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Re-evaluating the Benefits of Cancer Screening

Soulskill posted more than 2 years ago | from the equations-that-are-impossible-to-balance dept.

Medicine 253

uncleO writes "An article in the NY Times describes two studies that weigh the harm caused by cancer screenings against the benefits they provide. From the article, 'Two recent clinical trials of prostate cancer screening cast doubt on whether many lives — or any — are saved. And it said that screening often leads to what can be disabling treatments for men whose cancer otherwise would never have harmed them. A new analysis of mammography concluded that while mammograms find cancer in 138,000 women each year, as many as 120,000 to 134,000 of those women either have cancers that are already lethal or have cancers that grow so slowly they do not need to be treated. ... In recent years, researchers have found that many, if not most, cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated — they are harmless."

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253 comments

indolent (1)

alphatel (1450715) | more than 2 years ago | (#37897906)

Justin Bieber has stopped growing, but that doesn't make him harmless.

Re:indolent (1)

durrr (1316311) | more than 2 years ago | (#37898050)

Just wait until we find the metastases in his female fans. Oh god...
We need someone to do an emergency homestectomy! Someone call the US air force nuclear medicine department, we'll need a few tons of radioisotopes to ensure we can do a sucessful thermoablative intervention.

Re:indolent (1)

blair1q (305137) | more than 2 years ago | (#37898298)

His haircut has already metastasized onto teenaged losers everywhere.

And, for no good reason, onto this dude [draftdaysuit.com], who currently defines "winner" in a way not made so clear since Joe Namath and James Bond were peaking.

Re:indolent (3, Interesting)

ColdWetDog (752185) | more than 2 years ago | (#37898096)

I thought that was insolent.

OK, here are the things that can happen in a cancer screening:

1. You find a cancer that will eventually kill you AND that particular cancer has a treatment that works better when started earlier. (True Positive result)
2. You don't find a cancer that you don't have. (True Negative result)
3. You find a cancer or something that looks like a cancer however it will grow so slowly or regress so it won't cause any harm, but then you don't really know which is which so you elect to be treated for same with some morbidity or mortality. (False Positive result)
4. You don't find the cancer that existed and goes off to knock you off just before you design the next iPad killer. (False negative result).

Only #1 and #2 are unequivocally good. #3 might be a bit of a problem - say a lumpectomy for Ductal carcinoma in situ (DCIS) - which is painful and maybe slightly disfiguring but doesn't really change your overall health or it might be a radical prostatectomy for an indolent prostate cancer that would never kill you but now your are incontinent and impotent (a relatively common outcome). #4 is only bad if you would have been helped by earlier detection which is a theory often proposed but often doesn't hold up to scrutiny.

Right now the biggest noise is around breast cancer which unfortunately has problems with all four potential outcomes. You can miss aggressive cancers on mammography. It is not at all clear that getting aggressive cancers early affects any change in outcome. There are many, many false positives. There are a number of breast cancers (DCIS for example) that left alone, typically don't do anything.

So the 'preventative medicine' bandwagon needs to be taken down a notch or two. It is not helped at all that most of the bigger players in cancer research and therapy stand to gain by aggressive detection treatment strategies.

Patients, not so much.

Re:indolent (4, Interesting)

rollingcalf (605357) | more than 2 years ago | (#37898180)

You're leaving out #5:
You find a cancer that is so aggressive that it will kill you no matter what, but you still treat it and the treatment kills you faster or reduces the quality of your remaining life.

Re:indolent (0)

ColdWetDog (752185) | more than 2 years ago | (#37898270)

That's actually a subset of #3 from the point of view of a screening test. The test was a "false positive" because although the cancer was detected, the screening didn't help you as a patient.

Re:indolent (2)

sjames (1099) | more than 2 years ago | (#37898682)

Then there's a particularly nasty subset of #3, you find an essentially harmless cancer like object and treat it aggressively. As a result of long term damage to your immune system and genetic damage from harsh chemo, you develop a lethal cancer that can't be treated. Or you just spend the rest of your shortened life in relatively poor health.

Re:indolent (0)

Anonymous Coward | more than 2 years ago | (#37898334)

Or the extremely obvious and very important #6 (although so obvious and important it probably should be higher on the list): You find a cancer that is still treatable in it's current stage, and the cancer screening ends up saving your life.

Yea, there are a lot of things that can go wrong, but as a member of a family that has 4 cancer survivors and one who didn't make it because her cancer was caught too late, I find your insinuation that oncologists don't save lives on a daily basis rather ridiculous. And I get that you're including my #6 as your #1, but just because cancer only goes into remission and is never really cured does NOT mean that all cancers will eventually kill you. My mother has been in complete, 100% remission for 25 years.

Re:indolent (1)

durrr (1316311) | more than 2 years ago | (#37898430)

Nothing wrong with preventative medicine, problem is the human body, including the cancers it gives rise to have such a bloody huge variability that differentiating the killer-cancer from the not-killer cancer.
We need better detection methods, to both detect and differentiate.
We need better treatment. Jumping the shark with the scalpel is old fashioned. Cancer vaccines(tailored based on sampled cancer from patient itself) would be a fantastic method if proved efficient. Although general sweeping anti-cancer vaccines would be even better as it may greatly decrease the need for screening.
Unfortunately, immunostimulant treatments get less attention than they deserve despite their absolutely enormous poential(you can vaccinate against almost anything, toxins, cancer, bacteria, parasites. And that's only the classic aspect of immunostimulation, proliferating and guiding(or warding against) immune cells could do wonders)

Re:indolent (2, Insightful)

Artraze (600366) | more than 2 years ago | (#37898514)

But what's the alternative? Just wait until someone's sick enough to warrant a cancer screening?

Or, to be more direct, the problem isn't the _testing_, it the _reaction_. The view of cancer is too binary... You either don't have cancer or you have ZOMG CANCER. It seems to me that by making a third category of 'mostly harmless' we could really do away with #3 altogether. How could we determine that? Early detection and study. Exactly what abandoning screens would make impossible.

Really, this is just about the money, in a couple directions:
First, no doctor is going to volunteer "this is cancer, but it doesn't look dangerous so we'll just monitor the situation" because God help them if that person dies.
Second, people usually spend other people's money (government, 'insurance') on the treatments, so to them it's only 'some side effects vs your life' and not also about 10% of their lifetime earnings too. Guess what they'll take? And so the people paying for these tests have come to realize that they're just a money pit: the (usually negative) test, the (potentially) unnecessary treatment, and finally just the cost of treating real cancer a year or so earlier then you would have had to without the screen for someone that may well die anyway (any they get the pleasure of a year of treatment). All this for how many people that earlier treatment would have helped? Well, that is the point of the study.

But the point is, that it's not the data that's bad, it's a system the encourages people to get knee jerk treatment.

Re:indolent (2)

A beautiful mind (821714) | more than 2 years ago | (#37898924)

But what's the alternative? Just wait until someone's sick enough to warrant a cancer screening?

Absolutely! If the statistics show that we're better off without early screening in terms of health outcomes, by all means! We should be doing something else with our time and money than to spend them on ineffective screening.

Re:indolent (0)

Anonymous Coward | more than 2 years ago | (#37899032)

So the 'preventative medicine' bandwagon needs to be taken down a notch or two. It is not helped at all that most of the bigger players in cancer research and therapy stand to gain by aggressive detection treatment strategies.

Patients, not so much.

Don't confuse prevention with detection. This is detection, it does not prevent cancer from growing in anyway. Prevention may entail things like avoiding known carcinogens or making sure you have enough Vitamin D (implicated in 80% of breast and prostate cancer cases).

Could all cancers... (0)

Anonymous Coward | more than 2 years ago | (#37897958)

...please follow suit and just go away?

Thanks,
Humanity

Cancer screenings are wrong (0)

Anonymous Coward | more than 2 years ago | (#37897984)

They rob pharmaceutical companies of revenue streams that are rightfully theirs.

Re:Cancer screenings are wrong (1)

multi io (640409) | more than 2 years ago | (#37898192)

They rob pharmaceutical companies of revenue streams that are rightfully theirs.

Well, if cancer is found during the screening, chances are all kinds of products made by pharmaceutical companies will be unleashed onto the patient full-force.

Re:Cancer screenings are wrong (0)

Anonymous Coward | more than 2 years ago | (#37898764)

50% of the annual budget of the NHS (The UK's National Health Service, about $150 Billion a year) is dedicated to the final 12 months of peoples lives. The lion's share of this money naturally goes to people with terminal illnesses.

When patients are pretty much screwed, doctors can prescribe whatever they like since the patient was going to die anyway. If nothing has been formally diagnosed, the patient will get a "come back if things get worse" lecture, rather than the comprehensive screening program that they need.

Re:Cancer screenings are wrong (1)

CanHasDIY (1672858) | more than 2 years ago | (#37899050)

They rob pharmaceutical companies of revenue streams that are rightfully theirs.

Well, if cancer is found during the screening, chances are all kinds of products made by pharmaceutical companies will be unleashed onto the patient full-force.

Knowingly or not, you've just touched upon my issue with privatized medical treatment: the industry has incentive to "diagnose" any number of "maladies," real or imagined, in order to drum up business and boost profits. I wonder how many of these "illnesses" that magically popped into existence in the past 20 years are actual, physical conditions.

... and don't even get me started on the incentives to "treat" illness as opposed to curing it...

Re:Cancer screenings are wrong (0)

Anonymous Coward | more than 2 years ago | (#37898238)

Not only that, but it forces health insurance companies to actually pay out for the screenings and treatments their plan says they cover.

Filesharing pirates also have the nerve to actually fully use what they pay for, so these cancer patients should be criminalized just the same.

Often wondered (0)

Anonymous Coward | more than 2 years ago | (#37898006)

I was told years ago that the average person has between 3 - 5 'cancers' in their body at any given time.
They are usually destroyed by your immune system and you never know it. ( the size being one interesting component).
I guess the question is how do you tell the ones that need treatment from the ones that don't before it it too late to treat the ones that do. Also, treatment itself is really dangerous. Chemo therapy had a 50% survival read for a perfectly healthy person, last time I checked. When it comes to this, we are no where near having all the answers.

Re:Often wondered (1)

MightyMartian (840721) | more than 2 years ago | (#37898108)

I know in the case of prostate cancers, there are fast-growing tumors and there are slow-growing tumors. My father-in-law was diagnosed with a slow-growing tumor in his mid-70s and his doctor advised him to basically live with it, because something else would kill him first, and six or seven years later he died after a stroke.

Re:Often wondered (1)

durrr (1316311) | more than 2 years ago | (#37898490)

There's the fast growing terrible cancer variety.
And then there's hyperplasia, this only insults you by increasing the duration of the average urination by ~1000%, and UTI rate by similar numbers.

The problematic part is that there's a relationship between hyperplasia and malignitiy, and for prostates this is an eternal headache.

Re:Often wondered (2)

durrr (1316311) | more than 2 years ago | (#37898246)

It's a fair bit more complex than that.
Genetic damage accumulates _all_ the time, however you have DNA-repair mechanisms of rather amazing complexity that constantly patch things back into their original shape, and in the case they fail they still face down the checkpoints in the mitotic cycle that halts cell divison until damage is either repair or the self-destruct/apoptosis kicks in.

And there's more, if a cell starts to produce foreign proteins these will appear in fragments on its surface, which the immune system will latch onto, and then the cell will face down the subtly named Natural Killer cells which have methods to force the aptotic machinery into action even if the intial stages have somehow mutated into uselessness.
Also, cancer that grows fast will displace itself to the point where necrotic lesions appear, these will result in inflammation, a state usually not very conductive to growth, which may self-limit the cancer(not to mention that inflammation means the presence of immune mediators, a lot of them).

As for chemo, it's not that black and white, there's a very large difference between cancer cancer and chemo and chemo. Certain lymphoma(enormous proliferation of immune cells, circulating) have very close to 100% survival rate, if you enter chemo treatment. Testicle cancer also have a very good prognosis even if metastatized. For a perspective, take a look here http://en.wikipedia.org/wiki/Chemotherapy_protocol [wikipedia.org]

Re:Often wondered (4, Informative)

interkin3tic (1469267) | more than 2 years ago | (#37898470)

I guess the question is how do you tell the ones that need treatment from the ones that don't before it it too late to treat the ones that do

Histology at the moment. What a trained pathologist can tell from a slide of stained cells is incredible. In the near future, genomic sequencing is what experts seem to be saying. [ted.com] You find a tumor, you get a biopsy, look at it under the microscope and also sequence the DNA of the cancer. Between what the cells look like and the DNA sequence, they'll be able to tell how likely it is to kill you.

There are a number of well-characterized things a cancer cell must do to be really bad, and genomic sequencing will allow a good diagnosis as to what a cancer is doing exactly. If it's just that the cells are growing more than they should, but are otherwise playing by the rules (IE, unlikely to metastasize or start increasing the bloodflow to the tumor, and not in a critical location) keep an eye on it but it may not become a problem ever. If it is expressing several genes that will allow the cells to get into the bloodstream and take root elsewhere, chemotherapy now. Chances are much better that it will spread to critical areas like your lungs or brain and kill you.

Big implications for public health across world (2)

shilly (142940) | more than 2 years ago | (#37898012)

And the UK is now reviewing the entire breast screening programme it runs to see whether the evidence continues to show that, on balance, good outweighs harm. Tough decisions for all concerned, and an excellent demonstration of just why science is hard to do right.

Among the options:
1) Continue as-is
2) Use more selective screening with (hopefully) greater specificity -- eg familial history, gene markers, etc
3) Stop screening

Re:Big implications for public health across world (2)

SydShamino (547793) | more than 2 years ago | (#37898110)

The problem is that the corner cases (those with no family history) whose cancer was caught by the screening are humans, and they will be very, very vocal about their desire to continue living. And over here one of our political parties will point at you and say something like, "See? In government-run health care they want to stop the screenings that saved the lives of Mrs. A and Ms. B and Mrs. C! Isn't that horrible!" And then nothing is accomplished.

Re:Big implications for public health across world (1)

del_diablo (1747634) | more than 2 years ago | (#37898198)

If they where scientific: 2 is the most desirable one.
If nobody does that, we can never figure out how much harm the screening is causing in the first place.

Re:Big implications for public health across world (2)

shilly (142940) | more than 2 years ago | (#37898858)

No, you do the research and then use that to inform the design of the screening including selection criteria. I think you'll find that the designers of such screening programmes are pretty eminent medical scientists dealing with very difficult problems. Triviaising it does not favours to anyone.

Blood tests (3, Interesting)

ackthpt (218170) | more than 2 years ago | (#37898014)

I'm curious why blood tests aren't peformed regularly. You can certainly request Alpha-fetoprotein (AFP) any time you like, but it is not commonly recommended on a regular basis. AFP can indicate tumors growing in the body. Very high levels of AFP can indicate advanced cancer. In the case of a co-worker who was found to have advanced cancer, on first diagnosis, why not have this marker checked every 6 months?

I've been told a normal reading is about 100-120. Values over 10,000 should be investigated. Lance Armstrong, had levels of over 100,000 when he was diagnosed, with tumors spread throughout his body.

It seems a low impact test, why is it not advised as part of a standard checkup? We'll look for chelesterol, why not Alpha-fetoprotein?

Re:Blood tests (0)

Anonymous Coward | more than 2 years ago | (#37898128)

That is a damn good point. Within countries with socialised healthcare, the benefits of such a test would easily outweigh the costs. And while you're taking those blood samples from X Million citizens, why not check for a few other maladies too? Economies of scale would surely work here.

Re:Blood tests (3, Interesting)

ColdWetDog (752185) | more than 2 years ago | (#37898196)

I'm curious why blood tests aren't peformed regularly. You can certainly request Alpha-fetoprotein (AFP) any time you like, but it is not commonly recommended on a regular basis. AFP can indicate tumors growing in the body. Very high levels of AFP can indicate advanced cancer. In the case of a co-worker who was found to have advanced cancer, on first diagnosis, why not have this marker checked every 6 months?

I've been told a normal reading is about 100-120. Values over 10,000 should be investigated. Lance Armstrong, had levels of over 100,000 when he was diagnosed, with tumors spread throughout his body.

It seems a low impact test, why is it not advised as part of a standard checkup? We'll look for chelesterol, why not Alpha-fetoprotein?

Because, AFP is a crummy screening test [wikimedia.org].

We look for cholesterol because heart disease is one of the major killers of society. Testicular cancer isn't. It is also not terribly sensitive, not very specific and it isn't clear that early treatment helps. You need various qualities of all three aspects for something to be a good screening test.

Re:Blood tests (0)

Anonymous Coward | more than 2 years ago | (#37898366)

Your link shows no evidence that "AFP is a crummy screening test". Were you hoping that nobody clicked the link, and just took your word that it was correct?

Usually I laugh when I hear the word being used on slashdot, but perhaps you are a genuine "shill" for one of the big pharmaceutical companies.

Re:Blood tests (1)

greed (112493) | more than 2 years ago | (#37899012)

That's all right, he also claims serum cholesterol is a predictor of heart disease and doesn't back that one up at all.

Re:Blood tests (0)

Anonymous Coward | more than 2 years ago | (#37898230)

the idea is to catch cancer BEFORE it is advanced, which increases the chance of survival long term. ( assuming treatment IS necessarily). The problem is from what i can tell, no one knows if treatment is necessarily or not and much of the time it isn't.

The survival rate of the TREATMENT is something like 50/50 so you DON'T want to treat without better then 50/50 percent certainty you NEED too.

Re:Blood tests (4, Insightful)

MozeeToby (1163751) | more than 2 years ago | (#37898318)

Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives. Keep in mind, when you start talk about putting everyone through a screening, whether it be for cancer or HIV or terrorism, your screen had better be crazily accurate. Imagine there's a (really exceptionally good) false positive rate of 0.1% on your hypothetical test, if you give it to every person in the US twice a year you're going to produce 74,000 false positives a year. Or to put it another way, more false negatives than there are cancer deaths.

Cancer - i'ts not as bad as you think. (1)

gurps_npc (621217) | more than 2 years ago | (#37898016)

Yes, that's the PSA I think we need.

Deaths caused by cancer (US numbers, 2009): 562,875

Deaths caused by heart disease (US, 2009): 616,067

We know more about Heart Disease, but it gets less press - mainly because the treatments for it are not as painful.

You know, I bet if someone created a painful, dramatic, balding cure for Heart Disease that in 10 years we would cure it entirely.

Re:Cancer - i'ts not as bad as you think. (1)

gurps_npc (621217) | more than 2 years ago | (#37898058)

Note I meant a painful, dramatic, balding, PARTIAL cure for Heart Disease, then in 10 years we would cure it entirely - with a new, full cure that was not painful/dramatic/balding.

Anyway, I meant to say that cancer gets way too much press simply because our treatments for it are nasty. We should base funding on that are nasty, not ones that have nasty cures.

Re:Cancer - i'ts not as bad as you think. (4, Insightful)

Attila Dimedici (1036002) | more than 2 years ago | (#37898158)

The thing is that cancer is not one disorder, or even just a few disorders. Heart disease can reasonably be considered one disorder (although it is probably more accurately viewed as three or four disorders). There are hundreds of different disorders that we lump together under the term cancer.

Re:Cancer - i'ts not as bad as you think. (1)

ColdWetDog (752185) | more than 2 years ago | (#37898322)

Your correct. The scary thing about heart disease is how much we really don't know about it even if it is relatively 'simple'.

Good medical research is very, very hard to do. Humans are just absolutely horrid research subjects. They live too long, they are expensive to keep, they are genetically and environmentally diverse and the every time you get an Institutional Review Board involved you are in for years of meetings and paperwork.

Better for us if we were hamsters. Or Paramecium.

Re:Cancer - i'ts not as bad as you think. (1)

blair1q (305137) | more than 2 years ago | (#37898488)

Hundreds of different types, but they boil down to three or four deviations from proper operation of the DNA/RNA system. The different types do matter, though. The tissue affected initially can determine what treatments can be used, and what other tissues might be affected if it spreads.

And the thing about there being multiple types of heart disease is actually important as well, since not making the distinction means people can feel one thing, think it might be heart related, then read the symptoms for the wrong type of problem and decide they don't have heart disease and let it get worse figuring it's one of the dozens of other things that cause those pains. The ambiguities mean that cardiologists see a lot of people with acid reflux, but it also means a lot of people with blocked arteries don't go to the cardiologist.

Re:Cancer - i'ts not as bad as you think. (1)

blair1q (305137) | more than 2 years ago | (#37898420)

Heart Disease gets lots of press, it just isn't all labeled "Heart Disease", whereas anything about prostate cancer is pretty unambiguous.

Anything relating to cholesterol, "heart health", cardio anything, "eating right", etc., is ultimately about heart disease.

I also don't know why you think the treatments for heart disease are less painful than for cancer. Nothing is more painful than people digging around in your chest cavity running new pipe or replacing the pump. Chemo is pretty nasty, but compared with chopped-up thorax? Not even in the same pain ballpark.

The real difference is that 90% of heart disease is very easily *preventable*, but it means rejection of a culture foisted on us by greedheads in the junk-food industry. The economic distortions due to their business model mean that it's probably not possible to even feed us all enough calories if we have to stop eating waste products shaped as burgers and nuggets and washing it down with bubbly sugar-water all of a sudden.

They can't tell which are slow and which aren't (1)

sclark46 (969374) | more than 2 years ago | (#37898028)

The problem is they have difficulty, with prostate cancer, in telling which are slow growing and which are aggressive.

Re:They can't tell which are slow and which aren't (0)

Anonymous Coward | more than 2 years ago | (#37898808)

Just collect two data points separated by enough time to reliably determine speed of growth?

Seen this article everywhere now. (3, Insightful)

h00manist (800926) | more than 2 years ago | (#37898030)

Seems like someone is driving a huge PR campaign for "let's not have people visit doctors and get cancer screening". It's likely actually just costing a group of HMO insurers more money to have lots of people treat cancers early and undergo lengthy treatment, and then survive, rather than have a smaller number of people detect it too late, do a short treatment, and then just die.

After all, health services are a business. We understand. You can't just have insured people liviing a long time and making businesses lose money.

Re:Seen this article everywhere now. (1)

Cornwallis (1188489) | more than 2 years ago | (#37898140)

Funny, I was thinking along the same lines except from the point of view that this is a precursor for when gubmint takes over healthcare in the U.S. This would be a great way for it to hold costs down.

Re:Seen this article everywhere now. (4, Insightful)

robot256 (1635039) | more than 2 years ago | (#37898402)

What people always forget when talking about the "government takeover of health care" is that there are already bureaucrats sitting between you and your doctor--the private insurance companies--and you already have limited mobility between providers, due to limited open seasons and pre-existing conditions and whatever else your employer stipulates. But instead of being handled by a government agency overseen by elected officials, you are beholden to a for-profit organization who wants everyone to pay in more than they draw out. While I'm sure there are arguments to be made that efficiency gains can be produced in a properly regulated market versus a single-payer system, I don't think the market we have meets that criteria at the moment. It will be a little better after Obamacare goes into effect, but a lot of the health insurance system is still not working in the best interests of the patients.

Re:Seen this article everywhere now. (2)

Artraze (600366) | more than 2 years ago | (#37898854)

Which is why sane people realize that the proper course of action isn't to replace the money grubbing bureaucrats with apathetic ones (note that there is a big difference) and instead attempt to do away with them altogether. We could break apart the back room collective bargaining and price fixing and actually make health care something that people actually pay for, like car insurance and automotive services. That way, at least, we can see some competition for price and maybe people will even understand the resources they waste every time they go to the doctor about a cold. (Well, at least after they paid $80 to hear the doc say "It's a cold, drink some juice and get some rest" they'll think twice before doing it again.) Hell, it might even help with things like smoking and obesity if people see a big old 'your lifestyle is really unhealthy' surcharge.

It would also help the problems with cancer screening: once people see a $10,000+ price tag on treating that maybe-dangerous tumor they'll definitely give waiting and seeing a thought. And, of course, they could buy their own screening if they like.

Anyways, I can't promise it will work, and I'd expect medicare might need expand to cover preexisting condition type cases (e.g. birth defects or similar). But the one _really_ nice thing is that it would be vastly easier to change to single payer if it didn't work out, whereas the other way is basically impossible.

Re:Seen this article everywhere now. (1)

h4rr4r (612664) | more than 2 years ago | (#37898438)

Holding costs down is just as important if you pay out of pocket, as if you have insurance or national healthcare.

Ignoring cost there is another important factor here, quality of life.

There is little point in killing 70 year olds on the operating table to attempt to remove a cancer that would not have killed them for another 40 years.

Re:Seen this article everywhere now. (3, Insightful)

blair1q (305137) | more than 2 years ago | (#37898536)

Sure. If in your fantasy world nobody in government had any sort of ethics at all, and the government doesn't pass laws enforcing ethics standards.

But here, in the real world, government workers are generally more ethical than private-sector businesses, and are bound by strict ethics regulations.

So stop buying Fox News propaganda. The dysfunction of American healthcare is due to fractionation and greed in the system. Making it one system, with one set of standards and little opportunity for gouging people who are suffering, will make it far, far better. Not worse.

Re:Seen this article everywhere now. (1)

ColdWetDog (752185) | more than 2 years ago | (#37898220)

Seems like we have our tin foil hat on just a little too tight.

Not everything is an Illuminati conspiracy.

Re:Seen this article everywhere now. (1)

Anonymous Coward | more than 2 years ago | (#37898370)

No, but everything is MONEY. You don't need a conspiracy to have heartless greedy fucks looking for a way to maximize money returns by playing with other people's lives.

Re:Seen this article everywhere now. (2)

Hatta (162192) | more than 2 years ago | (#37898248)

Even if health care was completely not for profit, it would still make sense to be aware of false positives on cancer screens.

Re:Seen this article everywhere now. (1)

Attila Dimedici (1036002) | more than 2 years ago | (#37898476)

No, this is about saving the government money not about saving money for HMOs. The people who are advocating that the government pay for everybody's healthcare realize that it can't actually afford it so they are working on getting the public ready for bureaucratic triage as to who gets treatment.

Re:Seen this article everywhere now. (1)

sjames (1099) | more than 2 years ago | (#37898928)

You mean as opposed to the private bureaucratic triage that happens now coupled with the really ugly economic triage that makes lower income people die on average 10 years early?

Re:Seen this article everywhere now. (1)

MozeeToby (1163751) | more than 2 years ago | (#37898486)

Someone who catches cancer early and has 2 years of treatment is going to have a much smaller bill on average than someone who catches their cancer at stage 2 or 3 and has a 2 year death spiral of expensive, invasive, and life destroying (figuratively if not literally) treatments. Chemo and radiation is expensive, but it's a lot less so than surgery, rehab, months in the ICU, and, eventually, hospice care.

And for gods sakes people, do you really live in a world where you believe every single persons in a decision making position is a certifiable phsychopath who cares nothing for anyone's health and happiness but their own? I have no doubt that they exist in positions of power, perhaps even in significant numbers, but the kinds of conspiracy theories you're throwing out would require complacency from everyone from accountants and doctors to board members and congressmen; without a single one of them willing to step up and blow the whistle.

Re:Seen this article everywhere now. (0)

Anonymous Coward | more than 2 years ago | (#37898720)

You are missing the point. They are trying to say in many cases the treatment of the cancer is more damaging, invasive and expensive than not doing anything at all. They are talking about cancers that grow so slowly (or stop on there own altogether) that the patient would likely die of other causes before the cancer became a health issue at all. If they do find it, the patient ends up going into expensive treatment that reduces their overall quality of life.

The article goes on to state they agree with reducing screenings for specific types of cancer...types that have been known to grow very slowly, thus decreasing the need for urgency.

Re:Seen this article everywhere now. (1)

MozeeToby (1163751) | more than 2 years ago | (#37898846)

There are these things in Slashdot discussions called threads, where someone responds to someone else's post. Sometimes, their response only makes sense in light of what they are responding to. In this case, I was responding to someone trying to claim that this was something sinister being done by the insurance companies or the government to reduce healthcare costs at the expense of lives. My post was the point out the failures of logic in the OPs post, not argue for or against anything in the article.

Re:Seen this article everywhere now. (1)

sjames (1099) | more than 2 years ago | (#37898950)

And someone who doesn't needlessly get treated for something that was going to just go away saves HUGE amounts of money and quality of life.

Re:Seen this article everywhere now. (1)

blair1q (305137) | more than 2 years ago | (#37898502)

Dead people don't pay premiums. People with "cured" conditions pay higher premiums.

Re:Seen this article everywhere now. (2)

RonBurk (543988) | more than 2 years ago | (#37898688)

No, it's just one of those things that people who work in cancer research are aware of and, eventually, that awareness leaks into the public and the press realizes that the research community knows something the uneducated public would find astounding.

Let me give you a human example of the cost of screening. I was sitting in a mammography waiting room once when a women came in for her screening. The receptionist informed her that she could get screened, but the radiologist was out and she would have to wait a day to get the results. The woman became upset and demanded there be a radiologist present. The receptionist gave the same reply.

Eventually, the woman was sobbing and explaining that, though she was a nurse, false-positive mammograms had sent her in for biopsies three times already. The last time had been 5 years earlier and she simply stopped returning because she couldn't face another biopsy. This was the first time she had got her nerve up to come in for a mammogram again in all that time, and there was no way she could leave that office and not know if anything (false or not) had been found.

And that's not even a case with serious physical costs for screening, "merely" psychological costs: that caused someone to stop getting screened.

Likelihood of a false positive by your tenth mammogram? Nearly 100%. Since you're presumably working in some kind of technological field, you should really realize that technology always has a downside and not assume that anyone recommending shoving less technology down patients throats simply has a profit motive.

Re:Seen this article everywhere now. (4, Informative)

A beautiful mind (821714) | more than 2 years ago | (#37898702)

No, this is not the case. The problem is that we're still far away from evidence based medicine.

When evaluating what works and what doesn't, you have to tread very carefully. Sure, most people^Wgeeks know about double blind studies, but that's just the tip of the iceberg. The second edition of Testing Treatments [testingtreatments.org] came out recently (available as a free pdf on the website, although I bought it to support the authors) that explains the problems in an understandable language while not dumbing down the issues. The book comes with the recommendation of well known epidemiologists like Ben Goldacre, of Bad Science.net fame [badscience.net].

To talk about the specifics of screening, check out Chapter 4. To recap the main points there, for screening to be worthwhile you have to look at several factors:
  • The condition to be screened for has to be important - either because of it's deadliness and/or because it affects a lot of people
  • There has to be a detectable early stage of the condition which to screen against
  • There exists an effective and acceptable treatment for the condition
  • There is a reliable screening test to detect the condition with

The problem with lots of screening is that on the level of the population it can lead to more harm than good overall for a lot of different diseases, because of false positives, because of our psychological makeup that we'd prefer surgery for even harmless varieties of lumps in our bodies, etc. (see detailed examples in the book). In a lot of cases it happened that screening was introduced before the effectiveness of screening was established in a trial, then later trials showed that the screening was ineffective in reducing deaths or harm.

The bottom line is that well designed trials should be conducted and based on the systemic review of those trials it should be decided whether to conduct screening or not, based on whether it's improving health outcomes or not. A lot of trials don't improve outcomes.

Re:Seen this article everywhere now. (1)

stephanruby (542433) | more than 2 years ago | (#37898726)

Are you sure it's the HMOs driving this? I don't think so. If you take a look at the recommendations [nytimes.com] this group has given in the past, many of those recommendations would go against the interests of HMOs, so I do not see any particular pattern emerging one way or another.

Re:Seen this article everywhere now. (1)

Anonymous Coward | more than 2 years ago | (#37898902)

As a prostate cancer survivor who's alive thanks to 15 years of regular annual PSA blood tests - I am very much in favor of regular screenings. If I'd waited to display symptoms, I'd have been diagnosed @ stage 3 or 4 instead of stage 2. (Lower stage numbers, better long term odds.) Call me suspicious. Very, very suspicious. BTW THANKS! Dr. T & Dr. K

Translation (0)

jmorris42 (1458) | more than 2 years ago | (#37898034)

In other words, since we are about to have huge waiting lists for routine tests, lets just declare that is a feature instead of a bug.

Just more of the stuff we find out after passing Obamacare I guess. And notice how I will be flamed for calling it that, which says it all. If this turd were actually popular I'd be called a racist if I DIDN'T give President Obama proper credit for his signature achievement.

Re:Translation (0)

Anonymous Coward | more than 2 years ago | (#37898210)

You really think "Obamacare" is driving this? It would be happening regardless, driven by the insurance companies.

Re:Translation (1)

0123456 (636235) | more than 2 years ago | (#37898338)

You really think "Obamacare" is driving this? It would be happening regardless, driven by the insurance companies.

But people were complaining recently that health insurers drive people to have too many tests and unneccesary treatments, so that they can push up premiums.

Then today they're not paying for enough.

Seems they're damned either way.

Re:Translation (1)

jfmiller (119037) | more than 2 years ago | (#37898788)

Thank you for giving President Obama credit for the most dramatic overhaul in the nation's history. When Obamacare becomes as popular as Medicare and Social Security, it will be nice to know people will remember who was responsible for it.

Wrong interpretation (0)

Anonymous Coward | more than 2 years ago | (#37898046)

It does not mean that screening is useless; it means the medical community doesn't know nearly as much about cancers as they have been trying to convince us. (and maybe they need a big dose of humility)

What this info really means is that we need better tools to distinguish which patients will benefit from treatment, and which will not. In this case, closing our eyes does not make the Ravenous Bugblatter Beast of Traal unaware of our presence.

pretentious (0)

Anonymous Coward | more than 2 years ago | (#37898060)

"have cancers that are already lethal"
--> People that have lethal cancer can be treated nevertheless.
--> how do you know if a persons cancer will be lethal or not?

"cancers that grow so slowly they do not need to be treated"
--> how can you tell if a cancer will grow and kill or not?

What i read here is that you save 4.000 to 18.000 people anyways,
and for all the others you open up the evaluation of their disease.

So ... what kind of idiot wrote that pretentious article

Re:pretentious (1)

SteveFoerster (136027) | more than 2 years ago | (#37898088)

"have cancers that are already lethal"
--> People that have lethal cancer can be treated nevertheless.
--> how do you know if a persons cancer will be lethal or not?

Well, you'll find out sooner or later, right?

Re:pretentious (1)

0123456 (636235) | more than 2 years ago | (#37898098)

So ... what kind of idiot wrote that pretentious article

One who understands that cost/benefit calculations have to, you know, include the costs as well as the benefits?

If attempting to treat supposed cancers causes debilitating harm to thousands of people but benefits another few thousand people, then it's far from clear whether treatment is beneficial to the majority.

Re:pretentious (1)

Attila Dimedici (1036002) | more than 2 years ago | (#37898184)

One who understands that the government cannot afford the level of care we have become accustomed to, but wants the government to pay for everybody's health care anyway.

Re:pretentious (1)

h4rr4r (612664) | more than 2 years ago | (#37898478)

Government care would be cheaper, for evidence look around the world.

This is about not torturing people with pointless treatments, not saving a couple bucks.

Re:pretentious (1)

Attila Dimedici (1036002) | more than 2 years ago | (#37898532)

Sure, it's cheaper because with government care, sick people don't live as long. Just look at the prognosis for someone with a specific serious illness around the world.

Re:pretentious (1)

mosb1000 (710161) | more than 2 years ago | (#37898254)

People that have lethal cancer can be treated nevertheless.

If the cancer kills you anyway, then you went through a whole lot of pain and trouble for nothing. I'd rather not be put through all that for nothing.

how do you know if a persons cancer will be lethal or not?

You wait until they've died from it. Then you mark in your notes that the cancer was lethal. Pretty simple really. But only useful for generating statistics.

how can you tell if a cancer will grow and kill or not?

Again, you wait until they die, then you look and see if the cancer killed them, or if it was something else. Again, only really useful for generating statistics.

So ... what kind of idiot wrote that pretentious article

Some people know not to argue with the truth. That's the kind of person who would write this article. You can live your life however you want.

Or they could do MORE frequent screenings. (1)

mosb1000 (710161) | more than 2 years ago | (#37898150)

Another approach is to find an imaging technique that is cheap and harmless enough that you could image someone's whole body every week. Then you could compare week to week to monitor growth and spread of the tumors, and only target tumors that are fast growing, or persist beyond a certain threshold size.

Re:Or they could do MORE frequent screenings. (1)

RonBurk (543988) | more than 2 years ago | (#37898414)

Two reasons that won't work. Restrict the discussion to breast/prostate cancer for simplicity. Both are highly treatable if they haven't mutated enough to have the ability to metastasize. You can't make an imaging technique that checks every cancer cell to see if even one(!) has gained the ability to metastasize.

Second, the vast majority of people will INSIST on surgery if they know they have cancer. I used to try to explain to people that most of us have already (if we've got grey hair) thyroid cancer, but it is highly unlikely to harm us. Then I realized I was just causing people to run to their doctor to demand an X-ray of their thyroid. People can't process things like "likelihood" when it comes to cancer, which is why the fact that screenings can cause more harm than good is very difficult to have a rational discussion about.

Re:Or they could do MORE frequent screenings. (1)

mosb1000 (710161) | more than 2 years ago | (#37898504)

You can, however, tell if cancer has metastasized or not. You can see whether or not it is spreading.

Most people are unreasonably afraid of dying. Pathologically afraid, really. People need to accept that the question is how you're going live, not whether you're going to die.

Re:Or they could do MORE frequent screenings. (0)

blair1q (305137) | more than 2 years ago | (#37898696)

Here's a dirty little secret: imaging costs nothing but electricity and time.

There. I've said it.

GE have been scamming the world for decades, pretending their machines are expensive to make. They're not. And worse, they lease the damn things because the price to purchase and depreciation are so high.

But it shouldn't cost any more to roll through a CT or MRI scanner than it does to pull into a parking space in your car (which is a much more complex machine, when you decompose them).

For a few thousand dollars we could all have an MRI built into a doorframe at home (though you might want to switch your remaining CRT-based TVs out for flat-panels before you try this). Use an iPhone app to run it and produce the analysis of any differences since the day before. The whole thing would take seconds.

Think about it. The return of the American Dream:

A man walks through is own front door, which makes a loud hum, followed by a ding.
Breadwinner: "Honey, I'm home!"
Little Missus: "And you're polyp-free, dear!"

ughhh (1)

rish87 (2460742) | more than 2 years ago | (#37898182)

I've seen these and similar studies crop up recently. They really bother me because while they are technically right, I don't think their conclusions are helpful. One problem they point out is that once you've been diagnosed, so many times it is "too late". Their conclusion? Screening test are not as important as we thought. WRONG. If anything this points to MORE FREQUENT screening of assorted cancers. It's easy to be so dismissive of cancer when you are thinking about these things statistically...it's entirely different if you know anyone who has had cancer or if you yourself get it. I am starting to get "older" and am approaching an age where I personally believe I should start getting screened. When I start, I plan on doing this very often. To me, it is worth having a finger up my ass and some amount of money not to die a slow, painful death from something I could have caught and treated. If you want to take the gamble and bet with the statistics, then by all means do. I, however, plan on living as long and healthy as possible.

Re:ughhh (1)

blackest_k (761565) | more than 2 years ago | (#37898442)

booth my father and uncle have had prostate cancer treated and survived, guess that its a pretty good bet I am likely to have it at some point as well. I think i'll have the screening it's recommended for over 50's so in a few years it will be one of those things i'll have to put up with as i'd rather live to a reasonable age.

Re:ughhh (1)

Arrepiadd (688829) | more than 2 years ago | (#37898468)

Actually, some of the studies on the prostate cancer are not saying "you are diagnosed too late", they are saying that "you are diagnosed too early to tell if it's a real cancer" and that detecting one risk factor and starting treatment based on just that is probably going to have more nasty consequences than doing nothing for most of them.

Men are "pretreated" for their cancer and thus, men that maybe would never have a cancer (because a bigger percentage of men are treated than the average of prostate cancer incidence) are going through all the side effects of the drugs, which include impotence, among others. Does it seem like a good trade-off? Well yes, if you do have cancer! The problem is these screenings are not saying this person has a cancer, they say due to these factors this person *may* have cancer and that should not be enough to start cancer treatment.
While not focusing just on this subject, Malcolm Gladwell had a text on this [gladwell.com] a few years back. (Worth reading and if you are in a hurry just search for "cancer").

Re:ughhh (1)

rish87 (2460742) | more than 2 years ago | (#37898582)

I definitely would not advocate starting treatment too early, that's for sure. I would, however, prefer to have an early warning (even if it turned out false) than no warning at all. Similarly, I've had my SNP's sequenced from 23andme partly for a similar reason. One of the benefits of the results are showing more than typical risks for certain diseases. While not at all exhaustive or conclusive, it gives you a good idea of what to look out for and possible easy lifestyle changes to make. Same with a possible early indication of prostate (or any other) cancer. I'd rather know that I may be at risk and take the necessary precautions and plan future screenings than not know, get diagnosed too late and die.

What about treatments that prolong life? (4, Insightful)

Slashdot Parent (995749) | more than 2 years ago | (#37898378)

as many as 120,000 to 134,000 of those women either have cancers that are already lethal or

There are a lot of cancers that are incurable, but can still be controlled for a while. Statements like this make it sound as though catching these cancers early and controlling them for a while is a worthless endeavor.

My wife is one year into a battle with a cancer that she has only roughly a 25% chance of surviving with treatment. Without treatment, she would have been dead a few weeks after diagnosis. She is grateful to have spent the past year alive instead of dead, and of course the children and I are also grateful. I guess the point that I'm trying to make here is that treating a cancer that will most likely be lethal still has significant value. None of us would have been very happy if some government bureaucrat had told us that since the cancer was so likely to kill her, they wouldn't bother treating.

Re:What about treatments that prolong life? (0)

Anonymous Coward | more than 2 years ago | (#37898534)

If we only had the resources to treat your wife, or one other person, and the other person had a 75% chance of survival, who should we prioritize?

I feel for you, but your wife isn't the only person in the country who needs help.

Re:What about treatments that prolong life? (1)

h4rr4r (612664) | more than 2 years ago | (#37898700)

This has nothing to do with government bureaucrats, nor does it matter for your wife. No one wants to take away healthcare, they just want to know if on the whole it is worth it to keep going down this track.

The reality is treating someone who will die no matter what, if the treatment does not extend life by much is not medically worth it. If treatment adds only a month of life, a painful puking near death month, why bother? On the flipside, how many people are being treated and just did not need to be? Quality of life is much bigger issue than money.

I wish your wife well.

Re:What about treatments that prolong life? (0)

Anonymous Coward | more than 2 years ago | (#37898958)

The word government in the last sentence would seem to be unnecessary, and in fact, misleading.

Blame the "cure" as much as the diagnostic (1)

JoeMerchant (803320) | more than 2 years ago | (#37898472)

Some diagnostic tests (breast cancer screening, for example) increase the risk of contracting the disease you are screening for.

In the case of the prostate cancer study, it seems that treatment of detected, but actually benign, tumors was causing more mortality than just living in ignorance of them.

incontinent after radiation for prostate cancer (0)

Anonymous Coward | more than 2 years ago | (#37898618)

My dad got radiation for prostate cancer and the treatment seems to have been effective at mostly eliminating the cancer. His PSA score is way down now too. But, he now wears Depends because the radiation made him incontinent. He's 74. I suspect his case is typical. If they had done nothing to treat the cancer, he may well have been better off.

Re:incontinent after radiation for prostate cancer (0)

Anonymous Coward | more than 2 years ago | (#37899028)

My dad got radiation for prostate cancer and the treatment seems to have been effective at mostly eliminating the cancer. His PSA score is way down now too. But, he now wears Depends because the radiation made him incontinent. He's 74. I suspect his case is typical. If they had done nothing to treat the cancer, he may well have been better off.

Well, my dad never did prostrate cancer screening. By the time he found out about it, his prostrate was so large he couldn't urinate and ended up having a catheter inserted. He's 59.

I don't know whether screening is a good idea or not, that really depends on whether early treatment helps, and whether our anecdotes are typical. If most people are completely asymptomatic, my dad just had shitty luck, but it's still better not to get checked. If most people with prostrate cancer caught early just end up with incontinence, but survive otherwise unscathed I think my dad would have preferred that.

Better Tests Are Needed (1)

Bacon Bits (926911) | more than 2 years ago | (#37898632)

People read these articles and too many come away with "we shouldn't be screening for cancer". That's not what it's saying at all. It's saying "we shouldn't rely on our current screening tests". That's the key. Screening isn't a problem. Early detection isn't a problem. Inaccurate screening tests that encourage treatment when none would be necessary is the problem. That's what the US Preventive Services Task Force is trying to say: shitty tests create shitty outcomes.

It's like trying to use just a thermometer to diagnose H1N1 or Ebola. Well, you'd also catch the standard flu, or a head cold, or appendicitis, or a thousand other things that cause a fever. The prostrate screening test just tests for the known prostrate cancer antigen... but it's not very specific to the type of cancer present. That's the problem. Doctors and patients are stuck in the mindset of If (Cancer == True) { CancerTreatment(); }. That said, cancer treatment involves really dangerous and destructive things to the human body. Many cancer patients die from treatment as much as from the disease. They're akin to poisoning the whole body and hoping that you kill the cancerous bits before you kill the patient. This means that that Cancer == True test better damn well be pretty reliable and accurate. It's a reminder of the basis of medical ethics: primum non nocere -- first, do no harm. The data says doctors are doing a lot of harm if 120,000 of 138,000 cases (87%) have unwarranted treatments.

So, again, they're not saying "don't screen". They're saying "don't screen with shitty tests; get better tests, then screen."

It's their decision. (1)

AdamJS (2466928) | more than 2 years ago | (#37898724)

Whether the cancer was going to end up harmless or end up killing a person, it's better that they at least know if its existence and have the choice of whether or not they want treatment.

I was tested for prostate cancer recently (0)

Anonymous Coward | more than 2 years ago | (#37898826)

I was tested for prostate cancer recently as part of a series of tests to check my previous cancer hadn't come back, and my doctor explained the chance of a false result, and the pros and cons of surgery if anything as found. A lot of information to read and I had to give my consent before they'd do the test.

The risk of false positives outweight the risks... (1)

plcurechax (247883) | more than 2 years ago | (#37898904)

The change in policy stems from good mathematics, namely good statistics. Where the number of people who are subjected to a test may suffer from one of two failures,

a) false negative - that is the test fails to detect the presence of a disease and thus incorrectly reports a negative results, and
b) false positive, the test incorrectly reports a positive result, but the disease is not actually present.

The problem is that with a large pool of test population and a small affected sub-population, the misleading results are counter-intuitive, and can end up causing more harm (otherwise healthy individuals undergoing unnecessary biopsies, radiation, and chemotherapy increase mortality rate) to the overall population.

See The dangers of false positives [divisbyzero.com] by Dr. Dave Richeson [dickinson.edu], don't take my word on it.

See no evil? (1)

erice (13380) | more than 2 years ago | (#37898908)

Let's see if I have this right:

When people receive bad news about their health, they often make poor decisions about treatment.
Solution: Stop screening and therefore, there won't be any bad news to report.

What? Unless the testing itself is a hazard, we shouldn't be cutting off a potentially life saving source of information. We should be working on improving the decision making process. If most prostate cancers should not be treated then recognize this and develop an alternative response. Perhaps more extensive tests for those who come up positive. Perhaps more frequent tests. Maybe just wait and see if it has grown by the time next years test rolls around.

Screening != Treatment != Side effects (1)

ajknott (313187) | more than 2 years ago | (#37899002)

The general arguement is that 'screening comes with harms as well as benefits' (from TFA), which is false unless you believe that listening to the heart leads to side effects from open-heart surgery because too many false positive heart diseases or indolent heart conditions are overly treated. The problem lies within understanding the results and the possible outcomes from different treatments. For example, if cancer is found that is possibly slow growing or indolent, then go into a "watchful monitoring" treatment of more frequent and different checks. Because we have great screening systems that will be able to detect disease earlier and earlier, we need to understand that there is a point at which a disease is so early it is not worth treating. But it does not mean we should not look.

In othehr words, because bad actions can be taken as a result of getting the correct diagnosis information, then we need to fix our analysis and recommendation for treatments. Lets not stick our heads in the sand and not even look for the disease.

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