Early Detection: better late than never

Here is the scariest image in all of cancer:


Graph from Fortune Magazine article.

It’s cancer’s inconvenient truth that despite the trillions (with a “t”) of dollars  spent trying to cure it so far, there has been no statistical progress on that goal.  And don’t let the recent headlines fool you, most of the “progress” can be attributed to overall decline in smoking.

That’s one of the reasons why early detection has taken a front seat after many years of getting short shrift.  This month’s Wired Magazine cover story is all about “Why Early Detection Is the Best Way to Beat Cancer”.   There is another reason for the ascendancy early detection too though: the explosion of technology that makes it possible, including medical imaging, gene sequencing and other biotech.

The Wired article highlights the paradox of early detection which is that by looking you find all sorts of tumors and “growths” that may never become problematic.  What’s more is that you can do more harm than good in those cases by treating every irregularity you find as malignant.  Still, I believe the potential for good with early detection far outweighs the negatives and we should strive to detect and understand as much of what’s going on in the body as possible, simply as a matter of course in healthcare.  It is important though to keep in mind some basic truths as we ramp up our quest to peer into the nooks and crannies of our bodies in search of cancer:

  • Just because you detect, doesn’t mean you have to intervene. Sometimes it’s better to simply keep vigilant watch, as hard as this may be for both doctors and patients, who understandably are inclined to “do something, do anything” rather than “do nothing”.
  • Analysis and theory are critically important complements to detection. The amount of data we gather will be overwhelming, and has the potential to be worse than useless.  That is, unless we can successfully organize it into a framework for understanding what’s going on, both in the individual patient, and in general.
  • Scientific understanding is shaped by the tools we use to measure. This has two important implications: (1) we need to be careful in our analysis and in constructing theories not to be lulled into a false sense of understanding by our tools — i.e. not every problem is a nail just because you have a hammer; (2) in searching for deeper truths about cancer, we have choices as to what tools/technologies we utilize and develop — we can’t afford to allow our favorite toys, or lack of imagination, or lack of courage dissuade us from building the ultimate tricorder.
  • It’s not just about cancer. By looking without prejudice and developing new detection technology of all sorts, we will undoubtedly unlock mysteries other than cancer too.  If we are going to get hung up on a giant mystery, let’s not make it cancer, let’s make it health in general.