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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

#41

Post by StavrosK »

saiya-jin wrote: post #40
StavrosK wrote: post #33

Earlier quoted context omitted.

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. Ad…

Is that because of cloud cover? Why does it suddenly get much sunnier?

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

#42

Post by DanBC »

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…

> As a result, people are now coming in to their doctors with prostate cancer at stage 3 or 4. Might be the right choice for society, but the wrong choice for the individual.

Hypothetical Bob is going to die when he's 78. We can tell Bob he has prostate cancer when he's 76, or when he's 70. Telling him does not make him live longer. But telling him does mean he may undergo treatment that degrades his quality of life, or even shortens his life.

How can we justify telling him when he's 70, when that won't make him live longer but could well make his life worse?

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

#43

Post by jazoom »

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…

I'm a skin cancer doctor in Queensland. I find skin cancers in patients almost every day. In fact, I think there have only been a few days of working this year where I didn't find one.

This is from screening. People in Australia generally understand the importance of skin cancer screening because most people know of someone who's had skin cancer.

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

#44

Post by egman_ekki »

StavrosK wrote: post #41
saiya-jin wrote: post #40

Earlier quoted context omitted.

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. Ad…

Is that because of cloud cover? Why does it suddenly get much sunnier?

e.g. in Scandinavia you get an hour or sunshine per day in December, and that's at a very low degree above the horizon. In July, you can get more than 12 hours of sunshine per day. And that's for Copenhagen, don't ask about Stockholm...

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

#45

Post by StavrosK »

egman_ekki wrote: post #44
StavrosK wrote: post #41

Earlier quoted context omitted.

Is that because of cloud cover? Why does it suddenly get much sunnier?

e.g. in Scandinavia you get an hour or sunshine per day in December, and that's at a very low degree above the horizon. In July, you can get more than 12 hours of sunshine per day. And that's for Copenhagen, don't ask about Stockholm...

Yes but it doesn't go from an hour a day on March 20th to 12 hours a day on March 21st, it's a gradual lengthening. The GP said that it goes from not sunny at all to very sunny suddenly.

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

#47

Post by dagw »

StavrosK wrote: post #45
egman_ekki wrote: post #44

Earlier quoted context omitted.

e.g. in Scandinavia you get an hour or sunshine per day in December, and that's at a very low degree above the horizon. In July, you can get more than 12 hours of sunshine per day. And that's for Copenhagen, don't ask about Stockholm...

Yes but it doesn't go from an hour a day on March 20th to 12 hours a day on March 21st, it's a gradual lengthening. The GP said that it goes from not sunny at all to very sunny suddenly.

The big contributor is vacations. As flights and hotels have gotten cheaper and cheaper it is more and more common to take 1-2 weeks in places like Thailand or Bali or Dubai in the winter. So people are going from no sun on their body for 4 month, to spending 10+ hours a day in a bathing suit in extremely intense sun.

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

#48

Post by aeternum »

jedberg wrote: post #21
aeternum wrote: post #16

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.

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…

Just because a QA engineer finds a bug does not mean you should spend a bunch of time diagnosing and fixing it.

In either case you can choose to do nothing. Knowing that the bug exists should put you in a better place to make the right call.

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

#49

Post by edmundsauto »

cycomanic wrote: post #24
im3w1l wrote: post #5

Earlier quoted context omitted.

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 i…

Yes, patients should be making all decisions regarding their own health. Am I misreading you? Are you really suggesting they shouldn’t have these options because they might make a bad decision?

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

#50

Post by aeternum »

inglor_cz wrote: post #31
aeternum wrote: post #16

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.

"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://behaviour…

Then maybe the problem is the human. Perhaps an algorithm should take in the test information and determine the most logical path forward (do nothing, increased future testing, surgery).

From a Bayesian/logical POV, more information should still allow for a better decision.

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