I never knew Survival and Mortality rates weren't just the inverse of each other. It's good to know about the fact Survival rates are about a set amount of time since diagnosis, and Mortality rates are about the exact number of people who die from it each year regardless of if or when they knew they had it. Thanks for this important distinction.
Hearing about survival rates have always left an odd taste in my brain but I could never quite figure out what it was, so not only does this let me know more info on the difference but it also gives me material to explain better to others about it. Way to go!
It doesn't mean early detection is never useful or never saves lives, just that you can't tell one way or another from survival rates, because survival rates ALWAYS go up with early detection, by definition. Just because that's part of what survival rates are.
Actually, it's worse here in US than UK. If people of US are generally diagnosed early, more of them SHOULD be cured. But since same percentage of people die in US and UK although people are generally diagnosed much later in UK, US must be doing worse, or being diagnosed early has absolutely no advantage which I know can't be true.
Actually, that pretty much is true. The advantages of early detection are exaggerated pretty aggressively by business interests when it comes to cancer, since screenings are lucrative whoever pays for them. Someone's going to be that unlucky patient who could have been saved if that tumor that wasn't raising any obvious red flags had been caught just a year earlier, but usually, if it needs a screening to be detected, it can wait.
Zach Fernbaugh I guess it can't technically be considered a cure, but there's removal option for many cancers. It becomes much more difficult with higher risks later in the stage, so yeah, early detection SHOULD have an advantage.
Woo Cheol Shin Most of the time It does, but not always. Some cancers or illness just cannot be cured or treated, even if you diagnose them at day 1. He's not saying that early detection is useless, but that in some cases it's not what we should be focusing on or looking at to see the effectiveness of our healthcare.
I absolutely love this channel. It's the best I have seen and very informative. Please make as many videos as possible and let us know how we can help you to keep them going.
I always feel like I've learned something quite new whenever I watch your videos. Thank you for always making these high quality videos. I'm always looking forward to what the next one in my sub box will be :)
Thank you very much for posting these videos. There are some very very very very ignorant people at my school, and I have been using data and concepts learned from this channel to educate them
The only flaw is that when comparing Mortality rates between countries it's quite likely that one type of cancer is more common in one country than another due to environmental factors. This will cause an increase in mortality rates without there actually being any difference between healthcare services offered. It could also work the other way. However, survivability rates would account for this difference as they only sample from people who have the disease and so the only variable is the performance of the healthcare system. While it is true that survivability rates are influenced by early detection, it would be best to use survivability rates in conjunction with mortality rates to measure healthcare differences. Or even combine them into a single metric for comparison. Excluding either metric only results in error and misinterpretation when comparing healthcare systems.
***** Then we dont get rid of the mortality rate completely. We just shouldnt use it to compare which health care system is 'better.' We should be using a more complicated system than just dividing 2 numbers and taking nothing else into account. When people try to take rates of things and use it to compare what is 'better' it makes me insane. Unless you can prove to me that the mortality rate is directly related to how good a country is at treating a given disease, I cant even take it seriously. Or the survival rate for that matter. Does the US or UK statistics take into account those who do not seek treatment? What about illegal immigrants in either country? What about the populations affected, since maybe there just happen to me more elderly people in the UK? That could bring down their statistic since clearly elderly people cant live forever. What about rural vs city? Also there is another thing these videos always leave out. Yes America screens more often than any other country. Yes it doesnt make a HUGE difference. But the point that most people will make is that if it saves even 1 or 2 people, was it not worth it? This is a different mentality than youll find in the UK and abroad. There is no imaginary thumb cancer that responds to 0 treatments and you decline at a perfectly steady rate over time. There are cancers where you will almost certainly die, but nothing is 100%. Thats why we screen so much, for the 1% chance in which it might help to catch it early. Its not a good practice economically, socially, or really in any way. Its a question you have to ask yourself: Is it worth it?
PrincessZeldaGirl Sometimes saving a few people isn't worth it. For instance, if you screen so much that the increased radiation exposure causes more cancer cases, you now have a direct trade off. Not to mention the discomfort and costs involved.
Yet another brilliantly informative video! Though I'de heard the terms used before, I was not aware of the difference between them. I appreciate the run down and I'll be sure to keep it in mind next time I hear their use. Cheers :D
A nurse was pressuring me to get a mammogram, in spite no history of breast cancer in my immediate family. She wanted me to do this ASAP. Not because I'm at risk. Because time was running out for my scan to be counted for their grant.
Surprise... people are sometimes motivated by things that benefit themselves. It is somewhat unfair to expect everyone to have perfect motivations. However, you can instead always trust that every person will have ulterior motives even if they are a really really good person. It is human to make a decision based on multiple factors rather than just one factor.
Its funny. When I saw this video I thought it was going to be about how many people survive triage in the ER. I'm glad it wasn't. I'm glad that the video provided good information rather than what the title made me think when I first saw it.
Why doesn't early detection have a greater impact on mortality rates? If more people had more time/options for effective treatment, wouldn't more people live? Why isn't that showing up in the mortality rate comparisons between the US and UK?
Great video, and awesome information! But I have a question, can't early detection (like, say, of a tumor) lead to it being removed and you being "cured" of the disease?
If I'm understanding this video correctly there is another key difference between survival rates and mortality rates: survival rate is affected by other factors besides the disease itself. Example: if having prostate cancer increases your susceptibility to some other disease (SOD). SOD is much more common in the UK than the US. So even if the US and UK are equally skilled at diagnosing and treating prostate cancer (and thus have the same mortality rate) the UK will have a much lower survival rate because there is a higher chance you will get SOD and die, regardless of whether the prostate cancer itself is fatal. Please correct me if I'm misunderstanding.
This makes a lot of sense, but at the same time isn't it pretty inaccurate to compare mortality rates too? Since we don't know what the cause of some of these cancers are, wouldn't the environmental effects play a large role in determining the mortality rate, not just the level of healthcare? For example, maybe the air pollution levels between the two countries are very different or the amount of certain foods that people in each country eat. Your thoughts on this would be appreciated Healthcare Triage, since my current takeaway from this video is that there is not really an accurate way to compare healthcare effectiveness between countries since there are too many variables.
The problem with mortality rates is that it ignores the role of life style in disease. For example, higher smoking rates in one country will result in higher lung cancer mortality rates, regardless of healthcare. Likewise, poor diet and obesity rates will affect mortality from heart disease. Mortality is a better metric only to the extent that the lifestyle factors that contribute to the diseases are comparable in the comparison populations.
Diana Peña You are wrong about the smoking rates. In the U.S, smoking rate is 1,028 cigarettes per person per year, while in the U.K. it is 750 per person per year. (en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita)Lung cancer mortality reflects this: 35.4 (U.S.) versus 31.0 (U.K.) deaths per 100,000. (www.worldlifeexpectancy.com/cause-of-death/lung-cancers/by-country/)
Seems like there are a few other factors that could affect survival rates as well. 1) Since survival rate measures the people still alive, a person will count against it whether they die of the disease or some other cause. This means that when comparing survival rates for a disease in two populations, if one population has a higher _overall_ mortality rate (as opposed to mortality rate for that disease, specifically) then that will reduce that population's survival rate due to people dying from other causes while they have the disease. 2) Since survival rate only measures people who are _diagnosed_ with the disease, differing numbers of undiagnosed cases may have an effect. Although, I _think_ this is only a factor if there is a correlation between being diagnosed and some other factor... I need to ponder the statistics more to figure it out. (Also, I'm assuming that for mortality rates, cause of death determinations are always accurate.) 3) Accuracy of cause of death determinations can affect mortality rate. (i.e., The assumption I just stated may not hold.) ;) Failure to accurately attribute cause of death to a disease may artificially lower the mortality rate; similarly, mistakenly attributing deaths to a disease that were actually caused by something else may artificially raise the mortality rate.
Thanks for the great video! You guys should consider making a video about multivitamins. There's been a lot of hype in the last few days about how they don't help to prevent disease, but I'm wondering if the recent steps to "debunk" multivitamins has less to do with the vitamins themselves and more with public expectations that they prevent disease in the first place, rather than supplementing nutrition. I'd be interested to hear your take on it.
Are there any other resources out there for people that want to know more about policy? Particularly books or other RU-vid channels (its ok if its dry).
Basically, early detection will pretty much always boost survival rates, (except maybe in cases where the cure is worse than the disease) even if no lives are actually saved or extended. Even if nothing is done, the span between detection & death will be longer.
Every politician needs to see this. I'm so sick of people talking about how we have the "best healthcare in the world." If you're filthy, stinkin' rich you have fine healthcare in this country, but we're fooling ourselves into thinking our system is somehow better.
Ah statistics. As they say, there are three types of lies: "lies," "damn lies," and "statistics." Massage the numbers as you will, if it's your life on the line, you want as early a detection as possible.
If it offers absolutely no difference in outcome, I think many people would prefer not to know as early... For example, would you rather die of cancer after knowing for the last 10 years that you had terminal cancer, or die on the exact same day having known about the cancer for only the last 2 years of your life. If I'm going to die on the same day anyhow, I think *I* might prefer not knowing too far in advance and worrying about something I cannot change.
Dave Lillethun That is only if you assume that no cancer treatments have any effect, which is not true. IF the time from first cancer was always the same (as in his example), then your example would be true as well. But with most cancers, your best chance of survival is with early detection.
Not necessarily true. Take for example prostate cancer. You can live years without treatment with prostate cancer, and still be able to do everything with no cost to your quality of life. Or you can go through aggressive treatment that will leave you too tired to do anything, have your prostate removed (and become impotent in the process), and spend the last decade of your life in a hospital bed before a heart attack or disease brought on by being immobile takes your life. Or you can put your quality of life ahead and not take the treatment and *still be more likely to die of the heart attack*. If we don't waste the money on the tests, we can have a more efficient system, AND you won't spend those last years worrying about a disease that you can't do much about. Of course this doesn't apply to all cancers and all situations, but your doctor can better put into perspective what needs to be done.
Healthcare Triage What if Britain has 200 cases of a disease per 100,000 people but a mortality rate of 40/100,000 while the US has 100 cases/100,000 and a mortality rate of 30/100,000. Wouldn't that mean that only 20% of people with this specific disease die in Britain while 30% of people die in the US? What if people in Britain are simply more exposed to this disease than people in the US? They still cure a higher percentage of the sick people (in this little example) even though the mortality rate is higher.... doesn't that mean that they provide better treatment?
One more thing; if we wanted to improve the interpretability of survival statistics, couldn't we condition them on age, e.g. "5 year survival, given diagnosis at age 50"? Still not perfect, but it seems it would address a major objection to the use of survival statistics for making comparisons. Thanks for the great videos, BTW. I just found this channel and I'm enjoying them a lot.
Love the channel. It would be nice if there was a better measure to measure the effectiveness of treatment that takes into consideration detection. One issue with Mortality rate is that it doesn't have to be related to strength of treatment at all. If you are in a country that has a low average life expectancy it is possible to have very low rates of mortality for causes of death that strike the aged (certain types of cancers), simply because so few people make it to the age of probable affliction. We must make sure that we are comparing our mortality rates to regions (not necessarily countries) with similar circumstances to us.
just a tip, but when you are creating a timeline with your hand gestures you need to do the opposite of how you think it makes sense so that it looks normal to the people watching the video. Great stuff though!
Just a question. How serious is Gleason 6 for prostate cancer. I read it is very important and some say it should be dropped from the cancer classification and moved into “precancerous” do you have data on this?
I know that this isn't exactly the point of the video, but I love how Heathcare Triage makes an effort to use female pronouns instead of just male ones.
I am surprised that USA does such a good job with early diagnosis. I am Canadian. I would have thought there was an epidemic of people going undiagnosed in USA because so few people want to pay to see their doctor. If you asked me before I saw this video, I would have thought in Canada we caught disease earlier because there is no reason to stay away from the doctorb.
Cancer is the one thing Americans don't play around with. If we have a fever or the flu, it's fine just give it a few days and it'll pass. Appendicitis? Psh, suck it up, here's some tylenol. Cancer? MUST GET SCREENED NOW.
I don't object to paying to see the doctor, but I do object to wasting money. I rarely go. Unless it's a UTI. I don't mess around with that shit. My daughter goes for her shots but if it's just a cold, I don't worry about it. People on Medicaid - taxpayer funded insurance, they pay nothing or VERY little for healthcare - seem to be another story, though. Since they aren't paying for it, they don't care and they'll run to the E.R. for a cold or low grade fever or mild diaper rash.
I wanna ask if I have superficial bladder tumor detected in early 25 years of age which is removed through TURBT and regular check. Can i will able to live 70 years
I don't agree with the interpretation of the breast cancer statistics in this video, but maybe I'm doing the math wrong. An increase from 80% (UK survival) to 89% (US survival) is a (.89-.8)/.8 = 11.25% change. An increase from 22/100,000 (US mortality) to 24/100,000 (UK mortality) is a (24-22)/22 = 9.09% change. If you change which country's stat you use as the baseline, the denominator changes, but this doesn't make much difference. Comparing the US to the UK in terms of survival statistics vs. mortality statistics doesn't seem to paint a very different picture, unless I've overlooked something.
yes early detection increases the survival rates, but it also should descrease the mortality rate , the key to treating cancer (mostly with surgery) it catching it early, if you can do that then more people will be cured and will thus decrease the mortality rates. this video should point that out alltough i understand there was another point to be made
I think this would have been a better video if he hadn't compared countries. The technical terms are important to understand for anyone, and once you start comparing countries you end up politicizing it, which is not the point, or shoudn't be. Regardless of what you think of different health care systems, or how you feel about different treatment strategies, knowing what different terminology means is important so you know what it is you're actually discussing and that you're comparing apples to apples.
Sorry I'm confused. When you say the mortality rate of lung cancer is 53.6/100,000 does that mean 53.6 people out of 100,000 people die of lung cancer every year or 53.6 out of 100,000 people diagnosed with lung cancer die every year? I don't understand if the bottom number is a random sample of the population or people with the illness?
So we are just living with the knowledge that we have the disease longer? I wonder if having that knowledge earlier actually makes life better or worse. Does it make people value their life more or does this knowledge drag them down emotionally?
Emotionally, it probably depends on the person, physically it depends on how curable disease is. It may be smarter in the long run to only test regularly for diseases which early detection helps cure. I think it is good to be able to get your house in order, but I would rather not know, a car is just as likely to kill me in the mean time.
That depends on whether getting the diagnosis early actually makes a difference in how easy it is to treat. A lot of serious diseases are easier to cure if diagnosed early, but if an early diagnosis doesn't help at all, I don't think it helps.
So if one country diagnoses diseases earlier, wouldn't that also effect the mortality rate numbers (not the amount of people dying, but number of people we are looking at)? If we are calculating the number of deaths per 100,000 people with the disease, wouldn't a country that diagnoses earlier have a larger pool of people for that bottom section and wouldn't that also slant the numbers? Does that make sense?
Nice video. I just want to point out though that the Union Jack (UK flag) is not correct in this video as the red diagonal bars are not in the centered in the actual flag, but slightly off-center.
While this is an important distinction, I'm having trouble understanding parts of this concept. I know that many types of prostate cancer do not yet have effective treatments, so, like the thumb cancer example, this makes sense. However, does this mean that mortality of breast cancer is not very affected by staging at initial diagnosis?? (Healthcare Triage, I have stage I breast cancer, diagnosed at 26yo. I thought I benefited from early detection, but does this say otherwise?)
There are many times when early detection makes a difference. But super-agressive screening can pick up cases in a way that provides no additional benefit (and potential harm). See: theincidentaleconomist.com/wordpress/is-cancer-overdiagnosed-and-overtreated/ and theincidentaleconomist.com/wordpress/more-diagnoses-are-not-always-a-good-thing/ and theincidentaleconomist.com/wordpress/jama-viewpoints-on-mammography-guidelines/ and if you still have questions, email me.
How do you deal with diseases that have a different incidence in different places? If the incidence of prostate cancer in the UK is lower, but the mortality is the same, then they really aren't doing very well. They might be healthier, but perhaps not because of their health care system.
OK. So I now know the difference between Survival Rates and Mortality Rates. How does Life Expectancy come into play? Can we rate a Country's Healthcare System based on Life Expectancy? Or do some races tend to live longer than others? Is it fair to use Life Expectancy, when social factors (outside of direct healthcare) come into play, like diet and exercise and stress levels and whatnot. Or should we consider ALL of those lifestyle choices part of the overall "Healthcare System," since our Healthcare System can influence Lifestyle Choices? For instance, my mother's Health Insurance gives her a rebate on her Health Club Membership, if she actually goes there and exercises the required minimum times per month. That's a Win/Win/Win for everyone involved. My mother gets a discount. The Health Club gets more members. And the Health Insurance Company lowers their costs by seeing fewer cases involving heart attack or complications from obesity.
I don't get that statement about chemo. Are you essentially saying that it's useless and that taking steps to slow down cancer earlier does not have an effect on cancers? Isn't it still objectively better to be in the situation of finding and working against the cancer earlier?
biomerl He is using a hypothetical example here: "This is a newly identified cancer. We don't have a targeted treatment yet so we'll just use chemo therapy for now. Turns out, chemo therapy isn't actually effective for this particular cancer at all. Treating it earlier with chemo won't work either. But if people know of the cancer earlier, they'll live longer with the diagnosis." That doesn't mean that chemo isn't ever effective at all. Just not in this given hypothetical scenario. The scenario is hand-crafted for highlighting the differences between survival vs. mortality rate. It should not be taken as a serious comment for or against chemo.
The hypothetical thumb cancer scenario he created stated that regardless of treatment, 100% of patients would die 9 years after getting the cancer. In this scenario, chemo does absolutely nothing to extend the life of the patient.Ergo, the patient is simply subjected to the side-effects of chemotherapy with no benefit to longevity. His scenario doesn't mention or include testing as a part of researching an effective treatment, only the effect on the general population who have this cancer.
Pretty much. Chemo doesnt work against the more deadly types of cancer, regardless of how early you catch it. Some of them (not most) it makes a huge difference. Thats why the US is obsessed with screening. If it helps even 1 person..
I am not a doctor but my understanding is that most of the older forms of chemo were of questionable value. As we understand the biology of cancer better, we're able to create targeted drugs that are much more effective. However, those drugs are very specific and if you don't have the right type of cancer, they are useless. It's also worth remembering that cancer is actually hundreds, if not thousands of different diseases. Even a specific cancer (e.g.: lung cancer) is a whole collection of different diseases. Many diseases such as Alzheimers, high blood pressure, depression, schizophrenia, cardiovascular disease, etc are probably also collections of diseases. We lumped them together in the past because they had similar end-point symptoms. Only now are we just starting to learn how complex they are. It's one of the reasons we have had such poor luck treating them until now.
Basically, there are crap-tons of forms of cancer out there and many times they're hard to detect until later stages or people delay getting screened or something, for whatever reasons (uninsured, young and don't think it can possibly be cancer, etc). Some forms have very effective treatments--stage 0 breast cancer, for example, is virtually curable. For others in later stages well...doctors basically recommend just palliative care rather than actually treating to extend life for a LOT of reasons. In a patient with a REALLY rare form of cancer, there are times when treatment does not help at all because research dollars usually go to those that get "advertised" for--breast cancer with the giant pink ribbon campaign is an easy example to cite. It can take a while to find things that work and to get clinical trials approved and so on. Therefore, if a new cancer were to suddenly pop up (which is quite unlikely in today's world), it's actually entirely feasible that treatments that work would not be developed yet. There are chemotherapy resistant strains of cancer, as well. It's not what you hear about and things, but it's true. As a general rule, though, yes, it is better to be diagnosed earlier and try things sooner. For one, early diagnosis allows for detection in earlier stages, which frequently means that the cancer would be isolated to a single tumor and/or body part so it's a lot easier to surgically remove and otherwise treat said tumor. Metastasis is less likely the earlier a cancer is caught. Secondly, if things aren't working, it gives you a chance to try something else before you die. But really, the idea of a "cure" for cancer sounds GREAT, but is really something of a misnomer. Remission is not a cure, especially since a very large percentage of patients are left with long-term side effects. Plus there's the little fact that "cancer" is a term that covers literally hundreds of distinct and separate, though similar, diseases. What works for say...stage 1 colon cancer isn't going to come close to working for stage 4B Hodgkin's lymphoma. Sorry for the large wall of text there, but it's something that I've become kind of passionate about over the past several years as a cancer patient who does a lot of research and reads medical journals in my spare time and stuff.
People keep telling me that diet soda is actually worse for me than regular soda, but the "facts" they throw at me seem dubious. Can you clear this up? Thanks!
This sounds like you're saying early screening doesn't really help (though it isn't your main point), is this due to that actually being the case, or am I misunderstanding? We hear all the time that early screenings and everything is so important, is this only because it boosts the survival rate for statistical reasons?
What I'm getting from this is that early detection is pointless without effective treatments. And that there is too much emphasis on detection & not enough effective treatments. What's scary is that a lot of current cancer treatments would be deadly for most Healthy people.
In his completely made-up example of thumb cancer, early screening doesn't help extend life because there is no effective treatment available. For some cancers, early screening and treatment can be important to extending life, but the point is that you should ascertain whether or not that is the case before throwing tons of money at cancer detection.
mickycarcar but then he gave numbers for Breast Cancer it sounded like even though we screen earlier, it doesn't really do that much, but thats totally one of the ones everyone talks about the earlier you notice the more likely you are to survive. So it sounds like breast cancer and prostate cancer in his examples were a lot like his made up thumb cancer example.
jag519 But that's the point of his spiel at the end. 4:29 In many cancers, early detection *doesn't* change the mortality rate by much at all, but it does boost the survival rate (x number of years out). And when you're diagnosed with cancer, that's the main thing you want to know. How long do *I* have?
I don't really know anything about prostate cancer. For breast cancer, even though early screening does help extend life, perhaps screening every year starting at age 40 is overdoing it. At a certain point you are screening too much and it is not contributing to an extension of life.
