Can you imagine if all the money use for screenings were used to give patients 10 extra minutes with their doctors each visit. Or be put into real health promotion like 4 annual free visits with a PT to keep patients exercising. Or increasing pay for nursing assistants and other caregivers for the elderly. There are so many possibilities to improve quality of life with that money. What a waste.
How does this contrast to newborn screening of metabolic disease? I'm in no criticizing it, but would be interested in seeing the details. What parameters would make cancer screening worth it?
The ingrained and propagandized fear of death and disease is what makes the medical system so insanely rich. And if they do find a disease, they seldom have the cure that matches the extraordinary expenses. Many people want to treat their body as if it is a crash test dummy. Then they want modern medicine to save them over and over. What a freaking racket.
What would happen if all those billions were spent on teaching prevention? Then again, modern medicine has no clue as to how cancer starts or what conditions might lead to its propagation. They don't know much about prevention other than to tell you to quit smoking and drinking. So much of health or disease is guesswork and one can never know for sure which path will lead them to a quicker end or a longer life.
For me, no more tests and screenings (age 74) and no one can say if I get sick that testing and drugs will make any difference. It's that sense of fear. I do not fear dying...it is gonna happen regardless of what I do or don't do. The medical mafia has yet to prove it knows what it is doing and that it can prolong life. It's all hit and mostly miss.
I thought I saw a sensible medicine, where they were talking about a paper showing the results of all the different cancer screening trials, but I can’t find it, anyone know what I’m talking about?
It's so overkill. They operate on fear IMO. That and $$$$. Also they don't want to be liable which is understandable. I'm sure many have been saved by screening but how many cause more harm than good and is there truly a way to know for certain? I also think the anxiety should be factored in more considerably. Thanks for the informative post!
Regarding colorectal cancer screening, I think the study should include other endpoints such as avoiding needing to use a colostomy bag or avoiding colon surgery. Those are major harms that can be experienced by those who aren't screened.
I also personally know someone for whom screening probably saved their life (although they were determined to have cancer and needed surgery; that was several years ago and they've been cancer free since treatment). I also might have had my life saved or at least avoided surgery through screening, as a large adenoma was found and removed in the colonoscopy.
Regarding the other forms of screening, I am more persuaded that they may cause more harm than good (breast cancer, lung cancer, prostate cancer, etc.). And, yes, the anxiety is real from screening. Since those tests can't just easily remove any pre-cancers found, I can see how downstream testing and treatments can add cost and anxiety.
We underfund our primary care system, then burden primary care with screening mandates. This means that when you are sick and want to be seen by a doctor who knows you, you can’t get in. They are too busy clicking boxes that document screening to care for people with symptoms. So you end up with a stranger in an urgent care practice, or the ED, or to get no care at all.
Does liquid biopsies (MCED) offer a cost-effective compromise once their sensitivity and specificity numbers reach acceptable values, especially with the rapid decline in Next-generation sequencing costs, say $100 in a few year's time? Colonoscopy could be replace with such a lower-cost liquid biopsy product? Thoughts?
Do we know how much of this screening data becomes integrated research (as in "we follow up with the recipients over time on dozens of other health data points for research purposes")?
If this is low, it might indeed be a waste of resources at the moment.
I'm not so sure that many people would forgo screening with more data.
Paul Bloom has written about the problem of relying on empathy to make decisions and to convey information to people making decisions (Against Empathy: The Case for Rational Compassion). More people will be swayed by a sad story about grandpa dying of lung cancer than by the stats regarding how effective the screening is — politicians included. Empathy and the associated emotions are powerful.
I think the same can be said for cancer treatments. I have chosen to not treat my terminal cancer because the stats say it would most likely not do any good but my fellow patients overwhelmingly choose useless treatments to the very end rather than read the statistics. By all means, choose treatments that are helpful but read the stats first. It's hard for doctors to say 'no' because of the emotions at play.
does anyone have a good source on whether PSAs reduce deaths from prostate cancer? I see the death rate from PC is ~2%... wonder if that is reduced by PSA and related treatments
Mortality from prostate cancer was reduced by more than 40% 25 years after the introduction of PSA screening, while among men below the screening age, it was only reduced by 30%. I hope this answers your question.
Show me where it is shown that PSA levels do not correlate with prostate cancers. There are a lot of false postives, which cause many problems, but as a consequence of PSA screening, prostate cancers are treated very early, which is another source of problems.
one follow up on this... I saw a paper that said PSAD could help narrow the pool down to men that really need treatment and therefore could improve the QoL issues you note (bypassing MRI, TRUS & biopsy) for many ... could that be a simple protocol tweak that would make it better?
Maybe unpopular opinion here: since the rate of cancer is going up every year and there seems to be no political will to clean up the environmental toxins likely implicated, it seems pretty harsh to condemn those of us who have completely curable, silent but screenable cancers to just rolling the goddamned dice. Is it a lot of money? Sure. I can't think of much else that I or my husband or my four kids would prefer to spend our tax and health care dollars on besides finding and treating the stage 1 breast cancer I was diagnosed with last year at the age of 54, as a non smoker, non drinker, daily exerciser, vegan. I am a physician and the sole breadwinner for my family. Not being screened and treated would certainly have meant my untimely death from a treatable condition.
All of my grandparents lived into their 90s. That's a lot of years likely on the line for me. Me and those like me not dying in our 50s or 60s of something treatable is completely worth the cost to me, and more worthwhile than most of the things that money gets spent on imho.
Wait until you get a treatable, life threatening diagnosis on a screening test in the middle of your career with kids at home and a family depending on you, and then come back here and preach.
I’m so glad you had a successful outcome from screening. I’m not 50 yet and I’ve had two negative surgical biopsies, 7 years apart, in different breasts. Two unnecessary surgical interventions that removed healthy tissue, all the accompanying costs, risks, and worry.
There’s no way to know that catching it with screening saved your life. Slow growing tumors are just that, and aggressive ones will likely be caught at a more advanced stage even with annual screening. I totally understand it’s a risk benefit calculation for you, as it is for me and all of us. It’s not about preaching, it’s just asking whether or not all this screening does more harm than good. I wish I’d known more about the uncertainty surrounding these interventions years ago. See Vinay Prasad’s barnyard analogy, if you haven’t already (it’s in the first few minutes)
I appreciate the pain and stress of biopsies that turn out to be negative. And I would like our society to consider not spending a gazillion dollars in the last three months of life in elderly and terminally ill patients. But as a practicing internist no one will ever convince me that waiting until breast cancer causes SYMPTOMS isn't going to cost years of otherwise healthy life. Stage one breast cancer, like I have, has an 87-90% 10 year disease free survival rate. If I waited for symptoms, I would absolutely be beyond stage 1, very likely metastatic if we are waiting for symptoms. And that is a completely different and incurable disease with five year survival rates of 50 percent or less. I might still die of breast cancer. It may please you to know I had only one other mammogram in my life - never cared for them, and I considered myself low risk. Maybe the chance of dying in your 50s is worth it to avoid the pain and stress of benign biopsies? I don’t know. All I know is metastatic cancer is not the same disease as stage one cancer and it's irresponsible to tell the public otherwise when they are depending on us doctors to give accurate information with which to make an informed decision.
I've been using a fecal occult blood test for colorectal cancer for over 10 years. Since the incidence of that cancer is relatively low, I've often wondered how false positives compare to that that incidence rate. I'd hardly feel sanguine if those two rates were anywhere near the same magnitude.
Australia - Online misinformation and disinformation reform (page 44)
Benefit discussion and break-even analysis - Health of Australians
Australia undertakes a range of preventative health programs, such as cancer screening programs and vaccine programs. Cancer screening programs are an area that could be impacted by misinformation and disinformation and have reliable data on the costs and benefits of the programs. Three of the largest cancer screening programs are set out in Table 10. https://oia.pmc.gov.au/sites/default/files/posts/2024/09/Online%20Misinformation%20and%20Disinformation%20Reform%20Impact%20Analysis.pdf
Can you imagine if all the money use for screenings were used to give patients 10 extra minutes with their doctors each visit. Or be put into real health promotion like 4 annual free visits with a PT to keep patients exercising. Or increasing pay for nursing assistants and other caregivers for the elderly. There are so many possibilities to improve quality of life with that money. What a waste.
Progress in cancer treatment is minimal; early screening often leads to fear and overtreatment rather than providing meaningful benefits.
https://clo2xuewuliu.substack.com/p/the-chaos-of-overtreatment-in-cancer?r=48chtc
How does this contrast to newborn screening of metabolic disease? I'm in no criticizing it, but would be interested in seeing the details. What parameters would make cancer screening worth it?
The ingrained and propagandized fear of death and disease is what makes the medical system so insanely rich. And if they do find a disease, they seldom have the cure that matches the extraordinary expenses. Many people want to treat their body as if it is a crash test dummy. Then they want modern medicine to save them over and over. What a freaking racket.
What would happen if all those billions were spent on teaching prevention? Then again, modern medicine has no clue as to how cancer starts or what conditions might lead to its propagation. They don't know much about prevention other than to tell you to quit smoking and drinking. So much of health or disease is guesswork and one can never know for sure which path will lead them to a quicker end or a longer life.
For me, no more tests and screenings (age 74) and no one can say if I get sick that testing and drugs will make any difference. It's that sense of fear. I do not fear dying...it is gonna happen regardless of what I do or don't do. The medical mafia has yet to prove it knows what it is doing and that it can prolong life. It's all hit and mostly miss.
I thought I saw a sensible medicine, where they were talking about a paper showing the results of all the different cancer screening trials, but I can’t find it, anyone know what I’m talking about?
It's so overkill. They operate on fear IMO. That and $$$$. Also they don't want to be liable which is understandable. I'm sure many have been saved by screening but how many cause more harm than good and is there truly a way to know for certain? I also think the anxiety should be factored in more considerably. Thanks for the informative post!
Regarding colorectal cancer screening, I think the study should include other endpoints such as avoiding needing to use a colostomy bag or avoiding colon surgery. Those are major harms that can be experienced by those who aren't screened.
I also personally know someone for whom screening probably saved their life (although they were determined to have cancer and needed surgery; that was several years ago and they've been cancer free since treatment). I also might have had my life saved or at least avoided surgery through screening, as a large adenoma was found and removed in the colonoscopy.
Regarding the other forms of screening, I am more persuaded that they may cause more harm than good (breast cancer, lung cancer, prostate cancer, etc.). And, yes, the anxiety is real from screening. Since those tests can't just easily remove any pre-cancers found, I can see how downstream testing and treatments can add cost and anxiety.
We underfund our primary care system, then burden primary care with screening mandates. This means that when you are sick and want to be seen by a doctor who knows you, you can’t get in. They are too busy clicking boxes that document screening to care for people with symptoms. So you end up with a stranger in an urgent care practice, or the ED, or to get no care at all.
Does liquid biopsies (MCED) offer a cost-effective compromise once their sensitivity and specificity numbers reach acceptable values, especially with the rapid decline in Next-generation sequencing costs, say $100 in a few year's time? Colonoscopy could be replace with such a lower-cost liquid biopsy product? Thoughts?
https://ramkrishnan.substack.com/p/detect-cancer-early-using-blood-biopsy?r=6x69e
FYI-I just posted this to FB and it was removed in 3 minutes!
Do we know how much of this screening data becomes integrated research (as in "we follow up with the recipients over time on dozens of other health data points for research purposes")?
If this is low, it might indeed be a waste of resources at the moment.
I'm not so sure that many people would forgo screening with more data.
Paul Bloom has written about the problem of relying on empathy to make decisions and to convey information to people making decisions (Against Empathy: The Case for Rational Compassion). More people will be swayed by a sad story about grandpa dying of lung cancer than by the stats regarding how effective the screening is — politicians included. Empathy and the associated emotions are powerful.
I think the same can be said for cancer treatments. I have chosen to not treat my terminal cancer because the stats say it would most likely not do any good but my fellow patients overwhelmingly choose useless treatments to the very end rather than read the statistics. By all means, choose treatments that are helpful but read the stats first. It's hard for doctors to say 'no' because of the emotions at play.
does anyone have a good source on whether PSAs reduce deaths from prostate cancer? I see the death rate from PC is ~2%... wonder if that is reduced by PSA and related treatments
Mortality from prostate cancer was reduced by more than 40% 25 years after the introduction of PSA screening, while among men below the screening age, it was only reduced by 30%. I hope this answers your question.
Except PSA levels dont correlate with prostate cancer...
https://www.medscape.com/viewarticle/828854
Show me where it is shown that PSA levels do not correlate with prostate cancers. There are a lot of false postives, which cause many problems, but as a consequence of PSA screening, prostate cancers are treated very early, which is another source of problems.
one follow up on this... I saw a paper that said PSAD could help narrow the pool down to men that really need treatment and therefore could improve the QoL issues you note (bypassing MRI, TRUS & biopsy) for many ... could that be a simple protocol tweak that would make it better?
Maybe. In the future, prostate cancer screening will require a simple method of identifying fast-growing cancers.
Very helpful thank you. Perhaps that is the screening test that is cost effective. The exception
It certainly works, but it is a disaster for quality of life. Remember that prostate cancer is primarily a cancer of very old people.
The best screening by far is cervical cancer screening.
Maybe unpopular opinion here: since the rate of cancer is going up every year and there seems to be no political will to clean up the environmental toxins likely implicated, it seems pretty harsh to condemn those of us who have completely curable, silent but screenable cancers to just rolling the goddamned dice. Is it a lot of money? Sure. I can't think of much else that I or my husband or my four kids would prefer to spend our tax and health care dollars on besides finding and treating the stage 1 breast cancer I was diagnosed with last year at the age of 54, as a non smoker, non drinker, daily exerciser, vegan. I am a physician and the sole breadwinner for my family. Not being screened and treated would certainly have meant my untimely death from a treatable condition.
All of my grandparents lived into their 90s. That's a lot of years likely on the line for me. Me and those like me not dying in our 50s or 60s of something treatable is completely worth the cost to me, and more worthwhile than most of the things that money gets spent on imho.
Wait until you get a treatable, life threatening diagnosis on a screening test in the middle of your career with kids at home and a family depending on you, and then come back here and preach.
I’m so glad you had a successful outcome from screening. I’m not 50 yet and I’ve had two negative surgical biopsies, 7 years apart, in different breasts. Two unnecessary surgical interventions that removed healthy tissue, all the accompanying costs, risks, and worry.
There’s no way to know that catching it with screening saved your life. Slow growing tumors are just that, and aggressive ones will likely be caught at a more advanced stage even with annual screening. I totally understand it’s a risk benefit calculation for you, as it is for me and all of us. It’s not about preaching, it’s just asking whether or not all this screening does more harm than good. I wish I’d known more about the uncertainty surrounding these interventions years ago. See Vinay Prasad’s barnyard analogy, if you haven’t already (it’s in the first few minutes)
https://www.econtalk.org/vinay-prasad-on-cancer-screening/
I appreciate the pain and stress of biopsies that turn out to be negative. And I would like our society to consider not spending a gazillion dollars in the last three months of life in elderly and terminally ill patients. But as a practicing internist no one will ever convince me that waiting until breast cancer causes SYMPTOMS isn't going to cost years of otherwise healthy life. Stage one breast cancer, like I have, has an 87-90% 10 year disease free survival rate. If I waited for symptoms, I would absolutely be beyond stage 1, very likely metastatic if we are waiting for symptoms. And that is a completely different and incurable disease with five year survival rates of 50 percent or less. I might still die of breast cancer. It may please you to know I had only one other mammogram in my life - never cared for them, and I considered myself low risk. Maybe the chance of dying in your 50s is worth it to avoid the pain and stress of benign biopsies? I don’t know. All I know is metastatic cancer is not the same disease as stage one cancer and it's irresponsible to tell the public otherwise when they are depending on us doctors to give accurate information with which to make an informed decision.
I definitely won’t try to convince you, then. I’m glad you’re well and I hope you remain happy, healthy, and cancer-free! 💕
I've been using a fecal occult blood test for colorectal cancer for over 10 years. Since the incidence of that cancer is relatively low, I've often wondered how false positives compare to that that incidence rate. I'd hardly feel sanguine if those two rates were anywhere near the same magnitude.