“ One study in 2020 found that 95% of asymptomatic patients had some type of "abnormal" finding, but just 1.8% of these findings were indeed cancer.”

This has been my experience. And I’ve had oncologists echo exactly this. In the words of one: MRIs find too much.

The CT and the PET/CT are the gold standards for finding cancer, finding recurrences, and staging cancer. The trouble is the radiation dose.

MRI provides very inconclusive results. You’ll see something but it’ll be unclear what it is. And often what you see is not even visible on a CT. Or it’s visible on a PET/CT and is showing metabolic activity indicating its cancer.

MRIs are great for certain things like herniated disks in your back. They suck at cancer.

Answering the question in the title...

> One study in 2020 found that 95% of asymptomatic patients had some type of "abnormal" finding, but just 1.8% of these findings were indeed cancer.

So a bit less than 1.8% of the time in this study

> Prenuvo's recent Polaris Study followed 1,011 patients for at least one year following a whole-body MRI scan. Of these patients, 41 had biopsies. More than half of the 41 were diagnosed with cancer.

That's 2.0%

Note that this doesn't mean that 1.7~2.0% of people have cancer without knowing it. It could be more:

> A negative scan doesn’t mean you’re disease-free. Some cancers and conditions simply aren’t visible yet or aren’t reliably detected on a one-time full-body MRI."

But also perhaps less, in a way:

> "You're finding something that never would have caused you any problem in your life, and in cancer, we call that overdiagnosis," Vickers says.

Just to point out, cancer isn't the only reason to get these. Aneurisms, hemachromatosis, etc can all be serious. I know someone who got scanned for $500 and they caught hemachromatosis via iron deposits in the liver. Much better than eventual chirrosis and liver failure.

Doctors here are cognitively captured by a system designed to limit cost (and that's mostly a good thing)

But scanning frequently is overwhelmingly good for the patient. The problem is the doctors. Imagine two possibilities. 1. You scan every six months and a doctor reviews your scans but never tells you anything no matter what 2. You scan every six months and a doctor reviews your scans and only tells you results if you have an obviously growing mass that has a probability greater than 95% of being cancerous

Obviously #2 is better for the patient than #1, but #1 is equivalent to never testing if you ignore cost.

So the actual reason we don't have effect frequent scans combined with effective diagnostic techniques is cost, and doctors cope with this reality by saying clearly wrong things about "over diagnosis". It's a local minimum of the payer/provider dynamic that has nothing to do with scans per se.

Maybe the right answer isn't to do a biopsy, but to monitor the area with follow-up scans? It seems like that addresses much of the harm that a false positive can cause (invasive biopsy leading to complications) while maintaining most of the gains (still very early detection).

I pay an extra $60 a year to have my ophthalmologist take a digital image of my retina. It comes back as normal every year, but if something does change we can diff the image against the baseline.

Maybe I don't want to look for cancer right now but if I spend $1,000 every 5 years to take an image for later use... isn't that useful?

One important point is that many people die WITH cancer but not OF cancer. So even for the 1.8%, only a fraction of those people were going to die of the disease (or even suffer significant symptoms) - the rest were just going to die of natural causes anyway.

But now you've found it you pretty much have to remove it, which has significant quality of life implications.

I don't see the point of testing constantly. It's just creating stress and probably most of the time, the tumor might be benign or it might be small and go away on its own.

And anyway, you have to die of something so for me cancer would just be a sign that time's up.

There’s a major difference between having insurance cover something (socialized cost, immediately drives up provider fees for bizarre reasons) and letting the market allow people to buy it themselves (individual cost, the market drives the cost down fast and hard). Notice the pattern with LASIK and GLP1 where lack of insurance coverage has counterintuitively made it cheaper and more accessible.

Let everyone who wants to pay get their scans! But don’t make me pay for you

1. collecting baseline info for later comparison is good

2. i can afford the money for the chance of early detection. Many cancers are symptomatic only in the latter stages. It does not hurt to check.

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