Differences in cancer rates among adults born between 1920 and 1990
thelancet.com
thelancet.com
The biggest push-back from the medical profession is diagnosing cancers that are not clinically relevant and treatable (eg. A cancer may be detected 15 years before clinically relevant in some cases to my understanding). There is also a cost benefit dynamic of increasing preventative screening, for example lowering the prescribed age for breast screening would save lives but may carry costs for nations or corporations that are unacceptable.
Detection is being solved in some incredible ways. To my understanding moonshot catch all treatments are mostly a pipe dream given the diversity of disease under the “cancer” umbrella, and lifestyle based prevention is proving a way bigger factor than historically acknowledged - an inconvenient challenge in addressing the issue societally.
It is an endlessly interesting field to keep a track of, and I believe more entrepreneurs should be working on prevention topics!
One major driver in not screening for everything that can be screened for is the base rate fallacy [1]: We usually screen for things that are rare in the general population and in that case a large fraction of positive tests are false positives. But each positive test has to be followed up and potentially causes harm (because of invasive biopsies, psychological burden etc.).
This is not true.
The problem is that breast screening also flags lots of benign things. These benign flags then need to be followed up and those procedures have health implications which may harm the patient worse than not learning about something benign.
My friend's wife got a screen that flagged "something". During the time between "something" and the result of the biopsy (which has its own complication rate), her blood pressure went soaring due to anxiety and she had to significantly increase her blood pressure medication.
Medicine is conservative and sometimes has odd incentives but the vast majority of the profession really does try to adhere to "First, do no harm."
Nah.
First follow the corporate policy.
Second keep them in your hospital network.
Third always have follow up visits.
"Do no harm" is just branding for the Physician Cartel.
One way to break the cycle killing everyone is to remove "health" insurance companies from the system.
Healthcare is important in the US. We spend more on it than any other country on the planet.
There are tons of European countries that have highly functional Healthcare and private insurance.
In counties that have universal health-care, the government gets to decide which treatments are given to patients.
"One way to break the cycle killing everyone is to remove "health" insurance companies from the system."
I agree with you here. We should only have insurance for surgeries that won't benefit from competition (IE: are really expensive and don't happen that often). The rest should be paid for directly without insurance. This would reduce the cost quickly, as doctors and hospitals need to get paid and remove the middleman inflating all of our prices.
Lasik eye surgery is a good example of this working in practice. It's not covered by most health insurance and was $50,000 a decade ago. It's now less than $3000 now.
Insurance obviously creates misaligned demand at least as consumer and doctor's demand is ignored.
Being from the US, anything would be better as it's impossible to get health care here as the system is centered around insurance.
Sort of. As long as other people are helping to shoulder the bill: via US style health insurance, single payer, universal health care, etc then there needs to be a cost/benefit consideration based on population scale data.
Example: There's a treatment for Condition X where the data show a 0.001% chance of benefit and costs $50 million dollars to provide. It'd be absurd to suggest that a single patient & their doctor should be making that choice, unless the patient is the one footing the entire bill.
So then the trick is to determine where to draw the cost/benefit threshold and then to determine which treatments generally do vs do not meet those thresholds.
Is there a specific type of this procedure that was this expensive?
I ask because over here in Europe a friend of mine had lasik done for the equivalent of $600 per eye over a decade ago. Nowadays it's like $1000 per eye.
As far as i know LASERs were expensive. Powerful, movable ones, more so. And those where you could modulate the intensity were also more expensive.
look at how many of them are healthcare related (answer: a lot, including many of the top 10). and then ask yourself if the US will ever be able to remove them from the system.
Can you elaborate? As far as I know, abstinence from smoking and drinking as well as maintaining a healthy weight have long been the most important factors in cancer prevention. I don't think that's controversial, but that doesn't make them easy obviously.
Is an active lifestyle easy? Well, it is easy if you like being active, and extremely hard if you hate it.
Weather, proximity to parks/recreational areas, convenient public transit, and dense neighborhoods can contribute to increasing physical activity without someone actually wanting to "like being active".
There are local/regional/national differences in physical activity and health that are not merely explained by personal preference.
It's more of a prioritisation thing e.g. some people will live in New York even though they hate it because they get paid well there.
Or they'll live in Arizona because family is there.
You'd be surprised. There are unfortunately many people who will aggressively attack anyone suggesting diet, exercise or weight management in any way to address obesity-related diseases. In their worldview, people have no agency to change their eating habits, and advising patients to do so is unhelpful, they exclusively want drugs, surgery or other accommodations to address issues.
I've watched two people who waited for too long to seek treatment become eaten alive, quite literally, so I would have to imagine that at least on an individual level it would be a good idea to seek this out.
Just to make sure I understand, are you saying that the problem is that people essentially get a very early warning of a diagnosis, so they start coming in for regular checks to see if it has become treatable, but it has not, but they come in fairly frequently, and those frequent visits use a lot of time and thus this process would not scale to the general population?
The argument also goes that some cancers may never become clinically relevant, or in the case of the sick, vulnerable or elderly other causes of death will get you before the cancer does - And so detection in these cases may cause “unnecessary” treatment, patient worry and burden on society.
1. What is the average number of cancers per person as a function of age?
2. How many of those cancers are clinically relevant now?
3. How many will become clinically relevant in the future?
Then we can have an informed discussion about the trade-offs.
Unfortunately, I suspect that nobody actually knows those numbers. (So maybe we have to start doing the scanning, at least on a study population, in order to find out...)
I've experienced this personally, and visibly. I've had a few moles appear on my skin, then subsequently a white ring would appear around it (presumably my body was killing ALL melanocytes in that region?) while the mole slowly shrank over the span of a few months. I have a few dozen other moles that my body never bothered doing anything about.
And this is just the skin. I'm not sure I want to know what's gone on in the other 90% of my biomass.
Can you share some types of test / brands doing these testing?
That's not really justifiable imho.
Where?
I think cancer will be "cured" with detailed genetic mechanism detection that feeds into a "cookbook" knowledge base that specifically targets immunotherapy and other custom-targeted treatments. That is probably labor intensive, something of course modern business hates and doesn't lead to their stock market bonanza price margins.
IMO to cure cancer-the-umbrella-disease involves us focusing first on doing medicine, and less on the embarrassingly high profit margins of drug/device conglomerates. It will probably take a different kind of company.
> Additionally, the increased use of diagnostic testing and overdiagnosis probably contributed to the rise in incidence rates of cancers that are highly sensitive to diagnostic scrutiny
So they did consider it, but I am not sure if/how they attempted to control for it.
It’s an amazing time in that space. My poor late wife succumbed to metastatic melanoma last year. In 2010, the chances of living a year was 0. Now 5 year survival rates are 65% thanks to immunotherapy. Unfortunately, complications delayed treatment for my wife and she was one of the 35%.
In the next decade, many brain cancers will be curable. Unfortunately, those breakthroughs are built on the shoulders of those who come before us.
These random graphs from the study kind of support that, https://www.thelancet.com/cms/attachment/7e57a199-90a6-4451-... , again don't really have time to dig it all up at the moment but I think the previously linked study on HN had graphs for cancer mortality in various Western countries - again most of them trending slightly down.
So I mean, try to live healthy, keep your fingers crossed, knowing that the treatments are getting better all the time. Beyond that, if you're not an oncologist, how much should you really worry about this stuff.
> To evaluate birth cohort trends in cancer rates, adjusted for age and period effects, we fitted age-period-cohort models to the incidence or mortality rates of each cancer type using weighted least squares, assuming Poisson-distributed counts and including overdispersion parameters for potential extra-Poisson variation. A change in the birth cohort trend usually indicates changes in exposure prevalence, leading to varying risks of developing cancers for individuals of the same generation. By contrast, a period effect reflects systematic changes in cancer ascertainment or the influence of newly introduced or improved medical interventions, affecting all age groups simultaneously during the same period.
I was somewhat surprised that cohort effects are tied to changes in exposure prevalence, when I would have assumed those would give rise to period effects. Presumably exposure during childhood carries lifelong consequences.
So "we detect cancer better" isn't really a good theory, unless it just so happens we only have improved our detection for 8 of those cancers.
Would love for somebody more knowledgeable who read the whole paper to weigh-in.
But why the large monotonic rise in incidence? Are we somehow getting even less iodine in our food? I'm supplementing with it now, wish I started long ago.
It could be part of the problem that we discourage salt consumption. Salt binds with halides like bromide and fluoride, which compete for iodine receptors.
The same problem behind thyroid cancer may also contribute to the obesity epidemic by damaging energy metabolism via hypothyroidism. I almost hope so, since then my thyroid hormone replacement may help with weight loss. Or perhaps causation somehow flows in the other direction and obesity contributes to thyroid disease.
And much of the increase may simply be from growing diagnostic scrutiny. Thyroid disease is very profitable for the healthcare industry. Treatments are effective for many and are usually life long. So there's great incentive all around to pay more attention to it.
Sorry to hear about your surgery. Do you link it to iodine deficiency or something else?
But my surgeon made no association between the goiter, tumor and hypothyroid at all and she didn't even recommend iodine. There seems to be a lot of divergent opinion among the pros.
The biggest change from now to then is obesity which is an umbrella for lack of exercise/activity, sedentary jobs and leisure time, and a vast increase in corn syrup and caloric content in eating.
Environmental factors beside nuke testing might be a near-hundred-years of ICE pollution permeating the entire world, microplastics, and other pollution. Vitamin supplements may also help tumor growth. Staying indoors, aside from the exercise impact, may reduce vitamin D production from sunlight which seems to inhibit cancers as well.
But eating like crap, not exercising/being active, and being fat are all not-insignificant aspects to cancer. Exercise has dozens of ancillary health benefits that can tie into cancer incidence, sugar is rocket fuel for tumors, and obesity is directly linked to cancer.
I honestly hope once EVs and alt energy permeate the energy production and transportation sectors if we see a huge decline in cancer rates a decade later.
There's no obvious correlation here, because when you look at things like obesity, other countries had similar increases with no effect on the cancer rate. One outlier use of "mainly the US since 90s" is GMO use, but I don't believe there's much scientific proof of cause there. PFAS? Any other guesses?
Even though I'm not a libertarian, I can't help but engage when people invoke them in threads that had nothing to do with libertarians, with some nonsense like raw milk is poison and libertarians demand access to it.
Its so weird to me how people make it a hobby of doing that, especially when the whole libertarian thing is minding your own business. Why hate those people?
Because the vast majority of people who SAY they are Libertarian, are very much not libertarian. They also want to deconstruct a functioning government for ideological reasons, regardless of who that will hurt.
I suppose mixing raw milk in bulk might result in the spread of pathogens. Not really an expert on the topic, other then I'm pretty sure raw milk isn't necessarily poison.
Coffee contains 20 known carcinogens but I don’t see a lot of people voluntarily stop drinking it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933506/
And large studies of coffee drinkers don’t actually find higher rates of cancer.
Well it's worth asking the question though, if only 1% of these suspected carcinogens truly are carcinogens, or act in combination as carcinogens you potentially have hundred thousands of cancers caused by things as dumb as "colorant to make the chips red" or "oil that's 1% cheaper than the healthy alternative".
The vast majority of cancers are lifestyle related so if you can eat clean, exercise every day, be lean, avoid pollutants, avoid diet (known and suspected) carcinogens you improves your odds quite a lot.
Coffee has been around forever so the good thing is that you can rule it out as a cause of new unexplained rises. What hasn't been around forever are 900cal starbucks "coffee" with three times the daily recommended daily amount of sugar for example.
Another thing is that we spray virtually all our crops with chemicals having a skull, a dead fish and a cancer sign on the bottle
Looking at the regions with the lowest cancer incidence on the chart, it makes me think it could.
It would make sense that if heart disease or emphysema (or for that matter, just some drunk driver) don't get you while younger, some cancer will get you while older?
Hopefully, we make immunotherapy progress faster than we poison ourselves with pollution and poor diet.
[1] https://www.cancer.gov/about-cancer/causes-prevention/risk/o...
[2] https://www.who.int/azerbaijan/news/item/03-05-2022-obesity-...
[3] https://www.wcrf.org/new-study-links-overweight-and-obesity-...
1971–1974: About 5% of children were obese
1980: 13.4% of adults were obese
2008: 34.3% of adults were obese
2009–2010: 36% of adults were obese
2014: 36.5% of adults were obese
2017–2018: 42.4% of adults were obese
A truly astonishing set of data. I assume this has never happened in human history at this scale.
Many developed countries have much healthier people.
> As of December 2023, Finland's obesity rate is 27% for men and 30% for women, with a body mass index (BMI) above the obesity threshold of 30 kg/m2. This is higher than the EU average and has increased significantly in recent decades. Obesity is most prevalent among people aged 40–64, with one in three in this age group being obese. Abdominal obesity is also common, affecting almost half of adults.
It seems to be quite bad other places too.
A Finnish comedian has something to say about that)
Sweden and Switzerland are the lowest obesity of that list while being of the highest wealth. While Ukraine has been near the top with the lowest wealth. Greece and France are also outliers.
Probably due to changes in burden of time and stress and more refined taste in food and a focus on fitness when you reach true wealth.
My point stands. I’m saying it’s impossible to have high obesity, but that it’s a function of wealth.
But I think the US is leading some global fattening and we’re just first.
People STILL to this day are afraid of eating butter, yet consume margarine, seed oils (vegetable oils are the worst type of food known to man) and hundreds of grams in sugar EVERY DAY. And in many places, I bet in here too, this is still controversial and the only mode of dieting people know is eating less fat and less meat, as if they ever were the problem.
Keto and low carb diets are still described as "fad diets" on Wikipedia, and I wonder whose silly agenda they are pushing. If it is the one of the official health dept of Western governments, it should be clear that what is claimed to be healthy it is obviously not, and made even more dubious due to major lobbying from Big Food.
The same Big Food that has just won with the popularity of GLP-1 agonists: why eat healthy when you can eat packaged crap and take a pill?
Of course, this is wrong.
Vegetable pulp oil (i.e. coconut, extra virgin olive oil, etc.) is alright, if not beneficial.
"Worst type of food known to man" is a very strong statement, and surely there's a long list of foods that come before vegetable seed oils.
There is no logical reason to expect that seeds, in general—carrying the energy for new life, containing the most valuable and precious resources—would constitute the "worst" food ingredient known to mankind.
actually, there is no evidence that the commonly consumed vegetable seed oils such as sunflower, corn, canola, soy, peanut, safflower, cottonseed, walnut, linseed, etc., are harmful at all, except when rancid, trans, or hydrogenated. there was a long period when they were believed to be harmful simply because they were fats, but we now know that was wrong
there's a lot of old research where they were conflated with high-trans-fat-content partially-hydrogenated versions of themselves, and we now know that the trans fats were the major problem there. there was a period when it was believed that low ω-3 fatty acid levels relative to ω-6 levels were causing inflammation, and some people do see improvements in health when they eat more ω-3, but both ω-3 and ω-6 fatty acids are unsaturated fatty acids of the kind you find predominantly in vegetable seed oils; that's not a question of eating more or less seed oils but of which ones you eat. (and the ω-3 effect turned out to be fairly small on a population level.)
finally, there's a certain fanatical contingent that is convinced that unsaturated fatty acids in general (seed oils, fish oil) are terrible, and saturated fat (coconut oil, beef) is what's good for you, but this is basically completely unsupported by the evidence. a and there's a mountain of evidence against it. see https://slatestarcodex.com/2020/03/10/for-then-against-high-... for a deeper dive
(also it's hilarious that the article's academic editor is named "meat hacker" in german)
the abstract says
> Overall, heating to temperatures <200 °C had no appreciable impact on different TFA levels. Between 200 and 240 °C, levels of C18:2 t (0.05% increase per 10 °C rise in temperature, 95% CI: 0.02 to 0.05%), C18:3t (0.18%, 95% CI: 0.14 to 0.21%), and total TFA (0.38%, 95% CI: 0.20 to 0.55%) increased with temperature. A further increase in total TFA was observed with prolonged heating between 200 and 240 °C. Our findings suggest that heating edible oils to common cooking temperatures (≤200 °C) has minimal effect on TFA generation whereas heating to higher temperatures can increase TFA level.
so i probably shouldn't worry too much about frying eggs in sunflower oil
Are these statistics world or US?
It’s not the most accurate thing, but it’s close enough for most people.
It's pretty shocking how little food the human body actually needs and how little weight you actually need to carry, and anything over that is just stressing the circulatory and muscle systems. (And providing more cells from which cancer can potentially start, and more energy to feed it if it does.)
Losing 40 pounds on my frame… I’d look like death. I think BMI as estimated by the simple formula is a useful guide for the median height and build person, but it’s used as a health designation whose meaning is frankly bunk. I lay higher insurance rates, for example because of supposed risk of diabetes.
My wife was even worse. She had big boobs, so was declared obese. She was a runner, cyclist, and was a competitive swimmer, but was labeled a fat girl by her doctor.
Stupid things like this turn people off from medicine and delay being treated for real problems.
We never had synthetic nitrogen fertilizers before. This is the first era where humanity does not have to experience widespread, frequent, deadly, hunger. This is also why there are eight billion people on the planet: we have enough calories to support that many. There were only 1.7 billion people when the Haber process was invented.
Currently, in the US, there an estimated 40M people and 13M children at risk or experiencing hunger: https://www.ers.usda.gov/publications/pub-details?pubid=1077...
https://www.hsph.harvard.edu/obesity-prevention-source/globa...
I’m not even sure about that.
hell, even cooking oils are kinda 'new' and barely existed 100 years ago
So sure, incidences of cancer are going up, and while I briefly read the article I didn't deep dive into the data. I'll presume they corrected for population growth, the decline in other mortality rates, better testing, more testing, increasing life expectancy etc.
Alas youth it's fixated on rate of change, but without (ideally upfront) discussing the are rate. Consider this example; (made up numbers)
"Incidences of cancer generally are up 400%". Compared to "incidences of car deaths are down 80%". From those 2 statements alone should you be more worried about cancer or cars?
And lots of articles and news report this - rate of change. But rate of change is meaningless without a base number. Consider this (still made up numbers)
"Cancer went from killing 1 person per 100 to 4 per hundred" " road deaths went from 95 people per hundred to 19 per hundred". Are you now worried more about cars or cancers?
Side note : causes of death is a zero sum game. If one cause decreases the others have to increase.
Side note: the most important measure of course is the age if death. If I'm 90 I'm worried about cancer. If I'm 9 cars are a more immediate issue.
So yeah, eating more broccoli might reduce my risk of pancreas cancer. But saying it as 'drops the risk 45%' doesn't really help me if the base risk is say 1 in a million.
Seat belts though - highly recommended.
Sadly, that extra step up the causality ladder tends to meet furious resistance from most natural-scientifically-oriented people.
It could be as simple as “lack of will to live due to losing a partner in old age”, for instance—one of a variety of conditions with absent motivation to do things that correlate with not dying, or indeed to not do things that inversely correlate with such, therefore trivially leading to death via whatever first available mechanism (drinking to DUI to accident, or smoking to inflammation to cancer, or lack of sleep to chronic inflammation to cancer, and so on). The particular mechanism itself is not the most interesting part, and if the principle is right then eliminating each pathway is going to be a game of whack-a-mole draining healthcare resources while failing to accomplish the presumed goal (happy continued existence of a person).
"but why where they drinking and driving!?" could range from carelessness to chronic mental health issues and addition. too many to pin down, and not direct causes; indirect at best.
drunk driving killed them
The problem is that there’re seemingly no ready clear-cut one-size-fits-all solutions with root causes, while there are some we can use to alleviate the downstream mechanisms of harm (e.g., drunk driving bans, chemotherapy), so we prefer to address those instead. When all you have is a hammer and all that. It doesn’t show that such root causes can’t be helped, only that the topic is perhaps not being investigated as actively (it doesn’t lend itself to the traditional approaches used in natural sciences, and rather than treat it as a difficult challenge it’s easier to label it as too vague, not scientific enough, or beyond an arbitrary physicality line).
Seriously though, the trend in America is real, if you're concerned with the impact of pop growth, life expectancy, etc, then see how it compares in US vs countries with the same trends:
https://ourworldindata.org/grapher/cancer-incidence?tab=char...
Trends matter, and this trend is pretty dramatic