The framing of expanded early detection as "Silicon Valley's quest to live forever" seems uncharitable.
> My mum discovered she had breast cancer through a routine mammogram.
These two are not the same thing. We do mammograms, and only in women over a certain age, because they're a high risk population.
CT scans, especially chest CT scans, expose you to huge amounts of radiation. The odds that you randomly stumble on a super low-incidence tumor is dwarfed by the fact you're exposing people - especially children in your case - to large doses of ionizing radiation.
A chest CT scan smacks you with 7 mSv which is about the same as spending an hour at Chernobyl, or 7X the EPA annual dose limit for radiation exposure. [1]
Lest we not forget Bayes theorem. We only do tests on people who are likely to have the condition otherwise the risks associated with a false positive outweigh the benefits of early detection.
> while average Computer Tomography (CT) scan would equal to 105 BED or one hundred thousand eaten bananas
https://etn.redmud.org/banana-equivalent-dose/#:~:text=The%2....
What nobody has suggested is that "rich tech folks" are having lots of x-rays in a quest for early detection.
(This is poorly phrased on my part, btw - not trying to attack you, trying to show a chain of logical thought).
> We do mammograms, and only in women over a certain age, because they're a high risk population.
raises hand I'm a cis male who had to go for a mammogram (got some weird looks in the waiting room). It's not just for cancer screening high risk women.
Never get more radiation exposure that you need to but also the EPA numbers are in addition to normal, basically unpreventable, exposure. 7 mSv is not 7x the total.
Totally agree.
Also, we should be encouraging those with the means to spend on medical technology! It'll bring down the cost for everyone over time.
I would imagine this is downplayed because us insurance companies are generally not huge fans of expensive preventative care procedures with little evidence base (and to the last point, fair). And additionally I’d imagine physicians and radiologists have some worry about the potential liability of things being incorrectly being labeled as benign or to be monitored and turning into malpractice claims.
So the evidence base gets established by rich people who can afford to cut insurance out of the equation and hire physicians that are open to these kinds of procedures. Unfair and something I’ll be very bitter about if I ever die of a cancer that could have been detected earlier if I was lucky enough to get imaged in the area for whatever reason.
Sure this but also: the evidence does exist and it will be a huge expensive, inconvenience, and maybe dangerous unnecessary tests/surgery for >90% of the population. Really someone has to do the math to determine the inflection point; X% of people will get some early cancer/positive result found early, Y% will get a false-positive and undergo expensive and unnecessary procedures, and Z% will still get a false result but have cost some amount of money and time.
From a public health perspective, this is unlikely to be the best-next-thing because so many people die from more preventable diseases/things or lack access to health care at all. Is it a obvious service for the upper class in SF? Certainly, because the market thinks they are 5-30x more valuable than the average person so 2.5k is nothing to be extra certain of their survival.
Does that sound weirdly dystopian? Sure, but it is just moving your chance of living (for the next year as our unit) by 0.00001% or less. Most people would not spend 2.5k on a 1/100k outcome.
The problem is birds vs rabbits vs turtles (I didn't invent this; it's a classic metaphor [1]).
For any given finding on an MRI, they're going to be, tautologically, in one of three categories, in descending order of frequency:
* turtles (i.e. slow growth tumors). Most people of a certain age have them, and they'll never be an issue. MRIs will find them. You can't know they're turtles.
* rabbits (faster-growth, non-metastasized tumors). Maybe we can catch these, because they're slower than birds, and maybe can make a difference. Everyone wants to believe they're finding rabbits, but just because of the nature of the distribution, they're most likely finding turtles.
* birds (i.e. fast metastasizing tumors; think days or weeks). This is what you want to catch, because they're metastasizing. They're deadly. They're rare. You'd like to catch these before they fly away, but how often are you going to run an MRI? Daily?
Asymptomatic screening almost always catches turtles, sometimes catches rabbits, and rarely catches birds. You can't tell the difference from a single scan...so when do you choose to go further? At what cost?
[1] https://lactobacto.com/2018/02/13/viewing-cancers-as-birds-r...
[1] https://www.northcoastjournal.com/humboldt/cancer-part-2-tur...
[1] https://www.thedailybeast.com/all-these-cancer-screenings-pr...
I included that third link -- even though it's from the Daily Beast -- because it really drives home the practical implications of the metaphor. Consider this:
> In 2012, Archie Bleyer and Gilbert Welch published a study in the New England Journal of Medicine titled, “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence.” They found that, with the advent of screening mammographies, the incidence of breast cancer in the U.S. had doubled. For every 100,000 women screened, the number of women diagnosed with breast cancer had increased from 112 to 234. At the same time, the number of women presenting with late-stage breast cancer (the kind that often results in death), decreased from 102 to 94 (per 100,000). In other words, only eight of the 122 women diagnosed with breast cancer appeared to benefit from the screening. Eight. The others had been treated with mastectomy, radiation therapy, and chemotherapy without clear benefit.
This is a common story in the world of cancer diagnostics.
Far easier said than done. What actually happens when you get caught in one of these screening programs, is that you're suddenly in a universe of "continuous monitoring"...because they're trying to find the birds, and reason that since they looked at you once, they need to look at you more intensely than before.
Anyone who has ever had a mole biopsied for skin cancer will be familiar with this. They'll just keep looking for stuff, until you tell them to stop. If you get a positive, it's even worse. Everyone is acting with good intentions. It's just impossible to know the right answer, so the emergent behavior of the system is to harm people.
Additionally, MRI doesn't have the radiation side effects that other forms of imaging do
Take a look at individual tests to see if they make sense.
A PSA urine test, for example, is insanely cheap and catches many expensive prostate cancers in early stages. Mammograms are the similar (less cheap, but still life saving).
For those specific tests, the evidence is clear.
It also gets people treatment when none was required: https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
ETA: this is the page I was looking for actually: https://sciencebasedmedicine.org/the-early-detection-of-canc...