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Most cancer screenings don’t extend life, study finds

cnn.com

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Re: Most cancer screenings don’t extend life, study finds

#51
post #47

(Note: very US centric comment here) I’ve become skeptical of the motives behind any article that seems to seed some level of doubt about health screenings and any preventative or treatment measure that involves the healthcare system itself. They always stink of the insurance and for-profit healthcare system and their aversion to paying anything out beyond the absolute bare minimum to get people the care they need. I…

Ya exactly, I’ve had 2 family members catch pancreatic cancer early and be cured. It’s typically the most fatal cancer.

Re: Most cancer screenings don’t extend life, study finds

#52
post #6

Earlier quoted context omitted.

They are conflating cancer survival rates with longevity. When has someone claimed that treating cancer would increase life expectancy above the average? This is a dangerous article. People don't need more reasons to avoid cancer screenings.

It looks like they were comparing a group that got screening vs a group that didn’t get screening. If the group that got screening didn’t live longer than the group that didn’t get screening, that seems like a lot of wasted dollars.

FTA: "Overall cancer mortality worldwide has decreased significantly, falling 33% since 1991, in part due to early detection as well as advances in treatment and declines in smoking."

Re: Most cancer screenings don’t extend life, study finds

#53

Earlier quoted context omitted.

The paper [1] is more well written and clear than the CNN article. They were comparing the aggregate life expectancies of people who went through regular screenings vs those who did not, and there was near zero difference except for colorectal screenings where the difference was about 4 months of difference. The paper is indeed presenting strong evidence that regular screenings have minimal value. [1] - https://jaman…

> except for colorectal screenings where the difference was about 4 months of difference That sounds, uh, significant. So to clarify, does that mean people gain 4 months on average by getting this screening? Those who get the cancer gain years, and those that don't gain 0, so the average is 4 months?

[deleted]

Re: Most cancer screenings don’t extend life, study finds

#54

Earlier quoted context omitted.

> Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. Claiming that there are missing elements that could possibly turn the equation in favor of screening is cause for further research and analysis. You…

Given that screening is arguably benign for most people, you could argue that we continue screening while we gather more information. But you do whatever you want to do. I'm just pointing out that it's really premature to cancel all of your screenings based on the idea that it doesn't add any years to your life. That may be true, but there's more to a life than how long you live.

> Given that screening is arguably benign for most people

You're 100% wrong here, this is not a given. Prostate cancer screenings, which are very common, can have both false positives as well as findings of cancer that is and would remain completely benign. These can both lead to unnecessary treatments that cause serious negative health effects, including incontinence and erectile dysfunction.

https://www.cdc.gov/cancer/prostate/basic_info/benefits-harm...

Re: Most cancer screenings don’t extend life, study finds

#55

Earlier quoted context omitted.

Oh no! But what if we run the test a third time?

You have exhausted your region's capacity for testing. Game over womp womp

Well if I only have to re-test 1% of cases maybe I can even use a more accurate test the second go-round.

Re: Most cancer screenings don’t extend life, study finds

#56
post #6
post #3

This is the pertinent quote: > “Cancer screening was never really designed to increase longevity. Screenings are really designed to decrease premature deaths from cancer.” Explained another way, Dahut said, if a person’s life expectancy at birth was 80, a cancer screening may prevent their premature death at 65, but it wouldn’t necessarily mean they’d live to be 90 instead of the predicted 80. Personally I think this…

They are conflating cancer survival rates with longevity. When has someone claimed that treating cancer would increase life expectancy above the average? This is a dangerous article. People don't need more reasons to avoid cancer screenings.

I think the consensus on cancer screening is stil not fully there? Came across this video by a cardiologist a long time ago

https://youtu.be/yNzQ_sLGIuA?si=fUttSVFQjsrIqc-p

I guess the main gist is that screening is not completely benign and a positive screen might lead to more interventions for what in the end could just be a benign tumor. Then there's the other point of detecting it late in life. Like treatment for cancer might not make much sense if you are already 89 years old

Re: Most cancer screenings don’t extend life, study finds

#57

I am skeptical of the implied lesson of this analysis—and it is a meta-analysis of other research, not an original study. Just take as given that the analysis is correct, and screening for rare Disease A on net has no effect on life expectancy. Almost no one actually gets Disease A, but everyone is screened for it, and that has some diffuse cost to life expectancy: Screen enough people enough times and someone will d…

The article quotes some one saying this isnt a call to abandon screenings in totality.

The risks are not 'car crash from doctors visit' they are 'got cancer from imaging', 'unnecessary surgery and complications', etc - the risks are directly related to the screening.

This is an active topic in medical ethics as well which you seem ignored of (no offense intended), given that you are framing this in terms of insurance or public health from the perspective of a beaurocrat - the bottom line is that if your screening is more likely to kill or maim you than the thing being screened for then that screening shouldn't be standard practice, and when it is less clear cut than that you still have to make a determination about which screenings make sense to perform on a population level.

That is something that a caring doctor has to think about as part of their duty, there is the very real potential to do much more harm than good by being thoughtless about the interventions you perform.

Re: Most cancer screenings don’t extend life, study finds

#58
post #6
post #3

This is the pertinent quote: > “Cancer screening was never really designed to increase longevity. Screenings are really designed to decrease premature deaths from cancer.” Explained another way, Dahut said, if a person’s life expectancy at birth was 80, a cancer screening may prevent their premature death at 65, but it wouldn’t necessarily mean they’d live to be 90 instead of the predicted 80. Personally I think this…

They are conflating cancer survival rates with longevity. When has someone claimed that treating cancer would increase life expectancy above the average? This is a dangerous article. People don't need more reasons to avoid cancer screenings.

Why would it be dangerous for people to avoid cancer screenings if those screenings do not impact life expectancy? You might want to know if you have cancer, but doesn't this suggest that...there's no baseline argument to suggest that all people undergo those screenings?

Re: Most cancer screenings don’t extend life, study finds

#59

Earlier quoted context omitted.

It looks like they were comparing a group that got screening vs a group that didn’t get screening. If the group that got screening didn’t live longer than the group that didn’t get screening, that seems like a lot of wasted dollars.

Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. What if some people in the group that didn't get screening had fewer high-quality years? It might simply be that the last 5 years of life for people wh…

I'm going to start with one assumption that I believe is true: higher mental and physical stress will kill you faster.

If two statistical people both get cancer, one gets screened and potentially treated, and the other doesn't and they both live to 80, I would rather be the person that doesn't get treated.

A regular schedule of treatments is only better than a hail mary if you actually get more longevity from it, otherwise it's just more pain for the patient. At least with the hail mary, I only spend a short time feeling horrible before dying. This is most likely why doctors don't opt for treatment more than the average.

https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...

Re: Most cancer screenings don’t extend life, study finds

#60
The actual study is (after some URL sanitization):

https://jamanetwork.com/journals/jamainternalmedicine/fullar...

and I do not like it. It suffers from what I consider an extremely common problem in statistics: if you define the question poorly, then your output is garbage no matter how fancy or careful your analysis is.

We can start with the beginning of the abstract:

> Importance Cancer screening tests are promoted to save life by increasing longevity, but it is unknown whether people will live longer with commonly used cancer screening tests.

I have never heard of a doctor suggesting a cancer screening by saying "this might save your life by increasing your longevity." What does that even mean?

So let's try to figure it out. The paper uses the terms "lifetime" and "longevity" somewhat interchangeably, and it does not define either term. The best I can figure out is that, for an individual deceased person, they have a certain lifetime in days from when they were screened to when they because deceased. (Or a certain lifetime in days from birth to death, and I'm not sure this distinction matters.)

Great, but this is only for one patient. What about for a sample of patients or for a population in general or for the probability distribution of lifetimes of a given patient conditioned on whether they do or do not get screened? The article does not say, and a single "lifetime" number is not a probability distribution. Is it an expected value or a mean? A median? A mode? No comment.

One of the headline conclusions is:

> Based on the observed relative risks for all-cause mortality and the reported follow-up time in the trials, the only screening test that significantly increased longevity was sigmoidoscopy, by 110 days (95% CI, 0-274 days) (Table 2, Figure 2)

Figure 2 is useless. Table 2 is somewhat informative, and it has a column for relative risk of all-cause mortality and a column for lifetime gained and its 95% CI. But WAIT A MOMENT! The only way you can know the lifetime of an individual patient is if they're dead. If they're dead, their risk of all-cause mortality by the time they died is 100%. That's not 100% plus or minus something with some relative risk thrown in -- they are dead enough to have a date of death so that someone could compute their lifetime! Or maybe "lifetime" means something else, and the authors didn't bother to figure it out and say what they meant. So what exactly is this paper even analyzing?

So I suspect this is a meta-analysis of studies, of which some may or may not have been high enough quality to define their terms, and probably several of which used "lifetime" to mean some estimated property of a distribution, and this meta-analysis completely failed to figure out what the included studies were talking about.

So I rate this meta-analysis as almost entirely useless, on account of it failing to actually analyze anything that makes sense.

So I don't think any conclusions can be drawn. Although... ACS puts the lifetime risk of colorectal cancer at 1:25 or so. So one might naively translate a 110-day lifetime extension for everyone to a 110 day · 25 = 2750 day = ~7.5 year expected lifetime extension for people who actually get colorectal cancer. Sign me up -- 7.5 more expected years of life and presumably more than that of quality life years in the event I contract a not-particularly-rare disease sounds like a pretty good deal. (Colorectal cancer screening is not all that unpleasant, and I apparently only have a 96% chance of the screening being unnecessary.)

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