What is the correct amount of indirect for NIH grants? I'm not informed enough to have an opinion on this, but based on seeing the luxurious facilities and high administrative staffing levels at many research universities it seems like there might be some fat we could cut? I've read claims by other prominent researchers that this change is a net positive since it will free up funding for more actual research. So, I don't know who to believe?
Well just last year there were front-page stories on this website about the ballooning number of bureaucrats/admin staff at US universities. I think there was a flurry of articles since the proportion of admin staff had just exceeded faculty/students, or something similar. I'm with you though, I don't know who to believe, from the outside looking in. But some of the stuff that's been cut is only taking us back 5 years and it's hard for me to get worked up over that. What would really help with all these cuts is some historical perspective. Has 60% overhead been the norm for 50 years, 20 years, 5 years?
Gut response to this is twofold. First 'luxurious' sounds wasteful, but I guess that's the intent of the word. I suspect it's a trivial component of total funding, but is the most visible to non-science types.
Second, 'read claims' but not citing them sounds a lot like the hand-wavey 'People are saying ...'
I would be surprised if much of that funding went to constructing those fancy buildings - donors who want their name over the door like to do that. Keeping the lights on, air heated/conditioned, stockrooms stocked, etc don't come cheap. Let's also remember that the government doesn't _just_ get all the research output from that grant money, they get a pipeline of researchers (and undergraduates) that feed industry (plus world class research facilities that can do more research, beyond what the government directly funds). And that's a large part of what has made the US so economically successful, and such a desirable place for people to learn and work.
(Also professors and post docs in many areas can make a lot more in industry, so let's not knock them too much if a university wants to look at least a little attractive to them)
I've worked in higher ed for 26 years with nearly a decade each at two large research universities (1 public, 1 private). Indirects fund administrative (compliance, legal, HR, etc) overhead, facilities (bricks, mortar, plumbing, HVAC, etc.) and all the other stuff that a research lab needs to function and comply with the terms of their grant funding.
I'm sorry but there's no luxurious facilities being funded with research grant indirects. You've been misled or are mistaken.
HN crowd remembering it is not enough. The problem in the U.S. is that the electorate is divided into two camps: the educated and the uneducated. The uneducated camp votes without a deep understanding of important issues, and they can easily be influenced using "culture wars" topics such as DEI and trans kids. Consider that 53% of Americans approve of the administration’s performance so far—why is that? How can we effectively explain things to that 53%? That’s the challenge.
I've known > 10 people who have died from this cancer. It is my #1 fear (cancer wise). My best friend died 3 months to the day after being diagnosed. It is both a blessing and a curse how quickly this kills you. The day before he found out we went on a long walk. Within a couple of weeks we'd walk around the block, then just sit in his living room and talk for hours. The bad times lasted about 1 week and the last 2-3 days he was not really there.
I really hope this test becomes a reality and is OTC and not too expensive.
Just lost my father to pancreatic cancer as well a couple weeks ago. They caught it very early with a CT scan, performed a significant surgery followed by radiation and chemo. The chemo nearly killed him. Had a couple ok months after chemo, but then it spread and the last couple weeks were awful. Even catching this stupid cancer really early often isn't enough - I hate it.
just a hunch, but if you can detect it via CT or MRI isn't it already too late? I guess these blood tests can detect it even earlier an then the prognosis could be significally better
I was going to ask about this number, because it seems high enough to be statistically improbable, but back-of-the-envelope arithmetic says otherwise: there are about 10 cases of pancreatic cancer per 100,000 people per year [1], so let's say each person has a 1 in 10,000 chance of a diagnosis each year. If you know somebody for 50 years, there's a 1 in 200 chance they receive a diagnosis in that time, so you'd expect to need to know 2000 people to eventually know 10 diagnosed people. 2000 is a lot, but "knowing" a person is a pretty loose term, and pancreatic cancer has a miserably high death rate within 5 years, so it's unfortunately plausible.
This is people I know or my family knows. My mother knows 4-5 people. I've had 2 coworkers die of it. I've had 1 in-law die of it. It's crazy how fast the numbers add up.
Keep in mind that there could be clusters of cases related to environmental contamination so it's very possible that some people know more people who get a particular form of cancer.
My best friend died of pancreatic cancer at 41. By the time he received the diagnosis, it was too late. The cancer had metastasized so extensively that the surgeons could do nothing when they attempted to operate. What began as mild lower back pain led to a slow and agonizing death in just a few months.
That's exactly what happened to my friend's father. He had been complaining about lower back pain for many months and going to physio for it. During a family re-union during Christmas, he had to be hospitalized and got diagnosed with stage 4 pancreatic cancer. One week later, he died.
I signed in just to upvote this. I've lost friends and relatives to this. I couldn't agree more that I fear this cancer more than any other- because it is so untreatable by the time it's caught. An inexpensive test would be incredibly helpful towards improving the survivability.
I'm so sorry for your loss. Could you share how old they were ? I'm relatively young, but the fear of getting some form of cancer is on my mind lately. And the timing of it always seems to be so cruel.
Aspiring pancreatic cancer survivor here. This is excellent news. Part of the reason this is such a deadly form of cancer is that there are often no symptoms until it's far too late. I know that there is a blood marker - CA19 - can indicate issues with the pancreas. I don't know if this blood test is related to that or anything, but any advancements on this disease are great and sorely needed.
> The nanosensor correctly identified healthy individuals 98% of the time,
Since pancreatic cancer would have to be detected before any symptoms occur for this to be useful, the test would have to be applied to everyone. The incidence of PC is 1 per 10,000 per year. If the test is applied once per year, then for every true positive result there would be 200 false positives (actually worse, since it only detects PC 3/4 of the time.)
If you can cheaply test everyone, and narrow down the number of people requiring more expensive testing, you can potentially, at scale, detect and limit negative health outcomes. There is both an economic and societal benefit to testing and treating people.
If the more expensive testing is at all invasive (for example, biopsies) or still has false positives (benign tumors, say) then it could end up being a net negative. This effect has bedeviled screening for other cancers, like breast and prostate cancers.
I understand the recommendation for breast cancer screening is that women should stop doing it above age (I think) 70, even though the incidence of BC continues to increase with age, due to declining benefit/risk.
There seems to be a ton of benefits to doing all kinds of blood work - from vitamin deficiencies, hormonal changes, cancer signs, etc. Our system is very reactionary in that we order all these tests AFTER we get sick.
Why is there not a more proactive approach to getting bloodwork done with as many tests as possible? We should see this type of service like going to the dentist.
Say that this test has a false positive 1 in 1000 times. If you test 100,000 people, you'll get 100 positives that need invasive further testing and followup, and 5 real pancreatic cancer cases.
Society will pay for 100,000 tests, and 105 cases of followup. You may cause lasting harm to some of those 105 people. And then it's not clear if you can improve the survival of the 5 pancreatic cancer cases much. They'll live longer after diagnosis (because you diagnosed earlier) but not necessarily longer overall.
(One other screening effect: You'll find more "real cancer" that is so slow growing that it may have always remained subclinical before the more sensitive testing; And the most serious cancers, you won't find so much sooner, because they grow so much in the interval between tests.)
You are assuming that those false positive rates are fixed, but they aren't. The "positive" criteria are done by an analysis exactly as sophisticated as a human scanning a list of numbers. The process is a joke and it needs to be improved by more data and better analysis, not this nonsensical "don't test people because they might be positive" argument.
Then let's take those things into account when calculating what tests to do. Surely, though, we can do better as a society than solving this with "no preemptive testing except for extreme risks".
For better or worse, under the American healthcare system, the patient pays for those tests, sometimes covered by insurance. If the tests are paid for out of pocket by the patient, is there still such issue?
I was the tech lead at a YC company doing exactly this (Spot Health, W22) until a little while ago. There's a ton of very hopeful things happening in the industry behind the scenes. Insurance via employee benefit schemes is the lever to drive this into people's lives.
The industry refers to this as gap closure - care gaps are instances of a patient not receiving care when they should have. For example, not getting treatment for stage 1 cancer because you didn't have a checkup is a care gap.
Insurance companies are very incentivised to close care gaps because it results in cheaper premiums. Incentives between health insurance and patients are often not aligned (as we've seen in the news recently), but this is one case where they are radically incentivised to offer additional diagnostics if it results in fewer costly payouts for severe illnesses that come later.
In the medium term, the cost of full genome sequencing is quietly experiencing a 10x decrease in cost. Within a decade, I expect it to be the norm that all people are fully genetically sequenced and for the correlations enabled by that dataset to have made the value of being sequenced 10x. So probably a 100x increase or so in the value of genome sequencing over the next few years.
(Also, before anyone says it, yes 23&Me should feel very very ashamed for the deanonymised patient record data breaches they've experienced. The whole industry needs a slap in the face when it comes to privacy)
I guess after ~30 years past grad school in the software industry, having had high hopes for the internet and everything back in the 90s, I'm way too cynical.
This won't be used to "close the care gap", unless they can charge more $$ for the additional checkups than they'll expect to have to give out in care as a result.
And they'll drop anyone suspected of needing too much care in the future based on their genome, even if they aren't sick. Pre-existing conditions times 100 (you know they'll be re-instated by the current administration soon enough).
e.g. 17% of the people with that gene had cancer, and you have it, so raise your rates 151%. Oh wait, 37% of the people with this other gene had dementia - you're no longer covered.
Eventually, they'll only accept those people with a genomic lifetime 90% profit profile. That's the way this sort of thing works in the "real" world.
Despite how much we know in medicine we still know too little. Bloodwork will give you a snapshot of that persons blood chemistry. It’s still up to the doctor and lab to put together what that composition means. In other words, if there is too much iron in the blood there could be x number of reasons for that. Most might be benign, and a small handful could be life threatening.
Theranos tried the "move fast and test blood" approach. Maybe one of the existing testing companies can find a more balanced approach in the current environment.
Theranos’ specific claim was that they could do existing tests with way less blood and way less cost. One of the ways they kept their fraud under wraps was to simply do the tests the old way behind the scenes.
So, blood tests in general were not the controversial part of Theranos.
As others have pointed out, the obstacles to large scale prophylactic blood testing are false positives, and general resistance of health insurers to fund anything not strictly reacting to disease or injury.
Widespread pre-emptive testing was not what Theranos tried. Defrauding investors that the technology existed for widespread, inexpensive pre-emptive testing even at small scale is what Theranos tried.
There is almost certainly gold in them hills if you dig deep enough and survey systematically enough, but Theranos started with precise coordinates, claiming they'd "found it", and demanded investors for a mine, while privately they were thinking "If we don't find it on the surface, who cares, we got paid, this is how VC works".
It probably all comes down to cost. I remember reading studies about widespread melanoma screening and they were writing things that basically amounted to: "overall it adds ~0.5 day of life expectancy to the average Joe, based on costs &co it's worth it if you consider 1 year of human life worth $30k"
I find that doctors are very resistant to ordering blood tests. I often get responses saying it isn’t necessary or whatever. I feel patients should be entitled to whatever diagnostics they demand. I don’t know why doctors are even needed to get that done. Other than the scam of insurance coverage of course.
For me (eu) the dentist is pricy but these tests are included in public and private; i can ask my doctor any time and i get them, including for markers. Dentist costs, I do it every 6 months, but most people i know maybe once every few years.
I definitely prefer doing the testing myself instead of begging the doctor to order things.
About the only time I go to doctors is to beg for antibiotics- which they often refuse to give me. They say, "oh, it's probably a virus." Okay, but all of the virus tests I can find came back negative. I have a CBC showing elevated WBC. Coughing up yellow-green slime. Can you order a sputum culture for me? "no, come back if you are still sick after 10 days". Great, $200 and 30 minutes in the waiting room getting exposed to other sickos for nothing, miss another week of work. The gatekeeping of medical care infuriates me. I have plenty of money, let me use it to get better faster.
Yes but that blood work checks things like cholesterol and vitamin deficiencies. They aren't checking for these types of markers that point toward cancers. They may notice something is out of whack that may lead to more specific testing but I think the overall question is why aren't we just checking for everything more frequently with these blood draws?
Depends on the country you live in. There are countries that don't do them with similar health results as countries that do them.
There is a stereotype that Dutch doctors will prescribe paracetamol for anything because they are really defensive with medication and doctor visits and the result is generally the same as countries that do check ups.
Yes, but insurance does not cover large amounts of screening tests. Last year my A1C check was not covered. In North Carolina my wife's vitamin D test is not covered by her primary or gyno for routine checks.
Public service announcement: There are already blood tests for detecting pancreatic cancer and other cancers on the market, and more coming, depending on where you live. So get tested, if this is something you are worried about.
I believe the only commercially available one in the US is Grail's Galleri (https://www.galleri.com).
There are many tests in the pipeline -- although the technology is there, the regulatory and evidence process is slow. (Data relating to detecting cancer early, by its nature, takes a long time and a lot of people to prove out.)
>Assumes screening is available for all prostate, breast, cervical, and colorectal cancer cases and 43% of lung cancer cases (based on the estimated proportion of lung cancers that occur in screen-eligible individuals older than 40 years).
It's expensive, accuracy isn't very high, and no one has done the studies to demonstrate that it actually improves subject outcomes. By its very nature that type of research takes a long time because the investigators have to wait years to detect a difference in subject survival rates or other significant endpoints.
There's a huge amount of funding going into the liquid biopsy space so things will improve. But don't expect rapid changes in clinical practice.
Annual might not be any good. I knew a guy who had a history of colon cancer in his family. He got checked annually from his mid 30s on. At 46, a few months after a clear checkup, he visited his doctor who sent him for another check, and bam: he had cancer.
If you're feeling like your doctor/PCP is a gatekeeper, get a new one, seriously. Maybe I've been lucky, but my doctors have always written scripts for anything I ask for, assuming there's some validity to my need, and (though I've never tried) we're not talking about controlled substances.
Diagnostic test... they may not know what to do with the results, but I doubt you'll get pushback for a script. Insurance may give you a hard time, however, so assume you're going out of pocket.
So for a test like this, do you just give it to everyone without symptoms?
For a very high mortality cancer is it even useful to test after you have reason to test?
I read about these tests and breakthroughs that involve general predictions and test, but I'm pretty sure when I go into the doctor I'm not screened proactively for all that much.
The intent of non-invasive tests like this are that you give them to everyone, at scale, frequently.
And specifically tune them to minimize false negatives.
Worst case with a false positive? You're causing someone anxiety and giving them an extra scan.
Best case? You just saved someone's life by detecting an aggressive cancer early enough to do something about it.
At the end of the day aggressive, metastatic cancer is a time game. If the cancer is given time, it becomes progressively harder and harder to treat, and effective treatment options become tougher on the rest of the body, until finally there's nothing to be done.
> Worst case with a false positive? You're causing someone anxiety and giving them an extra scan.
It is arguable that this as minor an issue as you make it out to be. There has been work to try to assess this (google "cancer overdiagnosis").
The counterargument to what you state is that a false positive can not only lead to stress & unnecessary/more invasive screening, but a treatment plan that's a net negative. For instance: if a cancer were detected and it'd wind up being a cancer that someone dies with instead of from, and the treatment causes worse outcome than the cancer itself, that's not good. The hard issue here is that these things need to be determined at a population scale, and one can always cherry pick personal anecdotes in either direction to tug at heartstrings.
We seem to have found ourselves at a point where it's clear there's a balance that needs to be struck, but it's unclear what that balance is yet.
Cancer testing is not benign. False-positive cancer diagnosis has a >0 mortality rate, because further testing and treatment is potentially fatal. Just a colonoscopy can be fatal, as can a biopsy that requires anesthesia.
The medical world weighs these things against each other and determines when the data shows that the risk of mortality from testing is smaller than the risk of cancer.
Worst case is the scan “sees something” which then puts them on a diagnostic anxiety roller coaster for the rest of their lives, “just to be safe”. When in the alternate universe they might not have gone another 60 years hardly ever seeing a doctor.
They generally aren't going to give them to everyone. They will give them to everyone within a certain group, such as age 30+ since the under 30 group is very low risk (unless family history, etc). Similar to how they don't test most kids and younger people for cholesterol - it's just not a significant problem for that age group.
I'm sorry but that is a very naive and honestly wrong take. An "extra scan" is not just giving anxiety. It raises cancer rates. It can discover underlying relatively bening conditions which affect insurance coverage, for example. It can cause anxiety. It takes away resources "just to make sure". At the scale you are proposing, false positives are a massive issue that you simply cannot ignore. It is all but trivial.
Depends, colon cancer, breast cancer, prostrate cancer, etc. are pretty commonly tested/screened for in certain age groups and that definitely saves lives.
My aunt died of pancreatic cancer last year. It's a pretty common and aggressive form of cancer. She only had a few months from diagnosis to the grave. By the time she got diagnosed, there was nothing that they could do except provide pain relief.
My dad got lucky to get his detected relatively early (they happened to be doing an unrelated test and "saw something", but that just meant two years of chemo and all those side effects before he died. If they hadn't found it when they did it would have been 1 year of side effect free life followed by 6 months of pain for something untreatable - in short overall a better end of life though he would have lost 6 months. If they had found it 6 months sooner though odds are it would have been treated and he would still be with us.
AFAIU, with pancreatic cancer usually by the time you have symptoms you are already stage 4 and uncurable. So I'm assuming the intent is to test non-symptomatic people.
Isn't this fundamentally a statistical issue? With a test sensitivity of 99%, meaning a 1% false positive rate, administering it universally to individuals would generate a significant number of false positives. This influx could overwhelm the system, potentially limiting access for those who genuinely require medical attention.
That's what I'm wondering too. Even if 1%, if the follow up is very expensive, the initial test might be cheap but overall cost might be very expensive / prohibitive.
Screening recommendations are based on statistical arguments that take false positives (plus the risk of the test itself) into account and calculate whether more people would be helped than harmed.
If the test is cheap, you could run it 2 or 3 times. Then the false positive rate would be pretty low and you could proceed with more intense treatments/diagnostics.
Readit News
Sadly, the group lists funding sources as: National Cancer Institute: P30CA069533 National Cancer Institute: P30CA069533
So the group's activities likely on pause, and with a good likelihood of closure due to the lack of NIH indirects from the current administration.
Second, 'read claims' but not citing them sounds a lot like the hand-wavey 'People are saying ...'
(Also professors and post docs in many areas can make a lot more in industry, so let's not knock them too much if a university wants to look at least a little attractive to them)
I'm sorry but there's no luxurious facilities being funded with research grant indirects. You've been misled or are mistaken.
This could potentially help to sustain their work if the other groups/labs agree to take over.
Dead Comment
I really hope this test becomes a reality and is OTC and not too expensive.
[1] https://seer.cancer.gov/statfacts/html/pancreas.html
In 20s-early 30s, maybe 0 if your parents/uncles/aunts are lucky. You can be completely oblivious to it if your older relatives manage to escape it.
By 40 you start hearing about friends having it pretty routinely. We seem to have hit a one close friend per year pace at the moment.
Every time I talk to my 70+ parents, they are telling me about a funeral they've been to recently, often caused by either cancer or heart disease.
50 people: 8.36149e-12 %
500 people: 0.026%
1000 people 3.1%
2000 people: 50%
Since pancreatic cancer would have to be detected before any symptoms occur for this to be useful, the test would have to be applied to everyone. The incidence of PC is 1 per 10,000 per year. If the test is applied once per year, then for every true positive result there would be 200 false positives (actually worse, since it only detects PC 3/4 of the time.)
It's all in tuning the population & frequency.
You could test those aged 30+ or 40+ every 5, maybe even every 10 years.
https://www.science.org/doi/10.1126/scitranslmed.adq3110
Why is there not a more proactive approach to getting bloodwork done with as many tests as possible? We should see this type of service like going to the dentist.
Seems like a good industry to disrupt.
Say that this test has a false positive 1 in 1000 times. If you test 100,000 people, you'll get 100 positives that need invasive further testing and followup, and 5 real pancreatic cancer cases.
Society will pay for 100,000 tests, and 105 cases of followup. You may cause lasting harm to some of those 105 people. And then it's not clear if you can improve the survival of the 5 pancreatic cancer cases much. They'll live longer after diagnosis (because you diagnosed earlier) but not necessarily longer overall.
(One other screening effect: You'll find more "real cancer" that is so slow growing that it may have always remained subclinical before the more sensitive testing; And the most serious cancers, you won't find so much sooner, because they grow so much in the interval between tests.)
For instance, prostate cancer blood screening often led to radical treatments that are no longer thought to be worth it for most people.
> most prostate cancer grows so slowly, if it grows at all, that other illnesses are likely to prove lethal first
https://www.nytimes.com/2023/05/08/health/prostate-cancer-sc...
In the case of pancreatic cancer, it is much more aggressive and you need to catch it early.
Prevalence of breast cancer: 1%
Sensitivity (percent of people who have the disease test positive): 90%
Specificity (percent of people without the disease test negative): 91%
And asked, "How many people who test positive have the disease?" (i.e., positive predictive value)
It's only 1/11. I think only 20% got it right (in a 4 answer multiple choice question)
Could you elaborate on this?
For better or worse, under the American healthcare system, the patient pays for those tests, sometimes covered by insurance. If the tests are paid for out of pocket by the patient, is there still such issue?
The industry refers to this as gap closure - care gaps are instances of a patient not receiving care when they should have. For example, not getting treatment for stage 1 cancer because you didn't have a checkup is a care gap.
Insurance companies are very incentivised to close care gaps because it results in cheaper premiums. Incentives between health insurance and patients are often not aligned (as we've seen in the news recently), but this is one case where they are radically incentivised to offer additional diagnostics if it results in fewer costly payouts for severe illnesses that come later.
In the medium term, the cost of full genome sequencing is quietly experiencing a 10x decrease in cost. Within a decade, I expect it to be the norm that all people are fully genetically sequenced and for the correlations enabled by that dataset to have made the value of being sequenced 10x. So probably a 100x increase or so in the value of genome sequencing over the next few years.
(Also, before anyone says it, yes 23&Me should feel very very ashamed for the deanonymised patient record data breaches they've experienced. The whole industry needs a slap in the face when it comes to privacy)
This won't be used to "close the care gap", unless they can charge more $$ for the additional checkups than they'll expect to have to give out in care as a result.
And they'll drop anyone suspected of needing too much care in the future based on their genome, even if they aren't sick. Pre-existing conditions times 100 (you know they'll be re-instated by the current administration soon enough).
e.g. 17% of the people with that gene had cancer, and you have it, so raise your rates 151%. Oh wait, 37% of the people with this other gene had dementia - you're no longer covered.
Eventually, they'll only accept those people with a genomic lifetime 90% profit profile. That's the way this sort of thing works in the "real" world.
(Not a doctor just surrounded by them)
So, blood tests in general were not the controversial part of Theranos.
As others have pointed out, the obstacles to large scale prophylactic blood testing are false positives, and general resistance of health insurers to fund anything not strictly reacting to disease or injury.
There is almost certainly gold in them hills if you dig deep enough and survey systematically enough, but Theranos started with precise coordinates, claiming they'd "found it", and demanded investors for a mine, while privately they were thinking "If we don't find it on the surface, who cares, we got paid, this is how VC works".
Deleted Comment
I definitely prefer doing the testing myself instead of begging the doctor to order things.
About the only time I go to doctors is to beg for antibiotics- which they often refuse to give me. They say, "oh, it's probably a virus." Okay, but all of the virus tests I can find came back negative. I have a CBC showing elevated WBC. Coughing up yellow-green slime. Can you order a sputum culture for me? "no, come back if you are still sick after 10 days". Great, $200 and 30 minutes in the waiting room getting exposed to other sickos for nothing, miss another week of work. The gatekeeping of medical care infuriates me. I have plenty of money, let me use it to get better faster.
There is a stereotype that Dutch doctors will prescribe paracetamol for anything because they are really defensive with medication and doctor visits and the result is generally the same as countries that do check ups.
I believe the only commercially available one in the US is Grail's Galleri (https://www.galleri.com).
More info on this category of tests: https://www.cancer.org/cancer/screening/multi-cancer-early-d...
There are many tests in the pipeline -- although the technology is there, the regulatory and evidence process is slow. (Data relating to detecting cancer early, by its nature, takes a long time and a lot of people to prove out.)
>Assumes screening is available for all prostate, breast, cervical, and colorectal cancer cases and 43% of lung cancer cases (based on the estimated proportion of lung cancers that occur in screen-eligible individuals older than 40 years).
Doesn't list pancreatic.
EDIT: never mind, I found a more complete list.
https://www.galleri.com/what-is-galleri/types-of-cancer-dete...
There's a huge amount of funding going into the liquid biopsy space so things will improve. But don't expect rapid changes in clinical practice.
> The Galleri test is available by prescription only.
But JFC I can't stand being required to get permission from one of those glorified bureaucrats just to collect data on my own body.
Diagnostic test... they may not know what to do with the results, but I doubt you'll get pushback for a script. Insurance may give you a hard time, however, so assume you're going out of pocket.
For a very high mortality cancer is it even useful to test after you have reason to test?
I read about these tests and breakthroughs that involve general predictions and test, but I'm pretty sure when I go into the doctor I'm not screened proactively for all that much.
And specifically tune them to minimize false negatives.
Worst case with a false positive? You're causing someone anxiety and giving them an extra scan.
Best case? You just saved someone's life by detecting an aggressive cancer early enough to do something about it.
At the end of the day aggressive, metastatic cancer is a time game. If the cancer is given time, it becomes progressively harder and harder to treat, and effective treatment options become tougher on the rest of the body, until finally there's nothing to be done.
So anything that gains time is critical.
It is arguable that this as minor an issue as you make it out to be. There has been work to try to assess this (google "cancer overdiagnosis").
The counterargument to what you state is that a false positive can not only lead to stress & unnecessary/more invasive screening, but a treatment plan that's a net negative. For instance: if a cancer were detected and it'd wind up being a cancer that someone dies with instead of from, and the treatment causes worse outcome than the cancer itself, that's not good. The hard issue here is that these things need to be determined at a population scale, and one can always cherry pick personal anecdotes in either direction to tug at heartstrings.
We seem to have found ourselves at a point where it's clear there's a balance that needs to be struck, but it's unclear what that balance is yet.
Cancer testing is not benign. False-positive cancer diagnosis has a >0 mortality rate, because further testing and treatment is potentially fatal. Just a colonoscopy can be fatal, as can a biopsy that requires anesthesia.
The medical world weighs these things against each other and determines when the data shows that the risk of mortality from testing is smaller than the risk of cancer.
My aunt died of pancreatic cancer last year. It's a pretty common and aggressive form of cancer. She only had a few months from diagnosis to the grave. By the time she got diagnosed, there was nothing that they could do except provide pain relief.
I thought that's how HIV rapid testing works.
Although it is the opposite of what the doctors want, I would prefer a less sensitive but highly specific test.
If I had 80% sensitivity I'd miss out on 20% of cancers, but if I could match that with a 99.9% specificity I'd have very few false positives.
I hope this type of test can tune that direction.