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Cancer death rates are falling, five-year survival rates rising (ourworldindata.org)
269 points by hecubus 64 days ago | hide | past | web | favorite | 113 comments



The article goes into this, but reminder that cancer survival rates must be carefully considered as a part of a bigger picture. In short, if cancer patients are surviving on average 5 more years than, say, X years ago, but cancer is at the same time being detected 5 years earlier, then the expected length of life for a cancer patient remains the same. This is well-understood phenomenon in cancer statistics but often glossed over in press pieces and not particularly well understood by the general public.


https://slatestarcodex.com/2018/08/01/cancer-progress-much-m... """ 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. 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. """


Why would you consider smoking cessation not a medical advance? Prevention plays a big role in modern medicine and is based on medical advancement, how else would one even know that e.g. smoking is linked to cancer, an active lifestyle decreases cancer etc.


(They are quoting the article they are citing)

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.


Also, an increase in heart diseases will lower cancer deaths.

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.


Update to my post above: it's called "lead time bias".


The detection has value itself. I’d much rather know now that I have a year to live today than a week to live in 51 weeks.


Someone I knew was diagnosed with lung cancer, spent a year in hospitals getting chemo, radiation, scans, etc and had lots of pills, against the side effects of the treatment, against pain, against the side effects of the pills. Then he died.

At the end he wished he had never been diagnosed, then he probably would have had a decent half year or so.


Sure, but you can't know whether treatment will work ahead of time. You could have a decent half year if you do nothing, or you could have a decent 20 years if the treatment works.


You can't know, but that doesn't mean that you're completely in the dark. The doctors can provide you with estimates regarding the chances having decent 20 years.


Of course. If you're going through radiation and chemo there's a good chance the Drs think it has a good chance of helping. Not always though.


Doctors have a saying "if you're a man older than seventy, you will die with prostate cancer but you won't die from prostate cancer.". The only thing knowing you have it for sure will give you is stress.


Depends on the stage at diagnosis. If you have localized prostate cancer, I agree with you, you are probably good to go. A few years ago there was a recommmendation by a group of physicians (generally not urologic oncologists) to stop routine PSA testing in the US due a high rate false positives and 'over treatment'. This action has led to a dramatic increase in patient having metastatic prostate at initial diagnosis. Metastatic prostate cancer will give you much more than just stress, bone pain for instance.


Not everybody has that preference.


I wonder if you actually thought that one through.


Isn’t that what “stage” classifications are for? So that you have different starting points for tracking outcomes?


Stage refers to the progression of the tumor (size, spread). Generally Stage IV is bad news - the cancer has spread throughout your body. https://www.cancer.gov/about-cancer/diagnosis-staging/stagin...

It is generally helpful to track statistics by stage, but stage is just one of MANY factors.


Stage is also usually not just about the size. It's about genetics of it. Next stage is 'one particularly bad mutation later'. Basically, different stages of the same kind of cancer are different diseases, not different degrees of the same disease.


The further down the genetics rabbit hole you go, the more you realize how little we know. At the same time, the further down the cancer rabbit hole you go, the more you realize tumor size and tumor relationships to certain anatomic thresholds (vascular invasion, serosal involvement, etc) really, really matter.

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.


Staging is complex and depends on many factors.

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.


Yes, that’s exactly what they do to correct for the bias.

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)


I think I heard somewhere is that this doesn't fully correct for the bias. Do you know if that is the case?


Of course it doesn't fully correct. A consistent measurement of "how advanced is the disease" is only achievable in a very rough way (by staging).


In other words, detection is now earlier and earlier - which make it look like patients are surviving longer.


Early detection of cancer or any serious illness makes it easier to treat.


Yes. But I think the point of the OP is, patients might not be living any longer per se. What's "improving" is the earlier detection.

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.


I think pretty much for the large majority of cancers early detection leads on average to both longer survival and better quality of life.


There are plenty of serious illnesses that are untreatable (beyond symptomatic/palliative treatment) regardless of when they're detected.


Article with more details on this kind of “bias”: https://sciencebasedmedicine.org/cancer-deaths-continue-to-d...


Good article. Links to this interesting one from the same site:

https://sciencebasedmedicine.org/the-early-detection-of-canc...

Excerpt:

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.


Doesn't early detection lead to better odds of beating it? Something has to give...maybe you're out of luck either way?


In some cases, the only thing that detection of non-symptomatic cancer does is turn someone into a cancer patient who's tumor would otherwise never threaten their health or effect mortality. The more cancer you look for the more cancer you find.

https://fivethirtyeight.com/features/the-case-against-early-...

>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.


Ah. Excellent point.


Cancer represents a broad class of diseases (like "viral infection" is everything from common cold to HIV). If you or someone you know is diagnosed with cancer, and especially if it is later stage, please seriously consider comprehensive genomic profiling (CGP). CGP can help identify targeted therapies (and often clinical trials) which treat the specific genetic alterations or other factors in your disease.

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.


This is blatant self advertising of the worst kind.

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.

Addendum:

https://news.ycombinator.com/item?id=15187747


From what I've heard lots of oncologists and pathologists are not up to date on CGP in general. We've had several patients come in to speak saying they only heard about CGP after getting a second or third opinion - otherwise they would have tried chemo and that was it. You really think its unethical to try to spread awareness of something that could help people?


The way you are doing it? Yes, it is strictly unethical.

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.


> You really think an oncology specialist would be unaware of that kind of thing?

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.


Thinking that an oncologist does not know tumor sequencing is available is absolutely laughable as it is oncology 101. No need to go to conferences, just open any oncology textbook edited in the 21st century. But yeah of course your company is doing it more completely and more precisely, I get it. Now is the information that your company provides currently useful to the clinician? If your immediate answer is "of course", then you should think again.

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.


Thank you for this comment.

Edit: removed incorrect assumption about poster


For what its worth, I'm just a software engineer and I gain nothing from this personally. (I don't even have shares or RSUs). I knew nothing about CGP when I got into this field so I'm generally pretty enthusiastic about telling people. I'm not running a super bowl add to take a magic pill - you actually can't even order this test on your own as far as I know - it has to come from a pathologist or oncologist.


Fair enough. I believe you and will remove the snarky comment.


Isn't this done by default at some cancer centers? When my mother was treated at MD Anderson they did a genomic sequence of the tumor.

What's the difference between that and what your company does?


Yes some cancer centers do this for some cancers. Some also send out to Foundation medicine I believe. Foundation has their own specific panels which may be different than the cancer center etc...


That's exactly correct - we're trying to partner with facilities as much as possible. On the other side - we're also trying partner with pharma companies to help find prospective patients for their trials. It's a really exciting time to be in this field since we're finally able to deliver on the promise of CGP, at scale, and at a reasonable cost. I'm just a software engineer but I find this stuff really cool!


Some pathology labs do simpler sets of tests in house (e.g. testing for alterations in one gene in one class of disease). CGP tests sequence many many more genes and call out far more variants in the DNA. Basically you might test negative for strep throat at a CVS, but you still have an infection


Is there any reason not to do CGP preemptively?


Mutations can be divided to germline (~what you inherited, it's part of your normal dna, but it increases likelihood of getting cancer, for example by making dna self repair less effective, think Angelina Jolie) and somatic (random (?) mutations that enable unlimited growth, switch off cell death and so on and are only present in the tumor). There can be multiple mutation groups within a single tumor.

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

https://www.aacr.org/Research/Research/Pages/aacr-project-ge...


Depends on the tumor/cancer type. If it doesn't inform the treatment protocol then it's basically only useful for knowledge. However, more information is always better and useful, especially in the future. So if you can do a CGP you should, or even better get complete sequencing done. But that latter is a 10k cost possibly more. Most cancer centers have a pipeline for treatment and also for research so usually you are in good hands. If a particular CGP is useful then they and the insurance will do it.


There is no harm that I am aware of - but it may not be considered necessary depending on the source. For example, some insurance providers will only reimburse after you're at a certain stage. I can tell you that if I or someone I love was diagnosed, I would get CGP immediately. Potentially avoiding a round of chemo that probably wouldn't even work... that's worth it to me.


I believe they are sequencing tumor tissue


I couldn't find it on your website, but does your company sell/share any of your customer's genetic information or has your company received subpoenas for such information? Along those lines, does the EULA state that they can change the terms and conditions at any time without notice?

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[0] 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?

[0] https://www.nytimes.com/2019/02/21/business/china-xinjiang-u...


Stage Migration, otherwise known as, "The Will Roger's Phenomenon," is an important consideration.

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


How does 5 years survival rate relate to cancer deaths?

Do people survive longer with cancer before eventually dying, or are more people cured?


We're not sure.

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.


My mother in law lived with breast cancer for ten years, and dropped dead of a heart attack in a dentist's waiting room. Radiation effect on coronary arteries may well have contributed.


I am sorry for your loss. It may very well may have been due to the radiotherapy. Left Breast cancer patients were at greatest risk. The Left Anterior Descending (LAD) has been identified as the "Organ At Risk."

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:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188157/

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:

https://www.nejm.org/doi/full/10.1056/NEJMoa1209825


Thanks! I'll send those links to my daughter, who's in her residency right now.


If you diagnose the cancer earlier... it will appear as if they live longer.


100%

There's also some debate on what should be considered "cancer." DCIS, is stage 0 breast, but any diagnosis is a very emotional event.

https://blogs.plos.org/dnascience/2018/04/12/dont-tell-me-my...


There’s no such thing as “cured” with cancer, only remission.

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.


It's 5 year survival vs death from any cause.


Cancer really gives me shivers.

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.


I don't want to make you more nervous, but there are some car accidents that are not fatal but breaks so many things that you have a loooooong time to recovery with many operations and medical problems (perhaps you loose most of your liver?). I'm not sure if they are predictible fatal after a long time.

Some with heart or brain stroke. There are some variants between no stroke and fatal stroke.


Oh, I know, I know. I crashed with my motorcycle and had a concussion on my milt. Didn't think about it first but realized how bad it was, after doctors wouldn't let me go after four days in hospital.

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.


Yeah it was like that with my dad. He was super fit, didn’t drink, probably worked too much but that was about it as far as vices. But all the same the cancer came and just swallowed him up. We tried everything but it was just the disease was totally indifferent to our efforts.

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.


> "sit around" and wait till you die.

Accurate description of life :)


Medical statistics is an entire field of study that has multiple disciplines. There are many controversies in this field.

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 [1].

[1] https://www.thecut.com/2015/11/gender-controversy-over-white...


As the old saying goes, "smoking is the leading cause of statistics."


A more comprehensive immunotherapy approach to cancer (which in my unqualified opinion is the real path to "cure") will probably require custom treatments specific to the patient's genome and cancer biochemistry/gene expression.

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.


At some point we will be able to program the immune system to function like a smart bomb and kill most cancers. Some cancers may not be immunological targetable but might be druggable. Or druggable and later targetable.


Sad caners of the pancreas, lung, liver, esophasgus, stomach and brain are still pretty deadly.


Great. But we need to tackle it at multiple levels, specifically prevention and not just treatment.

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.


Having cloned organs ready for transplant won't extend life as much as you think. A lot of this doesn't mean much if you can't replace a faulty circulatory system, which will inevitably cause organs to fail even if they are brand new.

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'm going by the assumption that, aside from genetic reasons, a circulatory system can in principle be kept in good shape through diet and exercise.

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.


For your first 2 bullet points, the technology and providers exist already, and it's somewhat of a big business. For my kids, we used ViaCord. The collection of the Umbilical cord blood cost us about $4k per child, and the storage is supposed to work for at least 20 years (most likely they don't claim more because they don't have the history to prove it, not because the cells will somehow denaturate at the 20y point).

[1] https://www.viacord.com/why-bank/benefits-of-cord-blood/?gcl...


That may help in some cases, but cancer specifically represents a broad class of diseases and treatment isn't always that simple. Blood-based cancers and later stages (having spread to multiple parts of the body) become more challenging to treat. Additionally, the disease can mutate even with a patient so you might need different treatments depending on how your disease has changed.


This country (USA) can’t even agree to provide free universal vaccinations for children, how would they ever cover something like that for the masses? What you describe sounds like it would cost millions per person.


That sounded preposterous to me so I looked it up. I think it leans towards being false. Obamacare seems to require plans to cover them without copay, and if you don’t have health insurance, the CDC provides a free program to get vaccinations for kids.

https://www.cdc.gov/vaccines/programs/vfc/index.html

Bring 18 or under and uninsured is enough to qualify. To your credit, public awareness of this may not be everywhere.


Requiring people to buy something (insurance) and covering the cost only if their income is below a given level is not the same as providing it directly to everyone.


That’s not what this says? Either you have insurance and it must be covered or you don’t have insurance and it’s available for free through this program. Income is not a variable here.


In my hometown Columbus, Ohio, the county health department will provide free vaccinations if the parent states they are unable to pay anything. I don't know how common that is, but I don't generally consider our county or city governments to be particularly generous.


>prevention and not just treatment.

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!


> most shampoos, cosmetics, soaps, detergents, cleaning products, etc.

Cosmetics are a bit of a black box, but what carcinogens are supposed to appear in soaps, shampoos, detergents, or most common cleaners?


Here is just one small example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945593/

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.


That link you posted almost completely contradicts you. Here are a few choice bits:

> 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.


> Many of them will also have a number in the hazmat rhombus, which is also not a good thing.

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 [1] 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.

[1]: https://en.wikipedia.org/wiki/NFPA_704


I'm thinking of ways to start groups of aquaponics to grow local and toxin free. Spending more time in the green is good, eating simple and fresh too.

The ~power of mainstream is high, it's not super easy to swim across the flow


No, it is not easy at all. And even in educated circles, your opinions will be in the minority, and cognitive dissonance will work against you too.

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...


I think it's more fear of doubt than being wrong. I'm sure if you come with a ready made solution they won't resist nearly as much.


Unfortunately, there is no easy solution at this time...


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There's something wrong with your definition of 'toxin' then I think, it seems meaningless.


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Woah. My what? My 'political agenda'? Where on earth did that come from? What an extremely toxic comment. Don't do that here please. (See guideline on assuming good faith) I'm at loss to see how a 'political agenda' could have inspired my comment.

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.


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There is a difference between your opinion and science.

Your opinion may become science one day, but unless you've thoroughly reviewed the relevant literature before posting, it will be a coincidence.


When someone finds a way to patent fasting, the "science" will magically appear.


>the thousands of HN karma points I lost over the years to mindless downvoting of the simple truth nuggets

Everyone else feels that way too, you know! :-)


Can someone explain what does the 0.67 prevalence number mean? That can't be 67%?


If you mean the sentence which says:

    Global cancer prevalence has risen from 0.54 percent to 0.64 percent since 1990
then it 0.64% (or "64 times in ten thousand"); not 64% (or "64 times in one hundred")

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 [1].

1. http://verizonmath.blogspot.com/2006/12/verizon-doesnt-know-...


What 0.67 number? Are you refering to "The share of people with cancer (even when corrected for ageing) has been slowly increasing in recent decades. Global cancer prevalence has risen from 0.54 percent to 0.64 percent since 1990"?

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.


Yes, sorry. That's what I meant, thanks.


Obligatory reading before reading cancer statistics:

https://slatestarcodex.com/2018/08/01/cancer-progress-much-m...


The article links to that very post.


I recently researched about cancer and realised that anti oxidants are said to prevent cancer. There was a study done in US, the Boston study or something like that, it said that excess dairy consumption is directly linked to cancer.

Green tea, green vegetables and any anti oxidant source prevents cancer.


> 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:

https://www.cancer.gov/about-cancer/causes-prevention/risk/d...

Or can possibly make it worse:

https://www.scientificamerican.com/article/antioxidants-may-...

When Dr. Oz is turning on Antioxidants you know there's something there:

https://www.doctoroz.com/article/can-antioxidants-cause-canc...


Though it may seem cliche' and overused, speaking as someone with a close relative that is affected:

FUCK CANCER

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.


So what should one do today to minimize their early death from cancer risks? Do some kind of a genetic screening? Have periodic (annual?) checks for specific cancers?


Avoid getting too much sun (melanoma); reduce your read meat consumption (colon cancer); don't smoke, or quit if you currently do. Some studies have indicated that grilled meats can also increase the chance of risk. Other than that, pay attention to your body. My colon cancer indicated by bleeding that was not regarded by my GP as more than just a potential hemorrhoid. A year later a thoracic surgeon discovered a 5cm mass. I got lucky...


5 year survival rate is just a single data point. It would be better to also look at 7 year and 10 year survival data. Is this available?


I’m more interested in incidents of cancer among younger people. Is it rising or falling?


I believe the incidents of cancer for younger people are predicted to possibly rise in the future due to obesity becoming more of a liability as people age.


Rising.

But with huge progress in treatment over the past decade.


Why have uterine cancer survival rates fallen, anybody know?


Could it be because of the HPV vaccinations? That there are fewer more severe cases?




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