U.S. cancer death rate has dropped by a third since 1991
wsj.com
wsj.com
Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great.
The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence while receiving cancer therapy.
Point being, we don’t want to lose site of the ultimate goal, which is preventing cancer as much as possible.
I say this to highlight three things:
- Physicians routinely ignore things they shouldn't. Be your own advocate and research the things your doctor tells you, especially the things they believe are just worth watching.
- There is little to no awareness in the public over prostate cancer.
- Surviving isn't always a good metric. In my dad's case, surviving was a promise for a slow and miserable death.
https://www.discountedlabs.com/choose-a-test
Or use your insurance's telemedicine portal to get a random doctor on the line and get them to order the tests.
For many people this will be out of reach but for those earning a comfortable salary, you can pay out of pocket for X-ray, CT, MRI, etc and they're "only" like $500-2,000.
I share your concern but I think there is no definitive advise about how to prevent these horrible outcomes (besides the usual "do regular exercise", "lower sugar consumption", "avoid stress", etc.) Did you find anything more concrete?
Definitely worth doing:
- Don't smoke anything that burns or chew tobacco.
- Depending on your age and sexual experience, get the HPV vaccine.
- Investigate your family history of cancer. If there are multiple people on one side of the family getting cancer (particularly breast + ovarian + pancreatic, or colon + gastric) then consider getting genetic testing/discuss with a doctor.
- If you have certain ethnicity, just get a genetic test, pay for it if you have to (Mainly for Ashkenazim)
- Avoid consuming herbs/plants which contain aristocholic acid.
Probably worth doing:
- Reduce red meat consumption (observational data and plausible mechanism)
- Reduce or eliminate alcohol (observational data and plausible mechanism)
- Eat highly processed meats rarely (charcuterie etc)
- Make sure to get sufficient fruit and vegetables and fibre. This may offset the risk of red meat consumption.
- Take vitamin D, particularly if your levels are low or you live far from the equator. Don't take intermittent megadoses, take some every day. This seems less useful if you are overweight.
- If you are female, then have children and breast feed if possible. Longer durations of breastfeeding are more effective. Having more children is also more effective. (One may balk at this, but there is a lot of supportive data about long term breast cancer risk)
- Exercise. There is only (a ton of) observational data, but exercise is so universally beneficial. Going from nothing to a bit of exercise has a bigger impact than going from a bit of exercise to a lot. Most people over do it. Do cardio and resistance training. Try to do something every day.
- Avoid supplements designed to have antioxidant properties (based on data suggesting harm from controlled trials, and no clear benefits).
Maybe:
- Move closer to the equator.
- Avoid obesity (note this is complicated... obesity itself may not be the problem. Obesity is protective for some cancers, and this varies by age).
- Get checked for Hepatitis B and C, particularly if you have risk factors or were born/grew up in an endemic country.
- If you get chronic reflux or heartburn, consider pushing for your doctor to investigate further (usually a gastroscope) and do an H pylori test. This is particularly if you were born/grew up somewhere with a higher chance of exposure. If you have it, take the eradication therapy.
- Try to maintain metabolic health. This is highly personal and hard to give general advice around. Eg. South east asian/Subcontinental people can be metabolically ill despite not being overweight. Investigations here could vary from checking for insulin resistance (eg HOMA-IR calculation from a blood test), gettinga DEXA scan to look for visceral fat, or in the extreme case continuous glucose monitoring to look for foods which really spike your blood glucose. The interventions are exercise, sleeping well, and potentially avoiding foods which spike your sugar (or scheduling exercise after eating such foods). Soon we will have a better idea if certain personalised dietary interventions may be beneficial.
Can you elaborate on
- risks for Ashkenazim
- which plant families actually contain notable amounts of AA? I.e., do all ginger types pose a risk?
About the AA, it seems to be herbal supplements that are the primary concern (see https://www.accessdata.fda.gov/cms_ia/importalert_141.html). Normal ginger is fine, wild ginger is the problem. Wild ginger isn’t used in cooking as I understand it.
Can you elaborate on how you see this being actionable? Perhaps an increased cadence of screenings?
And that's the problem. If you did a test and saw something & then immediately eradicated that prostate cancer, what if it was going to be one of the ones that wouldn't have caused you real harm during your natural life? In that case the likelihood of the treatment causing more damage to you than the cancer itself is high. And predicting which are which is improving but still imperfect.
However, We’ve seen this before with prostate and breast cancer where early and often screening leads to not only false positives but undue stress on patients. Furthermore, catching a nonaggressive prostate cancer 2-5 years early may lead to the same outcomes as catching it when certain things like PSA are detected to be increasing. But you may drastically affect one’s quality of life. It can at times be a difficult balance.
We see more and more elderly patients being treated because they are living longer. For many though, “waitful watching” or “active surveillance” is the correct clinical decision and always is up to the patient.
Finally, while prostate cancer isn’t as publicized as breast cancer (we’re trying!). It is a well known cancer and there is awareness of it.
He was ordering psa tests but just ignoring the velocity ?
I had similar discussion on HN last week
They find spots on the pancreas by accident all the time. It is incredibly common. I know, I have one: I got an abdominal CT scan while getting something unrelated checked. Some of these go on to be cancer, and sometimes they know it is precancerous. The cyst I have wasn't immediately precancerous. Now I get regular MRIs to check on it. Since I have no symptoms, there is really nothing else to do.
That lack of symptoms, though, is a real issue. If you have a little bit of cancer and no symptoms and you don't find it accidentally, it is going to be much, much harder to detect early.
But we just aren't there yet.
And unfortunately, this is the case for a number or screenings - and is a downside of some routine screenings. I keep hoping that once we understand a variety of cancer better, this will improve.
FWIW, mine was found on a CT scan and all the monitoring was on an MRI - and both expensive (thankfully the out of pocket costs for healthcare here are low) and uncomfortable for some folks.
Diabetes, obesity, cancer, depression rates all exploded in unison starting around 1970. Why does everyone ignore the massive implications of this? It means there’s something we’re doing that is killing millions of people but everyone brushes that aside and supports treatments rather than figuring out what happened in 1970 that is actually causing it.
There are a trillion pet theories but nobody wants to do research to figure out. Nobody advocates for this research. What the hell
For a very long time people have been going to the doctor when they feel sick. Oliver Cromwell consulted with doctors and was convinced that he was very ill. Later on we understand that he had bipolar disorder. When people feel sick they consult doctors and have been doing this for hundreds of years. An illness like diabetes presents very specific symptoms and doctors have been aware of diabetes for a very long time. The same is true for many kinds of cancer. And even mental illnesses as I have pointed out were recognized as medical ailments by people for hundreds of years. It wasn’t that we suddenly started diagnosing these things.
Also, there are communities of people who do not develop heart disease or insulin resistance or depression or cancer. The common thread between every community like this is that they live outside of the modern world and do not eat modern foods. They live in an old way. This is well documented. Yet another insane data point that people somehow ignore. There are literally people out there who basically do not get cancer heart disease or diabetes and nobody seems to think it’s important to get to the bottom of this, people like you who leave snide comments and contribute nothing. A worthless parasite.
So there are communities that live in the old way and do not get any of these diseases. We see that these diseases exploded for us around 1970. It couldn’t be more obvious.
You can have diabetes and high blood pressure and cancer and not have symptoms. That's why we screen for them. If you have symptoms, it is no longer screening, it's diagnosing. A lot more screening is happening now than before the 70s so we are obviously finding a lot more disease.
I'm not arguing against the fact that lifestyle and environment play a significant role in increasing cancer, but that doesn't change the fact that dramatically increased screening rates have contributed to dramatically increased disease diagnoses.
> There are literally people out there who basically do not get cancer heart disease or diabetes and nobody seems to think it’s important to get to the bottom of this
I think there is probably more research these days into causes of cancer than ever before.
> people like you who leave snide comments and contribute nothing. A worthless parasite.
Really?
- the American Cancer Society didn't start promoting cervical cancer screening until the 1960s [1] - mammography was first recommended officialy in 1976 [1]
Screening was just coming of age 50 years ago so it's no surprise we started to find something once we started looking for it.
[1]: https://www.cancer.org/treatment/understanding-your-diagnosi...
https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac...
Looks like they went from 400 to 500 then back to 450 since 1975. It's trending down.
And you'd need to correct for age distribution to make sure it's not just the population having older people and thus higher chance of cancer in a given year.
It's one of those things were effects are so far ahead in time you don't really realise they're there until you're 60 and cancer kills you. And then it's "oh well, old people die" or "he had too many beers"
I was striving to be vegetarian for more than a decade (avoid red meat, low fat diet) because of the "science", before I started developing issues.
Good luck in finding research to back this up, the trend seems to be going all towards vegan highly processed food. I was impressed when mainstream science recently reluctantly backtracked on animal fat and meat.
The USDA is still to update recommendations of course.
So has life expectancy!
Cancer is ultimately a numbers game & you roll the dice every single day. Life expectancy in the US today is ten years longer than it was in 1970. All those extra dice rolls add up. Ideally you could correct for this effect, but it’s not clear we know enough about how cancer risk accumulates over time to do this correctly.
https://preview.redd.it/clcfr7xw08y31.jpg?auto=webp&s=6dc026...
It was around that time when modern society became remarkably efficient at poisoning or completely destroying ecosystems
This sort of hyperbole- "killing millions", "trillion pet theories"- is needlessly alarmist.
No, because the death rate is measured at the population level, not at the incidence level. Fewer people are dying today of cancer than 30 years ago.
The only way that detection bias could impact that outcome is if you make the argument that a large number of terminal cancer cases were going undetected in 1991 at the time of death.
no. being able to detect cancer doesn't mean people are getting tested twice a year for their whole life. for example, you wouldn't have routine cancer screenings for children, but sometimes they get cancer, and on those occasions it'd be nice to have better treatment options.
No disagreement with you there. By "perfect screening" I assumed a "perfect" patient set where problems brought up at annual checkups lead directly to tests which lead to detection, but perhaps that's a naïve assumption to the point of uselessness.
Still, I think it's easy to write off screening advances as skewing the data set vs. actually saving lives, when they do in fact help people that otherwise could have been much sicker.
i mean maybe not in the usa but in sane places
A person can't die twice, so if heart disease gets them first, then they won't die of cancer.
You could hardly have picked a worse counterexample. Deaths from heart disease have fallen dramatically over that time period, even faster than cancer deaths have dropped.
Deaths from strokes - which at one point equalled deaths from all cancers combined - have fallen as well, although much of that drop occurred before the time period in question.
Deaths from diabetes are actually quite few in number compared to heart disease and cancer. They've sort of plateaued over this time interval, which isn't good news, but hardly the alternate explanation for the reduction in cancer deaths.
Now, there is one big cause of death which we haven't addressed: COVID-19, which causes about 3x the number of deaths as diabetes, and over half the number of deaths as all cancers combined. But that only began in 2020, and this data shows a decrease across the entire interval, so it's not relevant here.
So, the cause of death won’t be “diabetes”, it’ll be heart attack, stroke, chronic infection, something like that.
Similar to AIDS in that it doesn’t kill you directly (not that we know that juvenile diabetes is a thing, and we routinely test for it), it just makes any other health challenge much dicier.
It's not like the CDC doesn't know this. They understand how diabetes works; that's reflected in the tabulation of data. It's still incorrect to say that the drop in cancer deaths is explainable by the increase in diabetes deaths, not the least because age-adjusted diabetes deaths decreased during most of that interval.
It would be nice if we could stop advanced cancers but at least we're getting better at prevention.
I lost my dad to cancer last year. It's a horrible disease. I really had no idea how horrific it is. My dad had a year longer than his initial prognosis thanks to new immunotherapy drugs.
Yes. I expected to find that the decline in smoking has also lead to the decline in fatal cancer — and there it is. Still a good thing.
@15:40 early detection is the way to eliminate cancer: https://youtu.be/iUqgTYbkHP8 https://youtu.be/iUqgTYbkHP8?t=15m37s
The reason people die from pancreatic cancer when they get it is because we can’t detect it early.
The article provides no numbers about cancer rate dropping. Yet the false association between the two ideas is so strong that even the authors themselves seem to theorize that the cancer rate itself is dropping because people don't smoke as often now.
Conflating those two concepts seems like a Very Bad Idea
The rate of people getting cancer in the US is a different question, but presumably it’s been increasing due to the aging population independent of other causes. https://www.statista.com/statistics/241494/median-age-of-the...
It's different for e.g. Flu, where more testing = more detection of an illness that would not necessarily have become serious, had it gone undetected.
What if they detect a slow growing cancer that wouldn't have become a problem before you hit the age of 150? Not every cancer is aggressively trying to eat its host whole.
https://en.wikipedia.org/wiki/Rituximab
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398399/
Flashier, and something I've already talked about, is CAR T-cell therapy, the first generations of which were approved in 2017. This therapy has definite risks of severe side-effects, but it can result in complete remission of cancers that have survived multiple lines of chemotherapy, as happened with me.
https://en.wikipedia.org/wiki/CAR_T_cell
Immunotherapy isn't just promising, it's here, and, because of it, so am I, but even more exciting is that it gives us more avenues of research to build off of known-useful therapies.
It is kind of scary to me that drugs these days have such long regulatory lead times that a drug developed in 1997 is just now being entered into treatment regimens.
I understand why that is (the Thalidomide tragedy stuff and like that), but I also clearly remember reading an article ~10 years back that asked why cancer treatment seemingly hadn’t made any leapfrogs since the ~70s, and the answer was back then they could aggressively iterate on treatments.
It's not that new in cancer therapy, with R-CHOP (the CHOP protocol plus Rituxan) apparently being introduced in the early 2000s:
> The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991
which mixes all meanings together (smoke → cases ; detection → fatality ...). So it's just "decreased number of deaths".
(Well, on the other hand, it makes sense that more factors impact such "final" result.)
From the CDC:
> In the past 20 years, from 2001 to 2020, cancer death rates went down 27%, from 196.5 to 144.1 deaths per 100,000 population
https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-de...
HPV is merely correlative, as well. That's basically how all endogenous cancers work. With Epstein-Barr Virus the association is quite strong, though the incidence of EBV-induced cancers doesn't seem to be quite as large as HPV--~1% vs 2-3%.
And poster's own link doesn't claim some of the viruses are actually an oncovirus.
That said, I don't think that pushing vaccines (either in research or into arms) for the listed diseases would be bad.
OP is talking about more vaccines as possible future mitigations - more vaccines as in new vaccines, not more vaccinations using existing ones (though that wouldn't hurt either.)
"[Epstein–Barr virus] has also been implicated in several other diseases, including Burkitt's lymphoma, hemophagocytic lymphohistiocytosis, Hodgkin's lymphoma, stomach cancer, nasopharyngeal carcinoma, multiple sclerosis, and lymphomatoid granulomatosis.".
https://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus#Rol...
Some of the articles cited in that section have sentences like "1 out 2 (50%) adult analyzed cases was positive, with 50% of stained tumor cells (this patient was a 22 years old female, coming from Napoli);" that don't follow the necessary standard of evidence. I continued to skim the linked articles and they are all clearly correlative.
https://news.ycombinator.com/item?id=34367905
"...several herpes viruses, which two-thirds of us carry, induce tumors in animal species."
https://pubmed.ncbi.nlm.nih.gov/4353788/
"A herpes virus causes Burkett's lymphoma in humans; another causes nasopharyngeal cancer in humans."
The link between hepatitis and liver cancer is rock solid, to the point chronic hepatitis is the leading risk of liver cancer.
Sure, it's great we got good at keeping incredibly sick people alive, but it'd be better to avoid it in the first place.
> The HR (reference group was never smokers) was 1.14 (95% CI 1.03–1.25; P = 0.010) for ever smokers, 1.24 (95% CI 1.08–1.43; P = 0.002) for starting smoking at ages < 17 years, and 1.23 (1.07–1.41; P = 0.004) for starting smoking 1–4 years after menarche.
However smoking rates have gone down massively since the '50s:
https://news.gallup.com/poll/237908/smoking-rate-hits-new-lo...
https://www.researchgate.net/figure/Trends-in-the-prevalence...
Also something that absolutely does seem to raise your risk of breast cancer is chest x-rays:
https://breast-cancer-research.biomedcentral.com/articles/10...
> Ever/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene.
Digital x-rays have largely replaced film, and they can reduce radiation exposure by 80-90%.
So I'm not sure one way or the other.