Are we screening too much for skin cancer? It's complicated • Hacker News Board

Re: Are we screening too much for skin cancer? It's complicated

#11

Post by Clewza313 » Thu, May 06, 2021, 4:59 AM UTC

dukeofdoom wrote: post #9

I once got stuck walking on a board walk behind an elderly man in a g-string european type swimwear in Hawaii. Looking at his extremely wrinkled ass, I quickly realized this man was addicted to sun bathing. Coming from a northern part of the world, did not know that was a thing. He looked about 70, formerly a white guy. So perhaps some people can develop some way of dealing with skin damage from the sun. The man need…

Well, it's also survivor bias. Melanoma rates are very high in Australia, which has lots of pasty people of European extraction toiling under some of the most brutal UV indexes on the planet.

Re: Are we screening too much for skin cancer? It's complicated

#12

Post by Clewza313 » Thu, May 06, 2021, 5:00 AM UTC

alexfromapex wrote: post #7

As someone who had an early melanoma detected and removed, I disagree with this. What I find frustrating is that they only attribute UV damage as the cause when it's probably a combination of UV damage and diet, or repetitive extreme UV damage combined with bad diet, etc.

Serious question: what's the link between melanoma and diet?

Re: Are we screening too much for skin cancer? It's complicated

#13

Post by throwlotterywon » Thu, May 06, 2021, 5:05 AM UTC

Recently, I had a mole on the top of my foot about an inch or two from my toes that grew from a normal size small dot to bigger than a pencil eraser in the span of two months. I went to the doctor, not suspecting any cancer, but because it was ANNOYINGLY itchy and started to grow a red ring around it. For context, I'm a nerdy software engineer who RARELY ventures outside of an air conditioned room, obviously no tanning or anything like that.

When I got there, the doctor, who was a local UCSF-trained expert, suddenly looked very stressed out and started taking pictures of it. He kept insisting I get tested for deadly skin cancer (remember, melanoma is AGGRESSIVE) in a very roundabout way, but would not give any probabilities or anything like that. The more I asked questions, the less information he would give about what was going on, other than that I should get a biopsy RIGHT NOW in his office (he even told his other patients to wait a while).

He numbed my foot with a shot, and then took the dermatology equivalent of an ice cream scooper and dug out a sizable chunk of my flesh. I was told I had to wait for two weeks for the results -- the most agonizingly stressful two weeks of my life -- hearing the news was less stressful. "We'll call you if there's any problems, if you don't get a phone call, nothing is wrong. See you at your next appointment!"

The results were a rare "spitz nevus" precancerous mole that looks exactly like melanoma but is completely benign. I had won the lottery. The doctor took even more pictures the next time.

So, to answer the article's question, no we are NOT screening too much for skin cancer; otherwise, I would have known to be in the doctor's office a LOT sooner. And I am a shut-in who does not sun bathe or even go outside for more than 30 minutes at a time on the occasional weekend...

Re: Are we screening too much for skin cancer? It's complicated

#14

Post by jedberg » Thu, May 06, 2021, 5:05 AM UTC

This sounds like the same arguments as whether mammograms should start at 40 or 50 years old. Apparently a lot of the cancers they catch during screenings at 40 would go away on their own, so now they only recommend mammograms before 50 if cancer runs in your family, to avoid unnecessary biopsies and other surgeries.

Re: Are we screening too much for skin cancer? It's complicated

#15

Post by MattGaiser » Thu, May 06, 2021, 5:09 AM UTC

md224 wrote: post #10

> “There’s no one trump card, no one criteria really that can tell us this is absolutely, without a doubt melanoma.” Does this bother anyone else? I really hope that level of uncertainty doesn't extend to too many other types of cancers...

> this is absolutely, without a doubt

The standard in this phrase is also exceedingly high. Even a test with just a 1 in 1000 rate of false positives would not pass. But are you really going to doubt a test that only has a 0.1% chance of being wrong?

I want a rate. Are half being misdiagnosed? 20%? 2%?

Re: Are we screening too much for skin cancer? It's complicated

#16

Post by aeternum » Thu, May 06, 2021, 5:44 AM UTC

jedberg wrote: post #14

This sounds like the same arguments as whether mammograms should start at 40 or 50 years old. Apparently a lot of the cancers they catch during screenings at 40 would go away on their own, so now they only recommend mammograms before 50 if cancer runs in your family, to avoid unnecessary biopsies and other surgeries.

I've never understood this argument, more information should always be better.

The real problem seems to be the knee-jerk biopsy/surgery.

If a QA engineer points out a potential bug, it's foolish immediately/blindly delete chunk of code containing the bug. It's just as foolish to say we're randomly deleting too much good code, so let's fire the QA engineers.

Re: Are we screening too much for skin cancer? It's complicated

#17

Post by arrosenberg » Thu, May 06, 2021, 6:05 AM UTC

aeternum wrote: post #16

jedberg wrote: post #14

This sounds like the same arguments as whether mammograms should start at 40 or 50 years old. Apparently a lot of the cancers they catch during screenings at 40 would go away on their own, so now they only recommend mammograms before 50 if cancer runs in your family, to avoid unnecessary biopsies and other surgeries.

I've never understood this argument, more information should always be better. The real problem seems to be the knee-jerk biopsy/surgery. If a QA engineer points out a potential bug, it's foolish immediately/blindly delete chunk of code containing the bug. It's just as foolish to say we're randomly deleting too much good code, so let's fire the QA engineers.

That’s a fine sentiment and all, but if you are looking for a logical response from most people in that situation, you’re gonna have a bad time.

Re: Are we screening too much for skin cancer? It's complicated

#18

Post by asdff » Thu, May 06, 2021, 6:22 AM UTC

Vecr wrote: post #2

As far as I can tell, all cancer is being screened for too much, except possibly colorectal cancer, mostly just because there's other stuff that can be found in the same exam. If better treatments existed, it might become more worthwhile.

Most cancers are a lot more treatable if caught early. Sometimes you can just cut it out and never relapse if caught early enough before it metastasizes. Screening is worthwhile.

Re: Are we screening too much for skin cancer? It's complicated

#19

Post by dehrmann » Thu, May 06, 2021, 6:34 AM UTC

aeternum wrote: post #16

jedberg wrote: post #14

This sounds like the same arguments as whether mammograms should start at 40 or 50 years old. Apparently a lot of the cancers they catch during screenings at 40 would go away on their own, so now they only recommend mammograms before 50 if cancer runs in your family, to avoid unnecessary biopsies and other surgeries.

I've never understood this argument, more information should always be better. The real problem seems to be the knee-jerk biopsy/surgery. If a QA engineer points out a potential bug, it's foolish immediately/blindly delete chunk of code containing the bug. It's just as foolish to say we're randomly deleting too much good code, so let's fire the QA engineers.

> more information should always be better

It's not, though. There's a cost to collecting the information, it's not always actionable, and it can be wrong. On the human side, there's a reason they say "ignorance is bliss."

Re: Are we screening too much for skin cancer? It's complicated

#20

Post by jvidalv » Thu, May 06, 2021, 6:59 AM UTC

I think people overblowns it.

I live in a rural town in Spain where most people are still farmers ( wineries, olives ).

It means most of the men can take up to 6-7 hours, at minimum, of sun their entire life each day.

Its a small town so we know whenever someone dies. In my 27 years never heard or someone died from skin cancer.

There have been many lung cancers from smoking, prostata, belly...

I dont know where this trend about skin cancer begun, maybe is a think for northen people and not mediterranean that we are more “brown”, and like everything it propagated like fire, trying to sell to you that if the sun hits you without protection youll get skin cancer.

Sorry but no