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Comment by Veserv | Hacker News Reader

Your response is a non-sequitur. The original statement was about intentionally not detecting cancer. You are talking about whether the cancer is medically necessary to treat.

You are just assuming that all cancer must be treated if detected, even if it is medically unnecessary, therefore we must not detect medically insignificant cancer which would be net harmful to treat. You can detect things and determine no action should be taken. I can understand if that might be the modern standard of care, but if so then that is the problem; not early detection of cancer, which could be medically insignificant, but which may also allow the early detection of medically significant cancer.

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I'm pretty sure every medical show had an episode where the "money-grubbing hospital admin" character want to start selling full body medical scans, and the "very well-respected and honor-bound doctor" character points out how this is quite literally one of the most useless and corrupt ways for a hospital to make money.

There are probably a dozen things wrong with your body right now. That doesn't mean they're even affecting you. While you may have some type of cancer that is at the absolute first day of detectability, or a bone slightly out of place, or a weird spot on your heart, someone else has a case that is 6 months deeper and needs more dire treatment.

There is zero benefit to society to massively overburden our healthcare system (this is true of any nation) by searching constantly for random problems that may or may not exist.

If there were good reason to do this, you'd have regularly-scheduled checkups, like with colon or breast cancer.

at the same time you have endless stories of people losing family and friends to cancer because a doctor dismissed complaints as anxiety or needing to exercise more leading to cancer not being discovered until it was too late to treat.

The answer can't be to put our collective heads in the sand.

You also have the issue of information creating liability. A thing that nobody knows about is nobody's problem, a thing that COULD be a problem but probably isn't in someone's professional judgement creates liability for the decision maker.

Perhaps BOTH the "money-grubbing hospital admin" and the "very well-respected and honor-bound doctor" are wrong for not involving their patients in these decision? And their insurance for that matter.

Recently my US-system, world-ranking university hospital complex was first convinced that my insurance would not pay for XXX (and consequently did not recommend it and delayed it). Then after I insisted and got that done, they told me how surprised they were (1) that my (US) insurance did in fact cover every single bit of everything we eventually got done and (2) how MUCH that same US insurance in fact paid them for each of the bits. On the first try. That insurance company has horrible problems, but I can't complain that they didn't cover the hell out of the thing. You know - on the same year we read everyone else's horror stories.

The whole system is very sick.

It's a human factors thing. If two patients both have a cancerous tumor that does not need treatment, the patient that did not have a screening is better off. The patient who was screened will deal with anxiety from having a positive screening result in addition to any negative effects from the screening and follow ups. Many patients are not comfortable living with a detected tumor, even if the standard of care is to watch and wait. Of course, the opposite scenario is also true --- if both patients have a tumor were removal would be best, the one that gets screened has a better outcome.

Maybe if we were all pretty rational people, we could better manage positive screening results and follow up actions that lead towards taking no specific action; but that's not where people are at the moment.

There's a tradeoff of early detection of fast growing tumors that are likely to cause issues vs detection of slow growing tumors that are likely to not cause issues except if they're detected. You can see how the consensus is shifting on things like breast, prostate, and colon cancer screenings over time. My TLDR is that we developed tools and methods, started applying them and have generally reduced the screening frequency over time as we understand more about the tradeoffs.

Except that the medical system already does that for various types of common cancer screening such as breast cancer. It is frequently detected extremely early when it is medically insignificant and patients may be recommended to just wait and watch with more frequent screening. Increased vigilance would have been impossible without early detection and early detection for breast cancer is viewed very positively and is very positive for society.

We have a system that partially results in anxiety because cancer screening is frequently only done when cancer would already be medically significant. A positive result usually means medically significant cancer because as a society we already chose to not screen when it would be medically insignificant. This is perfectly reasonable if the test is expensive, inaccurate, or harmful as even just the harms from doing the test in bulk could result in societally worse outcomes than occasional early detection. However, the rise in "medically unnecessary" screening indicates that we have turned the corner on that in many cases; that or it is easily billed corruption which is a separate problem.

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