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Comment by jacquesm | Hacker News Reader

But: that surgery is not without risk, and if there are no symptoms there is a fair chance that there never will be symptoms. Depending on your age and your genetic make-up you might be more or less at risk. There is such a thing as spontaneous remission and so on.

So no, I'm not 'basically giving up', and no you won't die anyway (well, unless you take that in the most abstract way), in particular likely not from cancer.

Even for those cancers where we do screen (such as for instance breast cancer) it is not a given that the increased frequency of detection has led to better patient outcomes.

But once you know someone's genetic disposition increased frequency of testing might be advantageous.

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Again, absolutely absurd. Many cancers have no symptoms until it’s too late. Do you even understand this? At that point the choices for treatment are extremely limited.

Even breast cancer needs x-rays to detect lumps, not detect cancer. You need a subsequent biopsy to differentiate. That’s our technology right now. If we had a blood test to detect cancer, not lumps, it’s game changing.

Maybe after a generation of early detection, new outcomes will emerge if we can detect the most deadly cancers early. You’re taking old studies and applying them to new technologies and saying “it won’t work.” It’s ridiculous that you are doing this.

Even if you detect cancer you will still need a biopsy to figure out which bits are the cancer and which bits are just 'lumps'.

Yes, it is a game changer, but it is not the kind of game changer that this is being made out to be here and mass screening using this method is not going to lead to improved outcomes.

As an extra tool in the toolbox of the diagnostician it is very useful.

It’s pretty easy. If blood test says “liver cancer positive. Colon cancer negative.” you check the liver for cancer. No need to check the colon for cancer. No need to scan the entire body for lumps.

Not that easy. “Check the liver for cancer” has lots of risks: surgery and the resulting tissue injury.

I’m generally inclined towards the position of more testing....but there are very real tradeoffs to any of the interventions that a blood test could prompt.

Also, you might have identified liver cancer that came from the patient's kidney. Or a colorectal cancer that came from the patient's liver.

What happens when it turns out that most of the people having surgery don't have cancer? Because that's the reality of tests with a .5% false positive rate if less than 1% of the population is positive.

I don't see why early detection means early treatment. What if after detected, the illness is monitored instead. If it then gets to a point where the treatment is no longer considered risky for the stage of the illness, then the treatment can proceed.

It would also give the person the opportunity to change lifestyle to perhaps prolong the time that the illness will become a problem, or perhaps halt its progress altogether.

Additionally, the person who is aware of such illness, can keep an eye out for symptoms related to it, that might otherwise be ignored as something else. At which point normal cancer treatment can progress.

This is a tricky bit. There is a lot of interplay here between medical professionals and the general public, and not all of that is either rational or ethical. But absent symptoms non-treatment is better than treatment.

Data about unnecessary procedures is relatively plentiful, which is of course sad, whether that's driven by commercial incentives or the need for 'something to be done' is not something that I have any grip on but it certainly is problematic.

Sounds to me like the issues with this early detection is more of a regulation and education problem then. That could be fixed.

> surgery is not without risk, and if there are no symptoms there is a fair chance that there never will be symptoms

Another incredibly irrational argument.

If the risk from surgery outweighs the risk from cancer it it should not be performed.

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