If the cancer is not clinically significant, then its not life-altering information.

Essentially they are saying that many of these diagnoses are potentially false positives. To the point where detecting them might be more harmful then not. Keep in mind most cancer treatments are pretty harsh. They are better than cancer, but if you don't have clinically significant cancer then the treatments can be very not worth it.

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jamesrom 15 hours ago | parent | next [-]

Then here's an idea: instead of hiding that information, you can explain it to the patient.

You have no authority to treat your patient like a child.

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Centigonal 12 hours ago | parent | next [-]

disclosing information is not a medically neutral act. Knowing you have a medical condition can create a great deal of anxiety and anguish and prompt lots of tests. If the result of all those tests and anxiety is "no action indicated," you've basically given your patient a condition that reduces their quality of life for no upside.

I once had a misdiagnosis of an incurable illness that I didn't actually have, and the stress of dealing with that caused me to develop another, very real medical condition that took a year to get under control.

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bryanlarsen 14 hours ago | parent | prev | next [-]

We're not talking about hiding information, we're talking about not looking for it in the first place. Information that is costly to acquire but not actionable once acquired.

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lurking_swe 14 hours ago | parent [-]

in some cases the knowledge itself is a curse. These commenters mostly have no clue what they’re talking about and it shows.

My spouse found out they had a benign brain tumor, an accidental discovery while doing a brain scan for some other reason. She now has to get annual scans done to make sure the size doesn’t change. Guess what? It hasn’t changed in 5 years.

You might say “better safe than sorry!” To that i say - bullshit. It’s caused her lots of unnecessary stress and anxiety. EVERY year she goes back to the testing center and stresses out about if it’s changed in the last year. She sleeps poorly sometimes because of the anxiety, etc. Knowing every microscopic issue within your body is not always a net benefit! Quality of life matters too, not just longevity.

I think it really depends on the type of cancer. Actionable information is the most useful information.

	▲	cjalmeida 4 hours ago \| parent \| next [-]
		I believe you’d have a very different opinion if the size did change and she had the opportunity to treat it at a very early stage.
	▲	nomel 12 hours ago \| parent \| prev [-]
		Nocebo [1], a well know/documented phenomenon, can be very damaging. [1] https://en.wikipedia.org/wiki/Nocebo

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bawolff 14 hours ago | parent | prev | next [-]

Hypothetically (totally made up numbers), if a positive result on the test means there is 1/10000 chance you have cancer, and negative result means a 1/20000 chance, with the test also having a 1/1000 chance of giving the patient an adverse reaction, i think the questions most patients would ask is why was the test run in the first place?

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dekhn 11 hours ago | parent | prev [-]

This is a "why don't you just" answer. The reason the establishment does this is that we know the outcome of telling people is worse than not telling them. This is an expensive lesson learned over over a century of medical treatment.

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delichon 11 hours ago | parent [-]

Outside of an emergency I would prefer "first, fully inform" to "first, do no harm", acknowledging the potentially mortal cost.

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dekhn 11 hours ago | parent [-]

What if you had stats that showed that (the fully inform) policy produced more negative results?

Would you insist on fully informing if the outcome was, on average, worse? If so, why?

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delichon 11 hours ago | parent | next [-]

Yes, because I have met many doctors whose judgement I profoundly mistrust, and prefer my own. Sometimes their whole paradigm is flawed, but sometimes they're just not informed about my own values. And I would rather die by my own misjudgment than theirs.

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dekhn 11 hours ago | parent [-]

OK good luck when you get real sick! Because that's what you'll be depending on.

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delichon 10 hours ago | parent [-]

I'm an old guy, it's happened several times. The last time, a surgeon removed a tumor, found that it was malignant ... and then told me that it was no big deal, it was a kind of cancer that would not have caused serious problems. She said if she had to get cancer she'd pick this kind. I wish she had told me that before the surgery. I may have had it anyway, but maybe not. Wouldn't you value being fully informed more after that? Surgeons have as much of a conflict of interest when selling their own services as anyone else.

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dekhn 10 hours ago | parent [-]

I'm not sure what your point is. This discussion is about medical researchers making decisions on thousands or millions of patients in aggregate... what you're describing is a common thing (don't know how bad a tumor is until it's removed).

The doctor didn't know that before removing the tumor (almost certainly; the alternative is medical fraud).

	▲	10 hours ago \| parent [-]
		[deleted]

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reverius42 11 hours ago | parent | prev [-]

Also, if the outcome is worse by informing, doesn't that imply a violation of "first, do no harm"? Which, to be fair, the OP says they wouldn't prioritize...

	▲	dekhn 11 hours ago \| parent [-]
		Depends on how you interpret: "First do no harm". Is that an obligation to minimize the harm to an individual patient? Or is the goal to maximize the health of many patients? Like I've said elsewhere, medical reasoning is subtle.

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poszlem 15 hours ago | parent | prev [-]

That could be true, but it isn't, since we don't always know at the individual level if a specific tumor is harmless at the moment of diagnosis.

	▲	bawolff 15 hours ago \| parent \| next [-]
		You could say the same thing about diagnosing cancer via astrology. A test that with low specificity is simply not a useful test. > we don't always know at the individual level if a specific tumor is harmless at the moment of diagnosis. You didn't know prior to the test either.
	▲	bryanlarsen 14 hours ago \| parent \| prev [-]
		We don't know if a tumor is harmless, but we do know that treatment has significant harm. Radiation and chemotherapy are nasty. We also know that the stress of a positive diagnosis has significant harm. First do no harm.