More skeptical people offer an alternate narrative. Cancer incidence and mortality rates are increasing for some cancers. They are decreasing for others, but the credit goes to social factors like smoking cessation and not to medical advances. Survival rates are increasing only because cancers are getting detected earlier. 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.
Smoking cessation is clearly an advancement in public health. We've definitely gotten better at getting people to quit smoking (and helping them to do so).
In this context, I read "medical advancement" as "increased effectiveness of medical intervention". Under that interpretation, it's dubious to claim it is an advancement. I mention this as the definition since it constitutes how helpful it is to visit a physician.
Another interpretation would be that the advancement of "knowing smoking cessation is a good idea" is fairly old at this point, and most have agreed on it for decades.
In first world countries, death is caused by very roughly 1/3 heart diseases, 1/3 cancer, 1/3 others. More heart diseases mean less cancer and vice versa.
5 year survival may be a good metric though.
At the end he wished he had never been diagnosed, then he probably would have had a decent half year or so.
It is generally helpful to track statistics by stage, but stage is just one of MANY factors.
For most cancer staging, anatomic thresholds remain the gold standard of staging. For many lymphomas and leukemias, and certain solid tumors, there are some specific genetic tidbits we have been able to tease out.
Sequencing by synthesis, whole slide imaging, mass spec, and just simple inventory control (e.g. barcoding specimens, blocks, and slides) are likely to significantly improve cancer care. Probably the biggest gains will be from barcoding samples. At some point in the distant future we'll have sufficient control of the inventory problem to actually do meaningful epidemiological studies where we can fluidly move through population data, prescribing and procedure data, anatomic data, histologic data, and finally into the molecular realms of mass spec and sequencing. But I think a lot of people think "We can just sequence this tumor and prescribe the appropriate drug." But that totally misses the problem that you run into, where you very quickly end up with a study population of N=1 for a lot of things.
I think a growing number of researchers at the ground level understand this is going to involve many, many classes of very, very large data problems.
But roughly you have pathologic staging (microarchitecture, genetics, etc.) and anatomical/clinical staging (size, laterality, lymph nodes, etc.). Those are distinct.
So what you say is not completely incorrect, but it's not really correct either.
We can, however, compensate for lead-time bias by tracking survival based upon the stage of the cancer (a measure of how advanced the cancer is)
For example, I'm going to die to age for. Detecting the cancer at 38 makes it look like I survived 2 yrs; detect it at 35 and it looks like I survived 5 years. But either way I'm still dead at 40.
This earlier detection can also lead to an overestimation of the efficacy of treatment. That’s the grain of truth in the comment above. The reasons for this are two types of bias in treatment studies known as lead time bias and length bias. In the case of cancer, survival is measured from the time of diagnosis. Consequently, if the tumor is diagnosed at an earlier time in its course through the use of a new advanced screening detection test, the patient’s survival will appear to be longer, even if earlier detection has no real effect on the overall length of survival, as illustrated below:...
Unless the rate of progression from the point of a screen-detected abnormality to a clinically detected abnormality is known, it is very difficult to figure out whether a treatment of the screen-detected tumor is actually improving survival when compared to tumors detected later. To do so, the lead time needs to be known and subtracted from the group with the test-based diagnoses. The problem is that the use of the more sensitive detection tests usually precede such knowledge of the true lead time by several years. The adjustment for lead time assumes that the screening test-detected tumors will progress at the same rate as those detected later clinically. However, the lead time is usually stochastic. It will be different for different patients, with some progressing rapidly and some progressing slowly. This variability is responsible for a second type of bias, known as length bias.
Length bias refers to comparisons that are not adjusted for rate of progression of the disease. The probability of detecting a cancer before it becomes clinically detectable is directly proportional to the length of its preclinical phase, which is inversely proportional to its rate of progression. In other words, slower-progressing tumors have a longer preclinical phase and a better chance of being detected by a screening test before reaching clinical detectability, leading to the disproportionate identification of slowly progressing tumors by screening with newer, more sensitive tests.
>What’s clear is that cancers fall into a few general behavior patterns, which Welch and others have compared to animals that must be kept in the barnyard to prevent a deadly rampage. Papillary tumors are like turtles — they move very slowly and never pose an escape risk. They don’t need screening, because they will never cause trouble. Then there are rabbits, which are eager to hop away to other parts of the body, but can be confined if they’re found and fenced. These are the cancers that can be helped by early detection and treatment. Birds, on the other hand, are so flighty and quick that they can’t be confined. Screening makes no difference for bird cancers, because they’re so aggressive that they can’t be detected before they’ve begun their deadly course.
>No cancer screening has ever eliminated the majority of cancer deaths. Instead, the best screening can do is reign in the rabbits. Birds remain unstoppable, and they’re the ones responsible for most cancer deaths. This is why, Welch says, three decades of mammography have failed to put a dent in the rate of women presenting with metastatic breast cancer upon their initial diagnosis. Women with breast cancers that behave like birds will almost never be helped by a mammogram, nor will men with the most aggressive prostate cancers be saved by PSA tests.
I'd like to shamelessly plug the company I work for, Foundation Medicine (https://www.foundationmedicine.com/) who is a leader in this area. Regardless of who you go with, please do CGP to learn more about your disease and the options you have.
Saying late stage people should contact your company to identify advanced or even trial therapies!
I strongly suggest that you take a course in medical ethics, so you can understand what is wrong about what you have written above and stop doing a disservice to already very sick patients.
You really think an oncology specialist would be unaware of that kind of thing?
Specialists may have their reasons, or they even may be wrong, but as a software engineer, it really is not your call.
The few comments you published here already reveal that your understanding of the implications of your advice is incomplete.
Again, I respectfully but strongly suggest studying some medical ethics.
Yes. I know there is an unfortunately large number who are. Doctors generally and oncologists specifically have an epic amount of research and publications to keep up with. I know the doctors and researches who work for and with my company do a ton of outreach (e.g. going to conferences, trying to raise awareness, trying grow partnerships). If you don't believe me, go to ASCO or something I guess? You definitely don't have to take the word of an internet stranger for this.
> Specialists may have their reasons, or they even may be wrong, but as a software engineer, it really is not your call.
You're 100% correct - I am not a doctor and not qualified in any way to give medical advice. I work for a company that provides CGP tests. I am not and could not possibly begin to advocate for a specific treatment path. I also do not want to imply a given specialist would be wrong for either not recommending or recommending against CGP.
> Saying late stage people should contact your company to identify advanced or even trial therapies!
That is categorically not what I am saying. As far as I am aware, you as an individual cannot order this type of test. Your pathologist or oncologist has to work with you to make the decision. CGP can provide a ton of insight, and I personally would absolutely do it if it was an option. I do really hope more people have this as an option even if they opt to not do testing. As I said above, awareness is really a big issue.
Just to be 100% crystal clear for now and posterity: I am not a doctor. I am not providing medical advice. I'm a technologist in a forum for other technologists discussing some of the cool tech we work with.
The issue is that what seems important about it to you is not the same as what they perceive as important. It is interprofessional miscommunication.
And just to be clear myself, you should understand that your defense, although rational, goes against accepted medical ethics and ethics research.
I also understand that this is not from bad intentions on your part.
Edit: removed incorrect assumption about poster
What's the difference between that and what your company does?
Preemptive testing is useful and done for people with history of early cancers in family but obviously can detect only germline mutations. Most of the targeted therapies target somatic mutations.
Some hospitals doing genomic testing share their data through AACR GENIE project
23&me is semi-notorious on HN for giving out genetic data to insurance companies, law enforcement, and other institutions. Thermo-Fisher is in a LOT of heat for working with China to target ethnic minorities via genetic data and then sending those people to re-education camps.
Will your company do the same?
Derived from a joke, "When the Okies left Oklahoma and moved to California, they raised the average intelligence level in both states."
When we move members of one set (undiagnosed) into another (diagnosed) it changes the values of both. In other words, if we diagnose people earlier, the entire diagnosed set appears to be living longer.
See this classic for more information: https://www.nejm.org/doi/full/10.1056/NEJM198506203122504
Do people survive longer with cancer before eventually dying, or are more people cured?
One interesting study on breast cancer patients receiving radiotherapy, found that local control was obtained but more women were eventually dying from heart failure from being in the radiation field. This essentially offset the gain. This couldn't be seen with 5 year survival rates. Now physicians are focused on protecting the heart and hopefully, eliminating cardiac toxicities.
That vignette just shows that 5y survival is a difficult metric and only shows a small piece of the picture. Others have rightly pointed out, stratification of data based on stage would be helpful. Improvement in 5 year survival of stage 4 patients, could be very meaningful.
Unfortunately, new treatments are adding months (on average) not years.
The best thing we (as a country) did, was wake up to the dangers of smoking. When per capita cancer diagnoses decline and survival rates remain steady (or improve), then we know more people are living longer.
We used to treat the heart as a parallel organ, like the lungs; damage a piece with no significant harm to the overall function. We've discovered that it may be a serial organ, like the spine; damage a piece and you impair the entire organ. Or in this case the LAD is a critical element.
The mechanism of action is believed to be accelerated atherosclerosis; hardening of the artery leading to blockage:
We now use breath hold techniques and completely spare the heart, but mistakes were made -- that only a long retrospective review of the data was able to reveal:
There's also some debate on what should be considered "cancer." DCIS, is stage 0 breast, but any diagnosis is a very emotional event.
In general the goal with Oncology is to help people live longer, and improve quality of life for people with cancer. 5 year survival rates are one broad metric which probably broadly indicates they’re getting better at fighting the disease on those fronts.
I can be hit by a car this evening and get killed. I can get a stroke in sleep and not wake up tomorrow morning. I could even be electrocuted by some stupid accident I make while tinkering with electronic components.
Somehow all those "types of death" are fine for me. They are accidents, bad luck, whatever. But they all come sudden.
Knowing that you are ill and will not get well again and can just "sit around" and wait till you die. That really hits me whenver I think about it.
Nevertheless I don't see a doctor regularly to do a checkup. I'm in my 30s, maybe I should start doing that.
Some with heart or brain stroke. There are some variants between no stroke and fatal stroke.
There is lots of scary stuff out there, I'm aware of that. Maybe it's also about the "actio = reactio" thing in my head. Crash = you may die or be severly injured. Overweight might lead to strokes, ok. I can grasp all of those concepts and understand them.
But cancer can just come out of nowhere and it could kill you, although you did nothing wrong.
Before that experience I never really got what the big deal with cancer was. But when it clicked that it’s basically your own cells evolving to destroy you: well it’s pretty dark if you think about it.
Accurate description of life :)
Regarding how death rates are calculated, there are controversies in the field regarding how to best calculate from both a math and even a philosophical standpoint.
This article, which talks about the famous paper from 2015 that first noted the dramatic rise in suicide, covers the controversy well. Some of the best statisticians and researchers in med stats, who all are competent and mean well, simply cannot agree if the death rate has gone up or down .
This does not match any sort of modern drug/device delivery method, which is all the corporate types want. It probably takes lots of labor and tests, not necessarily expensive, just not extremely profitable.
Which doesn't make me optimistic for its near term implementation.
Anyway, I've had a mother and three friends die of cancer. Basically, if the drugs and radiation failed, it was game over.
Furthermore, we need to develop a way of sustainable organ and blood availability. The only way I can see this happening is through synthetic/artificial means. What Organovo is doing is a good start, but they still need the matrix from an existing organ.
Here is what I see as ideal:
- Around the time a baby is born (before or after, or both), some stem cells, DNA samples etc are collected.
- We need a tech for storing those samples for decades, not years. Including a tech for "feeding" and growing them in a sustainable manner.
- Then we need to have a way to differentiate organs out of them.
- And be able to store working organs for decades, not years.
- And a tech to artificially grow, maintain, and store blood.
- And inject that person's immune system culture into those stored samples and organs on recurring basis. So that they are up-to-date with that person's immune system.
That means, if and when a person has organ failure, or is in need of blood, (s)he has the stuff ready from his/her own stash. No dependence on one another.
It's crazy and super-moonshot? yes. But it's a very realistic way forward. And it's a holy grail worth working towards.
Unfortunately, a circulatory system is practically impossible to replace. It would cost tens of millions of dollars and you'd have to already be in great shape to survive the very long recovery time. And then you do all this, only to die eventually, all the same.
I think the first step is to focus on things that we don't have a solution for. Having good diet and exercise is a fairly comprehensive solution, no matter how hard it might be to maintain a lifelong strict regimen (as long as you're able to have such a regimen, your chances of the circulatory system going bad are slim to none).
In the case of organ failure, we don't even have anything other than reliance on organ availability from others.
Bring 18 or under and uninsured is enough to qualify. To your credit, public awareness of this may not be everywhere.
Unfortunately, this conflicts with "the economy".
Many of us are getting paid to produce cancer-causing products, such as:
* processed foods (most of the things you buy in a supermarket)
* most shampoos, cosmetics, soaps, detergents, cleaning products, etc.
* paraffin candles
* cigarettes and alcohol
* components of all these products and the byproducts of their production
* not to mention shit done on industrial scale
* the air, if you live in a populated area
* and so on.
If you really want to reduce your and your family's chances of getting cancer, you're doing your research and doing a lot of work to move away from the mainstream (which is still stuck in 1950's level of knowledge) on these habits, but most people are not, and just blindly trust the government and oversight bodies to protect them because it's "easier" and "cheaper" and "they wouldn't allow it to be sold if it was harmful". Years later: Surprise!
Cosmetics are a bit of a black box, but what carcinogens are supposed to appear in soaps, shampoos, detergents, or most common cleaners?
If you look at the ingredients of your average shampoo bottle, google each one, click the Wikipedia link, you will find many more.
Many of them will also have a number in the hazmat rhombus, which is also not a good thing.
Detergents and cleaners are just as much of a black box, if not more, as cosmetics, and the largest source of indoor air pollution.
> triclosan’s ability to behave as an estrogen antagonist also suggests that its presence in the body alongside estradiol may actually lower risk for cancer development [22,23]. However, whether triclosan raises or lowers risk of cancer through estrogen-related pathways, and possible effect modification by estradiol, have not been examined in human studies.
> Together, the results of these in vitro studies suggest that FAS inhibitors, such as triclosan, may be an effective inhibitor of cancer growth, though no study has examined whether triclosan reduces cancer growth or incidence in humans, or what co-factors may potentiate any effect.
> the results of animal studies to date have been mixed, showing null, inverse, and positive associations.
> Both short and long-term studies have examined triclosan following oral and dermal exposure, showing rapid excretion from the body and no evidence of toxicity, irritation, or thyroid hormone disruption
> [studies] have not addressed experimental findings that suggest triclosan’s estrogenicity may function to either stimulate or inhibit human estrogen-dependent cancer cell growth.
Basically, a bit of speculation regarding triclocan's estrogenicity, one positive animal result with apparently no human application, and a handful of weak evidence showing that it just might actually decrease cancers.
Detergent formulations, such as for dishes and laundry, are simple and entirely uncontroversial with regard to health and safety.
Except for parabens, I'm unaware of any ingredients in cosmetic soaps or shampoos that are plausibly suspected of even faint carcinogenic activity. I'm happy to consider any contradictory evidence you may have.
That doesn't mean they're carcinogenic, or even that they're especially harmful.
Even if by "a number in the hazmat rhombus" you specifically mean a number in the health square of the NFPA 704  diamond, the health hazard of a substance is assessed based on the danger of exposure to a concentrated, pure form of that substance. Acetic acid rates a 3 out of 4 on that scale, for instance, because glacial acetic acid is quite corrosive -- but that doesn't mean that vinegar is dangerous.
The ~power of mainstream is high, it's not super easy to swim across the flow
People hate finding out that they're wrong, and nobody wants to admit that they've been poisoning themselves and their family for decades.
It's either that or cancer, though...
You also object to me calling it 'your definition'. My point was the not very controversial one (I would have thought) of saying that if you call everything a toxin, (which you seem to do, insisting strangely that nothing is or even can be 'toxin free') then the word becomes useless. It seems you misread my comment, or don't understand what 'toxin' means, or something, as I wasn't trying to redefine anything, particularly 'toxic', I don't know why you said that. Neither of your comments made much sense to me. But then, I was downvoted for saying so, so maybe my point wasn't as simple and obvious as I thought.
Your opinion may become science one day, but unless you've thoroughly reviewed the relevant literature before posting, it will be a coincidence.
Everyone else feels that way too, you know! :-)
Global cancer prevalence has risen from 0.54 percent to 0.64 percent since 1990
this is kind of similar to the famous problem of 0.02 cents (which is not 2 cents, but two hundredths of a cent) which gives verizon such difficulties in explaining correctly .
Prevalence is the the share of people who are currently diagnosed with cancer. The link in the first sencence quoted (https://ourworldindata.org/cancer#global-perspective-on-canc...) gives more info.
Green tea, green vegetables and any anti oxidant source prevents cancer.
That doesn't seem to be the case. They seem to have no effect:
Or can possibly make it worse:
When Dr. Oz is turning on Antioxidants you know there's something there:
There is vigorous debate in these comments on the exact stats and what they really mean.
All the same, this is fantastic news. Slowly, we are beating back this evil.
But with huge progress in treatment over the past decade.