Comment by alexey-salmin
4 days ago
No, the detector doesn't fix that, that problem is not treating people without cancer. The problem is treating people with cancer that won't kill or harm them during their lifetime. In this case even a low risk treatment becomes harmful, let alone cancer treatments.
Your claim is equivalent to claiming that most cancer treatment is net harmful btw
and this is obviously false, especially for cancers detected earlier
Whether treatment is net harmful or not depends on the level of the risk with no treatment. If you apply treatment with 15% chance of severe side effects to a tumor that will kill the patient with 50% chance in the next five years, of course it's net positive. If you apply it to a first-stage cancer that has 10% chance of progressing to the second stage, the very same treatment will be net harmful.
So no, most cancer treatments aren't net harmful now, but they likely will be in a world where your programme is implemented. Even something as "simple" as biopsy has mortality rates far from zero. Applying it at scale may not have the effect you expect. And surgeries and chemo are much worse.
But do you see how crazy that sounds? If we know the numbers, we would just not do the treatment in those cases.
And in reality it's not actually close like this. Early treatment is so overwhelmingly better than it completely dwarfs all considerations of biopsy risk.
Late stage lung cancer has less than half the 5 survival of early stage, and around 50% of lung cancer detection is late stage. That's around 30000 lives you could save every year from just lung cancer.
Let's say you don't protocol for all adults. Typically post CT or PET at most 10% get a biopsy. So let's say we increase the false positives that lead to CT or PET by X% of adults. That's 270M * X additional biopsies. Lung biopsy mortality is under 2%.
So the worst case you need a false positive rate under 5% for this to he net beneficial for lung cancer. That's low but with 3 scans 6 months apart and a good radiologist, it's not unreasonable
I believe I've assumed the worst case for all the quantities. In reality the addition screened people would have much lower CT detection rate than the background population, and biopsy mortality has been decreasing. Plus you can do this for only people above 40 where the benefits are higher
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So if this is true, it seems that we must accept that many people will die of cancer we could have detected and cured with frequent scans, because doing frequent scans will overall cause more harm to people who didn't need treatment. So the overall death/harm rate would be worst with more frequent scans?
Isn't that then just a problem with the scan and diagnosis? With more frequent scans it seems highly unlikely that we wouldn't improve this process and end up in a better place.