Do the arithmetic: according to that very reference, the Australian stage-IV-at-diagnosis statistic for lung cancer is not 80% but 42%, and it seems this is unchanged since 2011 [1]; notwithstanding which, cherry-picking lung cancer (notorious for late presentation) hardly invalidates the much more general observation being made.

[1] https://ncci.canceraustralia.gov.au/features/national-cancer...

It's only 42% because ~30% isn't even staged (those might or might not be stage 4). Drop that and 80% is stage 4.

And no, a general observation of "we don't see stage 4 cancers in Australia, we have to go to the US" is clearly invalidated by this data. There are plenty of stage 4 cancers in Australia.

Take a look at the US Seer data it appears more is diagnosed earlier in the US.[1] 50% are not stage IV and only 2% are unstaged.

[1]https://seer.cancer.gov/

No-one said "we don't see stage 4 cancers in Australia", so I'm afraid your so-called "bullshit detector" is broken.

On the other hand: intentionally misrepresenting people's statements, and crudely and inappropriately manipulating statistics, sets off my bullshit detector.

I am the OP, so along with your "bullshit detector", I'm afraid your eye for details may also be due for a service.

A stage IV of any single one of the myriad subtypes of cancer is not a representative example of all cancers, let alone a guide to their stage distribution. Cherry-picking one, and then grossly distorting its stats, tells us nothing.

The simple fact is, a very senior doctor, whose job is to diagnose cancer, observed that US institutions have a disproportionately large collection of late-stage presentations to study.

That’s why I said “there must be data missing” and I gave an example of a fully screened cancer (colorectal) that still has stage 4 prevalence in Australia. So pardon me if I’m struggling to figure out what cancer this is when the details are sparse.

So since you’re the OP, do you want to share the tumor type that “you rarely see stage 4 in Australia” but is apparently super common at Stanford? Since I work in healthcare I’d be super interested to know.

I will not be bothering the doctor quoted with this sealioning-by-proxy.

Had it not come on the coat-tails of such bad-faith misquoting, cherry-picking, statistical manipulation, misrepresentation et cetera, perhaps I might. Instead I bid you a good day.

Thank you for questioning this. I'll take your evidence and the evidence provided elsewhere in the thread (CONCORD-3 trial, a trial including millions of cancer patients in the US and AUS) over the secondhand anecdote of one physician. Is Stanford even the safety-net hospital for the Bay Area?

Stanford is absolutely not a safety net hospital. This is proof that even people with "good insurance" (especially since they are going to Stanford) are falling through the cracks regularly. UCSF General Hospital would be the safety net hospital in the area, though. Safety net hospitals are for the uninsured or poor typically.

Australia has no safety net hospitals, because everyone legally resident in Australia has health insurance. All hospitals in Australia have very high quality of care.

While we (Americans) may have comparable 5 year survival rates, it does not mean that there is not unnecessary death via the American system. There are deaths (mortality) and adverse conditions (morbidities) due to amenable and non-amenable medical errors in all healthcare systems in the world. The unique aspect about American healthcare is that there is another category that is not prevalent in other highly industrialized countries: mortalities and morbidities due to a lack of care (lack of ability to pay for care), which happens easily, even if you have money.

I can assure you that while we may have comparable 5 year survival rates, there’s more to the story here, and that there is so much unnecessary death in the US healthcare system.

I have studied health systems worldwide, country-to-country, via the open-access peer reviewed publications posted on HealthData.org.

I live abroad, basically over the American healthcare situation. I have 2 rare neurological diseases affecting my peripheral nervous system plus type 1 diabetes (autoimmune and insulin-dependent).

I am a US medical student so I am in a hospital or clinic almost every day. Our hospital is a tertiary care safety net hospital and all the patients are sick as hell because they have poor access to healthcare. So I know what that looks like, and I'm not arguing that the American "system" is good. I just think you can't say that patients present with higher stage cancers in America based on what's presented in that paper. America likely has worse health outcomes for lower income people, and my guess based on what I've seen is that that's driven by untreated diabetes, hypertension, and higher rates of smoking leading to increased incidence of MI, stroke, and kidney disease, but I have no data to back that up. I would also guess that the reason you're not seeing higher stage presentation in those papers is that poor people who would have had those later presentations are dying of heart disease and CKD before they can develop those cancers. Just my suspicion and I am happy to be proven wrong by data. It is just frustrating to me when people on this site who are generally more educated than your average person will toss anecdotes and unsupported claims around, particularly about healthcare.

Here’s a fun fact for you. When I talk to my wife, and she tells me things about work, I don’t say “citation needed”; nor would I change that in response to whinging demands from the peanut gallery, and doubly not as followup from that of a comment/opinion/anecdote-driven website as riddled with bad-faith weasels as this one.

Which is, of course, in part, why I’m still married.

Alternatively, for a related experience, since you're on rotation, try going up to your CMO and demanding evidence for some off-the-cuff remark they've made about their own professional choices. Good luck.

Thanks for calling me a “bad faith weasel”, LOL. BTW, I upvoted you for your sense of humor.

Oh, it was another, far more vitriolic correspondent I had particularly in mind with that epithet, but thanks.

Adding personal invective to your litany of misquotations, misrepresentations, straw-man arguments, and sealioning, as in comments passim, is not an inducement to further discussion.

True.

As for my personal situation, one of the rare diseases that I have is believed to have caused the autoimmunity that caused my T1D. It is a form of autoimmune autonomic neuropathy, and it showed up 6 months before the T1D diagnosis. We also believe that I am susceptible to other endocrine and neurological immune-mediated diseases through the anti-peripherin antibody. It’s the common denominator relating most of my health problems together, but there is no commercial test available for it at the moment.