Comment by xupybd
Comment by xupybd 4 days ago
I hate and fear cancer so much.
Why does it seem like so many are dying of cancer :(
Comment by xupybd 4 days ago
I hate and fear cancer so much.
Why does it seem like so many are dying of cancer :(
Was this a well-corroborated and fact-based opinion, or was it off-the-cuff and handwavey? Podcast answers aren't always totally reliable.
But you mention "the average person," which is really the crux of the matter. Cancer strikes perfectly average people, oftentimes in their 30s or 40s, and hands down death sentences at random. A bad roll of the dice. A stray cosmic ray hit a dividing cell. Who knows? That is what is scary.
Eliminating cancer may perhaps only increase the average lifespan by three years -- though I have my doubts -- but what's much more important is that it would cut down tremendously the number of premature and random-seeming deaths in the prime of life.
The thing is that we are led to believe that cancer just strikes at random, and anecdotally we know of someone that never smoked to get lung cancer that spread everywhere to strike them dead.
Yet we also know it is not quite like that. If you smoke, drink, make sculptures out of asbestos dust, eat processed meats, shoot depleted uranium rounds down at the range and work with radium in a gun sight factory then you probably have stacked the odds.
Now imagine you have an identical twin, maybe not cojoined, but living with the exact same stacked odds. However, you eat a strict diet of highly processed foods and only play tiddlywinks for physical activity. Meanwhile, your twin rides eats a strict diet that is mostly whole food, plant based and gets a lot of physical activity due to a passion for dancing.
One of you is going to be likely to suffer a cardiovascular event before the other and that same person is going to run the risk of catching cancer first.
Now we all know that eating processed foods, maybe with the exception of processed meat, isn't going to 'give you cancer' and neither is playing tiddlywinks. Equally, a few extra antioxidants and a bit of fibre from eating a few more carrots isn't going to spare you from cancer, neither is dancing for that matter. Nonetheless, cardiovascular and gut health is important for reducing cancer risks.
I say this with anecdotal evidence provided by a car dependent relative that chose not to eat a fibre rich diet and now has cancers that I would not wish on anyone, with his digestive tract having to be trimmed from the far end due to cancer.
Because he took the medical route with meaty pies and moderate alcohol levels, his life might only be cut short by three years. However, by then, there will be two decades of extreme medical interventions and a smorgasbord of medications that have to be taken daily. Lifespan is not as important as healthspan and there is much we can do through diet and physical activity to maximise healthspan.
The trouble with my relative is that advice to go absolutely teetotal, stay off the processed meats and to eat fibre (as in vegetables) was not a message that was well received. This advice is in line with WHO recommendations but this can be simply ignored once lifestyle choices have been decided on.
This is getting scarily close to “most people who get cancer only have themselves to blame” which can be a comforting thought if you’re putting in a lot of effort to reduce your own risk of cancer but at the end of the day it’s not true and kind of a shitty thing to say when we’re commemorating someone who fell victim to this horrible disease.
Reduce the odds it’ll get you too as much as you want, you’re wise to do so, but keep in mind it can still get you too and it is never somebody’s own fault.
More importantly, you can (almost) never say that if a cancer patient had done this and that or not done such and so they wouldn’t have gotten sick. You just can’t know and even if you did it’d still be a shit thing to say.
> Yet we also know it is not quite like that.
Oh, come on.
Even if you're correct and cancer is not completely random but rather has clear causative factors, a lot of those factors -- perhaps the majority -- are uncontrollable.
Radon exposure. Naturally occurring radioactive isotopes or beryllium in your vegetables or water. That virus you fought off a few years ago. That course of cyclosporine you once took. That cosmic ray from the Andromeda galaxy that happened to hit you and scramble some DNA. Many, many other factors. Cancer strikes in ways that seem truly random because many or most of its causative factors have absolutely nothing to do with lifestyle choices.
Maybe looking at the average is the wrong thing to do. People who die from cancer can be robbed of a lot of years. A couple of other recent cancer deaths I saw on HN:
Walter Ehmer died at 58 https://news.ycombinator.com/item?id=41490388
Jake Seliger was also known on HN died around 40: https://news.ycombinator.com/item?id=41201555
I find those estimates believable in a narrow interpretation of the question - i.e. if we solve cancer but change nothing else. I would expect a longevity M.D. to understand the spirit of the question and answer accordingly, though. I'm curious which podcast / doc this was?
It's true that solving cancer, heart disease, and even all other similarly deadly diseases, would not automatically mean humans living indefinitely, because there's still cellular senescence to contend with.
Fortunately, we've effectively solved senescence (or at least it seems we're well on our way). Check out the picture of the twin mice from David Sinclair's lab (https://sinclair.hms.harvard.edu/research) - it's hard to believe the two mice were born at the same time...
And if I recall correctly, they didn't even do any sort of telomere modification in that study either... Don't quote me on that. But telomeres are another potent avenue towards >10x extension of life span, and also as it turns out, fairly trivial to lengthen and thereby allow a cell to continue mitosis indefinitely.
The problem to solve is cancer, though. Telomeres limit the number of times a cell can divide by design, and seemingly the purpose of limiting division in the first place is to mitigate risk of developing cancers.
This sounds surprisingly short. Surely the average person with cancer isnt going to live just three additional years?
Went and did a brief lookup (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710558/) - life expectancy is reduced by at least 3 years, even for the oldest patients, and increases significantly as age at diagnosis goes down.
I suppose from the perspective of an 80 year old, curing cancer would in theory increase life expectancies by ~ 3 years, though I wonder how many people die of "old age" but have an undiagnosed cancer of some form contributing.
It's because of the Gompertz mortality law [1]--the probability of dying at a certain age is exponential. If you assume that the mortality of each age-related terminal illness itself follows the Gompertz law, then eliminating any one of those illnesses won't affect the overall life expectancy much, because exponential growth is so powerful. Even if we had cures for all age-related diseases except, say, Alzheimer's disease, the fact that Alzheimer's disease mortality also follows the Gompertz law (probably a reasonable assumption) would lead to lifespans not dissimilar from our present ones.
Essentially, in order to achieve dramatically longer lifespans, we would need to eliminate, or at least significantly slow, all aging-related causes of death.
[1]: https://en.wikipedia.org/wiki/Gompertz%E2%80%93Makeham_law_o...
Keeping the body alive is a low bar.
Lost quality-adjusted life years would be a better measure. Many people survive for many years with cancer, but the quality of life drops significantly.
Most people don't have cancer, so the average lifespan reduction of everyone is going to be quite a bit lower than the average lifespan reduction of people diagnosed with cancer.
My total guess(!) is because relatively few people lose a large number of years to cancer, due to both the median age of diagnosis and long term survival rates of some common cancers being high? (For example, breast cancer has a 75% 10 year survival rate with a median age of diagnosis of 62. Bowel cancer is about 60% and 71 respectively.)
Three years would be an amazing amount of precious time with a loved one. I know this.
This reminds me of a video I saw on HN yesterday: https://www.youtube.com/watch?v=CJkWS4t4l0k
The problem of controlled cellular growth in a multicellular organism is a really hard problem that evolution has spent billions of generations on, and any cell in any of the dozens of systems that keeps the human body going can potentially escape the normal cell cycle control process and go out of control, leading to cancer. (edit: the fact that so many people lead full lives without coming down with cancer is more remarkable from this view, it's one of the miracles of life).
While the ability to treat cancer using modern technology (especially if it is detected relatively early) has made vast advances, we're also surrounded by and exposed to a wide variety of molecules that can, especially in high concentrations, inflict damage on the cellular control system (a whole lot of proteins, nucleic acids, lipids, cofactors, etc.) and while that damage may be somewhat random in nature, if it happens to hit a key sequence in the cell control DNA you get a cancer cell. You can greatly reduce the prevalance of such carcinogenic mutagens in the food, air, water and soil with suitable regulations but this cuts into profit margins for the producers of various commodities and products who in turn lobby governments to eliminate said regulations (which to be fair may not have been well-designed or implemented).
Yes there are genetic factors which may increase one's cancer risk but these are very complicated and often overemphasized by those who dont't want to see clean air, water, soil, food etc. regulations implemented.
> ...a really hard problem that evolution has spent billions of generations on...
I think it's worth noting that this isn't evolution's "goal". We just need to produce offspring and give them a good start in life such that they are competitively successful. Beyond that, evolution doesn't care.
Even for that, there's a budget. If it's not economical over letting us die and not taking valuable resources from our offspring, then evolution also doesn't care.
That could suggest why longevity in humans (or primates ) was under active selection, as they put a lot of effort into raising the children so you'd expect that cancer in younger people would result in the death of their children, so evolution selects for robust anti-cancer systems (like the human immune system, which is relatively good at detecting and eliminating cancer cells as well as pathogenic bacteria, etc.).
These explanations are however always a bit hand-wavy, eg why do galapagos tortoises live to 150 when they don't seem to do much parental investment?
Because if nothing else gets you, cancer risk rises as you get older. At some point it gets you, I guess.
Yes, a few types are basically a numbers game. We're continuously successfully not getting them every day. But the longer we live and not die of other things, the higher chance there is of losing that game. And we're actually getting quite good and not dying of other things.
Then again, cancer treatments and vaccines are progressing recently, so that's good news.
This sounds good, but it can't be right. There are animals that live centuries. Greenland sharks may live up to 500 years, for example. There are trees that live millenia.
Turns out they have lower mutation rate which helps them. Their chances are much lower, but still not zero. https://www.monash.edu/news/articles/sharks-cancer-secret-al...
I don't think prolonging the life in a biological body is going to be the winning route. We will have to Star Trek it up and transfer our consciousness to computers. That, or replace parts, maybe even the entirety of our bodies with a machine that can be maintained and repaired rather than age.
You become a lot more aware of it as you get older, and what you see to some degree depends a lot on your socioeconomic status. A big part of it is that we've made so much progress when it comes to heart disease. Most people who go to my hospital are on public insurance, and they're dying more frequently from lifestyle-related diseases (like T2DM which leads to hypertension, chronic kidney disease, and congestive heart failure)
https://www.clubvita.net/us/news-and-insights/top-charts-23-...
Cancer (outside behavior related cancer like lung cancer) is on the rise.
In spite of better treatments, a twenty year old today is more likely from cancer while in their twenties than at any time before. Each younger age cohort has an increase risk of cancer, and at younger ages.
Cancer deaths overall are still going down though, as the smoking generation still alive goes out.
I have two people in my direct circle get and have stage4 lymphoma and adult leukemia this year at the time of their initial diagnosis. Does seem like it is on the rise from my perspective.
TL;DR: Because today, people are regularly living long enough to get it. It's often a good sign to have higher cancer rates -- societies with higher cancer rates are richer, happier, and live longer than those with lower cancer rates.
I mean, cancer is bad. But it's a good sign for society if lots of people die of cancer -- they tend to hit the elderly. Historically, about 80 percent of people who die of cancer are over 50, and that's fairly constant. (Interestingly, the share of cancer deaths that are in people over 70 have been rising, from about 36 percent to 49 percent - that's as a portion of the total.)[1]
The ranking for prevalence of cancer is higher income countries, upper-middle-income countries, lower-middle-income countries, and finally with the lowest rates low-income countries. Since the world is getting richer, it stands to reason that it's likely there will be higher cancer rates (of course, it's not guaranteed; it's possible being European makes you more likely to get cancer, which would explain the higher rankings of high-income countries, which are often European, but not lead to higher numbers elsewhere).[2]
This is borne out individually. Countries with the lowest rates of cancer tend not to be great places to live. Our World In Data has three countries[2] tied for the lowest cancer rates (0.1 percent), Niger, Chad and Benin, which have life expectancies of 62, 53, and 60[3][4] and had happiness scores (self-reported life satisfaction) of 4.56, 4.47, and 4.38 (out of 10; for reference, the world average is 5.27, with numbers for individual countries ranging from 7.74 to 1.72) respectively.[5] The full list of countries with a prevalence of cancer below 0.5 percent is as follows: Niger, Chad, Benin, Gambia, Somalia, Sierra Leone, Mali, Yemen, Democratic Republic of the Congo, Central African Republic, Cote d'Ivoire, Burkina Faso, Burundi, Liberia, Angola, Guinea, Cameroon Guinea-Bissau, Nigeria, East Timor, Tajikistan, Mozambique, Senegal, Togo, Papua New Guinea, Afghanistan, Ethiopia, Madagascar, Oman, Sudan, Nepal, Kenya, Mauritania, Maldives, Bhutan, South Sudan, Ghana, Vanuatu, Equatorial Guinea, Bangladesh, Tanzania, Solomon Islands, Sao Tome and Principe, Eritrea, Malawi, Rwanda, Laos, India, Uganda, Pakistan, Uzbekistan, Djibouti, Congo, Botswana, Zambia, Kiribati, Lesotho, Algeria, Gabon, Mongolia, Eswatini, Morocco, Comoros, Honduras, Haiti, Samoa, Zimbabwe, Guatemala, Turkmenistan, Myanmar, Kyrgyzstan, Marshall Islands, Namibia, Philippines, Egypt, Cambodia, Indonesia[2]
The happiest of those is Guatemala, at 6.29, and a prevalence of 0.4 percent. But most of them are much less happy. To take a random example (I used random.org to randomize the list and chose the top one and the top six, excluding Sao Tome which had no happiness data), Uganda is at 4.37, and the average of Uganda, Comoros, Turkmenistan, Yemen, and Bhutan is 4.41, nearly a point below the world average.
Life expectancy is no better; again doing Uganda, Comoros, Turkmenistan, Yemen, and Bhutan, Uganda had a life expectancy of 62.7 years, and the average of them is 66.2, almost 5 years below the world average of 71 (range of typical life expectancy is from 85.9 to 52.5).
Okay, so life expectancy and happiness are both lower for countries with lower rates of cancer, seemingly. What about those with higher rates?
Well, those with cancer rates up to or including 3 percent are as follows: Monaco, Bermuda, Italy, France, Netherlands, Finland, Germany, United States, Australia, New Zealand, Japan, Denmark, Portugal, Greece, Croatia, Spain, Estonia, Canada, Norway, Andorra, United Kingdom, Slovenia, Belgium, Iceland, Switzerland. Monaco comes in at the top, with 5.9 percent with some type of cancer.
Monaco has a life expectancy of 85.9 years, the highest. In the world. There was no happiness data available for it or the runner-up Bermuda, but Italy ranked itself at 6.32.
Of the top five countries in life expectancy that show up on the cancer list at all (Monaco, not Hong Kong or Macao, Japan, Australia, Switzerland, Malta), all of them but Malta show up on the list, and Malta just misses the cutoff (2.9 percent). In happiness (Finland, Denmark, Iceland, Sweden, Israel), Sweden and Israel aren't ranked. Sweden just misses the cutoff at 2.9 and Israel is at 1.6 percent but has a notably much younger population than any of the others.
Again using random.org and taking the top one and then the follow-up four, Monaco came in at number one (data already covered and missing happiness, so excluded), followed by the US, Switzerland, Iceland, Australia, and Italy. The US has a life expectancy of 77.2 years. The average for the five is 82.26, so if it were a country it would be number 21 globally and over TEN YEARS above the world average of 71, above even the Oceanian average (the highest) of 79.4; for happiness, the US is number 18 worldwide excluding ties, ranking itself at 6.72; the average is 6.938, meaning if it were a country it would come in number fourteen including ties and almost two points above the world average of 5.08.
[1] https://ourworldindata.org/grapher/cancer-deaths-by-age
[2] https://ourworldindata.org/grapher/share-of-population-with-...
[3] Rounded to the nearest whole number
[4] https://ourworldindata.org/grapher/life-expectancy
[5] https://ourworldindata.org/grapher/happiness-cantril-ladder
On some podcast a longevity doctor asked the host to estimate how much longer the average person would live if we eliminated/cured cancer.
The answer was about three years. Eliminate heart disease? Another three years. Eliminate both? About five years.
https://en.wikipedia.org/wiki/Memento_mori