Birds and Rabbits, etc.

I have a lot more to say about what’s going on in our country, but I ran across an article that I feel compelled to share.

I’m a big fan of numbers geek Nate Silver. I learned about him like most everyone else did, in the run-up to the 2012 election. He had it right, almost down to a single percentage point state by state. As far as I can tell, he predicted the 2014 election too.

His website, Five Thirty Eight, examines statistics in myriad contexts and I was looking today for an article discussing how rare the Darren Wilson grand jury situation was. Again, more that later.

I stumbled across this article by Christie Aschwanden, “The Case Against Early Cancer Detection.”

Hallelujah.

She’s saying what I’ve been trying to say and she has the numbers to back it up. I won’t regurgitate the article here, but I highly recommend it. I will say that she has come up with the best metaphor to explain it.

To summarize:

Many people are married to what she calls “the relentless progression model” of cancer. Meaning, one cell goes bad, then two, etc. If that were the case, early detection really would stop cancer deaths. But, she explains, we’ve learned that cancer is not one disease and the biology dictates how it behaves more than the timing of detection.

Here’s where she gets brilliant.  She describes four types of cancer:

  1. The Turtle – a cancer so slow-growing that it will never become an existential threat.
  2. The Rabbit – a cancer that is growing and spreading rapidly. This is the “relentless progression” type. Again, however, the biology of the tumor dictates whether current treatment methods are curative, and as I am so fond of saying, we only know we are cured if we die of something else.
  3. The Bird – a cancer that will become fatal before it is detected. Some have speculated, for example, that some breast cancers hides in the bone marrow, inactive and undetectable, then reactivate as metastatic breast cancer in the future. This “seeding” might even happen before the initial detection, no matter what at what stage the primary tumor is discovered.
  4. The Dodo – a cancer that will die off on its own without treatment.

We need to learn to identify these creatures.

We need to let go of the relentless progression model as panacea.

And, of course, we need to learn how to treat the rabbits and the birds to impact the death rates.

6 thoughts on “Birds and Rabbits, etc.”

  1. I read the same article this morning and posted it to one of my Facebook breast cancer groups. I have concluded my early bouts with breast cancer were rabbits as they were invasive, were stage 2, and grade 3 and would have killed me if not treated. The fact that I am still alive many years later, makes them rabbits not birds. My most recent diagnosis was in 2011 so it’s still too soon to tell if it is another rabbit or a bird quietly flapping its wings inside me and looking for the right place to nest.

  2. *sigh*

    My ex found out recently now that her Brother now has cancer in his lymph nodes and kidneys and has spread rapidly. He’s been bedridden and hasn’t done much. She’s going to try and visit him this week in Vegas. I’m beginning to wonder if her family is cursed or something, everybody from Cousins and Aunts to even immediate family keeps getting sick with it. 🙁

    1. Ugh. That’s awful. There are way more genetic things going on than we can identify, I think. The BRCA mutation everyone talks about with breast cancer accounts for less than 10% of new diagnoses.

  3. For a deadly disease with no known cure, aren’t studies that find no substantial relationship between disease detection and reduced death from the disease reporting the obvious?

    Seemingly, more meaningful would be studies that examine effects of screening mechanism, however blunt, on extending life. Disease detection enables subsequent treatment geared toward extending life—the central objective of medical treatment. Moreover, estimates of life-extension facilitated by screening mechanisms supports informed decision-making where detection process benefits can be weighed against possible costs (e.g., false positives, negative side-effects of treatment, etc.).

    1. Well, I think all the major cancer fundraising organizations (at least in the breast cancer world) keep selling the message that early detection saves lives. It’s a simple message that resonates with people who want to feel like they are in control and able avoid a scary disease. It’s awfully hard to break through that with message which is more nuanced and unwieldy.

      Absolutely, in today’s world, screening is information. But it’s not complete information. You can’t really weigh costs vs. benefits if you don’t know which kind of cancer you have. We treat them all like they are rabbits. And, of course, we need to figure out how to either stop it or cure it before it becomes fatal. Some people have their lives extended and some don’t. The longer we contribute to organizations that spend our donations on early screening, none of that will ever happen.

      I just finished the oysters a bit ago. Ready to start cooking. 🙂 Hope the pies are ready!!

Comments are closed.