The Other Half

What you say about prostate cancer is wrong/misleading/outdated. The side effects of prostate cancer treatment can absolutely not be described as "minor." Routine screening of asymptomatic average risk men have caused more harm than good.

https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...

>Prostate cancer is very common but isn’t always harmful. It is found in 80% of autopsies where the men died of something else. Many more men die with prostate cancer than because of it.

>The screening test for prostate cancer is a blood test for prostate-specific antigen (PSA). This is not a yes-or-no test. It must be interpreted in the context of the patient’s age and risk factors and the rate of rise, and any cut-off level is arbitrary and will miss some small percentage of cancers. If the PSA test is positive, the next step is biopsy. Typically, 12 needle biopsies are done, 6 on each side. They find cancer in 25% of patients. But if you go back and do more biopsies, you’ll find cancer in 25% more patients. Theoretically, if you could see every cell in the prostate, you might be able to find a cancer cell or two in almost everyone, most of which would never progress or kill the patient. So you have to decide how many biopsies are reasonable. If you find cancer on a biopsy, the next step is treatment, and treatments for prostate cancer are not benign.

>In a large European study, screening resulted in an absolute reduction in deaths from prostate cancer of 7 per 10,000 men screened. We can look at this in terms of number needed to screen (NNS) and number needed to treat (NNT). To prevent one death from prostate cancer, 1,068 men would have to be screened and 48 treated. But here’s the kicker: there was no reduction in all-cause mortality. The overall death rate was the same in the screened group as in the unscreened group.

>If a prostate cancer is localized and low grade, it is reasonable to observe the patient and not treat unless he develops signs of progression. A recent study compared surgery to watchful waiting and found no reduction in deaths. Within 30 days of surgery, 1/5 of the patients had complications including deaths. 2 years after surgery, these long term complications were present:

    17% were incontinent
    81% had erectile dysfunction
    12% had bowel dysfunction

>Popular advice has been “Get tested; it could save your life” but current expert advice is “Don’t get tested; it does more harm than good.” (Mainly from impotence and incontinence.) Emotional anecdotes abound. One doctor wrote an article titled “The New York Times Killed My Patient.” His patient refused PSA testing because he had read that it was not recommended; he developed invasive prostate cancer and died. Another doctor wrote about the opposite experience: his patient had insisted on testing. He was diagnosed with low-grade localized cancer, the kind that can be observed without treating. But he couldn’t face living with the knowledge that he was harboring an untreated cancer. He was afraid of surgery and opted for radiation treatment. He developed radiation proctitis and had rectal pain and bleeding for years. He became impotent and lost bladder control. He told his doctor he would rather be dead than live wearing adult diapers.

>The American Urological Association initially disagreed with the recommendation not to screen, but they have re-considered and issued these new recommendations:

    Don’t screen men under 40 or over 70
    Don’t screen men with a life expectancy of less than 10-15 years
    Don’t screen men age 40-50 who are at average risk
    Consider screening men age 55-69 who are at average risk
    Consider screening high risk men of any age
    Before any screening, doctor should discuss risks and benefits with patient

The U.S. Preventive Services Task Force concludes:

https://www.uspreventiveservicestaskforce.org/Page/Document/...

>Although the precise, long-term effect of PSA screening on prostate cancer–specific mortality remains uncertain, existing studies adequately demonstrate that the reduction in prostate cancer mortality after 10 to 14 years is, at most, very small, even for men in what seems to be the optimal age range of 55 to 69 years. There is no apparent reduction in all-cause mortality. In contrast, the harms associated with the diagnosis and treatment of screen-detected cancer are common, occur early, often persist, and include a small but real risk for premature death. Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit. The inevitability of overdiagnosis and overtreatment of prostate cancer as a result of screening means that many men will experience the adverse effects of diagnosis and treatment of a disease that would have remained asymptomatic throughout their lives. Assessing the balance of benefits and harms requires weighing a moderate to high probability of early and persistent harm from treatment against the very low probability of preventing a death from prostate cancer in the long term. The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.

We are slowly learning to do much less asymptomatic screening, though charities and celebrities are fighting against it. Joe Torre still comes on my TV saying "get screened early and often." The generic advice about "always catching cancer early" being an unequivocal good thing is false. Over-diagnosis and over-treatment are huge problems. For another example, thyroid cancer screening in South Korea has resulted in a massive increase in thyroid cancer diagnosis and treatment but not any decrease in thyroid cancer mortality.

I can go on about this topic, but I won't. I suggest reading that blog I linked to, its fantastic.

Once I learned I had Atrial Fibrillation (AF) I wrote an app that pulls my heart rate data from a normal consumer Polar chestband, then pushes it to a server where I can see it on Grafana.

It was incredibly useful, and helped me learn what the different feelings in my heart mean. I know exactly when I am in AF and when I am not.

There seems to be a huge gap for this kind of consumer grade offering, probably because the medical fraternity is extremely conservative about any technology, even though the alternative is ... nothing.

It's funny though, because I've heard tons of women, many of them progressive, from 20s to 60s, who eagerly acknowledge differences between men and women.

I have to think hard to recall otherwise. Usually it would be in context of a specific argument. Maybe I just don't know any hard core feminists.

I have traveled in some of the most socially liberal circles in the US, and I have to disagree with you about what's popular - or at least make it much more specific. It's not popular to claim that there are significant, biologically-determined, mental differences between men and women. Small differences, cultural differences, and corporeal differences are all accepted. This zeitgeist may still be incorrect, but it's not terrible as a heuristic.

It's not surprising that the US has such a problem of overdiagnosis and overtreatment.

http://www.bmj.com/content/349/bmj.g5432