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Speaker 1: All of that ultra processed food that is all part

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Speaker 1: of our diets. And I look around the room today,

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Speaker 1: people in the room here that are in your thirties

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Speaker 1: and forties, your number one risk of cancer mortality is

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Speaker 1: actually colling cancer.

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Speaker 2: Now, Hi everyone, I'm Katie Couric, and this is next question.

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Speaker 2: Since March is Colorectal Cancer Awareness Month, I wanted to

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Speaker 2: talk about a cause. Though important to me, I became

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Speaker 2: a fierce advocate for calling cancer awareness and screening after

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Speaker 2: my husband Jay died of this disease in nineteen ninety

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Speaker 2: eight when he was just forty two years old. It

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Speaker 2: shattered me and our girls, who were only six and

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Speaker 2: two at the time. So, as many of you know,

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Speaker 2: I became a screen queen of sorts, and increasing awareness

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Speaker 2: and spreading the gospel of early detection has become a

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Speaker 2: true mission for me. Today we're focusing on the symptoms,

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Speaker 2: the diagnostic tools, the treatments, and most urgently, why the

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Speaker 2: number of co directal cancer cases are going in the

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Speaker 2: wrong direction, especially in people under the age of fifty.

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Speaker 2: Joining the conversation is the CEO of Exact Sciences, Kevin Conroy.

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Speaker 2: Kevin is a business leader here in Madison is overseeing

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Speaker 2: in critical growth at his company. Kevin, of course, didn't

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Speaker 2: get the memo on the second commandment here at EPIC

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Speaker 2: because Exact Sciences shareholders just approved an acquisition by Abbott Laboratories.

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Speaker 2: Kevin has been a tremendous partner and a true blue

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Speaker 2: friend to me in the effort to get and keep

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Speaker 2: people talking about co directal cancer. Judy Faulkner, of course,

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Speaker 2: is the founder and CEO of Epic Systems. She's here

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Speaker 2: to talk about the role AI and large data sets

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Speaker 2: will be playing as we try to understand why this

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Speaker 2: disease is showing up more in younger people. And finally,

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Speaker 2: doctor Caitlin Murphy is a professor in the Departments of

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Speaker 2: Pediatrics and Public Health Services at the University of Chicago.

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Speaker 2: She holds a PhD in epidemiology from unc Chapel Hill

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Speaker 2: and a master's in public health from UT Health Houston.

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Speaker 2: And we'll be talking about the latest research and the

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Speaker 2: rising incidents of colorectal cancer and the quest to figure

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Speaker 2: out why this is happening. So please give our panel

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Speaker 2: a round of applause. Thank you all so much for

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Speaker 2: indulging me and for being here, and for talking about,

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Speaker 2: as I said, an issue that is so important to

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Speaker 2: me and I've become sort of synonymous with So you

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Speaker 2: look like you're kind of tearing up, Kevin.

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Speaker 1: I'm sitting here amazed that I am on this panel.

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Speaker 2: All right, Well, don't be ridiculous. You should be and

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Speaker 2: we'll talk to you about a lot of things, how

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Speaker 2: Exact Sciences has really changed the face of this disease.

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Speaker 2: So thank you for that. But first I wanted to

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Speaker 2: talk with doctor Murphy. Let's talk about this alarming statistic

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Speaker 2: that came out last year. Colorectal cancer is now the

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Speaker 2: leading cause of cancer deaths in people under the age

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Speaker 2: of fifty in this country, and we're seeing similar patterns

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Speaker 2: all over the world. There are a lot of theories

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Speaker 2: about why this is happening, and I wondered if we could,

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Speaker 2: Caitlin just run through them, and may I call you

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Speaker 2: Caitlin doctor Murphy. Yes, of course, So let's talk about

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Speaker 2: the various theories.

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Speaker 3: Well, I've been in the trenches doing work on this

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Speaker 3: for a long time, and my thinking about the theories

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Speaker 3: has really evolved over the last ten years or so.

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Speaker 3: When I first started studying coloactual cancer and young people,

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Speaker 3: I was really convinced that there was a smoking gun

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Speaker 3: of a risk factor, so one thing out there that

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Speaker 3: explained all of the increase in incidence in mortality rates,

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Speaker 3: as you're pointing out. But really, as I've studied this

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Speaker 3: disease over the last couple of years, it's been clear

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Speaker 3: that there's probably thousands of possibilities, and I think what

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Speaker 3: we need to do now is eliminate what some of

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Speaker 3: those top suspects could be. So I think it's the environment,

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Speaker 3: and how can we think about identifying maybe some of

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Speaker 3: the top clues or suspects in the environment that might contribute.

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Speaker 2: Let's talk about that, because you hear that and you think, well,

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Speaker 2: I want them out of my environment. So what are they?

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Speaker 3: We really don't know. I think maybe we can take

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Speaker 3: a step back, and first, there was a lot of

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Speaker 3: thought initially that things like obesity, physical inactivity, diet risk

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Speaker 3: factors that we know are related to col directal cancer

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Speaker 3: and older adults are also related to co directal cancer

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Speaker 3: and young people, and it makes sense to think that

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Speaker 3: those are the contributors because they've been increasing in our

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Speaker 3: population at the same time that the incidence rates have

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Speaker 3: been increasing. But we've learned in the last couple of

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Speaker 3: years or so that yes, those do contribute, but they

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Speaker 3: don't explain all of the increase that we're seeing, and

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Speaker 3: so that's left a lot of us in the research

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Speaker 3: field thinking that there's something else in the environment that

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Speaker 3: may contribute. What that is I have no idea, unfortunately,

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Speaker 3: but I think there's a lot of opportunity to apply

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Speaker 3: some of the new technologies and tools we have to

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Speaker 3: at least figure out what again might be those top suspects.

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Speaker 2: I want to mention some of the theories because as

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Speaker 2: you all can imagine, I'm obsessed with this topic and

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Speaker 2: i read constantly about it, and I'm just going to

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Speaker 2: throw out some of the reasons that people are looking into.

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Speaker 2: For example, there was a big article in jama in

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Speaker 2: November about ultraprocessed foods. As you mentioned, obesity, low fiber.

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Speaker 2: People are talking and looking at microplastics and how they're

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Speaker 2: interacting with something called the microbiome forever chemicals pfas, and

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Speaker 2: how they might be affecting sort of our microbiome and

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Speaker 2: our biology. I've also heard from doctors at Memorial Sloan

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Speaker 2: kettering about the over prescription of antibiotics that somehow that's

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Speaker 2: affecting our bacteria. You know that doctors were kind of

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Speaker 2: handing them out like handy, even for viral infections where

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Speaker 2: they weren't going to be particularly efficacious. So I even

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Speaker 2: talked to a doctor, a researcher, scientist. I started Stand

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Speaker 2: Up to Cancer, which is an organization that has scientists

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Speaker 2: collaborate in all areas of cancer research. And to brag

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Speaker 2: for a second, we've raised over eight hundred million dollars

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Speaker 2: for collaborative research. Thank you. She was saying interestingly enough

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Speaker 2: that scientists are even looking, Caitlin at screens and how

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Speaker 2: screens might be affecting our circadian rhythms, and how that

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Speaker 2: might have an impact on our biology and potentially this

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Speaker 2: lack of sleep on our microbiome. So I just sort

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Speaker 2: of read a laundry list of all the different theories

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Speaker 2: out there, and I'm just curious what you think.

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Speaker 3: Yeah, I think you're exactly right. There's a laundry list

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Speaker 3: of possibilities. And now I think we're at a moment

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Speaker 3: in science where we need to kind of narrow in

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Speaker 3: on one of those things in your laundry lists.

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Speaker 2: But it might be multifactorial, right, I mean, it might

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Speaker 2: be a whole confluence of things exactly.

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Speaker 3: I don't think it's a smoking gun, like I said,

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Speaker 3: but a lot of different possibilities. The challenge I think

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Speaker 3: in science has been that historically we study one thing

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Speaker 3: at a time. So we've been taught as scientist to

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Speaker 3: test one hypothesis and then move on to the next.

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Speaker 3: But I don't think we have time in this case

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Speaker 3: to test one thing at a time, and we really

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Speaker 3: need to think about how can we use different tools,

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Speaker 3: different methods to discover the thousands of possibilities that it

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Speaker 3: might be.

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Speaker 2: And that's where a huge data set and a company

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Speaker 2: like epic Judy comes in.

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Speaker 4: Right.

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Speaker 2: Epidemiological studies are notoriously difficult to conduct. They take years

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Speaker 2: and years. They have to get so many different people

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Speaker 2: to participate, right, Caitlin, and kind of give all this

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Speaker 2: personal info about what they may be eating on all

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Speaker 2: kinds of things. How does a large data set that

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Speaker 2: you all have accumulated here is possibility for that to

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Speaker 2: help us understand why this is happening, Judy.

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Speaker 4: Yeah, and I think that our customers who share their

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Speaker 4: data with us and have people who can do the research,

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Speaker 4: have a wonderful opportunity to look at that data and

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Speaker 4: help make some of the decisions that need to be made.

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Speaker 2: Because I know a lot of those doctors I queried

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Speaker 2: before our conversation, they were so excited about the research

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Speaker 2: aspect of EPIC and the database that you all have accumulated.

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Speaker 2: You haven't even started to necessarily turn that engine on

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Speaker 2: as much as it could be. Right.

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Speaker 4: If you look at epicresearch dot org, you'll see a

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Speaker 4: lot of the studies that we do and some of

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Speaker 4: the studies that are various customers do as well as

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Speaker 4: sometimes if you just read an article, you read, oh,

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Speaker 4: this was using epic stata at the end of the article.

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Speaker 2: Do you collaborate with researchers like Caitlin at other academic institutions.

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Speaker 4: Yes, some of our staff do. We do have a

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Speaker 4: small research group that works with some of the research

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Speaker 4: folks from our customer base. Plus we've worked with the

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Speaker 4: CDC a bit.

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Speaker 2: That's awesome because I think we need all the help

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Speaker 2: we can get. Right Meanwhile, Kevin, you know, in addition

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Speaker 2: to the number of people under fifty really increasing, the

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Speaker 2: American Cancer Society even more recently released a report that

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Speaker 2: said the number of colorectal cancer cases and patients between

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Speaker 2: the ages of fifty and sixty five has also increased,

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Speaker 2: as has the mortality rate. And I'm curious why you

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Speaker 2: think that's happening.

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Speaker 1: The issue is a real issue that the age is lowering,

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Speaker 1: and part of it is probably because we have done

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Speaker 1: such a good job of screening people over time that

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Speaker 1: older people are well protected because they've been screened. That's

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Speaker 1: part of it. But the other part of it is

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Speaker 1: there something going on in diets or the environment or

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Speaker 1: the microbiome that is causing younger people, including people under

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Speaker 1: sixty five, to get colon cancer. One researcher at Mail

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Speaker 1: Clinic said, Kevin, people at the Mail Clinic think that sugar,

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Speaker 1: a lot of sugar causes an insulin response. Insulin hits

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Speaker 1: the lining of the gut of your colon, which causes

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Speaker 1: cells to turn over a lot faster, which then just

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Speaker 1: because the cells die, you need new cells and you

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Speaker 1: have a random chance of a mutation in one of

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Speaker 1: the genes that protects against colon cancer. And he said,

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Speaker 1: you can look at the inside of the gut of

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Speaker 1: somebody who is fifty today, it looks like the gut

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Speaker 1: of an eighty year old from nineteen fifty. So all

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Speaker 1: of that ultra processed food that is all part of

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Speaker 1: our diets. And I look around the room today, people

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Speaker 1: in the room here that are in your thirties and forties,

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Speaker 1: your number one risk of cancer mortality is actually colon cancer,

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Speaker 1: now you know, and lung cancer mortality in younger people

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Speaker 1: has just plummeted, I think from first to third or fourth,

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Speaker 1: and for leukemia that has just plummeted, I think from

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Speaker 1: third to fifth. And so colon cancer just keeps increasing.

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Speaker 1: And so there must be something here in the diet

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Speaker 1: and the environment which means, okay, how do you protect

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Speaker 1: against it? It may be twenty years before we know

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Speaker 1: the answer.

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Speaker 2: Hi everyone, it's me Katie Couric. You know, if you've

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Speaker 2: been following me on social media, you know I love

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Speaker 2: to cook, or at least try, especially alongside some of

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Speaker 2: my favorite chefs and foodies like Benny Blanco, Jake Cohen,

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Speaker 2: Lighty Hoyke, Alison Roman and Ininagarten. So I started a

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Speaker 2: free newsletter called good Taste to share recipes, tips and

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Speaker 2: kitchen mustaves. Just sign up at Katiecuric dot com slash

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Speaker 2: good Taste. That's k A t I e c o

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Speaker 2: u ric dot com slash good Taste. I promise your

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Speaker 2: taste buds will be happy you did. What's interesting to me, Kevin,

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Speaker 2: is you know between the ages of fifty and sixty five,

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Speaker 2: and this is apparently due to an uptick and rectal cancer,

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Speaker 2: the cancer that killed Catherine O'Hara. These people, this cohort

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Speaker 2: is squarely in the middle of the key screening population.

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Speaker 2: Do you think that people are getting screened less? What

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Speaker 2: do you think is going on?

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Speaker 1: Well, the incidence going up is probably because more people

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Speaker 1: are getting screened. So when you do a jolt of screening,

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Speaker 1: what do you do is you pull forward and you

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Speaker 1: find a lot more cancers than you would find if

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Speaker 1: you just let them occur naturally.

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Speaker 2: And this includes early stage cancers, right, that's right when

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Speaker 2: the American Cancer Society says this.

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Speaker 1: Yes, So, for example, when you introduce a new screening

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Speaker 1: test like colo Guide, And to put this in perspective,

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Speaker 1: if you go back twelve years ago when coal Guard

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Speaker 1: was first launched, there are about five to six million

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Speaker 1: screening colonoscopies in the US every year. Today, there are

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Speaker 1: five to six million screening colonosopies in the US every year,

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Speaker 1: but there's also now this year will be about six

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Speaker 1: million coal guard tests Ballpark. I'm not giving guidance to

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Speaker 1: anybody about how many screening tests we're going to do,

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Speaker 1: but what that tells you is we got this BOLDUS

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Speaker 1: of people's screened twenty three million people in the last

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Speaker 1: twelve years. So you're going to find more cancers, but

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Speaker 1: you're going to find them earlier when they're treatable. And

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Speaker 1: to put this in perspective, a stage one colon cancer

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Speaker 1: ninety eight percent survival rate. Almost never do you get chemotherapy.

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Speaker 1: It's surgery is curative. Stage four colon cancer when it

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Speaker 1: has spread, eight percent survival. So this is a disease

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Speaker 1: that can be eradicated. And the one other cancer, there's

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Speaker 1: been one cancer that's been nearly eradicated, cervical can. You

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Speaker 1: don't hear about it a lot. There are forty five

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Speaker 1: hundred deaths a year in the US, but if you

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Speaker 1: go back into the nineteen fifties, cervical cancer was the

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Speaker 1: number one cause of death in women. There were forty

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Speaker 1: five thousand deaths. And then came along this test called

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Speaker 1: the pap smear. Doctor peploc and cow He invented the

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Speaker 1: test and pretty soon everybody got screened. The disease is

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Speaker 1: so slow growing it takes ten to fifteen years to

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Speaker 1: go from that lesion to cancer, and you can remove

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Speaker 1: the lesion, so we can do the same thing for

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Speaker 1: colon cancer. And I'll just say one more thing. I

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Speaker 1: know I'm going on too long.

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Speaker 2: But oh, you're fine.

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Speaker 1: I was at dinner with Judy and a group of

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Speaker 1: people about I want to say, about seven or eight

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Speaker 1: years ago, and I explained the problem that we had

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Speaker 1: that we were building code to integrate with every health

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Speaker 1: system in the US. And Judy looked at me and said, Kevin,

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Speaker 1: that is going to break and I said, I know,

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Speaker 1: but you won't let us become a customer. And he said,

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Speaker 1: let me think about that. And thirty days later, Alan

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Speaker 1: Hutchison called me and said, Kevin, not only do we

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Speaker 1: want you to become a customer, but we want to

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Speaker 1: create an electronic ordering capability so that we take the

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Speaker 1: friction out of ordering. We were getting all of our

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Speaker 1: orders basically by facts and results by facts. And I

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Speaker 1: remember saying to Alan at the time, this decision is

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Speaker 1: going to play a role in disease eradication. And so

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Speaker 1: Judy thank you.

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Speaker 2: And so I can plug col of Guard because I'm

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Speaker 2: sure Kevin doesn't really want to. But the reason it's

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Speaker 2: so important is there are many people who for whatever reason,

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Speaker 2: can't afford a kolonoscopy, can't take time off from work,

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Speaker 2: don't have people who will pick them up, They're afraid.

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Speaker 2: There are all sorts of sort of cultural reasons why

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Speaker 2: some people are reticent to get a colonoscopy. So you

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Speaker 2: were saving a lot of lives with coll of Guard,

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Speaker 2: So thank you for that. But let's talk at the

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Speaker 2: screening age. Because the screening age was lowered to forty

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Speaker 2: five everyone a couple of years ago. You get your

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Speaker 2: baseline calling cancer screening at age forty five. Now, only

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Speaker 2: one fifth of the people between the ages of forty

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Speaker 2: five and fifty have been screened. So if you fall

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Speaker 2: into that category, or your parents do, or your siblings,

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Speaker 2: you know, please urge them to get screens starting at

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Speaker 2: age forty five. Why do you think that number is

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Speaker 2: so bad, Caitlin, I mean one fifth of the people.

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Speaker 2: Do you think that the word hasn't gotten out? Do

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Speaker 2: you think doctors aren't educated enough? What is happening?

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Speaker 3: I think that maybe some of it. But if you

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Speaker 3: think about a forty five year old sort of in

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Speaker 3: the peak of their career. They may have young children

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Speaker 3: at home, they may have aging parents that they're caring for.

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Speaker 3: There are a lot of competing demands at that time

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Speaker 3: of life where maybe taking a day off to get

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Speaker 3: a colonoscopy isn't as important as maybe the other demand's

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Speaker 3: right in front of you. And I don't think the

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Speaker 3: awareness about alternatives to colonoscopy guys really infiltrated maybe that

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Speaker 3: age group yet, so things like colon guard or other

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Speaker 3: stool based tests as being sort of easier, more convenient alternatives.

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Speaker 2: I told you I wanted justin Timberlake to do a

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Speaker 2: whole ad campaign called shit in a Box. Don't you

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Speaker 2: think that would be clever? But Kevin didn't really go

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Speaker 2: for it. I was going to say poop, but I

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Speaker 2: thought why not? Anyway, what do you think it is,

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Speaker 2: Kevin that people forty five to fifty aren't getting screened?

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Speaker 1: Let me ask how many people in the room here today?

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Speaker 1: Raise your hand if you knew the screening age drop

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Speaker 1: from age fifty to forty five.

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Speaker 2: Well, this is a very smart group of people. I

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Speaker 2: like that.

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Speaker 1: I'm really happy to hear that. You know, part of

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Speaker 1: it is a lot of people that in that age

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Speaker 1: group go to the doctor every three or four years,

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Speaker 1: and if their doc doesn't talk to them about colon

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Speaker 1: cancer screening, you've missed it. And then they're the urgency

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Speaker 1: just isn't there. People think it's not going to happen

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Speaker 1: to me. Well, one in sixteen or one in seventeen

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Speaker 1: people here will be diagnosed with calling cancer in your lifetime,

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Speaker 1: and if you don't get screened, the odds of being

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Speaker 1: detected late stage go up massively.

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Speaker 2: I want to ask you about lowering the screening age.

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Speaker 2: You know, if in fact this has become an epidemic.

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Speaker 2: It's the number one cancer killer of people under fifty,

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Speaker 2: and certainly anecdotally, almost every huge medical institution now is

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Speaker 2: an early onset collorectal cancer department. You know, I've heard

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Speaker 2: stories of people in their early thirties getting it. I

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Speaker 2: talked to an oncology fellow from Monta Fiori who told

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Speaker 2: me she had to tell a twenty one year old

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Speaker 2: boy that he had stage four calling cancer. No family history,

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Speaker 2: no Lynch syndrome or familio polyposis, which puts you at

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Speaker 2: an increased risk, So why can't we lower the screening age.

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Speaker 1: The essential challenge with screening is that it costs money,

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Speaker 1: and so there's always just two variables that really matter

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Speaker 1: is what is the impact of screening and what is

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Speaker 1: the cost or the harms of screening, And so there's

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Speaker 1: always a balance. And what happened was that the increase

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Speaker 1: in the number of people being diagnosed the prevalence of

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Speaker 1: the disease in forty five to forty nine year olds

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Speaker 1: went up enough so that that balance between the impact

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Speaker 1: of screening and the cost of screening tipped over to

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Speaker 1: be more impactful than screening people aged seventy to seventy five,

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Speaker 1: which was recommended, And so the main guideline group said, well,

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Speaker 1: if it's good for seventy to seventy five year olds,

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Speaker 1: it's good for forty five to forty nine year olds.

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Speaker 1: And when you think about it that impact, you look

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Speaker 1: at life years gained and if you're forty two and

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Speaker 1: you're diagnosed with stage one cancer, you get a lot

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Speaker 1: more gained there. You get forty or forty five years

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Speaker 1: of gain there. So if you drop it to forty,

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Speaker 1: now that that age group is at higher risk and

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Speaker 1: you can do it with the lower cost test. So

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Speaker 1: you take colguard is a five hundred dollars test, colonoscopy

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Speaker 1: depending on where you go, is a twenty five hundred

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Speaker 1: dollars test. Now colonoscopy. There just are not enough gastroinrologists

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Speaker 1: in the US to screen everybody. We have a fixed

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Speaker 1: capacity of five to six million tests. That's a problem

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Speaker 1: when you have fifty million people not up to date

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Speaker 1: with screening. We have the ability with a test like

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Speaker 1: colo guard or what's called the fit test, which I

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Speaker 1: think is a bad test, don't use it, but to

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Speaker 1: screen a lot more people, and to start screening at

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Speaker 1: maybe even thirty five and then maybe seven years later

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Speaker 1: gets screened, and then once you hit forty five, get

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Speaker 1: screened every three years, which is what Colguard is recommended for.

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Speaker 2: Judy, do you ever use the epic data to change

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Speaker 2: public policy? In other words, can you make a vincing

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Speaker 2: argument where you have all this information about a whole

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Speaker 2: slew of patients to then say this needs to be

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Speaker 2: done differently? You have, haven't you? In the past.

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Speaker 4: We did that with fentanyl very successfully.

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Speaker 2: Tell me about that.

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Speaker 4: Well, we found that fentanyl was being examined for tested

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Speaker 4: for when people came in with drug overdose to the

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Speaker 4: EDS five percent at the time, but it was responsible

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Speaker 4: for forty five percent of the deaths. And so we

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Speaker 4: published that and I don't know where it is now,

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Speaker 4: but several states were changing their policy and what the

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Speaker 4: requirements were for fentanyl testing. And if you look at

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Speaker 4: the studies that are coming out now on the number

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Speaker 4: of deaths from overdose, they've gone way down and the

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Speaker 4: big changes with ventanyl.

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Speaker 2: So you can envision Kevin right using data to convince

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Speaker 2: well right now, I think who knows what you can

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Speaker 2: convince Robert F. Kennedy Junior to do, But I mean

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Speaker 2: you can can see where you could use data to

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Speaker 2: make a compelling reason to change public policy.

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Speaker 1: And this is the power of epic. So our customers

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Speaker 1: are doing this. Health systems all over the country are

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Speaker 1: using I think it's called healthy Planet. Healthy Planet allows

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Speaker 1: you to take a look at a population within a

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Speaker 1: health system and identify people within a certain age bracket

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Speaker 1: that are not up to date with screening, and then

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Speaker 1: they're initiating an electronic order for all of their patients

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Speaker 1: who fit into that category, and it automatically then electronically

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Speaker 1: triggers US shipping collection kits to hundreds thousands, tens of thousands,

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Speaker 1: in one case four hundred thousand collection kits being shipped

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Speaker 1: out over a two week period. So the power of

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Speaker 1: EPIC is just amazing. I do believe if you fast

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Speaker 1: forward twenty years, because of the power of EPIC and

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Speaker 1: the power of Cologuard, you're going to have a story

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Speaker 1: of calling cancer moving clearly in the direction of cervical

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Speaker 1: cancer a disease of the people that aren't being screened,

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Speaker 1: and that will be the rare case, not the common case.

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Speaker 2: If you want to get smarter every morning with a

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Speaker 2: breakdown of the news and fascinating takes on health and

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00:23:23,640 --> 00:23:27,000
Speaker 2: wellness and pop culture, sign up for our daily newsletter

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Speaker 2: wake Up Call by going to Katiecuric dot com. Wearable Technology.

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Speaker 2: I was curious about EPIC interfacing with wearable technology companies. Judy,

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Speaker 2: like the fitfit founders, recently announced the launch of a

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Speaker 2: new AI startup called Loofu that aims to help families

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Speaker 2: proactively monitor their health. Can you see a time where

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Speaker 2: you are pooling that information in individual information along with

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Speaker 2: EPIC information to help come up with sort of better

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Speaker 2: plans and even gleaning sort of more information about what's

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Speaker 2: happening in that patient that would then help the larger

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Speaker 2: patient population.

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Speaker 4: Let me ask the group here, they may know more

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Speaker 4: details about the limit. Are we already doing that with

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Speaker 4: these systems? Yeah? Okay, better answer than I could give.

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Speaker 2: They're saying, yes, come up and tell me what you're doing.

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Speaker 5: So through my chart and even directly if a patient

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Speaker 5: doesn't have my chart, organizations can enroll patients to be

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Speaker 5: able to send that data back in Many like Group

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Speaker 5: Health Cooperative here in town, allow patients to just link

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Speaker 5: up their own personal devices so that that data can

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Speaker 5: flow into the chart. They can see it in my chart,

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Speaker 5: and then if it becomes relevant for their care, their

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Speaker 5: providers can see it during a visit, or it can

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Speaker 5: be pulled into your point for that population monitoring and

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Speaker 5: seeing who are all of the patients using both the

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Speaker 5: clinician entered data as well as the patient entered data

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Speaker 5: from their devices to identify patients in potentially high risk

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Speaker 5: populations to drive that outreach.

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Speaker 2: What's your name, Trevor, Trevor? Thank you Trevor, because I

436
00:25:16,480 --> 00:25:19,119
Speaker 2: know you're working with like Apple Watch and a bunch

437
00:25:19,119 --> 00:25:21,919
Speaker 2: of other different tech companies. I can't keep you all

438
00:25:22,040 --> 00:25:24,159
Speaker 2: much longer. I could talk about this all day, and

439
00:25:24,200 --> 00:25:25,840
Speaker 2: I know you all have to work, But just a

440
00:25:25,880 --> 00:25:29,600
Speaker 2: couple more questions, Kevin, what about liquid biopsies? Okay, so

441
00:25:29,720 --> 00:25:34,320
Speaker 2: colonoscopes are too expensive, right, And I think a huge area,

442
00:25:34,560 --> 00:25:39,000
Speaker 2: exciting area of medical science is these blood tests that

443
00:25:39,119 --> 00:25:42,920
Speaker 2: will determine at a very cellular level. And Caitlin, I'd

444
00:25:42,960 --> 00:25:45,480
Speaker 2: love to hear your thoughts on this and indicate if

445
00:25:45,480 --> 00:25:49,280
Speaker 2: you have early stage cancers. Right, where are we in

446
00:25:49,320 --> 00:25:51,880
Speaker 2: the technology of those things. I know that there's some

447
00:25:51,960 --> 00:25:56,000
Speaker 2: on the market. Exact Sciences has one. How reliable are

448
00:25:56,000 --> 00:25:59,240
Speaker 2: they and could they be used? Like every time you

449
00:25:59,280 --> 00:26:02,359
Speaker 2: get a physical, you get a blood test and it

450
00:26:02,440 --> 00:26:05,200
Speaker 2: checks just like it checks your cholesterol. It could see

451
00:26:05,240 --> 00:26:07,399
Speaker 2: if you have any cancer cells in your blood.

452
00:26:07,880 --> 00:26:12,080
Speaker 1: I joined Exact Sciences seventeen years ago after a four

453
00:26:12,119 --> 00:26:15,880
Speaker 1: hour conversation with doctor David al Course at the Mail Clinic,

454
00:26:15,960 --> 00:26:19,600
Speaker 1: who had the idea for colo guard, but he also

455
00:26:19,720 --> 00:26:21,919
Speaker 1: had this far out there idea that you could do

456
00:26:21,960 --> 00:26:25,480
Speaker 1: a blood draw and look for what's called DNA methylation

457
00:26:26,600 --> 00:26:30,520
Speaker 1: patterns that occur in cancer and get shed into the blood.

458
00:26:30,840 --> 00:26:32,800
Speaker 1: And I thought that this is so far out there

459
00:26:32,800 --> 00:26:35,119
Speaker 1: it's going to take decades to do well. Here we

460
00:26:35,160 --> 00:26:38,119
Speaker 1: are two decades later, and we'd launch cancer Guard and

461
00:26:38,160 --> 00:26:41,720
Speaker 1: what cancer Guard would do in a population is detect

462
00:26:42,040 --> 00:26:46,560
Speaker 1: probably between thirty and fifty percent of cancers. So if

463
00:26:46,600 --> 00:26:49,479
Speaker 1: you ask yourself the question, if you could scream and

464
00:26:49,560 --> 00:26:52,320
Speaker 1: find thirty to fifty percent of cancers in the US

465
00:26:52,440 --> 00:26:57,000
Speaker 1: population today, would you well, yeah, because there's no treatment

466
00:26:57,080 --> 00:27:03,000
Speaker 1: that is effective as effective as earlier detection. Every week matters,

467
00:27:03,880 --> 00:27:07,840
Speaker 1: every month matters, and certainly a year matters. And so

468
00:27:08,280 --> 00:27:12,119
Speaker 1: I'll tell you a story. We launched cancer Guard and Alison,

469
00:27:12,280 --> 00:27:15,439
Speaker 1: who is our head of pr decided you wanted to

470
00:27:15,440 --> 00:27:17,880
Speaker 1: get the test, So she went online cancer guard dot

471
00:27:17,920 --> 00:27:21,199
Speaker 1: com got our test ordered by an online doctor. She

472
00:27:21,359 --> 00:27:23,879
Speaker 1: was the first person at exact to get the test.

473
00:27:24,560 --> 00:27:27,200
Speaker 1: She was the first person to have a positive result.

474
00:27:28,040 --> 00:27:31,760
Speaker 1: She had a twenty two centimeter ovarian cancer. Now she's

475
00:27:31,800 --> 00:27:38,080
Speaker 1: in her forties. It was stage one. Surgery alone treated it,

476
00:27:38,280 --> 00:27:43,879
Speaker 1: no chemotherapy, and her odds going forward are really good.

477
00:27:44,040 --> 00:27:49,639
Speaker 1: Earlier detection matters because almost all ovarian cancers are asymptomatic

478
00:27:49,720 --> 00:27:52,119
Speaker 1: until stage three or four, and by stage three or

479
00:27:52,200 --> 00:27:54,760
Speaker 1: four there are twenty thousand new cases every year in

480
00:27:54,880 --> 00:27:57,840
Speaker 1: twelve to fifteen thousand deaths. Your odds are really bad.

481
00:27:58,480 --> 00:28:03,399
Speaker 1: So can screening a whole population for all cancers? Yeah,

482
00:28:03,600 --> 00:28:06,080
Speaker 1: it matters because you don't have to screen that many

483
00:28:06,119 --> 00:28:09,720
Speaker 1: people to find one cancer. When one out of thirty

484
00:28:09,720 --> 00:28:12,720
Speaker 1: three people are walking around with cancer over age fifty

485
00:28:12,760 --> 00:28:13,399
Speaker 1: and don't know it.

486
00:28:13,760 --> 00:28:16,119
Speaker 2: So when do you think it will be truly ready

487
00:28:16,240 --> 00:28:20,680
Speaker 2: for prime time? That almost every cancer could be potentially

488
00:28:20,720 --> 00:28:23,320
Speaker 2: detected in a liquid biopsy or blood test.

489
00:28:24,280 --> 00:28:28,600
Speaker 1: The challenge is probably not the technology, It is the

490
00:28:29,080 --> 00:28:35,720
Speaker 1: regulatory framework, the reimbursement framework. Will Medicare pay for this technology.

491
00:28:35,880 --> 00:28:38,280
Speaker 1: We had to get a law passed by Congress, which

492
00:28:38,280 --> 00:28:41,360
Speaker 1: we did thankfully a month ago to make this happen.

493
00:28:41,440 --> 00:28:44,200
Speaker 1: That was a five year fight to make that happen.

494
00:28:44,840 --> 00:28:48,120
Speaker 1: And insurance companies don't like paying for screening because you're

495
00:28:48,320 --> 00:28:51,240
Speaker 1: spending money on a healthy population. So we'll have to

496
00:28:51,240 --> 00:28:54,080
Speaker 1: fight that fight. But we fought that fight with Coliguard,

497
00:28:54,280 --> 00:28:57,600
Speaker 1: and everybody initially said Coliguard is not good. You need

498
00:28:57,640 --> 00:29:02,520
Speaker 1: a colonoscopy. Eventually people came to the conclusion, Wow, col Guard,

499
00:29:02,520 --> 00:29:05,280
Speaker 1: it's pretty amazing. The same thing I believe will happen

500
00:29:05,280 --> 00:29:06,040
Speaker 1: with cancer good.

501
00:29:06,400 --> 00:29:09,680
Speaker 2: I think until the technology becomes available, the best thing

502
00:29:09,800 --> 00:29:13,760
Speaker 2: we need to remind people of are the symptoms of

503
00:29:13,840 --> 00:29:18,760
Speaker 2: colorectal cancer. Now, unfortunately, sometimes you're symptomatic when the cancer

504
00:29:18,840 --> 00:29:22,360
Speaker 2: is pretty advanced, but at the very least, knowing the

505
00:29:22,400 --> 00:29:26,320
Speaker 2: symptoms also allows you to go to a doctor right away. So,

506
00:29:26,560 --> 00:29:30,080
Speaker 2: Doctor Murphy, I thought you could just review the symptoms

507
00:29:30,120 --> 00:29:33,640
Speaker 2: of colorectal cancer so people will know if they have

508
00:29:33,800 --> 00:29:37,920
Speaker 2: any of this happening, to make an appointment immediately to

509
00:29:38,000 --> 00:29:38,800
Speaker 2: see your doctor.

510
00:29:39,360 --> 00:29:41,520
Speaker 3: Sure, this is an area that I've become just so

511
00:29:41,720 --> 00:29:45,600
Speaker 3: passionate about because I hear from many survivors and patients

512
00:29:45,640 --> 00:29:48,840
Speaker 3: that they experience symptoms for months and months and months

513
00:29:49,240 --> 00:29:52,320
Speaker 3: and get referred to doctor to doctor to doctor before

514
00:29:52,360 --> 00:29:56,000
Speaker 3: they finally get a diagnosis. And so the key symptoms

515
00:29:56,000 --> 00:29:58,320
Speaker 3: that you really want to look for are blood and stool,

516
00:29:58,440 --> 00:30:04,120
Speaker 3: or we call it hematic easia, any changes in your bowel, habits, diarrhea,

517
00:30:04,280 --> 00:30:06,400
Speaker 3: any sort of thing going on with your gut. And

518
00:30:06,440 --> 00:30:09,360
Speaker 3: sometimes these are pretty non specific symptoms or could be

519
00:30:09,400 --> 00:30:12,160
Speaker 3: related to a bunch of different things, but certainly you

520
00:30:12,240 --> 00:30:14,880
Speaker 3: know your body best and if you see something that's

521
00:30:14,960 --> 00:30:19,880
Speaker 3: different again, blood and stool diarrhea, change in bowel habits.

522
00:30:19,640 --> 00:30:23,240
Speaker 2: Or bloating. Can I just add to this fun list. Yeah,

523
00:30:23,280 --> 00:30:30,520
Speaker 2: symptoms like bloating, pain, unexplained weight loss, anemia right, if

524
00:30:30,520 --> 00:30:33,280
Speaker 2: you have anemia and another tests right.

525
00:30:33,320 --> 00:30:36,840
Speaker 3: And sometimes it's really easy to dismiss those symptoms, specifically

526
00:30:36,840 --> 00:30:39,880
Speaker 3: in women, because there are other reasons for anemia at

527
00:30:39,880 --> 00:30:43,240
Speaker 3: say mensies, you know, things like that, and so again,

528
00:30:43,520 --> 00:30:47,280
Speaker 3: just making being proactive. I hear so often, so many

529
00:30:47,320 --> 00:30:50,080
Speaker 3: times I saw my symptoms in my chart, for example,

530
00:30:50,160 --> 00:30:53,040
Speaker 3: but my doctor didn't notice the pattern for four years.

531
00:30:53,400 --> 00:30:55,840
Speaker 2: And sometimes you have to be pretty insistent, you know.

532
00:30:55,960 --> 00:30:59,520
Speaker 2: Doctors sometimes blow you off and say, oh, it's hemorrhoids

533
00:30:59,680 --> 00:31:02,680
Speaker 2: or it's nothing to be worried about. I think, particularly

534
00:31:02,680 --> 00:31:05,720
Speaker 2: if you're younger. So you need to really be your

535
00:31:05,760 --> 00:31:09,080
Speaker 2: own best advocate and be persistent, and if you're not

536
00:31:09,240 --> 00:31:13,520
Speaker 2: feeling right, go to another doctor or really continue to

537
00:31:13,640 --> 00:31:18,640
Speaker 2: search for answers because I think unfortunately some doctors aren't

538
00:31:18,680 --> 00:31:22,400
Speaker 2: as well versed in what's happening with early on set

539
00:31:22,440 --> 00:31:26,080
Speaker 2: colorectal cancer and in terms of preventing the disease. I

540
00:31:26,160 --> 00:31:29,040
Speaker 2: promised this my last question. I'm just trying to educate

541
00:31:29,080 --> 00:31:31,440
Speaker 2: everyone and help people because I care so much and

542
00:31:31,800 --> 00:31:33,880
Speaker 2: I would hate to see what happened to my husband

543
00:31:33,960 --> 00:31:38,560
Speaker 2: happen to any of you. It's just such a terrible loss.

544
00:31:39,120 --> 00:31:42,360
Speaker 2: So things that you can do, other than being vigilant

545
00:31:42,360 --> 00:31:46,880
Speaker 2: about screening and aware of symptoms are their preventative measures, Caitlin,

546
00:31:46,960 --> 00:31:49,440
Speaker 2: you can do to try to stave off this disease.

547
00:31:49,800 --> 00:31:52,000
Speaker 3: The other thing that goes with screening is knowing your

548
00:31:52,040 --> 00:31:55,280
Speaker 3: family history because oftentimes if you have a family history

549
00:31:55,280 --> 00:31:59,840
Speaker 3: of either color rectal cancer or the pre cancerous lesions adinoma,

550
00:32:00,120 --> 00:32:02,880
Speaker 3: you can get screened at an earlier age. And there

551
00:32:02,880 --> 00:32:05,000
Speaker 3: are a bunch of studies now showing that we could

552
00:32:05,040 --> 00:32:08,200
Speaker 3: prevent almost all of the early onset cancer is if

553
00:32:08,240 --> 00:32:10,920
Speaker 3: people had known that they had a family history in

554
00:32:11,040 --> 00:32:13,160
Speaker 3: garten screened at the appropriate age.

555
00:32:13,320 --> 00:32:16,760
Speaker 2: For example, my daughters both will be screened at thirty

556
00:32:17,280 --> 00:32:22,280
Speaker 2: one because that's ten years before their father was diagnosed.

557
00:32:22,280 --> 00:32:24,719
Speaker 2: He was diagnosed at forty one and died at forty

558
00:32:24,760 --> 00:32:28,760
Speaker 2: two after nine months. So it really is so important

559
00:32:28,800 --> 00:32:32,120
Speaker 2: to know your family history because then obviously insurance will

560
00:32:32,160 --> 00:32:34,960
Speaker 2: pay for it. Also, an active lifestyle, I mean I

561
00:32:35,000 --> 00:32:38,400
Speaker 2: think more and more we're hearing about the importance of exercise,

562
00:32:38,760 --> 00:32:41,959
Speaker 2: getting your heart rate up thirty minutes three times a day,

563
00:32:42,000 --> 00:32:44,640
Speaker 2: at least, that's what my interness just told me. Judy,

564
00:32:44,760 --> 00:32:49,920
Speaker 2: don't look at me like that. But no, three times

565
00:32:49,920 --> 00:32:53,160
Speaker 2: a week? Sorry? Did I say sorry? I am so

566
00:32:53,200 --> 00:32:57,040
Speaker 2: sorry three times a week? Sorry? No, wonder you looked

567
00:32:57,080 --> 00:33:00,960
Speaker 2: at me like that? And what about sort of limiting

568
00:33:01,000 --> 00:33:03,920
Speaker 2: your consumption of red meat and fruits and vegetables. I mean,

569
00:33:03,960 --> 00:33:07,000
Speaker 2: all these things to me can stave off all kinds

570
00:33:07,000 --> 00:33:09,120
Speaker 2: of cancer, right, Caitlin, Exactly.

571
00:33:09,200 --> 00:33:12,400
Speaker 3: It's not just colorectal cancer, but many other chronic health

572
00:33:12,400 --> 00:33:16,040
Speaker 3: conditions that are related to these lifestyle related risk factors.

573
00:33:16,280 --> 00:33:21,400
Speaker 3: Fiber fiber absolutely, taking insets or aspirin can reduce your risk.

574
00:33:21,600 --> 00:33:23,560
Speaker 3: There are many things that we're in control of in

575
00:33:23,640 --> 00:33:26,520
Speaker 3: terms of our diet and our lifestyle that might help

576
00:33:26,560 --> 00:33:27,080
Speaker 3: a little bit.

577
00:33:27,520 --> 00:33:30,120
Speaker 2: Well. I hope that everyone learns something today. I hope

578
00:33:30,160 --> 00:33:33,320
Speaker 2: you all now know that the screening age is forty five.

579
00:33:33,720 --> 00:33:36,880
Speaker 2: So anybody you know who's forty five, please tell them

580
00:33:37,200 --> 00:33:40,800
Speaker 2: it could save their life. And also in terms of

581
00:33:40,880 --> 00:33:44,280
Speaker 2: the symptoms, just be aware because as we know, it's

582
00:33:44,400 --> 00:33:48,120
Speaker 2: affecting younger and younger people, people in their twenties and thirties.

583
00:33:48,640 --> 00:33:51,320
Speaker 2: Pay attention to your body and if you have any questions,

584
00:33:51,360 --> 00:33:54,960
Speaker 2: definitely see a doctor. I feel like the nagging fish

585
00:33:54,960 --> 00:33:59,480
Speaker 2: wife of colorectal cancer, but I know how early detection

586
00:33:59,640 --> 00:34:03,160
Speaker 2: can say lives and that's why I feel so passionately

587
00:34:03,240 --> 00:34:03,760
Speaker 2: about it.

588
00:34:04,080 --> 00:34:07,000
Speaker 1: You could order cologuard dot com and then just drop

589
00:34:07,040 --> 00:34:09,759
Speaker 1: it off at our lab over there on trade.

590
00:34:09,480 --> 00:34:12,200
Speaker 2: But you have to be forty five. Yes, you have

591
00:34:12,239 --> 00:34:15,200
Speaker 2: to be forty five, but that's true. You can do that,

592
00:34:15,320 --> 00:34:17,120
Speaker 2: but talk to your doctor in any event.

593
00:34:16,960 --> 00:34:18,839
Speaker 1: Ghitting about dropping it off at the lab.

594
00:34:20,600 --> 00:34:24,640
Speaker 2: Well Kevin Conroy and Judy Faulkner, Doctor Caitlin Murphy, thank

595
00:34:24,680 --> 00:34:30,879
Speaker 2: you so much and so appreciate it. Thank you all

596
00:34:31,000 --> 00:34:41,600
Speaker 2: so much for coming. I'm so grateful. Thank you, Thanks

597
00:34:41,680 --> 00:34:44,560
Speaker 2: for listening. Everyone. If you have a question for me,

598
00:34:44,960 --> 00:34:47,440
Speaker 2: a subject you want us to cover, or you want

599
00:34:47,480 --> 00:34:50,840
Speaker 2: to share your thoughts about how you navigate this crazy world,

600
00:34:51,200 --> 00:34:54,440
Speaker 2: reach out send me a DM on Instagram. I would

601
00:34:54,480 --> 00:34:57,520
Speaker 2: love to hear from you. Next Question is a production

602
00:34:57,640 --> 00:35:02,000
Speaker 2: of iHeartMedia and Katie Kuric Media. The executive producers are

603
00:35:02,080 --> 00:35:06,200
Speaker 2: me Katie Couric and Courtney Ltz. Our supervising producer is

604
00:35:06,320 --> 00:35:11,280
Speaker 2: Ryan Martz, and our producers are Adriana Fazzio and Meredith Barnes.

605
00:35:12,000 --> 00:35:16,600
Speaker 2: Julian Weller composed our theme music. For more information about

606
00:35:16,600 --> 00:35:19,680
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607
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Speaker 2: Up Call, go to the description in the podcast app,

608
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609
00:35:26,480 --> 00:35:29,640
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