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Comment by snakeyjake | Hacker News Reader

>yet we're still stuck with the same treatments, mainly chemo, surgery, and radiation, and generally low survival rates for advanced cancers

Survival rates have been increasing for almost all forms of cancers so fast that it is astounding. Amazing. Stupendous. Heartening.

We've gone from an overall 50% five year survival rate to over 70% in just a couple of decades.

The pancreatic cancer five-year survival rate is very low, but has tripled since 1999.

When I was born you had a 33% chance of living for five more years if you were diagnosed with prostate cancer. Today you have a ~90% chance.

I don't know why people think nothing is changing.

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I think it's like voice recognition, which was overhyped in the 90's, then quietly made its way into phone trees, and cars, and now phones so it quietly works everywhere now. I think it used to miss a lot of stuff in the beginning, and that is conflated with missing words occasionally nowadays even though the field has advanced tremendously. which might be analogous to fighting cancer.

I personally know many people who have gotten and then gotten over cancer.

How much of this is due to better detection of cancer? If we discover cancers earlier but still don’t have effective treatment I’d expect the 5-year survival rate to go up even though the actual death day never changed.

which is still fine.

its part of the stack. earlier detection and improved treatments is a very important area.

we still are absolutely failing in preventing those same cancers from reoccuring because we don't know the sequence of triggers or how to prevent them. like, we might know the trigger, but we don't know why one body really becomes more susceptible to them aside from sometimes behavioral or genetic probabilities. hence why we still focus on remission instead of cured, since the body still remains in a state of susceptibility to the same thing and is exposed to the same unknown things, and doesn't revert back to a baseline of not being so.

Except we’re spending $50k+ on many of these treatments.

Are you serious? What better way to spend money than on not dying?

A simple question with many different details and answers that won't all fit into a single comment. The two easiest, though:

Which is a better use of 50k? To give one adult one extra year, or the same money to reduce child mortality for a hundred strangers in a different country?

Does the treatment actually reduce mortality, or is it just an expensive placebo?

> Which is a better use of 50k? To give one adult one extra year, or the same money to reduce child mortality for a hundred strangers in a different country?

Better for whom? Morals are always subjective to your point of view. While points of view of different people sometimes, and even quite often, align with each other enough so that we can talk about shared morals between them, they don't necessary do this all the time. Especially in a scenario of allocation of limited resources.

In the end the only thing that really matters, though, is the point of view of the person who owns these 50k, and nobody else's.

> Which is a better use of 50k? To give one adult one extra year, or the same money to reduce child mortality for a hundred strangers in a different country?

The answer to that one is very clear: the G7 have more than enough money to fix both extreme poverty (it's just 40 billion $ a year to end hunger [1]) and access to quality medical care (which is a purely USA problem, everyone else has sorted that out decades if not - in the case of Germany - centuries ago) at the same time. There is no need to pit these two issues side-to-side at all.

> Does the treatment actually reduce mortality, or is it just an expensive placebo?

At least for stuff that's not on off-label use, proving efficiency is a mandatory criteria for being allowed to be sold. And some quackery aside, most of the off-label stuff at least has some scientific backing proving that it can actually help.

[1] https://www.wfpusa.org/articles/how-much-would-it-cost-to-en...

"Which is better" would be a great question if those were the only two things we spent our money on. In reality, both are better than many other ways we spend our money.

> its part of the stack. earlier detection and improved treatments is a very important area.

Earlier detection is important but mortality is a better metric than 5-year survival. People tend to conflate the two. If earlier detection doesn't decrease mortality then it's just goosing the 5-year numbers.

This is especially true in geriatric cancers, particularly for example prostate cancers, where most of them are slow growing and not particularly dangerous. You'll outlive the cancer, so knowing about it doesn't mean, well, anything, other than exposing you to risky tests with serious side-effects. Prostate biopsy is really not great.

No-treatment is a great choice in these cases, so really, the detection is all downside, no upside for asymptomatic cases. [1]

[1] https://newsroom.ucla.edu/releases/older-prostate-cancer-pat...

This is called the lead time bias - https://en.wikipedia.org/wiki/Lead_time_bias

>We've gone from an overall 50% five year survival rate to over 70% in just a couple of decades.

Has there been a change in actual life expectancy, or does early detection mean that 5 year survival is equivalent to 5-(average years earlier detection) year survival decades ago?

> Has there been a change in actual life expectancy,

Yes!

There’s been a 25% drop in cancer deaths even ignoring differences in demographics. https://www.statista.com/statistics/184566/deaths-by-cancer-...

Back in 1950 it was 193.9 people died of cancer per 100k population, but it was a much younger population. By 1990 216 people died of cancer per 100,000 Americans due to an aging population and possibly lifestyle etc. But it has fallen literally every year since then despite an aging population.

We are down to 146.2 cancer deaths per 100,000 people.

I agree that much is changing in cancer therapy, most promisingly around immunotherapies and other immune related strategies, but the 5 year survival rate change over decades is often attributed to earlier detection as opposed to improved treatments.

> had a 33% chance of living for five more years if you were diagnosed with prostate cancer.

This is patently false. Only late stage prostate cancers are killers. In most cases you catch them early on.

> Only late stage prostate cancers are killers. In most cases you catch them early on.

That doesn't contradict the claim you're replying to.

> I don't know why people think nothing is changing.

It's because people expect a cure the likes of a vaccine, with >95% efficacy.

But it's not entirely their fault, the media all but says "they've cured cancer!" every other day.

When you expect a cure, increasing five year survival rate by 10% falls short.

Maybe mentioning vaccines efficacy is not very on point with the past few years track record

I think people expect cancer cures to be as effective as vaccines really are, while also expecting vaccines (and antibiotics) to be as effective as a Potion of Cure Disease in Skyrim.

I guess people want "real" cure (i.e. a vaccine that makes the cancer fully go away), not just to get couple of extra years of life while puking their brains out on chemo most of that time. Observing how an extended family member and an acquaintance succumbed to cancer in recent years I would agree that the way we treat cancers is still quite barbaric and it sucks immensely for patients.

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