Blood test that finds 50 types of cancer is accurate enough to be rolled out • Hacker News Board

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#371

Post by pie420 » Fri, Jun 25, 2021, 10:58 PM UTC

throwawaytcp wrote: post #348

throwawaynotmd wrote: post #109

Earlier quoted context omitted.

The argument you’re making has always bothered me because it’s hiding the ball. If finding something that otherwise carries no symptoms is best left untreated, then the fact that you found it should make no difference to the decision. The doctor should say that the best course of action is to do nothing. More information can never be harmful. If you know information is best not acted on in the abstract, then you also…

If I can step in with a personal anecdote: I was diagnosed in my late 20s with papillary thyroid cancer. PTC is a very survivable cancer, with a near-100% survival rate (death usually only occurs in rare cases where the disease is diagnosed very late, the progession is atypical, or there are comorbidities at play). It is very easy to screen for and diagnose: a neck ultrasound identifies thyroid nodules, and if the no…

But this really just illustrates a lack of knowledge on our part. If we made thyroid screening a regular thing and invested $10B/year into diagnostics, analysis, and study, i guarantee you in 5 years or less we would have the most efficient, effective system for treatment, determining which microcarcinomas are bad, which ones to keep an eye on, etc.

There simply isn't a profit motive right now, and there aren't a ought resources, so unprofitable, minor things like thyroid cancers and other, small, mostly non-fatal things fall by the wayside. If we could massively increase the resources and time spent of solving health issues, we'd have a lot better solutions. There only exist a certain amount of cancer researchers, oncologists, and clinical pharmacologists that can profitably exist. Lots of diseases will never be cured because there are too few people affected by them. Until we decouple medical progress from profit, there's a only a certain amount of progress we can make. Unfortunately, it seems like tying profit to medicine is the most efficient system we have, so it may be centuries till we get there

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#372

Post by vmception » Fri, Jun 25, 2021, 11:10 PM UTC

jacquesm wrote: post #354

vmception wrote: post #352

Earlier quoted context omitted.

These are all in animals and I specified human cancers for that specific reason, thanks for the article though, I only knew about the Tasmanian Devil one

Yes, correct. But there are also some viruses that cause cancer that can spread from human to human (HPV for instance, the cause of cervical cancer), and the case of that doctor is some proof that at least in theory cancer can spread by blood or tissue contact.

Yeah got vaxxed against that, fingers crossed

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#373

Post by nyokodo » Fri, Jun 25, 2021, 11:22 PM UTC

TaupeRanger wrote: post #96

reacharavindh wrote: post #3

This is one of those medical revolutions that I am waiting dearly for. Facilities that are not hospitals(to avoid the risk of occupying medical devices that sick people need) built to _regulary_ check up otherwise healthy people for preventive care. Heck, I have so many alerts defined on my monitoring setup for servers to watch for signals of failure before they get too big. But, my own body is not observed until som…

Actually you don't want this, and you are describing a nightmare scenario that everyone who studies health policy understands all too well. Mass screening of healthy people will result in extreme iatrogenics and unnecessary psychological damage and stress (which leads to physical effects as well), not to mention overwhelming the medical system. The fact is that many things that could be detected will never result in…

> Actually you don't want this, and you are describing a nightmare scenario that everyone who studies health policy understands all too well.

Would a very large representative sample of volunteers doing this kind of hitherto unprecedented level of medical monitoring help improve this technology while limiting the unintended consequences? If we could get to the point where the technology was very highly predictive of specific outcomes and even had the ability to test early interventions on those outcomes, that would both allay the psychological cost of a population-wide roll-out and drastically improve outcomes across the board, would it not?

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#374

Post by mrandish » Fri, Jun 25, 2021, 11:27 PM UTC

londons_explore wrote: post #31

More technologies like this are coming... Is it worth taking blood samples now, keeping them in a freezer, and then waiting for the test tech to come so I can get it tested to see disease progression of whatever disease I get when I get older?

"Worth" doing is situational but, assuming you have the personal resources to spare and the interest in doing so, grabbing some snapshots in time might be useful to you in the future. That said, I'm fairly sure it would not have good ROI to do that as a broad public health measure. I'm more assuming we're talking about a 40-something affluent tech worker who has all the basic needs of life already well-covered and is up for spending time and a few thousand dollars which may well be wasted.

It's not so much that "new" tests are incoming, it's that last time I checked, a really large, thorough lab had a menu of over 900 different blood tests they could run. Just for grins, I did Select All and it would be several thousand dollars to run them all (plus who knows how many gallons of blood draws over time). To me the point is if, in the future, you have a new reason (symptom or indicator) to look at one specific test, if your immediate test shows positive you could go back and run that specific test on earlier samples to establish a baseline or perhaps even a progression rate (assuming it is a chronic condition which develops gradually over time).

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#375

Post by dennis_jeeves » Sat, Jun 26, 2021, 12:41 AM UTC

throwawaynotmd wrote: post #109

TaupeRanger wrote: post #96

Earlier quoted context omitted.

Actually you don't want this, and you are describing a nightmare scenario that everyone who studies health policy understands all too well. Mass screening of healthy people will result in extreme iatrogenics and unnecessary psychological damage and stress (which leads to physical effects as well), not to mention overwhelming the medical system. The fact is that many things that could be detected will never result in…

The argument you’re making has always bothered me because it’s hiding the ball. If finding something that otherwise carries no symptoms is best left untreated, then the fact that you found it should make no difference to the decision. The doctor should say that the best course of action is to do nothing. More information can never be harmful. If you know information is best not acted on in the abstract, then you also…

>That is a lie! And a very nasty one at that.

Nope. TaupeRanger's overall observations seem spot on.

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#376

Post by refurb » Sat, Jun 26, 2021, 12:50 AM UTC

postingawayonhn wrote: post #156

refurb wrote: post #44

Earlier quoted context omitted.

Yup. Let’s say the test shows “very likely” for pancreatic cancer. Now you do imaging. Ok, nothing there? Now what? Biopsy? That’s general anesthesia now and costly (for the patient or govt). Biopsy is negative. Now what? Start chemo? Watch and wait? For how long? Do a biopsy every 6 months? None of these tests are 100% accurate. If broadly used, a false positive of 0.1% will result in tens of thousands getting unnec…

> Now you do imaging. Ok, nothing there? Now what? Put the patient on a more frequent screening schedule (blood tests and imaging) to pick up any growth.

Ok, now multiply this scenario by thousands. This sounds like a great way to bust your healthcare budget.

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#377

Post by Gatsky » Sat, Jun 26, 2021, 4:02 AM UTC

dannyw wrote: post #21

Gatsky wrote: post #15

Earlier quoted context omitted.

Note this test is about early detection, not prevention. If your pancreatic cancer is detected early, you will still need to have your insides rearranged to get it out.

That's a critically better health outcome though. It's like fixing a corruption bug when you detect it on one server, versus finding out there's corruption in every shard and all of your backups.

I’m not saying it isn’t a great development. It certainly adds an option for early detection of some cancers where there previously were none. But it isn’t cancer prevention. It is a highly sophisticated technical undertaking which for educated and motivated patients in well resourced health systems will reduce cancer mortality and morbidity by some increment. Depending on many factors this could be a big or small increment. In the real world the efficacy will be less than what the trial shows. It is also likely that Grail (with north of $1 billion in VC funding) will charge as much as they can for this test. The size of the trials necessary to prove efficacy means that there will be highly constrained competition in this space.

The distinction with prevention is important, because we ultimately must aim for preventing almost all cancers, and not be content with anything less than that.

Disclaimer: I’m an Oncologist.

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#378

Post by rocho » Sat, Jun 26, 2021, 4:37 AM UTC

nybble41 wrote: post #262

jacquesm wrote: post #59

Earlier quoted context omitted.

Your understanding as evinced by the comment above leaves me to wonder if you actually get that this is not about individual outcomes but about the overall statistics. Even if more accurate tests would turn up more true positives that still would not necessarily result in increased patient outcomes. That is why absent symptoms testing makes sense for only a very low number of cancers where early detection does improv…

> absent symptoms A positive blood test is a symptom. One which you'll miss if you don't do the blood test regularly. And looking for symptoms (other than a blood test) is a form of testing... one with much worse accuracy (both positive and negative) than the blood test, especially in the early stages.

That's not what symptoms are.

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#379

Post by radu_floricica » Sat, Jun 26, 2021, 5:42 AM UTC

vidarh wrote: post #326

radu_floricica wrote: post #243

Earlier quoted context omitted.

You're missing a step. There are several responses saying basically the same thing (testing kills), and more or less randomly I'm going to answer yours. All have the same step missing. Testing doesn't kills by itself, not in numbers worth mentioning. Treatments - sure, a whole different ball game, they're positively dangerous. But between testing and treatments there should be a specialist that crunches the numbers a…

> Testing doesn't kills by itself, not in numbers worth mentioning. Mammography involves radiation and pressure. The radiation alone is a significant risk [1], and kills by causing cancer . It can also cause tumors to rupture and spread malignant cells. It's significant enough to significantly increase the hurdle where mammography is justified. It does not mean it never is - absolutely not. But it means screening pro…

The study reads like a success story to me. They started from a hypotheses of testing reducing deaths overall, which was confirmed. Once they had more data they were able to find ways to optimize the process, like delaying testing for large breasted women who have a worse risk/benefit profile.

What I'm advocating for btw, just to make clear, is regularly showing up to a doctor who will recommend all the cost effective non-intrusive tests (like blood work) plus the intrusive testing depending in your particular risk profile. This doesn't seem like a controversial opinion to me - more like a common sense default.

As for conventional wisdom, look at this thread. Count the pro/contra comments if you want. Other then a tautological "some medical procedures can be dangeours if misused/overused", I still don't get how people can be against testing, in general.

Re: Blood test that finds 50 types of cancer is accurate enough to be rolled out

#380

Post by msrenee » Sat, Jun 26, 2021, 7:42 AM UTC

jacquesm wrote: post #270

msrenee wrote: post #228

Earlier quoted context omitted.

No mammograms? No pap smears? No prostrate screening? That's shocking.

We do all of those, but they're all voluntary (as they should be), there are regular drives for all of these.

Did I reply to the wrong comment? I thought I was replying to one about how the Netherlands doesn't cover cancer screening under its national healthcare.