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Comment by eftychis | Hacker News Reader

I think this is unique to prostate cancer.

As it says the average age of men getting it is 67. From experience and from data I had seen, a lot of times, the surgeons simply believe the patient is too old to have any surgery. And when they die -- e.g. family I had -- they note down the cause of death as natural causes. When you are 80-90+, practically everything gets written as natural causes.

Finally, with prostate cancer, from what we know it is not a question if a man will have prostate cancer but if the man will die before prostate cancer becomes serious or appears. That is if we doubled the age of survival to 200 years I think we would expect virtually every male at that age to have gone through prostate cancer.

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There was a meta-analysis published in JAMA last year which concluded that screening is unlikely to prolong lifetime for other than colorectal cancers:

https://jamanetwork.com/journals/jamainternalmedicine/articl...

> The findings of this meta-analysis suggest that colorectal cancer screening with sigmoidoscopy may extend life by approximately 3 months; lifetime gain for other screening tests appears to be unlikely or uncertain.

I am neither a physician nor qualified to comment on the article itself, but remember reading an MD commenting on it last year saying efficacy of screening was better in the 80s-90s, but with contemporary cancer medicine and improvements in surgery, we can now treat bigger cancers so early screening doesn’t necessarily prolong life expectancy.

I would not take medical advice from myself or that article though. But to your comment, I doubt it’s only prostate cancer where early screening and treatment might not yield any returns

Hmm, I notice that melanoma wasn't addressed in this study; maybe "having a good look at suspicious moles just in case" doesn't count as screening, but early detection of melanoma is considered pretty important for survival.

Yeah, again without really having any education in healthcare, I suppose that if you find a cancer before it spreads then you can operate it out. So makes sense to get suspicious moles or generally any health issues checked

It's sort of a good example of the counterpoint at the same time though: other than melanoma, skin cancer is pretty minor in general (and having it is correlated with increased life expectancy!) so combined with how rare melanoma is, I could imagine that a lot of such screening might not be associated with a net benefit.

"how rare melanoma is"

For a rare disease, I have already met too many people who have/had it. Lifetime risk is about 1:100 for white Europeans, not exactly commonplace, but not that rare either. I definitely don't ignore anything that happens on my skin, that would be a stupid way to die.

Fair, but globally it causes something like 60 thousand deaths per year (out of 55 million or so). That’s nothing to sniff at, but certainly in the realm of something you are very unlikely to die from. For comparison, cardiovascular disease kills about 17 million people per year.

That may be the case, but the other failure mode for early cancer testing is that you identify disease signals which will not turn out to be meaningful in the long run even without intervention. Iatrogenesis is a big problem with a lot of this stuff: the follow-on treatment for an epithelial precancer hit from your stomach is not harmless.

This is a reason I've read evidence based medicine people use for arguing against routine whole-body imaging.

Yes. I was touching solely the likely unique characteristics of prostate cancer. Maybe I need to clarify, but that is what I got the comment I was replying to indicated.

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