> "However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies."
What that means is analytical body-burden data collection should be a medical norm, for a variety of substances: polychlorinated biphenyls, triazine herbicides (atrazine), industrial solvents like trichloroethylene, brominated fire retardants, nitrosoamines, plastic-sourced phthalates, perchlorates, hydrazine, hexavalent chromium and so on.
Collecting such individual data via blood & urine samples (possibly fat biopsies & breast milk as well) on a yearly basis should really be part of a standard medical checkup procedure. That would provide a dataset which could be used to address that question.
This is hardly a new proposal, for example see this 2001 PBS report, in which journalist Bill Moyers got his body burden test results:
The results are not unusual. Each of us has some load of industrial chemicals stored in or passing through our bodies. These chemical residues – termed the "chemical body burden" – can be detected in blood, urine and breast milk.
Coronary calcium deposit scans are cheap and extremely effective at giving a probabilistic window of possible future heart attack, but doctors don't order them prior to a CVD event, and insurance doesn't cover them as a pre-CVD elective.
Instead we're told: We have no way of knowing if or when you'll experience infarction, it's one of God's Great Mysteries. Just don't eat eggs and pray.
You're absolutely right, but the entire medical industry has no intention of actually reducing mortality. It's a cash grab from top to bottom, and preventative monitoring of the kind you suggest already has precedent in coronary calcium scanning. It's not going to happen if it reduces the overall predicted revenue per patient.
In the same way that a single triple-bypass surgery is far more lucrative than a hundred coronary calcium scans, a full course of cancer treatment is absurdly more profitable than regular tissue carcinogen testing.
If you avoid smoking, have a healthy diet, get adequate exercise and consequently maintain a healthy weight you’ll do far more to prognosticate your MI risk than a calcium score.
Is this even worth doing when people are still smoking, drinking alcohol, living in polluted areas and eating red meat? These are all known risk factors with large effects on cancer risk in younger people.
> still smoking, drinking alcohol, living in polluted areas and eating red meat
One of these is not like the others. I can decide to not smoke, not drink alcohol and not eat red meat. It is a personal choice, and my choice doesn’t affect the health outcomes of those around me. (Mostly. Second hand smoke is a thing, but we did a lot society wise to act against that.)
On the other hand living in poluted areas is absolutely an economy thing. People don’t live in polluted places because they love the sweet buzz it gives them. They live there because by far and large that is the place they can afford to live at. And these areas are not polluted because god made them so. They are mostly polluted because industry or transportation polluted them.
In other words rich people polluting poor people. (By and large.)
I find it very interesting that you choose to ignore the one cause people can’t do anything on their own, and choose to formulate policy proposals against the ones they can.
Well people can certainly move to some extent. Nobody with functional brain considers metropoles to be healthy place to live. People stay there mostly for the money, I know I do and I accept the risks (and working on improving the situation).
Moving to mountainous/overall remote regions is relatively cheap. But people like easy life, close work, shopping, services and so on.
Smoking and alcohol are unfortunately too convenient as coping mechanisms go. A stimulant-anxiolytic to keep you going through a shift, and a sedative to slow down and stay numb. And they (nicotine especially) feel just too effective—at the start before you build up dependence at least.
Lifestyle modification can only go so far when the stress of living remains high. Swap the burnt stuff with something that puts less tar in your lungs, maybe, but any further is… sigh.
has smoking, drinking, and eating red meat gone up in the past several decades? because, according to the first sentence of the abstract early onset cancers have gone up in the past several decades.
In a practical sense, if you do not track something, you have no way of knowing whether it has an impact and whether it outweighs currently known carcinogens. And why immediately go after something people actually willingly put in their bodies as opposed to something that ends up there... somehow?
It would be nice to have this information to see if any trends are discovered (all of this is theoretical, I question whether measuring excreted compounds rather than stores is is relevant but that’s a separate point) however it is unclear what value this information will provide and seems unlikely it will generate anything actionable.
With that in mind, it’s hard to justify the colossal costs that would be involved in administering such a program. Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated.
Annual urinalysis is not indicated as part of the general work up for patients of any age, so this would be adding a whole extra step in specimen collection and not just adding on a test.
Healthcare is generally a zero sum game and if we divert $ and lab resources to something like this that means other tests and procedures are not being done.
A small prospective study as the authors suggest would be interesting, yet still expensive. It’s a huge stretch to say everyone should be getting this and ignores the harm that this would cause.
Hmm, you could use that argument to dissuade all of scientific research. Science is zero sum, if we devote resources to it then you are taking them from someone else!
But at the end of the day we all know there are significant potential benefits to this type of testing. Not only that, more demand can increase jobs & labs in the first place.
Just because the system is dysfunctional is not a good argument for ceasing progress.
Suggesting we perform niche lab examinations annually on the entire population is not scientific research, that’s jumping straight into a screening program.
Such an initiative would require more lab resources than currently exists in the US.
I’m questioning whether this is the best use of $100-200 billion a year. Instead, I suggested a small study (appropriately powered) to further investigate.
> But at the end of the day we all know there are significant potential benefits to this type of testing. Not only that, more demand can increase jobs & labs in the first place.
But at the end of the day we all know there are significant potential benefits to [testing cars every year]. Not only that, more demand can increase jobs [in testing centres] in the first place.
The question isn’t whether there are benefits. It’s whether the benefits exceed the costs. You need to actually measure those to find out. You can’t just assume it. Jobs in testing centres and labs are not a benefit. If they are doing useless work they don’t just cost money. They cost the potential output from the jobs those people could have done instead. The TSA doesn’t just massively inconvenience millions every year to almost zero benefit. It also wastes the labor of tens of thousands of people who could have done something better and more useful with their lives.
The reason is that many medical tests have high false positive rates, and the follow procedures have side effects (sometimes). When you administer tests and followups at population scale for a disease with a low prior probability you will do more harm than good, on the average.
An annual physical exam isn’t really powered to detect cancer in the modern world, it’s a relic from the past.
If you develop cancer in your 30s (sadly too many people) a physical exam or blood test almost certainly wouldn’t have made the difference.
We have mammograms for breast cancer and women > 40. Unfortunately there isn’t enough evidence to support a screening program for people younger than that where the pretest probability for malignancy is so low and there are harms associated with tests.
> Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated.
I am sorry for whatever happened/happens to your mom. That being said, when looking at cold hard data, this is a valid point.
We all have various weird stuff in us, the older the more. Cystes, weird bulges, benign cancers that wont kill us for 50 years. If you are a male say above 40 or 50, you probably have some very early (or not) prostate cancer.
Often you need an invasive procedure to get more info. Even then its quite often not 100% clear if surgery is overall safer and better than keeping and monitoring.
We like this idea of omnipotent medicine but its a pipe dream. Difficult procedures are extremely expensive regardless of location (US stands apart as always but still a valid point), and even ignoring price there simply isnt enough staff/equipment. Covid and often selfish clueless people certainly didnt help.
Medicine tries to fix as much as it can, which is mostly not enough. The hard part is accepting that when it becomes about a close one. There is no easy solution.
Source: wife is an emergency/gp doctor, went through this countless times. And much worse, even smart people become completely irrational, cruel or selfish very easily in such situations.
>I question whether measuring excreted compounds rather than stores is relevant
I would have to figure that chemicals sitting in fat cells that rarely divide are probably not causing cancer. Cancer occurs mostly in epithelial tissue; in my case, the germ cell. Excreted compounds are probably a better measure of actual blood levels. I'm not a nephrologist or anything, though.
>A small prospective study
will almost certainly find nothing, because the rate of early-onset cancer is too low to detect changes in a small population. You probably need >100k participants to have a good chance of finding anything.
>it is unclear what value this information will provide
I mean, that's the billion-dollar question, isn't it? Should probably try to control for obesity first, it's the most obvious candidate (changes since 1990, so not, e.g., smoking), but it certainly wasn't my problem (BMI 21).
> Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated.
> Collecting such individual data via blood & urine samples (possibly fat biopsies & breast milk as well) on a yearly basis should really be part of a standard medical checkup procedure
No so long as sickness is so profitable. The incentives aren't there like you would think.
It's not so much that sickness is profitable as the abject laziness and refusal to properly dispose of chemical byproducts in industry, as that costs money which hurts the bottom line. This is absolutely rampant worldwide and governments are corruptly influenced to look the other way to more or less degree depending on the country you are in.
I disagree with the comment you are replying to, but I also disagree with yours too.
Healthcare is crazy profitable. Insurance companies, healthcare providers, suppliers etc form a decent chunk of most western economies, the US of A in particular.
~40% of is spent on “External service providers” out of ~$2B budget by my local public health board. So there is leeway for private profit in public health in my country at least. https://www.cdhb.health.nz/wp-content/uploads/d682178a-cante... See page 79 of PDF or page 71 printed (note about ~50% of budget is for personnel)
Invasive biopsies in common medical screening? Yeah, that just isn't gonna happen. Nobody is going to test for any of those chemicals either due to the huge cost and questionable benefit.
What that means is analytical body-burden data collection should be a medical norm, for a variety of substances: polychlorinated biphenyls, triazine herbicides (atrazine), industrial solvents like trichloroethylene, brominated fire retardants, nitrosoamines, plastic-sourced phthalates, perchlorates, hydrazine, hexavalent chromium and so on.
Collecting such individual data via blood & urine samples (possibly fat biopsies & breast milk as well) on a yearly basis should really be part of a standard medical checkup procedure. That would provide a dataset which could be used to address that question.
This is hardly a new proposal, for example see this 2001 PBS report, in which journalist Bill Moyers got his body burden test results:
https://www.pbs.org/tradesecrets/problem/bodyburden.html
The results are not unusual. Each of us has some load of industrial chemicals stored in or passing through our bodies. These chemical residues – termed the "chemical body burden" – can be detected in blood, urine and breast milk.