Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great.
The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence while receiving cancer therapy.
Point being, we don’t want to lose site of the ultimate goal, which is preventing cancer as much as possible.
Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, you'd find the beginnings of prostate cancer in all of them. It's a question of when, not if."
I say this to highlight three things:
- Physicians routinely ignore things they shouldn't. Be your own advocate and research the things your doctor tells you, especially the things they believe are just worth watching.
- There is little to no awareness in the public over prostate cancer.
- Surviving isn't always a good metric. In my dad's case, surviving was a promise for a slow and miserable death.
You're misinterpreting the "when not if" adage. For prostate cancer it's generally used as an example of how there are cancers you die of and cancers you die with. Many prostate cancers are so nonaggressive that men will die with them and never know they were there.
And that's the problem. If you did a test and saw something & then immediately eradicated that prostate cancer, what if it was going to be one of the ones that wouldn't have caused you real harm during your natural life? In that case the likelihood of the treatment causing more damage to you than the cancer itself is high. And predicting which are which is improving but still imperfect.
I work in this field and directly am involved with the treatment of prostate cancers. What you describe is not standard of care, and I’d hesitate to say that everyone should be so alarmed of getting prostate or any cancer. It’s unfortunate that your father’s PCP wasn’t aware of such warning signs, and I’m sorry for your loss.
However, We’ve seen this before with prostate and breast cancer where early and often screening leads to not only false positives but undue stress on patients. Furthermore, catching a nonaggressive prostate cancer 2-5 years early may lead to the same outcomes as catching it when certain things like PSA are detected to be increasing. But you may drastically affect one’s quality of life. It can at times be a difficult balance.
We see more and more elderly patients being treated because they are living longer. For many though, “waitful watching” or “active surveillance” is the correct clinical decision and always is up to the patient.
Finally, while prostate cancer isn’t as publicized as breast cancer (we’re trying!). It is a well known cancer and there is awareness of it.
> Be your own advocate and research the things your doctor tells you
I share your concern but I think there is no definitive advise about how to prevent these horrible outcomes (besides the usual "do regular exercise", "lower sugar consumption", "avoid stress", etc.) Did you find anything more concrete?
By the time my friends dad had pancreatic cancer detected, he died within 6 weeks. It’s also the fastest growing cancer in the US. Every time I read about someone dying of cancer quite often it’s pancreatic cancer and it terrifies me.
They find spots on the pancreas by accident all the time. It is incredibly common. I know, I have one: I got an abdominal CT scan while getting something unrelated checked. Some of these go on to be cancer, and sometimes they know it is precancerous. The cyst I have wasn't immediately precancerous. Now I get regular MRIs to check on it. Since I have no symptoms, there is really nothing else to do.
That lack of symptoms, though, is a real issue. If you have a little bit of cancer and no symptoms and you don't find it accidentally, it is going to be much, much harder to detect early.
In general the worst cancers are the ones that are difficult to detect early enough before they metastasize. As the article says, this death rate has dropped mostly because of preventative care and early screening.
Cancer rates have exploded since 1970. I told this to someone and they arrogantly corrected me. But I just looked it up right there and they had confused death rates with cancer rates. Thanks be to god for smartphones.
Diabetes, obesity, cancer, depression rates all exploded in unison starting around 1970. Why does everyone ignore the massive implications of this? It means there’s something we’re doing that is killing millions of people but everyone brushes that aside and supports treatments rather than figuring out what happened in 1970 that is actually causing it.
There are a trillion pet theories but nobody wants to do research to figure out. Nobody advocates for this research. What the hell
This is already well-known and understood in science: cancer rates exploding is not because of an external force causing more cancer, but a sign that we addressed other things that kill you before you get cancer. And we also got far better at screening, including being able to identify benign tumors.
This sort of hyperbole- "killing millions", "trillion pet theories"- is needlessly alarmist.
It's one of those things were effects are so far ahead in time you don't really realise they're there until you're 60 and cancer kills you. And then it's "oh well, old people die" or "he had too many beers"
I was striving to be vegetarian for more than a decade (avoid red meat, low fat diet) because of the "science", before I started developing issues.
Good luck in finding research to back this up, the trend seems to be going all towards vegan highly processed food.
I was impressed when mainstream science recently reluctantly backtracked on animal fat and meat.
The USDA is still to update recommendations of course.
And obesity skyrocketed because nobody knew the difference between a fat person and a skinny person before 1970? We knew what cancer was before 1970. We certainly knew what diabetes was. The simple fact is that people started getting sicker in the 70s.
For a very long time people have been going to the doctor when they feel sick. Oliver Cromwell consulted with doctors and was convinced that he was very ill. Later on we understand that he had bipolar disorder. When people feel sick they consult doctors and have been doing this for hundreds of years. An illness like diabetes presents very specific symptoms and doctors have been aware of diabetes for a very long time. The same is true for many kinds of cancer. And even mental illnesses as I have pointed out were recognized as medical ailments by people for hundreds of years. It wasn’t that we suddenly started diagnosing these things.
Also, there are communities of people who do not develop heart disease or insulin resistance or depression or cancer. The common thread between every community like this is that they live outside of the modern world and do not eat modern foods. They live in an old way. This is well documented. Yet another insane data point that people somehow ignore. There are literally people out there who basically do not get cancer heart disease or diabetes and nobody seems to think it’s important to get to the bottom of this, people like you who leave snide comments and contribute nothing. A worthless parasite.
So there are communities that live in the old way and do not get any of these diseases. We see that these diseases exploded for us around 1970. It couldn’t be more obvious.
Cancer is ultimately a numbers game & you roll the dice every single day. Life expectancy in the US today is ten years longer than it was in 1970. All those extra dice rolls add up. Ideally you could correct for this effect, but it’s not clear we know enough about how cancer risk accumulates over time to do this correctly.
Cancer rates for each age have exploded, not just total cancer rates. Cancer rates for cancers that were known and diagnosed well before 1970 have exploded.
Looks like they went from 400 to 500 then back to 450 since 1975. It's trending down.
And you'd need to correct for age distribution to make sure it's not just the population having older people and thus higher chance of cancer in a given year.
Could it be that people started living long enough to develop these problems, or that the problems were just previously undercounted? There are a lot of fairly boring theories that are more likely than anything extravagant.
There have been some wonderful advances in cancer therapy, such as immunotherapy. For example, Rituxan (rituximab) only dates to 1997, but it's already in a number of chemotherapy protocols, leading to a clear improvement in survival rates in previously difficult-to-treat cancers such as aggressive non-Hodgkin's lymphoma.
Flashier, and something I've already talked about, is CAR T-cell therapy, the first generations of which were approved in 2017. This therapy has definite risks of severe side-effects, but it can result in complete remission of cancers that have survived multiple lines of chemotherapy, as happened with me.
Immunotherapy isn't just promising, it's here, and, because of it, so am I, but even more exciting is that it gives us more avenues of research to build off of known-useful therapies.
> For example, Rituxan (rituximab) only dates to 1997
It is kind of scary to me that drugs these days have such long regulatory lead times that a drug developed in 1997 is just now being entered into treatment regimens.
I understand why that is (the Thalidomide tragedy stuff and like that), but I also clearly remember reading an article ~10 years back that asked why cancer treatment seemingly hadn’t made any leapfrogs since the ~70s, and the answer was back then they could aggressively iterate on treatments.
I get what you're saying: it's a bit of an apples-to-oranges comparison since better screening means we're comparing cancers of different severities. I don't necessarily see that as a problem, though, since a lot of these earlier screened cancers would have become more advanced cancers down the line. If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no?
The "US Cancer Death Rate" talked about in the article is measured in deaths per 100,000 population, not deaths per detected cancer. So we are comparing apples to apples, but finding and treating cancers earlier could be helping to result in fewer deaths.
> If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no?
no. being able to detect cancer doesn't mean people are getting tested twice a year for their whole life. for example, you wouldn't have routine cancer screenings for children, but sometimes they get cancer, and on those occasions it'd be nice to have better treatment options.
The thing we don't know is which early cancers actually progress to advanced cancer. It's possible that we detect more things that look like cancer, but that would not have ever progressed into full blown metastatic cancer (at least, not before the patient died of something else). So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer.
"problem" is a bit of a strong word, but when someone says "Cancer Death Rate Dropped" dropping people assume "Cancer Rate Dropped", which is not at all the same thing
The article provides no numbers about cancer rate dropping. Yet the false association between the two ideas is so strong that even the authors themselves seem to theorize that the cancer rate itself is dropping because people don't smoke as often now.
Conflating those two concepts seems like a Very Bad Idea
> The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991, the report said, averting an estimated 3.8 million cancer deaths in that time.
Yes. I expected to find that the decline in smoking has also lead to the decline in fatal cancer — and there it is. Still a good thing.
I think this would only matter if some of the additional detected cancer would have gone away on its own. Correct me if I'm wrong, but I think that's impossible.
It's different for e.g. Flu, where more testing = more detection of an illness that would not necessarily have become serious, had it gone undetected.
>detected cancer would have gone away on its own. Correct me if I'm wrong, but I think that's impossible.
What if they detect a slow growing cancer that wouldn't have become a problem before you hit the age of 150? Not every cancer is aggressively trying to eat its host whole.
Avoiding cancer in the first place matters too. Lung cancer is a lot less common, now that nobody smokes any more. The rate of lung cancer deaths for men has halved since 1991, which itself accounts for half of the overall decline.
It's mostly due to the reduction in smoking, not screening. Screening helps, but it often extends lifespan and healthspan rather than preventing a death.
I wouldn't use the word "problem" but to explain it better, cancer rate itself has not dropped necessarily but due to early detection, number of deaths from cancer has dropped. We still have a long way to go to actual be able to cure cancers especially in advanced stages. Still a good win but more work to do.
Screening, the HPV vaccine and dropping rates of smoking.
It would be nice if we could stop advanced cancers but at least we're getting better at prevention.
I lost my dad to cancer last year. It's a horrible disease. I really had no idea how horrific it is. My dad had a year longer than his initial prognosis thanks to new immunotherapy drugs.
Yes it is a theoretical mess. The article manages to conflate in the same sentence:
> The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991
which mixes all meanings together (smoke → cases ; detection → fatality ...). So it's just "decreased number of deaths".
(Well, on the other hand, it makes sense that more factors impact such "final" result.)
From the CDC:
> In the past 20 years, from 2001 to 2020, cancer death rates went down 27%, from 196.5 to 144.1 deaths per 100,000 population
More vaccines seems like one of the most straightforward future mitigations since viruses like Hepatitis/HPV/mono/HIV/herpes/etc cause almost a fifth of cancer cases:
That is a dubious claim. While links between HPV and cervical cancer are quite strong and well-defined, the associations with the other viruses you cite are only correlative. Also, Hep C, HIV and herpes have no vaccine, so unclear what your statement is referring to anyway? What has contributed to a drop in cancer mortality would be advances in treatment (like targeted therapies and immunoncology), better image/blood/genetic screening practices, and certainly the decreased popularity of smoking.
This particular virus has a solid link to various forms of cancer:
"[Epstein–Barr virus] has also been implicated in several other diseases, including Burkitt's lymphoma, hemophagocytic lymphohistiocytosis, Hodgkin's lymphoma, stomach cancer, nasopharyngeal carcinoma, multiple sclerosis, and lymphomatoid granulomatosis.".
> While links between HPV and cervical cancer are quite strong and well-defined, the associations with the other viruses you cite are only correlative.
HPV is merely correlative, as well. That's basically how all endogenous cancers work. With Epstein-Barr Virus the association is quite strong, though the incidence of EBV-induced cancers doesn't seem to be quite as large as HPV--~1% vs 2-3%.
> Also, Hep C, HIV and herpes have no vaccine, so unclear what your statement is referring to anyway?
OP is talking about more vaccines as possible future mitigations - more vaccines as in new vaccines, not more vaccinations using existing ones (though that wouldn't hurt either.)
Readit News
Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great.
The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence while receiving cancer therapy.
Point being, we don’t want to lose site of the ultimate goal, which is preventing cancer as much as possible.
I say this to highlight three things:
- Physicians routinely ignore things they shouldn't. Be your own advocate and research the things your doctor tells you, especially the things they believe are just worth watching.
- There is little to no awareness in the public over prostate cancer.
- Surviving isn't always a good metric. In my dad's case, surviving was a promise for a slow and miserable death.
And that's the problem. If you did a test and saw something & then immediately eradicated that prostate cancer, what if it was going to be one of the ones that wouldn't have caused you real harm during your natural life? In that case the likelihood of the treatment causing more damage to you than the cancer itself is high. And predicting which are which is improving but still imperfect.
However, We’ve seen this before with prostate and breast cancer where early and often screening leads to not only false positives but undue stress on patients. Furthermore, catching a nonaggressive prostate cancer 2-5 years early may lead to the same outcomes as catching it when certain things like PSA are detected to be increasing. But you may drastically affect one’s quality of life. It can at times be a difficult balance.
We see more and more elderly patients being treated because they are living longer. For many though, “waitful watching” or “active surveillance” is the correct clinical decision and always is up to the patient.
Finally, while prostate cancer isn’t as publicized as breast cancer (we’re trying!). It is a well known cancer and there is awareness of it.
I share your concern but I think there is no definitive advise about how to prevent these horrible outcomes (besides the usual "do regular exercise", "lower sugar consumption", "avoid stress", etc.) Did you find anything more concrete?
He was ordering psa tests but just ignoring the velocity ?
I had similar discussion on HN last week
https://news.ycombinator.com/item?id=34251569
They find spots on the pancreas by accident all the time. It is incredibly common. I know, I have one: I got an abdominal CT scan while getting something unrelated checked. Some of these go on to be cancer, and sometimes they know it is precancerous. The cyst I have wasn't immediately precancerous. Now I get regular MRIs to check on it. Since I have no symptoms, there is really nothing else to do.
That lack of symptoms, though, is a real issue. If you have a little bit of cancer and no symptoms and you don't find it accidentally, it is going to be much, much harder to detect early.
Diabetes, obesity, cancer, depression rates all exploded in unison starting around 1970. Why does everyone ignore the massive implications of this? It means there’s something we’re doing that is killing millions of people but everyone brushes that aside and supports treatments rather than figuring out what happened in 1970 that is actually causing it.
There are a trillion pet theories but nobody wants to do research to figure out. Nobody advocates for this research. What the hell
This sort of hyperbole- "killing millions", "trillion pet theories"- is needlessly alarmist.
Dead Comment
It's one of those things were effects are so far ahead in time you don't really realise they're there until you're 60 and cancer kills you. And then it's "oh well, old people die" or "he had too many beers"
I was striving to be vegetarian for more than a decade (avoid red meat, low fat diet) because of the "science", before I started developing issues.
Good luck in finding research to back this up, the trend seems to be going all towards vegan highly processed food. I was impressed when mainstream science recently reluctantly backtracked on animal fat and meat.
The USDA is still to update recommendations of course.
For a very long time people have been going to the doctor when they feel sick. Oliver Cromwell consulted with doctors and was convinced that he was very ill. Later on we understand that he had bipolar disorder. When people feel sick they consult doctors and have been doing this for hundreds of years. An illness like diabetes presents very specific symptoms and doctors have been aware of diabetes for a very long time. The same is true for many kinds of cancer. And even mental illnesses as I have pointed out were recognized as medical ailments by people for hundreds of years. It wasn’t that we suddenly started diagnosing these things.
Also, there are communities of people who do not develop heart disease or insulin resistance or depression or cancer. The common thread between every community like this is that they live outside of the modern world and do not eat modern foods. They live in an old way. This is well documented. Yet another insane data point that people somehow ignore. There are literally people out there who basically do not get cancer heart disease or diabetes and nobody seems to think it’s important to get to the bottom of this, people like you who leave snide comments and contribute nothing. A worthless parasite.
So there are communities that live in the old way and do not get any of these diseases. We see that these diseases exploded for us around 1970. It couldn’t be more obvious.
[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/
So has life expectancy!
Cancer is ultimately a numbers game & you roll the dice every single day. Life expectancy in the US today is ten years longer than it was in 1970. All those extra dice rolls add up. Ideally you could correct for this effect, but it’s not clear we know enough about how cancer risk accumulates over time to do this correctly.
https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac...
Looks like they went from 400 to 500 then back to 450 since 1975. It's trending down.
And you'd need to correct for age distribution to make sure it's not just the population having older people and thus higher chance of cancer in a given year.
https://preview.redd.it/clcfr7xw08y31.jpg?auto=webp&s=6dc026...
It was around that time when modern society became remarkably efficient at poisoning or completely destroying ecosystems
https://en.wikipedia.org/wiki/Rituximab
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398399/
Flashier, and something I've already talked about, is CAR T-cell therapy, the first generations of which were approved in 2017. This therapy has definite risks of severe side-effects, but it can result in complete remission of cancers that have survived multiple lines of chemotherapy, as happened with me.
https://en.wikipedia.org/wiki/CAR_T_cell
Immunotherapy isn't just promising, it's here, and, because of it, so am I, but even more exciting is that it gives us more avenues of research to build off of known-useful therapies.
It is kind of scary to me that drugs these days have such long regulatory lead times that a drug developed in 1997 is just now being entered into treatment regimens.
I understand why that is (the Thalidomide tragedy stuff and like that), but I also clearly remember reading an article ~10 years back that asked why cancer treatment seemingly hadn’t made any leapfrogs since the ~70s, and the answer was back then they could aggressively iterate on treatments.
no. being able to detect cancer doesn't mean people are getting tested twice a year for their whole life. for example, you wouldn't have routine cancer screenings for children, but sometimes they get cancer, and on those occasions it'd be nice to have better treatment options.
@15:40 early detection is the way to eliminate cancer: https://youtu.be/iUqgTYbkHP8https://youtu.be/iUqgTYbkHP8?t=15m37s
The reason people die from pancreatic cancer when they get it is because we can’t detect it early.
The article provides no numbers about cancer rate dropping. Yet the false association between the two ideas is so strong that even the authors themselves seem to theorize that the cancer rate itself is dropping because people don't smoke as often now.
Conflating those two concepts seems like a Very Bad Idea
Yes. I expected to find that the decline in smoking has also lead to the decline in fatal cancer — and there it is. Still a good thing.
It's different for e.g. Flu, where more testing = more detection of an illness that would not necessarily have become serious, had it gone undetected.
What if they detect a slow growing cancer that wouldn't have become a problem before you hit the age of 150? Not every cancer is aggressively trying to eat its host whole.
It would be nice if we could stop advanced cancers but at least we're getting better at prevention.
I lost my dad to cancer last year. It's a horrible disease. I really had no idea how horrific it is. My dad had a year longer than his initial prognosis thanks to new immunotherapy drugs.
> The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991
which mixes all meanings together (smoke → cases ; detection → fatality ...). So it's just "decreased number of deaths".
(Well, on the other hand, it makes sense that more factors impact such "final" result.)
From the CDC:
> In the past 20 years, from 2001 to 2020, cancer death rates went down 27%, from 196.5 to 144.1 deaths per 100,000 population
https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-de...
https://en.wikipedia.org/wiki/Oncovirus
"[Epstein–Barr virus] has also been implicated in several other diseases, including Burkitt's lymphoma, hemophagocytic lymphohistiocytosis, Hodgkin's lymphoma, stomach cancer, nasopharyngeal carcinoma, multiple sclerosis, and lymphomatoid granulomatosis.".
https://en.wikipedia.org/wiki/Epstein%E2%80%93Barr_virus#Rol...
The link between hepatitis and liver cancer is rock solid, to the point chronic hepatitis is the leading risk of liver cancer.
HPV is merely correlative, as well. That's basically how all endogenous cancers work. With Epstein-Barr Virus the association is quite strong, though the incidence of EBV-induced cancers doesn't seem to be quite as large as HPV--~1% vs 2-3%.
OP is talking about more vaccines as possible future mitigations - more vaccines as in new vaccines, not more vaccinations using existing ones (though that wouldn't hurt either.)
And poster's own link doesn't claim some of the viruses are actually an oncovirus.
That said, I don't think that pushing vaccines (either in research or into arms) for the listed diseases would be bad.
Sure, it's great we got good at keeping incredibly sick people alive, but it'd be better to avoid it in the first place.
Deleted Comment