Does Early/Invasive Screening for Glandular/Intestinal Cancers Extend Lives?
It all sounds good, the medical establishment does varieties of early screening for breast/thyroid/prostate/colon cancer, some sort of red flag goes up resulting in a biopsy, and you get the supposed life-saving surgery. However, there is growing evidence that these invasive early detections create their own risks, and do not actually prolong lives. Meanwhile, less invasive detections (mostly bloodwork and genetics) are emerging, and most cancer reduction seems headed to the prevention/vaccine/immune boosting/genetic modification route.
When you’re a male and turn 50, your medical life changes immensely. Get ready for intensive interest in your colon, thyroid, and prostate (with frequent probes up the wazoo), while females can look forward to the same with booby smashing and vaginal speculi, with fewer booty probes. Yet recent Scientific evidence keeps rolling in to the general theme of many false positives, unnecessary surgeries with risks, and less overall efficacy or life extension. It is as though the real dangerous cancers (around 15% of those suspected, my estimate) are so aggressive they’re going to get you anyway, while you’d have been better off ignoring the 85% that weren’t going to hurt you even without intervention. Meanwhile, great strides are being made in prevention (mostly not smoking and drinking, better diets and more exercise), bloodwork detection (much less invasive), vaccines (famously HPV vax now, with several others in development), immunotherapy (often employing CAR-T), and genetic interventions (possibly future CRISPR-CAS). Will the era prior to 2020s be looked upon as the era of “needless and annoying early cancer detection”? Let’s look at five major areas:
COLON CANCER: This was sort of the last frontier of early detection to fall under the scrutiny of long-term studies. Many over-50 patients had listened to Katy Couric and dutifully undergone Colonoscopies to search and destroy nasty polyps (thought to be pre-cancerous growths). Never mind that it was scary, it hurt, and was expensive, it was the right thing to do, or so we were taught. But a recent Norwegian Clinical Trial showed that while Colonoscopies do indeed detect more cancers, they do not decrease mortality from cancer. This may be because of a fundamental concept that “not all things considered to be cancerous endanger one’s life” (many abnormal growths may be benign, or at least slow-growing enough to not present a threat of mortality). Since there are risks associated with the interventions (mostly surgeries and after surgery complications), the overall good of a colonoscopy may not outweigh the bad. As a result, Kaiser and many other HMOs have gone to at-home blood-in-stool-sample tests, which they believe does a better job of screening for dangerous colon cancers, more cheaply and less-invasively with fewer false-positives. (Chen, 2022)
BREAST CANCER: This is another big one, it is now known that over 10% of Mammograms produce a false-positive. It is also now known that women with dense breast tissue are more at risk. Increasingly, doctors are relying on genetic testing (chiefly for the BRCA1 and BRCA2 genes) in combination with Mammograms. In the old days prior to all of this, many women were needlessly frightened into endless follow-up testing and needless mastectomies by relatively crude early Mammograms (which are now 3D and much improved). One wonders if bloodwork and genetic testing will be the future of most breast cancer screening (with less frequent Mammograms), since this may be the best way to measure true cancer risk. (Bauman,2019),(Yehya,2022)
PROSTATE CANCER: Prostate Cancer is thought to be a growing epidemic, but its hard to tell since the “growth” of prostate cancer detection may be related to increased use of the PSA test in the 90s, along with the related BPH false positive (Benign Prostate Hyperplasia, a non-cancerous enlargement of the prostate generating high PSA numbers). As such, many old men have had their sex lives and urinary habits needlessly destroyed by prostate biopsies and removals precipitated by false positives. In addition, prostate cancer is notoriously slow-growing, so that even if a 65 year old patient has this cancer, they are more likely to die of something else before the prostate cancer runs its roughly 20 year course. That said, there are a percentage of men who have aggressive prostate cancers in need of treatment (about 10% of those biopsied), who have a 7 or greater “Gleason Score” (indicating an aggressive cancer). For those below this number, “watchful waiting” (continued monitoring of PSA numbers) and “active surveillance” (watchful waiting with increased frequency of PSAs and biopsies) are in order. One hopes that someday, bloodwork alone will determine the proper course of action. As for a “prostate cancer epidemic”, it may be that the Western Diet has increased occurrence along with increased detection, so that preventative lifestyle changes (see below) are in order. (Sauerwein,2017),(Phillips,2022)
THYROID CANCER: Thyroid Cancer biopsies, though less invasive than others, also have created a large share of false positives, making some wonder if the treatment (usually thyroid removal) is appropriate for the risk. The art of analyzing biopsy results in thyroid cells is still something of a crap shoot, by the admission of endocrinologists. The only good thing about all this is that a) Thyroid removal is relatively noninvasive and b) One can do well without a thyroid. Yet going in, Thyroid Cancer is one of the most survivable cancers (due to the radioactive iodine “magic bullet” and relatively slow-growing nature), so one wonders why there is so much overtreatment. In the future, look for better blood-work and genetic methods of assessing thyroid cancer risk. (Yi,Ahn,Park,Lee,Lee et al,2017)
PREVENTION: This may be the unsung hero of modern cancer therapy. In the olden days, most everyone knew that tobacco caused lung (and other) cancers, but it is now known that fatty red meat and alcohol (darn it, plus sugar too?), plus a sedentary lifestyle are also causes. There has been a marked decrease in lung cancers (tied to less smoking) and melanoma (related to knowledge of sun exposure risk and increased early detection). There has been an increase in pancreatic, brain and bone cancers. Additionally, there have been breakthroughs in slowing the overall aging process (though a slowing of the metabolic process called mTOR inhibition, which also decreases cancers). So in an era when the Western Diet and longer lifespans are serving up more cancers, we are actually lowering cancer risks with the knowledge of lower risk lifestyles. Naturally, the medical establishment pats itself on the back for all of this (the same way they do for lower cardiovascular risk, which has a similar lifestyle prevention element). That way they can justify all the costs of their somewhat unnecessary and invasive (and costly) analytics and treatments! (Williams,2022),(Hua,Kong,Zhang,Wang,Luo,et al,2019),(nlm.nih.gov,2003)
In conclusion, all the poking and prodding, biopsies, scans, and excisions may give way to blood work and genetic analysis (thank God), since about 85% of the suspicious nodules found by current invasive poking and hacking are likely benign or slow-growing, while about 15% are so aggressive that even early-detection doesn’t help (by my own gross estimate). Meanwhile, a good lifestyle may prevent the cancer, mTOR inhibitors (like coffee, turmeric, and drugs like Rapamycin) may limit it, your genetics reveal a predilection (with CRISPR-CAS editing the defective genes). Agents in your blood (related to genetics) may become a better means of early cancer detection, while CAR-T and related immunotherapies may effectively manage the cancer. There may be much better means of determining whether cancer cells are benign or aggressive, and a means of “turning off” cancer metastasis (thereby making all cancer cells effectively benign). In addition, cancer cachexia (the late-stage wasting condition), may become better understood and addressed. Ultimately, all cancers may be found to have causes effectively prevented by mRNA or similar vaccines, making all this prodding, biopsy, surgery, chemotherapy, and radiation look obsolete! (Markman,2022),(Belete,2021)
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