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Comment by josho | Hacker News Reader

From the abstract the US has 0.7% higher survival rate than Australia. Which I wouldn’t be surprised turns out to be within the margin of error.

Regardless, in Australia fewer will reach that cohort because preventive measures through universal health care are in place. That means widely available cancer screenings will catch malignant tissues before they turn cancerous.

Additionally those screenings will be lower cost than the US model and the patients will have a better quality of life.

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It’s hard to go through the actual study on my phone to find the appropriate context for that statistic but keep in mind cancer is a disease that will cause a drug to get a standing ovation at a presentation for increasing life expectancy 2 months. In that context, seemingly small improvements matter

That reminds me. A loved one died of cancer. All involved would have preferred that they died in 6 months instead of 2.5 years. Because the final 2 years of their life was filled with painful treatment that left everyone involved stressed, anxious, and saw a loved one slowly decline.

Optimizing for those extra 2 months is not a goal we should be striving for.

There have been some really interesting articles around this on here in the past, particularly around medical doctors dying. If you Google “How doctors die Hacker News” you get a lot of good threads. Here are two I found interesting.

https://news.ycombinator.com/item?id=21852625

https://news.ycombinator.com/item?id=5104430

I’m sorry to hear of your loss and that experience. This is an important discussion. A while back Peter Attia had a guest who spoke to this. Their stance was we aren’t aggressive enough about what we consider “success” especially if those last two months are spent shuttling back and forth to painful treatments.

I'm sorry, but who in this scenario was forcing them to receive the treatments?

Fair question.

The problem is as patient's we've never gone through the experience before and are totally unprepared for what it's going to be. From the beginning all we know is that path A ends too soon, and path B has a chance of having a good outcome. We hope beyond what's rational that path B will have an exceptional outcome for us and go down that path. Only later do we realize how painful and miserable the experience can be for everyone.

> Regardless, in Australia fewer will reach that cohort because preventive measures through universal health care are in place. That means widely available cancer screenings will catch malignant tissues before they turn cancerous.

This is an assertion that you're stating as fact, but it's directly contradicted by both the aforementioned study (it's not true that "fewer people reach that cohort") and by existing domain knowledge about how cancer screening actually works.

As explained below, screening people for cancers earlier actually doesn't improve mortality rates significantly. In fact, survival rates are actually roughly flat when adjusted for detection time, because earlier detection mostly catches cancers that wouldn't actually progress to be fatal in the first place.

> Additionally those screenings will be lower cost than the US model

You have this backwards. Screenings for early asymptomatic cancer are actually the textbook example of gratuitous costs.

Yes there can be gratuitous screenings. Something that, I understand, happens often in the US system due to risk of law suits and patients with good insurance demanding they take every precaution possible.

But I’m quite confident that we have enough data to establish guidelines on what circumstances to screen. And health insurance coverage shouldn’t be a factor whether to screen or not.

We do have guidelines provided by the US Preventative Services Task Force - https://www.uspreventiveservicestaskforce.org/uspstf/recomme... - and other specialty organizations may have their own. All medical students in the US are expected to know all of these screening guidelines and generally learn them during their Family Medicine rotation.

Here are the cancer screening guidelines - https://www.uspreventiveservicestaskforce.org/uspstf/topic_s... - You can see that many of these carry the D recommendation, meaning they should not be done because the harm outweighs the benefit of the screening. Screening only makes sense if the cost of the test is low, the test is very accurate, and the benefit of the treatment you're going to undertake after a positive screen is large.

The 0.7% margin is not within the margin of error for for that cancer (breast cancer). US is 90.2 [90.1-90.4], AUS is 89.5 [89.1-90]. US compares well to other countries on Breast cancer as well, UK 85.6 (85.4–85.9), France 86.7 (85.5–88.0). The Affordable Care Act has required insurance companies to cover the cost of mammograms (the breast cancer screening test) with no out of pocket costs. Same with colonoscopies (the colon cancer screening test).

The population of Australia is 25M. The population of the US is 328M. That 0.7% could just be the deviation inherent in the smaller population. Similarly, the SEER data only comes from 14 states (1), so there's a sampling problem with the US data. Additionally, this is only for the big 4, so there's another bias. Australia, for example, has an enormous burden of skin cancer relative to the US, so much that the world-recognized leading textbook on skin pathology is written by an Australian dermatopathologist (2, 3)

(1) https://seer.cancer.gov/registries/ (2) https://en.wikipedia.org/wiki/David_Weedon (3) https://www.amazon.com/dp/0702075825/

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