Comment by _alternator_
7 days ago
The major reason not to do this is that you often get worse outcomes for patients. Oncology provides a lot of examples where “more knowledge” does not lead to better outcomes. Routine ovarian cancer screening, prostate screens, childhood neuronlastoma screens, and breast cancer screens all have shown that overuse will identify more cancer, but do not lead to better outcomes like reduced mortality.
The reasons are complex, but the short answer is that cancer treatment is extremely hard on your body, and even if you don’t treat, stress can literally make you sick. I recommend reading The Emperor of all Maladies if you want to really get a sense for how delicate the problem of early screening is.
I’m married to someone running various prostate cancer studies in the UK. I hear the arguments against screening a lot and the issue really blew up recently in the news here.
The thing is, when researchers talk about “worse outcomes” they’re often comparing survival (or rather lack of) against terrible side-effects.
What this fails entirely to capture is that doing something to increase your odds of survival, damn the consequences, is an individual choice. It shouldn’t be up to a health economist to make that judgement.
But who will pay for the hundreds of thousands of screening MRIs, along with the large number of incidental results that will require some sort of follow-up? Many patients will seek second opinions if not recommended to "cut it out", with additional costs also for the complications resulting from unnecessary biopsies. US medical care is already tremendously expensive; adding all of these costs will break the bank and for no real benefit.
> What this fails entirely to capture is that doing something to increase your odds of survival, damn the consequences, is an individual choice.
What you're failing to capture is that this is a hard problem because it's both an individual choice and a collective one as well. Those "terrible side effects" might actually end up killing someone. You're choosing between a high-chance lottery on a small population or a low chance lottery on a far larger one. It's not that simple.
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Bot?
I appreciate that, but do wonder, if this is an issue with too much data or how we act on that data. In other words, could there be a future where we do have tons more data, but also use the data in such a way to achieve an overall better outcome for patients?
Maybe, but there's a human element that can make things worse too. Take prostate cancer as an example. Most men die with prostate cancer. Most men don't die _from_ prostate cancer. It isn't usually aggressive enough to matter. Most people aren't zen enough to accept that though, so just knowing that you have cancer can add stress to your life with measurably bad health impacts from the resulting hormonal changes (reduced immune function, impaired sleep, increased clotting tendency, slower wound healing, etc).
Ultimately its a balancing act between what we can know and what we can do about it. If you can’t treat a cancer (or your treatment is not effective, cf the radical mastectomy) then knowing who has it doesn’t help. As technology progresses and more cancers become readily treatable, it will make more sense to do early screening, and potentially full body MRIs.
But right now it is likely to cause a huge waste of time, resources, and yes, human lives to know about every little lump in your body.
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You’re assuming a future with highly competent specialists who also don’t make medical decisions based on insurance requirements.
Unfortunately too many radiologists and specialists are more focused on upping cash flow than medical care.
Then they should decide not to treat certain things and have better criteria around that than choosing to bury their heads in the sand and letting people die out of their ignorance.
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