The most common cancer: colon cancer, would be 95% preventable if only people got over silly notions about their butts and got a colonoscopy when they have reached age 45-50.

Colon cancer takes a decade to develop from polyp to tumour. The main purpose of a colonoscopy is to find and snip any polyps there could be in the colon. Then you'd be safe from colon cancer for a decade or more.

You would normally not feel much: the sensory nerves in the colon are only really able to feel if you have gas. And many hospitals offer sedation, so you wouldn't need to experience the procedure anyway. The worst part is the restricted diet for a week before (avoiding foods that would cling to the intestine wall) and emptying the bowels the day before. If you know that you have healthy kidneys, do ask your doctor for the good laxative that is a small dose that doesn't taste bad.

Myself I have an unusual genetic condition, so I unlike normal people, I do a colonoscopy every year. I stay awake and watch the monitor, because I actually want to see what I look like inside. At the end when you reach the small intestine, the cilia on the walls inside there are quite fascinating.

UK here for context. We only have to fast for 12-24 hours prior to the colonoscopy. You can drink water or plain tea (no sugar, cream or milk).

They offer "gas and air" mainly. You don't even have to have that. You are fully awake during the procedure, laughing at the live HD video feed from inside you on the big screen.

You can be fully anaesthetised but that's very rare here in the UK.

After the appointment, it's a free cup of tea, and some biscuits. You have to wait for a couple of blood pressure tests, but after 15 mins recovery you can leave and go home. The entire process from entering the clinic unti leaving is about an hour.

The process is mildly uncomfortable but not really painful. Nothing like childbirth for example.

Don't be scared. It doesn't hurt too much. And as other commenters have written, any polyps they remove could have become tumours in 10 years, and afterwards, you are effectively safe from colon cancer for a decade.

If the NHS (UK) find and remove any polyps, they'll add you to a watch list for regular colonoscopy procedures. I have one every 2-3 years, others have them annually.

Get that camera up you... It might save your life.

I've suffered from IBS all my life. At this point I've had several colonoscopies done in different countries.

The one in the UK was done without sedation and was a terrible experience. Apparently having an overly sensitive colon makes it pretty unbearable.

But yeah, the stigma around a doctor introducing a tube/camera up your ass is just that. You dont lose anything and you dont become any more/less anything. The prep is a bit rough but nothing unbearable as well.

I am 40 now, but will deffo get to it yearly once I'm 45.

In Switzerland it's 4 days restricted diet (zero fibers etc), a day fasting with liquids or sugar, and strong laxatives the evening before and the morning of the action. You sleep (aka pass out for like a blink) during the intervention then wonder at your incredibly clean pipe on TV. 5 years later you come again if they found and removed something, otherwise after 10.

> UK here for context. We only have to fast for 12-24 hours prior to the colonoscopy. You can drink water or plain tea (no sugar, cream or milk).

Are you saying you only have to fast, without laxatives/prep? How does that work? I find it hard to imagine that anyone's colon is clean enough to get a good view after only fasting for a day?

Based on how much my need for toilet paper depends on what I’ve been eating recently, I suspect diet makes a massive difference to how clean you are inside.

Not sure how waiting longer than 24 hours is going to get you much cleaner in any case.

We have to take laxatives as well. The night before the appointment usually. That's when you must start fasting.

I have to have colonoscopy every year since I was 18 because of risk factors. I agree it's much less awful than people think (and I especially agree that laxatives and liquid diet prior to it suck much more than the procedure itself). I never take sedation cause it doesn't really hurt and doctors say it's better to have feedback from the patient.

I also have to do MRI every year and it's much more frustrating for me because they always complain I'm breathing wrong, and I have asthma so it's not easy to "breath right". It takes ages.

I think it depends. It doesn't hurt for you but it does for me. I had to take some pain killers during mine. The doctor told me that having a bigger belly would help, though I should not become fat for the next time.

Yes - mine was no-fuss, but my sister had major reflux-like complaints and great discomfort after hers.

The first (and only) time I ever had a CAT scan was pretty awful because they didn't tell me exactly what to do.

I walked into an urgent care because I had severe back pain. They put me through a bunch of chest x-rays where they told me to inhale and hold my breath, then they bring me over to the CAT scanner and tell me to hold my breath when the light goes green. So I inhale and hold my breath. Then the tech comes out and tells me "did you inhale? don't do that, it ruins the results".

They decided not to re-run them because the odds I had something wrong even with those symptoms were apparently less than the odds of the additional CAT scan giving me cancer down the line. Certainly didn't help my peace of mind.

But the muscle relaxants and a proper desk chair seems to clear it up within a week so I guess they were right...

I actually enjoy my annual MRI scans. It's a meditative experience.

"Fortunately" they only have to scan my head, so no issues arise from (wrong) breathing.

In my experience, the entire process takes up about 3 days: 2 for the colon cleansing, 1 for the process and recovery from sedation and possible biopsies.

Mine takes in total 1 evening and 1 morning; the cleansing is 1 evening and they biopsy on the way through which makes it take up a little bit more time but not much. And I never take the sedation as I want to really get out of there asap and I don't feel much anyway.

What is the purpose of the yearly MRI, if I may ask?

I have colitis ulcerosa and liver problems associated with that - called PSC in English I believe? When I was younger I did MRI every 2 years but now they told me to do it every year.

Timely colonoscopies save lives.

However, I have a hunch that frequent colonoscopies are maybe not a good idea.

Doubts:

1. We know more but we don't know all things creating colon cancer. Knowing the existence of cancers caused by viruses, disinfection procedures applied on the device could matter a lot.

2. Even if we disinfect properly, we know of a notorious little fellow: H.pylori, which can go down to the intestines. "Helicobacter pylori infection is associated with colon adenomatous polyps detected by high-resolution colonoscopy." https://bmcgastroenterol.biomedcentral.com/articles/10.1186/...

3. H. pylori (which serves just as an example, there can be other bad guys) is really hard to get rid of with disinfectants. It builds up resistance over time so it's doubtful that our disinfectants currently in use will stay as effective as well.

4. Frequently putting a foreign object to different people's colons (yes, I know it's disinfected) would increase the probability of transmitting such unknown risks.

I didn't talk about perforation risk. Just the possibly transmissible cancer risk.

So I remain doubtful that it's completely harmless It's necessary but every year? Doubtful without more data.

Finally, thanks for the people who invented and use it to save lives. I wanted to share my doubts on frequent colonoscopies

> It's necessary but every year? Doubtful without more data.

Did you read the part where the commenter said that they have an unusual genetical condition and that's the reason they have yearly colonoscopies?

Yes, I did. I'm not denying the validity of the case here. My concern is related with the core risks of the procedure.

Why are you concerned about it? Doctors aren't going to recommend intervals shorter than 10 years for people with no risk factors and even with risk factors the cancer screenings are every 5 years. If someone is getting them more frequently than that, there are probably additional factors.

In the US, insurance isn't going to pay for it unless a doctor says it is medically necessary.

This is an incredible stretch. (your doubts based on reading the source you provided)

There is an interesting difference between the way countries approach this btw. In US, sedation is standard and used in 90%+ of colonoscopies. In UK sedation is rarely used unless specifically requested by the patient, you usually get some gas and air instead. It's not even due to cost, it's just that sedation for colonoscopy is generally unnecessary, it's an uncomfortable but not particularily painful procedure.

The US loves to sedate. You guys get absolutely blasted when you have your wisdom teeth removed. In most of Europe you get strong pill painkillers for the first few days and then it’s paracetamol.

I don't know if you're expressing a common misconception here, but a lot of Americans also think general anaesthetic is widely used for wisdom teeth removal, and it isn't. What is widely used is deep sedation, a combination of ketamine and benzos which keeps the patient calm and, the nice part, prevents any memories of the event from forming. It's maybe an extra hour of recovery, same-day procedure in either case.

Post-care is a few day's worth of entry-level painkillers unless the patient gets a dry socket. We use acetaminophen for post-treatment rather than paracetamol, since it's better (never understood the British obsession with that stuff, it's nasty business).

Anywhere else I would walk away from a terrible joke like that, but this is HN. I'm joking.

You really got me there, was halfway through writing an angry reply when I read the last sentence.

I don't see the joke -- is this entire post untrue then?

Ah no. It hinges on paracetamol and acetaminophen being two names for the same analgesic. Everything but that sentence was perfectly serious.

It's also a rare joke where explaining it won't reduce the effect: by the time a Brit hits the end of the offending sentence, it's too late.

It depends on the situation. I had all of mine out this past weekend (in the US) and, because they were fully grown in, all they had to do was some local anaesthetic (about 8 shots around various parts of the mouth), wait 15 minutes, and loosen/pull them all. Total procedure was less than 30 minute and no painkillers prescribed after the fact.

> In UK sedation is rarely used unless specifically requested by the patient

It varies by hospital trust, there is no uniform guideline.

My local NHS hospital sedates for colonoscopy as a matter of course (using fentanyl). But as you say, some don’t, and others ask the patient.

Fair enough, I was told that this is standard practice

It is not due to cost, but profit. In the US the hospital makes more money if you get sedated. So why not offer, or even push it?

It's unnecessary but a lot of pain medication is "unnecessary." We use it to reduce pain because we don't like to feel pain. This seems self evidently common sense to me. In New Zealand my colonoscopies were carried out with ketamine, which is incredibly safe under medical supervision. Unless there are contraindicated medical conditions, I see no reason not to use something like ketamine or a light dose of oxygenated nitrous oxide.

In Poland they give you option for sedation, but advise against it because sedation disables the feedback from patient and that slightly increases the risk of complications. When they do the procedure they ask how you feel and when it gets too uncomfortable they change the angle etc.

I've had like a dozen of colonoscopies (have to be checked every year cause of risk factors), and they were never really painful.

Pain relief and sedation are two separate things.

Nitrous oxide is a fairly strong anagelsic (pain medication) but a very weak sedative. That's exactly why it's often used for minor routine procedures where keeping the patient awake and reasonably alert is more valuable than keeping the patient fully sedated.

Used a lot during birth here in the UK too

>>or a light dose of oxygenated nitrous oxide.

Which is what "gas and air" is in the context of my comment.

How many have you had? My understanding is the risk of a perforated colon is actually quite high, like 1 in 500. Do you worry about that risk? I got referred to a gastroenterologist before I was 45 and he talked me out of it because he didn't think it was going to show anything (my symptoms that I was referred there for were gone by then) and the risk wasn't worth it. Obviously if you're going to get some life-saving results, the risk-reward calculation changes.

I've heard such numbers before and asked my doctor about them, but been told that those are overexaggerated. A higher risk apply to patients with intestinal diseases such as Chron's (not me) or when doctors have conducted minor surgery from inside the gut.

A normal colon is quite flexible, and should not get hurt just from the endoscope being pushed through the gut.

Snipping a "normal" polyp or taking a biopsy would cause a little bleeding, but should heal up quickly. I've been told that I could see blood in my stool after it, but it's been so little that I haven't.

Commonly quoted figures are 1:2000 in western countries with experienced operators with good operators claiming significantly better than that

You consider 1 in 500 high? That's only 0.2%. At that rate, assuming the probability of complication for each procedure is independent from all the others, you could undergo the procedure 20 times with only about a 4% chance of complication. Since the American Cancer Society only recommends colonoscopy every 10 years, starting at age 45, most people wouldn't even have 5 procedures done in a lifetime, which would give about a 1% cumulative chance of complication.

It would be one thing if you were to have done that math to show "the risk of colon cancer is so high that this decision is worth it"--and to be clear: maybe it is!--but the idea that you simply don't find a 1% chance of a complication to be a big deal as the absolute number looks small to you (as opposed to making some relative comparison to the rate of preventable cancer) horrifies me... and, for your sake, I hope you aren't that careless continually with all of the other decisions you make in your life (any number of which might also have a 1% chance of going badly for you). 1 in 500 is absolutely a very very large number.

You have roughly a 4% chance of developing colorectal cancer in your lifetime: https://www.cancer.org/cancer/colon-rectal-cancer/about/key-...

Amazingly, the American Cancer Society had already done that calculation when they made their recommendation to get scoped once every 10 years.

... which might lead one to ask "do you worry about the risk of complications?" when hearing about someone who gets the scope 10x as often as recommended. The answer may be "well, even if the risk of complications is 10x, my risk of getting a disease the scope will catch still far outweighs it, so it's worth it. Or it may be "yeah, that is a concern, but it's mitigated somewhat by xyz factor." And both of those are interesting answers. Why the hostility to this conversation?

That is very high if you get one every year.

So, don't do that, unless you have enough risk factors to justify it. Get it done once every 10 years as per the recommendation.

You realize the context of my question was that I was responding to someone who actually does get one done every year, right? And that I acknowledged that the risk-reward calculation changes quite a bit depending on what risk factors you have? I don't know what point you're trying to make, unless you think I'm just wrong to be asking this person in a special circumstance how he thinks about the risk. For example, perhaps there are extra precautions that I don't know about that can be taken for someone for whom yearly scopes are important.

After being diagnosed with colon cancer when I was 26, I'd say start even earlier. Don't settle for "it's probably just hemorrhoid's". That's the reason my kids will start when they are 16.

Does anyone know why I got cancer? No. Does it really matter? Honestly, no.

Just to re-iterate the point: Go through all the screening you can, cancer (of any form) is easer treated when caught early. Or even prevented.

>Go through all the screening you can, cancer (of any form) is easer treated when caught early. Or even prevented.

There's reasons why we don't screen for all cancers all the time - one being that when you are young and healthy the false negative rate and risk of complications of the test are often higher than the chance the test catches something.

Full-fledged biopsies, without any other indication, are exaggerated. A simple colonoscopy isn't. Nor are the other, standard, screening tests. And still most people just don't even use the standard screening options. My personal guess, because people are afraid the screening is finding something. Without the screening, you can happily continue your life in ignorance. Usually, this is regretted if they actually have cancer later, once the cancer is so advanced that actual symptoms manifest.

If you got it at 26, I'd recommend a gene test to see if there is a hereditary factor, and for your kids too.

That is what I have. "Luckily", out of four siblings, I'm the only one that tested positive and therefore the only one in my family that gets checked every year.

That was the first they did, now that's almost 14 years ago. Luckily it's not hereditary, would have sucked with a 3 year old back the day.

Nope. That's how medical costs get out of control. Routine colonoscopies for 20-somethings is just a waste of money.

High risk? Sure. But the general population, no.

I did mention the available screening, didn't I? High risk is much earlier, for sure, and much more frequent. I'm down to one every 5 years now, plus some routine checks every two.

Sorry to hear that. What were your symptoms if you don't mind sharing.

Hemorrhoids, initially. Being rather, young with damn office job, that's the initial diagnosis. Lucky for me, I had a good doctor that started to feel uneasy and insisted on a colonoscopy. All things considered, I think I was lucky!

So were no serious symptoms so, cancer is a sneaky bastard.

In my country we have a national program that screens via a stool sample, no need for colonoscopies unless the test comes back positive. It’s for 60-74 year old who aren’t at high risk of bowl cancer, those with family history still get colonoscopies.

I've had a colonoscopy and yeah: it's a nothing procedure. You're anesthetized for it and there's no recovery period so its just been and done. You also feel great afterwards from the prep medicine (at least I did).

If you have the money, I recommend a bidet toilet seat (which I recommend anyway) before you do the prep for it - makes the whole process a breeze.

I know some gastroenterologists and they take competitive pride in how good they are at scoping patients. Not everywhere does the restricted diet as long as you suggest, but just don't eat bread with little seeds on it. They hate that

You're clearly someone who takes care of yourself, so why watch polyps being snipped from your colon on a tiny screen? Hi, I'm Cologuard. I'm a non-invasive product to detect altered DNA in your stool. I find 92% of colon cancers even in early stages.

This is good advice but that laxative can be a doozy. I was pooping for 12 hours straight. I had to drink several litres of laxative. I'm sure it was squeaky clean inside afterwards.

> Myself I have an unusual genetic condition, so I unlike normal people, I do a colonoscopy every year. I stay awake and watch the monitor, because I actually want to see what I look like inside. At the end when you reach the small intestine, the cilia on the walls inside there are quite fascinating.

Same here, but I stopped watching the monitors; I just watch a movie on my phone; makes it go (much) quicker for me => I hardly notice anything if the movie (or tv show) is good.

See- I didn't know this. I'm in that age group. When I get my yearly checkup I will ask doctor to add it to the list of checks.

To whomever might be curious, the author probably is talking about MUTYH-Associated Polyposis. If you have 2 of the wrong genes, you are very likely to develop colorectal cancer at some point in your life. That's why it's indicated that you test every year.

To scale whole population could just do ultra-sound for colon Polyps + CRP blood test. Then go from there.

Ultrasound is not a useful imaging modality for anything in the GI tract. Most countries do have FOBT screening available

My sincere admiration for the author's strength in the face of this terrible hardship.

A person can also avoid cancer by choosing a career that is not cancer-inducing. Given the author's cabin crew history:

    3.4% of female flight attendants reported having had breast cancer compared with 2.3% of women in the general population group
    2.2% of female flight attendants reported having had melanoma skin cancer compared with 0.98% of women in the general population group
    1.2% of male flight attendants reported having had melanoma skin cancer compared with 0.69% of men in the general population group
    7.4% of female flight attendants reported having had non-melanoma skin cancer compared with 1.8% of women in the general population group
    3.2% of male flight attendants reported having had non-melanoma skin cancer compared with 2.9% of men in the general population group

https://www.cancer.org/latest-news/study-examines-cancer-rat...

The skin cancer + flight attendant connection has to be due to white people working in the industry. People tend to fly to places with plenty of sun and warm climates. Australia's skin cancer rates are also very high, although not so much among the aboriginal population.

I would imagine it's because of the increased radiation you receive during a flight. For one flight, it's negligible, but if it's your job to be in the stratosphere for 20+ hours a shift, year round, it will probably start to add up. It would be like spending all your work life on the beach.

> It would be like spending all your work life on the beach.

This is where flight attendants spend their non-work life :-)

The radiation from the flight could be a factor of course; but being from Norway myself, and getting burned like a cooked lobster every time I go to Spain etc. I can't imagine that stuff being healthy to do regularly (or perhaps at all).

They are also at higher risk of breast cancer though (female aircrew)

Do pilots have similarly increased rates? Or does it likely correlate with lifestyle factors (sunbaking, smoking etc).

After some googling I found a few studies that seem to show an increased risk for pilots as well, particularly skin cancer. I think the increased risk of skin cancer is interesting since that would (layman's speculation) probably be the most affected by radiation.

https://pubmed.ncbi.nlm.nih.gov/12862322/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559846/

Normal glass has low transmission for UV-B and UV-C, but significant transmission of UV-A. This in combination with high altitudes (so less atmosphere) and also simple thermal heating, could already explain this.

Perhaps aircraft should add an UV-A blocking layer to their windows?

I don't think increased radiation levels would contribute differentially to skin cancer, because we're talking about gamma rays.

Looks like planes need more radiation protection. A thick heavy lead shield would be best.

thick and heavy are generally counterproductive to flying.

You shouldn't fly at all because of the increased exposure to the solar radiation at high altitude, better taxi on the ground.

unless someone comes up with another way to get across the Atlantic in 6 hours affordably, flying will be indispensable.

Isn't the paint already made out of lead? Or couldn't it be the percentage to be too low? Windows letting radiation in too.

It was interesting that reading that abstract, that it didn't cite another possible reason - more regular medical examination. I wouldn't be surprised in such a job, flight attendants might be expected to do regular medicals or have other reasons like needing prescription drugs say for sleep tablets. Having more eyes looking may pop up more incidents.

i'm guilty of the kind of avoidance that negates this. For example, you can't be forced to quarantine if you never get tested for COVID. I wonder if there's an official term for this state of mind, it's a tough habit to break and your life could depend on getting passed it.

Maybe it is related to irregular sleep schedule. Also more exposure to uv radiation while flying.

You're also exposed to more ionizing radiation the higher up you are.

But they are not really exposed to the elements while up there. How much aluminium and airplane interior does it take to replace 10.000m of atmosphere?

According to the CDC, a west-east coast flight is about 0.035 mSv per passenger.

The average annual exposure per person in the US would be about 3.3 mSv (without medical radiation from xrays and such)[0], mostly from natural background radiation. There are high regional differences[1], could be as low as 1 mSv or as high as 20 mSv. Human made factors play a role as well, e.g. coal burning (e.g. in power plants) will dose people living close by with radioactive elements in coal ash.

Anyway, a busy crew member can do maybe the equivalent of 100 such flights a year, which would be roughly an additional dose of 3.5 mSv per year.

Their total annual exposure would then come out as double the average (US).

For comparison, an xray can be as low as 0.1 mSv for a chest one, but a whole body PET scan comes in at about 23 mSv.

So I'd conclude that being a flight crew member would of course somewhat increase your radiation-induced health risks, but maybe not as bad as people might think.

Looking at other health factors for crew members, like in-flight air quality, increased exposure to fuel (kerosene) fumes and burn products working in airports and planes, or work/sleep schedules might offer additional/better explanations for the increase in cancer in this group compared to the average population.

[0] the world average is about 2.4 mSv, Germany comes in at 2.2 mSv, Japan 1.5 mSv. Didn't find a good number for India, where the article author lives.

[1] E.g. here is a map of Germany for radon concentrations in living spaces https://www.bfs.de/SharedDocs/Bilder/BfS/EN/ion/environment/...

> Didn't find a good number for India, where the article author lives.

Kerala in India is among the places with the highest natural radioactivity: https://www.ias.ac.in/article/fulltext/jess/095/03/0397-0407

> a busy crew member can do ... 100 such flights a year

100 flights? More like 3-500.

Thanks! I had no idea flying meant higher radiation.

A column of atmosphere 1m^2 in area weighs about 10 metric tonnes.

The thin Al skin of an aeroplane might as well be nothing at all by comparison.

The sleep disruption is a good thought.

I would also think the exposure to jet exhaust. For me, that smell evokes a nostalgia for picking up grandparents at the airport. It is probably hazardous to work at an airport and breathe it all the time.

See "fume events"

Also, regular exposure to pathogens.

Hmm could this also be because they have to get through the x-ray scanners more often than regular travellers?

It's caused by frequent air travel. While flying, there is less atmospheric shielding against cosmic ray radiation compared to being on the ground. Even though you get less radiation from an average flight than from medical x-ray, it adds up.

Ah I see! What alloy do you think could block the cosmic ray radiation, I though lead was doing that, isn't there enough of it on the paint? Or maybe the windows are letting the radiation in?

reported is the important word. and those populations are not equivalent.

The author is from India. India has been experiencing a wave of changes in the face of a growing middle class. The pollution level in every major cities is just abysmal, there is very little regard for quality control - parts of India in the north are basically covered in toxic fogs for a decent part of the year. Add to that an increasing adoption of plastics, recipes involving frying oil in high temperature and western style take out meals, even the wealthy Indians are not leading as healthy of lifestyle as they might think.

Here is an anecdote - growing up we used to have local festivals in the temples where they would distribute meals in banana leaves almost exclusively in all the temples. Fast forward these have been replaced with single usage low grade plastics and cups which when served hot I honestly fear leech plastic into food. The number of cars in any metropolitan cities have exploded - older forms of transportation like rickshaws are almost gone (not that I am saying I condone the poor rickshawalas having to pull weights twice their own but just setting context). Traditional Indian meals involved less frying and using ghee, which has higher smoke temperature compared to soybean which is also very poor quality.

Preventive healthcare.

It's way cheaper than treatments and medicines once you're sick and the best part, you don't get sick that much.

And that's something private healthcare can't provide, or at least not as effectively as the public healthcare.

I wish the government published statistics on healthy-years-of-life-lost-per-year-covered for each private insurance agency.

Wouldn’t that data necessarily lag by so many decades as to be useless?

Dont forget radon, depending on your location: https://www.env.go.jp/en/chemi/rhm/basic-info/1st/02-05-07.h...

Edit: of course country averages are mildly pointless, since it can strongly vary between different places in that country, so it might be worth to check on the city level

The high values in Sweden (and partly perhaps Finland) was partly(there are also geological reasons) due to a popular popular brand of concrete (called Blue Concrete colloquially) being made with Alum Shale that happened to contain a large amount of Uranium (and thus the radiation/decay will eventually produce Radon gas).

This combined with Sweden being a fairly cold country (with people keeping their windows shut) was a recipe for disaster with the further combined effect of smoking and radon gas leading to quite a few fatalities.

These days multi-family housings are regularly inspected to make sure that Radon gas amounts aren't too high (even if the required limits are fairly high in an international context).

The way I think about cancer: Each and every one of us is playing Russian roulette daily with a revolver with a giant drum with tens of thousands of empty slots and a single bullet. And some people load more bullets in the drum by smoking, drinking, getting sunburned, other risky behavior or just losing the genetic lottery.

At the end of the day, the outcome is still random. You'll still come across chain smokers that live to be 100 and people like Seema in the post, who get cancer despite doing everything "right". It doesn't seem fair - because it isn't, it's random. The best we can do is change the odds, not guarantee the outcome.

It's never random. All is just a process of causes and conditions, albeit a very complex one. We just can't track all the variables.

At the root of medicine is biochemistry, and at the root of chemistry is quantum physics: the formation and breaking of chemical bonds is at core random events shaped by probabilities. We can only say how likely events are, not which ones will happen when.

Or rather even if it is deterministic, it might as well be random to us.

Sure, in the same sense that a roulette table or a deck of shuffled cards isn't actually random, it's just cause and effect.

It's random for all practical purposes if you can't figure out the causes.

Half of cancers in the developed world are due to lifestyle; so how you live has a huge impact in you chances of developing cancer. People often overlook other factors that increase your chances of developing cancer such as obesity, exposure to viruses, immunodeficiency, background radiation etc.

Humans are in quite an unlucky position when it comes to developing cancer, due to our relatively small size and long lifespan. Cancer doesn't affect smaller animals so much, as they generally don't live long enough for it to develop. Larger animals that live long lifespans aren't affected so much, such as elephants and whales.

These ‘X % of cancers are due to lifestyle’ statements are an extrapolation from observational data we know is confounded and are an overestimate for sure. What they mean by ‘lifestyle’ isn’t even consistently defined, and thus has no predictive let alone explanatory power. Just look at the data from animals, they get cancer all the time and they aren’t eating cheerios and binge drinking. Cancer does effect smaller animals just as much [1].

[1] https://www.nature.com/articles/s41586-021-04224-5

One other major factor people also overlook is genetics - not that you can do anything about it, but if you have cases of cancer in your family, you should probably be extra careful. Plus the obvious things like fair-skinned people needing to be more careful about skin cancer etc.

Pretty much everyone has some cancer in their family. Cancer is really common.

You won't always know there was cancer, though: How often do you hear about Grandpa's prostate or that mole your cousin had removed?

That’s always shared among the family. Don’t know where you are from.

No, it most definitely isn't. I'm originally from the US, by the way. The midwest, if that helps. Some families will talk about it, others don't, and a lot will pass on talking about it if it was 'no big deal'. So the weird mole? Yeah, you probably didn't hear. You especially didn't hear if it was your cousin. Not everyone will talk about their prostate, especially folks more embarrassed about bodily functions or anuses. A lot of prostate cancer doesn't require treatment, after all, and no reason to talk about it. If your great grandmother had cancer, you probably don't know, especially if she died from a heart attack or stroke. Doubly so if your parents and grandparents are still alive and have not had cancer.

And yes, I've met all sorts of folks like this. I worked in a pharmacy for years.

You just assume everyone will talk about such things.

Ok I see. I’m from Italy and I know what medications my grandfather takes, that my grandma had cryosurgery for a malignant mole, and when my father goes to the proctologist.

Also: families usually go to the same doctor so even if you don’t personally know something, your doctor probably will.

Ah, yeah, definite difference. Even when I was a child, we didn't go to the same doctor as my parents. My parents went to doctors that specialized in adults and wouldn't take patients under 18 - and it has been some time since I lived in the same town as my parents. Heck, it has been nearly a decade since I lived in the same country.

As far as I can tell, the US and Norway are similar - but heck, I'm an immigrant and haven't actually looked into this.

One of my parents died recently due to cancer and I beg to disagree with your statement "It's not a disease that primarily comes from unhealthy living".

Perhaps not that scientifically savvy but this video presentation by a medical doctor does highlight the anomaly of the Middle East population that have significantly least mortality due to cancer, most probably because of their lifestyle and habit.

[1]Why Does the Middle East Have the Lowest Cancer Rates in the World:

https://news.ycombinator.com/item?id=29852556

I like the video

We’re still grasping at straws

Its nice that we have all these distinct populations to give clues to a broader solution, but there is still nothing to emulate, no rubric to follow, just a couple things to help you feel like you’re in slightly more control than you actually are

All these rates of cancer stats per capita are based on detecting the cancer, which we are notoriously bad at. It is either by happenstance or because its too late. We don't know how fast it grows, some practically overnight, some over decades. The delta changes as well. When detection methods get more personalized and better, I think the rates will go up dramatically while also providing the biggest chance at fixing and figuring out real prevention methods.

Yes you are right nothing concrete yet but it's beginning to take shape now regarding the lifestyle and habit as the risk factors for cancer.

For more scientifically savvy research please check this recent video presentation from Dr. Leeper, Professor of Surgery and the Chief of Vascular Medicine at Stanford University. He's a cardiologist and co-founder of two biotechnology companies, 47 Inc. and Bitterroot Bio, that aim to prevent cancer and cardiovascular disease.

[1]What do cancer and heart disease have in common?

https://www.youtube.com/watch?v=BnzYymcRnrs

Ban burning wood in cities, they are even bigger sources of pm2.5

Cars have other issues such as noise pollution and road danger.

Ban / substantially reduce both, please.

Also, uneconomical use of urban land.

> Also, uneconomical use of urban land.

Uh, like green spaces? Those aren't economically valuable, but they're immensely valuable to humans.

Not green spaces, as those do provide significant value to humans, and that value does show up economically too, even though we shouldn't value them primarily in that respect.

It's more about people hoarding lots of land for parking, roads for cars that are unsafe for use by non-car users, and then also vertical space above short buildings that goes unused.

Make an exception for gasifier furnaces.

give the poor people LPGs, and yes it is possible.

No mention of diet although you hint at it indirectly when you say avoid subburns.

So Copper is used to make melanin the skin pigment which then converts 99.9% of UV radiation into heat. Now if the copper in your diet is going towards the melanin production there is less for Interleukin-2 which helps white blood cells become more accurate. Ironically, people eat more leafy greens (salds) during the summer months when UV levels are highest so there is a seasonal environmental element to factor in as well.

Too much copper though and it will make you paranoid (dopamine-noradrenaline), and the female oestrogen pill (oestrogen) increases or retains more copper in the body which might probably explains some young womens reports of not feeling too brilliant when young and on the pill.

Second to not smoking is getting checked at the first sign of anything suspicious. A lot (tens of percents) of people wait months or years.

My brother had mild breathing issues and back pain for a really long time. He resisted getting tested until the day his pain got severe enough to call for an ambulance. It turned out to be a giant tumor - large enough to press against nerves and cause back pain. He’s the fittest person I know and we all thought he overdid himself at the gym causing a back issue.

It’s just that everything can be cancer and nothing. Some cancers have obvious symptoms others not so much. Any unexplained and rapid weight loss seems to be the most obvious. I don’t want to look up all the symptoms. Everything from gastric issues, back pains to moles and warts can be due to cancer.

What's suspicious?

From what I can tell as a non-medical professional, some of the most concerning warning signs are:

- Sudden weight loss (>10-15 pounds without a change in exercise or diet)

- Any kind of recurring pain, especially headaches

- Your poop is messed up

- Blood anywhere - coughing up blood, nosebleeds when you don't usually have them, blood in your poop or urine

- Mood or behavior changes (helpful if you have someone close to you who may notice this)

- Feeling fatigued even when well-rested

- Swelling or lumps anywhere

- Trouble sleeping

Which is a lot of stuff, but fortunately can be summed up as "If you feel consistently worse than you usually do, go see a doctor".

The key is to make your judgement of "I am indeed feeling consistently worse" within a couple of weeks, not a few months or even years while hoping it'll get better on its own. It's harder than it sounds - life is always busy and it's easy to tell yourself that your discomfort is mild and you can hold out a little longer. I waited too long to act on some bad heartburn and my few months of delay were rewarded with permanent damage to my lower esophagus...

I'd just add signs of skin changes too:

- New moles.

- Moles that increases in size.

- An outline of a mole that becomes notched.

- A spot that changes colour from brown to black or is varied.

- A spot that becomes raised or develops a lump within it.

- The surface of a mole becoming rough, scaly or ulcerated.

- Moles that itch or tingle.

- Moles that bleed or weep.

- Spots that look different from the others.

Info directly from here: https://www.cancer.org.au/cancer-information/causes-and-prev...

when i was in my 20's a drank a lot of dr pepper. I switched to diet dr. pepper just by chance and it stuck as a habit. I lost so much weight so fast i went to the doctor fearing the worst. He did the math in front of me around how much less sugar i was consuming by that switch and it all added up. i was blown away.

For anyone reading with children... My daughter has cancer in her eyes. The only symptom was a barely noticeable squint despite it being very late stage (and then suddenly, dilated pupil and a color change in her pupil). In theory, the other symptom would have been a white reflection in her pupil had we ever taken a flash photo.

So sorry man. Also, what the fuck is wrong with the world? Cancer in someones's daughter's eyes, really?

If you have to ask you probably lack the suspicion gene.

I’m surprised no one mentioned excess calories (typically from carbs) as a risk.

Yes it's most probably one of the main risk factors and it's being actively research at the moment. Please check my other comments for the recent video presentation that's based on the state-of-the-art research from a Stanford University Professor regarding the risk factors for cancer and CVDs.

And not forget to ban all fastfood from society. No coca cola, no burgers, no sweets. Healthy diets obligation for everyone.

Maybe too specific, but a better ventilation while soldering and 3D printing is also a good idea.

How prevalent was colon cancer a) historically and b) since the advent of colonoscopies?

It doesn't take much to realize that no one can answer this. Causes of death get really weird as you go back in time. And it isn't like we can dig up bodies to know since soft tissue isn't usually preserved. We know cancer has been an issue for centuries, though.

We've not been doing colonoscopies nearly as long and we still don't do them to the general population (Even if your country recommends you get them once you reach a certain age: Healthcare is sparse in many areas of the world). This does mean that we really don't know how prevalent it is except in some populations. And even then, we probably don't know since we do not routinely do them to younger folks.

I'm sure there are all sorts of other issues with this, but I'm a layperson and I'm guessing you are too.

How healthy was the average diet a) historically and b) since the advent of colonoscopies?

also stop eating meat, specially red meat.