[HN Gopher] U.S. cancer death rate has dropped by a third since ...
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U.S. cancer death rate has dropped by a third since 1991
Author : impish9208
Score : 154 points
Date : 2023-01-12 18:08 UTC (4 hours ago)
(HTM) web link (www.wsj.com)
(TXT) w3m dump (www.wsj.com)
| aaron695 wrote:
| [dead]
| Gatsky wrote:
| This is great progress.
|
| Important to note this is not an average effect across all
| cancers. Some cancers still have terrible outcomes eg pancreatic
| cancer, GBM, small cell lung cancer, stomach and esophageal
| cancer, certain types of breast cancer. Advanced colorectal
| cancer also not great.
|
| The other aspect of this is that death can often be replaced with
| multiple years of a highly medicalised and sallow existence while
| receiving cancer therapy.
|
| Point being, we don't want to lose site of the ultimate goal,
| which is preventing cancer as much as possible.
| kodah wrote:
| Prostate cancer is one that men should be especially familiar
| with. My dad was diagnosed years ago after his PCP ignored
| escalating PSA levels. Although he's a "survivor" of Stage 4
| his life is a shell of what it was, and has expressed a number
| of times he wishes he was dead. When I spoke to the oncologist
| after his diagnosis I remember this adage specifically: "If you
| did an autopsy on every man that dies over 40, you'd find the
| beginnings of prostate cancer in all of them. It's a question
| of when, not if."
|
| I say this to highlight three things:
|
| - Physicians routinely ignore things they shouldn't. Be your
| own advocate and research the things your doctor tells you,
| especially the things they believe are _just worth watching_.
|
| - There is little to no awareness in the public over prostate
| cancer.
|
| - Surviving isn't always a good metric. In my dad's case,
| surviving was a promise for a slow and miserable death.
| jghn wrote:
| You're misinterpreting the "when not if" adage. For prostate
| cancer it's generally used as an example of how there are
| cancers you die of and cancers you die with. Many prostate
| cancers are so nonaggressive that men will die with them and
| never know they were there.
|
| And that's the problem. If you did a test and saw something &
| then immediately eradicated that prostate cancer, what if it
| was going to be one of the ones that wouldn't have caused you
| real harm during your natural life? In that case the
| likelihood of the treatment causing more damage to you than
| the cancer itself is high. And predicting which are which is
| improving but still imperfect.
| omniglottal wrote:
| Knowing something must be checked, while your primary refuses
| to check it, what is one's recourse in the US?
| dylan604 wrote:
| Typically, for HMOs, it's getting your doctor to recommend
| a specialist.
| nequo wrote:
| I've never met a doctor who refused to check something if I
| asked for it. If yours does, can you switch?
| grandiego wrote:
| > Be your own advocate and research the things your doctor
| tells you
|
| I share your concern but I think there is no definitive
| advise about how to prevent these horrible outcomes (besides
| the usual "do regular exercise", "lower sugar consumption",
| "avoid stress", etc.) Did you find anything more concrete?
| zamadatix wrote:
| Generally it's about catching issues early as possible not
| necessarily preventing the issue from occurring. If you
| wait until you're experiencing impacting systems before
| getting things like this checked your likelihood of having
| the same quantity of quality adjusted years of life is much
| lower.
| nerdponx wrote:
| Isn't pancreatic cancer in particular usually very far advanced
| before it's detected?
| juve1996 wrote:
| In general the worst cancers are the ones that are difficult
| to detect early enough before they metastasize. As the
| article says, this death rate has dropped mostly because of
| preventative care and early screening.
| paulpauper wrote:
| The problem is this is mostly due to screening, not progress at
| treating advanced cancer, although that has improved too.
| Wowfunhappy wrote:
| I think this would only matter if some of the additional
| detected cancer would have gone away on its own. Correct me if
| I'm wrong, but I think that's impossible.
|
| It's different for e.g. Flu, where more testing = more
| detection of an illness that would not necessarily have become
| serious, had it gone undetected.
| stonemetal12 wrote:
| >detected cancer would have gone away on its own. Correct me
| if I'm wrong, but I think that's impossible.
|
| What if they detect a slow growing cancer that wouldn't have
| become a problem before you hit the age of 150? Not every
| cancer is aggressively trying to eat its host whole.
| smt88 wrote:
| It's mostly due to the reduction in smoking, not screening.
| Screening helps, but it often extends lifespan and healthspan
| rather than preventing a death.
| nluken wrote:
| I get what you're saying: it's a bit of an apples-to-oranges
| comparison since better screening means we're comparing cancers
| of different severities. I don't necessarily see that as a
| problem, though, since a lot of these earlier screened cancers
| would have become more advanced cancers down the line. If our
| testing were perfect such that we could detect all cancers
| early enough to stop, that would functionally be a cure, no?
| jagraff wrote:
| The thing we don't know is which early cancers actually
| progress to advanced cancer. It's possible that we detect
| more things that look like cancer, but that would not have
| ever progressed into full blown metastatic cancer (at least,
| not before the patient died of something else). So that could
| artificially make it look like we've gotten better at
| treating cancer, when actually we've just gotten better at
| detecting non-life-threatening cancer.
| chimeracoder wrote:
| > So that could artificially make it look like we've gotten
| better at treating cancer, when actually we've just gotten
| better at detecting non-life-threatening cancer.
|
| No, because the death rate is measured at the population
| level, not at the incidence level. Fewer people are dying
| today of cancer than 30 years ago.
|
| The only way that detection bias could impact that outcome
| is if you make the argument that a large number of
| _terminal_ cancer cases were going undetected in 1991 _at
| the time of death_.
| pasquinelli wrote:
| > If our testing were perfect such that we could detect all
| cancers early enough to stop, that would functionally be a
| cure, no?
|
| no. being able to detect cancer doesn't mean people are
| getting tested twice a year for their whole life. for
| example, you wouldn't have routine cancer screenings for
| children, but sometimes they get cancer, and on those
| occasions it'd be nice to have better treatment options.
| nluken wrote:
| > it'd be nice to have better treatment options.
|
| No disagreement with you there. By "perfect screening" I
| assumed a "perfect" patient set where problems brought up
| at annual checkups lead directly to tests which lead to
| detection, but perhaps that's a naive assumption to the
| point of uselessness.
|
| Still, I think it's easy to write off screening advances as
| skewing the data set vs. actually saving lives, when they
| do in fact help people that otherwise could have been much
| sicker.
| tshaddox wrote:
| We wouldn't normally even consider talking about these
| things as if they're in any way mutually exclusive, would
| we? Like normally we would all understand that it's good
| for cars to get safer and for trauma care to get better.
| kragen wrote:
| if cancer screenings for children were painless, lower risk
| than the cancer, and cost five dollars, you would totally
| have routine cancer screenings for children
|
| i mean maybe not in the usa but in sane places
| HWR_14 wrote:
| They would have them in the US as well, but only for
| people in the Gold tier of insurance
| tshaddox wrote:
| And only children of parents who were members of
| whichever political party had decided the scans aren't an
| evil hoax.
| timerol wrote:
| The "US Cancer Death Rate" talked about in the article is
| measured in deaths per 100,000 population, not deaths per
| detected cancer. So we are comparing apples to apples, but
| finding and treating cancers earlier could be helping to
| result in fewer deaths.
| londons_explore wrote:
| Or it could simply mean that another cause of death has
| increased. Like heart disease/diabetes from ever increasing
| obesity rates.
|
| A person can't die twice, so if heart disease gets them
| first, then they won't die of cancer.
| stjohnswarts wrote:
| You have to got to decide a parameter at some point. It
| will never be 100% descriptive in reality, biology is a
| messy science.
| chimeracoder wrote:
| > Or it could simply mean that another cause of death has
| increased. Like heart disease/diabetes from ever
| increasing obesity rates.
|
| You could hardly have picked a worse counterexample.
| Deaths from heart disease have fallen dramatically over
| that time period, even faster than cancer deaths have
| dropped.
|
| Deaths from strokes - which at one point equalled deaths
| from all cancers combined - have fallen as well, although
| much of that drop occurred before the time period in
| question.
|
| Deaths from diabetes are actually quite few in number
| compared to heart disease and cancer. They've sort of
| plateaued over this time interval, which isn't good news,
| but hardly the alternate explanation for the reduction in
| cancer deaths.
|
| Now, there _is_ one big cause of death which we haven 't
| addressed: COVID-19, which causes about 3x the number of
| deaths as diabetes, and over half the number of deaths as
| all cancers combined. But that only began in 2020, and
| this data shows a decrease across the entire interval, so
| it's not relevant here.
| TylerE wrote:
| Diabetes is almost never the direct cause of death, but
| it's damn hard in the body. Hurts circulation, hurts your
| nerves, hurts your organs... and it can flare badly in
| reaction to some medications.
|
| So, the cause of death won't be "diabetes", it'll be
| heart attack, stroke, chronic infection, something like
| that.
|
| Similar to AIDS in that it doesn't kill you directly (not
| that we know that juvenile diabetes is a thing, and we
| routinely test for it), it just makes any other health
| challenge much dicier.
| chimeracoder wrote:
| > Diabetes is almost never the direct cause of death, but
| it's damn hard in the body. Hurts circulation, hurts your
| nerves, hurts your organs... and it can flare badly in
| reaction to some medications. So, the cause of death
| won't be "diabetes", it'll be heart attack, stroke,
| chronic infection, something like that.
|
| It's not like the CDC doesn't know this. They understand
| how diabetes works; that's reflected in the tabulation of
| data. It's still incorrect to say that the drop in cancer
| deaths is explainable by the increase in diabetes deaths,
| not the least because age-adjusted diabetes deaths
| _decreased_ during most of that interval.
| SketchySeaBeast wrote:
| Seems less of a problem, more of a success.
| vikingerik wrote:
| Avoiding cancer in the first place matters too. Lung cancer is
| a lot less common, now that nobody smokes any more. The rate of
| lung cancer deaths for men has halved since 1991, which itself
| accounts for half of the overall decline.
| xupybd wrote:
| Screening, the HPV vaccine and dropping rates of smoking.
|
| It would be nice if we could stop advanced cancers but at least
| we're getting better at prevention.
|
| I lost my dad to cancer last year. It's a horrible disease. I
| really had no idea how horrific it is. My dad had a year longer
| than his initial prognosis thanks to new immunotherapy drugs.
| JKCalhoun wrote:
| > The decline in smoking rates in the U.S., better early
| detection and innovative treatments including immunotherapy
| drugs have driven a drop in death rates since 1991, the report
| said, averting an estimated 3.8 million cancer deaths in that
| time.
|
| Yes. I expected to find that the decline in smoking has also
| lead to the decline in fatal cancer -- and there it is. Still a
| good thing.
| cokeandpepsi wrote:
| it's crazy how fast smoking died out in the US even 10 years
| ago it felt people were puffing away all over the place
| caeril wrote:
| Indeed. Now we just need to do the same for overeating.
| msla wrote:
| There have been some wonderful advances in cancer therapy, such
| as immunotherapy. For example, Rituxan (rituximab) only dates
| to 1997, but it's already in a number of chemotherapy
| protocols, leading to a clear improvement in survival rates in
| previously difficult-to-treat cancers such as aggressive non-
| Hodgkin's lymphoma.
|
| https://en.wikipedia.org/wiki/Rituximab
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398399/
|
| Flashier, and something I've already talked about, is CAR
| T-cell therapy, the first generations of which were approved in
| 2017. This therapy has definite risks of severe side-effects,
| but it can result in complete remission of cancers that have
| survived multiple lines of chemotherapy, as happened with me.
|
| https://en.wikipedia.org/wiki/CAR_T_cell
|
| Immunotherapy isn't just promising, it's _here_ , and, because
| of it, so am I, but even more exciting is that it gives us more
| avenues of research to build off of known-useful therapies.
| Hackbraten wrote:
| Congrats for your success!
| melling wrote:
| That's not a problem, it's the key to curing cancers, according
| to Craig Venter
|
| @15:40 early detection is the way to eliminate cancer:
| https://youtu.be/iUqgTYbkHP8
| https://youtu.be/iUqgTYbkHP8?t=15m37s
|
| The reason people die from pancreatic cancer when they get it
| is because we can't detect it early.
| ZainRiz wrote:
| "problem" is a bit of a strong word, but when someone says
| "Cancer Death Rate Dropped" dropping people assume "Cancer
| Rate Dropped", which is not at all the same thing
|
| The article provides no numbers about cancer rate dropping.
| Yet the false association between the two ideas is so strong
| that even the authors themselves seem to theorize that the
| cancer rate itself is dropping because people don't smoke as
| often now.
|
| Conflating those two concepts seems like a Very Bad Idea
| Retric wrote:
| The % of the US population that dies every year from cancer
| has dramatically reduced. The % the US population that is
| detected to have cancer is up dramatically.
|
| The rate of people getting cancer in the US is a different
| question, but presumably it's been increasing due to the
| aging population independent of other causes.
| https://www.statista.com/statistics/241494/median-age-of-
| the...
| hooande wrote:
| Why is this a problem? The point of screening is to find and
| treat the most common forms cancer before they become advanced.
| codegeek wrote:
| I wouldn't use the word "problem" but to explain it better,
| cancer rate itself has not dropped necessarily but due to early
| detection, number of deaths from cancer has dropped. We still
| have a long way to go to actual be able to cure cancers
| especially in advanced stages. Still a good win but more work
| to do.
| impish9208 wrote:
| https://archive.is/coMAR
| HPsquared wrote:
| Is this "cancer deaths per person per year", or "cancer deaths
| per detected cancer"?
| mdp2021 wrote:
| Yes it is a theoretical mess. The article manages to conflate
| in the same sentence:
|
| > _The decline in smoking rates in the U.S., better early
| detection and innovative treatments including immunotherapy
| drugs have driven a drop in death rates since 1991_
|
| which mixes all meanings together (smoke - cases ; detection -
| fatality ...). So it's just "decreased number of deaths".
|
| (Well, on the other hand, it makes sense that more factors
| impact such "final" result.)
|
| From the CDC:
|
| > _In the past 20 years, from 2001 to 2020, cancer death rates
| went down 27%, from 196.5 to 144.1 deaths per 100,000
| population_
|
| https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-de...
| myroon5 wrote:
| More vaccines seems like one of the most straightforward future
| mitigations since viruses like Hepatitis/HPV/mono/HIV/herpes/etc
| cause almost a fifth of cancer cases:
|
| https://en.wikipedia.org/wiki/Oncovirus
| docdendrite wrote:
| That is a dubious claim. While links between HPV and cervical
| cancer are quite strong and well-defined, the associations with
| the other viruses you cite are only correlative. Also, Hep C,
| HIV and herpes have no vaccine, so unclear what your statement
| is referring to anyway? What has contributed to a drop in
| cancer mortality would be advances in treatment (like targeted
| therapies and immunoncology), better image/blood/genetic
| screening practices, and certainly the decreased popularity of
| smoking.
| wahern wrote:
| > While links between HPV and cervical cancer are quite
| strong and well-defined, the associations with the other
| viruses you cite are only correlative.
|
| HPV is merely correlative, as well. That's basically how all
| endogenous cancers work. With Epstein-Barr Virus the
| association is quite strong, though the incidence of EBV-
| induced cancers doesn't seem to be quite as large as HPV--~1%
| vs 2-3%.
| docdendrite wrote:
| HPV isn't correlative, it's causative. Additional co-
| transformation factors may be required, but it is well
| understood that E6 and E7 proteins directly lead to
| tumorigenesis. EBV pathogenic mechanisms are more autocrine
| and therefore a muddier picture, hence correlative.
| chasil wrote:
| This particular virus has a solid link to various forms of
| cancer:
|
| "[Epstein-Barr virus] has also been implicated in several
| other diseases, including Burkitt's lymphoma, hemophagocytic
| lymphohistiocytosis, Hodgkin's lymphoma, stomach cancer,
| nasopharyngeal carcinoma, multiple sclerosis, and
| lymphomatoid granulomatosis.".
|
| https://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus#Rol.
| ..
| vineyardmike wrote:
| > the associations with the other viruses you cite are only
| correlative. Also, Hep C, HIV and herpes have no vaccine
|
| And poster's own link doesn't claim some of the viruses are
| actually an oncovirus.
|
| That said, I don't think that pushing vaccines (either in
| research or into arms) for the listed diseases would be bad.
| pfg wrote:
| > Also, Hep C, HIV and herpes have no vaccine, so unclear
| what your statement is referring to anyway?
|
| OP is talking about more vaccines as possible future
| mitigations - more vaccines as in _new_ vaccines, not more
| vaccinations using existing ones (though that wouldn 't hurt
| either.)
| fexecve wrote:
| Now remove lung cancer and see if the numbers have changed that
| much.
| andirk wrote:
| Because of smoking?
| digger250 wrote:
| Yes. As well as asbestos and occupational exposure to inhaled
| particles.
| bsuvc wrote:
| Also radon remediation has become more prevalent
| robotnikman wrote:
| fuck cancer
| yamanawabi wrote:
| I did a ride with the Fireflies West
| (http://www.fireflieswest.com) cycling/fundraiser group this
| past year, and that was our motto. Indeed, fuck cancer.
| babypuncher wrote:
| I'd rather not
| newbee123 wrote:
| [dead]
| drummer wrote:
| [flagged]
| arroz wrote:
| Did it improve or did people stop getting diagnosed because it is
| too damn expensive?
| moooo99 wrote:
| Screening is more widespread and so is general awareness for
| symptoms. This leads to earlier diagnosis which generally has a
| better outlook than later stages. Then there's also general
| progress in terms of surgical procedures as well as medication
| for treatment
| [deleted]
| kgwgk wrote:
| Cancer death rates decline because people find that dying of
| cancer is too damn expensive?
| [deleted]
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