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Comment by alexey-salmin | Hacker News Reader

Whether treatment is net harmful or not depends on the level of the risk with no treatment. If you apply treatment with 15% chance of severe side effects to a tumor that will kill the patient with 50% chance in the next five years, of course it's net positive. If you apply it to a first-stage cancer that has 10% chance of progressing to the second stage, the very same treatment will be net harmful.

So no, most cancer treatments aren't net harmful now, but they likely will be in a world where your programme is implemented. Even something as "simple" as biopsy has mortality rates far from zero. Applying it at scale may not have the effect you expect. And surgeries and chemo are much worse.

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But do you see how crazy that sounds? If we know the numbers, we would just not do the treatment in those cases.

And in reality it's not actually close like this. Early treatment is so overwhelmingly better than it completely dwarfs all considerations of biopsy risk.

Late stage lung cancer has less than half the 5 survival of early stage, and around 50% of lung cancer detection is late stage. That's around 30000 lives you could save every year from just lung cancer.

Let's say you don't protocol for all adults. Typically post CT or PET at most 10% get a biopsy. So let's say we increase the false positives that lead to CT or PET by X% of adults. That's 270M * X additional biopsies. Lung biopsy mortality is under 2%.

So the worst case you need a false positive rate under 5% for this to he net beneficial for lung cancer. That's low but with 3 scans 6 months apart and a good radiologist, it's not unreasonable

I believe I've assumed the worst case for all the quantities. In reality the addition screened people would have much lower CT detection rate than the background population, and biopsy mortality has been decreasing. Plus you can do this for only people above 40 where the benefits are higher

Yes, IF we know the numbers, that's the whole problem. Unprompted full-body MRI scans turn up a completely new probability distribution. We CAN'T know the numbers as of today, it takes decades of controlled studies to get them. (Which is exactly what doctors advocate for)

Even for something as studied as colon cancer it's still controversial whether mass colonoscopies are better than occult blood tests. US sticks to the former, Europe to latter. US have higher rates of polyp removal, higher rates of cancer detection, higher rates of surgeries and ... higher mortality rates than EU. Why this happens is being studied today, there are some early results. What is absolutely clear though is that higher detection rates don't automatically lead to better outcomes, it can easily be the opposite.

Or take something as simple as sunscreen. It's well-known that sun exposure for light-skinned people can cause cancer and sunscreen is advised. A few multi-decade studies have shown that while it indeed eradicates the skin cancer it also shortens the life expectancy by a few years.

Primum non nocere, doctors and scientists are unsure whether sunscreen should be applied at scale and you effectively call for mass biopsies and surgeries.

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