What about the base rate of getting breast cancer? Am I to understand women still get diagnosed at the same rate but the treatment has gotten better? What happened in the 70s that made it so much more common?
"Deaths within 5 years" are strongly affected by when you start the 5 year clock. The earlier you detect cancer, the better your 5-year survival rate will be.
Without treatment they don't change much. It's detection followed by treatment that changes anything. And discounting early detection as a part of treatment is horribly misleading.
I'm finding it difficult to imagine how you think this could possibly work.
Cancers start small and develop into larger problems over time. Consider a hypothetical patient who develops cancer at the age of 70 and dies of it, untreated, at the age of 78.
If the cancer is detected at the age of 75, detection will lower the 5-year survival rate, since the patient dies after three years of "having cancer". If it is detected at 72, detection increases the 5-year survival rate, since the patient now dies after 6 years. Without treatment, early detection has a very strong impact on 5-year survival rates.
Untreated cancer kills people very quickly effectively by definition. Basically if you have a lump that's not going to kill you quickly it's not cancer.
This is why Mammograms are every 1 or 2 years. If you could wait 4 years without treatment early detection would be less of an issue.
PS: People generally assume a lump becomes cancer as soon as it starts to form. But the general case is you get a lot of little growths from pre-cancerous cells which are predisposed to cancer. Then one or more of those cells become cancer and then you die fairly quickly after that transition.
Cancer is defined based on the growth rate of the tumor (some other characteristics contribute, like propensity to spread from one area of the body to another), not based on how long you can live with it. Even the xkcd comic will tell you that no matter how bad your cancer currently is, you might end up living for a long time to come.
>From 2005 to 2014, overall breast cancer incidence rates increased among Asian/Pacific Islander (1.7% per year), non-Hispanic black (NHB) (0.4% per year), and Hispanic (0.3% per year) women but were stable in non-Hispanic white (NHW) and American Indian/Alaska Native (AI/AN) women. The increasing trends were driven by increases in hormone receptor-positive breast cancer, which increased among all racial/ethnic groups, whereas rates of hormone receptor-negative breast cancers decreased.
See also Figure 5, and the paragraph above it with the subheading of "Incidence" in the "Temporal Trends" section:
>Much of the historic increase in breast cancer incidence rates reflect changes in reproductive patterns, such as delayed childbearing and having fewer children, which are recognized risk factors for breast cancer.[22, 23] Incidence rates of in situ and invasive breast cancer rose rapidly during the 1980s and 1990s (Fig. 5), largely because of increased use of mammography screening in the United States. The widespread uptake of mammography screening inflated the incidence rate, because cancers were being diagnosed 1 to 3 years earlier than they would have been in the absence of screening, and screening also may have led to the detection of indolent cases. Invasive breast cancer rates stabilized between 1987 and 1994, followed by a slower increase during the late 1990s. The continued increase particularly among older women may reflect rising rates of obesity and the use of menopausal hormones, both of which increase the risk of postmenopausal breast cancer, as well as further increases in the prevalence of mammography screening.[24] Around the year 2000, incidence rates began to decline among women ages 50 years and older; and, between 2002 and 2003, breast cancer rates decreased nearly 7%, likely because of the decreased use of menopausal hormones after publication of the Women's Health Initiative randomized trial results linking the use of estrogen plus progesterone menopausal hormone therapy to breast cancer and heart disease.[25-27] The decline occurred primarily in white women and in those who had HR-positive disease.[26, 28] The drop in incidence may also reflect in part the small declines in mammography screening since 2000. The percentage of women aged 40 years and older who reported having a mammogram within the past 2 years increased from 29% in 1987 to 70% in 2000 and dropped to 64% in 2015.[29]
> What happened in the 70s that made it so much more common?
In the 70's Doctors ramped up their prescriptions of Horse Estrogen because they were tricked into thinking it helped. PREMARIN is made from PREgnant MAres' uRINe:
>> In response to the 1962 Kefauver Harris Amendment the FDA had [Premarin's] efficacy reviewed, and in 1972 found it effective for menopausal symptoms and probably effective for osteoporosis [0].
Now doctors realize that excess estrogen -> cancer, and are using anti-estrogens for breast cancer:
>> Other improvements have included tamoxifen, an anti-estrogen agent that was approved in the late 1970s; Herceptin, a drug used to treat tumors with a higher-than-normal level of a protein called HER2 and drugs called aromatase inhibitors.
(quote from this article)
Edit: yesterday I commented on a submission about cancer probably being a mitochondrial disease [1]. This is the old/new idea about cancer, that it's not actually caused by genetic mutations - the observed genetic mutations are actually caused by metabolic failure.
Edit 2: DES was the first synthetic estrogen. It was used on women until 1971, when they realized it caused cancer [2]. Those women would've developed cancer in the 2-3 decades that followed their exposure to this drug.
Testosterone lowers life expectancy, increases the risk of heart disease, and is a factor in prostate cancer.
That’s not a “side-effect” of it though. Be careful about attributing causation. The effects of testosterone bring about the conditions that lead to these problems.
The same goes for estrogen: women develop breasts as a result of increased levels of estrogen. The increased cellular activity in the breast cells over many decades leads to an increased risk of cancer. It is because the breasts grow that cancer rates greatly increase; they are inseparable to some degree.
That article seems to indicate they're been given serious looks, and that even their proponents object to the idea of diet/exercise as an alternative:
> Even Seyfried acknowledges, despite his zeal for treating cancer by tinkering with calories, that in all likelihood diet and nutrient-based cancer treatments will serve as adjuncts to existing therapies.
AKA "our unsupported fringe theory can't actually survive direct study, but if we can linger in the noise of actual effective treatments then there are more suckers to be bilked"
Because this is pseudo-science that has been studied _many_ times and proven not to improve cancer survival rates? The relatively few preliminary small study that showed some trivial effect have failed to reproduce in larger or more comprehensive studies.
Some people claim alternative "medicine" (aka magic) is harmless but it isn't. The harm comes from people avoiding or delaying real treatment. Prominent HIV-deniers have died from AIDS because they refused to take the anti-viral medication. Countless people have died from treatable cancers because they went to chiropractors or "traditional healers" instead of actual doctors.
It is entirely possible that Steve Jobs would still be alive if he hadn't refused treatment for 9 months.
Agree that ketogenic diet is definitely worth a look.
The science behind that is that cancer calls can live on glucose only, while all other cells in the body are able to use ketones as fuel. Starving out cancer cells is definitely a good start.
Is that actually true? Why would cancer cells suddenly lose an ability that all the other cells have? Especially since cancer is not just one single disease, but a set of symptoms displayed by lots of different mutations.
Without agreeing with the GP about diet and cancer, the rationale for diet-based approaches is the observation that most cancer cells shift energy production to glycolysis. This is known as the Warburg Effect (https://en.wikipedia.org/wiki/Warburg_effect). Several theories have been put forward to explain this effect, I favor the mitochondria/apoptosis link.
Does anyone know when we decreased the age for recommended mammograms to 40? My assumption is that it's in the time range of the article.
I can only find references to us raising the recommended age to 45 in 2015, controversy over raising it to 50 in 2009 and how there are diverging opinions on when they should be done.
This is very controversial - in short, there is no national recommendation for mammogram screening to start at 40 years.
Multiple professional organizations disagree (see below). For the societies that recommend age 45, they suggest that concerned women speak with their doctor regarding earlier screening.
Importantly, note that screening looks for signs of a disease in asymptomatic, normal-risk individuals. The presence of a family history or a lump/mass moves one from the category of screening into that of diagnosis.
Mammograms are pretty bad for cancer detection in most women. Most of the time it is really hard to tell from it (too much noise) to say anything conclusive. So doing it earlier or later does not change the fact that its a very imperfect method.
but the prognosis for prostate cancer is very good though (except for African Americans, in which it is markedly lower). How about lung, pancreas, esophagus, and stomach cancer
But perhaps more research for breast cancer will lead to better treatments for all cancers , even if the focus on one cancer is excessive
Isn't this because prostate cancer is already far less deadly at this point? Both by rate and absolute numbers. Most men will get prostate cancer if they live long enough and we are constantly improving treatment.
Your post is an example of a phenomenon known as what-about-the-men-ism. It is nearly inevitable that any article, tweet, etc that discusses women's issues will get one or more replies essentially asking "... but what about the men?"
Honest question: If this were an article about leukemia death rates would you have posted about prostate cancer? Most people wouldn't because it wouldn't be relevant to the article. The only way I can see this topic being relevant is if you believe in "battle of the sexes" theories or think men are systematically victimized by society (we aren't) and want to point out this as an example. I don't know if you believe in either of those things or if you have a different explanation? Linking to DC implies an agenda but based on the principle of charity I will assume you just weren't thinking about the implications when you posted this.
There are several reasons prostate cancer doesn't get the same attention as breast cancer.
1. Fewer high-profile people organizing around it and starting foundations to study it. You may wish the world worked on a slightly more utilitarian scale where we distributed medical research resources fairly according to need and impact. The reality is the squeaky wheel gets the grease.
2. Prostate cancer isn't nearly as squeaky of a wheel:
a) men who get it usually get it later in life compared to women who get breast cancer. Dying at 45 of cancer is a tragedy. Dying at 75 of cancer is a day that ends in Y.
b) most forms of prostate cancer are slower-growing and less metastatic; as a result even men who get it often choose not to get treatment and end up dying of heart failure or other ailments before the prostate cancer has any negative effects. In the US, the 5-year survival rate for prostate cancer diagnosis is 99%.
I'm glad research is being done on prostate cancer and breast cancer at the same time; I don't see any need for an "equal" funding principle. If such rules did exist it would have to be based on # of affected people and life-expectancy. Under such a system prostate cancer would probably rank as over-funded right now.
Do you have data to back up the claims that a) prostate cancer and its consequences kill less people than breast cancer and b) that men aren't systematically victimized by society?
For the latter, I'd say that this topic is inherently sex-specific and thus in a way, has to be sexist. Obviously we wouldn't be talking about prostate cancer if it was leukemia, but it is not. Discussing the survival rates across genders is a legitimate topic and it might turn out that men at more danger - apart from prostate cancer, keep in mind that men commit much more suicides [1], usually take much riskier jobs and in some countries are forced to participate in the army. As a source, I would recommend The Red Pill movie by Cassie Jaye - a woman who called herself feminist until she actually researched what masculism is about.
Also, it doesn't have to be a "battle of the sexes" as you put it. Working on male health does not mean stopping research on female health - it's just that prostate cancer definitely isn't getting enough exposure. It would be great if we learned to acknowledge that we can fight for our gender's rights without shouting how the other one oppresses us.
both men and women can die from breast cancer, too. in fact, men have worse survival rates because it's generally diagnosed later in the process, because there's so little awareness.
I think you are agreeing with the parent. 300,000+ lives are saved... for now.
I've thought about this too. No life is saved, it is only prolonged.
If these people have been given an extra five years of life, that must be a pretty spectacular return on investment. Compare how much was spent developing and administering treatment to the value of 1.5 million years of life.
I don't know much about statistics - can someone tell me why five year survival rates are always used for cancer? This seems kind of off, that instead one should be using the average or median age to which one is expected to live versus how long a cancer survivor lives. Five years seems most misleading when applied to children that get cancer.
Warning: not an expert. Someone smarter/better educated, correct me (or better, tell me I'm right =)
Cancer tends to (though not always) correlate with age when you break it up by type of cancer. For example, children don't get prostate cancer or lung cancer all that often. Similarly, Retinoblastoma and other types of cancer are more common amongst children. So, because of that, you have a built-in tendency to control for age and allow the 5-year statistic to be more of a valid comparison. Similarly, you can calculate 5 year survival rates for any set of subgroups you want – break it up by age, race, gender, co-morbidity or even cancer variant (many of those are frequently done) and then compare. At some point (usually in pretty quickly) the 5 year survival rate is a meaningful comparison...
Also, to be honest/in my opinion, 5 years is a meaningful number for the lived experience. You can imagine doing a lot in five years vs, say, 6 months – so for that reason, it's a useful metric for generally understanding "what chance do I have at having more life to truly live?"
5-yrs mortality rates are a questionable statistic, especially when comparing death rates in time. Critics would argue that the lead time (i.e. the time between diagnosis and clinical symptoms) has changed in time due to earlier diagnosis but the effective time of death has not. It's a long winded debate.
Breast cancer mostly affects women 45+ -- or younger women with a genetic disposition.
But otherwise you'd get a lot of age related deaths? If you use a 15 year window, many people with cancer treatment at the age of 70 won't survive the 15 year period. That makes cancers 'deadlier' where they affect older people. A 5 year horizon is probably more suitable to reduce unrelated deaths.
It's my opinion that OS5 is a largely misleading stat that makes us underestimate the role early stages of cancer like ADH/ALH have in recurrence.
That being said, there are a number of reasons that I believe it's so prevalent.
(1) 5 year long survival studies are long and risky affairs, increasing that number just makes it longer and riskier
(2) particularly when speaking about differences in treatment, a statistically significant average increase of 1 month survival over standard of care is sufficient to supplant it, so OS5 v. OS10 doesn't change much if your treating advanced cancers that result in deaths before 5 years.
When it comes to most cancers though, I think OS5 is a very bad stat.
Tradition. Each study is a riff on past studies. To make things more comparable, you want to change only enough to make your study novel. Therefore, you often use the same analytical methods and report the same indicators as past studies.
5-year survival is just one measure of health. You proposed two others, but none of them are the complete picture. They're all about the same really. Best is actually looking at the distribution of each metric you care about, but then those curves are hard to compare.
Traditionally, cancer was considered "cured" when the patient survived 5 years without evidence of disease. We now know that quite a few cancers, including breast, have a significant rate of late recurrence, ie, after the five-year window. But it's still a very strong psychological milestone for the patient and a convenient and practical benchmark for the clinician.
Because otherwise you couldn’t lobby for early screening programs. Only so few women will get breast cancer and need treatment, while every woman needs to be screened.
When you look at medicine as a business based on billing all the needs justifications make so much more sense.
This is controversial, because the study everybody was talking about last year[1] concluded that there hasn't been a decrease in the breast cancer death rate over that same period.
That study looks at something else entirely: The relation between screening and mortality. It doesn't say anything about survival rates over time.
> Conclusions and Relevance When analyzed at the county level, the clearest result of mammography screening is the diagnosis of additional small cancers. Furthermore, there is no concomitant decline in the detection of larger cancers, which might explain the absence of any significant difference in the overall rate of death from the disease. Together, these findings suggest widespread overdiagnosis.
Great! Now can the people interested in helping fewer women (and men) die of cancer please turn their attention to lung cancer, where there is far better "bang for the buck" on research investment?
Someone should probably run charity drives for something like "non-smoke related lung cancer" research, and then wow, what do you know, it helps smokers also...
"Overall, the chance that a man will develop lung cancer in his lifetime is about 1 in 14; for a woman, the risk is about 1 in 17. These numbers include both smokers and non-smokers. For smokers the risk is much higher, while for non-smokers the risk is lower."
> Cigarette smoking is the number one risk factor for lung cancer. In the United States, cigarette smoking is linked to about 80% to 90% of lung cancers. Using other tobacco products such as cigars or pipes also increases the risk for lung cancer.
[...]
> People who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. Even smoking a few cigarettes a day or smoking occasionally increases the risk of lung cancer. The more years a person smokes and the more cigarettes smoked each day, the more risk goes up.
It's true that not all lung cancer is caused by smoking.
So i've become super interested in lung cancer, and recently found that radon gas is the most common cause of lung cancer in non-smokers.
If you want bang for your buck, buy a radon detector and mitigate [slab vacuum treatment or regular ventilation] where you find levels > 100bq/m^3 [probably your basement]
I paid a home inspector $150 for a professionally administered radon test so I could be confident in the results. I wouldn't trust something so important to Amazon as they have a lot of counterfeits. Also, if you sell your home you want to show the results to prospective buyers.
Do you trust your CO alarm to Amazon or did you call the fire brigade just to be sure?
Joking aside, I agree the products will improve but I feel Airthings have gone a long way to prove the reliability of their product and a future where we trust “something from amazon” isn’t all that wacky as we already live in it.
No, I absolutely would not buy a CO2 alarm on Amazon! Counterfeits are rampant on Amazon, I would buy life saving devices from a retailer that has better control over their inventory such as Walmart, Target, Best Buy, Home Depot, Lowe's, True Value, Costco, our local chains, etc, etc.
This isn't some sort of exaggeration, house fires have started due to counterfeit electrics.
People here on HN have reported getting counterfeit body wash, counterfeit books, counterfeit diapers, and counterfeit toys from Amazon plus there's a lawsuit against Amazon for selling counterfeit eclipse glasses.
>In 2012, Amazon Marketplace was identified by the Consumer Fraud Center as America’s single-largest counterfeit outfit, warning shoppers to be on their guard over the holiday season. [1]
> Do you trust your CO alarm to Amazon or did you call the fire brigade just to be sure?
No, I bought it from a retailer that isn't a multi-seller marketplace known for mixing inventory from unreliable sellers who push counterfeit products where they are a middleman with those that they are selling themselves as the retailer.
You should be able to buy an absorption test kit. For instance in the UK, you can pay £50, you get a couple of detectors to sit in your house for a few months and then you send them to a certified lab.
These kits are fine if you want to check or sell your house - in most cases the amount of radon in your house is determined by your local geology. If you pass an absorption test, it's unlikely you'll suddenly find dangerous levels of radon in the future.
The advantage of the real-time detectors is that they're real-time, but it's hard to prove that they're calibrated.
Realtime sensor calibration is hard to prove, but proving that an absorption kit is a reliable reading also has it's challenges: In practice radon emissions vary dramatically throughout the seasons and based on rainfall, in particular in colder climates.
Hopefully one day we see slab depressurization become standard in all houses with below grade construction, combined with a realtime sensor just like you would have a smoke alarm.
In practice radon emissions vary dramatically throughout the seasons and based on rainfall, in particular in colder climates.
When I did Radon measurement for my house the guidelines for getting an accurate reading was to measure for 2 month between October and April to mitigate those factors.
Yep that certain does a decent job. I’ve been measuring for around 18 months now, my surprise finding is that only in the last few months has it gone up over 150 for the first time. I’d encourage you to do both if possible.
I have the AirThings one. I like it. The biggest drawback is that there is no easy way to automatically record readings, so I do it manually.
I move it from room to room every few days. I was surprised that the upstairs bedroom read as high as the basement (but none are high).
Also, as every website points out, the readings vary quite a bit through the day, and from day to day.
I also noticed that the readings increase when it rains (my current theory is that the low pressure that precedes rain pulls more radon from the ground).
> The biggest drawback is that there is no easy way to automatically record readings, so I do it manually.
Sounds like an opportunity for a fun project. Set up a webcam (or laptop with a cam?) and take screenshots/snapshots of the feed every n minutes. OCR the output and append to a log file.
Yeah unfortunately they are not cheap; I have two, both by Airthings. I first purchased the Corentium version [shows a 1 day, 7 day and lifetime average], and most recently the "Wave" product [graphs the details over time, also tracks temperature and humidity, transmits results to an app via bluetooth].
I actually went to the effort of decompiling the source code to their Android app as I want to integrate the Wave product to my SmartThings hub so i can automatically ventilate if levels go too high. I find my radon levels build up from around 60 to 200bq/m^3 over time [takes about a month], and my basement walk out opening for 15 minutes once a month tends to lower them < 100bq/m^3 again. The goal i have is to intercept the BT traffic and send it to SmartThings from there over an internet connection or local wifi, ideally automating turning on a vent to the outside that is located near the ground level.
I also learnt a while back that different countries have different levels of "acceptable" radon in residential properties. Currently Canada has a limit set pretty high compared to the rest of the world (200bq/m^3), where as most European countries are suggesting < 100bq/m^3. I found that in the code they consider this when deciding what colour LED to show on the device: https://gist.github.com/ndroo/384bceeb16d771757b6996bd28001d...
The level's they use i personally find a little irresponsible, I'd prefer they pick reliable research (1) and go by that. Experts in Canada acknowledge our recommended levels are out of date and need changing, hopefully an update comes soon that lowers what is acceptable. For now, I've told the app I live in France.
Here is a snippet that I find interesting from the study:
"Radon levels greater than Health Canada’s acceptable limits (of 200 Bq/m3) for the naturally occurring but cancer-causing gas were detected in all areas, with one in eight containing dangerously high radon levels between 200 and an astounding 3,441 Bq/m3. The World Health Organization estimates that the relative lifetime risk of lung cancer increases by 16 per cent for every 100 Bq/m3 of chronic radon exposure. Surprisingly, the scientists found that newer homes, built within the past 25 years, contained substantially higher radon gas levels compared to older homes."
The goal of Airthings states they want "to make radon sensors as common as smoke alarms". I don't know how many lives per year smoke alarms save, i imagine a lot, i would guess if everyone had one of these we would see a massive public health spend drop in relation to lung cancer treatments.
Expensive, but hopefully they get cheaper with time. If you can afford one, get one.
No, this is quite common throughout numerous regions as a totally natural occurrence. It is definitely nothing new or unique to fracking areas. It's especially likely in older homes with space below the floors at ground level. It's easy to test for it.
It has nothing whatsoever to do with fracking. Radon is a by-product of uranium and radium decay. It is present to some level in just about any soil. It is also a gas at standard pressure and temperature, so it is slowly filtering its way up from deeper rocks through the soil and then out into the atmosphere. When you dig a hole, for example a house foundation, you create more exposed soil surface through which the gas can escape. Some aspects of a home also cause more radon to escape into a cellar than would escape through surface soil, like the suction effect of natural convection in the house due to daily heating and cooling. How much radon your local soil is producing can be quite variable due to random variation of subsurface rocks and other effects of local geology.
I was wondering about the spatial variability of radon gas emissions. Is it possible/likely for one house to report normal levels while an adjacent house might report high/significant levels?
In other words, if your neighbor gets a test and finds acceptable levels, would it still be a good idea to get a test/monitor for your house?
It is likely that a close neighbor will have similar soil, but differences in home construction can have enough of an impact on radon exposure that you can't quite treat a neighbor's level as an indicator as your own. Think of it like groundwater, if the water table is high enough then both of you have an equivalent risk of seepage and leaking into your cellar, but how those cellars or foundation slabs are constructed also has a big impact. If this is a cookie-cutter suburban development where all the houses were built using the same materials and same basic plan then they will probably have similar radon levels, but if houses were built at different times or by different companies at the same time all bets are off.
How do they figure that radon gas, rather than inorganic pollutants (silicates including asbestos, synthetic silicates, or aromatic hydrocarbons, or other classes of pollution)?
> Lung cancer mainly occurs in older people. About 2 out of 3 people diagnosed with lung cancer are 65 or older, while less than 2% are younger than 45. The average age at the time of diagnosis is about 70.
[honest question] Could this have any impact on the perceived priority of studying lung cancer? (i.e., you're already near EOL when diagnosed with it?)
65 isn't so near EOL, the average life expectancy for a 65 year old woman is 20 years, and 18 for a man[1].
20 years is a long time... everything you do between 15 and 35? The majority of life's accomplishments for most -- you could do that all over again between 65 and 85, now with the capital and experience to do something interesting.
I think computer-assisted medical developments might push that out another 5 years in the next decade or two; so the life expectancy is 25 instead of 20 from age 65.
Why does that spoil it. It's clearly not true. Most people are just starting to get life figured out at 35. Most 35-year-olds haven't accomplished all that much yet.
Median makes sense to me :) I was just pointing out the discrepancy -- cannot (should not) specifically make a contrast between median of one data set and mean of another.
Why should someone being a smoker deprioritze lung cancer research? They’re people who engage in a legal activity and pay heavy taxes to do so.
We rarely discount medicine for the myriad other medical problems that occur from many other activities like eating bad foods (way worse than smoking), avoidable stress (not addictive) and the various substance abuse from pharmaceuticals et al.
A major part of the prevention of tobacco use is education. This is partly done through explaining the health impact on the people affected by smoking (smoker+surrounding), partly through moralizing (since health and the personal responsibility for ones own health are exercised as a value).
The latter nicely fits with an externality argument based on scarcity of resources in research & treatment. At this point, if you accept all those premises, lung cancer research for smokers is a negative externality for all the non-smokers in need for research & treatment.
And it's not necessary that those premises are accepted on an individual level; it's enough to just teach them. Long term policy making is in many value questions just a proxy for mass education.
You currently don't have any of that for the misuse of medicine, etc.
High taxes on tabacco are not supposed to fund treatment, they're supposed to deter people from smoking.
While self inflicted illnesses are (and should be) covered by health care, there is a point in trying to avoid those rather than making them easy to treat. Deterring people from smoking while researching treatment for other forms of cancer can save more lives in the long run.
If we didn't want people to smoke, it would be illegal.
Yet, as US taxpayers, we have subsidized a synthetic opioid epidemic for almost 20 years, and state governments use legal settlements against drug distributors to subsidize treatment (which are not standardized) and fund the purchase of more pharmaceutical products (suboxone and narcan).
To be fair, most people weren't aware of the problems prescription opioids cause until very recently. People also smoked for decades until it was established that smoking is unhealthy.
Banning a drug will only lead it to go underground. If you ban cigarettes, everything moves to the black market. The US has experienced in past decades that banning drugs and fighting their distribution is not necessarily effective. If you legalise a drug but tax it heavily (and provide other restrictions), you control the supply chain (ensuring quality) and can recover some of the costs via taxes.
>Most people who get and die from lung cancer are not smokers
This is not true:
More than 161,000 lung cancer deaths are projected to occur in the U.S. in 2008. Of these, an estimated 10–15% will be caused by factors other than active smoking, corresponding to 16,000–24,000 deaths annually.[1]
That said:
lung cancer in never smokers would rank among the most common causes of cancer mortality in the U.S. if considered to be a separate category
120 comments
[ 3.6 ms ] story [ 323 ms ] threadCancers start small and develop into larger problems over time. Consider a hypothetical patient who develops cancer at the age of 70 and dies of it, untreated, at the age of 78.
If the cancer is detected at the age of 75, detection will lower the 5-year survival rate, since the patient dies after three years of "having cancer". If it is detected at 72, detection increases the 5-year survival rate, since the patient now dies after 6 years. Without treatment, early detection has a very strong impact on 5-year survival rates.
This is why Mammograms are every 1 or 2 years. If you could wait 4 years without treatment early detection would be less of an issue.
PS: People generally assume a lump becomes cancer as soon as it starts to form. But the general case is you get a lot of little growths from pre-cancerous cells which are predisposed to cancer. Then one or more of those cells become cancer and then you die fairly quickly after that transition.
>From 2005 to 2014, overall breast cancer incidence rates increased among Asian/Pacific Islander (1.7% per year), non-Hispanic black (NHB) (0.4% per year), and Hispanic (0.3% per year) women but were stable in non-Hispanic white (NHW) and American Indian/Alaska Native (AI/AN) women. The increasing trends were driven by increases in hormone receptor-positive breast cancer, which increased among all racial/ethnic groups, whereas rates of hormone receptor-negative breast cancers decreased.
See also Figure 5, and the paragraph above it with the subheading of "Incidence" in the "Temporal Trends" section:
>Much of the historic increase in breast cancer incidence rates reflect changes in reproductive patterns, such as delayed childbearing and having fewer children, which are recognized risk factors for breast cancer.[22, 23] Incidence rates of in situ and invasive breast cancer rose rapidly during the 1980s and 1990s (Fig. 5), largely because of increased use of mammography screening in the United States. The widespread uptake of mammography screening inflated the incidence rate, because cancers were being diagnosed 1 to 3 years earlier than they would have been in the absence of screening, and screening also may have led to the detection of indolent cases. Invasive breast cancer rates stabilized between 1987 and 1994, followed by a slower increase during the late 1990s. The continued increase particularly among older women may reflect rising rates of obesity and the use of menopausal hormones, both of which increase the risk of postmenopausal breast cancer, as well as further increases in the prevalence of mammography screening.[24] Around the year 2000, incidence rates began to decline among women ages 50 years and older; and, between 2002 and 2003, breast cancer rates decreased nearly 7%, likely because of the decreased use of menopausal hormones after publication of the Women's Health Initiative randomized trial results linking the use of estrogen plus progesterone menopausal hormone therapy to breast cancer and heart disease.[25-27] The decline occurred primarily in white women and in those who had HR-positive disease.[26, 28] The drop in incidence may also reflect in part the small declines in mammography screening since 2000. The percentage of women aged 40 years and older who reported having a mammogram within the past 2 years increased from 29% in 1987 to 70% in 2000 and dropped to 64% in 2015.[29]
[1] http://onlinelibrary.wiley.com/doi/10.3322/caac.21412/full
In the 70's Doctors ramped up their prescriptions of Horse Estrogen because they were tricked into thinking it helped. PREMARIN is made from PREgnant MAres' uRINe:
>> In response to the 1962 Kefauver Harris Amendment the FDA had [Premarin's] efficacy reviewed, and in 1972 found it effective for menopausal symptoms and probably effective for osteoporosis [0].
[0] https://en.wikipedia.org/wiki/Premarin#History
Premarin prescriptions fell off a cliff in response to the preliminary findings of the Women's Health Initiative - https://en.wikipedia.org/wiki/Women%27s_Health_Initiative#HT...
Now doctors realize that excess estrogen -> cancer, and are using anti-estrogens for breast cancer:
>> Other improvements have included tamoxifen, an anti-estrogen agent that was approved in the late 1970s; Herceptin, a drug used to treat tumors with a higher-than-normal level of a protein called HER2 and drugs called aromatase inhibitors.
(quote from this article)
Edit: yesterday I commented on a submission about cancer probably being a mitochondrial disease [1]. This is the old/new idea about cancer, that it's not actually caused by genetic mutations - the observed genetic mutations are actually caused by metabolic failure.
[1] https://news.ycombinator.com/item?id=15382104
Edit 2: DES was the first synthetic estrogen. It was used on women until 1971, when they realized it caused cancer [2]. Those women would've developed cancer in the 2-3 decades that followed their exposure to this drug.
[2] https://en.wikipedia.org/wiki/Diethylstilbestrol#Adverse_eff...
That’s not a “side-effect” of it though. Be careful about attributing causation. The effects of testosterone bring about the conditions that lead to these problems.
The same goes for estrogen: women develop breasts as a result of increased levels of estrogen. The increased cellular activity in the breast cells over many decades leads to an increased risk of cancer. It is because the breasts grow that cancer rates greatly increase; they are inseparable to some degree.
This comment is relevant: https://news.ycombinator.com/item?id=15290462
Relevant article: http://www.npr.org/sections/health-shots/2016/03/05/46828554...
> Even Seyfried acknowledges, despite his zeal for treating cancer by tinkering with calories, that in all likelihood diet and nutrient-based cancer treatments will serve as adjuncts to existing therapies.
Some people claim alternative "medicine" (aka magic) is harmless but it isn't. The harm comes from people avoiding or delaying real treatment. Prominent HIV-deniers have died from AIDS because they refused to take the anti-viral medication. Countless people have died from treatable cancers because they went to chiropractors or "traditional healers" instead of actual doctors.
It is entirely possible that Steve Jobs would still be alive if he hadn't refused treatment for 9 months.
The science behind that is that cancer calls can live on glucose only, while all other cells in the body are able to use ketones as fuel. Starving out cancer cells is definitely a good start.
Quick search showed https://sciencebasedmedicine.org/ketogenic-diets-for-cancer-...
Seems like the Warburg effect is obviously real, but far from universal in cancers.
I can only find references to us raising the recommended age to 45 in 2015, controversy over raising it to 50 in 2009 and how there are diverging opinions on when they should be done.
Screening and/or prophylactic treatment for high risk women is a different topic entirely and probably highly individualized.
Multiple professional organizations disagree (see below). For the societies that recommend age 45, they suggest that concerned women speak with their doctor regarding earlier screening.
Importantly, note that screening looks for signs of a disease in asymptomatic, normal-risk individuals. The presence of a family history or a lump/mass moves one from the category of screening into that of diagnosis.
Age 40: https://www.acr.org/About-Us/Media-Center/Press-Releases/201... - College of Radiology
https://www.acog.org/About-ACOG/News-Room/News-Releases/2017... - America College of Gynecology
Age 45: http://jamanetwork.com/journals/jama/fullarticle/2463262 - American Cancer Society
Age 50: https://www.uspreventiveservicestaskforce.org/Page/Document/... - United States Preventive Services Task Force
Breast cancer receives half a billion dollars more funding for research than does the latter, despite the latter being more common: http://dailycaller.com/2010/10/05/breast-cancer-receives-muc...
I'm loathe to link to the Daily Caller, but it's a pretty neutral piece with no politics, nonetheless:
https://prostate.org.nz/2014/01/men-die-earlier-womens-healt...
But perhaps more research for breast cancer will lead to better treatments for all cancers , even if the focus on one cancer is excessive
Is there anywhere to keep up-to-date on this specific topic, if it is indeed nearly inevitable?
That's an understatement. According to my mother's medical school teachers, all men get prostate cancer, but it develops pretty slowly.
Honest question: If this were an article about leukemia death rates would you have posted about prostate cancer? Most people wouldn't because it wouldn't be relevant to the article. The only way I can see this topic being relevant is if you believe in "battle of the sexes" theories or think men are systematically victimized by society (we aren't) and want to point out this as an example. I don't know if you believe in either of those things or if you have a different explanation? Linking to DC implies an agenda but based on the principle of charity I will assume you just weren't thinking about the implications when you posted this.
There are several reasons prostate cancer doesn't get the same attention as breast cancer.
1. Fewer high-profile people organizing around it and starting foundations to study it. You may wish the world worked on a slightly more utilitarian scale where we distributed medical research resources fairly according to need and impact. The reality is the squeaky wheel gets the grease.
2. Prostate cancer isn't nearly as squeaky of a wheel:
a) men who get it usually get it later in life compared to women who get breast cancer. Dying at 45 of cancer is a tragedy. Dying at 75 of cancer is a day that ends in Y.
b) most forms of prostate cancer are slower-growing and less metastatic; as a result even men who get it often choose not to get treatment and end up dying of heart failure or other ailments before the prostate cancer has any negative effects. In the US, the 5-year survival rate for prostate cancer diagnosis is 99%.
I'm glad research is being done on prostate cancer and breast cancer at the same time; I don't see any need for an "equal" funding principle. If such rules did exist it would have to be based on # of affected people and life-expectancy. Under such a system prostate cancer would probably rank as over-funded right now.
For the latter, I'd say that this topic is inherently sex-specific and thus in a way, has to be sexist. Obviously we wouldn't be talking about prostate cancer if it was leukemia, but it is not. Discussing the survival rates across genders is a legitimate topic and it might turn out that men at more danger - apart from prostate cancer, keep in mind that men commit much more suicides [1], usually take much riskier jobs and in some countries are forced to participate in the army. As a source, I would recommend The Red Pill movie by Cassie Jaye - a woman who called herself feminist until she actually researched what masculism is about.
Also, it doesn't have to be a "battle of the sexes" as you put it. Working on male health does not mean stopping research on female health - it's just that prostate cancer definitely isn't getting enough exposure. It would be great if we learned to acknowledge that we can fight for our gender's rights without shouting how the other one oppresses us.
[1]: https://en.wikipedia.org/wiki/Gender_differences_in_suicide
No, because both men and women can die from leukemia.
I've thought about this too. No life is saved, it is only prolonged.
If these people have been given an extra five years of life, that must be a pretty spectacular return on investment. Compare how much was spent developing and administering treatment to the value of 1.5 million years of life.
Maybe even greater is the opportunity cost. If you have a good result, it would take the double of time for the society to benefit from it.
Cancer tends to (though not always) correlate with age when you break it up by type of cancer. For example, children don't get prostate cancer or lung cancer all that often. Similarly, Retinoblastoma and other types of cancer are more common amongst children. So, because of that, you have a built-in tendency to control for age and allow the 5-year statistic to be more of a valid comparison. Similarly, you can calculate 5 year survival rates for any set of subgroups you want – break it up by age, race, gender, co-morbidity or even cancer variant (many of those are frequently done) and then compare. At some point (usually in pretty quickly) the 5 year survival rate is a meaningful comparison...
Also, to be honest/in my opinion, 5 years is a meaningful number for the lived experience. You can imagine doing a lot in five years vs, say, 6 months – so for that reason, it's a useful metric for generally understanding "what chance do I have at having more life to truly live?"
Breast cancer mostly affects women 45+ -- or younger women with a genetic disposition.
That being said, there are a number of reasons that I believe it's so prevalent.
(1) 5 year long survival studies are long and risky affairs, increasing that number just makes it longer and riskier
(2) particularly when speaking about differences in treatment, a statistically significant average increase of 1 month survival over standard of care is sufficient to supplant it, so OS5 v. OS10 doesn't change much if your treating advanced cancers that result in deaths before 5 years.
When it comes to most cancers though, I think OS5 is a very bad stat.
5-year survival is just one measure of health. You proposed two others, but none of them are the complete picture. They're all about the same really. Best is actually looking at the distribution of each metric you care about, but then those curves are hard to compare.
When you look at medicine as a business based on billing all the needs justifications make so much more sense.
Also, why has the threshold for high blood pressure moved lower over the last 20 years (multiple times)?
[1] http://jamanetwork.com/journals/jamainternalmedicine/fullart...
> Conclusions and Relevance When analyzed at the county level, the clearest result of mammography screening is the diagnosis of additional small cancers. Furthermore, there is no concomitant decline in the detection of larger cancers, which might explain the absence of any significant difference in the overall rate of death from the disease. Together, these findings suggest widespread overdiagnosis.
https://www.cancer.org/cancer/non-small-cell-lung-cancer/abo...
Most people who get and die from lung cancer are not smokers. Like my mom.
"Overall, the chance that a man will develop lung cancer in his lifetime is about 1 in 14; for a woman, the risk is about 1 in 17. These numbers include both smokers and non-smokers. For smokers the risk is much higher, while for non-smokers the risk is lower."
https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm
> Cigarette smoking is the number one risk factor for lung cancer. In the United States, cigarette smoking is linked to about 80% to 90% of lung cancers. Using other tobacco products such as cigars or pipes also increases the risk for lung cancer.
[...]
> People who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. Even smoking a few cigarettes a day or smoking occasionally increases the risk of lung cancer. The more years a person smokes and the more cigarettes smoked each day, the more risk goes up.
It's true that not all lung cancer is caused by smoking.
If you want bang for your buck, buy a radon detector and mitigate [slab vacuum treatment or regular ventilation] where you find levels > 100bq/m^3 [probably your basement]
Joking aside, I agree the products will improve but I feel Airthings have gone a long way to prove the reliability of their product and a future where we trust “something from amazon” isn’t all that wacky as we already live in it.
This isn't some sort of exaggeration, house fires have started due to counterfeit electrics.
People here on HN have reported getting counterfeit body wash, counterfeit books, counterfeit diapers, and counterfeit toys from Amazon plus there's a lawsuit against Amazon for selling counterfeit eclipse glasses.
https://www.dailydot.com/news/amazon-marketplace-conterfeit-...
>In 2012, Amazon Marketplace was identified by the Consumer Fraud Center as America’s single-largest counterfeit outfit, warning shoppers to be on their guard over the holiday season. [1]
http://losangeles.cbslocal.com/2017/05/18/amazon-counterfeit...
[1] Due to comminging policies items from marketplace sellers can end up "sold and shipped by Amazon."
No, I bought it from a retailer that isn't a multi-seller marketplace known for mixing inventory from unreliable sellers who push counterfeit products where they are a middleman with those that they are selling themselves as the retailer.
These kits are fine if you want to check or sell your house - in most cases the amount of radon in your house is determined by your local geology. If you pass an absorption test, it's unlikely you'll suddenly find dangerous levels of radon in the future.
The advantage of the real-time detectors is that they're real-time, but it's hard to prove that they're calibrated.
http://www.ukradon.org/information/measuringradon
Hopefully one day we see slab depressurization become standard in all houses with below grade construction, combined with a realtime sensor just like you would have a smoke alarm.
When I did Radon measurement for my house the guidelines for getting an accurate reading was to measure for 2 month between October and April to mitigate those factors.
I move it from room to room every few days. I was surprised that the upstairs bedroom read as high as the basement (but none are high).
Also, as every website points out, the readings vary quite a bit through the day, and from day to day.
I also noticed that the readings increase when it rains (my current theory is that the low pressure that precedes rain pulls more radon from the ground).
Opening windows helps a lot.
Sounds like an opportunity for a fun project. Set up a webcam (or laptop with a cam?) and take screenshots/snapshots of the feed every n minutes. OCR the output and append to a log file.
I actually went to the effort of decompiling the source code to their Android app as I want to integrate the Wave product to my SmartThings hub so i can automatically ventilate if levels go too high. I find my radon levels build up from around 60 to 200bq/m^3 over time [takes about a month], and my basement walk out opening for 15 minutes once a month tends to lower them < 100bq/m^3 again. The goal i have is to intercept the BT traffic and send it to SmartThings from there over an internet connection or local wifi, ideally automating turning on a vent to the outside that is located near the ground level.
I also learnt a while back that different countries have different levels of "acceptable" radon in residential properties. Currently Canada has a limit set pretty high compared to the rest of the world (200bq/m^3), where as most European countries are suggesting < 100bq/m^3. I found that in the code they consider this when deciding what colour LED to show on the device: https://gist.github.com/ndroo/384bceeb16d771757b6996bd28001d...
The level's they use i personally find a little irresponsible, I'd prefer they pick reliable research (1) and go by that. Experts in Canada acknowledge our recommended levels are out of date and need changing, hopefully an update comes soon that lowers what is acceptable. For now, I've told the app I live in France.
Here is a snippet that I find interesting from the study:
"Radon levels greater than Health Canada’s acceptable limits (of 200 Bq/m3) for the naturally occurring but cancer-causing gas were detected in all areas, with one in eight containing dangerously high radon levels between 200 and an astounding 3,441 Bq/m3. The World Health Organization estimates that the relative lifetime risk of lung cancer increases by 16 per cent for every 100 Bq/m3 of chronic radon exposure. Surprisingly, the scientists found that newer homes, built within the past 25 years, contained substantially higher radon gas levels compared to older homes."
The goal of Airthings states they want "to make radon sensors as common as smoke alarms". I don't know how many lives per year smoke alarms save, i imagine a lot, i would guess if everyone had one of these we would see a massive public health spend drop in relation to lung cancer treatments.
Expensive, but hopefully they get cheaper with time. If you can afford one, get one.
(1) http://cmajopen.ca/content/5/1/E255.full
https://www.epa.gov/radon/find-information-about-local-radon...
In other words, if your neighbor gets a test and finds acceptable levels, would it still be a good idea to get a test/monitor for your house?
You can actually test for this on empty lots by keeping the tester under a flipped-over bucket (using the bucket as a cover).
> Lung cancer mainly occurs in older people. About 2 out of 3 people diagnosed with lung cancer are 65 or older, while less than 2% are younger than 45. The average age at the time of diagnosis is about 70.
[honest question] Could this have any impact on the perceived priority of studying lung cancer? (i.e., you're already near EOL when diagnosed with it?)
20 years is a long time... everything you do between 15 and 35? The majority of life's accomplishments for most -- you could do that all over again between 65 and 85, now with the capital and experience to do something interesting.
I think computer-assisted medical developments might push that out another 5 years in the next decade or two; so the life expectancy is 25 instead of 20 from age 65.
[1] https://www.ssa.gov/oact/STATS/table4c6.html
I was having a great day.
No reason for your day to be spoiled!
Granted, that's the 33 percentile for age of diagnosis. In the UK at least, median age at death is more like 75 [1].
But...for breast cancer median age of death is also about 75. [2]
AFAIK there isn't a dramatic age difference.
[1] http://www.cancerresearchuk.org/health-professional/cancer-s...
[2] http://www.cancerresearchuk.org/health-professional/cancer-s...
Not to be picky, but the US stats are mean, which is different from the median.
We rarely discount medicine for the myriad other medical problems that occur from many other activities like eating bad foods (way worse than smoking), avoidable stress (not addictive) and the various substance abuse from pharmaceuticals et al.
The latter nicely fits with an externality argument based on scarcity of resources in research & treatment. At this point, if you accept all those premises, lung cancer research for smokers is a negative externality for all the non-smokers in need for research & treatment.
And it's not necessary that those premises are accepted on an individual level; it's enough to just teach them. Long term policy making is in many value questions just a proxy for mass education.
You currently don't have any of that for the misuse of medicine, etc.
While self inflicted illnesses are (and should be) covered by health care, there is a point in trying to avoid those rather than making them easy to treat. Deterring people from smoking while researching treatment for other forms of cancer can save more lives in the long run.
Yet, as US taxpayers, we have subsidized a synthetic opioid epidemic for almost 20 years, and state governments use legal settlements against drug distributors to subsidize treatment (which are not standardized) and fund the purchase of more pharmaceutical products (suboxone and narcan).
Banning a drug will only lead it to go underground. If you ban cigarettes, everything moves to the black market. The US has experienced in past decades that banning drugs and fighting their distribution is not necessarily effective. If you legalise a drug but tax it heavily (and provide other restrictions), you control the supply chain (ensuring quality) and can recover some of the costs via taxes.
This is not true:
More than 161,000 lung cancer deaths are projected to occur in the U.S. in 2008. Of these, an estimated 10–15% will be caused by factors other than active smoking, corresponding to 16,000–24,000 deaths annually.[1]
That said:
lung cancer in never smokers would rank among the most common causes of cancer mortality in the U.S. if considered to be a separate category
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170525/