> Even though we know prognosis is much better for cancer, and many other diseases, if you catch it early
This is, to some extent, misleading.
I mean, earlier treatment is beneficial, but there's a significant confound. All else being equal, if a cancer is less aggressive and slowly growing it is more likely to be detected early.
Put in other terms, the cancers detected earlier by screening are a very different population of cancers detected late and with progression.
Probably hyperbole but a colleague told me about a 80/20 distribution, that a decreasing amounts are spent on substantial life extension or quality of life improvement in the west as the pop ages.
The basic good old medical care invented 100 years ago, while dizzying amounts are spent on prolonging lives for very, very few years, often very late in life - efforts that are very close to - in effect to have done nothing, ie. almost performative.
I don’t know about that, speaking to oncology as I work in a NCI designated cancer center (i.e. somewhere that spends dizzying amounts) and it skews younger than you might think these days.
I’m not sure what you mean by “very, very few years”. As a hypothetical would prolonging life for ~3-7 years in a 40-50 year old be considered “almost performative” to you?
“Good old medical care” often means 3-6 month survival for these patients.
yes. the amount we spend to keep people alive who have little to no hope of ever recovering is immense. of course it is cruel and leads to myriad bad outcomes if you were to even attempt to have a discussion about trying to change that (it is the slippery-est of slippery slopes)
there's probably no way to actually do anything concerted about it without turning society into Logan's Run but having gone through it with a grandparent and a parent, it is clear something is broken at the end of life
Probably. Look at the people in the hospital - they’re old. Inpatient costs are astronomical, and seniors with poor social supports end up hospitalized at great expense with issues where root cause are easily prevented… like dehydration.
Being old is a fairly long part of life nowadays. Old is not the same as hopeless or almost dying.
My grandma had a melanoma at the age of 74, which is "old" by most human standards. It was located on her earlobe and an operation helped her get rid of it.
She then lived to be 90, most of that extra time either fully or partially self-sufficient. Only in the last months in her life she really deteriorated.
Basically, she gained almost a fifth of her life by that single operation performed when she was already old.
That’s awesome. I’m not suggesting that older folks not get care.
But because of way our system works, we’ll happily pay $300k to hospitalize an otherwise healthy 70 year old who is dehydrated and develops serious problems that could be solved by an aide or helper that would cost $20-30k.
> I mean, earlier treatment is beneficial, but there's a significant confound. All else being equal, if a cancer is less aggressive and slowly growing it is more likely to be detected early.
Wow! That makes so much sense! I had never considered this!
Sure, but my understanding is that for many types of cancer, detecting that specific cancer early does make a big difference. It can be the difference between a single, minimally invasive surgery to remove a tiny rumour that hasn’t spread, that can be effective even without chemo/radiation/etc., and stage 4 cancer that has spread a tonne where even with extensive chemo/radiation/etc., your chances aren’t good.
> Sure, but my understanding is that for many types of cancer, detecting that specific cancer early does make a big difference.
The problem is, this is hard to measure. We know that "detected early" correlates with better long term outcomes. But "early" means "smaller and with less spread" which in turn is strongly correlated with "growing slower and spreading less".
We've had unpleasant surprises where e.g. extending screening to earlier ages detects more cancers but doesn't decrease the number of people dying from that type of cancer because of these confounds.
How frequently do you want to screen? Monthly? Weekly? Some also have no known effective treatment - maybe some super early detection helps, but maybe not.
Cancer isn’t one thing and AI is an important tool that will accelerate treatment and drug development.
My late wife detected a mole that was melanoma in 2019. She was within months of being cleared for observation in 2023 when two brain tumors were detected. Despite the best of care, she was gone in 6 months.
If her initial treatment had been in 2024 instead of 2019, it’s 80% likely she would be around for another decade or more. That’s how fast new treatment options are coming to market, and data analysis with AI and other tech is improving it. New trials are using platforms like Moderna to provide custom vaccines that should reduce treatment side effects.
While the hyperbole of the media is annoying, the impacts of new tech to identify genetic vulnerabilities in cancers is near miraculous.
I was speaking specifically towards screening more and detecting earlier. They have utility, but recent evidence seems to indicate that it's not nearly as much as the public assumes.
No worries. I share it frequently here because I think the personal connection underscores the import, which sometimes gets lost. It's easy to think about "cancer" in the abstract, and sometimes we miss that it's a mother, a wife, a friend -- I know that I did.
And at the end of the day "cancer" is a category, not a thing. Sometimes (prostate cancer) early detection and intervention is bad, as the cure is worse than the disease! Other times (ovarian cancer), accidental early detection while looking for something else entirely, as symptoms don't present until you've hit Stage 4 typically.
Can you elaborate a little on what's new? Someone close to me had a melanoma scare on almost the same time frame, and had a lot of difficulty finding doctors who would take her seriously.
In the case of my wife, she would have been given a round of nivolumab or keytruda. These are immunotherapies that enable your immune system to kill the cancer cells.
You have to advocate very heavily. With melanoma, I wouldn’t mess around and seek at a minimum second opinions from the nearest major cancer center.
This is, to some extent, misleading.
I mean, earlier treatment is beneficial, but there's a significant confound. All else being equal, if a cancer is less aggressive and slowly growing it is more likely to be detected early.
Put in other terms, the cancers detected earlier by screening are a very different population of cancers detected late and with progression.