics matter.
However, in the case of cervical cancer, it may be more cultural. Blacks in the US hav
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Correction: the condom use is the other way around (higher for blacks), so definitely not a possible explanation. Sorry, did not fact-check in time :)
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It wouldn't matter anyway, since condom use has zero impact on HPV rates. HPV can be spread without sexual intercourse (and mostly is) and condoms do not prevent it or even reduce the risk. Even sexual activity rates don't affect HPV rates - it spreads way to easily and in way too many different ways. That's one reason we give the vaccine in childhood. The younger the better with this one.
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If there is an actual medical/statistical reason for separating groups like that, I'm genuinely curious, otherwise whats the point?
Because there are actual differences between the races - both genetic and cultural - that can make a certain disease more prevalent in different races. This is a good example, by the way.
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>The virus that causes cervical cancer is transmitted as the result of habitual unprotected sex.
Falsehood one. HPV can be, and most often is, spread by non-sexual contact.
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