Dr. Prasad, can you please address the frequency of dermatologists identifying basal cell carcinoma and whether this "cancer" should be removed? I had a very young and eager PA take a biopsy of a spot I couldn't even see, left a pretty big scar and then, of course, was told it was BCC and I needed a full excision. It just feels excessive to me. But, they try to scare you into thinking it's going to kill you if you don't have it removed.
I would love a layman’s explanation why all cause mortality is the best measure. as you stated, the disease signal gets lost in the absolute numbers of death.
As a radiologist I acknowledge that I have probably been indoctrinated with the bias that imaging-based screening saves lives. But I still tend to agree that the criteria to determine cancer screening effectiveness should be cancer- specific mortality, not all cause mortality. And probably even cancer specific quality-adjusted life years. As an analogy, has mandated seatbelt use ever been shown to decrease overall all-cause mortality rates over a 5-10 year period (which seems to be the follow up period for most cancer screening studies) with statistical significance, as opposed to just traffic-specific fatality rates?
so in other words since some patients can't be cured we should not bother detecting or treating the ones that can be. It seems there is something about getting a medical degree that results in people not being able to distinguish between screening, diagnosis and treatment. This is just information, and I don't need another gatekeeper to tell me what I don't need to know. https://royse.substack.com/p/early-detection-and-ottoman-scribes?r=1v5bia
Dr. Prasad, can you please address the frequency of dermatologists identifying basal cell carcinoma and whether this "cancer" should be removed? I had a very young and eager PA take a biopsy of a spot I couldn't even see, left a pretty big scar and then, of course, was told it was BCC and I needed a full excision. It just feels excessive to me. But, they try to scare you into thinking it's going to kill you if you don't have it removed.
This is something I have been thinking about a lot too and would love to see an article addressing.
The “work on my car” article is one of your best…as is your “ duty” essay.
My thoughts: https://substack.com/@dfloramd/note/c-294945933?r=11bw2f&utm_medium=ios&utm_source=notes-share-action
I would love a layman’s explanation why all cause mortality is the best measure. as you stated, the disease signal gets lost in the absolute numbers of death.
As a radiologist I acknowledge that I have probably been indoctrinated with the bias that imaging-based screening saves lives. But I still tend to agree that the criteria to determine cancer screening effectiveness should be cancer- specific mortality, not all cause mortality. And probably even cancer specific quality-adjusted life years. As an analogy, has mandated seatbelt use ever been shown to decrease overall all-cause mortality rates over a 5-10 year period (which seems to be the follow up period for most cancer screening studies) with statistical significance, as opposed to just traffic-specific fatality rates?
so in other words since some patients can't be cured we should not bother detecting or treating the ones that can be. It seems there is something about getting a medical degree that results in people not being able to distinguish between screening, diagnosis and treatment. This is just information, and I don't need another gatekeeper to tell me what I don't need to know. https://royse.substack.com/p/early-detection-and-ottoman-scribes?r=1v5bia