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

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

#21
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.

Think of it more like this: A QA engineer finds a bug. You spend a bunch of time diagnosing and fixing the bug. But it turns out that no user actually hit that bug because they never used that feature, and in fact that feature gets taken out in the next release.

That's a lot of wasted time. Time better spent having the QA engineer only look at bugs reported by users and not looking for them on their own.

In the case of the mammogram, it's even less clear cut. The mammogram only shows spots. A biopsy is necessary to determine if it's cancer. A biopsy is surgery and could have complications. And could in fact make the problem worse.

So the idea is that you only do the test if you actually have symptoms or a family history of breast cancer, until the risk level gets high enough that it warrants going to look for cancer without symptoms.

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

#22
post #20

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…

Studies I've seen from Sweden seems to suggest that the big problem is people going from no sun to lots of sun with no 'transition' period. Basically one big cause of the increase in skin cancer is people going straight from 4 month of basically no sun, to spending 2 weeks in Thailand sunbathing on the beach for hours a day.

Another factor is altitude. The risk of skin cancer is higher the higher up you are. People who spend a lot time in the mountains are at higher risk compared to people closer to sea level (at the same latitude).

Basically if you get a 'constant' amount of sun every day, are below ~1000-2000 m above sea level and stay reasonable covered up (wear a shirt, hat if you're bald etc.) the risks seem to be pretty low.

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

#23
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.

An under 3-minute video by a funny and informative doctor explaining this (youtube handle "medlife crisis"):

https://www.youtube.com/watch?v=7kQk9-KLPfU

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

#24
post #5

Earlier quoted context omitted.

It's definitely complicated because most of these older men with stage 1/2 prostate cancer will not actually die from it since it's so slow. However, getting the treatment for it leaves a huge number with erectile dysfunction or other issues. Is it really worth screening/treating a disease with a small chance to kill you if that treatment has a huge chance to make you impotent?

Depends on your values. Some people may think it's worth it for them, and that's valid.

I don't think it's as easy as "let the patient decide". First, probabilities are very abstract concepts for people, that's why people respond very differently to the dangers of things when given the probability. Some people are scared if there is a 1:1000 chance of something happening, others are reassured, but both might have very similar reactions if they actually get hit by the chance event.

Secondly, also there is significant evidence of high incidence of depression for people with side effects, such as incontinence and impotence. I don't think people have the ability to assess that effect based on their values. To use an extreme example, should we operate something that has a 1:1000 change of killing you before something else, if it increases your suicide risk to 1:500? Should we allow patient to make that decision?

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

#25

Earlier quoted context omitted.

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.

An under 3-minute video by a funny and informative doctor explaining this (youtube handle "medlife crisis"): https://www.youtube.com/watch?v=7kQk9-KLPfU

This one is even more relevant as he talks about dangers of over screening for beast cancer, and side effects of mastectomy+chemo:

https://youtu.be/yNzQ_sLGIuA

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

#26
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.

"Let's operate before the patient gets better" or something close was an in-half-jest quote I have read in one of the articles linked here on HN (it was about how surgery does not directly heal people, but makes conditions ideal for the body to repair itself).

Now if I could find its source...

Edit: a search revealed that it was about knee surgeries that do not always make things better.

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

#27

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 tanni…

Statistically speaking, your individual story says next to nothing about what we should do regarding screening. And screening strategies are all about statistical analysis.

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

#28

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 tanni…

I'm surprised he only took a sample. Where I live, anything suspected of being melanoma gets removed immediately, it's still sent off for testing to see whether it was cancerous or not but if you're taking a biopsy might as well just take it out entirely.

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

#29

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…

It depends a lot on the UV index. If you're near the hole in the ozone layer you get cancer before you get that tanned.

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

#30

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 tanni…

Well done on spotting it! I have hundreds of moles. I can't even imagine how I'd be able to keep track of any increases in size, there are more than I can remember.
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