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U.S. cancer death rate has dropped by a third since 1991

wsj.com

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Re: U.S. cancer death rate has dropped by a third since 1991

#71

Post by Broken_Hippo »

nerdponx wrote: post #54
Gatsky wrote: post #41

This is great progress. Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great. The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence whi…

Isn't pancreatic cancer in particular usually very far advanced before it's detected?

Yes, unless you get lucky.

They find spots on the pancreas by accident all the time. It is incredibly common. I know, I have one: I got an abdominal CT scan while getting something unrelated checked. Some of these go on to be cancer, and sometimes they know it is precancerous. The cyst I have wasn't immediately precancerous. Now I get regular MRIs to check on it. Since I have no symptoms, there is really nothing else to do.

That lack of symptoms, though, is a real issue. If you have a little bit of cancer and no symptoms and you don't find it accidentally, it is going to be much, much harder to detect early.

Re: U.S. cancer death rate has dropped by a third since 1991

#72

Post by dunbr »

kodah wrote: post #53
Gatsky wrote: post #41

This is great progress. Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great. The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence whi…

Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, y…

I work in this field and directly am involved with the treatment of prostate cancers. What you describe is not standard of care, and I’d hesitate to say that everyone should be so alarmed of getting prostate or any cancer. It’s unfortunate that your father’s PCP wasn’t aware of such warning signs, and I’m sorry for your loss.

However, We’ve seen this before with prostate and breast cancer where early and often screening leads to not only false positives but undue stress on patients. Furthermore, catching a nonaggressive prostate cancer 2-5 years early may lead to the same outcomes as catching it when certain things like PSA are detected to be increasing. But you may drastically affect one’s quality of life. It can at times be a difficult balance.

We see more and more elderly patients being treated because they are living longer. For many though, “waitful watching” or “active surveillance” is the correct clinical decision and always is up to the patient.

Finally, while prostate cancer isn’t as publicized as breast cancer (we’re trying!). It is a well known cancer and there is awareness of it.

Re: U.S. cancer death rate has dropped by a third since 1991

#73

Post by [deleted] »

dunbr wrote: post #72
kodah wrote: post #53

Earlier quoted context omitted.

Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, y…

I work in this field and directly am involved with the treatment of prostate cancers. What you describe is not standard of care, and I’d hesitate to say that everyone should be so alarmed of getting prostate or any cancer. It’s unfortunate that your father’s PCP wasn’t aware of such warning signs, and I’m sorry for your loss. However, We’ve seen this before with prostate and breast cancer where early and often screen…

[deleted]

Re: U.S. cancer death rate has dropped by a third since 1991

#74

Post by Gatsky »

grandiego wrote: post #62
kodah wrote: post #53

Earlier quoted context omitted.

Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, y…

> Be your own advocate and research the things your doctor tells you I share your concern but I think there is no definitive advise about how to prevent these horrible outcomes (besides the usual "do regular exercise", "lower sugar consumption", "avoid stress", etc.) Did you find anything more concrete?

There are not really any lifestyle interventions with good quality evidence for preventing cancer. This is my list:

Definitely worth doing:

- Don't smoke anything that burns or chew tobacco.

- Depending on your age and sexual experience, get the HPV vaccine.

- Investigate your family history of cancer. If there are multiple people on one side of the family getting cancer (particularly breast + ovarian + pancreatic, or colon + gastric) then consider getting genetic testing/discuss with a doctor.

- If you have certain ethnicity, just get a genetic test, pay for it if you have to (Mainly for Ashkenazim)

- Avoid consuming herbs/plants which contain aristocholic acid.

Probably worth doing:

- Reduce red meat consumption (observational data and plausible mechanism)

- Reduce or eliminate alcohol (observational data and plausible mechanism)

- Eat highly processed meats rarely (charcuterie etc)

- Make sure to get sufficient fruit and vegetables and fibre. This may offset the risk of red meat consumption.

- Take vitamin D, particularly if your levels are low or you live far from the equator. Don't take intermittent megadoses, take some every day. This seems less useful if you are overweight.

- If you are female, then have children and breast feed if possible. Longer durations of breastfeeding are more effective. Having more children is also more effective. (One may balk at this, but there is a lot of supportive data about long term breast cancer risk)

- Exercise. There is only (a ton of) observational data, but exercise is so universally beneficial. Going from nothing to a bit of exercise has a bigger impact than going from a bit of exercise to a lot. Most people over do it. Do cardio and resistance training. Try to do something every day.

- Avoid supplements designed to have antioxidant properties (based on data suggesting harm from controlled trials, and no clear benefits).

Maybe:

- Move closer to the equator.

- Avoid obesity (note this is complicated... obesity itself may not be the problem. Obesity is protective for some cancers, and this varies by age).

- Get checked for Hepatitis B and C, particularly if you have risk factors or were born/grew up in an endemic country.

- If you get chronic reflux or heartburn, consider pushing for your doctor to investigate further (usually a gastroscope) and do an H pylori test. This is particularly if you were born/grew up somewhere with a higher chance of exposure. If you have it, take the eradication therapy.

- Try to maintain metabolic health. This is highly personal and hard to give general advice around. Eg. South east asian/Subcontinental people can be metabolically ill despite not being overweight. Investigations here could vary from checking for insulin resistance (eg HOMA-IR calculation from a blood test), gettinga DEXA scan to look for visceral fat, or in the extreme case continuous glucose monitoring to look for foods which really spike your blood glucose. The interventions are exercise, sleeping well, and potentially avoiding foods which spike your sugar (or scheduling exercise after eating such foods). Soon we will have a better idea if certain personalised dietary interventions may be beneficial.

Re: U.S. cancer death rate has dropped by a third since 1991

#75

Post by remote_phone »

dunbr wrote: post #72
kodah wrote: post #53

Earlier quoted context omitted.

Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, y…

I work in this field and directly am involved with the treatment of prostate cancers. What you describe is not standard of care, and I’d hesitate to say that everyone should be so alarmed of getting prostate or any cancer. It’s unfortunate that your father’s PCP wasn’t aware of such warning signs, and I’m sorry for your loss. However, We’ve seen this before with prostate and breast cancer where early and often screen…

What is your opinion on the Grail blood test?

Re: U.S. cancer death rate has dropped by a third since 1991

#76

Post by remote_phone »

nerdponx wrote: post #54
Gatsky wrote: post #41

This is great progress. Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great. The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence whi…

Isn't pancreatic cancer in particular usually very far advanced before it's detected?

By the time my friends dad had pancreatic cancer detected, he died within 6 weeks. It’s also the fastest growing cancer in the US. Every time I read about someone dying of cancer quite often it’s pancreatic cancer and it terrifies me.

Re: U.S. cancer death rate has dropped by a third since 1991

#77

Post by tee_0 »

Cancer rates have exploded since 1970. I told this to someone and they arrogantly corrected me. But I just looked it up right there and they had confused death rates with cancer rates. Thanks be to god for smartphones.

Diabetes, obesity, cancer, depression rates all exploded in unison starting around 1970. Why does everyone ignore the massive implications of this? It means there’s something we’re doing that is killing millions of people but everyone brushes that aside and supports treatments rather than figuring out what happened in 1970 that is actually causing it.

There are a trillion pet theories but nobody wants to do research to figure out. Nobody advocates for this research. What the hell

Re: U.S. cancer death rate has dropped by a third since 1991

#78

Post by mythhouse »

kodah wrote: post #53
Gatsky wrote: post #41

This is great progress. Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great. The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence whi…

Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, y…

> PCP ignored escalating PSA levels.

He was ordering psa tests but just ignoring the velocity ?

I had similar discussion on HN last week

https://news.ycombinator.com/item?id=34251569

Re: U.S. cancer death rate has dropped by a third since 1991

#79

Post by mythhouse »

omniglottal wrote: post #59
kodah wrote: post #53

Earlier quoted context omitted.

Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, y…

Knowing something must be checked, while your primary refuses to check it, what is one's recourse in the US?

you mean the cases where a layman thinks he knows more than a trained professional ?

Re: U.S. cancer death rate has dropped by a third since 1991

#80

Post by msla »

jorvi wrote: post #69
msla wrote: post #27

Earlier quoted context omitted.

There have been some wonderful advances in cancer therapy, such as immunotherapy. For example, Rituxan (rituximab) only dates to 1997, but it's already in a number of chemotherapy protocols, leading to a clear improvement in survival rates in previously difficult-to-treat cancers such as aggressive non-Hodgkin's lymphoma. https://en.wikipedia.org/wiki/Rituximab https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398399/ Fl…

> For example, Rituxan (rituximab) only dates to 1997 It is kind of scary to me that drugs these days have such long regulatory lead times that a drug developed in 1997 is just now being entered into treatment regimens. I understand why that is (the Thalidomide tragedy stuff and like that), but I also clearly remember reading an article ~10 years back that asked why cancer treatment seemingly hadn’t made any leapfrog…

I think you misunderstood: I said it dates to 1997 because that's when it was first approved for use in America.

It's not that new in cancer therapy, with R-CHOP (the CHOP protocol plus Rituxan) apparently being introduced in the early 2000s:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9036549/

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