
Signs of cancer can appear long before diagnosis, study shows - rushi_agrawal
https://www.theguardian.com/science/2020/feb/05/signs-of-cancer-can-appear-long-before-diagnosis-study-shows
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skwb
While it is certainly interesting to hear of new developments for cancer
screening, it must be taken in with the proper context. I see a lot of people
without medical or public health training fall into the trap of thinking that
any sort of screening mechanism is a net positive, without taking into
consideration the "costs".

For example, a lot of breast cancer screening has been highly controversial,
because of either A) false positive diagnosis B) slowly growing cancers that
are too aggressively treated. To properly assess the utility of a cancer
screening technique, you need to look at specific long term metrics, such as
mortality reduction, that can only be quantified using randomized controlled
trials. On the other hand, there's many pitfalls for over treatment. Patients
may die during surgery. Biopsy isn't a fun procedure to go through on the
receiving end. There's a lot of emotional stress involved. Adverse reactions
from chemotherapy/biological agents used to treat the disease. And all this is
in the face of the fact that you may die from other causes such as a heart
attack.

Certainly I share the optimism with many that we can develop breakthrough
cancer screening techniques, but it's irresponsible to let it interfere with
rational decision making based on proper studies.

~~~
kaitai
This is a hugely important comment and given the demographics of HN, I'll
bring up prostate cancer as an example. It is important to catch prostate
cancer in younger men, as in younger men it tends to be an aggressive cancer
and lead to mortality. Paradoxically, in older men, aggressive screening for
prostate cancer is _bad_ if you want men to live longer and healthier lives.
To oversimplify a bit, old guys with prostate cancer tend to have slow-growing
cancers and they will most likely die of something else long before the cancer
becomes a problem. Overtreatment of prostate cancer among old guys leads to
_increased mortality_ due to the risks of treatment, as well as leading to
decreased quality of life due to side effects of surgery. This is why prostate
cancer screening guidelines have been revised over the last 3-5 years.

~~~
DoofusOfDeath
It's interesting that one argument against early detection (in certain
situations) is that patients + medical community can't be trusted to act
rationally with the information.

~~~
Gibbon1
What no one talks about is when you get an indeterminate result. For thyroid
tumors that might be as high as 25-30%.

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foxyv
Lately I've been doing 7 day fasts two times a year mostly to reduce visceral
fat and reduce my chance of type 2 diabetes. However a lot of science is
pointing to it being a good way to reduce cancer risk. Nothing definitive, but
it's nice to think I may be helping my body fight possible cancer too. Maybe I
will catch some of these things early during these phases where the genes are
present but the cancer hasn't begun to be diagnosable or slow it down.

I've also heard some doctors suggest that fasting during cancer treatment
improves the effectiveness of chemotherapy.

~~~
bitL
7 days fasting (electrolytes-only) gives me a week-long euphoria afterwards,
but days 6-7 show some ugly symptoms of previous diseases, so persevering
those is a bit tricky. It also leads to 10-12lb weight loss.

~~~
foxyv
Lately I've been trying supplementation of potassium, magnesium and calcium
which are supposedly lost during a fast. (I'm skeptical of most
supplementation...) Pretty much just sea salt, creme de tartar, and lime
juice. Seems to help a little with the weirder effects of a long fast.
(Cramping, weakness, lightheadedness) In water they taste a little like
gatorade without the sugar.

~~~
bitL
The electrolytes I use are some kind of salt combined with the elements you
mentioned; without proper electrolytes you might die during longer fasts. I
avoid any kind of juice to make sure that part of my digestive tract can rest
and do some internal cleanup. Autophagy should start at around day 5 and
immunity renewal at around day 3.

If I do sauna (many hot/cold cycles), I feel great for a day, if I do a 7-day
fasting, I feel like that for a week. Sauna probably forces some mild cleanup
through sweating, fasting through autophagy and burning off fat that stores
toxins body didn't want to deal with earlier.

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pintxo
... can appear in the genome long before ...

> “What’s extraordinary is how some of the genetic changes appear to have
> occurred many years before diagnosis, long before any other signs that a
> cancer may develop, and perhaps even in apparently normal tissue,” said
> Clemency Jolly, a co-author of the research based at the Francis Crick
> Institute in London.

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RcouF1uZ4gsC
>The findings, based on samples from more than 2,500 tumours and 38 cancer
types, reveal a longer-than-expected window of opportunity in which patients
could potentially be tested and treated at the earliest stages of the disease.

One issue with this might be selection bias towards cancer. What is the
baseline rate of finding these type of mutations in people that do not develop
cancer? There are cells going bad all the time in the human body, but because
of factors such as the immune system, they actually don't cause any problems.

One example of this kind of thing is prostate cancer. Prostate cancer used to
be aggressively treated often with a lot of side effects such as not being
able to control urine and sexual dysfunction. However, further research showed
that a lot of these cancers either don't continue to progress or progress so
slowly that the patient will die with the cancer rather than from the cancer,
and so not doing anything is the best course of action.

Overall this is an exciting development, but it will take a lot more research
to know what should be done with that information, and to avoid over-treating
which has its own downsides.

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melling
According to Craig Venter, early detection is what we need to eliminate
cancer:
[https://youtu.be/iUqgTYbkHP8?t=15m37s](https://youtu.be/iUqgTYbkHP8?t=15m37s)

~~~
rtny4821
Early detection is what the industry wants so they can improve their 5-year
survival stats. And of course increase the total addressable market for
conventional treatment options

~~~
bobbiechen
Scott Alexander has an interesting blog post about this:

 _Official statistics say we are winning the War on Cancer. Cancer incidence
rates, mortality rates, and five-year-survival rates have generally been
moving in the right direction over the past few decades.

More skeptical people offer an alternate narrative.

[...]

Suppose a certain cancer is untreatable and will kill you in ten years. If
it’s always discovered after seven years, five-year-survival-rate will be 0%.
If it’s always discovered after two years, five-year-survival-rate will be
100%. Better screening can shift the percent of cases discovered after seven
years vs. two years, and so shift the five-year-survival rate, but the same
number of people will be dying of cancer as ever.

This post tries to figure out which narrative is more accurate._

[https://slatestarcodex.com/2018/08/01/cancer-progress-
much-m...](https://slatestarcodex.com/2018/08/01/cancer-progress-much-more-
than-you-wanted-to-know/)

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SubiculumCode
My friend 40 years young died of cancer yesterday. Fuck Cancer. I know this
doesn't add much to the conversation. My apologies.

~~~
Arelius
Hey, maybe it doesn't contribute much to the conversation. But it's a super
rough thing, and dealing with your grief in the ways you are able to is super
important. And as long as you're not taking it out on other people, which you
clearly are not in this comment, I figure it's a good thing.

It's always amazes me when such an awful thing happens how the world keeps on
spinning, when it really feels like it should just not be able to, but maybe
there is ultimately some comfort to be found in that.

Anyways, I really have no idea what you're going through, the loss of any
relationship is a very individual experience, but you have my deepest
sympathies, I really do feel for your loss.

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cactus2093
Obviously human bodies are not machines, they're much more complex and less
understood than computer hardware, but I can't help but think of the analogy
to running web servers.

Medicine today seems a lot like running a web app and never knowing if
anything is broken unless users complain. It sort of works, but with good
monitoring and alerting set up you can catch issues earlier or prevent them
altogether. And the stakes with your body are much higher than just a web app
going down, the difference between catching something like cancer a few months
earlier is literally life or death.

From what I've read in threads like these, almost everyone in the medicine
field is very opposed to moving in this direction, even seemingly in
principle, and I really can't understand why. I get that doing certain tests
can be invasive on its own, so the cost/benefit has to be considered on a case
by case basis. This argument also as an analogy to operations - you get false
positives on your webservers too, and sometimes people get woken up in the
middle of the night for no reason. But we work to fix noisy alerts one by one,
and things generally improve over time. Why is this not possible in medicine?

~~~
ncphillips
It's because of the idea of iatrogenics: harm caused by the doctor.

If things are going wrong in a web server then intervention is almost always
necessary.

The human body can take care of itself, and most of the time it's better to
let it.

[https://fs.blog/2013/10/iatrogenics/](https://fs.blog/2013/10/iatrogenics/)

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kazinator
> _The findings, based on samples from more than 2,500 tumours ..._

Findings based on tumors sound like 20/20 hindsight!

If your crystal ball tells you where in a body tumor will develop five years
from now, then if you look at the cells there, you might see some subtle signs
that you know are not false positives.

Somehow, I don't think I'm holding my breath for new screening tests.

~~~
sjg007
The idea is to take blood samples from a patient population every year for a
few years and sequencing the cells and cell free DNA population in the sample.
You do this for years until the patient is diagnosed with cancer. At that
point you can look back to the original samples a look for any potential
biomarkers that in retrospect could have predicted the cancer. You do this for
a large number of people. Right now we take a tumor and look for known
biomarkers.

