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AI used for skin cancer checks at London hospital

bbc.com

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Re: AI used for skin cancer checks at London hospital

#51

Post by TulliusCicero »

Tade0 wrote: post #42
ircshotty wrote: post #12

Anecdotally, when I had a potential skin cancer checked at a London hospital they were completely ill-prepared. When I came back to Australia, it was checked and immediately removed as an obvious melanoma. Perhaps the idea of Comparative Advantage also applies to healthcare between countries with natural variances to types of disease?

It's even more granular than that. My neighbour who is a doctor moved to another city because that's where he managed to get a spot to train for his field. It appears that he's learning much more there than he would back home because in this country some procedures are rare outside of his current location.

Reminds me of that South Korean trauma surgeon who trained in the states and has pushed for Korea to get US-style trauma centers.

Dude got plenty of experience dealing with gunshot wounds, which probably helped him when that one North Korean defector came over the border, riddled with bullets (you may have heard this story, it was big news at the time). The especially weird coincidence was that the surgeon's mentor from the states was in Korea at the time this happened, what are the odds.

https://abcnews.go.com/International/doctor-north-korean-def...

Re: AI used for skin cancer checks at London hospital

#52

Post by zdragnar »

Scoundreller wrote: post #31
qq66 wrote: post #24

Earlier quoted context omitted.

Sadly, a friend of mine died from this type of problem. He traveled from Ghana to Jordan and fell ill in Jordan, the Jordanian doctors didn't diagnose it as malaria in time to save him because Jordan doesn't have malaria. I'm sure it would have been obvious to a Ghanaian doctor.

Friend did a lot of work in Africa. Got back to the US and starts getting symptomatic and says to himself “I think I got malaria”. Goes to the biggest university hospital nearby he can find. Was initially dismissed but waited it out for the infectious diseases specialist and they quickly agreed with his self-diagnosis. They kept them in hospital for a few days so a parade of clinical students/residents could come by…

Weird. Pretty much every time I've gone to a doctor (in the Midwest US, no less) for an illness, the second question they ask is always "have you been out of the country recently?" just to rule out anything caught from abroad.

Then again, my one experience with a university hospital was pretty shitty, so maybe that's it?

Re: AI used for skin cancer checks at London hospital

#53

Post by kennyadam »

Spooky23 wrote: post #33
andy99 wrote: post #7

99% accuracy in diagnosing benign case This is meaningless. The only thing that matters in this kind of application is false negative rate at some acceptable false positive rate. I assume whoever is working on this knows that, so this is mostly a criticism of the article. That said, this is a horrible use of AI.

It’s really all about the protocol. AI tends to spot things that doctors don’t, and vice versa. Dermatology is also an area being pillaged by private equity and access is poor for many people. I lost my wife to melanoma. She noticed a lesion within days of it appearing, and a doctor saw it within 48 hours and felt it was benign. My wife didn’t accept it and had a plastic surgeon remove it and biopsy, then had a margi…

Similar story: mom had a melanoma removed from her foot. multiple lymph node biopsies and other tests said it had been successfully removed.

She went back once a year for checks for 4-5 years. It was only when she was called into see an oncologist and told an unrelated x-ray lead them to discover she had stage 4 metastatic melanoma (brain, liver, spine, femur, lungs and i’m sure i’m forgetting something) that we found out that they’d only been giving her visual checkups each year, no PET scans or anything else. The oncologist was shocked that the checks were so basic, mom didn’t know she was supposed to have anything else and she was dead in about 8 weeks.

We were told that the form of melanoma only came back like that in 1% of patients and usually simple visual checkups were enough. I have no idea how true that is.

Re: AI used for skin cancer checks at London hospital

#54

Post by fn-mote »

alistairSH wrote: post #20
RobinL wrote: post #16

Earlier quoted context omitted.

The referral is just because a non expert can't be sure. The cost of the referral is relatively small, but the cost of getting it wrong is large. Someone I know recently had a referral - it's pretty light touch, you just get a prompt appointment, and they do a minor op to remove the mole, and send it to the lab for testing. Luckily in their case, it wasn't cancer. But nothing in the process seemed weird, it was just…

Do all cases in the UK start with a GP? No ability to go straight to a dermatologist? And are all dermatologists based out of hospitals? In the US, we'd just go straight to a dermatologist, who would either remove it on the spot, or for a location that's liable to scar badly, refer to a specialist surgeon. For somebody fair skinned with lots of sun damage like myself, it's an annual "ritual".

> In the US, we'd just go straight to a dermatologist

In the US, you would go straight to a dermatologist, because your health insurance plan (or high paying job) allows you to do that.

People with an HMO would begin with the GP, because that's what the plan requires.

Re: AI used for skin cancer checks at London hospital

#55

Post by fn-mote »

alistairSH wrote: post #43
mattlondon wrote: post #30

Earlier quoted context omitted.

Most UK health stuff starts with a GP appointment. Even for private health care, you usually see a GP first (could be a private GP or NHS, in-person or video) and they then refer you to the next thing whatever that may be. ( N.B. that a NHS GP can give you a referral that you use for private treatment) There are some things you can just straight up book an appointment for yourself without a referral from a GP, but 95…

I wonder what % of GP skin consults result in a referral? If it’s even remotely close to a majority, seems like it would be better just going straight to the dermatologist. Sample of one, but every spot (5+ over the past decade) I’ve asked my dermatologist about has resulted in a biopsy and of those several were cancer.

> every spot (5+ over the past decade) I’ve asked my dermatologist about has resulted in a biopsy

Not to be too cynical but... is there a financial incentive for them to do a biopsy?

Of course it might be best practice as well.

Re: AI used for skin cancer checks at London hospital

#56

Post by kennyadam »

osn9363739 wrote: post #46
Spooky23 wrote: post #33

Earlier quoted context omitted.

It’s really all about the protocol. AI tends to spot things that doctors don’t, and vice versa. Dermatology is also an area being pillaged by private equity and access is poor for many people. I lost my wife to melanoma. She noticed a lesion within days of it appearing, and a doctor saw it within 48 hours and felt it was benign. My wife didn’t accept it and had a plastic surgeon remove it and biopsy, then had a margi…

Dude that sucks mate. I had a melanoma taken off last year. It was dormant (stage 0) but had been there for 10ish years. But reading shit like this reminds me that even though I'm probably fine, all I can do is just live my best life. Hang out with my family. Enjoy the things I enjoy and not think about it too much. (and get my skin checks every 6 months :D)

Are your skin checks just visual checks? If so, read my other comment in this thread. It was in UK fyi.

Re: AI used for skin cancer checks at London hospital

#57

Post by ClumsyPilot »

alistairSH wrote: post #20
RobinL wrote: post #16

Earlier quoted context omitted.

The referral is just because a non expert can't be sure. The cost of the referral is relatively small, but the cost of getting it wrong is large. Someone I know recently had a referral - it's pretty light touch, you just get a prompt appointment, and they do a minor op to remove the mole, and send it to the lab for testing. Luckily in their case, it wasn't cancer. But nothing in the process seemed weird, it was just…

Do all cases in the UK start with a GP? No ability to go straight to a dermatologist? And are all dermatologists based out of hospitals? In the US, we'd just go straight to a dermatologist, who would either remove it on the spot, or for a location that's liable to scar badly, refer to a specialist surgeon. For somebody fair skinned with lots of sun damage like myself, it's an annual "ritual".

> Do all cases in the UK start with a GP?

yes, and in the entire GP practice they do not have a single device invented in the 21st century. All the tools they have are a stethoscope, oxymeter, otoscope, blood pressure monitor, basically stuff you might have at home

They can't, for example, do a rapid antigen test or a lateral flow test, ultrasound or anything else you may consider a sign of modern medicine and diagnostics. Stuff countries in Eastern Europe and East Asia have already adopted.

Their diagnostic conclusion is heavily influenced by a spreadsheet that lists statistic probability of illness for different demographics, as advised Mckinsey.

If you happen to have a serious condition but fall into a group that is 'suppose to be' healthy (young man with Pneumonia) you will be bounced and told to go home until your condition deteriorates.

They will gatekeep you from getting an X-ray. When your condition deteriorates and is incontrovertible you will be taken seriously, but now you need serious treatment instead of a quick round of antibiotics.

Popular opinion in Britain is that the NHS is great, but it's overburdened. But it's fallen behind - management practices are archaic, diagnostics is poor, and there is lack of accountability and first reaction to medical errors is to brush off the patients / victims.

Over the past few decades, the first reaction of NHS management is to cover up their mistakes.

Just read the Wiki page about Great Ormond Street Hospitalk, the hospital that treats the country's most severely ill children:

> Great Ormond Street Hospital was involved in a scandal regarding the removal of live tissue and organs from children during surgery and onward sale to pharmaceutical companies without the knowledge of parents in 2001

Or the case with bone surgeon Yaser Jabbar, at the same hospital, who caused severe harm to 22 children and the hospital fought the parents and brushed issues under the carpet. Issues like removing wrong organ and getting length of a foot wrong by 20 centimeters. He operated on 700 children before someone put a stop to it

Re: AI used for skin cancer checks at London hospital

#58

Post by degamad »

andy99 wrote: post #7

99% accuracy in diagnosing benign case This is meaningless. The only thing that matters in this kind of application is false negative rate at some acceptable false positive rate. I assume whoever is working on this knows that, so this is mostly a criticism of the article. That said, this is a horrible use of AI.

> The only thing that matters in this kind of application is false negative rate at some acceptable false positive rate.

It sounds like they are inverting the scenario here. The question is not "do you have skin cancer?", it's "can you safely go home without seeing a doctor?".

For this new question, we set the acceptable false positive rate to zero (we never want to send a real cancer case home), and determine the false negative rate (we accept that some benign cases will be seen by a doctor).

The reason for the interest in identifying benign cases, rather than trying to identify the positive cases, is that it improves the situation for everybody: benign cases identified by AI are sent home almost immediately, everyone else has a shorter waiting time, so benign false negatives can be assessed more quickly by the doctor and given the all clear, and more time is now available for spending with the real cancer cases.

The numbers they're citing are 7000 cases with 5% real, so 350 real cancer, 6650 benign. If we can accurately say that 6500 of those benign cases are benign without wasting the doctors' time, then we're down to only 500 people needing to see a doctor, which is a huge improvement for everyone.

Re: AI used for skin cancer checks at London hospital

#59

Post by cmcaleer »

jampekka wrote: post #26
frereubu wrote: post #18

Earlier quoted context omitted.

What do you mean by this being a "horrible" use of AI? (Although as another commenter has mentioned, this should more properly be called ML).

It's quite easy to correctly classify 100% of benign cases as benign.

If it's so easy, then why do people die from having lesions misdiagnosed as benign?

Even if the success rate of the human eye was in the 99.5%+ range, why not have an extra sanity check from an AI model?

Re: AI used for skin cancer checks at London hospital

#60

Post by cmcaleer »

TulliusCicero wrote: post #51
Tade0 wrote: post #42

Earlier quoted context omitted.

It's even more granular than that. My neighbour who is a doctor moved to another city because that's where he managed to get a spot to train for his field. It appears that he's learning much more there than he would back home because in this country some procedures are rare outside of his current location.

Reminds me of that South Korean trauma surgeon who trained in the states and has pushed for Korea to get US-style trauma centers. Dude got plenty of experience dealing with gunshot wounds, which probably helped him when that one North Korean defector came over the border, riddled with bullets (you may have heard this story, it was big news at the time). The especially weird coincidence was that the surgeon's mentor f…

Similar vein: during The Troubles, physicians in Belfast got particularly good at dealing with managing cranial pressure and making skull plates from bar bombings, and dealing with bone repair from kneecap punishment shootings

https://www.nytimes.com/1987/08/18/world/ulster-doctors-lear...

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