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This is great progress.
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?
Knowing something must be checked, while your primary refuses to check it, what is one's recourse in the US?
> PCP ignored escalating PSA levels.
He was ordering psa tests but just ignoring the velocity ?
I had similar discussion on HN last week
Isn't pancreatic cancer in particular usually very far advanced before it's detected?
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 most likely animal fat and meat demonisation
https://www.youtube.com/watch?v=hzQAHITIUhg
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.
Cancer rates skyrocketed because we started screening for cancer. It's that simple.
> Cancer rates have exploded since 1970
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.
They have?
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.
I think about things like this:
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
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.
The problem is this is mostly due to screening, not progress at treating advanced cancer, although that has improved too.
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.
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.
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?
That’s not a problem, it’s the key to curing cancers, according to Craig Venter
@15:40 early detection is the way to eliminate cancer: https://youtu.be/iUqgTYbkHP8 https://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 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.
Why is this a problem? The point of screening is to find and treat the most common forms cancer before they become advanced.
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.
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.
Is this "cancer deaths per person per year", or "cancer deaths per detected cancer"?
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
https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-de...
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.
I'd be interested in seeing cancer occurence rates over death rate.
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.
Now remove lung cancer and see if the numbers have changed that much.
Out of curiosity, I chose one cancer from the article: breast cancer. Deaths declined from a peak of 33 to 19.1 per 100k women, whereas smoking only seems to increase your risk modestly: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698948/
> The HR (reference group was never smokers) was 1.14 (95% CI 1.03–1.25; P = 0.010) for ever smokers, 1.24 (95% CI 1.08–1.43; P = 0.002) for starting smoking at ages < 17 years, and 1.23 (1.07–1.41; P = 0.004) for starting smoking 1–4 years after menarche.
However smoking rates have gone down massively since the '50s:
https://news.gallup.com/poll/237908/smoking-rate-hits-new-lo...
https://www.researchgate.net/figure/Trends-in-the-prevalence...
Also something that absolutely does seem to raise your risk of breast cancer is chest x-rays:
https://breast-cancer-research.biomedcentral.com/articles/10...
> Ever/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene.
Digital x-rays have largely replaced film, and they can reduce radiation exposure by 80-90%.
So I'm not sure one way or the other.
Because of smoking?
fuck cancer
I did a ride with the Fireflies West (http://www.fireflieswest.com) cycling/fundraiser group this past year, and that was our motto. Indeed, fuck cancer.
I'd rather not
Did it improve or did people stop getting diagnosed because it is too damn expensive?
Screening is more widespread and so is general awareness for symptoms. This leads to earlier diagnosis which generally has a better outlook than later stages. Then there's also general progress in terms of surgical procedures as well as medication for treatment
Cancer death rates decline because people find that dying of cancer is too damn expensive?