[HN Gopher] Proteins in blood could provide early cancer warning...
       ___________________________________________________________________
        
       Proteins in blood could provide early cancer warning 'by more than
       seven years'
        
       Author : racional
       Score  : 267 points
       Date   : 2024-05-15 13:11 UTC (9 hours ago)
        
 (HTM) web link (www.theguardian.com)
 (TXT) w3m dump (www.theguardian.com)
        
       | anonzzzies wrote:
       | Hope we found a lot of these type of things. 7 years is a big
       | win.
        
       | ekanes wrote:
       | Compared to most cancer-related findings, this seems clear,
       | simple and easy to replicate / disprove. Hopefully quickly, as
       | it'd be a huge win for humanity.
        
       | unsupp0rted wrote:
       | Oh boy, I hope one of those markers is for Pancreatic. That's
       | the/a silent killer.
        
         | adamors wrote:
         | It isn't unfortunately
         | 
         | > Little evidence for protein associations was observed in
         | these data for cancers of the pancreas, thyroid, lip and oral
         | cavity, or melanoma after correcting for multiple tests
         | 
         | From the study
         | https://www.nature.com/articles/s41467-024-48017-6
        
         | anotherpaulg wrote:
         | The Galleri blood test claims to pick up pancreatic cancer
         | early. Which I agree, is one which would be great to find
         | early.
         | 
         | > More aggressive cancers, such as pancreatic cancer, tend to
         | release more cell-free DNA into the bloodstream at early stages
         | and are more likely to be detected by the Galleri test.
         | 
         | https://www.galleri.com/hcp/galleri-test-performance
        
         | arrosenberg wrote:
         | CA 19-9 is the marker everyone is look at for Panc.
        
       | nerdjon wrote:
       | Am I crazy in thinking that we heard about this several years
       | ago? Is this just a continuation of that study or am I mis-
       | remembering/my timeline way off?
       | 
       | This is really exciting though, especially when mixed with other
       | cancer treatments the ability to catch and deal with this is
       | fascinating. How long until a theoretical, "Oh we detected some
       | cancer cells in your regular blood work, here is a shot to deal
       | with it" like we treat many other things.
        
         | jemmyw wrote:
         | You're not crazy, I recall a similar story too.
        
         | graywh wrote:
         | we've been searching for blood biomarkers for cancer for
         | decades -- I'm sure we've found several by now
        
         | yieldcrv wrote:
         | with the addition of an mRNA treatment approach I'm willing to
         | think 8 years off from at least a dozen cancers that currently
         | only get detected after they've metastasized.
        
         | nextos wrote:
         | You've been hearing about ctDNA. Which is really interesting
         | and predictive.
         | 
         | But it is hard to tune so that it is practical enough to be
         | deployed in routine healthcare. Efforts so far have not been
         | sensitive or specific enough.
        
       | blindriver wrote:
       | How does this differ from the GRAIL blood tests?
        
         | epistasis wrote:
         | Grail is looking at DNA methylation sites, this is looking at
         | proteins.
         | 
         | GRAIL is available today, this test will need to be validated
         | and commercialized
        
       | forinti wrote:
       | And how are you going to find the source?
        
         | _xerces_ wrote:
         | You're right, these proteins could be associated with
         | conditions that can later lead to mutations that cause cells to
         | become cancerous, but they don't point to a specific cancer.
         | Interestingly they hint at modifying the proteins to reduce the
         | likelihood of getting something, but that could be risk in
         | itself. A lifestyle change could be helpful in some cases.
         | 
         | I suppose if you have enough of these markers they could
         | schedule routine testing earlier than usual, say 40 instead of
         | 45 for colonoscopy, mammogram, etc.
        
       | stuff4ben wrote:
       | How long before that becomes a mandatory test to get health
       | insurance? Or somehow the data is bought by insurers who then use
       | it to jack up the rates for those who will eventually get cancer.
       | God I hate the US healthcare system!
        
         | DennisP wrote:
         | Insurance companies haven't been allowed to deny coverage for
         | preexisting conditions since 2014, due to Obamacare. They can't
         | even raise premiums. The only variables are age, sex, smoking,
         | and where you live.
         | 
         | This applies both to employer plans and the ACA plans on
         | healthcare.gov, where you can get a quote without giving them
         | any health data at all.
        
           | bonton89 wrote:
           | Is there anything stopping an employer from pretesting you to
           | avoid adding a potentially expensive employee to their
           | roster?
        
             | zamadatix wrote:
             | Generally it runs aground with things like the ADA because
             | you can't just "accidentally" find out the person has a
             | covered condition, you're just never allowed to ask or
             | require it be told. Exceptions for something like an
             | airline pilot on matters related to the job like sight
             | notwithstanding. This is why you always see things like
             | "can lift up to 40 lbs" type requirements instead.
        
           | Koala_ice wrote:
           | But, you can get absolutely destroyed on life insurance and,
           | just as critically, long-term care insurance. Genetic
           | discrimination is perfectly legal in those domains.
        
           | qclibre22 wrote:
           | You can be denied some kinds of health insurance :
           | https://www.medicarefaq.com/faqs/can-you-be-denied-a-
           | medicar...
        
             | DennisP wrote:
             | Only if you miss the open enrollment period, and even then,
             | you still have Medicare regardless.
             | 
             | It seems reasonable not to let people over 65 wait until
             | they have cancer before purchasing supplemental insurance.
        
         | Tenoke wrote:
         | This is such an odd take for me. If the test works and
         | insurance makes the test mandatory (which seems pretty
         | unlikely, what other comparable tests are mandatory?) then more
         | people will get an early diagnosis, and less people will die!
         | The incentives are aligned, the system works!
        
       | tombert wrote:
       | This is cool, though I do wonder if the tests will be good enough
       | to differentiate between "cancers that will be lethal in the next
       | seven years" and "cancers that are technically there but will
       | take so long to kill you that something else will beforehand
       | anyway".
        
         | two_handfuls wrote:
         | Also "cancers that your body takes care of on its own"
        
         | Jedd wrote:
         | > .. though I do wonder if the tests will be good enough ..
         | 
         | Sure .. but ..
         | 
         | a) knowing that cancer is there, but you may get hit by a bus
         | before it kills you, can still inform some medical care
         | decisions
         | 
         | b) the 12 authors of that paper have probably put a bit of
         | thought into the usefulness and efficacy of this kind of very
         | early detection, and concluded it was worth reporting on their
         | research
        
           | tombert wrote:
           | I don't dispute either of your points. It was a genuine mere
           | curiosity on my end, not a rhetorical "gotcha!".
           | 
           | I've just heard that for stuff like prostate cancer, a
           | diagnosis can be misleading, because sometimes it can take
           | 20+ years to kill you. If you get it when you're 70, it's
           | probably not worth going through surgery or chemo because
           | you'll likely die of heart disease or another cancer before
           | that anyway.
        
             | thfuran wrote:
             | That sort of issue crops up all the time in medicine.
             | Screening for conditions will always produce some false
             | positives, and the ramifications can vary from scaring the
             | shit out of someone for a few weeks before you determine
             | they don't have cancer after all to them dying as a result
             | of further testing/treatment that wouldn't have happened
             | without that initial screening. That and the potential
             | adverse outcomes of the screening itself (and its costs)
             | always has to be weighed against the value of the true
             | positives.
        
         | snarf21 wrote:
         | I think we also should be looking more at change over time, not
         | just results as a distinct value. A lot of these values have
         | ranges and error margins but looking at changes over time can
         | be quite informative, especially for cases where your body
         | takes care of any potential issues. I think there are a lot of
         | diseases we could treat in cheaper ways with improved QoL if
         | detected early. Too often we try to fix a crashed car instead
         | of checking the brakes once a year.
        
       | EspadaV9 wrote:
       | I donated some blood a couple of years back and they came back
       | saying there were proteins present. Having follow up tests at the
       | moment, but none of the other markers are present that would
       | normally be there if there was cancer. Still waiting to get
       | further follow up tests, but no one seems to be worried enough to
       | rush things along.
        
         | dogtorwoof wrote:
         | Which proteins?
        
         | HappyJoy wrote:
         | Where did you donate? The only feedback I usually get is a
         | certificate every 8 trips.
        
           | Symmetry wrote:
           | I donate platelets with the Red Cross every month and I've
           | got an app where they give me the blood pressure and
           | hemoglobin level, and which used to tell me if I had Covid-19
           | antibodies before everybody did via vaccine or infection.
           | 
           | Before I donate I have to sign something that says, among
           | other things "We're going to test your blood for AIDS and
           | tell you if you have it, so if you don't want to know don't
           | donate". I hadn't thought about the other things they test
           | for but of course they don't want blood with Leukemia in it
           | either.
        
             | frontman1988 wrote:
             | Why wouldn't someone not want to know they have AIDS? Given
             | the disease is not a death sentence anymore and the earlier
             | you know better your chances of survival. The warning
             | probably deters a lot of people who could have otherwise
             | been saved by timely treatment.
        
               | vundercind wrote:
               | You still need to get consent for that. Like, you can't
               | just assume.
        
         | krisoft wrote:
         | > Still waiting to get further follow up tests,
         | 
         | I hope all will turn out good for you, and wishing you the best
         | of luck.
         | 
         | > they came back saying there were proteins present.
         | 
         | I think probably there is a bit of a Chinese whisper kind of
         | misunderstanding here. Your blood will contain proteins. It
         | must. Everyone's blood does. For example hemoglobin is a type
         | of protein which makes your red blood cells able to carry
         | oxygen.
         | 
         | What they probably told you is that they found the wrong
         | quantity or the wrong kind of proteins.
         | 
         | Wishing you the best!
        
       | zero-sharp wrote:
       | https://youtu.be/FzFT-KuE4BQ?si=7-EXbRz1TD4a5leL&t=56
       | 
       | The video makes the case that the early detection of cancers
       | isn't always a good thing. See 6:30 and 7:00 for specific
       | references to scientific studies. Some cancers (thyroid and skin)
       | can be detected at a much higher rate, but the associated
       | mortality remains constant (we are detecting benign cancers).
       | 
       | To be clear: obviously this is dependent on the cancer. Really my
       | point is that we need studies that show that the screening
       | improves outcomes.
        
         | brnt wrote:
         | This is how Dutch public healthcare motivates its general
         | aversion to medical testing, as many a foreigner finds
         | surprising and incongruent to the generally OK level of
         | healthcare outcomes provided by the system. You can test and
         | detect, but the error margins are often large (so many false
         | positives and/or false negatives), would generate way too much
         | workload to follow up and thereby cost time and money for
         | better leads. Plus, as you say, knowing early doesn't always or
         | even often mean you can actually change the outcomes.
         | 
         | Now, this is what they say... I have tried to find the actual
         | literature they use to motivate their protocols, and apart from
         | occasionally, have not been able to find that evidence. I'd
         | love to have a resource that demonstrates these sorts of
         | things.
        
           | fidotron wrote:
           | I am not sure that is unique to the Dutch, it is the line I
           | have heard in several countries.
           | 
           | Heavy agreement on your last part - if there is substantial
           | evidence to back this up I would like to see it.
           | 
           | As it stands I personally prefer the idea of constant mass
           | testing in order that we learn as much as possible as quickly
           | as possible, including improving the tests from the resulting
           | feedback loop.
        
             | brnt wrote:
             | When I see the prices of some of that testing, I know that
             | that cannot be the reason, and indeed, establishing
             | personal baselines by regular testing can only be helpful.
             | The aversion to it grounded on taking some average patient,
             | I am convinced.
             | 
             | I really wish there was more transparency, because test
             | aversion is exactly the same protocol you'd invent if you
             | were trying to save money. I want to be able to see which
             | of the two we're dealing with.
        
               | radicalbyte wrote:
               | Given how the Dutch system seems to be designed to
               | maximise paper filling and busywork instead of healthcare
               | - and of course to make the insurance companies rich -
               | it's no surprise that they're against it.
               | 
               | Medical experts here have very little say in how things
               | are run. It's all bankers and bureaucrats.
        
               | brnt wrote:
               | Do you have any sources for that?
               | 
               | I've worked for a hospital and I've never been able to
               | find anything approaching a complete balance sheet.
               | Financing it utterly opaque, but I'd love to have
               | something solid before I accuse anyone.
        
               | 6510 wrote:
               | I'm far from an expert on this topic, more on the
               | contrary.
               | 
               | The surgeons use to run the hospital. In contrast with
               | mba's they knew things. I don't know what the difference
               | is precisely but I hear the ziekenfonds use to have
               | people to divide money over treatments (set prices)
               | without their salary depending on their choices.
               | 
               | I don't know about the scale but longer ago we would just
               | build hospital buildings and house a workforce of nuns
               | nearby who had their own garden. Now we some how cant
               | afford to put down a building and with realestate prices
               | on the rise the salaries need to follow. We might not
               | like the factory village concept but if you have to be on
               | call all of the time it seems fkn convenient to me. Cut
               | the salary and give the employees a house, seems a great
               | perk.
               | 
               | Employee shortage is also costing a fortune.
               | 
               | We've created ambitious labor protection laws then we
               | created a loop hole where all you have to do is pay 190%
               | of the salary to a job agencies (uitzendbureu) and no
               | laws apply, anything goes. If you don't like it you can
               | go home. This didn't need to cost 90% of the salary.
               | Unless our labor taxes are now that complicated(?) but
               | that doesn't work as an excuse either.
               | 
               | Our taxes not paying for education doesn't mean we don't
               | have to pay for it eventually (+interest)
               | 
               | I read they are also lacking the money to streamline the
               | processes.
        
               | pessimizer wrote:
               | The reason this rings wrong for people is because the
               | reasons early testing is dangerous are entirely social.
               | People are motivated by fear to have every test
               | available, doctors are motivated by fear of being accused
               | of neglect by the patient, doctors are also motivated by
               | the profit that they make from the tests, the
               | manufacturers and patent-holders of tests are motivated
               | to have them done as much as possible, the labs that do
               | tests make money on the number of tests that are done,
               | the nonprofits that campaign based on diseases are
               | expected to message to increase testing for those
               | diseases and accept money from manufacturers and patent-
               | holders, there's motivation to exaggerate the danger of
               | what's detected by the manufacturers and patent-holders
               | of _treatments_ for the disease, and there 's motivation
               | by researchers who formulate the criteria for determining
               | whether a particular feature of something detected is
               | potentially dangerous/deserves treatment, and a
               | motivation to give them the most expensive treatment,
               | regardless of whether that treatment is unpleasant; in
               | fact if the treatment is dangerous, it opens up secondary
               | markets.
               | 
               | There's just an enormous number of tailwinds pushing
               | overdetection and overtreatment. The sum of that is
               | what's important, which is that when you test earlier,
               | you often objectively end up with more death and
               | suffering. Which is what a state-run national healthcare
               | systems needs to look at, they can't get lost in the
               | trees. You pick an optimum age for testing that shifts
               | the balance to less suffering and death (and costs), and
               | you look for specific exceptions (genetic, lifestyle,
               | comorbidities) and test _just those people_ early.
               | 
               | Could there be a way in which all testing would help
               | instead of hurt? Yes, but it's political and
               | psychological and not likely to ever happen. You'd have
               | to (as a patient) trust probability in general, and
               | additionally you'd have to trust the probabilities that
               | they're handing you haven't been distorted by the self-
               | interest of others. Not likely for the foreseeable
               | future; maybe 1000 years from now.
               | 
               | If you want to do the study, all you have to do is
               | compare the number of deaths from a thing when people are
               | tested early to the number of deaths when people are
               | tested late. Or just look for other people who have done
               | them. If early testing obviously saved lives, the people
               | who sell testing would tout them everywhere. Instead,
               | they're stuck trying to look for angles to argue that
               | lessening death and suffering isn't the biggest
               | consideration. They recently did this to push breast
               | cancer screening earlier again, by arguing that if you
               | specifically look at black American women, they benefit
               | from early cancer screening. So overall, breast cancer
               | deaths go up, _but that 's just your privilege talking._
               | Woke conglomerates. Ignore that black people have a
               | unique, neglected, discriminated against, and poverty-
               | ridden situation in the US; in fact, it might even be
               | racist to point that out (in backwards land.)
               | 
               | Of course, you definitely don't have to do the studies,
               | plenty have been done. Anybody saying that they've looked
               | and haven't found them has not looked or has seen them
               | and is not telling the truth. Both positive and negative,
               | about every test. The studies that support earlier and
               | more testing are press released and marketed, though,
               | while the others can be suppressed or simply ignored,
               | unless some public health system or insurance company
               | champions them, and _of course they would._
        
               | brnt wrote:
               | I fully agree.
               | 
               | However, the converse is also true: we don't actually
               | know which protocols are there because they're social,
               | and which are there to benefit the insurers. Both could
               | motivate cost cutting.
               | 
               | I want to see the difference. I want whatever the full
               | story is laid out in front of me.
        
           | leto_ii wrote:
           | > would generate way too much workload to follow up and
           | thereby cost time and money for better leads
           | 
           | Having lived a decade in NL, my impression was that keeping
           | costs down is the top priority. Unless you have a serious
           | chronic condition or were in an accident, good luck getting
           | somebody to take a look at you.
           | 
           | (irl, after a while you learn to push, exaggerate symptoms
           | etc. or just go back home to get tests and treatment).
        
             | brnt wrote:
             | Yep, the loudest people get the most help. There's no good
             | solution for that other than to become a bitchy 'client'.
             | It's unfortunate that despite the promises, you still have
             | to 'use it correctly' if you want those good outcomes as a
             | patient.
        
           | mort96 wrote:
           | It's not _just_ about keeping costs down, but also about
           | increasing quality of life. If you detect a benign cancer in
           | someone, and they then go on to receive chemotherapy, you 've
           | massively decreased that person's quality of life for a
           | significant period with no upside.
        
             | iknowstuff wrote:
             | A benign tumor doesn't spread and doesn't warrant
             | chemotherapy I believe? And if it's actually cancer than I
             | don't understand how you would not want it gone as soon as
             | possible to avoid metastasis?
        
               | Fire-Dragon-DoL wrote:
               | Well, this is talking specifically about the case where
               | the cancer is benign. Of course you want a metastatic one
               | gone.
               | 
               | For the benign ones, that's going to hurt the person's
               | body quite a bit
        
               | jvanderbot wrote:
               | I think the jump from "protein blood test" to
               | "Chemotherapy" is a bit of a stretch. There are almost
               | surely additional screenings and diagnoses going on
               | there. And I don't think anyone is going into chemo for
               | benign tumors.
        
               | Fire-Dragon-DoL wrote:
               | Makes sense. Is it possible for the two types of cancer
               | to be confused?
               | 
               | Should also point out that tests will negatively affect
               | your life seriously either way, especially if these
               | benign cancers are common. Think of the time spent going
               | to/from the doctor, the incredible stress (am I dying?),
               | the tests itself: it is damaging the person's life.
               | Detection is good, false positives are unacceptable
               | though.
        
               | jvanderbot wrote:
               | I recently read Outlive, and he makes the claim that
               | almost all of the increase in survivability for cancer
               | comes from early detection. I think projects like this
               | are extrapolating that out. I think a little heartache
               | and worry is excusable if it means 10 years added to your
               | life. Over time, we'll develop a callous there and take
               | it in stride.
               | 
               | e.g.,
               | 
               | My two friends who got early screening had a few false
               | positives, and one true positive treated early. One later
               | died of heart attack and one lived long enough to get
               | dementia.
               | 
               | My two friends who didn't get early screening, one died
               | of heart attack and one died of cancer that could have
               | been caught. Both died earlier than two above.
               | 
               | Sadly, at this point, you _want_ to die of cancer, but
               | you want to do it when you 're 85. It beats a sudden
               | heart attack and it beats dementia. You just want to
               | prolong the outcome.
        
               | robocat wrote:
               | > [costs:] the incredible stress
               | 
               | I have seen a few people get benefits from a cancer
               | scare: a refocus onto what matters in their lives. Agree:
               | I would guess most people just get costs. Of my middle-
               | aged friends with health scares only a few addressed the
               | underlying cause (and even fewer are proactively avoiding
               | health issues).
        
               | canes123456 wrote:
               | It's more complex than this. There is a pretty narrow
               | sweet spot where early detection actually helps.
               | 
               | If the cancer is very fast growing, it could be too fast
               | for treatment to help at all. Even if treatment helps
               | there likely not a very long period of time before you
               | develop symptoms that would have lead to treatment
               | regardless.
               | 
               | If it is very slow growing, you might outlive the cancer
               | and it doesn't require treatment. It is effectively but
               | not actually a benign tumor.
               | 
               | You also have to deal with false negative and positives,
               | that could be an order of magnitude higher than the
               | Goldilocks true postives that earlier detection actually
               | made a difference. It's easy to see how population
               | results will not show much of a benefit.
        
               | jajko wrote:
               | Probably the most famous slow growing tumor is prostate
               | cancer. As per my friend who is urology surgeon,
               | basically all men eventually catch it, unless they die
               | young. But it goes so slowly and symptoms are rather mild
               | in most cases no invasive treatment is done.
        
               | dukeofdoom wrote:
               | Prostate cancer. Lots of nerve endings there. The
               | procedure to remove it can lead you to be incontinent.
               | Let's say you treat the cancer but get damaged by the
               | procedure and can't be as active. Your seditary life
               | style leads to a blood clot and an early death ...in the
               | end you may have lowered your life expectancy as prostate
               | cancer is slow growing
        
               | vharuck wrote:
               | Prostate cancer also came to my mind first. Doctors
               | generally stop screening for prostate cancer after a
               | certain age (70 and older is the recommended cutoff from
               | the US Preventative Services Task Force), because, if the
               | cancer wasn't causing symptoms, it's unlikely to impact
               | quality of life or cause death before something else.
               | 
               | The USPSTF references a lot of meta-analyses dealing with
               | screening outcomes. They make decisions by whether a
               | specific screening practice decreases mortality rates.
               | They explicitly don't even include the financial cost of
               | a screening practice.
        
             | whimsicalism wrote:
             | the scenario you're describing would never happen, you
             | don't prescribe chemo based on a blood test of protein
             | markers
        
             | dukeofdoom wrote:
             | My nurse friend said she only discharged 2 people after
             | chemo in about 7 years of service. People have a misguided
             | notion about the odds of survinvg a deadly cancer. They
             | also found the diagnostic procedures for breast cancer was
             | causing the cancer.
        
               | arcticbull wrote:
               | > They also found the diagnostic procedures for breast
               | cancer was causing the cancer.
               | 
               | I assume you're referring to mammograms. You do get
               | exposed to a significant amount of ionizing radiation in
               | mammography, about 0.4mSv, about 40% of the EPA's annual
               | radiation limit for a member of the public.
               | 
               | That's one of the very good reasons why guidance is women
               | wait until age 45 to get annual screenings and switch to
               | biennial at 55.
               | 
               | At that point the rewards outweigh the risks.
        
         | epistasis wrote:
         | This is not about early detection in general, but rather a
         | specific test of dubious utility, specifically full-body MRI,
         | which often leads to tons of follow-on tests and invasive
         | procedures that may have zero benefit.
         | 
         | For a test with high enough specificity and sensitivity for
         | early detection, it's likely that it would be quickly adopted,
         | and then studied to show that it actually improves outcomes
         | without undue cost (not merely dollar cost but also health
         | cost) to people in terms of treatment and its side effects.
        
           | zero-sharp wrote:
           | They specifically talk about using the fully body MRI for the
           | purpose of detecting cancers. I'm not sure how you missed
           | that. You literally had to watch 10 seconds of the clip.
           | 
           | It's interesting because they explicitly talk about follow up
           | testing (@2:10) which is to say that multiple methods are
           | used if the MRI indicates a problem. So yes, the initial MRI
           | may produce a misdiagnosis and that is a defect of the test.
           | But the commentary in the video obviously suggests that
           | _additional_ testing for early detection is done. That 's
           | partly a problem as you pointed out, but then it clearly also
           | indicates the scope of the conversation is more broad.
        
             | ceejayoz wrote:
             | They didn't miss it at all.
             | 
             | You've misunderstood the comment's point, which is "just
             | because prospective full-body MRI is bad doesn't mean all
             | diagnostics are".
        
               | zero-sharp wrote:
               | It's true that some of the commentary is specific to the
               | full body MRI itself (such as misdiagnosis due to an
               | imaging artifact), however many of the claims in the
               | video are very general. And the scientific study they
               | referenced at 6:30 has nothing to do with fully body
               | MRIs. The study is in regards to thyroid cancer
               | overdiagnosis due to screening (using ultrasound and not
               | MRI). This is clearly a statement regarding the
               | effectiveness of screening. And, yes, it is specific to
               | the cancer.
               | 
               | I'm not saying anything that the studies aren't saying.
               | For some kinds of cancers and for some kinds of screening
               | methods, screening can result in overdiagnosis.
        
               | ceejayoz wrote:
               | OK, so you had to watch a little more than ten seconds.
               | 
               | There's no doubt that _some_ diagnostic tests - like
               | getting a full-body MRI as a precaution - may do more
               | harm than good. Your apparent mistake is thinking that
               | means _all_ diagnostic tests probaby do.
               | 
               | We'll have to figure out which one this is; it's a start
               | of that process. We've demonstrated we can do it; now we
               | have to figure out if we can distinguish between "big bad
               | scary" cancer and "whatever it won't kill you" cancer.
        
               | epistasis wrote:
               | At 6:30 it's about a specific test for thyroid cancer,
               | which as discussed in my second paragraph, was not found
               | to actually improve outcomes for that specific type of
               | cancer, not cancer in general.
               | 
               | However, early detection is responsible for greatly
               | improving outcomes in many specific cancers. Full body
               | MRI is not the test to achieve that. GRAIL's gallery test
               | might be one to do it for many classes of cancer, but
               | that still remains to be fully seen.
               | 
               | The general of idea of early detection is still an
               | extremely promising one for most types of cancer, and in
               | particular for some of the deadliest, like ovarian and
               | pancreatic cancer.
        
         | Wowfunhappy wrote:
         | I can't watch a video at work but I have seen this argument
         | before.
         | 
         | I just find it fundamentally hard to believe that having more
         | data is a bad thing. What we choose to _do_ with that data is a
         | different story, and the actual source of these bad outcomes.
        
           | mort96 wrote:
           | Are you prepared to make the decision, "I have cancer but
           | statistically it has a relatively low likelihood of killing
           | me before I would die of other causes, so I won't do anything
           | about it"?
           | 
           | Are most people?
        
             | thimkerbell wrote:
             | It might provide enough impetus for getting you to avoid
             | sugar and processed meats though.
        
               | mort96 wrote:
               | Has avoiding those things been shown to stop existing
               | cancer? I thought those foods just increased the chance
               | of getting cancer in the first place. But I'm totally
               | ignorant here, it sounds plausible that some carcinogens
               | work by worsening cancer which would otherwise have been
               | benign, I just haven't heard about that
        
             | nick__m wrote:
             | There is a spectrum between invasive treatment and not
             | doing anything.
             | 
             | You could have a scan 3 months later and if there is no
             | progression the doctor schedule a scan 6 months later and
             | then 12 months... If there is a progression he schedule an
             | appointmentwith an oncologist.
        
             | ggm wrote:
             | If you're male and live to over 60, you are going to be in
             | this camp regarding the PSA and intervention for Prostate
             | Cancer. Two GPs, a Urologist and an Epidemiologist (none of
             | whom know each other btw) have all said to me "you will die
             | with this not of this" because they can trace the dynamics
             | of my presentation.
             | 
             | Enhanced imaging and blood tests alone didn't do this:
             | their intuition based on progression and behaviour of the
             | system as a whole did.
             | 
             | Treat the person, have a longterm relationship with your
             | health provider.
        
           | cityofdelusion wrote:
           | Data isn't necessarily good because medicine and biology are
           | messy and inaccurate. I just went through a scare myself with
           | elevated markers on a typical blood panel. Lots of fuss,
           | anxiety, and cost for zero gain. At the end, I learned that
           | human bodies vary so much that we're was just no way to know
           | upfront if a finding was a concern or if my body was just on
           | a tail end of a bell curve. Turns out, if you fully scan
           | people, we all have lumps, bumps, and various anomalies. How
           | much do you spend "treating" and investigating this stuff? I
           | wasted my own time and precious time with doctors for
           | nothing, increasing costs to society as a whole.
           | 
           | That kind of data, the costs, we have tons of. That's why
           | pretty much every medical association regardless of culture
           | has limits on recommended screenings.
        
           | canes123456 wrote:
           | If your are choosing not to do anything based on the data,
           | gathering the data is objectively a net negative. There are
           | financial costs related to taking the tests as well as
           | emotion costs related to false positives and even with
           | deciding not to act with possibly true positives.
           | 
           | There needs to be a net positive action on a subset of the
           | cases to outweigh the costs of gathering and sharing the
           | data.
        
           | brnt wrote:
           | Most data is crap, and you generally can't tell where the
           | needle in the haystack is.
           | 
           | Having more consistency between doctors would already be a
           | change needed to actually use data. You will find it matters
           | more than you'd like. We can't all have the best doctors, but
           | we could use data to level the outcomes.
        
         | siliconc0w wrote:
         | The problem with this is that they haven't done the long term
         | studies (which they admit). They also don't consider that once
         | these are cheap and regular enough you get the change over time
         | which should get you a lot less false in positives.
        
         | Spooky23 wrote:
         | It's a risk assessment like any other. Probability/impact.
         | 
         | My wife ultimately lost her life to metastatic melanoma, which
         | was believed to be in remission. Had there been a way to detect
         | the proteins associated with the mets that developed ahead of
         | symptoms, the odds are she we be alive and thriving.
         | 
         | In other scenarios, say most prostate cancers, early knowledge
         | has low or negative benefits.
        
         | Fire-Dragon-DoL wrote:
         | I don't understand how we don't consider benign cancers false
         | positives? Acting against those cause serious damage to the
         | body for no gain
        
         | mensetmanusman wrote:
         | The more data the better though. We need to train the models to
         | understand what is worth doing over time.
        
       | kazinator wrote:
       | Say we find some proteins in the blood that hint at cancer 7
       | years away. How is that actionable, and will it make a
       | difference?
       | 
       | How low is the false positive rate?
        
         | tomoyoirl wrote:
         | A key benefit is that it might be able to perform follow up
         | screenings that make sense for that type of cancer, rather than
         | expecting absolutely everyone to take all the tests ever at the
         | same rate, at significant inconvenience and expense.
        
       | macawfish wrote:
       | So you can get seven years more of nocebo effect, anxiety, stress
       | and worry?
        
       | njarboe wrote:
       | Does this mean we can get the 5 year cancer survival rate to
       | 100%?
        
       | m3kw9 wrote:
       | You detect it and then what? You get depressed and there is no
       | treatment for something that early. Better to test for obvious
       | signs every year based on susceptiblility.
       | 
       | Maybe the depression and stress can make you more sick, let alone
       | the effect on your family should you announce it
        
         | goda90 wrote:
         | Improve your health with better diet, exercise, sleep. Find and
         | reduce carcinogen exposures. Give your immune system a chance
         | to nip it in the bud before you even need treatment.
        
       | andrewmutz wrote:
       | You can get these sorts of tests already. Last year I used this
       | company's product and it was a smooth experience:
       | 
       | https://www.galleri.com/
        
         | ak217 wrote:
         | Grail's test is a cfDNA test. It detects DNA fragments in blood
         | that are indicative of specific methylation patterns that are
         | in turn indicative of possible cancerous growth. While a good
         | approach, there are continued sensitivity challenges with cfDNA
         | tests.
         | 
         | This research is a high quality longitudinal retrospective
         | study of protein cancer biomarkers, not cfDNA. Protein
         | biomarkers are a complementary signal that has the potential to
         | boost the sensitivity and precision of these tests, especially
         | when the signals are combined together.
        
       | zjp wrote:
       | It seems like every other day there's a new breakthrough. I
       | watched my paternal grandmother succumb to lung cancer when I was
       | 7. She was my favorite person on Earth at the time and watching
       | her go was devastating. It gives me so much hope to watch the
       | category "treatable and preventable cancers" expand over time.
        
         | consf wrote:
         | I have a similar experience with my grandmother. Only she had
         | stomach cancer. Such research warms my heart
        
       | consf wrote:
       | Early detection is crucial in improving outcomes for cancer
       | patients, as it allows for timely treatment and intervention when
       | the disease is most treatable. And these kinds of research are
       | promising
        
       | kemmishtree wrote:
       | i.e., Why We Need Utility-Scale Solid-State Molecular Sensing,
       | Reason #53,444,001
        
       | srigi wrote:
       | Isn't the cancer the "exponential game"? If there are 20 cancer
       | cells in the body on day 1, on day 30 there will be 10737418240
       | (10.7B) cells if they double every day. This is how we were
       | taught about cancer, so it is a very quick process when started.
       | How can you get 7 years of ahead of time in this setup?
        
         | arrosenberg wrote:
         | They don't necessarily double every day. Some tumors are very
         | stable, some are particularly metastatic. It often depends on
         | access to blood supply and what type of cell has become
         | cancerous.
        
       | jimbobthrowawy wrote:
       | Here's hoping this kind of screening becomes quick and cheap
       | enough to do at home or regularly at a pharmacy.
       | 
       | I'd like to get a rough estimate of how many moles I have at
       | least once a year if it wasn't a huge effort.
        
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