Comment by nathan_f77 | Hacker News Reader

Comment by nathan_f77 | Hacker News Reader

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I'm a bit confused by your response. Are you arguing for or against regular MRI scans? I think your example clearly shows why regular scans are very important.

My proposal is that a healthy person will go to get regular MRI scans, and you would compare any new lumps against a baseline scan. For your very first scan, you statistically don't have anything to worry about, since everyone has a few benign lumps or spots. Obviously if they find a massive tumour on your kidney or a lump near your lymphatic system, then they're going to take it very seriously.

However, if something is just "suspicious", then perhaps you would come back in a few weeks or months for another scan, instead of one year. Machine learning could inform the period of time between scans. (Or just a trained radiologist who knows how to determine the risk.)

I'm not a trained doctor or radiologist, so in that sense, I don't have any clue what I'm talking about. I just enjoy discussing ideas and trying to figure out why my ideas wouldn't work, so unfortunately I haven't found your comment to be very helpful. I think we might even be arguing about different things.

There is no baseline. You go to the doctor because you’re concerned about a lump, probably because you had never felt it before. A scan needs to be done. It doesn’t always need to be MRI. But in my non-clinical knowledge of BC survivors, MRI are a must for young/dense breast tissue. It should be required.

I’ll give you specifics on a patient I know (I actually went to all doctors appointments).

32F. Feels something but hard to find next day, I felt it, she couldn’t. I urged her to see doctor. (I actually worked for a pathologist as college job, I know what pretty much every type of tissue looks/feels/smells like... and I knew it was cancer, but maybe benign). Anyways, she goes to doctor. He can’t feel it in exam. But, she has family history so he finds a way to get the MRI done. He explains why it should be standard on young women (denser tissue). Next day, MRI. Confirms lump, doctor is blown away as it was only ~0.5mm in diameter. He’s about 70 and it’s the smallest lump he’s ever identified, surprised it even showed up on MRI. Long story short, she had a full mastectomy ~5 days later and the pathology showed the lump was over 3cm in diameter, super aggressive (triple negative). Started chemo shortly after because the milk duct had opened and cells could have reached her lymph nodes and spread the cancer anywhere in her body.

I know many other people that have similar stories, so this is why you get thrown into full on crisis mode when you get a positive imaging. So I would ask, if she waited a month or more to come back and see if this thing was growing, how do you think that would have played out?

Wow, I'm really glad they caught it in time! That's a very scary situation.

Obviously I wouldn't change anything about the way this was handled. To be honest, my proposal is mostly a concession. It is an attempt to reduce the number of unnecessary tests and biopsies, while still gathering more data about the things that are going on in your body. It doesn't supersede anything that you've described, so if you feel a lump, you would still follow exactly the same course of action that you've outlined.

There must be a way to collect more data and respond appropriately to aggressive and dangerous cancers, while still reducing the number of unnecessary tests and biopsies. This is obviously a very important problem to solve and will save millions of lives.

Interesting debate btw. I think the correlation between high levels of testing as relates to early identification is a big contributor to trend of increasing survival rates (along with advancing treatment options of course).

Also important to note. MRIs are noninvasive. Biopsies, in BC cases, are fairly noninvasive. It’s typically just pulling out some cells with a needle, not to say it’s comfortable, but nothing to really fear either. So, I guess I just don’t see what the big deal is. Except it’s expensive. So, as is always the case with healthcare, the real debate should probably be about cost.

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