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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

#31

Post by inglor_cz »

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"

Should it? Running around with a known cancer that your doctors refuse to treat (because they expect it to go away), is a major stress factor and may, in the end, damage your own immune response.

Actually, "more information may lead to worse performance" has been shown in another psychologically heavy field: the stock market. [0]

Humans are complicated.

[0] https://behaviouralinvestment.com/2019/01/09/can-more-inform...

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

#33

Post by StavrosK »

dagw wrote: post #22
jvidalv wrote: 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 w…

Hmm, I wonder if it's that us Mediterranean people have an easier transitional period and have learned to pace ourselves. I'll go out for a walk without sunscreen, but I'll definitely put it on if I go to the beach, when I'm going to be in the sea for an hour without a shirt on.

Most people here are pretty tan unless they spend all day in an office.

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

#34

Post by the-dude »

bricemo wrote: post #3

This is a complicated space to get right. Prostate cancer is the opposite: The government used to screen for it (PSA blood test) and so people would see their doctor at stage 1 or 2 cancer, when it can be easily tested. But the problem was that the positivity rate was about 45:1, and the test is too expensive at that scale. So now PSA tests are not routine. As a result, people are now coming in to their doctors with…

I would like to share my personal view on prostate cancer screening : my father was found 'positive' at around ~61 yrs. He evaluated the offered treatments and opted for 'internal radiation' : a bunch of radio-active pellets are implanted in the prostate.

I heard from him one of the pellets went 'missing' and was assumed to be 'wandering'.

At 63 yrs, he developed acute leukemia and basically died within a week.

I am not going to research and pursue this, but I am very bitter.

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

#35

Post by StavrosK »

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…

In Greece, we get a lot of tourists (mainly from England, I want to say) who seem addicted to sunbathing. They've been doing it so much that their skin looks like leather, though I can't say how healthy that is, because I guess everyone here looked like that before the invention of sunscreen.

Between the risks of melanoma and the risks of not enough vitamin D and who knows what else we need from the sun, I can't say what's worse, but I don't think staying pasty-white and avoiding all sun contact is healthy any more.

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

#36

Post by adrianN »

elric wrote: post #30
throwlotterywon wrote: post #13

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.

Take pictures once a month and compare them. If you have lots of moles you're in a high-risk group.

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

#37

Post by fifteenforty »

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.

All tests have false positives and false negatives. Whether we explicitly say it or not, most clinical decision making algorithms are based on a Bayesian approach.

If you have next to no risk of a disease, don’t get tested for it. You might get treated for it!

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

#38

Post by ddeck »

Clewza313 wrote: post #11
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.

Indeed. Australia and New Zealand have the highest incidence rate for melanoma in the world.

Ozone depletion plays a role, but interestingly, the Earth is also closer to the Sun during the southern hemisphere summer, resulting is ~7-10% greater solar UV intensity:

Australia’s unusually harsh sunshine results mainly from its location in the Southern Hemisphere. The elliptical orbit of the Earth places the Southern Hemisphere closer to the sun during its summer months than the Northern Hemisphere during its summer. This means that the summer sun in Australia is 7 to 10 percent stronger than similar latitudes in the Northern Hemisphere. Air currents high in the atmosphere sometimes bring ozone-depleted air from Antarctica’s ozone hole to Australia, letting even more UV through. And Australia’s sunny weather and relatively pollution-free air provide little additional protection from harmful UV rays

https://earthdata.nasa.gov/learn/sensing-our-planet/aerosols...

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

#39

Post by nicwilson »

Clewza313 wrote: post #12
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?

presumably increased metabolic activity which equates to increased (epi)dermal turnover (among many other factors, e.g. immune surveillance). Increased turnover leads to more chance for errors during replication

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

#40

Post by saiya-jin »

StavrosK wrote: post #33
dagw wrote: post #22

Earlier quoted context omitted.

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 w…

Hmm, I wonder if it's that us Mediterranean people have an easier transitional period and have learned to pace ourselves. I'll go out for a walk without sunscreen, but I'll definitely put it on if I go to the beach, when I'm going to be in the sea for an hour without a shirt on. Most people here are pretty tan unless they spend all day in an office.

Which is fine for Mediterranean, but ie rest of europe looks exactly opposite - pale white from late autumn till late spring, very little to no sun exposure per day, sometimes nothing for a week or longer.

And then super intense exposure over vacation or sunny weekends. I am not even talking about long hours in the office or covid lockdowns, just regular situation. When its colder then logically people dress more. Add more pale skin by default, meaning less genetic predisposition for good long term protection and the result is what we see.

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