[Clent]

They are conflating cancer survival rates with longevity.

When has someone claimed that treating cancer would increase life expectancy above the average?

This is a dangerous article. People don't need more reasons to avoid cancer screenings.

[amanaplanacanal]

It looks like they were comparing a group that got screening vs a group that didn’t get screening. If the group that got screening didn’t live longer than the group that didn’t get screening, that seems like a lot of wasted dollars.

[throwway120385]

Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die.

What if some people in the group that didn't get screening had fewer high-quality years? It might simply be that the last 5 years of life for people who are screened positive early on and who subsequently receive treatment is a better 5 years than the last 5 years of life for people who aren't screened positive early on and who subsequently have to undergo brutal hail mary treatments at the last minute.

[pessimizer]

> Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die.

Claiming that there are missing elements that could possibly turn the equation in favor of screening is cause for further research and analysis. You can't just claim that they fall in your favor; some diagnostic and exploratory processes due to false positives are painful and/or dangerous in and of themselves.

> What if

"What if" is right. You can't just conjure these people into existence to justify current policies, you have to find them and do the statistics.

[throwway120385]

Given that screening is arguably benign for most people, you could argue that we continue screening while we gather more information. But you do whatever you want to do. I'm just pointing out that it's really premature to cancel all of your screenings based on the idea that it doesn't add any years to your life. That may be true, but there's more to a life than how long you live.

[idopmstuff]

> Given that screening is arguably benign for most people

You're 100% wrong here, this is not a given. Prostate cancer screenings, which are very common, can have both false positives as well as findings of cancer that is and would remain completely benign. These can both lead to unnecessary treatments that cause serious negative health effects, including incontinence and erectile dysfunction.

https://www.cdc.gov/cancer/prostate/basic_info/benefits-harm...

[Gibbon1]

Also read that death rates from thyroid cancer hasn't changed in 50 years. Despite huge numbers of thyroid screenings and treatment.

An ultrasound of the thyroid often leads to finding a nodule. Which leads to a biopsy. Which comes out indeterminate. Which leads to a thyroidectomy and life long dependence on thyroid hormones.

Another one is ductal carcinoma in situ. Read somewhere there is a 1% chance that will evolve into cancer. And yet you have women having double mastectomies and chemo for it.

[DennisP]

So work the numbers. Put together the chance of false positives, false negatives, rate of negative effects from treatment, and rate of death with and without treatment. Tell the patient the risk of each outcome.

The math is easy. If we don't have the numbers for it, then get them. Plenty of people get prostate cancer and some of them choose to just monitor. We should have plenty of information to make a rational decision. This seems preferable to blinding ourselves out of fear that we'll do something stupid with the information we might get.

[pintxo]

It’s important to note that it’s not the screening causing those issues. It’s the fact that our health care systems are rather inadequate in properly handling those screening results at the margin.

[vc8f6vVV]

There is another consideration:

1. You have an aggressive (i.e. non-treatable) cancer, maybe you feel slightly off, but you go on with your life, until you finally got worse and die. Or you performed screening, focus on treatment, bankrupt your family and ... die anyway,

2. You have a slow growing cancer (e.g. prostate), live your life and die of some other causes. Or you performed screening, got surgery, got tons of problems and die of myocardial infarction (yes, that's one of complications after prostate surgery).

If you read the original JAMA publication you would notice that there is a research on quality of life metric. That metric for breast cancer is higher among non-screened women.

[kirkni]

There are attempts to address this, “The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions.” See: https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year

[dudeofea]

I'm going to start with one assumption that I believe is true: higher mental and physical stress will kill you faster.

If two statistical people both get cancer, one gets screened and potentially treated, and the other doesn't and they both live to 80, I would rather be the person that doesn't get treated.

A regular schedule of treatments is only better than a hail mary if you actually get more longevity from it, otherwise it's just more pain for the patient. At least with the hail mary, I only spend a short time feeling horrible before dying. This is most likely why doctors don't opt for treatment more than the average.

https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...

[DennisP]

Yes but as someone else mentioned, it's like an insurance policy. Buying insurance doesn't make you richer on average, it makes the insurance company richer. But you aren't guaranteed the average outcome, so it's still rational to get the insurance, to cover the cases where you'd otherwise have a catastrophic loss. As with gambling, it's not just about expected value. You also have to consider risk of ruin.

[pessimizer]

False positives can be debilitating or fatal.

[DennisP]

But at what rate? The study doesn't say.

[lowbloodsugar]

FTA: "Overall cancer mortality worldwide has decreased significantly, falling 33% since 1991, in part due to early detection as well as advances in treatment and declines in smoking."

[rdedev]

I think the consensus on cancer screening is stil not fully there? Came across this video by a cardiologist a long time ago

https://youtu.be/yNzQ_sLGIuA?si=fUttSVFQjsrIqc-p

I guess the main gist is that screening is not completely benign and a positive screen might lead to more interventions for what in the end could just be a benign tumor. Then there's the other point of detecting it late in life. Like treatment for cancer might not make much sense if you are already 89 years old

[haltingproblem]

This is the negative expectation part of most medical screening that most analyses miss.

- Medical screenings themselves have iatrogenic effects,

- the false positives interventions resulting from screenings have further negative effects and

- finally the true positive interventions don't necessarily prolong life.

All in all very difficult (confounding) tradeoffs that are impossible to quantify and understand especially when the cultural pressure is to do something.

[arisAlexis]

Do you really believe your third point? That most medical interventions for cancer do not prolong life? Or the word necessarily means your argument is null like "not all interventions prolong life". Yeah , we knew that already. It's never 100%.

[haltingproblem]

Sorry for the delay in responding.

I actually do and most of it based on what I have have directly experienced with what, especially older doctors, counsel their patients.

There is a lot of literature on how doctors die [1], which also drives my beliefs.

I am also influenced and how weak the statistical significance is on evidence based literature on interventions and how often the interventions are difficult to replicate.

As always, please do your own research :)

1- https://www.thehappymd.com/blog/bid/295228/how-doctors-die

[csours]

> most medical interventions for cancer do not prolong life

Specifically, medical interventions for cancer AS A RESULT of some types of screening do not prolong life.

Medical interventions for symptomatic cancer, and some types of screening, certainly do prolong life, and quality of life.

There are so many confounding factors in this it's hard to do something like a pareto breakdown, but it would certainly be interesting to see.

[NoZebra120vClip]

I'd rather die of cancer than die of chemotherapy.

[newaccount74]

A friend of mine had a pretty agressive cancer at age 16. He suffered through chemotherapy, a bone marrow transplant, and another round of chemo a year later. I think it sucked pretty bad. I visited him once in hospital, they made me wear a full body suit to prevent any infections.

But that was 20 years ago. He lives a normal life now and has a family. I'm pretty sure chemo was worth it.

[aeturnum]

Why would it be dangerous for people to avoid cancer screenings if those screenings do not impact life expectancy? You might want to know if you have cancer, but doesn't this suggest that...there's no baseline argument to suggest that all people undergo those screenings?

[arisAlexis]

They do impact life expectancy. The English language is a bit confusing to some mixed with statistics. They do not make life greater than average but they do make you closer to the average than if you die earlier.