Tell us the ugly truth then paint a happy picture.
“for one in six deaths around the world, killing nearly 10 million people a year globally and over 600,000 people a year in the US.”
A lot of reduced deaths come from less smoking and early detection. We will eventually get there but we need a lot more research.
Get a colonoscopy at 45. We are seeing a big increase in younger people.
https://www.cancerresearch.org/blog/colorectal-cancer-awaren...
> Get a colonoscopy at 45. We are seeing a big increase in younger people.
N.B. this is not just an increase in detection (as could happen with more/better screening where the true rate isn't changing), but mortality:
> In people under 55, however, death rates have been increasing about 1% per year since the mid-2000s. https://www.cancer.org/cancer/types/colon-rectal-cancer/abou...
It's certainly the case that colorectal cancer is becoming more common, and among younger people. Plenty of possible reasons; diet, plastics, PFAS, all of the above, take your pick.
However, the fact that mortality has been decreasing above the age of frequent screenings, and increasing below that age, tells us that whatever the problem, the symptom (cancer) could be addressed with better screening, leading to earlier detection and treatment.
Mortality is increasing in young people because they don't get screened, so when it does happened no one catches anything until it's too late.
If the age for recommended regular colonoscopies was 40 or 45, we would see the same mortality reduction above that cutoff.
> Plenty of possible reasons; diet, plastics, PFAS, all of the above, take your pick.
I think obesity is the main confounder in all such statistics. Thats the thing that has most markedly gone up over the past decades
You don't know that. Environment is much more polluted, and thus is our food. We move less. And so on.
Whose environment is much more polluted. In the developed world, pollution is decreasing. For the U.S., for example: https://gispub.epa.gov/air/trendsreport/2024/
That's showing that air pollution I would guess mostly from cars has gone down since 1990.
There are lots of other new chemicals not shown on that chart that are in our food and clothes and everything, particularly almost everything modern babies in the US come in contact with.
While PFAS and microplastics and the like are a huge problem, you can't just dismiss the major efforts done over the decades to reduce pollution and improve health; wood / coal fire bans, mandatory catalytic converters, ban on asbestos and CFCs, lead-free fuel and paint, EVs, renewable electricity generation, emission zones, trash collection & safe disposal, smoking bans and discouraging measures, etc. It's not an either/or, and not celebrating successes means there will be less inclination to also solve the newly discovered issues.
Fair points honestly. We tried a lot of awful stuff in the 1900s that has been stopped and that should be celebrated.
There's also a lot that was never stopped, and more and more coming all the time.
There is also a lot less toxic chemicals around nowadays such as flame retardants, DDT, lead (petrol), asbestos, PCB etc.
Obesity is a symptom; food poverty, financial poverty, lifestyle choices, city design, culture, etc etc etc.
This mindset drives me nuts. It's like the rhetorical opposite of victim-blaming. It takes something that is within an individual's locus of control and pretends they have zero agency in the matter.
Last week I finished a two month diet where a big chunk of my weekly calories and nutrients came from cheap staples I prepared myself (specifically brown rice, black beans, steelcut oats, spinach, and eggs).
Aside from the food, the cost was 1. watching some ads in the free version of the calorie counter app I used to make sure I was getting the nutrients I needed and 2. ~$30 for a food scale so I could be precise about what I was eating.
Circumstances make it easier to be unhealthy but what I did is attainable by the vast majority of obese people.
It's complicated because it's both, with varying levels of influence.
Obviously, it cannot be 100% on the individual. Because then, how did we get an obesity epidemic? Did people somehow, magically, become more lazy since 1970? That doesn't sound plausible to me.
It's systemic in nature. Consider tobacco use, a problem we've largely solved in the US. We went from something like 50% of people smoking in 1960 to about 10% now. In young people, the results are even more drastic. It's sort of magic - a reverse obesity epidemic.
How did we do this? A combination of things. Of course people worked very hard to quit, but they also got PSAs and their doctor's helped them. And then we made it much, much harder to smoke.
The thing is, people are creatures of influence and habit. Much of what we do is because it's low resistance. We've allowed obesity to become a systemic problem because of our food available, our culture, and our lifestyles.
It's not that some place like, say, Paris is healthy. But it's a lot easier to be accidentally not-obese in Paris, France than in Paris, Texas.
The question of how someone who wants to lose weight should do so doesn't really have much to do with why people in general are more overweight than decades ago. People in the 80s and 90s had a lot of processed foods, didn't generally use food scales, and calorie counter apps hadn't been invented yet.
FOBT which you can do painlessly at home for a few dollars is not meaningfully less preventative than an invasive colonoscopy and carries almost no risk. https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
Very true, and this is what caught my father's bowel cancer and saved his life.
That said, for someone with increased risk, nothing compares to a colonoscopy - at it does a better job of catching things early, before you start getting blood in your poo.
But if you are at a standard risk, doing a fobt every couple-few years is hugely important. Ask your doctor now!
The superior stool based test would be the FIT-DNA test, which compares favorably to a colonoscopy in sensitivity. These are covered by insurance in the US.
www.nejm.org/doi/full/10.1056/NEJMoa1311194
However, if pre-cancerous polyps are found during a colonoscopy, they can be removed right then.
Of course, the best prevention is one that people actually do.
How effective is it when you get one every year? The idea of a colonoscopy scares the shit out of me (pun not intended).
I have done mine at 50, you are half asleep, does not hurt, you do not remember anything. Fasting day before is the worst part.
All in all, nothing to worry about, just do it.
While earlier detection has been beneficial, there's such a thing as too much. Really, there's balance to be struck. For instance the detection procedures themselves (even things like non-invasive imaging) aren't risk free themselves, false positives can set off a chain of events that carry their own harm, and even it's not at all uncommon to develop cancers you "die with" instead of "die from" but once they're detected you have to assume the worst - and treatment itself causes its own form of harm.
Getting one annually is not recommended for most patients. After my bowel resection, I had annual colonoscopies for five years, then every three years, now every five (the normal recommendation for my age cohort).
Colonoscopies are no big deal from my perspective, but they do have some risk; bowel perforation being the primary one. The prep stuff is the worst aspect for most patients; I used to love lemon lime Gatorade before I used it once as a way of drinking the liquid laxative...
FOBT = Fecal Occult Blood Test (A highly sensitive test for detecting blood in poop even at tiny concentrations).
Thanks for the reminder. My containers to shit in are waiting to be picked up from the doctor's office.
Looks like colonoscopy is better from your link.
The issue with things like cologuard is they really only detect cancer. Colonoscopies can prevent cancer by having polyps removed before they turn into cancer.
Colonoscopy is a more invasive procedure obviously, but complication rates are very low. It's worth it to find a great gastroenterologist to do the procedure.
Until things radically change, people are always going to die of something. The more people avoid death from other things, the more people live long enough to die from cancer.
I know at least a dozen people in my family and friend network that are alive now after treatment from a cancer that was fatal in most cases 20 years ago. That’s not proof by any measure but I am certainly thankful it’s not 20 years ago.