[LexiMax]

> Do you have any evidence that the cancer is a type that would have been caught by a screening regime currently in place in other countries which is not in place in the US?

Do you have any evidence that it wasn't?

I honestly don't know if earlier detection was possible, or would have helped her out or not. What I can tell you is that given the state of health care in this country, you can bet that my default assumption would be "yes" until proven otherwise.

Starting with the assumption of "no" gives our system more slack than it deserves.

[CrazyStat]

> Do you have any evidence that it wasn't?

Most types of cancers are not routinely screened for. The post says that the cancer was in her liver and lungs, and neither liver cancer nor lung cancer are routinely screened for (lung cancer screenings are recommended for people with a history of heavy smoking).

> What I can tell you is that given the state of health care in this country, you can bet that my default assumption would be "yes" until proven otherwise.

This is clearly a politically-motivated point rather than one grounded in science or reality. Cancer screening in the US is generally more aggressive, not less aggressive, than in other developed countries. For example, the US has historically recommended annual mammograms starting at age 40, while Europe doesn't start until age 50 and only does them every two years. US guidelines are to start screening for colon cancer at age 45 (c.f. 50 in most of Europe), and the US uses a much more invasive (and costlier) approach to colon cancer screening on top of the age gap.

If anything the US probably overinvests in cancer screening. The evidence in favor of starting mammograms at 40 is extremely dubious, as is the evidence for invasive and expensive colonoscopies (standard US practice) over fecal matter tests (standard European practice) for colon cancer screening.

[Findecanor]

> The post says that the cancer was in her liver and lungs, and neither liver cancer nor lung cancer are routinely screened for ...

If you have got cancer in your liver and lung then those are probably metastases, and most often the original cancer is in the colon.

> the evidence for invasive and expensive colonoscopies (standard US practice) over fecal matter tests (standard European practice) for colon cancer screening [is extremely dubious].

Fecal matter tests will tell if you have got a tumour and that tumour is bleeding. But not all colon tumours bleed. Colon cancer can be a silent killer, that often goes without symptoms for years until it has metastasised and become terminal.

A colonoscopy will tell if you if you have got a polyp — an early pre-stage of cancer. And a polyp can be removed right then and there during the procedure with a tiny wire-loop or claw at the end of the instrument ­— and then you're safe.

I recommend everyone who is 45 y/o or older to get a colonoscopy every ten years. That is how long a polyp takes to develop into a tumour .. for normal people. Myself, I have Lynch syndrome, so I have had to start earlier and get a colonoscopy every year. I had my fourteenth two days ago.

A COLONOSCOPY IS NO BIG DEAL. It is not invasive, it is not sexual, it is not demeaning. Everyone is professional, interested in your intestine, not your butt. It does usually not hurt, and if it does it is because of gas, as there are no other types of sensory nerves in the colon. If you are otherwise healthy, it is not dangerous. You can get it done it medicated, or even sedated if you want. I usually do it without any such drugs. The worst part is not the procedure but the prep — because laxatives taste bad. But if you are healthy and ask for it, a doctor could give you a stronger laxative that you don't have to drink as much of.

Screening is good. Do it!

[CrazyStat]

Colonoscopies, involving inserting instruments into the body, are definitely an invasive medical procedure.

> An invasive procedure is one where purposeful/deliberate access to the body is gained via an incision, percutaneous puncture, where instrumentation is used in addition to the puncture needle, or instrumentation via a natural orifice. It begins when entry to the body is gained and ends when the instrument is removed, and/or the skin is closed. Invasive procedures are performed by trained healthcare professionals using instruments, which include, but are not limited to, endoscopes, catheters, scalpels, scissors, devices and tubes.

[1], emphasis added.

> A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into the body.

[2], emphasis added

> An invasive procedure is one in which the body is "invaded", or entered by a needle, tube, device, or scope.

[3], emphasis added

Is it a big deal? Maybe not to you, maybe to other people. Is it better than a much cheaper (and not invasive) FOBT? Questionable.

NordICC [4] found an 18% reduction in colon cancer incidence after 10 years with a colonoscopy screening program, but no statistically significant reduction in mortality (either colon cancer or all-cause). Hardcastle et al. [5] found no reduction in colon cancer incidence but a 15% reduction in colon cancer mortality after 7.8 years with a FOBT screening program.

Everyone's gungho about evidence-based medicine until the evidence fails to support their preferred procedures.

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6678000/

[2] https://www.cancer.gov/publications/dictionaries/cancer-term...

[3] https://medlineplus.gov/ency/article/002384.htm

[4] https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

[5] https://pubmed.ncbi.nlm.nih.gov/8942775/

[delichon]

> you can bet that my default assumption would be "yes" and "yes" until proven otherwise.

That's a recipe for healthcare inflation. There are endless unproven tests and treatments.

[altairprime]

Looking at corporate profit levels versus wage levels over the past twenty years, the U.S. as a capitalist country can afford a great deal more of healthcare inflation in order to raise the quality of life for its population.

Should its businesses afford that out of their profits?

Since households can’t afford eggs, much less health care costs, at the wages paid by businesses; so this decision is up to firms rather than households to decide. Founders, your input would especially be appreciated here.