[HN Gopher] Cheap blood test detects pancreatic cancer before it...
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Cheap blood test detects pancreatic cancer before it spreads
Author : rbanffy
Score : 301 points
Date : 2025-02-13 12:19 UTC (10 hours ago)
(HTM) web link (www.nature.com)
(TXT) w3m dump (www.nature.com)
| mbreese wrote:
| Here is the link to the actual paper.
|
| https://www.science.org/doi/10.1126/scitranslmed.adq3110
| duxup wrote:
| So for a test like this, do you just give it to everyone without
| symptoms?
|
| For a very high mortality cancer is it even useful to test after
| you have reason to test?
|
| I read about these tests and breakthroughs that involve general
| predictions and test, but I'm pretty sure when I go into the
| doctor I'm not screened proactively for all that much.
| allturtles wrote:
| AFAIU, with pancreatic cancer usually by the time you have
| symptoms you are already stage 4 and uncurable. So I'm assuming
| the intent is to test non-symptomatic people.
| duxup wrote:
| That's what I was assuming as well. But then that leads to my
| other question, do we really regularly screen people this
| proactively for much at all?
| The_Colonel wrote:
| Measuring your blood pressure is an example of proactive
| screening.
|
| I assume we will start screening for things like cancer
| when the test will be as simple / cheap as measuring your
| blood pressure.
| mwigdahl wrote:
| In the US, asymptomatic people 50+ are routinely screened
| for colon cancer with a much more expensive and invasive
| process. A cheap blood test for another major killer seems
| pretty reasonable to add in.
| alistairSH wrote:
| Are we still doing colonoscopies on "everybody", or are
| we pivoting to the mail-in stool sample tests? FWIW, my
| health plan sent my wife and I the mail-in kits last
| year.
| bluGill wrote:
| There is still debate on that. Colonoscopies are
| expensive and invasive, but they are the "gold standard".
| A colonoscopy is every 10 years, the mail in sample is
| every 3 (check with your doctor to see what is right for
| you). The mail in sample is not as sensitive as well - I
| used to know someone who died of colon cancer 1 year
| after a negative mail in sample, a colonoscopy would have
| saved her life. If the mail in sample finds anything they
| send you to a colonoscopy anyway (but you get to the
| front of the waiting list) to fix the problem.
|
| For people at low risk the mail in sample is likely good
| enough, and since a colonoscopy has other risks
| (including kill you) may even be on balance be better for
| those. However anyone with a higher risk should get
| colonoscopies. Where the line between low and high risk
| is though is very much up for debate.
|
| The above is general discussion. For medical advice talk
| to your doctor - who will know the right questions to ask
| to figure out what is right for you.
| unsupp0rted wrote:
| How do the "mail-in" samples compare against the Amazon
| "take a dab of stool and mix it in this bottle and look
| for a color change" test kits?
| absolutelastone wrote:
| There's a long list of stuff people are supposed to be
| screened for. Many people die of stuff that has high
| survival rates when caught early.
|
| Pap tests, mammograms, prostate exams, are other examples
| for cancer.
| moooo99 wrote:
| Don't forget about skin cancers. Screening for it is
| easily among the least invasive and least uncomfortable
| screening procedures for any kind of cancer, yet many
| people miss the opportunity for an early diagnosis
| ethbr1 wrote:
| The intent of non-invasive tests like this are that you give
| them to _everyone_ , at scale, frequently.
|
| And specifically tune them to minimize false negatives.
|
| Worst case with a false positive? You're causing someone
| anxiety and giving them an extra scan.
|
| Best case? You just saved someone's life by detecting an
| aggressive cancer early enough to do something about it.
|
| At the end of the day aggressive, metastatic cancer is a time
| game. If the cancer is given time, it becomes progressively
| harder and harder to treat, and effective treatment options
| become tougher on the rest of the body, until finally there's
| nothing to be done.
|
| So anything that gains time is critical.
| giantg2 wrote:
| They generally aren't going to give them to everyone. They
| will give them to everyone within a certain group, such as
| age 30+ since the under 30 group is very low risk (unless
| family history, etc). Similar to how they don't test most
| kids and younger people for cholesterol - it's just not a
| significant problem for that age group.
| ethbr1 wrote:
| Traditionally, tests have been metered that way because of
| costs (expensive reagents, preparation, processing) or side
| effects (radiation from scans).
|
| But the actual relevant equation is {cost of testing} vs
| {cost of delayed treatment}
|
| If the cost of testing, in economic and health senses,
| decreases while the cost of delayed treatment holds
| constant, a different mass deployment optimal point is
| created.
|
| Thankfully broader proactive testing is also in insurance
| companies' financial interests, given the high costs of
| late stage cancer treatment.
| bluGill wrote:
| Nearly everyone will reach 30 in their life, so it is safe
| to say we give them to everyone. It isn't a one and done
| test, cancer can form at any time in your life. To be
| useful we need to give this to everyone over 30 (40,
| 50....?) , on a regular schedule (yearly?). The article
| doesn't specify those details (or at least not before I hit
| the sign in wall)
| absolutelastone wrote:
| I think these days they do recommend screening all children
| for cholesterol.
| AlexErrant wrote:
| Which is good because "ASCVD is a disease that begins in
| childhood; hence, primordial prevention is an important
| target for improving cardiovascular morbidity and
| mortality later in life."
|
| > Elevated LDL-C and triglyceride levels have a positive
| correlation with atherosclerotic lesion prevalence that
| persists from childhood through early adulthood...
| Follow-up data from the Young Finns cohort after 12 and
| 27 yr also demonstrated positive correlations between
| elevated childhood serum cholesterol and triglycerides to
| elevated levels in adulthood... Children from the i3C
| cohort with high and borderline-high total cholesterol
| have 1.5 to 2.13 times the risk of both fatal and
| nonfatal cardiovascular events in adulthood than children
| without. In addition, i3C children with high and
| borderline-high triglycerides have 1.69 to 2.47 times the
| risk than children with normal triglycerides.
|
| https://journals.lww.com/jcrjournal/fulltext/2022/11000/p
| rim...
| litoE wrote:
| One way to test lots of patients where a) there's a low
| probability that an individual patient will have the
| disease and b) the test is expensive is to first mix some
| of the blood of each of N patients and do one test on the
| mix. If the batch tests negative then all patients are
| negative and you've only paid for one test. If the batch
| tests positive then you have to repeat the test on the
| remaining blood of each of the N patients to determine
| which were positive. Thus, with a high probability you only
| pay for 1 test, and with a low probability you have to pay
| for N+1 tests. The value of N is easily computed to
| minimize the overall cost, given the cost of each test and
| the percentage of patients that have the disease.
| nsxwolf wrote:
| Worst case is the scan "sees something" which then puts them
| on a diagnostic anxiety roller coaster for the rest of their
| lives, "just to be safe". When in the alternate universe they
| might not have gone another 60 years hardly ever seeing a
| doctor.
| smt88 wrote:
| No, the worst case is death. Overdiagnosis of cancer leads
| to overtreatment, which has a risk of harm.
| modzu wrote:
| how is information making that worse? you either have a
| scan that shows a blip and you can use that information
| to inform your decision making, or you have no scan and
| go on without any kind of decision making. i know which
| option id prefer
| jghn wrote:
| Because you can wind up in a situation where the "blip"
| would have otherwise led to nothing problematic, but the
| followup for the "blip" actually does cause harm. And at
| an individual level it's impossible to tell which
| category you're in.
| daedrdev wrote:
| Every medical procedure after a scan has danger. Biopsies
| kill people. Colonospies kill people. The rate is
| extremely low, but test enough people who aren't at risk
| to have the disease and you will actively harm them.
| jghn wrote:
| > Worst case with a false positive? You're causing someone
| anxiety and giving them an extra scan.
|
| It is arguable that this as minor an issue as you make it out
| to be. There has been work to try to assess this (google
| "cancer overdiagnosis").
|
| The counterargument to what you state is that a false
| positive can not only lead to stress & unnecessary/more
| invasive screening, but a treatment plan that's a net
| negative. For instance: if a cancer were detected and it'd
| wind up being a cancer that someone dies with instead of
| from, and the treatment causes worse outcome than the cancer
| itself, that's not good. The hard issue here is that these
| things need to be determined at a population scale, and one
| can always cherry pick personal anecdotes in either direction
| to tug at heartstrings.
|
| We seem to have found ourselves at a point where it's clear
| there's a balance that needs to be struck, but it's unclear
| what that balance is yet.
| mattmaroon wrote:
| He did say that you tune them to minimize false negatives.
|
| I do find it interesting that in the early days of HIV
| testing even most people who got a "positive" result were
| in fact negative. The tests have since greatly improved and
| the number of people taking a test due to hysteria rather
| than likelihood of infection declined.
|
| But I can imagine a world in which we get very many forms
| of liquid biopsies like this every year, and false
| positives become a thing we understand and are used to.
| Goronmon wrote:
| _He did say that you tune them to minimize false
| negatives._
|
| That's a bit hand-wavy for something that appears to be
| the core issue with "test early, test often", isn't it?
| ethbr1 wrote:
| Whether one should bias to allow more false positives or
| false negatives depends on the next steps after a false
| positive vs the risks after a false negative.
|
| False positive: more costly scans
|
| False negative: untreatable terminal illness
| mapt wrote:
| The existing downsides of a might-be-cancer hit on a test
| are real, for now - a statistically significant number of
| people with a breast cancer diagnosis end up killing
| themselves out of despair or doing radical surgery "to be
| sure", which detracts from the social benefit of
| mammograms. But there's no indication that they would
| persist if false positives were more common because
| proactive testing was more common. There would be a
| pipeline of followup testing and risk evaluation, which
| would be normalized by how common it was and how nonlethal
| diagnostic hits would become.
|
| It would become "Oh, yeah, my cousin got a hit, but
| followup biopsy said it was a mutation that doesn't
| metastasize. Guess we'll see next week." rather than "My
| great-grandmother died of breast cancer, my mother died of
| breast cancer, my friend's aunt died of breast cancer, this
| feels like a death sentence", which is the information
| people who receive hits on their mammogram testing are
| acculturated with now.
| jghn wrote:
| Again, this is a well studied topic. Anyone claiming
| they've identified the one true answer isn't someone who
| should be believed. The topic is complex, at best. But
| these are not hypothetical situations. There are data to
| support the point to which you're countering.
|
| You are correct that there exists a world where the
| problem is minimized and at that point obviously the math
| changes. But we're not there yet.
| mapt wrote:
| The argument is over whether we should seek to get there.
| belmarca wrote:
| I'm sorry but that is a very naive and honestly wrong take.
| An "extra scan" is not just giving anxiety. It raises cancer
| rates. It can discover underlying relatively bening
| conditions which affect insurance coverage, for example. It
| can cause anxiety. It takes away resources "just to make
| sure". At the scale you are proposing, false positives are a
| _massive_ issue that you simply cannot ignore. It is all but
| trivial.
| moooo99 wrote:
| This is it, I am not sure how people can be so dismissive
| about the risks of over diagnosis.
|
| However, usually there are studies done to carefully weigh
| the risks and benefits of testing likes this. I would
| expect tests like these to become the norm for screening at
| risk populations at some point (usually people beyond a
| certain age or people with family history).
| smt88 wrote:
| This is incredibly wrong. This whole thread is.
|
| Cancer testing is not benign. False-positive cancer diagnosis
| has a >0 mortality rate, because further testing and
| treatment is potentially fatal. Just a colonoscopy can be
| fatal, as can a biopsy that requires anesthesia.
|
| The medical world weighs these things against each other and
| determines when the data shows that the risk of mortality
| from testing is smaller than the risk of cancer.
| blackeyeblitzar wrote:
| > The medical world weighs these things against each other
| and determines when the data shows that the risk of
| mortality from testing is smaller than the risk of cancer.
|
| Let the patient weigh the odds. Especially when they can
| afford retesting or may be otherwise in good health or
| whatever. Plus the test's algorithms can be tuned to
| provide more or less false positives.
| smt88 wrote:
| > _Let the patient weigh the odds._
|
| Patients are uninformed and emotional. Part of a doctor's
| job is to make the best decision for the patient using
| the information they have.
|
| For example, if you tell people that daily aspirin
| reduces the risk of heart disease, you might get a 25yo
| with no heart issues starting to take it.
|
| But if you look at actual data, all-cause mortality
| _increases_ for people who have no risk of heart disease
| if they take daily aspirin, because aspirin can cause
| fatal internal bleeding.
|
| That's the kind of thing doctors know and need to be firm
| about.
| blackeyeblitzar wrote:
| I disagree. Doctors are frequently incompetent, don't
| spend enough time with patients to understand them
| deeply, and are not aware of the latest research or these
| nuances.
|
| But leaving that aside, this is about patient control.
| Doctors should not be gatekeepers for diagnostics. I
| don't even want them to be a gatekeeper for many
| relatively safe prescriptions, which is clearly a way to
| increase medical costs.
| smt88 wrote:
| > _Doctors should not be gatekeepers for diagnostics._
|
| Doctors mostly aren't gatekeepers for risk-free
| diagnostics, like a blood test for a vitamin deficiency.
| Insurance companies are.
|
| But for risky tests, doctors have a duty to "do no harm"
| and can't/shouldn't order something that they know causes
| an increase in all-cause mortality for their patients.
|
| The concept is the same with antibiotics or anything else
| a patient might ask for without knowing the risks.
| ethbr1 wrote:
| > _Doctors mostly aren 't gatekeepers for risk-free
| diagnostics_
|
| That's not entirely true. There are more than a few
| diagnostics in the US that the FDA explicitly discouraged
| companies from offering without physician referral. E.g.
| whole genome sequencing several years ago
| modzu wrote:
| the obvious answer is additional testing to reduce the
| likelihood of a false positive -- if additional tests are
| invasive _those_ tests can be weighed on the balance of
| risk just the same. i think the real problem is cost, we
| cant afford /manage to do that correctly currently, which
| is exactly what improved non invasive tests could enable
| and disrupt this reactionary approach forever
| smt88 wrote:
| > _if additional tests are invasive those tests can be
| weighed on the balance of risk just the same_
|
| So let's say you have an extremely safe test. Let's use
| the "mail your poop to a lab" test for colon cancer as an
| example.
|
| If that test (regardless of its accuracy) comes back with
| a positive, you're going to do one of two things: A)
| order a colonoscopy, perhaps with biopsy, to confirm the
| presence of a malignant tumor; B) start treatment
| immediately (if you trust the initial test enough).
|
| So that brings you back to square one: you shouldn't do
| the test, regardless of the safety, if the math works out
| to make it riskier (due to false positives and
| unnecessary tests/treatment).
| modzu wrote:
| i think i agree about "if the math works out" -- but
| thats the hard question isnt it? isnt the accuracy of the
| poop test significant? if 2 or 3 poop tests increase our
| confidence in the result it changes the risk:benefit
| calculation for the colonoscopy or treatment. thats an
| easy win. but even if it did not, is the result from the
| (preventative) poop test less valid data than a patient
| complaining of pain? so generally speaking i agree we
| dont want to enable a path to risky procedures based on
| dubious evidence, but i think overall we are presently
| operating with a dearth of information (waiting for
| symptoms) and the math itself improves by having more
| proactive testing (information) in the first place
| derektank wrote:
| I feel like you're missing the point. Yes, false positives
| have risks. But if blood tests (or in the case of bowel
| cancer, fecal tests like cologuard) are effective, we can
| replace more invasive screening options with them. People
| have historically been encouraged to get colonoscopies once
| they reach a certain age because, for the general
| population, the risks of cancer are higher than the risks
| associated with a colonoscopy above the age of 50.
| Developing less invasive tests lets us lower that age,
| catching more cancers, while at the same time making
| screening safer for people already in the recommended
| screening window.
|
| Also, pancreatic cancer, which is what the original article
| is about, has no alternate form of screening. Most people
| only find out they have it once it's already symptomatic,
| which is usually stage 3 or 4
| jghn wrote:
| I'd argue that you are the one missing the point.
|
| These things are already taken into account via
| population scale statistics. In most cases, it's at best
| debatable whether more or less screening leads to an
| overall better outcome across the entire population
| aggregate. The argument against more screening is that it
| can (and the claim is it does) lead to overall worse
| outcomes in aggregate. For any individual case however,
| the story may be totally different.
|
| What we need are better mechanisms to bin positive
| results to steer people towards a finer grained course of
| action. That'd change the math to be more of an overall
| net benefit.
| smt88 wrote:
| > _But if blood tests (or in the case of bowel cancer,
| fecal tests like cologuard) are effective, we can replace
| more invasive screening options with them._
|
| That is not what I'm arguing against. People in this
| thread are talking about testing earlier and more often
| because we have these new tests, not "just" replacing
| existing tests.
|
| The math is very unlikely to work out that we should do
| that.
| ethbr1 wrote:
| Howso? Existing solutions vs more widely deployed and
| frequent blood+fecal tests followed up by existing
| solutions in the case of a potential positive?
| cameronh90 wrote:
| The emphasis there is on "further treatment". The test
| itself is broadly benign (except the general risks
| associated with phlebotomy and any risk of psychological
| harm).
|
| The issue is that doctors often over-react to adverse
| results due to the risk of being sued if it did turn out to
| be a true positive.
|
| I have two examples of this. One was during a routine blood
| test I had a liver enzyme flag up, which was then further
| investigated non-invasively with ultrasound and it was
| determined that I might either have moderately developed
| NAFLD (non-alcoholic fatty liver disease, I'm obese) or
| very early stage NASH (non-alcoholic steatohepatitis)
| associated fibrosis. The doctor wanted to perform a liver
| biopsy to confirm which is obviously an invasive procedure
| with a 1%-ish risk of complications.
|
| My response was to ask how the treatment would differ
| between diagnoses, and he said in either case the treatment
| would be the same: lifestyle change. He agreed that from a
| risk perspective the biopsy was just inviting additional
| risk for no benefit, but that policy is to recommend the
| test and if I refuse it I'll need to sign an
| indemnification document saying I was refusing further
| diagnostics against medical advice. A few years go by, I've
| made efforts to improve my lifestyle, lost weight, and now
| my liver tests are all normal proving it was just NAFLD
| after all.
|
| In another case, I had a suspicious finding in an eye test
| which (long story short) led to me getting two head CT
| scans which showed no problems. In hindsight, I think a
| double dose of brain radiation over a common minor finding
| with no other symptoms was a crazy over-reaction and I
| would have refused if I had all the facts, but it could
| have been a life threatening situation in some ridiculously
| tiny percentage of cases so it was all rush rush and I
| didn't have time to weigh it up.
|
| Often the correct thing to do may be a combination of
| further non-invasive testing, repeating the test (possibly
| after a period of time), and "watchful waiting". Doctors
| often don't feel comfortable with the level of personal
| risk that could expose them to, and for good reason. That
| is the issue, not the test.
| smt88 wrote:
| > _The issue is that doctors often over-react to adverse
| results due to the risk of being sued if it did turn out
| to be a true positive._
|
| Do you think a patient is going to receive a false
| positive and accept a response from a doctor of, "Oh,
| might be a false positive. Let's ignore it and not do any
| more risky testing."?
|
| That scenario makes no sense from either perspective. If
| you get a positive, you do more testing (or skip to
| treatment).
|
| Your examples are well-taken and I understand them, but
| they don't apply to cancer. When you detect cancer with
| any test, you immediately do something risky: either a
| further test that involves risk, or treatment that
| involves a lot of risk.
| toast0 wrote:
| > Do you think a patient is going to receive a false
| positive and accept a response from a doctor of, "Oh,
| might be a false positive. Let's ignore it and not do any
| more risky testing."?
|
| I mean, it depends on the test; a reasonable answer could
| be this is likely a false positive and confirmation tests
| have risks, here are some symptoms to look out for, and
| we'll test on a regular basis and see if anything
| changes. That's not appropriate for all positive results
| from screenings, but it is for some.
| jillesvangurp wrote:
| Depends, colon cancer, breast cancer, prostrate cancer, etc.
| are pretty commonly tested/screened for in certain age groups
| and that definitely saves lives.
|
| My aunt died of pancreatic cancer last year. It's a pretty
| common and aggressive form of cancer. She only had a few months
| from diagnosis to the grave. By the time she got diagnosed,
| there was nothing that they could do except provide pain
| relief.
| bluGill wrote:
| My dad got lucky to get his detected relatively early (they
| happened to be doing an unrelated test and "saw something",
| but that just meant two years of chemo and all those side
| effects before he died. If they hadn't found it when they did
| it would have been 1 year of side effect free life followed
| by 6 months of pain for something untreatable - in short
| overall a better end of life though he would have lost 6
| months. If they had found it 6 months sooner though odds are
| it would have been treated and he would still be with us.
| blindriver wrote:
| If we don't detect more people early and try to cure them,
| it will never be solved. The more people that get detected
| early, the better chance everyone has of surviving,
| especially those in the future.
| chasebank wrote:
| Isn't this fundamentally a statistical issue? With a test
| sensitivity of 99%, meaning a 1% false positive rate,
| administering it universally to individuals would generate a
| significant number of false positives. This influx could
| overwhelm the system, potentially limiting access for those who
| genuinely require medical attention.
| duxup wrote:
| That's what I'm wondering too. Even if 1%, if the follow up
| is very expensive, the initial test might be cheap but
| overall cost might be very expensive / prohibitive.
| bluGill wrote:
| So you are arguing we should just let people die?
|
| This is a cancer that is typically detected only after it
| advances far enough that you will be dead in 6 months (not
| treatment possible). If we could detect it 2 years sooner
| it would be treatable and most people could life for many
| more years. Sure the total cost of a positive will be much
| higher - between whatever tests to verify it isn't a false
| positive, and all the treatment it will be a lot more
| money. However by spending that money many people will live
| a lot longer.
|
| Maybe you don't like any old people, but I often wish I
| could show my dad my latest project. This test could have
| saved his life if we had it 15 years ago.
| cameronh90 wrote:
| Technically we just "let people die" all the time.
|
| We could spend more money on road safety (or say, reduce
| the speed limit to 10 mph) but we don't because the costs
| are too high.
|
| Now, given the relatively common but almost universally
| fatal nature of pancreatic cancer, any sort of moderately
| effective screening is probably worth doing, but the
| argument that if we don't then some people will die isn't
| very strong.
| daedrdev wrote:
| If you test enough people, you can reach a point where
| given you have a positive test, there is say a 90% chance
| it's a false positive. Taking further action can
| potentially harm you. Given the danger of further
| testing, and that many time people see no benefit from
| treatment, its is completely possible on average it can
| make die more often to get tested.
| thinkingtoilet wrote:
| If the test is cheap, you could run it 2 or 3 times. Then the
| false positive rate would be pretty low and you could proceed
| with more intense treatments/diagnostics.
| rflrob wrote:
| That assumes that what causes the false positive is some
| kind of analytical noise in the test. The bigger concern is
| biological noise that would persist if you tested the
| patient again.
|
| It might still be useful to know you have weird protease
| activity that isn't cancer derived, but the more of these
| tests we do, the more likely it is that for every person,
| there'll be at least one non-cancer oddity that looks like
| cancer signal for at least some test.
| onlyrealcuzzo wrote:
| Isn't this problem fixed by just doing another blood test?
|
| I thought that's how HIV rapid testing works.
| crhulls wrote:
| Sensitivity is the false negative rate.
|
| Although it is the opposite of what the doctors want, I would
| prefer a less sensitive but highly specific test.
|
| If I had 80% sensitivity I'd miss out on 20% of cancers, but
| if I could match that with a 99.9% specificity I'd have very
| few false positives.
|
| I hope this type of test can tune that direction.
| absolutelastone wrote:
| Screening recommendations are based on statistical arguments
| that take false positives (plus the risk of the test itself)
| into account and calculate whether more people would be
| helped than harmed.
| pfdietz wrote:
| > The nanosensor correctly identified healthy individuals 98% of
| the time,
|
| Since pancreatic cancer would have to be detected before any
| symptoms occur for this to be useful, the test would have to be
| applied to everyone. The incidence of PC is 1 per 10,000 per
| year. If the test is applied once per year, then for every true
| positive result there would be 200 false positives (actually
| worse, since it only detects PC 3/4 of the time.)
| newsclues wrote:
| If you can cheaply test everyone, and narrow down the number of
| people requiring more expensive testing, you can potentially,
| at scale, detect and limit negative health outcomes. There is
| both an economic and societal benefit to testing and treating
| people.
| pfdietz wrote:
| If the more expensive testing is at all invasive (for
| example, biopsies) or still has false positives (benign
| tumors, say) then it could end up being a net negative. This
| effect has bedeviled screening for other cancers, like breast
| and prostate cancers.
| steveBK123 wrote:
| Sure but the current state of affairs is clearly not
| optimal from an individual patients perspective. You notice
| this as you hit 40, 50 years old.
|
| I know multiple "woops we don't screen
| often/early/proactively for that" cancer deaths in mid 30s
| to mid 50s.
|
| I even know a few "wow good thing you had that CT scan for
| xyz, we just found some unrelated Stage 2 cancer elsewhere"
| people.
|
| I know ZERO "oops false positive, we killed you with an
| invasive procedure" deaths. I know they happen, just clear
| to me its less often than the above.
| jf22 wrote:
| From now on we should probably make all medical decisions
| treatment decisions based upon your steveBK's personal
| experiences.
| steveBK123 wrote:
| Maybe you are young and/or lucky, but you'll find over
| time an increasingly disconcerting amount of
| friends&family dying preventable/otherwise treatable
| (with screening) deaths from cancer.
|
| Note I said "from an individuals perspective". It is
| possible for the system to be optimized from a
| cost/benefit system level perspective without it
| providing the best possible outcome for each individual.
| Given that its run by the government & for-profit
| insurance, this is probably the case.
|
| I think it is a bit hard to argue that the US medical
| system in general is perfect, and beyond reproach. Let
| alone the gaps in our pro-active cancer screening. Places
| like South Korea and China do far more, with less.
| steveBK123 wrote:
| Most of these symptom-less-until-you-are-dead cancers are very
| very slow moving and mostly hit above certain ages.
|
| It's all in tuning the population & frequency.
|
| You could test those aged 30+ or 40+ every 5, maybe even every
| 10 years.
| pfdietz wrote:
| I understand the recommendation for breast cancer screening
| is that women should stop doing it above age (I think) 70,
| even though the incidence of BC continues to increase with
| age, due to declining benefit/risk.
| steveBK123 wrote:
| Correct a lot of stuff can stop being screened for because
| of incidence of disease, how slowly it moves, expected
| remaining lifespan, and ability of elderly to endure
| whatever treatment they would receive anyway.
| bloomingkales wrote:
| Elizabeth Holmes: I was too early!
|
| Speaking of the banality of evil in another thread, Elizabeth
| Holmes really just made a poorly timed stock pick. Lying and
| stuff, that's a constant amongst that type, so let's factor that
| out.
|
| She might have been right all along though, weird.
| jghn wrote:
| There is an enormous gulf between what Theranos was doing and
| these sorts of tests. For starters, one was just making crap
| up. The other actually has some potential merit.
| blackeyeblitzar wrote:
| Her notion of frequent and cheap diagnostics was correct. But
| the main difference with their solution was being able to just
| do a finger prick, which was maybe a nice idea but definitely
| did not work. And their claims, knowing it didn't work, were
| fraudulent and harmed thousands of people who got bad test
| results.
| proee wrote:
| There seems to be a ton of benefits to doing all kinds of blood
| work - from vitamin deficiencies, hormonal changes, cancer signs,
| etc. Our system is very reactionary in that we order all these
| tests AFTER we get sick.
|
| Why is there not a more proactive approach to getting bloodwork
| done with as many tests as possible? We should see this type of
| service like going to the dentist.
|
| Seems like a good industry to disrupt.
| NotYourLawyer wrote:
| I mean, you're supposed to get a yearly checkup. They do blood
| work.
| plasticsoprano wrote:
| Yes but that blood work checks things like cholesterol and
| vitamin deficiencies. They aren't checking for these types of
| markers that point toward cancers. They may notice something
| is out of whack that may lead to more specific testing but I
| think the overall question is why aren't we just checking for
| everything more frequently with these blood draws?
| 6LLvveMx2koXfwn wrote:
| I had to explicitly ask for Vit D and Iron/Ferritin to be
| added to the default bunch of tests on my _decennial_
| check-up as I was constantly tired. They eventually found
| out I had iron-deficient anaemia caused by undiagnosed
| Coeliac disease.
| OptionOfT wrote:
| It's very important to advocate for yourself at the
| doctor.
|
| My wife went to the doctor many times complaining about
| fatigue. Response: "Oh, you're unemployed, you must be
| just bored...".
|
| We moved, new doctor, new yearly checkup, and one
| attentive doctor noticed something on her. 6 months and a
| whole battery of tests later she got a diagnosis of EDS.
| A genetic disease that causes issues with connective
| tissue.
|
| She was always tired because her muscles were
| compensating in places where people who have normal
| connective tissue can rely on this tissue as a
| stabilizer.
|
| I'm very glad that you were able to get your diagnosis.
| kodt wrote:
| The amount of blood drawn isn't enough to run all of these
| tests at once. They would need to multiple blood draws for
| tests that in most cases will end up being unnecessary.
| plasticsoprano wrote:
| It's unnecessary until it finds something. My doctor is
| pretty thorough and I will give 3 vials with my yearly
| physical bloodwork. I get a pretty comprehensive set of
| results but my grandfather died of pancreatic cancer and
| I'd love for this to be included in that testing.
| mapt wrote:
| I had a wide panel at one point after a statistically
| unlikely health event.
|
| It was something like 300ml of blood spread over ~40
| vials. They tried to charge me $7500.
|
| It did lead to a diagnosis.
| davikr wrote:
| It's complicated - for screening to be done, the mortality
| reduction must outweigh the overtreatment and overdiagnosis
| risks.
| leetrout wrote:
| Yes, but insurance does not cover large amounts of screening
| tests. Last year my A1C check was not covered. In North
| Carolina my wife's vitamin D test is not covered by her
| primary or gyno for routine checks.
| Sloowms wrote:
| Depends on the country you live in. There are countries that
| don't do them with similar health results as countries that
| do them.
|
| There is a stereotype that Dutch doctors will prescribe
| paracetamol for anything because they are really defensive
| with medication and doctor visits and the result is generally
| the same as countries that do check ups.
| axus wrote:
| Theranos tried the "move fast and test blood" approach. Maybe
| one of the existing testing companies can find a more balanced
| approach in the current environment.
| mapt wrote:
| Widespread pre-emptive testing was not what Theranos tried.
| Defrauding investors that the technology existed for
| widespread, inexpensive pre-emptive testing even at small
| scale is what Theranos tried.
|
| There is almost certainly gold in them hills if you dig deep
| enough and survey systematically enough, but Theranos started
| with precise coordinates, claiming they'd "found it", and
| demanded investors for a mine, while privately they were
| thinking "If we don't find it on the surface, who cares, we
| got paid, this is how VC works".
| snowwrestler wrote:
| Theranos' specific claim was that they could do existing
| tests with way less blood and way less cost. One of the ways
| they kept their fraud under wraps was to simply do the tests
| the old way behind the scenes.
|
| So, blood tests in general were not the controversial part of
| Theranos.
|
| As others have pointed out, the obstacles to large scale
| prophylactic blood testing are false positives, and general
| resistance of health insurers to fund anything not strictly
| reacting to disease or injury.
| rsynnott wrote:
| Theranos's issue was that their tests simply didn't work. It
| was more "move fast and pretend to test blood".
| anonzzzies wrote:
| For me (eu) the dentist is pricy but these tests are included
| in public and private; i can ask my doctor any time and i get
| them, including for markers. Dentist costs, I do it every 6
| months, but most people i know maybe once every few years.
| 10729287 wrote:
| The issue is that too much tests could also lead to false
| negatives and all the impacts that follow, especially on the
| patient's mind.
| blackeyeblitzar wrote:
| I find that doctors are very resistant to ordering blood tests.
| I often get responses saying it isn't necessary or whatever. I
| feel patients should be entitled to whatever diagnostics they
| demand. I don't know why doctors are even needed to get that
| done. Other than the scam of insurance coverage of course.
| jpeizer wrote:
| Despite how much we know in medicine we still know too little.
| Bloodwork will give you a snapshot of that persons blood
| chemistry. It's still up to the doctor and lab to put together
| what that composition means. In other words, if there is too
| much iron in the blood there could be x number of reasons for
| that. Most might be benign, and a small handful could be life
| threatening.
|
| (Not a doctor just surrounded by them)
| mlyle wrote:
| You have to be careful with screening tests.
|
| Say that this test has a false positive 1 in 1000 times. If you
| test 100,000 people, you'll get 100 positives that need
| invasive further testing and followup, and 5 real pancreatic
| cancer cases.
|
| Society will pay for 100,000 tests, and 105 cases of followup.
| You may cause lasting harm to some of those 105 people. And
| then it's not clear if you can improve the survival of the 5
| pancreatic cancer cases much. They'll live longer after
| diagnosis (because you diagnosed earlier) but not necessarily
| longer overall.
|
| (One other screening effect: You'll find more "real cancer"
| that is so slow growing that it may have always remained
| subclinical before the more sensitive testing; And the most
| serious cancers, you won't find so much sooner, because they
| grow so much in the interval between tests.)
| caesil wrote:
| Then let's take those things into account when calculating
| what tests to do. Surely, though, we can do better as a
| society than solving this with "no preemptive testing except
| for extreme risks".
| lm28469 wrote:
| > Surely, though, we can do better as a society
|
| We haven't even solved the most basic shit like shelter,
| food, education, &c for millions of people in the west, as
| a society we're faaaaaaaaar from universal yearly full
| health checkups. As an individual feel free to get private
| checks, they'll gladly take your money
| aurizon wrote:
| The fact that there are huge costs in the USA to even
| periodic medical checkups has severely impacted longevity
| in the USA to the point it ranks close to Cuba in
| longevity. Those with a health plan are close to the
| highest ranked nations. The poor without a plan at all
| are around ~4-5 less long lived. There is a nice rabbit
| hole in this data. https://www.google.com/search?q=longev
| ity+charts&rlz=1C1CHZN...
|
| This has a huge GDP cost in the USA, that needs to be
| addressed. The causes are big
| pharma/hospo/AMA/insuro/lobbyo.... One wonders why the
| AMA is there? - they limit the numbers of doctors trained
| in Universities/training hospitals to forestall price
| competition among doctors by various means. Dentists do
| the same.
| toast0 wrote:
| Cost of a yearly checkup should be "taken care of",
| because Obamacare mandated free annual checkups, as long
| as you don't accidentally trigger any other billing codes
| while you're there. But, regardless of cost, there's a
| shortage of providers, so it's hard to schedule the
| checkup. And there's still a lot of uninsured people out
| there.
| vharuck wrote:
| The US Preventive Services Task Force (USPSTF) is the body
| doing that meta-analysis and writing recommendations. The
| recommendations are for general patients (high-risk
| patients should be identified and guided by their doctors),
| and are based on how much the screening/prevention will
| extend or improve patients' lives. The USPSTF explicitly
| does not consider monetary cost.
|
| https://www.uspreventiveservicestaskforce.org/uspstf/recomm
| e...
| mlyle wrote:
| There's a ton of research and regulatory oversight in this
| area, and the choices made generally make sense. You can
| safely assume that the testing recommendations are 3-5
| years behind the research, though.
| okaram wrote:
| We do, it's not as if we aren't doing any testing. I've
| been getting a yearly prostatic antigen test for several
| years now.
|
| The recommendations tend to take these into account, and
| then you and your doctor adjust.
|
| Sometimes politics gets into it, like with the recent
| changes to breast cancer recommendations, but, overall, it
| works well for many people.
| GeekyBear wrote:
| You would need to take into account how aggressive a given
| cancer is and our ability to treat it.
|
| For instance, prostate cancer blood screening often led to
| radical treatments that are no longer thought to be worth it
| for most people.
|
| > most prostate cancer grows so slowly, if it grows at all,
| that other illnesses are likely to prove lethal first
|
| https://www.nytimes.com/2023/05/08/health/prostate-cancer-
| sc...
|
| In the case of pancreatic cancer, it is much more aggressive
| and you need to catch it early.
| mlyle wrote:
| > In the case of pancreatic cancer, it is much more
| aggressive and you need to catch it early.
|
| It's not clear that the cancers that you would find early
| with a more sensitive test are those more aggressive
| cancers.
|
| The pancreatic cancers we find with our current detection
| (generally after becoming symptomatic) are typically quite
| aggressive. But are they _all_ the cancers? Likewise, if
| the cancer is aggressive, it can grow quite a bit between
| screening intervals and not be found all that early.
|
| (Part of why we think that "finding cancer early" is such a
| benefit is that because the smaller/earlier cancers we find
| are less aggressive than the cancers that we first find
| when they're huge and spread. There is definitely an effect
| from earlier detection but our estimate of it has been
| confused by this effect.)
|
| As we've increased cancer screening, we've found that
| survival rates have gone up, as have survival times after
| detection... but unfortunately we've often also found that
| the screening doesn't always reduce the number of people
| dying of that cancer at a certain age. Instead, you find
| more cancers, and you find them earlier so more people live
| to 5 years, even if you've changed nothing. Cancer
| treatment has gotten better, but most of the benefits we
| have expected from better cancer screening have not
| materialized.
|
| Finding pancreatic cancer early sounds good. And it _may_
| be able to reduce mortality from pancreatic cancer, but it
| 's not a sure thing.
| slashdev wrote:
| My grandfather (a doctor) always used to say this. There's
| also an aggressive fast growing kind of prostate cancer,
| but treatment basically does nothing for survival rates (or
| at least that was the case decades ago when he was
| practicing.)
|
| So his advice was, don't look, don't treat. Either you have
| the slow one and treatment is harmful, or you have the fast
| one and you're going to die soon anyway.
| GeekyBear wrote:
| Your grandfather's take has become increasingly accepted
| for prostate cancer. There is more of a watch and see
| attitude to make sure that the patient doesn't have a
| rare case of aggressive growth.
|
| As you mentioned, the outcomes aren't significantly
| different, regardless of how you treat it.
|
| From the article linked above:
|
| > Researchers followed more than 1,600 men with localized
| prostate cancer who, from 1999 to 2009, received what
| they called active monitoring, a prostatectomy or
| radiation with hormone therapy.
|
| Over an exceptionally long follow-up averaging 15 years,
| fewer than 3 percent of the men, whose average age at
| diagnosis was 62, had died of prostate cancer. The
| differences between the three treatment groups were not
| statistically significant.
| slashdev wrote:
| The irony is he died of prostate cancer. He ignored his
| own advice and treated it. It did not change the outcome
| or buy him much time, if any.
| hsuduebc2 wrote:
| You can just run test multiple times to eradicate this
| possibility or you can confirm it with another method.
| mlyle wrote:
| > You can just run test multiple times to eradicate this
| possibility
|
| The measurements are not independent and the quality of
| the measurement is not improved by this.
|
| > you can confirm it with another method.
|
| Yes. And usually the other method is invasive and
| expensive and bears some risk.
|
| And then you get results like the blood test saying "very
| likely cancer" and the biopsy saying "uh, _probably_ not?
| " that you need to decide what to do with.
| Redoubts wrote:
| > You may cause lasting harm to some of those 105 people.
|
| Could you elaborate on this?
| jtc331 wrote:
| For example you might do surgery on people who wouldn't
| benefit.
| daedrdev wrote:
| you will do surgery on some of the 105 people. Some of them
| might die from complications, infections, etc or at least
| have lasting damage. Since several of the 5 people will not
| be any better off with treatment it's entirely possible
| that the screening produces palpably worse outcome.
|
| The earlier you screen, the worse this is, since the ratio
| of false positives vs true positives gets higher and
| higher, for example 1000 vs 5 or 10000 vs 5.
| tptacek wrote:
| It's also psychologically harmful to have the positive
| test hanging over your head. I'm nearing the age where
| doctors start harassing about colonoscopies. You can do
| an at-home test instead of the full procedure, and it has
| a very good chance of ruling out the need for a
| colonoscopy. But it also has a high false positive rate;
| there's a decent chance that you'll end up in a state of
| "need a colonoscopy, also a colon cancer screener flagged
| you". I'm dreading the colonoscopy prep, but I'm not
| doing the at-home thing.
| jeswin wrote:
| I've had colonoscopies twice. Was just half a day of
| inconvenience if you schedule it for the morning.
| tptacek wrote:
| The scope, right? Not the at-home test? The only thing
| about the scope that bugs me is the prep.
| kelseyfrog wrote:
| I've been scoped twice and the prep sucks. It's shitting
| your ass out for half a day. On the positive side,
| getting sedated isn't half bad and you get the day off
| work.
| AustinDev wrote:
| Can't you just run the test again instead of doing a full
| follow up? 1/1000 * 1/1000 = 1/1,000,000
| okaram wrote:
| You only get that probability if the test results are
| completely uncorrelated, chances are, they're not.
|
| I'd assume the chances of getting a second false positive
| if you already got one are much higher.
| tptacek wrote:
| For people surprised by this argument, the phenomenon he's
| invoking here has a name: the Bayesian Base Rate Fallacy.
| fragmede wrote:
| > Society will pay for 100,000 tests
|
| For better or worse, under the American healthcare system,
| the patient pays for those tests, sometimes covered by
| insurance. If the tests are paid for out of pocket by the
| patient, is there still such issue?
| s1artibartfast wrote:
| I think the issue is exactly the same no matter who pays.
|
| To reframe it from the individual patient's perspective,
| when you take a test simply for the sake of screening,
| there is the chance you'll learn something true that helps
| you, and the chance you will learn something false that
| hurts you
| mlyle wrote:
| The economic argument doesn't change whether it's a private
| cost or purely a social cost (private costs are included in
| social costs, since private expenditures are part of
| society's expenditures).
| fallingknife wrote:
| You are assuming that those false positive rates are fixed,
| but they aren't. The "positive" criteria are done by an
| analysis exactly as sophisticated as a human scanning a list
| of numbers. The process is a joke and it needs to be improved
| by more data and better analysis, not this nonsensical "don't
| test people because they might be positive" argument.
| mlyle wrote:
| No, I'm assuming there's a tradeoff between sensitivity
| (spotting cancers) and specificity (having your positive
| results actually be cancer).
|
| ANOVA to pick variables and then reasonably selecting
| thresholds is a fine process that avoids overfit.
|
| The big problem is, biology is messy and measuring lots of
| people to find correct thresholds is really expensive and
| time consuming. It's not really a technological problem,
| though technology has helped a little.
| lm28469 wrote:
| It probably all comes down to cost. I remember reading studies
| about widespread melanoma screening and they were writing
| things that basically amounted to: "overall it adds ~0.5 day of
| life expectancy to the average Joe, based on costs &co it's
| worth it if you consider 1 year of human life worth $30k"
| stuartjohnson12 wrote:
| I was the tech lead at a YC company doing exactly this (Spot
| Health, W22) until a little while ago. There's a ton of very
| hopeful things happening in the industry behind the scenes.
| Insurance via employee benefit schemes is the lever to drive
| this into people's lives.
|
| The industry refers to this as gap closure - care gaps are
| instances of a patient not receiving care when they should
| have. For example, not getting treatment for stage 1 cancer
| because you didn't have a checkup is a care gap.
|
| Insurance companies are very incentivised to close care gaps
| because it results in cheaper premiums. Incentives between
| health insurance and patients are often not aligned (as we've
| seen in the news recently), but this is one case where they are
| radically incentivised to offer additional diagnostics if it
| results in fewer costly payouts for severe illnesses that come
| later.
|
| In the medium term, the cost of full genome sequencing is
| quietly experiencing a 10x decrease in cost. Within a decade, I
| expect it to be the norm that all people are fully genetically
| sequenced and for the correlations enabled by that dataset to
| have made the value of being sequenced 10x. So probably a 100x
| increase or so in the value of genome sequencing over the next
| few years.
|
| (Also, before anyone says it, yes 23&Me should feel very very
| ashamed for the deanonymised patient record data breaches
| they've experienced. The whole industry needs a slap in the
| face when it comes to privacy)
| hn_acc1 wrote:
| I guess after ~30 years past grad school in the software
| industry, having had high hopes for the internet and
| everything back in the 90s, I'm way too cynical.
|
| This won't be used to "close the care gap", unless they can
| charge more $$ for the additional checkups than they'll
| expect to have to give out in care as a result.
|
| And they'll drop anyone suspected of needing too much care in
| the future based on their genome, even if they aren't sick.
| Pre-existing conditions times 100 (you know they'll be re-
| instated by the current administration soon enough).
|
| e.g. 17% of the people with that gene had cancer, and you
| have it, so raise your rates 151%. Oh wait, 37% of the people
| with this other gene had dementia - you're no longer covered.
|
| Eventually, they'll only accept those people with a genomic
| lifetime 90% profit profile. That's the way this sort of
| thing works in the "real" world.
| MPSimmons wrote:
| I believe the answer is the false discovery rate -
| https://en.wikipedia.org/wiki/False_discovery_rate
| mattmcknight wrote:
| I just order them myself every year at LabCorp.
| https://www.ondemand.labcorp.com/products
|
| I definitely prefer doing the testing myself instead of begging
| the doctor to order things.
|
| About the only time I go to doctors is to beg for antibiotics-
| which they often refuse to give me. They say, "oh, it's
| probably a virus." Okay, but all of the virus tests I can find
| came back negative. I have a CBC showing elevated WBC. Coughing
| up yellow-green slime. Can you order a sputum culture for me?
| "no, come back if you are still sick after 10 days". Great,
| $200 and 30 minutes in the waiting room getting exposed to
| other sickos for nothing, miss another week of work. The
| gatekeeping of medical care infuriates me. I have plenty of
| money, let me use it to get better faster.
| nanomonkey wrote:
| At this point you just order the same antibiotics off of
| Amazon for your "fish" and self administer?
| StevenNunez wrote:
| Is this the test offered by https://www.functionhealth.com/? I
| know they have an early cancer blood screening as a part of their
| tests.
| fosterfriends wrote:
| Has anyone tried function? I'm curious how legit it is.
| devin wrote:
| I have wondered about it as well. I worry that I'll get a few
| results that are slightly outside of normal range and then
| sit around wondering if I'm dying, which seems like more
| stress than it's worth.
| Symmetry wrote:
| My parents got it for me. A lot of dark pattern upselling on
| the website you can't correct there but relatively painless
| to correct that on the phone. All the labwork seems to be
| done via CLIA labs in the standard way, they grab as many
| vials of blood as you'd expect and the numbers for one test
| were close to the ones from a test my doctor ran. Lots of
| hogwash interpretation in addition.
|
| So: they're predatory but play by the rules.
| kylesnc wrote:
| i have, feel it's reasonably priced, and i've been pleased
| with what i've gotten for the money. i wanted it for exactly
| the reason of "don't wait until after you've got a serious
| problem".
| pharaohgeek wrote:
| Aspiring pancreatic cancer survivor here. This is excellent news.
| Part of the reason this is such a deadly form of cancer is that
| there are often no symptoms until it's far too late. I know that
| there is a blood marker - CA19 - can indicate issues with the
| pancreas. I don't know if this blood test is related to that or
| anything, but any advancements on this disease are great and
| sorely needed.
| e40 wrote:
| I've known > 10 people who have died from this cancer. It is my
| #1 fear (cancer wise). My best friend died 3 months to the day
| after being diagnosed. It is both a blessing and a curse how
| quickly this kills you. The day before he found out we went on a
| long walk. Within a couple of weeks we'd walk around the block,
| then just sit in his living room and talk for hours. The bad
| times lasted about 1 week and the last 2-3 days he was not really
| there.
|
| I really hope this test becomes a reality and is OTC and not too
| expensive.
| croissants wrote:
| I was going to ask about this number, because it seems high
| enough to be statistically improbable, but back-of-the-envelope
| arithmetic says otherwise: there are about 10 cases of
| pancreatic cancer per 100,000 people per year [1], so let's say
| each person has a 1 in 10,000 chance of a diagnosis each year.
| If you know somebody for 50 years, there's a 1 in 200 chance
| they receive a diagnosis in that time, so you'd expect to need
| to know 2000 people to eventually know 10 diagnosed people.
| 2000 is a lot, but "knowing" a person is a pretty loose term,
| and pancreatic cancer has a miserably high death rate within 5
| years, so it's unfortunately plausible.
|
| [1] https://seer.cancer.gov/statfacts/html/pancreas.html
| steveBK123 wrote:
| The number of people you know who have or die of cancer grows
| exponentially with age once you are an adult.
|
| In 20s-early 30s, maybe 0 if your parents/uncles/aunts are
| lucky. You can be completely oblivious to it if your older
| relatives manage to escape it.
|
| By 40 you start hearing about friends having it pretty
| routinely. We seem to have hit a one close friend per year
| pace at the moment.
|
| Every time I talk to my 70+ parents, they are telling me
| about a funeral they've been to recently, often caused by
| either cancer or heart disease.
| Teever wrote:
| Keep in mind that there could be clusters of cases related to
| environmental contamination so it's very possible that some
| people know more people who get a particular form of cancer.
| s1artibartfast wrote:
| if you take the 1/200 chance over 50 years, here is the
| percent chance you know 10 diagnoses depending on your number
| of friends/acquaintances
|
| 50 people: 8.36149e-12 %
|
| 500 people: 0.026%
|
| 1000 people 3.1%
|
| 2000 people: 50%
| e40 wrote:
| This is people I know or my family knows. My mother knows 4-5
| people. I've had 2 coworkers die of it. I've had 1 in-law die
| of it. It's crazy how fast the numbers add up.
| cyberlimerence wrote:
| I'm so sorry for your loss. Could you share how old they were ?
| I'm relatively young, but the fear of getting some form of
| cancer is on my mind lately. And the timing of it always seems
| to be so cruel.
| e40 wrote:
| He was 76 and in really good health. Worked out regularly.
| Ate well.
| kaidon wrote:
| Just lost my father to pancreatic cancer as well a couple weeks
| ago. They caught it very early with a CT scan, performed a
| significant surgery followed by radiation and chemo. The chemo
| nearly killed him. Had a couple ok months after chemo, but then
| it spread and the last couple weeks were awful. Even catching
| this stupid cancer really early often isn't enough - I hate it.
| wolfi1 wrote:
| just a hunch, but if you can detect it via CT or MRI isn't it
| already too late? I guess these blood tests can detect it
| even earlier an then the prognosis could be significally
| better
| jghn wrote:
| Not necessarily but that's the idea. Tumors will start
| shedding cells into the bloodstream as they start forming.
| These types of tests are able to identify tumor cells in a
| blood draw.
| rilkeanheart wrote:
| I signed in just to upvote this. I've lost friends and
| relatives to this. I couldn't agree more that I fear this
| cancer more than any other- because it is so untreatable by the
| time it's caught. An inexpensive test would be incredibly
| helpful towards improving the survivability.
| saturn5k wrote:
| My best friend died of pancreatic cancer at 41. By the time he
| received the diagnosis, it was too late. The cancer had
| metastasized so extensively that the surgeons could do nothing
| when they attempted to operate. What began as mild lower back
| pain led to a slow and agonizing death in just a few months.
| busymom0 wrote:
| That's exactly what happened to my friend's father. He had
| been complaining about lower back pain for many months and
| going to physio for it. During a family re-union during
| Christmas, he had to be hospitalized and got diagnosed with
| stage 4 pancreatic cancer. One week later, he died.
| csours wrote:
| > The nanosensor correctly identified healthy individuals 98% of
| the time, and identified people with pancreatic cancer with 73%
| accuracy.
|
| ctrl+f specificity
| ForOldHack wrote:
| Steven P. Jobs.
| daft_pink wrote:
| How come we're always talking about new and amazing tests, but I
| never am able to actually get these test at the doctor?
| croes wrote:
| Cheap for whom?
|
| And it the part I can read without subscription it says simple
| test not cheap. Did they mention they price further down.
| ugh123 wrote:
| Cue the doctors and industry saying "too many tests are bad for
| you"
| doctoring wrote:
| Public service announcement: There are already blood tests for
| detecting pancreatic cancer and other cancers on the market, and
| more coming, depending on where you live. So get tested, if this
| is something you are worried about.
|
| I believe the only commercially available one in the US is
| Grail's Galleri (https://www.galleri.com).
|
| More info on this category of tests:
| https://www.cancer.org/cancer/screening/multi-cancer-early-d...
|
| There are many tests in the pipeline -- although the technology
| is there, the regulatory and evidence process is slow. (Data
| relating to detecting cancer early, by its nature, takes a long
| time and a lot of people to prove out.)
| e40 wrote:
| The Galleri website says:
|
| _> Assumes screening is available for all prostate, breast,
| cervical, and colorectal cancer cases and 43% of lung cancer
| cases (based on the estimated proportion of lung cancers that
| occur in screen-eligible individuals older than 40 years)._
|
| Doesn't list pancreatic.
|
| EDIT: never mind, I found a more complete list.
|
| https://www.galleri.com/what-is-galleri/types-of-cancer-dete...
| Someone1234 wrote:
| If Grail's Galleri is that great, why isn't it part of an
| annual checkup?
| raffraffraff wrote:
| Annual might not be any good. I knew a guy who had a history
| of colon cancer in his family. He got checked annually from
| his mid 30s on. At 46, a few months after a clear checkup, he
| visited his doctor who sent him for another check, and bam:
| he had cancer.
| nradov wrote:
| It's expensive, accuracy isn't very high, and no one has done
| the studies to demonstrate that it actually improves subject
| outcomes. By its very nature that type of research takes a
| long time because the investigators have to wait years to
| detect a difference in subject survival rates or other
| significant endpoints.
|
| There's a huge amount of funding going into the liquid biopsy
| space so things will improve. But don't expect rapid changes
| in clinical practice.
| fallingknife wrote:
| Sounds great.
|
| > The Galleri test is available by prescription only.
|
| But JFC I can't stand being required to get permission from one
| of those glorified bureaucrats just to collect data on my own
| body.
| caycep wrote:
| https://europepmc.org/article/MED/39937880
|
| Sadly, the group lists funding sources as: National Cancer
| Institute: P30CA069533 National Cancer Institute: P30CA069533
|
| So the group's activities likely on pause, and with a good
| likelihood of closure due to the lack of NIH indirects from the
| current administration.
| daedrdev wrote:
| If I expressed my thoughts on this it would break a lot of HN
| guidelines.
| phony-account wrote:
| Aw come on - the money is obviously much better spent on some
| armored Cybertrucks.
| pstuart wrote:
| It's a pity that even discussing policy/objectives/outcomes
| is fraught with danger here. Partisan sniping obviously
| doesn't belong, but we now live in a world where vaccines,
| energy production and efficiency of use, climate science et
| al, are all "politicized".
|
| For those wielding power, that's a feature, not a bug.
| boplicity wrote:
| Please remember this next time there's an election.
| pstuart wrote:
| This and so much more.
| breadwinner wrote:
| HN crowd remembering it is not enough. The problem in the
| U.S. is that the electorate is divided into two camps: the
| educated and the uneducated. The uneducated camp votes
| without a deep understanding of important issues, and they
| can easily be influenced using "culture wars" topics such as
| DEI and trans kids. Consider that 53% of Americans approve of
| the administration's performance so far--why is that? How can
| we effectively explain things to that 53%? That's the
| challenge.
| baxtr wrote:
| Can someone build an agent that identifies groups that will
| have to stop activities and then match them with groups outside
| the US?
|
| This could potentially help to sustain their work if the other
| groups/labs agree to take over.
| baxtr wrote:
| Genuinely curious: why downvote this idea?
| nradov wrote:
| What is the correct amount of indirect for NIH grants? I'm not
| informed enough to have an opinion on this, but based on seeing
| the luxurious facilities and high administrative staffing
| levels at many research universities it seems like there might
| be some fat we could cut? I've read claims by other prominent
| researchers that this change is a net positive since it will
| free up funding for more actual research. So, I don't know who
| to believe?
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