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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

#61

Post by haltingproblem »

rdedev wrote: post #56
Clent wrote: 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.

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…

This is the negative expectation part of most medical screening that most analyses miss.

- Medical screenings themselves have iatrogenic effects,

- the false positives interventions resulting from screenings have further negative effects and

- finally the true positive interventions don't necessarily prolong life.

All in all very difficult (confounding) tradeoffs that are impossible to quantify and understand especially when the cultural pressure is to do something.

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

#62

Post by twoodfin »

burnished wrote: post #57
twoodfin wrote: post #10

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…

I’m not arguing that all screenings are worthwhile, or that the questions you raise aren’t vital to answer for good medical practice.

I’m arguing that this specific analysis has very little to tell individuals about how they should perceive the value of any particular test. A different analysis—looking at the particular negative outcomes of the testing itself or the reaction to false positives—would be a different story entirely.

What do you think the individual patient should take away from this analysis in actionable terms?

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

#63

Post by kirkni »

throwway120385 wrote: post #18
amanaplanacanal wrote: post #8

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…

There are attempts to address this, “The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions.” See: https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year

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

#64

Post by Gibbon1 »

idopmstuff wrote: post #54
throwway120385 wrote: post #42

Earlier quoted context omitted.

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/can…

Also read that death rates from thyroid cancer hasn't changed in 50 years. Despite huge numbers of thyroid screenings and treatment.

An ultrasound of the thyroid often leads to finding a nodule. Which leads to a biopsy. Which comes out indeterminate. Which leads to a thyroidectomy and life long dependence on thyroid hormones.

Another one is ductal carcinoma in situ. Read somewhere there is a 1% chance that will evolve into cancer. And yet you have women having double mastectomies and chemo for it.

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

#65

Post by LorenPechtel »

kazinator wrote: post #15
kccqzy wrote: 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…

If we decrease premature deaths from any cause, particularly a common cause of premature deaths, we increase life expectancy. Or just what do the authors think life expectancy means? It's an average. Every premature death drags down average life expectancy. If we say that cancer screening has no effect of life expectancy, that's exactly the same as saying that it doesn't prevent premature deaths. If cancer screening…

No, because we might be replacing one cause with another.

That's what they've found with PSA--it kills (via treating things that wouldn't actually have killed the patient) as many as it saves.

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

#66

Post by francisofascii »

slingnow wrote: post #43
francisofascii wrote: post #27

Earlier quoted context omitted.

> 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?

Think of what you're saying. If it was so bimodal that the screened people "gained years" while the ones who didn't "gained 0", then how could the average possibly be 4 months? If we take your theory at face value, on average the screened people would have an 8 month increase.

A very simplistic hypothetical scenario could be, people who get colon cancer die an average of 6-7 years earlier than they would have. And if 5% of the population get colon cancer, then the average gain would be 4 months with screening.

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

#68

Post by arisAlexis »

haltingproblem wrote: post #61
rdedev wrote: post #56

Earlier quoted context omitted.

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…

This is the negative expectation part of most medical screening that most analyses miss. - Medical screenings themselves have iatrogenic effects, - the false positives interventions resulting from screenings have further negative effects and - finally the true positive interventions don't necessarily prolong life. All in all very difficult (confounding) tradeoffs that are impossible to quantify and understand especia…

Do you really believe your third point? That most medical interventions for cancer do not prolong life? Or the word necessarily means your argument is null like "not all interventions prolong life". Yeah , we knew that already. It's never 100%.

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

#69

Post by arisAlexis »

aeturnum wrote: post #58
Clent wrote: 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.

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?

They do impact life expectancy. The English language is a bit confusing to some mixed with statistics. They do not make life greater than average but they do make you closer to the average than if you die earlier.

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

#70

Post by teleforce »

kccqzy wrote: 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…

There's only two things that are certain in this world, death and taxes - Benjamin Franklin.

The main purpose of screening for early disease or genetic condition detection regardless of the diseases or illness, cancer, heart attack, stroke, etc, is not really to prolong longevity, even though that's a wonderful side effect, but the main thing to prevent complication(s) that may arise from the late detection.

Apparently death does not incurs extra and massive medical bills, on the other hand complications will certainly do. If you connect the dots, this suddenly become a really good and plausible conspiracy theory.

It's a shame that most of the health organizations, I'm looking at you American Heart Association (AHA), are really against any form of routine screening [1],[2].

[1] American Heart Association 14-Element Screening (Maron, BJ Circulation 2014):

https://med.stanford.edu/content/dam/sm/ppc/documents/HSuper...

[2] ACC/AHA Release Recommendations For Congenital and Genetic Heart Disease Screenings in Youth:

https://www.acc.org/latest-in-cardiology/articles/2014/09/15...

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