Are at-home genetic tests worth it? As an oncologist, here's my advice. | Hacker News Reader

Are at-home genetic tests worth it? As an oncologist, here's my advice.

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23 pointsbookofjoe35 comments

Ive watched people die of cancer. I do not want to die of cancer. Early detection and treatment increases the chances of a better outcome. What is a normal person supposed to do exactly to avoid this terrible fate when doctors say nothing works and you should just yolo it?

Follow the currently recommended standard of preventative care. They check for the most likely indications of the most likely cancers. An indication from your DNA is valid when it informs a new course of care. We don't know many of those markers, and family history can tell if those should be checked.

Everybody has to die of something. If you don't die of something else first then you'll eventually die of cancer.

There is good medical evidence to support colorectal cancer screening so go ahead and get that (along with other recommended preventive care services) if you meet the criteria.

https://www.healthcare.gov/preventive-care-adults/

Obesity and insulin resistance (type-2 diabetes) greatly increase the risk of many types of cancer. Don't overeat, don't get fat, and exercise enough to keep your metabolism working well.

Your DNA is not guaranteed to mutate into something cancerous that spreads and mutates. I do think there are things humans can do to avoid carcinogens, but remember, bananas give off radionuclides.

Bananas don’t actually linearly increase your radiation risks because the body maintains homogeneous with relation to potassium. Banana equivalent dose is a misleading analogy not medical advice.

Critically, risks are cumulative so the chances of cancer depend not on individual events taken in isolation but multiple events combined, and many of them are under your control.

If we're getting critical here...

>> and many of them are under your control

This is the societal problem with cancer. If someone gets cancer I'm guessing it might be an incorrect reaction for one to think it was the person's "fault", but the reality is cancer just happens, and it's not a modern phenomena. No one can control the type of cancer they get and no one can control the (unaided) outcome.

My banana comment was partly in jest, but as an example that ionized radiation is found everywhere, and our body is set up to protect, remove, and repair broken DNA on a regular basis.

Nothing is 100% under your control.

But there’s a great number of things that increase risks of cancer to the point where you can be well below average cancer risks.

Agreed, but if you do healthy habit X, Y, and Z, can you formulate and rely on those risks assessments? What was the risk of the person who smoked cigarettes all their lives yet didn't die of cancer? Should we calculate the risk score of a child with leukemia?

Cancer is scary, because there always looms the unknown causes. Heart disease, less scary, because people have much more control through healthy habits. Cancer, not as much.

There are certain mutations like MSH6 which pretty much guarantee that you are going to die of cancer unless you are extremely proactive.

Avoiding alcohol is gonna be a whole lot better to avoid cancer than not eating bananas

It's like anything else in life - you do your best.

My wife fell victim to metastatic melanoma and we lost her a little over a year ago. She previously had a cancerous mole removed on her shoulder that was detected within days of appearing.

She was 5 years out. By all reasonable accounts, she was clear of cancer and had a low risk of recurring. Until it did.

I say this because cancer is fundamentally a numbers game. Very few cancers can be prevented by medical intervention and some of the common ways to prevent certain cancers (HPV vaccines) are controversial, because society is stupid.

So you take your 23andMe, and find out you have a 50% increased risk of developing cancer of some sort. Now what? Do you know what that really means? Do you go to your doctor? What do they say? Do you decide you’re gonna die anyway and embrace van life? Do you go buy squid ink from some Instagram quack for $50/oz?

In business we make a distinction between data and information. This is data that creates anxiety with no purpose.

In my wife’s case, what should she have done? She had elevated, low risk for developing melanoma within 5 years. We knew that, she knew that. Ultimately, cancer is about math and risk. Reduce risk if you can - stop drinking and smoking. The variables you can’t control are fate. Worry won’t affect them, but will affect you.

Accept that you cannot prevent everything bad happening in life.

Doctors don't just say it, evidence bears it out. Screening detects way more false positive than true positives. Following everything up is simply not possible, unless you have tons of money and basically making your life about prevention and little else.

https://archive.ph/lCvqt

the real mvp.

i’ve worked in R&D for DNA sequencer companies for over a decade. this is a pretty good TLDR on why genetic testing is a “complicated” test. you kind of need continuous testing over your lifetime to see what’s changing due to cell division errors. those are the true monsters that cause cancer.

one study i worked on showed that on average every 12th cigarette you smoked created a mutation in your DNA. usually benign but that’s another path for how it starts.

The mutations will just be in single cells a few cells- you’d have to be liquified in order to sequence your whole body for cancer mutations. Leukemia would be an exception though, as you could find that from a blood sample.

right. single cell analysis is a big thing people are hoping to achieve.

the cigarette study i mentioned was looking at cells in the lungs and tumor samples iirc.

And I hope we get there. My wife died because her cancer mutated in such a way to evade chemo. Why? How could we have discovered this sooner? Do we have the tools to accelerate this and stay ahead of cancer mutations?

I am so sorry for your loss. I’m sadly a CS guy living in a biology world and don’t have the foresight to predict anything like that.

You’re not understanding what I am saying- there is no way to identify which single cell has a mutation until it is already growing a tumor. There is no way to do what you are proposing -using sequencing to detect cancer mutations early before they turn into cancer- on a living person, even in principle. Single cell sequencing is for individual cells in a liquid culture- not living organisms- and the cells are destroyed to sequence them.

This is about germline variants for BRCA etc, not somatic mutations.

People should not try to be their own doctors, like they should not try to be their own lawyers. Your self-interest will work against your objectivity, most likely to your detriment.

You should try to be able to provide as much of a level of care for yourself as possible. Learning more should be encourage. On a basic level being in the woods it's a positive benefit that someone can provide first aid. Doing research on a medical issue the health system doesn't have answers and making decisions for yourself is okay.

Being able to read and understand legal text helps you in common areas like agreeing to terms when signing up for cable.

Be your own lawyer or doctor but accept the level of skill and education you currently have and call one when you are over your head.

leave to the experts they say

but are we experts at choosing experts?

life is such is that we have to muddle through when we barely know anything

live or die by your own choices you got only this one

If there's one thing that 2016 (really 2015) onwards has taught me, it's to give absolutely zero of my damns to "experts". Unless I am paying them cold hard cash or some other incentive to work for me, and even then I will still be wary.

Anecdata, my mother's cancer diagnosis (which she passed from a year later) took longer than it should have because her general physician was a piece of crap and kept insisting it was just bad constipation.

I mean you're still paying them a bunch of cash, yet most of them are still morons.

Take a first, second, third, whatever opinion always. And best not to show previous diagnosis reports to the next guy, as that tends to bias them.

Had a "reputed" doctor-professor at an Indian medical school who barely looked at my endoscopy and colonoscopy reports and insisted I was simply suffering from stress and diet issues, when it was actually the signs of Crohn's disease, which was correctly diagnosed by NHS doctors.

Traditional American medicine is reactive to symptoms and a small suite of affordable blood draws, and for the 95% limited to FDA and insurance approval.

And only 20% of Americans get an annual physical.

So, yes, if you can afford both the the time and money to seek proactive, possibly concierge medical advice from a professional, choose it.

Doctors are similarly limited by your advice. If you want to eat healthy, a dietician will be able to offer much more specific and actionable advice. If you want to gain mobility, muscle, and health span, a physical therapist, physical trainer, or yoga instructor is who you want to see.

Financially, we're at a point where blood and urine tests can be taken at home for a fraction of the cost of a single health care professional visit, boosting sample rates and ability to react (including talking to a doctor)

For healthy adults without a diagnosed medical condition there is no reliable evidence that getting an annual physical improves outcomes. It appears to be largely a waste of time and money.

There are certain preventive care services which are justified by evidence-based medicine criteria on an annual (or other periodic) basis. But those aren't what most people think of as a "physical".

https://www.healthcare.gov/coverage/preventive-care-benefits...

It's called "advocating". They are advocating on either their health / legalese or on someone else's behalf.

(And as someone with a rare incurable disease, I had no choice but to advocate for better tests, second opinions, more information. ALWAYS get a second opinion on major life events, IMO.)

This is terrible advice.

Most doctors would tell you they would love it if patients advocated for their own health. Most of the time they deal with patients who are barely interested in their health.

I would be in bad shape if I had always waited for doctors to give their opinion in the hopefully 10 minutes I get with them. I find it much better to educate myself and if needed, discuss things with a doctor.

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