f13.net

Phase Two: ask questions?

I am trying to get feedback from individuals, for those of you who have time…

If you went to your doctor’s office and could have a test done that could tell you whether you have a cancer, would you want it done?  Second question, what if the test was 70% accurate, 80% accurate, 90% accurate? Lastly what if the test was only able to say you have a 50% chance of getting the cancer, 70% chance?  Thanks for the input just trying to see what the limits are for some people.

Not sure I entirely understand, but I wouldn't feel like it was really worth it if I took a test to see if I'd get cancer and it just said I have a 50/50 chance.

I especially wouldn't bother if it was any less than 90% accurate.  If it's only 70% accurate and they tell me I definitely will or definitely will not get cancer, I still don't know how seriously I should take it.

I imagine I'd want the test done, on the theory that the sooner they know about it the sooner they can try to carve it out of me or whatever.

I don't have any limits and wouldn't be afraid of certain results. Life is easier and less complicated for me when I have more facts and info on hand, not less.

I would have it done multiple times. I won't get into the math here but a 90% accurate test is not 90% accurate in the way people think it is. The basic idea is that not many people have cancer, and many people will be mis-identified as having cancer. In the extreme case say 1 person in the US has cancer, if everyone takes the test 10% of the population or 26 million or so will be mis-identified as having cancer, while only 1 person actually does have it. So even if your test comes up positive there is only a 1/26 million chance you are cancerous.

I guess I just did get into the math. Anyway my answer is I would have it done and done more than once if it came back positive.

That depends on whether the 10% inaccuracy is 10% chance of a false positive (your case), or 10% of a false negative.

I would imagine it would be required by me as a reservist (assuming such a test existed).  But yes, I would rather know I have a disease then be ignorant of the fact.  Yes to all the above, as early detection is the best method of prevention!  Or something along those lines.

Even then, at a 70% chance.  So you have the test done 10 times, and it gives you let's say 4 negatives and 6 positives.  What then?  A statistician would get a larger sample size, but how many damn times are you gonna go through the test?

Fuck it.  We are all going to die, so why sweat the small stuff.

Because it distracts from sweating the big stuff, like that we're all going to die.

My area of expertise is Cancer.  The first thing that troubles me about this is that I can really only think of a couple of commonly used tests that can reliably detect cancer at a moderately early stage.  Second, the question that you're asking is too vague and generalized to make any response meaningful. If you really want answers to your question, you need to offer specifics:

1) What kind of cancer are we testing for here?  Finding out that I have prostate cancer would provoke a very different response than finding out that I have pancreatic cancer. 
2) What is the nature of the test? 
    a) Is it invasive?
    b) Does it rely on some type of patient complience?
    c) Is it genetically based (i.e. will some insurance carriers consider a positive test as sign of some pre-existing condition?)
3) How expensive is the test?
4) Will the cost be covered by insurance?
5) 70% accurate means nothing.  What is the rate of false positives? False negatives? Confounders?  Humans are complex beasts.  Creating a test that works for everyone on something as diverse and complex as cancer is almost unimaginable.
6) Doctor's office?  Do you mean a GP? An Oncologist?  The person administering the test can/may have a profound effect on outcomes.

More importantly,

7) Are we testing for the existence of cancer or cancer risk?

The list goes on. 

What I'm saying here is that a more specific line of questioning may give you more specific response data.  If you want purely ethical data, I suggest you find a way to rephrase the question to help you obtain data that supports/rejects your hypothesis.  Are you interested in determining whether people wish to know in advance about their mortality and are guising it in this cancer question?  Is this more of a marketing thing?  What is the crux of what you really want to know? 

The government currently spends hundreds of millions of dollars a year funding researchers like myself to develop methods of early cancer detection.  Even more money is invested annually in the private sector.  It's obvious that we want a method of early cancer detection. The current problem is that most methods are unreliable, too expensive, or too slow to be worthwhile. 

Edit: The word "lastly" makes me cringe.

Death will happen, today, tomorrow, next year, decades in the future.  One does not fight death, one fights to live.  So, why should I waste thought on death, I would prefer to put my energies into living.

Those are not my words, but unfortunately I don't have a name, only the words left in my brain.

What Rat Boy said.

The logical part of me says that yes, I would want the test done.

The part of me that has panic attacks, and very bad ones, would say no, never ever get the test because the more you ignore it, the more you won't have to deal with facing the potential problem and consequences.

With cancer, my family has a history of it and primarily breast. My grand-mother was diagnosed three or four years ago and had both breasts removed. However during that time it spread to her lymph nodes and they said she would probably not live out the year. She is now 84 years old and although her mind is very much slipping (we think due to it spreading to the brain) she is still very much alive though she refuses treatment and will not talk about it with you.  Thus, I have decided for Cancer only, yes I would want to know because you can be a breast cancer survivor.

It is odd that every other kind of disease I would not get a test for, but Cancer, I would easily get the screening.

SPT you really should get that boil on your breast looked at.  It could be THE CANCER!

Rotting in a hospital bed, in excruciating agony, in your late 40s is NOT small stuff for the ill or the family members who have to watch, completely helpless. Dying in your sleep when you're 80 is a different way to go. Everyone should get tested for cancer if there's a chance it'll save their life.

Lt. Dan raises the question that I would have regarding false positives vs. negatives, particularly since some tests are more uncomfortable (and expensive) than others to take. I'd hate to drink three bottles of phosphorescent dye and have a camera shoved up my ass if I thought there was a 30% chance the test would miss the cancer. That's not even addressing the cost of the test.

Like SuperPopTart I have a (recently discovered) maternal family history of cancer and have to start getting tested approximately 15-20 years earlier than is typically recommended. My mom probably had the cancer that killed her for ten years, but since she hated going to the doctor she didn't find out until it was WAY too late.

Prevention is the best medicine! But early detection of disease is the next best.

Edit: sorry, I just read Nebu's post and he pretty much covered everything I said.

The hard part about modern medicine is that death is more rarely a sudden occurrence.  Watching death approach slowly, over the course of years, with chronic conditions taking you away a bit at a time, that is a terrifying thing.

Of parallel interest, the FDA is currently considering licensing an HIV oral swab test for over the counter sale.  Swab your mouth, pop the swab into the solution, wait 20 minutes, and you know.  One major concern is people who discover they are positive in the absence of counseling.

As much as I'd personally want to know for insurance reasons I'd probably pass.

To paraphraase Reagan, 'Lie to the insurance company, but verify.'  I need to know. What the rest of the world gets told is negotiable.

First I would like to say thank you to all those who have replied so far.

I work in the cancer field. The only reason why I brought up the questions is because of a discussion I had with colleagues of mine about whether we would even want to be tested with a diagnostic method we are working on. As Nebu has pointed out it is much more complicated then what I was asking but my question, although convoluted, is simple enough to answer to get an understanding on whether you would even want to be tested.

Out of curiosity If you could take a test that would inform you that cancer is in your body but at that stage their is nothing that can be done to treat it, because you have to wait until it gets worse to treat it, would you still want to take the test?

A couple of points for Nebu

1.) There are no screening tests currently available for pancreatic cancer. Any test for this which is better than prostate detection via PSA is a good thing. I really wasn't trying to get specific at all, let us say for example it is lung cancer.

2.) Again I don't think this is needed to answer the question. Specifics such as if insurance will cover it are irrelevant to my question. But for you let us say serum based test which is not based upon DNA and covered.

3 and 4.) Again this is not relevant to answer the question as the question was hypothetical. But let’s say it is covered by insurance so the cost is based upon your co pay.

5.) I agree. I wasn't that specific here I was really just trying to say what someone’s range is before they wouldn't bother even taking a test. For you though say false positives are 1/10. False negatives are 1/10. Confounders none known. Of course a test doesn't work on everyone it would be absurd to say it does.

6.) That is why you ideally would want to take the human out of the test. Pulling blood, isolating serum and pipetting this into a channel shouldn't have any outcome on the test.

7.) Very important, again my question may not have been clear enough, this would of course be presence of cancer cells within the body not risk. Test for cancer risk are already being used such as BRCA1 on chromosome 17 and BRCA2 on chromosome 13 for Breast.

Yes the list would go on hence the question being very general. If this was for market research this would be a joke. I was just curious as to what people thought nothing more. As for your last comment I think you are going to be surprised at how soon the private sector is going to be releasing products which are inexpensive and can detect early stages of many common cancers. IMO this will be only a few years if not sooner.

I don't mean to sound difficult, but I still don't understand the question.  If we can detect any cancer early, we can treat it.  The lack of early detection is the reason that many treatments fail, not the converse.  Other than PSA and cervical smears, only breast cancer has the potential for very early diagnosis and even that is still in its infancy.  Couple to this the fact that we already have drugs that we can use prophylactically for women genetically predisposed to certain types of breast cancer.  It's late and I may be overlooking something, but I can't think of a single type of cancer that we couldn't treat immediately.  If this test was even moderately reliable, then any positive response would likely be met with immediate treatment assuming you have patient compliance and the patient is healthy enough to survive treatment.  The way the question is phrased assumes that there are cancers we cannot treat at an early stage.  

I also wanted to offer some reasoning behind a few points I made earlier.

1) The question about pancreatic vs. prostate was more a question of survivability.  If I have prostate cancer, there is a good chance I'll survive it.  With pancreatic cancer, the outcome is usually grim.  So in essence I'm asking if you wish to know about our desire to learn whether or not we have cancer or whether we want to discover the limits of our mortality. 

2) The question about genetic connection was one of being labelled with a pre-existing condition. If knowing the answer to your question tells me of my mortality, it does so at the cost of any medical coverage for the remainder of my life.  Get what I mean here?  Tests that tell us something prior to the actual event may have consequences beyond the scope of just our health/mortality.

3) The question about invasiveness is one of patient complience.  Many patients will decline a test if they suspect discomfort. 

4) As Americans, cost is possibly the most important aspect of healthcare.  As much as we don't want to hear it, unless you're wealthy and well educated you're more likely to have healthcare decisions based on financial matters than what's the best course of treatment.   If a procedure is expensive and not covered, you'll likely not have it presented as an option by many physicians.  Since this type of test would require some state-of-the-art molecular biology techniques, it would likely be expensive. The case could be made that for those genetically predisposed that this could save money, but then we go back to the ethics of preexisting conditions. 

I still curious what information you're really after here.  Are you asking if people want to know they're life expectancy?  Are you trying to assess people's fear of cancer diagnosis?  Throw me a crumb!

 

Too many big words, not enough flesh!

why is the subject of "profit" leading a thread about cancer detection? 

It's a South Park reference. As to it's appropriateness, eh.. who cares.

I know the underwear gnomes reference.  Just wondering why.  Not an idle topic and curious subject heading.  Cancer <> $profitability

Problem is if at any point the test comes out in auditing you will find yourself in court to pay backexpenses and completely uninsurable by any player in the industry likely to pay their claims.  Some of the younger folks in the community may not yet appreciate how destructive that can be to someone's life in this country.

Though if I could cross a border and have it done in a country with very loose reporting laws I'd definitely book that flight.


The folks that find any cure for any cancer will be stinking rich beyond precedent.

Sadly this isn't going to be the case.  Famous, yes.  Rich, no.  The people that will make all of the money from any cure will be corporate executives and university administrators... and attorneys.   

The last figure I was given for a compound in development in my lab was $600 - 800 million to take a new drug entity to market.  Most scientists that believe their agent is helpful will sign their rights away to get the agent to the clinic faster.  Sure, they'll be comfortable for the rest of their lives.  None of them will become filthy rich. 

Sorry for the aside.

Yeah, but I'd hazard a guess that the scientist who cures cancer will win the Nobel Prize, and that comes with a million dollar reward.

I think we can agree that $1 million is chump change compared to what would be made from the work.  Actors get 10-20x that for pretending to be someone else for a month or two.  Scientists get it for the toil of a lifetime.

Don't mind me... I'm just bitter.

The teachers who taught those scientists got paid even less.

Hey, man, I feel you. I chose to go into sciences after being voted "Most Artistic" by my senior class. Why? Because I knew I'd at least make a living. Now I'm an unemployed field biologist pushing 30 and the best I can hope for is a year-round job that starts at $30K. If I keep at it, I might be able to open my own consulting firm in five years or so, but the overhead is so high that it's probably not even worth it. If I land a position as senior scientist in ten years, I might break the $60 mark. We don't go into the sciences for the money, we do it for teh luv. And if we get really lucky, the glory. People who want regular lives (i.e., not living in the jungle for 9 months out of the year to hopefully discover a new species) really get the shaft.

Considering that median household income is $44k, and the US having one of the (but not the) highest incomes in the world, how much do you have to make to be considered rich?

I think Oregon has higher-than-average median household income. We have the highest income taxes in the country, and a fairly high cost of living. It's all relative, really, I'd just like to put my kids through college and maybe open that B&B when I retire. American dream and all.

No, actually it's below the US mean at 42k.

Huh. Must be all the migrant farmers and timber workers. Well, at least I don't feel so bad about my status anymore.

Scientists are not rich as a rule, but they are usually quite comfortable.  They generally are well rewarded for their efforts and as a bonus their work gives them more easily accessible opportunities to become rich so a high portion of them do eventually become rich.  The same as your average doctor, lawyer or engineer.  Education pays, IF you actually get an education that is valuable.

As far as what the teachers of those highly educated people are paid, well in my experience the ones who actually teach the valuable skills are pretty well off.  Several of my engineering prof's drove late model Beamers and Benz's and I know at least one of them was a millionaire several times over before deciding to teach.

If it makes you feel any better, my state about bottoms the list on mean income.  I still can't figure out how most people can survive if that's the case, except that maybe it's because housing is so damn cheap (180k=lakefront).

As for teaching - if you can become a prof, you're likely to be doing really well, esp. once you get tenured.  It's also considered one of the best professions to go into in terms of stress (there's almost none, relatively speaking).  Downside is the requirement for a doctorate and having to chase grant money all the time.

Nah, you just get your grad students to write your grant proposals and do your research for you, then put your name on it. They get their MS and you get to keep with "publish or perish".  :wink: (kidding)

As far as being comfortable, I'd agree. I went from earning $400/month as a student to being able to afford my apartment without a roommate within 4 months after I graduated.