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Cancer DNA is detectable in blood years before diagnosis

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279 points bookofjoe | 7 comments | 18 Jul 25 18:39 UTC | HN request time: 0.426s | source | bottom
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mikert89 ◴[18 Jul 25 20:12 UTC] No.44609276[source]▶
The big secret is that they could detect cancer very early in most people, but the health care companies don't want to pay for the screening. You can pay out of pocket for these procedures. I was told this by a cancer researcher

EDIT:

Adding these caveats:

1. There is a ton of nuance in the diagnosis, since most people have a small amount of cancer in their blood at all times

2. The screenings are 5-10k + follow up appointments to actually see if its real cancer

3. All in cost then could be much higher per person

4. These tests arent something that are currently produced to be used at mass scale

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doctoring ◴[18 Jul 25 20:23 UTC] No.44609391[source]▶
The not so big secret is that we can detect cancer early in a lot of people, but we also would detect a lot of not-cancer. We don't currently know the cost/benefit of that tradeoff for all these new types of screening, and therefore insurers and health systems are reluctant to pay the cost of the both screening and the subsequent workup. This is not just a financial consideration, though the financial part is a big part -- the workup for those that end up as not-cancer has non-negligible risks for the patients as well (I have had patients of mine suffer severe injury and even die from otherwise routine biopsies), and on top of that, some actual cancers may not really benefit from early discovery in the first place.

This is not to downplay the potential benefit of early cancer detection... which is huge. And in the US/UK anyway, there are ongoing large trials to try to figure some of this stuff out in the space of blood-based cancer screening, as part of the path to convincing regulatory bodies and eventual reimbursement for certain tests. As mentioned, you can currently at least get the Galleri test out of pocket (<$1k, not cheap, but not exorbitant either), as well as whole body MRIs (a bit more expensive, ~$2-5k).

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DiscourseFan ◴[18 Jul 25 20:36 UTC] No.44609546[source]▶
Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up. The only people who would benefit from these screenings are already unhealthy and cancer might be just one of many potential conditions they could experience—the goal of healthcare is not to dedicate an inordinate amount of resources for procedures that may amount to not much of any long term benefit.

People talk about the “immune system” but they are really referring to a number of systems the body uses to regulate itself, more or less successfully, around environmental pressures. The body is a system under tension, sometimes extreme tension leads to extreme success (success here being growth of power), sometimes it breaks the body, and sometimes the systems have been slowly failing for a while, and most treatments will not help. Medicine is only useful in the specific case where the power of the body would be promoted if not for one thing, that the body would be healthy, at least manageably so, without that issue.

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1. cogman10 ◴[18 Jul 25 20:51 UTC] No.44609695[source]▶
> Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up

Incorrect.

There are tons of cancers that hide and mask with symptoms common to other symptoms. Kidney cancer, for example, presents pretty similarly to both kidney stones and UTIs. Even blood in the urine isn't proof positive that anything is wrong beyond either of those conditions. And, by the time blood is in the urine, it's often too late.

Liver cancer is even worse. The first symptoms you get can be thought of as a simple pulled muscle, just a little ache in the back. By the time you have appreciable problems, like turning yellow, it's quite advanced and too late to really do much.

There are common cancers like colon, skin, breast, and prostate that more fit your description of being mostly harmless so long as you get regular screenings and eat healthy. But, for every part of the body, a cancer can form and the symptoms are very often invisible.

I'm unfortunately all too familiar with how cancer looks. My wife currently has stage 4 cancer that started as kidney cancer. She does not drink or smoke, gets enough rest, and is very active.

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2. unsupp0rted ◴[18 Jul 25 21:05 UTC] No.44609824[source]▶
What's a good way for an otherwise healthy person to screen for kidney cancer, in terms of trade-offs?

Annual MRI?

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3. cogman10 ◴[18 Jul 25 21:19 UTC] No.44609957[source]▶
IDK TBH. My wife had all the general recommended screenings. The only thing that showed potential problems was slightly elevated WBC. It was ultimately what they thought was a UTI that stayed a little too long that got us to get a CT and ultimately the diagnosis.

I do wonder if a 5 year whole body MRI or CT would be generally beneficial for the population. I don't think it needs to be Annual to have benefits.

The problem is it really isn't uncommon for your body to create random puss fill sacks all over the place. It's one thing our cancer doctor warned us about. My wife is now on a 6 month CT regimen and ultimately, they'll just ignore new lumps.

4. brudgers ◴[18 Jul 25 23:10 UTC] No.44610808[source]▶
Talking to your doctor is the simplest thing that might work.
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5. jacobgkau ◴[18 Jul 25 23:33 UTC] No.44611003{3}[source]▶
My NP would tell me "nothing to worry about" whether she knows what's going on or not, but that's beside the point.

GP wasn't asking what they should personally do. They were asking how the doctor would screen for it. (The truth is, the doctor can't/won't-- an annual MRI on every otherwise healthy person, for example, would be prohibitively expensive with how MRIs are currently set up-- and as another commenter pointed out, findings from those can be just as easily ignored or put off until it's too late.)

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6. brudgers ◴[18 Jul 25 23:48 UTC] No.44611115{4}[source]▶
but that's beside the point

Being beside that hypochondric point is statistically a much healthier place to be.

The current state of medicine is the current state of medicine in the actual world.

7. DiscourseFan ◴[19 Jul 25 16:54 UTC] No.44617141[source]▶
No I mean that people who are healthy in general are less likely (or completely unlikely) to “get cancer” in the first place because cancer is something that has more to do with an immune system failure, which happens due to unhealthy lifestyles or genetic problems in general which are unavoidable. Cancer only affects people who generally already have other problems (old, sick, unhealthy lifestyles etc.) and young people because they are growing very quickly.

Thus, in young people cancer presents rapidly as they develop, these screenings are expensive and unnecessary. For old/sick/unhealthy people, or people who are predisposed to certain cancers, they will probably get something else anyway, so its an expensive workup to help treat a disease that won’t actually benefit much in the long term.

I’m not against treating cancer, however let’s recognize that cancer treatment is already an expensive and resource/labor intensive process. And 10yr survival rates are not great for most cancers, we’re only slowing the burn, not stopping it. Sometimes you get lucky and die of something else before the cancer can come back, but nobody is ever “cured,” they are all just delaying the inevitable. Which, as we have seen, can sometimes be worth it (who wouldn’t want another 10 years with a loved one?), but that doesn’t mean our goal should be to find a way to “cure” cancer, it should be to find a way to better manage it, and these screenings don’t seem like they really are, or at least the use-cases for them are minimal.