
Cancer Progress: Much More Than You Wanted To Know (2018) - sethbannon
https://slatestarcodex.com/2018/08/01/cancer-progress-much-more-than-you-wanted-to-know/
======
herodotus
This author writes so well. The introduction, in just 169 words, tells you
exactly what the article is about. I wish more articles had such good
introductions.

~~~
misrab
Rather than starting with some personal anecdote contrived for some sort of
empathy, as is the common style these days!

Thank you.

~~~
randomsearch
Or something like:

“””

“I’ve always hated coffee” said Joe Bloggs, sipping his chai latte as he sits
somewhat dishevelled in a grey overcoat that insulates him against the wintry
London weather. The Hackney coffeehouse he chose for this interview
specialises in Peruvian blends, an apt reflection of his latest film set in
South America.

... (insert interview)

... Joe, for one, will be hoping reviews for his next film is more of a blend
than a roast.

“””

~~~
Pimpus
I know the kind of article you mean. I always exit them quickly. If that style
helps in SEO, surety it is offset by people not wanting to read that kind of
crap. Funny post, though.

~~~
seanwilson
I really don't think people do it for SEO reasons. People that do that for SEO
tend to write text that is on-topic but explain simple things in drawn out
ways using lots of related keywords.

I think people that write articles that start with long anecdotes (which are
usually linked back to in the end) are trying to emulate the writing style
you'd usually see in newspapers and magazine going back decades. It doesn't
work well on the web I feel when there's an abundance of information where
you're trying to filter through what's useful to read and what isn't. It's
different when you're e.g. reading a magazine and have limited articles to
pick from.

~~~
adrianratnapala
> It doesn't work well on the web

It doesn't work in magazines and newspapers either, but certain writerly
circles (mostly American ones) consist of telling each other that this kind of
fluff is a good idea.

You will find this kind of writing in _Time_ magazine, but not in _The
Economist_. Which is one of many reasons why _TE_ is a better paper.

------
natalyarostova
When I read this in August it was fascinating. Since then an immediate family
member was diagnosed with cancer, and it all feels so much more real and
painful :(

~~~
hpcjoe
Hang in there ... I've ridden that particular train[1][2]. You have to be
strong, positive for the family member. Know you are not alone, there have
been many people who've gone through this, and as I discovered, it helps to
talk to them.

I am happy to report that as of 29-Dec, we are at 7 years post op. On the 1
year anniversary of when we got the diagnosis, I saw an xkcd strip[3]. That
gave me some hope of an eventual return to normalcy. A few years later, I saw
one of the followons[4].

Little things like that help. They really do.

[1] [https://scalability.org/2011/11/ot-it-really-focuses-your-
at...](https://scalability.org/2011/11/ot-it-really-focuses-your-attention-on-
the-important-things/)

[2] [https://scalability.org/2012/01/ot-what-is-and-what-
should-n...](https://scalability.org/2012/01/ot-what-is-and-what-should-never-
be/)

[3] [https://xkcd.com/1141/](https://xkcd.com/1141/)

[4] [https://xkcd.com/1928/](https://xkcd.com/1928/)

~~~
samplatt
Currently riding the train for my mum who is doing fairly well after ~9 years
with one recurrence, and my dad who isn't doing so well @ 4 years and two
recurrences.

There's another xkcd strip that, while not as optimistic, is just as
important: [https://xkcd.com/931](https://xkcd.com/931)

~~~
dcarmo
My mom was diagnosed 1.5 years ago, and the uncertainty of it all is the worst
part. It soothes my heart to know I'm not going through this alone.

~~~
hpcjoe
You aren't alone. You need to stay strong and positive for her, but you need
to be able to talk with others who've tread this path before. Many have.

------
SideburnsOfDoom
I would have thought that smoking cessation and earlier detection are - in a
sense - medical advances?

Medicine pushed for these, as the most effective ways of fighting cancer. And
it's working.

The same will hopefully happen to air pollution in cities, as a public health
problem.

~~~
toper-centage
The same will also happen due to diet changes in the next years. More and more
people are severely cutting back on meat intake, specially smoked and
processed meats, and it will likely have an impact on a multitude of types of
cancer down the road.

~~~
Cthulhu_
Which types are caused by which meat though? I haven't seen a strong
correlation between the two (unlike smoking and cancer). The charts on that
article don't really show much change in most types of cancer over the past 50
years, despite changing diets and a higher availability of meat and processed
foods.

~~~
SideburnsOfDoom
[https://www.theguardian.com/society/2015/oct/26/bacon-ham-
sa...](https://www.theguardian.com/society/2015/oct/26/bacon-ham-sausages-
processed-meats-cancer-risk-smoking-says-who)

------
dannykwells
I think "the War on Cancer" is a great teaching moment for technologists: be
careful with huge promises that millions latch on to: they won't forget, and
when you fail, it will be (very, very) hard to win their trust back (thus, in
the case of cancer, the continued fallacious narrative which the author so
nicely deconstructs that we aren't making progress on cancer)

------
asdfasgasdgasdg
Well that's fantastic news, and I'm glad to hear it. I expect we will more or
less beat cancer someday, and heart disease too. Probably long after I'm gone,
but I'm happy for future generations that will no longer have to fear this
scourge. (Assuming we don't wipe ourselves out some other way first.)

~~~
SmellyGeekBoy
The sad thing is that most instances of cancer and heart disease are down to
diet and lifestyle. We already have the "cure" to these conditions, but people
won't take care of themselves.

~~~
cannonedhamster
No, you're absolutely incorrect that most cancer is down to lifestyle. As
someone with cancer, I don't smoke, I never really drank, there's no history
in my family for my type of cancer, and I haven't eaten meat in years. I've
exercised more than the average person. Most cancer is due to dumb luck. The
only cancers we know of that are attributable to lifestyle are basically lung
cancers. Breast, Colon, Pancreatic, Stomach, Leukemia, etc. are all just dumb
luck or family history. You obviously didn't read the article. We're only
better at things we know how to screen for. Survival rates in Asia for Stomach
cancer are significantly better than the US because they have regular
screenings for it. The typical cases are salty diets, but Americans still get
this even though we've changed our diets.

There's no "cure" for cancer as of yet, you can't even guarantee prevention.
It's a combination of genetic damage and an immune system that gets prevented
from stopping the proliferation of cancer cells because the cells mask
themselves as healthy cells. In effect cancer is an immune disease, but that's
not fully accurate. Saying it's down to lifestyle is like telling people who
got the plague they should have just moved. We have barely more understanding
about cancer causes than doctors at the time did about disease.

------
sulam
I'm not sure I buy the logic of ignoring improved detection when it comes to
survival chances. As the article and pretty much everyone else tells you,
early detection is the key to a better prognosis in most cancers. If all
malignancies proceeded to stage IV before detection, survival rates would be
very low despite the medical advances we've made. Successfully treating a
cancer, usually indicated by being cancer-free 5 years post-treatment, is not
discussed in this article at all and seems like it would provide some evidence
for or against cancer treatment getting better from the perspective that
matters most -- the likelihood that a diagnosed cancer will kill you.

------
salex89
As someone who has quite unsettling health anxiety and somewhat of a cancer-
phobia, these articles kinda calm me. But what doesn't calm me are usually the
comments because it seams that cancer is really all around me, and it's just
around the corner, just waiting to snatch me. I don't have any cases in my
closer or further family, but I'm frightened I'm going to be the one... The
1-in-2 statistics doesn't soothe either...

~~~
neuronic
I have 1000s of moles and get checked once a year. I live in crippling anxiety
that one they, melanoma will pop up and I won't notice early enough. So I get
your fear _very_ well.

All we can do is to reduce the probability by causing less DNA damage through
all the various means. Even then, pure chance can still strike because this is
what life is at its core: a cumulation of (seemingly?) random chance events.

~~~
salex89
Yep, I have quite some moles myself and get them checked. Although, thanks to
the place I live in, I don't get too much UV exposure and try to protect
myself well. That's the thing, I'm not too frightened by the things I can
control, it's those that do not have so much prevention, such as pancreatic or
leukemia... I think I did some permanent damage to my psyche by just reading
too much about those things and too much statistics. Sometimes I see myself as
just a number when reading these articles.

Don't get me wrong, I'm going to therapy and I'm not depressed. Just scared :)
.

------
bsder
> The only contrary data point I can find is this study of laryngeal cancer,
> which finds worsening stage-specific survival rates for high-stage laryngeal
> cancer since 1977.

I seem to recall someone theorizing that the increased prevalence of oral sex
is responsible by putting HPV deeper into the throat and thereby increasing
the prevalence of throat cancers.

HPV vaccinations should cause a corresponding down tick shortly if that is
true.

~~~
faltad
> Recent data suggest that individuals that come to the disease from this
> particular cause have a significant survival advantage,[20] as the disease
> responds better to radiation treatments than tobacco caused disease.

From Wiki + [https://www.mdanderson.org/newsroom/2010/06/hpv-positive-
tum...](https://www.mdanderson.org/newsroom/2010/06/hpv-positive-tumor-status-
indicates-better-survival-in-patients-.html)

It does seem indeed that there is more prevalence of laryngeal cancer due to
HPV however according to that link above, it should not worsen survival rates
but rather make them better, wouldn't it?

------
PunchTornado
can't wait to see how much improvement whole genome analysis will bring to
patient outcome.

------
yolodeveloper
I wonder how widespread was cancer in, say 17-18th century. Obviously there
would not be much technology do diagnose it, but still, if someone has any
references, that'd be of interest.

~~~
cannonedhamster
It would be by necessity less of a killer as people didn't live as long. The
average age of death in those times was late thirties, far lower than the
common age of cancer in the mid to late 60s. Keep in mind that sanitation,
food preparation, medical science, and clean water were all huge advances in
life spans and general health.

The PBS series "How We Got to Now" is a great resource for the huge advances
in health made in the 19th and 20th centuries.

------
nonbel
I always thought this plot:
[https://slatestarcodex.com/blog_images/cancer_tobacco.jpg](https://slatestarcodex.com/blog_images/cancer_tobacco.jpg)

Looked eerily similar to this one:
[https://i.ibb.co/cLbTRfM/nuctest.png](https://i.ibb.co/cLbTRfM/nuctest.png)

Source for nuclear test data:
[https://www.armscontrol.org/factsheets/nucleartesttally](https://www.armscontrol.org/factsheets/nucleartesttally)

And before there were nuclear tests, there was a big fad to expose yourself to
radiation early in the 1900s:
[https://www.popsci.com/scitech/article/2004-08/healthy-
glow-...](https://www.popsci.com/scitech/article/2004-08/healthy-glow-drink-
radiation)

Is the argument that the nuclear tests, etc had zero effect on lung cancer
rates? If not, what was it?

~~~
sanxiyn
The usual strategy is to control for smoking. If nuclear test rate correlates
with lung cancer rate, but does not correlate with non-smoker lung cancer
rate, nuclear test is not causing lung cancer.

Epidemiology is a field of study about how to do this right. One of the great
achievement of humanity in the 20th century was advance of epidemiology.

~~~
nonbel
But here you go:

> _" the lung cancer mortality rate has risen substantially between 1914 and
> 1968 among persons who never smoked cigarettes. For white males the relative
> increase for ages 35--84 years has been about 15-fold; the relative increase
> for ages 65--84 years has been about 30-fold."_
> [https://www.ncbi.nlm.nih.gov/pubmed/285289](https://www.ncbi.nlm.nih.gov/pubmed/285289)

~~~
cbkeller
That's interesting -- doesn't seem to have a graph, but states a significant
increase between 1914 and 1967 in nonsmokers. There doesn't appear to be any
control for secondhand smoke, however, which could also be a significant
factor over that time period.

~~~
nonbel
Sure, another thing to consider is fallout incorporated into tobacco and then
smoked...

But do you see why I didn't care if a correlation existed? There are a bunch
of ways to explain such a correlation. That line of reasoning was based on the
affirming the consequent fallacy[1]:

If

    
    
      H: Nuclear tests are a significant factor in lung cancer rate 

Then

    
    
      O: We should still see a correlation between lung cancer incidence and nuclear test frequency [in non-smokers]
    

We can't conclude "O is true, therefore H" (since there are a million
potential reasons for O besides H), so we don't learn anything from it. Now if
O had been some very specific prediction unlikely to arise from other
hypotheses, I would care.

In terms of Bayes' Rule, I only care if p( O|H[0] ) dominates all the other
possibilities (H[1:n]) in the denominator. The mere existence of a positive
correlation isn't specific enough for me to care:

    
    
      p( H[0]|O ) = p( H[0] )*p( O|H[0] )/sum( p( H[0:n] )*p( O|H[0:n] ) )
    

[1]
[https://en.wikipedia.org/wiki/Affirming_the_consequent](https://en.wikipedia.org/wiki/Affirming_the_consequent)

~~~
sanxiyn
Yes, epidemiology is not deductive, and in the end it depends on whether
observation is "specific enough" for you st unlikely to arise from other
hypotheses, which in turn depends on your prior, which is informed by
laboratory results in addition to field results. Epidemiology is a truly
fascinating subject.

~~~
nonbel
> _" epidemiology is not deductive"_

-Not sure what you mean by this, it is quite possible to deduce precise predictions from an epidemiological model. See, eg, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2007940/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2007940/)

> _" it depends on whether observation is "specific enough" for you [is]
> unlikely to arise from other hypotheses, which in turn depends on your
> prior"_

-This has to do with the likelihoods, p( O|H[i] ), not the priors: p( H[i] ).

> _" [the prior] is informed by laboratory results in addition to field
> results"_

\- Yes

~~~
sanxiyn
Affirming the consequent is a deductive fallacy. It is not a fallacy in
probabilistic reasoning, because the consequent _is_ an evidence of the
antecedent.

Re: laboratory results, it is noteworthy smoking and non-smoking lung cancer
have different molecular signature. Lung cancer probably should be considered
two separate diseases, and this probably overstates smoking connection because
some lung cancer by smokers is of non-smoking kind and not caused by smoking.
This can be better understood by including such signatures in epidemiological
study.

~~~
nonbel
> _" Affirming the consequent is a deductive fallacy. It is not a fallacy in
> probabilistic reasoning"_

Nevertheless, people commit that fallacy all the time in epidemiology. They
say stuff like "if smoking caused cancer, then people who smoked would get
cancer more often". Then if there is a (statistically significant) positive
correlation between cancer and smoking, they conclude smoking causes cancer.

That is quite obviously affirming the consequent. I explain the (completely
different and correct) probabilistic way to think about this situation using
Bayes' rule in my post.

It has nothing to do with arbitrary cut-offs for telling us whether a
correlation exists or not. Instead it requires comparing the relative
performance of the various explanations (at least the top few candidates since
extremely unlikely ones can be dropped from the sum in the denominator).

~~~
sanxiyn
I don't think anyone serious about epidemiology says stuffs like that. On the
other hand, it is true many people _interpret_ what epidemiology says as such.

Saying smoking is a risk factor of cancer is very different from smoking
causes cancer. As you said, you must consider alternative explanations. On the
other hand, people can disagree about what alternative explanations are
"extremely unlikely" and "can be dropped", that's what I meant by prior. For
example, nuclear test causes cancer, is probably extremely unlikely.

Smoking being a risk factor of cancer _is an evidence_ of smoking causing
cancer. Being evidence of causal relation is completely different from being
sufficient to prove causal relation.

~~~
nonbel
>"I don't think anyone serious about epidemiology says stuffs like that."

Pick a paper, I bet they do.

