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doctoringyesterday at 8:23 PM3 repliesview on HN

The not so big secret is that we can detect cancer early in a lot of people, but we also would detect a lot of not-cancer. We don't currently know the cost/benefit of that tradeoff for all these new types of screening, and therefore insurers and health systems are reluctant to pay the cost of the both screening and the subsequent workup. This is not just a financial consideration, though the financial part is a big part -- the workup for those that end up as not-cancer has non-negligible risks for the patients as well (I have had patients of mine suffer severe injury and even die from otherwise routine biopsies), and on top of that, some actual cancers may not really benefit from early discovery in the first place.

This is not to downplay the potential benefit of early cancer detection... which is huge. And in the US/UK anyway, there are ongoing large trials to try to figure some of this stuff out in the space of blood-based cancer screening, as part of the path to convincing regulatory bodies and eventual reimbursement for certain tests. As mentioned, you can currently at least get the Galleri test out of pocket (<$1k, not cheap, but not exorbitant either), as well as whole body MRIs (a bit more expensive, ~$2-5k).


Replies

PaulHouleyesterday at 9:28 PM

Or cancers that aren't clinically relevant.

Many prostate cancers, for instance, are slow growing and won't kill you before something else does. If you try to take that kind of cancer out surgically or zap it with radiation or chemo the side effects could be severe.

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mikert89yesterday at 8:25 PM

Yeah, after a detection there is alot of work to determine if what they detected should be worried about. But this doesnt take away from the fact that cancer can be detected very early, and these screenings could easily save your life

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DiscourseFanyesterday at 8:36 PM

Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up. The only people who would benefit from these screenings are already unhealthy and cancer might be just one of many potential conditions they could experience—the goal of healthcare is not to dedicate an inordinate amount of resources for procedures that may amount to not much of any long term benefit.

People talk about the “immune system” but they are really referring to a number of systems the body uses to regulate itself, more or less successfully, around environmental pressures. The body is a system under tension, sometimes extreme tension leads to extreme success (success here being growth of power), sometimes it breaks the body, and sometimes the systems have been slowly failing for a while, and most treatments will not help. Medicine is only useful in the specific case where the power of the body would be promoted if not for one thing, that the body would be healthy, at least manageably so, without that issue.

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