I think this is a technical article about a narrow aspect of public health policy, not advice to individual patients.

One point in the article is that early detection would give you more years to live even if there were no treatment. Because "early" means "more years". This wasn't obvious to me right away.

But he is not saying don't get screened! He is not saying there are no cancer treatments! He's saying that the 5-year survival rate, considered alone, is a tricky measure that can fool our intuition. In my case he's right.

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Details.

Dumb toy model. Let Tumor X kill you exactly 8 years after it becomes detectable in screening. Assume screening is 100% accurate with no false positives. Assume X cancer kills you exactly 2 years after it causes symptoms. Imagine that there is no treatment for X cancer.

In this dumb model, everybody dies at exactly the same time after the tumor became detectable. The people who caught it in screening had more warning, but otherwise they didn't get a better outcome. Even though screening boosts the 5-year survival rate from 0% to 100%.

Never mind his like 7-state Markov model. OMG. Why.