Comment by burnished | Hacker News Reader

Comment by burnished | Hacker News Reader

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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.

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?

I see! Who are you arguing against? The article gives zero indication that any of this is actionable, seems to advocate not changing anything with respect to your regular medical care.

But to answer your question; 'nothing'. This is interesting but it isn't actionable.

I thought the article was pretty sloppy in its description of the results. Here’s the lede:

Most cancer screenings don’t ultimately give someone extra time beyond their regular lifespan, according to a new review of clinical trials involving more than 2.1 million people who had six kinds of common tests for cancer.

This is trivially misreadable as “an individual with cancer who catches it early via screening doesn’t see appreciable lifespan benefits”, which is decidedly not what the analysis purports to show.

The use of “someone” makes me question whether the author of the CNN article understood the analysis in the first place. The phrase “extra time” is also particularly strange, since it’s something of a loaded term in the world of serious disease. I don’t get a cancer screening because I want “extra time”. I look to get on the early-access list for an unapproved chemo drug because I want “extra time”. The article goes on to frame the results in a way that easily could be misunderstood to be the benefits for sick patients to early detection rather than the average benefits across the entire population, sick and healthy.

Ok, you've convinced me. This article could have given more information and context so that folk without that benefit would walk away with a more nuanced understanding of screening and its seemingly paradoxical costs. A short article that glosses over the details was not appropriate for this subject. Seeing plenty of evidence for that in this comment section.

If you add "on average" that's exactly what the original paper says. The averaging is over "someone who doesn't get cancer but died of screening complications", "someone who got false positive and decreased their lifespan with unnecessary treatments", and of course "someone who got true positive and increased his lifespan due to treatment". Are you sure you will be in the last group?

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