

On The Last Lecture - acangiano
http://antoniocangiano.com/2008/04/08/on-the-last-lecture/

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projectileboy
The author mentions survival rates, but these often just reflect improved
diagnosis techniques. Mortality rates are more meaningful, and - sadly -
haven't improved so much. (Props to Edward Tufte for pointing out this one.)

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apathy
The risk of any given disease 1) occurring and 2) contributing to mortality
rises proportionally with age. More generally, age is a risk factor for the
majority of diseases.

One result of the increasing life expectancy in the general case is that
mortality from degenerative disease must necessarily increase, unless the rate
of improvement in a given disease's treatment effectiveness is greater year-
over-year than the risk differential from simply getting older. That sounds
easy but history suggests otherwise (progress is spiky, and while elucidation
of risk factors is getting faster and faster, the follow-on work of treating
consequences hasn't accelerated apace)

This is particularly important for degenerative diseases of the sort that most
cancers represent, namely, accumulated genetic damage leading to what seems to
be de-differentiation and malignant re-differentiation of one or more cell
types into something bad. This is not entirely unlike what happens when an
embryo becomes a fetus, with the unfortunate side effect that the host must
'deliver' surgically and the location of the 'child' is unknown (and in some
cases unknowable). If you have children, you can perhaps relate to the
systemic burden of such a situation. Now just take that kid and put it in a
person's pancreas, or their white blood cells, and try to figure out how to do
a 'C-section' or 'morning-after pill' effectively. Depending on the specific
pathology, it may be almost impossible.

Anyhow, while it is true that earlier diagnosis can influence the recorded
survival times, if you rip into the data using (eg.) Cox regression, the
hazard rates _do_ change with treatment, and that's about all you can ask for
until we figure out how to target individual cell types for apoptosis in an
agreeable fashion :-)

~~~
projectileboy
Thanks for a much better breakdown. My only point was that "survival" and
"mortality" rates are often bandied about as a simple way of rolling up
historical progress in diagnosis _and_ treatment, and that if _I_ was
diagnosed with some nasty form of cancer, I'd be more interested in the latter
stat (for my particular age group).

