Episode #677

[Fast Eddie B]

Getting away from the medical angle of DNA testing, I’m not sure if I mentioned here that I got an interesting result from Ancestry.com.

I knew that all my grandparents were Jewish and immigrated from Russia. So the result I got had one small aberration, but one I didn’t think much about:



I’m talking about the blob over the British Isles.

I had always wondered if I was adopted - none of my relatives are tall, had curly blond hair as a child, or blue eyes.

Long story short - I was contacted by a lady who said her husband and I were either siblings or very close cousins. They also live in Georgia and we met, and had a lot in common. So far, it seems as though I share a father - not the one who raised me - with at least 3 other males and 3 other females. All of whom were born in Washington, DC between 1947 and 1955 to mothers who were having trouble conceiving. Speaking to another descendant led to a gentleman of Scottish descent in Washington, DC, who was a medical student and almost certainly the common sperm donor to at least the 6 “siblings” so far discovered. A living aunt confirmed that my mom had had trouble conceiving and had finally gotten pregnant after a “procedure”.

Just pointing out you never know what your DNA might show if you take the leap and have it checked!

[Fast Eddie B]

One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

[God Bomb]

Seems like begging the question. 

Just because something works doesn't necessarily mean it's practical or will become popular.

[lonely moa]

Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.

In Swedish populations, genetics plays a role in around 50-60% of cases, in particular BRCA1 and BRCA2 confers a moderate to high risk of prostatic carcinoma in men and breast and ovarian carcinoma in women.

A summary from the NIH:

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

And, no, I haven’t learnt how to insert links.  I typed in the link laboriously.  Perhaps someone can tell me how to do it?  But I promise not to do a CarbShark with his block dumped lists of links.

 

Your link worked, btw. Ta.  I just click the address box, copy and paste.

The official breast screening pamphlet in NZ says screening cuts one's risk of death by 25%, that 5 of 10,000 screened women will die from breast cancer and 7 of 10,000 unscreened women will die from breast cancer annually. My beautiful wife has given mammograms a miss some time ago.

[bachfiend]

Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.

In Swedish populations, genetics plays a role in around 50-60% of cases, in particular BRCA1 and BRCA2 confers a moderate to high risk of prostatic carcinoma in men and breast and ovarian carcinoma in women.

A summary from the NIH:

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

And, no, I haven’t learnt how to insert links.  I typed in the link laboriously.  Perhaps someone can tell me how to do it?  But I promise not to do a CarbShark with his block dumped lists of links.

 

Your link worked, btw. Ta.  I just click the address box, copy and paste.

The official breast screening pamphlet in NZ says screening cuts one's risk of death by 25%, that 5 of 10,000 screened women will die from breast cancer and 7 of 10,000 unscreened women will die from breast cancer annually. My beautiful wife has given mammograms a miss some time ago.

There’s some argument about whether mammography is worth doing.  Whether it’s picking up cancers that wouldn’t be causing a problem.

Anyway.  In the summary from the NIH there was a link to a summary on measures to prevent prostatic carcinoma also published by the NIH.  It noted that high fat diets increase the risk of prostatic carcinoma, and I thought of you and CarbShark (actually the studies were mixed - half showed an increased risk, and half showed no difference).

[lonely moa]

Interesting that breast and prostate cancer screening didn't arise in the DNA testing discussion... but not surprised.

In Swedish populations, genetics plays a role in around 50-60% of cases, in particular BRCA1 and BRCA2 confers a moderate to high risk of prostatic carcinoma in men and breast and ovarian carcinoma in women.

A summary from the NIH:

https://www.cancer.gov/types/prostate/hp/prostate-genetics-pdq

And, no, I haven’t learnt how to insert links.  I typed in the link laboriously.  Perhaps someone can tell me how to do it?  But I promise not to do a CarbShark with his block dumped lists of links.

 

Your link worked, btw. Ta.  I just click the address box, copy and paste.

The official breast screening pamphlet in NZ says screening cuts one's risk of death by 25%, that 5 of 10,000 screened women will die from breast cancer and 7 of 10,000 unscreened women will die from breast cancer annually. My beautiful wife has given mammograms a miss some time ago.

There’s some argument about whether mammography is worth doing.  Whether it’s picking up cancers that wouldn’t be causing a problem.

Anyway.  In the summary from the NIH there was a link to a summary on measures to prevent prostatic carcinoma also published by the NIH.  It noted that high fat diets increase the risk of prostatic carcinoma, and I thought of you and CarbShark (actually the studies were mixed - half showed an increased risk, and half showed no difference).

 

We conclude that dietary fat may indeed be related to prostate cancer risk, although the specific fat components that are responsible are not yet clear. Given the diverse effects of fatty acids on cellular biology and chemistry, it seems likely that the relationship is complex, involving the interplay of fat with other dietary factors, such as antioxidant vitamins and minerals, or with genetic factors that influence susceptibility.

The study you quote suggests that the best way to avoid prostate cancer is to be castrated before puberty, not something most males would be keen to do.

[brilligtove]

I think Steve may have gotten something wrong about the Heat Death of the universe.

He opined there would still be stuff. I think as long as there’s “stuff”, there will be gravity working on that stuff, which would involve movement and some degree of work, energy and heat.

From what I understand, the heat death will not arrive until the last proton “evaporates”. Though there are possibly more fundamental particles that will need to “evaporate” as well before Heat Death is complete.

But I’m not a physicist or cosmologist, so I’d appreciate being straightened out on this if I have it wrong.

If I recall correctly, the expansion of space will eventually accelerate to such an extent that it will overwhelm the strong nuclear force. Even works cannot remain bound together, there will be nothing left.

[gebobs]

I am in the States form Pennsylvania so my thoughts about the SGU being too parochial come from this viewpoint.  I have never thought the SGU was making fun of the U.K.  If anything I sometimes wonder if they are too much is awe of it.

I kind of understand it. When someone from the UK or wherever affects some American accent and says something stereotypically American, I'm not necessarily offended. But I may roll my eyes and wonder if they think all Americans speak or act that way. Of course, they probably don't. It's just funny pointing out our differences. Just so, when the rogues do their accents and say things like "Cor blimey", any Brit is probably rolling their eyes. The rogues just like doing bad accents and "Cor blimey" is funny anytime you say it.

[daniel1948]

The study you quote suggests that the best way to avoid prostate cancer is to be castrated before puberty, not something most males would be keen to do.

And the next-best is to avoid eating excessive amounts of fat. The fact that the "best" is something most guys won't want to do, is not a reason for neglecting to do the second-best.

[CookieMustard]

One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

It seems to be the opposite of something like "If homeopathy wasn't effective  there wouldn't be so many people using it."

[gebobs]

One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

I think if he was in a debate, he would have couched his terms more carefully. And what I suppose he means is that medical science is always on the hunt for better diagnostic tools and I am sure they are watching DNA analysis quite closely. When this kind of tool becomes useful, the medical community will be tripping over themselves to get in on it.

[CarbShark]

One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

I think if he was in a debate, he would have couched his terms more carefully. And what I suppose he means is that medical science is always on the hunt for better diagnostic tools and I am sure they are watching DNA analysis quite closely. When this kind of tool becomes useful, the medical community will be tripping over themselves to get in on it.

What Steve is not mentioning is the cost benefit calculation. It's not just risk/benefit.

If full-body MRI scans and/or full genome sequencing helped 5% of people who had them done, but were inexpensive, then they'd be standard practice.

If they helped 95% of people who had them done, and cost as much as they do currently, they'd be standard practice.

In the US today, it may even be the cost/benefit analysis is given more weight than the risk/benefit analysis.

I'm wondering what the actual figures are? What percentage of people are discovered to have serious risks or conditions are by these procedures?

It's not zero, but I'm guessing it's less than 5%

[bachfiend]

One more thing...

Regarding certain screenings for medical issues, Steve said something like...”If that was really effective, they’d already be doing it”.

Smacks of a fallacy, but I can’t put my finger on it.

I think if he was in a debate, he would have couched his terms more carefully. And what I suppose he means is that medical science is always on the hunt for better diagnostic tools and I am sure they are watching DNA analysis quite closely. When this kind of tool becomes useful, the medical community will be tripping over themselves to get in on it.

What Steve is not mentioning is the cost benefit calculation. It's not just risk/benefit.

If full-body MRI scans and/or full genome sequencing helped 5% of people who had them done, but were inexpensive, then they'd be standard practice.

If they helped 95% of people who had them done, and cost as much as they do currently, they'd be standard practice.

In the US today, it may even be the cost/benefit analysis is given more weight than the risk/benefit analysis.

I'm wondering what the actual figures are? What percentage of people are discovered to have serious risks or conditions are by these procedures?

It's not zero, but I'm guessing it's less than 5%

I’m guessing that the figure would be vanishingly close to zero (not much more than rounding error) for an unselected population undergoing full body MRI scanning and and full genome sequencing in the absence of symptoms or a positive family history.  But it would throw up numerous ‘abnormalities’ either on MRI scanning which are of no significance (but which would either require further investigation or leave the person worrying) or on full genome sequencing with the presence of gene variants associated with a slight increase (of the order of less than 1% or so) in the risk of certain diseases.

If an ‘abnormality’ is detected, what do you do?  Worry yourself sick?  Henry Marsh, a retired British neurosurgeon, recounted an example in his book ‘Do No Harm.’  A patient had tension headaches, so her GP ordered a CAT scan (which was inappropriate), which showed a very small berry aneurysm on one of her cerebral arteries.  The risk is that it might rupture causing death or a stroke.  The lifetime risk of either of these two occurring is around 2% for the size of the aneurysm.  The aneurysm could be surgically clipped, removing future risk, but with a 2% risk of an intraoperative stroke or death, which occurs immediately.  The rational decision would be to do nothing, besides ensuring that the blood pressure is normal and remains normal (since high blood pressure is a risk factor for rupture).  The patient opted for immediate operation so as to avoid a lifetime of worrying about a timebomb in her head that was unlikely ever to cause her harm otherwise.

[arthwollipot]

Personally I don't get bothered by the America-centrism of the hosts. They are American, they live in America and are immersed in American culture. It's okay for them to approach things from an American viewpoint. They do at least make an effort - and a good one - to be international, and I appreciate that, because it's something that a lot of American podcasts don't bother with.

[CarbShark]

If an ‘abnormality’ is detected, what do you do?  Worry yourself sick?  Henry Marsh, a retired British neurosurgeon, recounted an example in his book ‘Do No Harm.’  A patient had tension headaches, so her GP ordered a CAT scan (which was inappropriate), which showed a very small berry aneurysm on one of her cerebral arteries.  The risk is that it might rupture causing death or a stroke.  The lifetime risk of either of these two occurring is around 2% for the size of the aneurysm.  The aneurysm could be surgically clipped, removing future risk, but with a 2% risk of an intraoperative stroke or death, which occurs immediately.  The rational decision would be to do nothing, besides ensuring that the blood pressure is normal and remains normal (since high blood pressure is a risk factor for rupture).  The patient opted for immediate operation so as to avoid a lifetime of worrying about a timebomb in her head that was unlikely ever to cause her harm otherwise.

My Medical Choice by Angelina Jolie - The New York Times

I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.