New Radiotracer Can Identify Nearly 30 Types of Cancer • Hacker News Board

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#21

Post by asdf21 » Mon, Jun 10, 2019, 5:09 PM UTC

ascar wrote: post #8

legohead wrote: post #5

Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening and nobody would give me the time of day - "that's not done". At most they said they would do a blood test which checks for a couple types of cancer. I asked if I could get a CT and have a professional go over it. nope. But something like this tracer is what I…

Out of curiosity: What would you be willing to pay for it? Did you mention you pay yourself? Or do you expect your healthcare provider to cover the thousands of dollars for tests without any indication?

Hospitals don't want people to "pay themselves" when they can bill insurance companies 10x as much.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#22

Post by Waterluvian » Mon, Jun 10, 2019, 5:14 PM UTC

asdf21 wrote: post #20

nkrumm wrote: post #18

Earlier quoted context omitted.

MD here. It's "not done" because it could hurt you. Here's the Bayesian argument: - Let's assume a lab test (or imaging test) has a 1% false positive rate and 100% sensitivity (that would be pretty good for many tests and imaging modalities!). - The cancer you screening for has a 1% incidence as well (low-ish, for the sake of argument). - Therefore the chance that a "positive" scan would be due to a false positive or…

This would also force advancements in the field re: distinguishing false positives. More information is better than less, imo.

False positives can be actively harmful. Unnecessary biopsies lead to unnecessary infections and stress and such.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#23

Post by madengr » Mon, Jun 10, 2019, 5:14 PM UTC

legohead wrote: post #5

Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening and nobody would give me the time of day - "that's not done". At most they said they would do a blood test which checks for a couple types of cancer. I asked if I could get a CT and have a professional go over it. nope. But something like this tracer is what I…

A CT is about 1 rem of exposure. It takes 2500 rem to cause a cancer (the linear approximation). So every 2500 CT scans you have given someone cancer.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#24

Post by buildzr » Mon, Jun 10, 2019, 5:17 PM UTC

asdf21 wrote: post #16

sjg007 wrote: post #11

Earlier quoted context omitted.

The Iatrogenic risk is too high. CT and MRIs have false positives or reveal benign tumors/conditions that have to be investigated which result in additional testing, surgery etc... So in the absence of symptoms or known genetics / family history it is just not done. But fear not, in the next 20 years we will likely have blood based tests for finding some early cancers though. You should ask yourself why do you want t…

Shouldn't everyone want to be checked for it? I spend 10000x more time and effort monitoring the health and performance indicators of my servers compared to my body, it's astoundingly ignorant that we aren't more honed in on early detection for all sorts of issues.

False positives in the case of server monitoring are extremely rare and easy to detect when they do happen.

Can you imagine if your server monitoring runs once per minute and randomly fails 1/100 times? You'd be getting panic-inducing server is down emails many times per day. Such server monitoring would produce little to no value as you'd quickly ignore them as noise, just like you should avoid doing more tests like this on your body.

Additionally, CTs in particular produce ionizing radiation and increase your risk of cancer. If monitoring your server increased the risk of it failing, would you still want monitoring on it?

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#25

Post by docker_up » Mon, Jun 10, 2019, 5:19 PM UTC

legohead wrote: post #5

Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening and nobody would give me the time of day - "that's not done". At most they said they would do a blood test which checks for a couple types of cancer. I asked if I could get a CT and have a professional go over it. nope. But something like this tracer is what I…

Why is this not available? It's ridiculous that we can't do this conveniently. All I read about is new tests and detections, etc and they are only available when it's too late. Things like pancreatic cancer and liver cancer are death sentences and on the rise. Why can't we test for this sooner rather than later?

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#26

Post by dannykwells » Mon, Jun 10, 2019, 5:20 PM UTC

asdf21 wrote: post #20

nkrumm wrote: post #18

Earlier quoted context omitted.

MD here. It's "not done" because it could hurt you. Here's the Bayesian argument: - Let's assume a lab test (or imaging test) has a 1% false positive rate and 100% sensitivity (that would be pretty good for many tests and imaging modalities!). - The cancer you screening for has a 1% incidence as well (low-ish, for the sake of argument). - Therefore the chance that a "positive" scan would be due to a false positive or…

This would also force advancements in the field re: distinguishing false positives. More information is better than less, imo.

No, this is the wrong argument. What would happen is, eventually people just wouldn't believe any of these tests and they would become useless, even when they did reach a high level of PPV. Also see the point about biopsies - definitely not non-invasive, often require surgery. Also cost - you're now looking at 5-10k extra charges.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#27

Post by sxg » Mon, Jun 10, 2019, 5:20 PM UTC

asdf21 wrote: post #16

sjg007 wrote: post #11

Earlier quoted context omitted.

The Iatrogenic risk is too high. CT and MRIs have false positives or reveal benign tumors/conditions that have to be investigated which result in additional testing, surgery etc... So in the absence of symptoms or known genetics / family history it is just not done. But fear not, in the next 20 years we will likely have blood based tests for finding some early cancers though. You should ask yourself why do you want t…

Shouldn't everyone want to be checked for it? I spend 10000x more time and effort monitoring the health and performance indicators of my servers compared to my body, it's astoundingly ignorant that we aren't more honed in on early detection for all sorts of issues.

The health and performance indicators of your servers are reliable and (relatively) accurate. Analogous indicators for the human body are much less so. False positive and false negative rates for many different kinds of tests/exams are uncomfortably high. In cases where patients have other signs/symptoms suggesting an underlying issue, it does make sense to use these tests and exams, but in otherwise healthy patients, you may do more harm than good.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#28

Post by docker_up » Mon, Jun 10, 2019, 5:22 PM UTC

nkrumm wrote: post #18

legohead wrote: post #5

Anyone have any experience getting tested for cancer when marked as "healthy"? I contacted my PCP and some other random places asking to get a cancer screening and nobody would give me the time of day - "that's not done". At most they said they would do a blood test which checks for a couple types of cancer. I asked if I could get a CT and have a professional go over it. nope. But something like this tracer is what I…

MD here. It's "not done" because it could hurt you. Here's the Bayesian argument: - Let's assume a lab test (or imaging test) has a 1% false positive rate and 100% sensitivity (that would be pretty good for many tests and imaging modalities!). - The cancer you screening for has a 1% incidence as well (low-ish, for the sake of argument). - Therefore the chance that a "positive" scan would be due to a false positive or…

Maybe figure out a better way to verify that doesn't require biopsy? Maybe use machine learning in conjunction with better data? I don't know enough but there must be other techniques we could devise that don't require major invasive surgery every single time.

Just sitting on our hands on this information and letting people die is the worst decision. We need to improve our technology to get better results, not throw our hands up in the air and say the problem is too hard.

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#29

Post by Randypea » Mon, Jun 10, 2019, 5:24 PM UTC

lipman wrote: post #15

Randypea wrote: post #4

I was diagnosed with NET cancer recently and my doctor incorrectly ordered the older radiotracer scan. It only showed 1/2 of my tumors, missing the most important primary tumor. This newer scan/radiotracer showed double the number of tumors including the most important step of finding the primary. I will soon have cytoreduction surgery to remove the tumors. Unless you have other biomarkers showing cancer, the issue f…

Thanks for sharing. You got FDG PET ("older") as well as FAPI? Are you in the US? Curious if FAPI is already in wide use.... does FDG not work that well for NET ?

I am in the US and FDG PET does not work for NET. The "older" scan was Pet radiolabeled with indium-111. Comparison is here: http://prntscr.com/o02jsg Left is the newer scan, which uses Gallium 68. The primary tumor is uppermost right side, liver metastasis is left side, and small lower lighted up areas are lymph nodes. All will be removed soon. Lit up area below is the radiotracer in my bladder before urinating. :-)

Re: New Radiotracer Can Identify Nearly 30 Types of Cancer

#30

Post by lipman » Mon, Jun 10, 2019, 5:29 PM UTC

Randypea wrote: post #29

lipman wrote: post #15

Earlier quoted context omitted.

Thanks for sharing. You got FDG PET ("older") as well as FAPI? Are you in the US? Curious if FAPI is already in wide use.... does FDG not work that well for NET ?

I am in the US and FDG PET does not work for NET. The "older" scan was Pet radiolabeled with indium-111. Comparison is here: http://prntscr.com/o02jsg Left is the newer scan, which uses Gallium 68. The primary tumor is uppermost right side, liver metastasis is left side, and small lower lighted up areas are lymph nodes. All will be removed soon. Lit up area below is the radiotracer in my bladder before urinating. :-)

Good luck with the surgery! You probably got Octreoscan which is used for NET - it's SPECT imaging which is generally worse that PET, but (until now) there wasn't a good PET tracer that works in NET. Awesome to hear a story of how this new tracer could really help patients.