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> The biggest push-back from the medical profession is diagnosing cancers that are not clinically relevant and treatable [...]. 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.

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.).

[1] https://en.m.wikipedia.org/wiki/Base_rate_fallacy

> for example lowering the prescribed age for breast screening would save lives

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."

>"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.

Yes, no doubt there are inverse consequences: I mean on an individual level, would catch cancers and potentially save those people’s lives. I believe breast cancer in pre-screening populations are often caught later.

This is really detached from reality in the USA. In USA, health care is not important. Insurance companies decide which treatments should be given to patients, not doctors. There should theoretically be incentive to pretend to care about people and keep them alive, but no one has time to pretend.

One way to break the cycle killing everyone is to remove "health" insurance companies from the system.

That is more of a politically driven position than a rational one.

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.

"insurance companies decide which treatments should be given to patients, not doctors"

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.

Doctors and patients should dictate health care, not a third party.

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.

> Doctors and patients should dictate health care, not a third party.

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.

> It's not covered by most health insurance and was $50,000 a decade ago.

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.

> Is there a specific type of this procedure that was this expensive?

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.

pull up the list of Fortune 500 (and Global F500) companies.

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.

Hmm, I think it’s more like Medicare / Medicaid decides these matters, and the rest of the system is shaped around these programs. People with insurance have the worst of both worlds: they get socialized quality medicine but still have to pay for it.

> lifestyle based prevention is proving a way bigger factor than historically acknowledged

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.

Being active for example correlates with massive health benefits.

Is an active lifestyle easy? Well, it is easy if you like being active, and extremely hard if you hate it.

There are many people who would love to live an active lifestyle but their bodies do not allow them to express what their minds desire.

It's more than just personal preference. There are environments that make it easier to get some kind of physical activity, and others that make it very hard.

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.

Where you live is personal preference for the vast majority of Western individuals, at least barring visa issues.

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.

> maintaining a healthy weight have long been the most important factors in cancer prevention. I don't think that's controversial

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 know someone who is obese, rather unhealthy in other ways, and aggressively resists any proposed change in behavior from their doctor or anyone else. They are pushing to get a wheelchair prescription so that they can be even more inactive. Doctors probably over-index on these types of patients.

Unless humans themselves have significantly changed somehow in the last fifty years, it would seem that there are indeed some systemic issues in play. I myself have had hip arthritis since I was seven years old, so I have sympathy for people who have individual issues that stymie them; it's been an absolute bitch for me to figure out how to exercise within my limits.

> 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.

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?

Exactly.

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.

I would really like to know:

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 read a medical article some time back stating that cancer (and tumors in general) occur all the time in basically everybody, but in the vast majority of cases, the immune system kills them.

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.

> For those not keeping up, we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation patterns.

Can you share some types of test / brands doing these testing?

The one I’ve read up on is called GRAIL. I believe this is the leading lab in terms of commercialization.

The best reactive, futile, end-of-life medical procedures and bankruptcies money can buy rather than reducing suffering with prophylaxis and individualized care identifying root causes sooner. And the ostensible demands for prior evidence to shutdown discussion.

>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.

That's not really justifiable imho.

> we now have commercialized blood-based screening tools designed for early detection of multiple cancers by analyzing cfDNA methylation patterns

Where?

Google GRAIL Gallery

Did. You have a strange definition of "available". I see no sign up or way to pay.

I have the dictionary definition of available: https://www.galleri.com/patient/complete-your-blood-draw

Yeah I think the cancer cure endeavor is still hampered by trying to find the one-pill-to-fix-them-all, or at least the pill popping drug complex's desire for one.

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.