Women are more likely to be survivors because cancers among women (e.g., breast or cervical cancer) usually occur at a younger age...

Yeah, my first question on the "more survivals" was going to be maybe we are all just getting cancer earlier. Which would be grim rather than great news.
posted by DU at 7:50 AM on March 11, 2011

This is colorectal cancer awareness month in the US. If you're middle aged or older and haven't gotten your butt scoped, make an appointment. Your ass will thank you.
posted by middleclasstool at 7:54 AM on March 11, 2011 [3 favorites]

In Canada, we raise colorectal cancer awareness with cheeky ads (links from this page go to some naked butts) or a playground (scroll down for video).

The Giant Colon is impossible to miss or ignore ¨C a state of the art 40-foot long by 8-foot high, pink inflatable walk-through reproduction of the human colon. Bookings are currently being accepted to bring The Giant Colon to you, as of March 1, 2009, just in time for Colorectal Cancer Awareness Month. The Giant Colon will also be available throughout the year. ...

Dr. Preventino, the Colorectal Cancer Association of Canada¡¯s visiting professor ¨C a puppet ¨C will greet all visitors and guide them on their voyage through The Giant Colon. During their journey, they will view everything on a large scale, from Giant Hemorrhoids to Giant Polyps and much more.

posted by maudlin at 8:05 AM on March 11, 2011

In my case, those numbers entirely make sense. The form of cancer I was treated for (testicular, 2001) used to have a mortality rate of 95% or higher. To my understanding, the introduction of Cisplatin as a chemotherapeutic agent in the late 1970s completely flipped that statistic. Which has never ceased to be humbling, the arbitrary fortune of being born at a time and place when human ingenuity enabled me to live beyond my body's intentions.
posted by Hesychia at 8:08 AM on March 11, 2011 [12 favorites]

This really is wonderful news. I can't help but smile when I think about the would-be broken hearts that have been avoided. and I echo middleclas-stool's sentiment (see what I did there)
posted by IvoShandor at 8:29 AM on March 11, 2011

>Women are more likely to be survivors because cancers among women (e.g., breast or cervical cancer) usually occur at a younger age...

>Yeah, my first question on the "more survivals" was going to be maybe we are all just getting cancer earlier. Which would be grim rather than great news.

Well, kind of, but not really. Look cancer epidemiology is all sorts of complicated, particularly when we start using the word "cancer" generically and not narrowing in on any of the dozens of different cancers you can end up with. So you're really asking two different questions:

1) Do female specific cancers (breast/cervical) really have earlier ages of onset then male-specific cancers (prostate/testicular)?

Well, a quick look at the SEER stats for breast cancer and cervical cancer show average ages of onset at 61 and 48 years of age, respectively. With breast cancer the breakdown is more complicated because it of early-onset breast cancer, which can develop in women well before they hit menopause (when most breast cancers start developing).

On the XY side, the average age of onset for prostate and testicular cancer is 67 and 34, respectively. Looking at the age breakdown, something like less than 10% of prostate cancers occur in men under the age of 55. So yes, prostate cancer typically occurs at a later age than breast cancer.

Testicular cancer seems like it may skew the results with it's very early age of onset, until you look further in the data and see that the average age of death from testicular cancer is age 40. While this is yet another reason Lance Armstrong (and Hesychia, go you!) is awesome, it also brings me to the next question.

2) Are we getting cancer earlier?

Yes. No. Maybe. Nobody really knows.

Look, 50 years ago -- hell, 30 years ago -- a lot of cancer cases got diagnosed right about the time there was nothing left to do but spend about 6 months in a grueling treatment program and then die. All the fancy diagnostic tools and screening programs we have today either didn't exist or were in their scientific infancy. So there's really no way to compare the data from a couple decades ago to the data we have today without a few very large grains of salt and some complicated equations trying to control for the enormous differences in diagnostic power.

Really, any epidemiology of cancer has one big problem: the better we get at diagnosing and treating cancer, the more people with cancer we have. Cancer, and other chronic diseases, have the perverse nature of being diseases where more people with the disease in the population can be an indicator that the population is actually healthier than before. In those ye olde tymes of last century I referenced, no one expected someone diagnosed with cancer to keep on chugging along for years and years. But again, looking at the most recent SEER data for 5-year survival rates (the industry standard measure) for breast and prostate cancer, they're 89% and 99%, respectively.

Cancer, all cancers, are easier to treat (I'll let someone else get in to the question of whether cancer is ever really cured, suffice to say that people in cancer treatment programs are generally in follow-up for the rest of their long and happy lives) when they're discovered earlier. With all the advances in cancer detection and treatment in the past few decades we do find cancer earlier and more people do survive, but in the epidemiologic data, that just shows up as more people with cancer for longer periods of time. So keep rooting for the age of onset to drop and the incidence rate to plummet, but don't get freaked out by a high prevalence in the meantime.
posted by Panjandrum at 8:45 AM on March 11, 2011 [8 favorites]

My mom died of cancer in 1971, oddly enough. I would have been more than happy had she lived 20% longer.
posted by tommasz at 9:52 AM on March 11, 2011

June 2005, 5-3/4 years ago diagnosed with Stage 3A garden variety Uterine Cancer and Stage 1C Fallopian Tube Cancer (very aggressive and rare, considered under the Ovarian Cancer umbrella). After major surgery then heavy duty chemo half a year, external beam and internal radiation for 3 months.

2008, 3 years ago diagnosed with Stage 3A Tall Cell Papillary Thyroid Cancer (very aggressive and rare). After major surgery, then mega radiation swallowed (Radioactive iodine 156 millicuries).

Not one, not two but three types of cancer. Yikes. Two of these cancers are late stage, two are rare, two are very aggressive.

The side effects of the chemo almost did me in, 4 aneurysms in 12 days, brain surgery.

Cannot count the CAT scans, X-rays, tests. Every two months another test to see how bad the recurrence of the thyroid cancer is. Am waiting now for this test's results. tick tock, tick tock.

And still alive and kicking. Right here on the blue. All of you here kept me fantastic company in every way. The blue is highly medicinal. :)
posted by nickyskye at 11:10 AM on March 11, 2011 [4 favorites]

Ehhhh.

Part of me knows that I need to go in and get a thing checked out but then the other part of me feels like he knows that its probably too late anyway and would rather live the rest of his life somewhat normally (and much less broke)

Not the thread I needed to see on this particular day, altho it is good news.
posted by Senor Cardgage at 11:11 AM on March 11, 2011

My dad had terminal cancer. He said he wanted to die within 5 years because if you live longer than that they count you as a "cancer survivor" for statistics purposes even if you die at 5 years and a day after diagnosis. He thought that was bullshit. Don't call them "cancer survivors" when they ultimately die from their cancer.

I suppose earlier detection does give them better "survival" rates, if only because it would increase the time between diagnosis and death. But that's really a cruel way to give false hope. We've had chemo since the 60s (yes there have been improvements), but the sad fact is the chances of surviving for most cancer patients hasn't changed much since then.
posted by banished at 11:29 AM on March 11, 2011 [1 favorite]

Yay, screening!
posted by Mental Wimp at 11:41 AM on March 11, 2011 [1 favorite]

I suppose earlier detection does give them better "survival" rates, if only because it would increase the time between diagnosis and death.

Yes, but mortality rates are decreasing significantly as well, meaning that some screening really is increasing survival rates. Some screening even decreases incidence rates. So, again, yay, screening.
posted by Mental Wimp at 11:47 AM on March 11, 2011 [1 favorite]

Yes, yay screening.

Although docs wince when a patient asks for a cancer blood test as it's not called cancer screening and there *may* be false positive results, there are blood test that can be useful. Had I been able to buy blood tests online, as one can do now, the uterine cancer I am surviving could have, I am convinced, been caught at a very early stage.

Life Extension Foundation blood tests to order online. Amazingly affordable.
posted by nickyskye at 12:13 PM on March 11, 2011

I'm hooked up to an apheresis machine right now. I am donating platelets at MD Anderson. While my mom does get credit for them, I donate because people need them and my 90 minutes is insignificant to the life of fear and uncertainty cancer patients face.

I like this post.
posted by polyhedron at 12:28 PM on March 11, 2011 [2 favorites]

Oh and my mom was diagnosed at stage 4. More screening please.
posted by polyhedron at 12:30 PM on March 11, 2011

Thanks so much for your kind generosity polyhedron. It's inspiring and brings me joy to know what you are doing for others.
posted by nickyskye at 12:31 PM on March 11, 2011

Life Extension Foundation blood tests to order online. Amazingly affordable.

nickyskye, as enthusiastic as I am about screening, the blood tests in that link have not been shown to reduce mortality or morbidity from cancer. CA125 is currently being studied in the PLCO trial and results are expected soon. The others have no trials currently ongoing. The reason for the skecpticism by some people and the unbounded enthusiasm of others for cancer screening is that there are benefits and costs from any screening and it is not axiomatic that either one will always predominate. That's why studies like the Minnesota Colon Cancer Control Study, the HIP Breast Cancer Screening Trial, the Canadian Breast Cancer Screening Trial, the PLCO Trial, the National Lung Screening Trial, the UK Sigmoidsocopy Trial, and the National Colonoscopy Study were all started. You need to know not only if deaths from the cancer can be reduced, but you also need to know if the harm that is done by the cost, inconvenience and morbidity from additional, often invasive, expensive, and painful examinations to follow up on positive screening tests outweighs that benefit. So far, only cervical, breast and colorectal cancer screening tests have been proven to be effective in large-scale clinical trials. Prostate cancer screening with PSA has little to no effect on mortality and sizable morbidity associated with diagnosis and treatment and is no longer universally recommended. As I mentioned, results on ovarian cancer screening with CA125 are pending, and the National Lung Screening Trial recently announced a 20% lung cancer mortality reduction as well as overall mortality reduction in heavy smokers and former smokers, but that study has not yet been published and negative effects have not yet been evaluated.

As a result, I would not recommend anyone wasting their money on the tests given in the links, even though they may be cheap. The harm could outweigh any benefit, and there may not be any benefit. Keep getting Pap smears (or HPV tests), mammography, and colorectal screening (fecal occult blood test, sigmoidoscopy or colonoscopy), if you are at risk.

(I have now removed my public health hat and put it back on the rack in the corner for another day. As you were.)
posted by Mental Wimp at 12:55 PM on March 11, 2011 [1 favorite]

My two year old was diagnosed with cancer at age 20 months, last November. It was caught the old-fashioned way, by a concerned GP with a particular aptitude for an odd constellation of symptoms. Her treatment has been rigorous, and we are yet to start the last stage of mega-dose chemo plus stem cell re-transplantation. The knowledge about the fairly rare cancer she has, the knowledge of its treatment, and the international networks of consultation and knowledge sharing are magnificent to behold.

It is also amazing, and less commonly commented on, to see how many solutions and remedies they have for the side effects of the chemo - both on the short term and long term scales. We know there are some very upsetting long term side effects that are more likely than not, but luckily everything so far from surgery to monitoring MRIs has gone as well as it possibly could have.

Anyway, though I will never witness it, I fully expect her to celebrate being an eighty year cancer survivor and this post helps sustain that belief!
posted by Rumple at 3:02 PM on March 11, 2011 [1 favorite]

middleclasstool: "This is colorectal cancer awareness month in the US. If you're middle aged or older and haven't gotten your butt scoped, make an appointment. Your ass will thank you"

My boss made me well aware last Friday of this by declaring after his doctor appointment "The doc said I have an asshole of a 20 year old."

Yeah. Thanks. I needed that image in my head.
posted by symbioid at 4:11 PM on March 11, 2011 [1 favorite]

Part of me knows that I need to go in and get a thing checked out but then the other part of me feels like he knows that its probably too late anyway and would rather live the rest of his life somewhat normally (and much less broke)

Ah, but that's putting it backwards. Earlier detection of cancer means a greater possibility of treating it in such a way that you be able to live the rest of your life normally (and that "the rest of your life" is longer, rather than shorter).

I'm nearing the one-year anniversary of my diagnosis of colon cancer (which was a big surprise to my docs, given my age, good diet, and lack of colon cancer in my family history). The fact that they caught it at Stage II, rather than stage III or IV in a couple of years means a MASSIVE difference in terms of both prognosis and treatment. Now, treatment has by no means been a walk in the park: 5 weeks of chemo/radiation, then 2 surgeries, then 6 rounds (approx. 3 weeks each) of chemo. My prognosis, after all this, is very good -- my likelihood of surviving 5 years (to use one of the many metrics) is well into the 80-90% range. Once treatment is over, I can pretty much plan on going back to a normal life within another few months.

Contrast this with the treatment for stage III or IV, which can mean additional weeks or months or radiation, additional surgeries, and additional months or even years of chemo or (failing that) experimental treatments -- all of that additional grueling treatment for a less favorable prognosis, and the possibility of a permanent disruption of "normal life."

Catching colon cancer at stage I is even easier: they simply remove the polyp and, in most cases, you're basically good to go.

So yeah, it's certainly your choice if you don't want to get screened. But if you really do wind up with cancer, it's not going to be any easier or cheaper to catch it later rather than earlier.
posted by scody at 6:47 PM on March 11, 2011 [1 favorite]

as enthusiastic as I am about screening, the blood tests in that link have not been shown to reduce mortality or morbidity from cancer.

I presume that's because doctors do not encourage people to get them, in spite of how affordable they are.

Ten or more years ago I tried to get a CA-125 test as a screening test for gyn cancer but no doctor would give me a prescription for the test. Now, one can buy the test online for little money.

The Life Extension company offers the tests to people who *already have* cancer. But if I'd had these tests available years ago I'd have taken a couple of the tests, the CA-125 and the CEA tests as I have a mammogram every year. Mammograms are not perfect tests either. I had one and was told -incorrectly by the doctor, a noted breast specialist/surgical oncologist here in NYC that I had a breast tumor that needed removing. Wrong.

Right before the first cancer surgery the CA-125 test result was something like 581. the normal range is 0 to 37. Had I gotten that test I believe I could have caught the cancer at a *much* earlier stage because gyn cancer often has no symptoms that are visible. I'd had my regular gyn check-ups, had Pap tests and no doc detected the gyn cancer.

When I suspected the lump on my neck was cancer, my gyn oncologist pooh poohed my concern. I went on my own to a head and neck oncologist and asked for a biopsy. It was by accident that I then found out I had thyroid cancer because the lump was just an inflamed lymph gland.

Had I had a thyroid blood test of any kind the thyroid cancer could have been noticed.

What's the harm in getting a blood test and discussing the result with a doctor?

Would it not be better to once in a blue moon get a false positive, then follow up with a biopsy or further testing than let any cancer grow to late stage because it is isn't detectable by a gyn check-up?

Cancer is much more treatable at an early stage than late stage. I think the risks of false positive are far outweighed by the benefits of knowing about having cancer as early as possible and treating it.
posted by nickyskye at 8:13 PM on March 11, 2011

Senor Cardgage, if you're in NYC and need company to go get a checkup I will accompany you. Please go asap. It's worth it.
posted by nickyskye at 8:17 PM on March 11, 2011

Thank you NickySkye for reminding me to state this: If you or someone you care for has cancer in the Atlanta (or surrounding) area, please MeMail me. I know no small amount of amazing Oncologists at an NCI recognized cancer center, and by "know," I mean I have them by the administrative balls.
posted by Panjandrum at 9:32 PM on March 11, 2011 [1 favorite]

These numbers are even more impressive than they sound like given that the sample excluded "Persons who had diagnoses of in situ cancer or nonmelanoma skin cancer." My gooogling shows that "in situ cancer" is cancer that has not spread. So these are on only survivors among people whose cancer had spread? All those people cured before it spread aren't even counted. Presumably there are lots of those, too.
posted by If only I had a penguin... at 9:19 AM on March 12, 2011 [1 favorite]

I presume that's because doctors do not encourage people to get them, in spite of how affordable they are.

No, nickyskye, it's because no one has done careful studies to determine whether they are beneficial yet. I tried to illustrate with the links I provided the types of studies that need to be done to determine whether screening is beneficial or not. I wish it were as easy as you suggest. It's more than just a matter of cost or whether doctors recommend it. Real harm can be done when a false positive can lead to life altering complications for someone who otherwise would never have had any problems. Prostate cancer is a good example. Although many prostate cancers are killers, at least 20% and maybe as high as 50% of them will never hurt the person who has them. When such a person is screened and undergoes diagnosis and treatment, they can end up with fecal and urinary incontinence and impotence, and may have intractable pain for the rest of their lives.

One of the problems is the reluctance of the NIH to fund large-scale trials to determine whether screening is effective. They are very costly, but they have huge impact on not only health but the cost of health care. It took over a decade to get studies of PSA screening done, after it was already entrenched as common practice. The amount of money that was wasted on tests and the harm that was done is tragic. This is backwards. If a new test comes along for cancer screening, the first step should be to institute a randomized trial to see if it reduces mortality and to measure the amount of harm to be sure the balance is right. People are still arguing about breast cancer screening in women below the age of 50, because these trials failed to consistently show a benefit and showed considerable harm. You can't just assume that any test someone thinks up is beneficial, regardless of cost or prior beliefs about the curability of disease detected early.
posted by Mental Wimp at 1:48 PM on March 12, 2011 [1 favorite]

You can develop the technology to bring a camel to water...but you may not be able to get it to stop smoking.

You aren't kidding. My mom's cancer came back over the holidays (what a lovely present...) and since then I've been driving her to the treatment clinic a couple times a week for chemotherapy. The treatment takes about 2-3 hours and I usually sit outside and work on my laptop. It seems about 80% of the people that come out of the clinic light up a cigarette. It's just baffling to me.
posted by the_artificer at 12:06 AM on March 13, 2011