Cancer screening: How testing can find more disease but not make us healthier with Gil Welch
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- čas přidán 27. 01. 2022
- Melanoma: NEJM last year
pubmed.ncbi.nlm.nih.gov/33406...
Was just sent this classic video April 21, 1995 by Robert Swerlick
• Melanoma Epidemic: Mor...
2. Liquid Biopsy
www.statnews.com/2021/02/12/n...
www.statnews.com/2021/08/31/l...
www.statnews.com/2022/01/12/m...
Our paper in December showing the UK GRAIL trail has the sample size to test ACM (under their expected 27% decrease in all-cancer mortality)
pubmed.ncbi.nlm.nih.gov/34847...
3. Taiwan: LDCT screening in Asian Women
jamanetwork.com/journals/jama...
Vinay Prasad, MD MPH; Physician & Associate Professor
Google Scholar: scholar.google.com/citations?...
Substack: vinayprasadmdmph.substack.com/
Podcast: podcasts.apple.com/us/podcast...
Personal Website: www.vinayakkprasad.com
Laboratory Website: www.vkprasadlab.com
Podcast Website: www.plenarysessionpodcast.com
Academic Publications: www.vinayakkprasad.com/papers
Follow me on:
Twitter @vprasadmdmph
10 years ago a routine mammogram revealed a tiny lesion in my breast. With a lumpectomy the dr. found that the cancer had not spread to the lymph nodes and that it was a very slow-growing type. Dr. didn't think I needed chemo but recommended hormone therapy and radiation. After researching this very topic of over diagnosis and over treatment, I decided that the risk from the cancer was not much greater than the risk of adverse outcome from the recommended treatments and that the benefit of treatment would have a negligible impact on my prognosis. I refused both and have never regretted it.
Ignorance may be a bliss in some cases.
Testing may help but creates more stress and worry.
Thank you, Doctors!!!!
I did my undergrad in health sciences, and worked 10 years in public health. This channel has become one of my favourites for the topics covered, incredible insights, and the general accessibility for even the non medical specialist like me. Thank you VP for sharing these conversations with us.
Had my first mammogram at 52 years old, was told there was an abnormality and it was 50/50 cancer and they needed to do a biopsy. I refused and said I wanted to wait a year to see if it changed, my doctor was appalled and told me stories about his patients dying of breast cancer! My mammogram a year later showed no change.
I have avoided potential unnecessary invasive and harmful treatment.
I will have no more mammograms unless I have symptoms.
Smart lady
@@sassysandie2865 thankyou ♥️
@@BeaHindebars check this out.
czcams.com/video/8DnYjetn6QY/video.html
I had been following his work for awhile and then back in '13 bought Overdiagnosed. Have always like his work. He makes a lot of sense (has for years)
Holy cow, I am reading his book right now. Hard to sit with a doctor who treats a patient as if they get what they deserve if they don’t screen for every type of disease yearly.
Awesome show! Just heard about Dr. Welch. Everything he says is what my gut has been telling me all along. Just found his books. Thank you, Dr. Welch and thank you, Dr Prasad for having him on your podcast.
What are the books? I’ve searched and I’m not finding.
The illness merry - go- round. As a person with 6 serious chronic illnesses I have learnt that if I go to Drs all they want to to do is find something to treat to keep me on that merry-go-round. The health system is incentivised to keep people in treatment.
This discussion is so important to those engaged in patient care. Our health system is designed to accomplish one overriding task- to make money. Providers are obligated to navigate the patient through a system which could care less about improving health- cynical but true- Walter Bortz MD
In treatment and never cured.
Hopefully someday we will have a less arrogant, more transparent, non profit-driven, and more patient centered medical system. Until then we are all forced to navigate the minefield of inept, over competent, aloof, and greedy providers that make up such a large part of our modern healthcare system. Trying to find doctors and hospital systems we can actually trust is so difficult these days.
I wish Dr. Prasad was my family doctor.
5 minutes in…such an important topic, thank y’all for highlighting it
Thank you for bringing attention to this gigantic problem that most healthcare participants are incentivized to ignore.
Discussing this topic with patients and colleagues makes one acutely unpopular. Patients equate more care with better care and the typically agreeable physician just wants to give people what they want, and be loved for it….
I remember reading a study that looked at breast cancer screenings and treatment. There was a pretty significant number of people who were treated with surgeries and chemo for cancers that were VERY slow-growing and not likely to cause problems. We have so much testing now days that can tell a doctor what is a dangerous cancer and what is a cancer that will not have a negative impact on a patient.
I heard this a few years ago in a program on the BBC. They also said that having a mammogram carries a risk. It's not something you should repeat too often.
@@tender.rebellion There's actually documented cases of women developing breast cancer because they had too many mammograms. I believe they changed the age recommended to start mammograms. I got my first mammogram when I was 40 and was told I needed to do it every year. I think I will do it every 5 years since I don't have any family history of breast cancer.
Well, overly testing for this virus (esp when the testing is faulty) is doing a lot of damage. I get it - It's not the topic at hand, and it's like comparing apples and pears. Yet still it's a relevant issue that is affecting everyone.
This cancer screening discussion is so interesting.
You are right. If we tested and tracked each cold /flu season like we are currently people would live in constant terror. If we publicised deaths each day for all diseases then the general public would be horrified. It might be the way to fix heart disease, obesity and many other diseases caused by poor life style choices.
@@KRDos_Aus I could not agree more, if they want to frighten people into making healthier choices they could list deaths of smokers, drinkers, obese etc. Clearly this would be totally gross and unacceptable but it's basically what they are doing with covid in order to justify the tyranny.
The sad part is this video will not get anywhere near the views that the covid-19 vaccine related videos get. People forget this doctor actually specializes in cancer research.
Dr. Vinay -- interpreting all the data and conveying in simple terms for this RN who doesn't have time to do it!
Very interesting topic. Thank you for all that you do!
Very interesting and excellent conversation. Thank you for sharing your thoughts with us. These types of dialogs are needed.
Even my wife who is a fellow provider, albeit in surgery, doesn't get the idea of avoiding excessive screening. "Why WOULDN'T you check a PSA, it's TREATABLE!" The lack of insight on this amongst physicians is pretty amazing.
Sadly the lack of medical and research ethics among researchers and doctors is also incredibly lacking these days, as is having the courage to stand against mass formation dragging the medical field in drastically wrong directions. At the heart of this problem is the core of greedy profit-driven "health" systems.
I know the "early treatment is ALWAYS cheaper" mindset was dominant in 2009 health policy debates (mostly among Liberals but even most Conservatives also assumed it was true) even though that was an empirical claim that could be tested. False positives seem to be a common point of concern with security concerns (which involve humans in conflict) but not with medicine or economic decisions (which involves humans in cooperation).
For some reason, a lot of people are less able to think of diagnostic risks when not facing opposition.
@@guapodesperado2822 and patients damand it. "Dr. [previous PCP] always checked my PSA, my so-and-so had prostate cancer, I want it." Nothing you can say to these people.
I used Grail to rule out the existence of cancer after conflicting MRI indicating cancer and PET/CT results showing no metabolic activity. The oncologist wanted to do a biopsy, but Grail was less invasive and confirmed no cancer. It confirmed no cancer not only in the area in question, but none of the many cancers they test for anywhere in my body. I felt it was a great tool.
Thank you for sharing, good to learn about this
Dr Prasad, is there any chance you could do an episode going over common screening tests, which if any are likely to improve morbidity / mortality on net, which you would get yourself or act on if they came back abnormal, etc - from the perspective the informed non-physician, who knows about Bayesian probability and the importance (& dearth) of RCTs, but doesn't have the background or journal access to know the current state of the evidence?
Yes please as I'm lynch syndrome ambiguous for pms 2 (dad and grandma died stage 4 colon and I was first ovarian at 19yrs old with 2b LMP). Lynch was iffy on positive. Now I'm 40 and getting second colonoscopy and I'm frankly scared to death.
Come on ppl, lets smash that "Like" button so Vinay can pay the heating bill...
Really interesting discussion. Right up my alley.
Yeah this is really fascinating and kinda changes everything. Sometimes you find a lecture that you just didn't see coming but is so perspective-altering. This here is definitely one of those. I'm just thinking of all the times I've heard how invaluable "early detection" is. Everything has such complex motivations.The more I learn, the more my trust in everything is eroded. I honestly hope there's a foundation here somewhere (I believe there must be, if what we're seeking is truth 🦞) where I can put my feet and begin to rebuild.
Thanks for this.
Your comment perfectly represents my thoughts as well.
Hopefully someday we will have a less arrogant, more transparent, non profit-driven, and more patient centered medical system. Until then we are all forced to navigate the minefield of inept, over competent, aloof, and greedy providers that make up such a large part of our modern healthcare system. Trying to find doctors and hospital systems we can actually trust is so difficult these days.
I wish Dr. Prasad was my family doctor.
😔🙏🌿
FDA approval no longer reassures me that anything is safe…strange isn’t that. And screening generates money doesn’t help.
It is sad that medicine has become financially based.
It has been profit driven for a very long time, but that has recently reached a fever pitch.
What is even more frightening is that medicine is now political.
@@guapodesperado2822 yup!
FDA WILL RUBBERSTAMP EVERYTHING PHARMA GIVES THEM.
54:42 shows Dr. Prasad's face when mentioning some potentially needless thoracotomies (surgeries involving cutting into the chest cavity). Being aware of the risks of invasive surgery is going to make that face a lot more understandable.
It makes the "wait and see" approach Dr. Welch much more understandable.
The melanoma study discussion resonated with me. When my mother was diagnosed with melanoma at age 80, the prognosis was something along the lines of "you'll likely die of some other cause before your melanoma kills you..." and so my initial instincts were for my mom to disregard "treatment options" and focus on quality of life. But it wasn't my decision, and so my mom chose the treatment regime (mainly chemo). What followed appeared to me to be a treatment regime that was too hard on her body, weakening her to the point of having 'side effects' like injuries due to falls, etc. And of course statistically, once you start falling at her age, related injuries feedback loop into further loss of mobility and contribute to a poorer quality of life. Then you add to that the first periods of time with undiagnosed urinary tract infections (which at her age, has big impact on cognitive functioning), and then once in that wheel chair, it remained near impossible for her to get out and return to normal mobility. She wanted to die at home like my father, but in the end, imho it was the chemo that killed her remaining good years too weakened and her last days spent in a hospital room.
Side note: the UTIs were at first scary as the immediate loss of cognitive function gave us the impression that we "lost her" -- but once we learned about it, and her caregivers picked up on it sooner, it was quite the relief, and almost magical how the biochemistry at that age responded so quickly both ways (first to the UTI which made my mom angry and incoherent, and then to the antibiotics which transformed her almost immediately back to herself). Whenever I talk to friends about their initial foray into elder care with parents, I now always mention UTIs - especially for the older moms being looked after.
Length time bias is a major under-recognized cause of over-treatment. This is case and point.
Terrific show ! Great guests. Thank You! Very insightful and informative.
I think cancer ( you might think I am crazy) are cells that we all human have in our body. In waiting until some part of our body is dying or dead. They feed on it. I see this cancer cells as clean up crew. Decomposing cells. Is that crazy way ? Anyway, that has been on my mind for a long time. Your the person to ask. Thanks again for being there.🙏
Sadly the lack of medical and research ethics among researchers and doctors is incredibly lacking these days, as is having the courage to stand against mass formation dragging the medical field in drastically wrong directions. At the heart of this problem is the core of greedy profit-driven "health" systems.
Great interview!
What an eye-opener. Just wow.
I love to be informed. Thanks a lot !
What an amazing engaging Doc. Thank you for this interview Dr Prasad
My relative's doctor has become part of a concierge medicine organization that, in addition to submitting claims to insurance, has a $2k annual fee for their wellness exam. This exam includes a long lists of screenings and lab tests (which are sent to the Cleveland Clinic). Of course these scans will have findings which many patients will want to investigate.
What about mammograms ? So many false positives…I was once told I had breast cancer but after the biopsy it wasn’t cancer. Doctors don’t treat the root of the problem or try to help us have a stronger immune system. Most people know that some meds will make immune system weaker….
I have a friend who was diagnosed with pancreatic cancer based on a CT scan. Then she had surgery and there was no cancer.My friend refused the initial diagnosis. Another friend accepted the diagnoses and submitted to experimental drugs and lasted 3 months. Doctors denied her the surgery without getting chemo before. She had a horrible death after went into hospice.She went in much suffering. Not fair…
Thanks for making me aware of an issue I had no knowledge of. Obviously financial incentives really matter in this discussion. It also make me wonder why US hospitalization and deaths are so much higher in the US versus other western countries for SARS-COV-2. Is there a financial incentive to increase reporting?
Love this podcast! I would love to see a video on Evusheld and the pros and cons on giving it to immunocompromised patients such as cancer patients.
I feel it is very auspicious that the topic of the podcast is not Covid related. It augurs the beginning of a new era 😊. Thank you, as always.
This sounds like people forgetting about the mechanisms of the data gathering resulting in a lot of checklist medicine.
I guess it may take a bit more context to realize why a certain number is significant and it might also become so full of questions that a cautious person will just go by what is the worst case scenario (actual malignant cancer) and forget the costs of misdiagnosis. Risks of misdiagnosis don't seem to be as high profile once some objective biological markers exist (even if they are not as relevant).
Relevancy requires context and context requires information and risk tolerance.
There is also the under emphasized profit motive in excessive sequential screening.
We need screening tests for Glioblastoma ASAP. My husband died from it at diagnosis at the age of 41... Completely healthy otherwise. He never even got to hear the diagnosis. This is devastating and early diagnosis is needed.
Glad you cover your other area of expertise. I work closely w pharma and often focus on oncology (development/research and commercial side).
Excellent talk! Learned lots :)
Wonderful video and discussion.Thanks😘🥰😍
thanks
excellent!!!
Dr. Prasad I really appreciate your channel… so much insight and critical evaluation of complex data… I am curious if you know of a cardiologist or cardio/vascular specialist with a YT channel or blog as I have some issues that I am trying to research… and I am also experiencing perimenopause which is giving me many troublesome symptoms so if you have any recommendations on where to find good information, I would be so grateful and I would hope many people could benefit. Thanks 🙏🏼
"crazyville". Fine discussion
Been listening to you for a while now and somehow just realized that you're associated with OHSU!
Interesting Dr when you posed the Question ,what is Cancer? How does Cancer-causing monkey Viruses help shape that perspective.
I said this about my mother’s teeny tiny ‘bump’ on the top of her pancreas, never mind these tiny bumps are all inside her body, it’s normal for her. I wanted to wait 6 months and test again, but my sister, a CEO of a hospital, insisted she start chemo right away. Put her right into the ‘system’, and I saw first hand the chemo factory, disgusting (especially the severely overweight man drinking a Big Gulp of soda with a needle in his arm)
Oh my gosh, I don’t think I could have stopped myself from telling him what he is doing to himself.
MGUS is another good one....how many people are walking around with that and if you find it during testing, it has to be monitored forever.
The problems is when they find cancer early and doctors can’t stop it. The patient might die sooner by the anguish to know about the cancer.
👍
My thoughts for so long now…
So are colonoscopys really needed for everyone?
Nope
Your link says PAPER OUT OF DATE AND … can’t remember verbage but they apologized for publishing. Is that what you were intending to show?
Turn on the Heat
He just had his booster. He said he's feeling a bit rough.
Or he's cheap like me and only turns the heat on in rare occasions.