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Speaker 1: Throughout this series, we'll be discussing many aspects of cancer

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Speaker 1: diagnosis and treatment, and we will be sharing several personal

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Speaker 1: stories related to cancer. Some listeners might find this content upsetting.

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Speaker 1: Please listen with discretion.

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Speaker 2: My name is Christina and I'm a healthy, cancer free,

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Speaker 2: thirty year old woman who was about to undergo a

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Speaker 2: double mistact tomy. Let me tell you why. My aunt

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Speaker 2: Helen was diagnosed with breast cancer at age thirty four

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Speaker 2: and ultimately passed away ten years later when I was thirteen.

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Speaker 2: Just a few years later, still relinking the loss of

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Speaker 2: our beloved Helen, another aunt was diagnosed with ovarian cancer.

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Speaker 2: My whole life, I had looked at my aunts and

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Speaker 2: saw myself fall blue eyes and big foreheads and curly hair.

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Speaker 2: If their fate was cancer, it was bound to be

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Speaker 2: mine too. And it wasn't just my aunt's. Six other relatives,

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Speaker 2: from great aunts to distant cousins had been diagnosed with

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Speaker 2: either breast or ovarian cancer. It was high time for

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Speaker 2: genetic testing, and we discovered that my aunt and father

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Speaker 2: carry the Brocketuo mutation. This mutation is associated with a

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Speaker 2: forty to eighty five percent lifetime risk for breast cancer

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Speaker 2: and fifteen to forty percent risk for a varian cancer,

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Speaker 2: along with increased risks for other cancers including prostate, pancreatic,

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Speaker 2: and melanomas. As a teenager, I wanted to be tested immediately.

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Speaker 2: This was around when the Affordable Care Act was being passed,

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Speaker 2: and my doctors recommended that I wait until protections for

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Speaker 2: pre existing conditions were fully in effect before diagnosing myself

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Speaker 2: with one. Finally, at nineteen, I received confirmation of what

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Speaker 2: I had felt for years. Just like my aunts, I

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Speaker 2: was positive for rokutwo. I heard constantly at the time

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Speaker 2: that nineteen was too young to test, years before any

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Speaker 2: screenings would be recommended, but I wanted those years to

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Speaker 2: sit with my diagnosis and process it as slowly as

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Speaker 2: I wanted to. I'm so grateful for the protections that

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Speaker 2: allowed me to do so. My cancer screenings began at

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Speaker 2: twenty four, and for six years, I dutifully scheduled breast

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Speaker 2: exam skin checks, and an annual date was a clunking,

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Speaker 2: thumping MRI. I'm treated by an excellent hereditary cancer clinic,

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Speaker 2: and my team is optimistic that any breast cancer would

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Speaker 2: be caught early and be survivable. But that's not good

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Speaker 2: enough for me. I don't want to survive breast cancer.

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Speaker 2: They never have it at all. Hereditary cancer causes incalculable

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Speaker 2: loss in trauma to the families that it tears. Through

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Speaker 2: both modern genetic testing, younger generations can use that trauma

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Speaker 2: to ford a different path forward. My journey has always

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Speaker 2: been mapped onto my aunt Helens. The age I started

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Speaker 2: cancer screenings and planning for my mistectomy is all based

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Speaker 2: on her timeline and the hopes that mine can be different.

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Speaker 2: My double mistectomy will reduce my lifetime risk of cancer

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Speaker 2: by ninety to ninety five percent. It's not one hundred percent,

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Speaker 2: but it's nothing less than a gift.

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Speaker 3: Hi.

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Speaker 4: I'm clear from South Africa and I'm undergoing treatment for

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Speaker 4: cholorectal cancer. I knew something was wrong for at least

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Speaker 4: a year before I did anything about it. As a

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Speaker 4: friend said, we're more scared of the treatment than the disease.

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Speaker 4: When I finally went for colonoscopy, I'm pretty sure I

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Speaker 4: knew I had cancer. It's always been my biggest fear,

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Speaker 4: But in a way, it's freeing knowing that the waste

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Speaker 4: has happened after barely interacting with a medical system. For

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Speaker 4: forty one years of my life. I have now had

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Speaker 4: two major surgeries, spent weeks in US. You have an

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Speaker 4: iliostomy and am undergoing chemo. Finding chemo very frustrating because

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Speaker 4: no one knows how each person will react, so hard

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Speaker 4: to tell if it will get worse or better. I'm

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Speaker 4: trying to stay very positive and interested in the biology

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Speaker 4: of it all, and also trying to be a good

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Speaker 4: example and educate my students. I teach high school science

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Speaker 4: and bio. I really wish people were more open about

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Speaker 4: gross body processes because I'm sure if we talked more

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Speaker 4: about poo, more people would be diagnosed earlier. As it is,

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Speaker 4: I'm telling everyone to go for krodnoscopies.

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Speaker 1: Thank you all again so so much for sharing your

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Speaker 1: stories with us. We are truly touched and cannot believe

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Speaker 1: how many people wrote in We're willing to be vulnerable

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Speaker 1: and share such an intimate part of their lives with us,

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Speaker 1: because it really adds more than we can possibly say

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Speaker 1: to the series, So thank you, it really does. Thank you.

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Speaker 5: We have a lot more stories that will also be

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Speaker 5: sharing that we have shared throughout this series and throughout

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Speaker 5: this episode. We really wish that we could have included

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Speaker 5: every story. Thank you so much to everyone who wrote

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Speaker 5: in and who recorded your stories and who shared them

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Speaker 5: with us. We really just can't say thank.

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Speaker 1: You enough, even though we've tried.

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Speaker 2: We tried.

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Speaker 3: Hi, I'm Aaron, and I'm Aaron aman Updyke and.

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Speaker 1: This is this podcast will kill you.

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Speaker 5: Welcome to episode four and final for and final of

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Speaker 5: our series on cancer.

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Speaker 3: It's been a journey.

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Speaker 1: Yeah, that's that's the word. Yeah. Yeah, We've covered a

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Speaker 1: lot of ground so far in this series. If this

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Speaker 1: is your first time tuning into the Cancer series, you

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Speaker 1: can listen to these out of order.

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Speaker 5: Honestly, this would not be a bad place to start.

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Speaker 5: We could have started here, we could have, but we're

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Speaker 5: ending here instead.

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Speaker 1: The point is that these are all pieces of a

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Speaker 1: big puzzle, and there are still pieces that we haven't

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Speaker 1: filled in yet, pieces that remain to be filled in

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Speaker 1: by science and medicine. But we can tell you what

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Speaker 1: we've covered so far. So the first episode we talked

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Speaker 1: about what cancer is, both conceptually and clinically, kind of

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Speaker 1: the definitions of cancer. The second episode we talked about

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Speaker 1: the evolution of cancer and cellular aspects of cancer, So like,

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Speaker 1: what's actually happening within that cancer cell to make it cancerous.

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Speaker 1: Third episode, last episode all about treatment, history of treatment,

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Speaker 1: existing treatments today, possible treatments in the future. And today

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Speaker 1: we're talking about kind of the big picture of like

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Speaker 1: what the status of cancer is around the world today

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Speaker 1: and ways that we might be able to see that

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Speaker 1: status change in the future thanks to things like screening

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Speaker 1: and prevention.

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Speaker 3: Some of our favorite things to talk about, Yes podcast, public.

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Speaker 5: Public health, and as much ground as we have covered

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Speaker 5: so far in the series and as much as we're

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Speaker 5: covering today, it is not everything that has to do

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Speaker 5: with cancer. So we want everyone to know that. First

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Speaker 5: of all, we have a very very long list of

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Speaker 5: sources for every one of these episodes. So if you

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Speaker 5: are inspired to learn more about cancer, about cancer, treatment,

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Speaker 5: about the epidemiology, about any aspect of cancer, go to

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Speaker 5: our website, this podcast with Hey dot com and check

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Speaker 5: out the sources list. And these are not the only

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Speaker 5: cancer episodes that we're going to do.

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Speaker 1: Correct.

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Speaker 5: This is sort of what we see as is sort

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Speaker 5: of laying the foundation and a jumping off point for

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Speaker 5: us to be able to explore individual cancers in the future. Yeah,

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Speaker 5: So we would also love your feedback on what episodes

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Speaker 5: you'd like to hear more about, what topics you really

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Speaker 5: want to learn more about.

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Speaker 1: Yeah, it really, it really does help us. Like we

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Speaker 1: are already planning next episodes, not just for cancer, but

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Speaker 1: for many other things. And it's like, what do what

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Speaker 1: do you all want to know about?

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Speaker 5: Yeah, what questions arise? Yes, tell us right, see what.

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Speaker 3: We can do.

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Speaker 1: We'll see what we can do. Also, you know, we

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Speaker 1: we're approaching cancer from a very biological perspective, historical perspective.

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Speaker 1: The focus is on cancer as this phenomenon, thing, this thing,

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Speaker 1: and so in throughout these episodes, we haven't really touched

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Speaker 1: very much on the personal experience of cancer and what

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Speaker 1: that can look like for somebody, whether that's somebody who

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Speaker 1: has been diagnosed, someone undergoing treatment, someone who's loved one

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Speaker 1: has been diagnosed. Maybe you're a caretaker, maybe you're the

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Speaker 1: friend or colleague. And our first had accounts have been

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Speaker 1: so invaluable for to share aring just some of those

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Speaker 1: perspectives on that experience. So again, thank you.

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Speaker 3: Thank you.

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Speaker 5: We really truly can't say it enough. These first hand

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Speaker 5: accounts mean so much to us and they make this

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Speaker 5: series what it is and our podcast and our podcast

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Speaker 5: in general.

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Speaker 1: Yeah, so thank you, thank you. One piece of business

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Speaker 1: before the last piece of business and that so last week,

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Speaker 1: if you listened to our treatment episode, I shouted out

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Speaker 1: a couple of episodes of Advances and Care, which is

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Speaker 1: another podcast that I host that interviews physician scientists at

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Speaker 1: New York Presbyterian and talks about some of the incredible

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Speaker 1: cutting edge work that they do. And I want to

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Speaker 1: shout out another episode that's related to kind of the

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Speaker 1: topic today, which is Screening Prevention, Epidemiology of Cancer, and

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Speaker 1: that is episode thirty five titled rise in Early onset

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Speaker 1: colon Cancer being Studied through single cell Sequencing. Oh very cool.

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Speaker 1: It features research done by Joel Gabrie to look for

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Speaker 1: clues that underlie this issue, like why are we seeing

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Speaker 1: colon cancer rise in younger adults?

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Speaker 2: Right?

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Speaker 1: Because it's a scary thing.

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Speaker 5: It really is, and it's a lot of headlines. So

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Speaker 5: there's a lot of good information there. So check out

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Speaker 5: Advances and Care.

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Speaker 1: Advances and Care available wherever you get your podcasts.

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Speaker 3: Last, but not least, Quarantine any time if.

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Speaker 5: You were this is the last time we're going to

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Speaker 5: say that, yes, then it will just be taken for

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Speaker 5: granted after.

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Speaker 1: That starting Yes, we figured this was this series was

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Speaker 1: a good time to stop including alcohol in our quarantini recipes.

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Speaker 1: We're still going to call them quarantinies because it's too

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Speaker 1: good of a name to pass up.

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Speaker 3: Nice.

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Speaker 1: This week's quarantini is the Crab.

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Speaker 3: The Crab, the crab. It's an afo gatto, which means

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Speaker 3: espresso and ice cream delicious, so good.

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Speaker 1: It just sounded good to us.

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Speaker 6: It did.

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Speaker 1: That's the whole thing.

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Speaker 3: There's nothing deeper behind it.

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Speaker 1: The crab means cancer like that is, if you listen

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Speaker 1: to the first episode you would know. But anyway, I

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Speaker 1: think a.

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Speaker 5: Lot of people know that because it's like a what

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Speaker 5: do you call it? Star sign thing?

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Speaker 1: Astrology?

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Speaker 5: Yeah, astrology, yeah, astrology, not astronomy that start sign.

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Speaker 1: Yeah, yes.

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Speaker 5: Anyways, So check out our social media like Instagram and

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Speaker 5: whatever all those other ones to see that recipe, and

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Speaker 5: also check out our website, this podcast with killia dot com,

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Speaker 5: where you can find I already said the sources to

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Speaker 5: all of our episodes, but also transcripts.

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Speaker 3: And mermobile and merch and linked links.

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Speaker 1: First account contact us form.

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Speaker 3: There's more.

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Speaker 1: There's got to be something cool that's there that we've missed.

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Speaker 3: Anyways, moving on, we should update our website.

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Speaker 1: Moving on break.

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Speaker 5: Sure, yeah, yeah great, but then tell me all about

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Speaker 5: where we got to how we I'll do all that.

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Speaker 1: Yeah, thank you.

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Speaker 7: My story of brain cancer starts when I got COVID.

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Speaker 7: COVID was still at best. Weeks after I developed a

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Speaker 7: weird loss of my voice that wouldn't go away. After

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Speaker 7: seeing an E and T and getting tests, I was

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Speaker 7: diagnosed with focal cord paralysis, most likely from the virus.

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Speaker 7: One scain done was an MRI. I took it home,

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Speaker 7: took a look, and that's when I saw a hazy

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Speaker 7: blob in my frontal lobe, which I named abby normal.

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Speaker 7: I could tell from my doctor's reactions it was serious.

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Speaker 7: I was shuffled from doctor to doctor, and a couple

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Speaker 7: of weeks ended up at a brain tumor center, being

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Speaker 7: told it's most likely brain cancer and they recommended surgery.

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Speaker 7: During that time, I was convinced I was dying. All

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Speaker 7: I could think about was I'll be dead that year.

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Speaker 7: I wanted Abby out. I wanted surgery yesterday. I needed

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Speaker 7: to know what this was. A month later, I was

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Speaker 7: in surgery, having a two and a half centimeter piece

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Speaker 7: of my frontal lobe removed. Recovery was rough, between the

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Speaker 7: brain healing effects and very high doses of steroids. I

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Speaker 7: gained twenty pounds and had an odd urge to steal

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Speaker 7: stupid things. I still remember the half dead plant with

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Speaker 7: a post a note that said plant on it. I

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Speaker 7: so desperately wanted to steal from a local smoothie place.

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Speaker 7: Three and a half years later, I no longer want

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Speaker 7: to steal. That was short lived, and I don't notice

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Speaker 7: my missing friend. I have oligodendroglioma, and probably had it

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Speaker 7: for several years before discovering it accidentally. I consider myself

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Speaker 7: lucky finding it so small before seizures. After recovery, I

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Speaker 7: went on my surviving death tour. I said yes to everything,

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Speaker 7: and I had a blast. I realized who my friends are.

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Speaker 7: I saw how amazing of a support system I have,

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Speaker 7: and I will always remember and be grateful. I will

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Speaker 7: also always remember that plant. I see my doctors two

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Speaker 7: times a year looking for growth, and chances are i'll

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Speaker 7: have more treatment. While I do believe it will one

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Speaker 7: day kill me, that knowledge is oddly freeing. Even if

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Speaker 7: it sucks. My cancer doesn't define me, doesn't define my life.

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Speaker 7: I'm still living it to its fullest.

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Speaker 6: Hello. My name is April Rideout. My brother James Carl

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Speaker 6: ride Out was diagnosed with a acute lymphoblastic leukemia all

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Speaker 6: in twenty seventeen, and the cancer returned in twenty twenty one.

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Speaker 6: He passed in March to twenty twenty three from complications

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Speaker 6: related to graph versus host disease. I like to share

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Speaker 6: his story of his first cancer diagnosis and his own

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Speaker 6: words from twenty eighteen to twenty nineteen at a dinner

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Speaker 6: honoring the nurses who cared for him with love, kindness,

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Speaker 6: and understanding. Before I was diagnosed, I was a happy,

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Speaker 6: go lucky staff accountant doing motor fuel tax, married to

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Speaker 6: my beautiful wife Amanda, and we just got a wonderful

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Speaker 6: dog named Indy. But come the beginning of July in

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Speaker 6: twenty seventeen, I started not feeling right. I had dizzy spells,

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Speaker 6: I had pain in my right foot along with other

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Speaker 6: symptoms as well as lightheadedness. I started to look like

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Speaker 6: Uncle Fester, to be honest, and on July nineteen, twenty seventeen,

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Speaker 6: my boss Larry told me to leave because I looked

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Speaker 6: like crap and I had to go to the doctor,

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Speaker 6: and my wonderful wife suggested that they do a blood test.

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Speaker 6: Come to find out, the doctors there told me to

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Speaker 6: go to the er, and then from that er they

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Speaker 6: did an additional blood test and found out that I

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Speaker 6: have leukemia because I had over one hundred and ninety

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Speaker 6: seven thousand white blood cells in my body, and if

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Speaker 6: I waited even one day, I would have passed away.

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Speaker 6: Lying in the hospital in complete terror. I seriously thought

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Speaker 6: my life was going to end that day. Horror was

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Speaker 6: all across the room, from my immediate family to my wife.

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Speaker 6: But after the news had struck, we started working on

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Speaker 6: a treatment plan. One week later, we determined for research

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Speaker 6: and diligence that Virginia G. Piper was the answer and

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Speaker 6: we moved me there from the hospital I was at.

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Speaker 6: For the course of my many stays there, the constant

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Speaker 6: pleasure was the nursing staff, and because of them and

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Speaker 6: the doctors and the treatment plan, which was a stem

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Speaker 6: cell transplant, I have been remissioned for for a year

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Speaker 6: and beat the crap out of cancer. Thank you for

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Speaker 6: the opportunity to share James's words. He always wanted to

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Speaker 6: publish a book on his experiences with cancer, and this

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Speaker 6: is a lovely way to honor that wish of his.

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Speaker 6: Every year, my family keeps James's memory alive by attending

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Speaker 6: and raising donations for Blood Cancer United's Light the Night event.

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Speaker 1: Thank you. Let's spend a moment taking stock of what

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Speaker 1: we've learned so far.

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Speaker 3: I love that idea.

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Speaker 1: Okay, we have learned what cancer is, uncontrolled cell proliferation.

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Speaker 1: We've learned why it's so common. It's an unavoidable consequence

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Speaker 1: of multicellularity. We've learned how we treat the forty percent

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Speaker 1: of the population that will develop cancer in their lifetime.

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Speaker 1: And we've learned that, despite these treatment advances, seventeen percent

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Speaker 1: of the population will die from cancer. But what we

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Speaker 1: haven't addressed yet in any great detail are those numbers

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Speaker 1: forty percent and seventeen percent. For much of the twentieth century,

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Speaker 1: cancer research efforts were directed towards finding a cure for

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Speaker 1: that forty percent, and as you shared with us last week, Aarin,

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Speaker 1: we have made incredible headway in that regard for many,

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Speaker 1: though not all, types of cancer. Despite these innovations, cancer

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Speaker 1: treatment can be grueling. It can be expensive, prohibitedly so

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Speaker 1: in some cases, and that expense mostly refers to the US.

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Speaker 1: It often includes debilitating side effects, It can lead to

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Speaker 1: long term issues, including increasing the risk of developing a

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Speaker 1: second cancer, and it comes with no guarantee. What has

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Speaker 1: received far less attention in cancer research historically is how

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Speaker 1: to reduce the number of people getting cancer or needing treatment,

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Speaker 1: or needing advanced treatment in the first place. Right, Like,

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Speaker 1: that's received a much smaller piece of the pie as usual.

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Speaker 3: With public health.

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Speaker 1: Yes, yes, which and there's more, there's understandable blah blah blah.

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Speaker 1: People need solutions right now. Yeah, I know there's a

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Speaker 1: lot that goes into it. Yeah, given what we know

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Speaker 1: about what we've learned so far about the evolution of cancer,

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Speaker 1: we're unlikely to ever bring that forty percent all the

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Speaker 1: way down to zero, that lifetime risk of forty all

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Speaker 1: the way down to zero. But with prevention, we can

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Speaker 1: make it part of the way there. Cutting edge treatments

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Speaker 1: might increase survival for those with cancer, giving people more

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Speaker 1: precious time with their loved ones. But if we can

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Speaker 1: intervene earlier through screening, we may be able to shrink

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Speaker 1: that's seventeen percent significantly significantly. Prevention and screening, though cornerstones

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Speaker 1: of cancer care fail to get the appreciation they rightfully

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Speaker 1: deserve naps. I mean, and that's historically as well as today.

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Speaker 1: It continues to today. This is not surprising again, like this,

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Speaker 1: this concept about public health being invisible until it fails.

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Speaker 1: So I'm gonna spend We're gonna spend this episode making

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Speaker 1: cancer prevention and screening more visible.

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Speaker 8: Ah.

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Speaker 1: I love this. Cancer prevention, prevention of any kind requires

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Speaker 1: linking cause to effect. Yes, yes, Why did death from

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Speaker 1: infectious diseases drop over the twentieth century? Largely because germ

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Speaker 1: theory gave us the mechanism, and then we applied that

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Speaker 1: knowledge to prevention via vaccines, sanitation, and hygiene. Cancer's cause

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Speaker 1: and effect relationship is quite a bit more complex than that.

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Speaker 3: If we didn't make that clear in episode two.

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Speaker 1: Yeah, and namely because there isn't just one cause and

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Speaker 1: one affect one mechanism, but there's a dizzying number of

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Speaker 1: all of these different things, some of which are completely

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Speaker 1: beyond our control, or at least beyond our control as

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Speaker 1: we know it right now, or as individuals. As individuals, Yes,

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Speaker 1: like a random mutation that might just happen It happens

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Speaker 1: all the time. Actually, so how can we ever prevent

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Speaker 1: that or link that? So disentangling that web has proven

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Speaker 1: quite the challenge, but we have had some success. And

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Speaker 1: as I go through a few case studies in our

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Speaker 1: centuries long quest to understand the drivers of cancer, I

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Speaker 1: want you to take note of two things.

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Speaker 3: Okay.

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Speaker 1: Number one, establishing a causal relationship is often difficult and

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Speaker 1: it takes time. And number two, knowledge alone is not enough.

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Speaker 3: Oh my gosh.

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Speaker 1: There also has to be political will and public buy

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Speaker 1: in for it to have an impact.

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Speaker 3: I already love this.

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Speaker 8: That's it.

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Speaker 1: I mean, that's the end of the episode. Now, okay,

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Speaker 1: if you lived in London in the eighteenth century, you

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Speaker 1: probably kept your home warm by burning coal see our

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Speaker 1: London smoger. So in which case you probably had a chimney,

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Speaker 1: in which case you probably hired a chimney sweep to

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Speaker 1: clean out the accumulated soot. That chimney sweep was probably

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Speaker 1: between four and ten years old.

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Speaker 3: Oh my gosh.

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Speaker 1: Yes, oh, was forced to work naked and bathed about

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Speaker 1: once a year.

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Speaker 3: Oh wow wow. Okay, yeah, four and ten year olds

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Speaker 3: four and ten year olds.

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Speaker 1: Yeah, there are many issues with the situation. Yes. Yeah, So,

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Speaker 1: as English physician Percival Pot described in seventeen seventy five, quote,

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Speaker 1: in their early infancy, they are most frequently treated with

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Speaker 1: great brutality and are almost starved with cold and hunger.

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Speaker 1: They are thrust up narrow and sometimes hot chimneys where

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Speaker 1: they are bruised, burned, and almost suffocated, and when they

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Speaker 1: get to puberty, become peculiarly liable to a most noisome, painful,

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Speaker 1: and fatal disease. End quote. That disease was chimney sweeps cancer. Okay,

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Speaker 1: have you ever heard of cancer?

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Speaker 6: Okay?

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Speaker 1: Pot's description of the quote unquote sootwart and subsequent metastasis.

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Speaker 1: So it started out as a footwart and then metastasized.

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Speaker 1: It ranks among the earliest, if not the first observations

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Speaker 1: of occupational cancer. Really really yeah, in babies and baby So,

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Speaker 1: what would happen was that these chimney sweeps would, uh,

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Speaker 1: it would be exposed to all of the everything. Yeah, constantly,

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Speaker 1: there would be like a sore that arose, a sootwart,

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Speaker 1: and then that would eventually metastasize as they went into adolescence. Oh,

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Speaker 1: was they went through puberty? Yeah, And so his report

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Speaker 1: on this. He wrote a report that was like describing

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Speaker 1: what happened, describing the inhumane conditions, and it spurred the

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Speaker 1: publication of other case studies and people were like, oh, yeah,

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Speaker 1: I've seen this. I had chalked it up to something

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Speaker 1: else before. Yeah. So it was like a lot of

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Speaker 1: these case studies that came out and came out and

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Speaker 1: came out, and that like there was a public outcry.

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Speaker 1: I was like, we have to do something about this.

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Speaker 1: This is awful, and it's it's hard to imagine anyone

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Speaker 1: making the argument that like, oh, these chimney sweeps are

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Speaker 1: perfectly fine for four years old is plenty old enough

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Speaker 1: to work in a chimney on your own, right, But

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Speaker 1: people did make that argument, Oh yeah, yeah, And it

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Speaker 1: took decades for any meaningful policy changing this to be passed.

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Speaker 1: In seventeen eighty eight, so this is thirteen years after

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Speaker 1: Pott's observation, the minimum age requirement for a chimney sweep

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Speaker 1: was raised to eight years old. Oh my goodness, No,

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Speaker 1: there's so much more, Like.

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Speaker 5: There's so many weaves that is blowing my start. No,

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Speaker 5: you know what I knew about chimney sweeps. Erin Mary Poppins.

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Speaker 1: Yeah, no, that's all I knew. That would be like

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Speaker 1: pasted eighteen seventy five, which is when the next legislation,

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Speaker 1: meaningful legislation was passed, like one hundred years l one

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Speaker 1: hundred years after his observation was published. Oh my, So

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Speaker 1: this is when the Chimney Sweepers Act was passed, and

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Speaker 1: this forbade any children from sweeping chimneys, and it introduced

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Speaker 1: a licensing system that helped with enforcements, so like you

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Speaker 1: could not sweep a chimney unless you were an adult,

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Speaker 1: and it was at sixteen years old. I don't know, Okay,

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Speaker 1: who knows, but still right, Pot's observation was just that

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Speaker 1: it was an observation, okay, end of he didn't have

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Speaker 1: supporting statistics. Soot was not proven as a carcinogen until

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Speaker 1: nineteen twenty two, when researchers induced cancer in mice after

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Speaker 1: exposure to soot.

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Speaker 8: Wow.

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Speaker 1: So it was sort of like there was this hypothetical tank,

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Speaker 1: like this theoretical link that was like, well, clearly this

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Speaker 1: is the exposure one to one.

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Speaker 3: But they just never put that like directly together.

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Speaker 1: And like what is it about soot? Yeah, that kind

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Speaker 1: of thing would those laws have been passed sooner if

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Speaker 1: he had that information earlier. The story of cigarettes and

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Speaker 1: cancer would suggest that no, not necessarily.

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Speaker 5: I mean, especially when it sounds like they were kids

439
00:23:59,320 --> 00:24:03,159
Speaker 5: who weren't well taken care.

440
00:24:03,040 --> 00:24:05,120
Speaker 1: Of marginalized communities.

441
00:24:05,160 --> 00:24:09,040
Speaker 5: Yeah, yeah, yo, Aaron, Yeah.

442
00:24:08,600 --> 00:24:10,800
Speaker 1: I mean and in fact, when you look at the

443
00:24:10,880 --> 00:24:15,159
Speaker 1: timeline for like the initial observation of chimney chimney sweeps

444
00:24:15,200 --> 00:24:19,360
Speaker 1: cancer to then you know, policy change for that, that

445
00:24:19,520 --> 00:24:24,320
Speaker 1: timeline seems downright speedy compared to cigarettes and cancer.

446
00:24:24,520 --> 00:24:26,480
Speaker 3: Just curious, by the way, what kind of cancer is

447
00:24:26,520 --> 00:24:27,480
Speaker 3: chimney sweeps cancer?

448
00:24:27,640 --> 00:24:28,639
Speaker 1: Chimney sweeps cancer?

449
00:24:29,240 --> 00:24:31,639
Speaker 3: I mean does it have like is it testicular cancers?

450
00:24:31,640 --> 00:24:32,280
Speaker 3: That love cancer?

451
00:24:32,560 --> 00:24:35,600
Speaker 1: It's like scrodle cancer? Okay yeah yeah yeah sorry.

452
00:24:35,800 --> 00:24:37,240
Speaker 5: I was like I thought that you said that in

453
00:24:37,240 --> 00:24:38,959
Speaker 5: the first episode, but I couldn't remember.

454
00:24:39,000 --> 00:24:41,240
Speaker 3: It's in the name chimneys.

455
00:24:41,480 --> 00:24:41,800
Speaker 9: I know.

456
00:24:42,480 --> 00:24:44,760
Speaker 3: We talked about how you have to define a cancer

457
00:24:44,840 --> 00:24:45,359
Speaker 3: to go back.

458
00:24:45,280 --> 00:24:45,960
Speaker 1: To page too.

459
00:24:46,040 --> 00:24:53,320
Speaker 5: Yeah okay, thank you, No, that makes sense, yeah yeah yeah.

460
00:24:53,359 --> 00:24:55,360
Speaker 1: And it's because they were sweeping chimneys naked like they

461
00:24:55,359 --> 00:24:56,359
Speaker 1: were there was nothing.

462
00:24:56,560 --> 00:24:59,560
Speaker 5: Yeah, and like as in development, you're like then with

463
00:24:59,640 --> 00:25:01,800
Speaker 5: puber all of the hormones and.

464
00:25:01,960 --> 00:25:07,119
Speaker 1: Okay, yeah, yeah, yeah, yeah, yeah, cell proliferation, et cetera. Yeah, Okay, So,

465
00:25:07,600 --> 00:25:12,679
Speaker 1: of all the recognized carcinogens today, tobacco is probably the

466
00:25:12,720 --> 00:25:15,040
Speaker 1: most well known. Like, if you ask someone lists some

467
00:25:15,160 --> 00:25:18,119
Speaker 1: carcinogens for me, probably cigarettes woul be the number one

468
00:25:18,160 --> 00:25:19,000
Speaker 1: for sure, number one.

469
00:25:18,920 --> 00:25:21,160
Speaker 5: And I mean rightfully so in terms of the number

470
00:25:21,200 --> 00:25:22,400
Speaker 5: of people it kills every year.

471
00:25:22,480 --> 00:25:25,399
Speaker 1: Absolutely, yeah, yeah. And I think this is also a

472
00:25:25,440 --> 00:25:29,760
Speaker 1: real demonstration of the power of awareness campaigns, all those ads,

473
00:25:29,840 --> 00:25:34,360
Speaker 1: I remember those ads. Yeah. This notoriety, though, was incredibly

474
00:25:34,400 --> 00:25:37,879
Speaker 1: hard won, with decades of big tobacco sewing doubt and

475
00:25:37,960 --> 00:25:42,439
Speaker 1: obfuscating the facts, a reluctant public, and a government afraid

476
00:25:42,520 --> 00:25:45,760
Speaker 1: to take a stance, even if that meant preventing tens

477
00:25:45,800 --> 00:25:50,560
Speaker 1: of thousands of deaths. Someday we will cover the story

478
00:25:50,600 --> 00:25:53,840
Speaker 1: in all its lord detail, but for now, I'm just

479
00:25:53,840 --> 00:25:56,560
Speaker 1: going to give you the bare bones, Okay. Our first

480
00:25:56,600 --> 00:26:00,800
Speaker 1: marker along the timeline takes us to seventeen sixty one,

481
00:26:01,520 --> 00:26:05,879
Speaker 1: with John Hill's publication of his pamphlet titled Cautions against

482
00:26:05,960 --> 00:26:07,840
Speaker 1: the Immoderate Use of Snuff.

483
00:26:08,720 --> 00:26:11,000
Speaker 3: Seventeen sixty one.

484
00:26:11,960 --> 00:26:16,480
Speaker 1: Oh boy, Okay, and in this pamphlet he argued that

485
00:26:16,680 --> 00:26:21,080
Speaker 1: oral tobacco caused lip mouth and throat cancer. Wow. Yeah,

486
00:26:21,720 --> 00:26:26,560
Speaker 1: Unlike percival Pots observation, people largely ridiculed or ignored Hill,

487
00:26:26,880 --> 00:26:30,960
Speaker 1: tobacco was exceedingly popular, and he was telling them something

488
00:26:31,000 --> 00:26:33,600
Speaker 1: that they didn't want to hear. Where's your proof for this, bro,

489
00:26:33,760 --> 00:26:38,160
Speaker 1: don't take this away from pamphlet. Get real that, get real,

490
00:26:38,200 --> 00:26:42,320
Speaker 1: and get out of here. Reaction would remain surprisingly consistent,

491
00:26:42,560 --> 00:26:46,360
Speaker 1: startlingly so, over the next two centuries. In the late

492
00:26:46,400 --> 00:26:49,959
Speaker 1: eighteen hundreds and early nineteen hundreds, Hill's pamphlet had largely

493
00:26:50,000 --> 00:26:51,120
Speaker 1: been forgotten by that.

494
00:26:51,119 --> 00:26:54,160
Speaker 3: Jome just kick it over this seventeen seventeen sixty one.

495
00:26:55,960 --> 00:26:59,320
Speaker 1: I mean, and I wonder too whether anything about like

496
00:26:59,560 --> 00:27:02,160
Speaker 1: imma under it, because like, was that was when did

497
00:27:02,160 --> 00:27:04,840
Speaker 1: the temperance movement begin? Was it that sort of thing

498
00:27:04,960 --> 00:27:08,080
Speaker 1: the woes of modern society, which is always a thing

499
00:27:08,119 --> 00:27:09,240
Speaker 1: that always happens.

500
00:27:10,040 --> 00:27:12,639
Speaker 5: It's just wow, yeah, because that's two hundred years until

501
00:27:12,680 --> 00:27:14,040
Speaker 5: Mad Men where they're.

502
00:27:14,000 --> 00:27:16,359
Speaker 1: Like smoking all the time. Oh my god. Oh, because

503
00:27:16,359 --> 00:27:19,240
Speaker 1: you're watching that, yes, Because last year I was watching

504
00:27:19,320 --> 00:27:22,560
Speaker 1: it was a series and I was like, there's so

505
00:27:22,680 --> 00:27:25,040
Speaker 1: much relevant things for pregnancy. There's so many relevant things

506
00:27:25,040 --> 00:27:30,480
Speaker 1: for cancers. Yes, yeah, so many relevant things for cancer. Yes,

507
00:27:31,800 --> 00:27:34,760
Speaker 1: but yeah so by the time his by the like

508
00:27:34,800 --> 00:27:38,359
Speaker 1: early nineteen hundreds, his pamphlet had long been forgotten, but

509
00:27:38,480 --> 00:27:43,240
Speaker 1: scientists and medical you know, practitioners were forming their own

510
00:27:43,280 --> 00:27:48,040
Speaker 1: suspicions of a tobacco cancer link, more specifically, cigarettes and

511
00:27:48,119 --> 00:27:51,800
Speaker 1: lung cancer. Lung cancer by this time had begun to

512
00:27:51,840 --> 00:27:56,000
Speaker 1: transform from a rarity to like a pretty common diagnosis.

513
00:27:56,600 --> 00:27:59,240
Speaker 1: Research conducted over the first half of the twentieth century

514
00:27:59,359 --> 00:28:05,240
Speaker 1: solidify the cigarettes lung cancer risk, using epidemiological data, animal experimentation,

515
00:28:05,960 --> 00:28:10,520
Speaker 1: cellular research, and chemical analysis of cigarette smoke to show

516
00:28:10,880 --> 00:28:14,639
Speaker 1: beyond a doubt, not just a reasonable doubt, no any doubt,

517
00:28:15,359 --> 00:28:21,399
Speaker 1: that smoking greatly increased the risk of lung cancer. Proven. Yes, proven.

518
00:28:22,119 --> 00:28:26,480
Speaker 1: In nineteen fifty four, cancer authorities in several countries around

519
00:28:26,520 --> 00:28:31,000
Speaker 1: the world announced this unequivocal link, and even big Tobacco

520
00:28:31,200 --> 00:28:37,919
Speaker 1: was convinced, although only privately in memos. Yes, it still

521
00:28:37,960 --> 00:28:41,840
Speaker 1: took another ten years for the US Surgeon General to

522
00:28:41,880 --> 00:28:45,680
Speaker 1: announce that cigarettes are a cause of lung cancer. Pressured

523
00:28:45,680 --> 00:28:49,480
Speaker 1: by the tobacco industry to stay quiet, smoking declined a

524
00:28:49,520 --> 00:28:52,000
Speaker 1: bit after this announcement in nineteen sixty four or so,

525
00:28:52,440 --> 00:28:56,320
Speaker 1: but then it plateaued like it kind of went and

526
00:28:56,400 --> 00:28:59,160
Speaker 1: went back up a little bit until nineteen eighty. And

527
00:28:59,200 --> 00:29:04,480
Speaker 1: that's when broad cast ads ended for cigarettes. Wow yeah,

528
00:29:04,480 --> 00:29:06,760
Speaker 1: because it was like again in mad Men, you know,

529
00:29:07,040 --> 00:29:09,320
Speaker 1: oh well we have this filter. Oh well ours you

530
00:29:09,400 --> 00:29:12,560
Speaker 1: can smoke, but like ours are clean, our health ours

531
00:29:12,560 --> 00:29:16,600
Speaker 1: are this yeah yeah, And so it's like the laws

532
00:29:16,600 --> 00:29:18,840
Speaker 1: had to catch up to like what was allowed to

533
00:29:18,920 --> 00:29:26,160
Speaker 1: be said. And so clearly though, skepticism remained, both in

534
00:29:26,240 --> 00:29:30,480
Speaker 1: the public in politicians everywhere, and this was partly the

535
00:29:30,520 --> 00:29:34,440
Speaker 1: handiwork of big tobacco swing their seas of doubt. Partly

536
00:29:34,480 --> 00:29:38,640
Speaker 1: it was also the lag time between exposure and cancer development,

537
00:29:38,760 --> 00:29:42,040
Speaker 1: which can be decades in the making, and partly because

538
00:29:42,080 --> 00:29:48,600
Speaker 1: cigarettes were well loved and highly addictive. In nineteen sixty five,

539
00:29:48,680 --> 00:29:51,920
Speaker 1: so this is the year after the Surgeon General's announcement,

540
00:29:52,360 --> 00:29:54,960
Speaker 1: fifty percent of men and thirty two percent of women

541
00:29:55,000 --> 00:30:00,400
Speaker 1: in the US smoked wow yeah, okay yeah. The amount

542
00:30:00,400 --> 00:30:03,560
Speaker 1: of cigarettes was also high, about ten per day on

543
00:30:03,680 --> 00:30:08,000
Speaker 1: average something around there, half a pack, half a pack, yeat.

544
00:30:08,360 --> 00:30:10,640
Speaker 1: And then there was a poll that had been conducted

545
00:30:10,640 --> 00:30:13,680
Speaker 1: a few years prior so before the Surgeon General's announcement,

546
00:30:13,720 --> 00:30:15,440
Speaker 1: but after the link had been.

547
00:30:15,600 --> 00:30:16,440
Speaker 3: Very clear shown.

548
00:30:16,520 --> 00:30:21,520
Speaker 1: Yeah, one third of US doctors believed that cigarettes were

549
00:30:21,560 --> 00:30:25,280
Speaker 1: a major cause of lung cancer. Really one third? Only

550
00:30:25,320 --> 00:30:29,760
Speaker 1: one third and forty three percent of doctors smoked regularly. Yeah,

551
00:30:30,120 --> 00:30:33,200
Speaker 1: Tobacco is woven into the history and the culture of

552
00:30:33,200 --> 00:30:36,360
Speaker 1: the US and in so many other countries, and uprooting

553
00:30:36,400 --> 00:30:40,280
Speaker 1: it has proven to be quite difficult. But the decline

554
00:30:40,320 --> 00:30:44,120
Speaker 1: in cigarette consumption since the nineteen eighties, driven by awareness

555
00:30:44,160 --> 00:30:48,120
Speaker 1: campaigns and policy changes like age limits and smoking bands

556
00:30:48,120 --> 00:30:52,080
Speaker 1: in restaurants. I still remember going into restaurants smoking or.

557
00:30:52,080 --> 00:30:55,120
Speaker 3: Non smoking, hotels smoking non smoking. Yeah.

558
00:30:55,160 --> 00:30:59,160
Speaker 1: Yeah. It has led to thousands of lives saved and

559
00:30:59,400 --> 00:31:03,400
Speaker 1: estimated eight hundred thousand lung cancer deaths were averted between

560
00:31:03,480 --> 00:31:07,000
Speaker 1: nineteen sixty four and nineteen eighty five because of reduced smoking.

561
00:31:07,280 --> 00:31:09,520
Speaker 3: Wow, just in those like twenty years.

562
00:31:09,520 --> 00:31:13,440
Speaker 1: In those twenty years, and lung cancer deaths are projected

563
00:31:13,440 --> 00:31:16,480
Speaker 1: to drop seventy nine percent from twenty fifteen to twenty

564
00:31:16,520 --> 00:31:17,760
Speaker 1: sixty five. Wow.

565
00:31:17,880 --> 00:31:18,720
Speaker 3: Yeah, that's great.

566
00:31:19,080 --> 00:31:22,200
Speaker 1: Lung cancer will never be eradicated because while cigarettes are

567
00:31:22,240 --> 00:31:25,280
Speaker 1: the leading cause. They are not the only one, nor

568
00:31:25,360 --> 00:31:29,760
Speaker 1: is sustained progress guaranteed. Smoking has increased in some parts

569
00:31:29,760 --> 00:31:33,320
Speaker 1: of the world. Shock Like, it still blew my mind.

570
00:31:33,320 --> 00:31:35,120
Speaker 3: Well, especially with e cigarettes and vaping.

571
00:31:36,240 --> 00:31:40,240
Speaker 1: Even cigarette smoking has increased. Yeah, Yeah, And air pollution

572
00:31:40,720 --> 00:31:45,280
Speaker 1: remains a major driver of lung cancer. Despite these present

573
00:31:45,360 --> 00:31:47,920
Speaker 1: day hurdles, and despite the centuries long fight to put

574
00:31:47,960 --> 00:31:50,640
Speaker 1: tobacco in the spotlight as a cause of lung cancer,

575
00:31:50,840 --> 00:31:55,960
Speaker 1: this is still a remarkable success story. Yeah, remarkable. Over

576
00:31:56,000 --> 00:31:58,880
Speaker 1: the twentieth and into the twenty first centuries, many other

577
00:31:58,920 --> 00:32:03,600
Speaker 1: carcinogens have been idne Lifestyle factors such as alcohol, red meat,

578
00:32:03,760 --> 00:32:09,600
Speaker 1: processed meats, UV, radiation, occupational exposures like asbestos and silica dust,

579
00:32:10,120 --> 00:32:14,360
Speaker 1: infectious agents like epstein bar virus, Helicobacter pylori which is

580
00:32:14,400 --> 00:32:18,800
Speaker 1: the cause of stomach ulcers, and human papalomavirus see RHPV

581
00:32:18,800 --> 00:32:22,360
Speaker 1: episodes See RHPV episode. These are just a handful of

582
00:32:22,440 --> 00:32:26,800
Speaker 1: known carcinogens. The list of probable carcinogens is much longer.

583
00:32:27,760 --> 00:32:32,080
Speaker 1: What we've done with this information varies. It varies based

584
00:32:32,080 --> 00:32:35,120
Speaker 1: on the individual and when whether you can modify your

585
00:32:35,120 --> 00:32:38,480
Speaker 1: behavior to reduce your exposure. Maybe that means drinking less alcohol.

586
00:32:38,880 --> 00:32:41,600
Speaker 1: Maybe it means that you can't afford to buy healthier foods.

587
00:32:41,720 --> 00:32:44,320
Speaker 1: Maybe it means wearing sunscreen, maybe it means smoking. All

588
00:32:44,320 --> 00:32:48,280
Speaker 1: of these different things that are individually modifiable or potentially not.

589
00:32:49,280 --> 00:32:53,239
Speaker 1: It varies around the globe due to national policies, and

590
00:32:53,360 --> 00:32:55,800
Speaker 1: it varies on whether we have the technology to do

591
00:32:55,840 --> 00:32:59,360
Speaker 1: something about it. So, for instance, epstein bar virus EBV

592
00:32:59,840 --> 00:33:03,040
Speaker 1: is one of the most ubiquitous viruses. I've infected ninety

593
00:33:03,040 --> 00:33:05,360
Speaker 1: percent of adults. It's responsible for nearly three hundred and

594
00:33:05,400 --> 00:33:10,120
Speaker 1: sixty thousand cancers annually across the globe. Yet at the

595
00:33:10,120 --> 00:33:12,640
Speaker 1: time of writing, we do not have a vaccine for

596
00:33:12,680 --> 00:33:14,800
Speaker 1: this virus. We do have several in the works. Also,

597
00:33:15,080 --> 00:33:17,840
Speaker 1: EBV is thought to be linked to many other things

598
00:33:18,160 --> 00:33:23,320
Speaker 1: in our MSMs EBV. Yeah, but we do have a

599
00:33:23,400 --> 00:33:26,680
Speaker 1: vaccine for the hepatitis B virus we do, which can

600
00:33:26,760 --> 00:33:30,040
Speaker 1: lead to liver cancer, and human pepeloma virus HPV, which

601
00:33:30,080 --> 00:33:35,280
Speaker 1: can cause cervical other intogenital cancers and oropharyngeal cancers. It's

602
00:33:35,320 --> 00:33:37,160
Speaker 1: amazing that we have these these vaccines.

603
00:33:37,200 --> 00:33:38,560
Speaker 3: We can prevent cancers.

604
00:33:38,560 --> 00:33:42,080
Speaker 1: With vaccines, we can prevent some cancers. Yes, these are

605
00:33:42,120 --> 00:33:46,360
Speaker 1: incredible achievements that are projected to prevent millions of cases

606
00:33:46,360 --> 00:33:49,440
Speaker 1: of cancer over the next few decades. And as with

607
00:33:49,520 --> 00:33:53,800
Speaker 1: any success, there is room for improvement, you know, which

608
00:33:53,800 --> 00:33:57,960
Speaker 1: is understated. Hopefully we will see HEPB and HPV vaccine

609
00:33:58,040 --> 00:34:01,320
Speaker 1: uptake improve in their near future, include in policy changes

610
00:34:01,360 --> 00:34:03,880
Speaker 1: that will reverse some of the horrific decisions made by

611
00:34:04,000 --> 00:34:09,959
Speaker 1: this current head of HHS. But that is a major

612
00:34:10,000 --> 00:34:13,640
Speaker 1: concern here in the US. Like we will see reversal

613
00:34:13,680 --> 00:34:16,280
Speaker 1: in some of these trends, we will see cancer development

614
00:34:16,280 --> 00:34:20,520
Speaker 1: because people elect not to use these vaccines if they can. Yeah,

615
00:34:21,440 --> 00:34:26,279
Speaker 1: but before we had the HPV vaccine, we had ANHPV

616
00:34:26,360 --> 00:34:29,200
Speaker 1: testing I'll throw that in there. We also had another

617
00:34:29,280 --> 00:34:32,440
Speaker 1: powerful tool to reduce cancer deaths due to this virus.

618
00:34:32,680 --> 00:34:35,920
Speaker 1: We did the paps mares, the pap smear. We again

619
00:34:36,160 --> 00:34:39,360
Speaker 1: check out our episode. The pap smear was first developed

620
00:34:39,400 --> 00:34:43,000
Speaker 1: in nineteen twenty eight by Georgias Pepa Nicolau. He was

621
00:34:43,120 --> 00:34:45,719
Speaker 1: a physician and a scientist. He became interested in the

622
00:34:45,719 --> 00:34:51,000
Speaker 1: menstrual cycles of humans and especially cellular changes throughout the cycle,

623
00:34:51,080 --> 00:34:54,279
Speaker 1: like what's going on going on? What's happening Yeah, as

624
00:34:54,280 --> 00:34:57,480
Speaker 1: we go through this twenty eight through twenty five to

625
00:34:57,719 --> 00:35:01,799
Speaker 1: thirty seven days whatever this, Yeah, and he noticed that

626
00:35:01,840 --> 00:35:04,840
Speaker 1: he as he was like observing these cellular changes, he

627
00:35:04,880 --> 00:35:08,680
Speaker 1: saw that in certain samples the cells seemed oddly shaped,

628
00:35:10,200 --> 00:35:14,680
Speaker 1: kind of like they were cancerous maybe, And he realized like, oh,

629
00:35:14,719 --> 00:35:17,000
Speaker 1: I could use this test not just to like see

630
00:35:17,080 --> 00:35:21,759
Speaker 1: what's happening, but also to detect pre clinical, pre symptomatic

631
00:35:21,800 --> 00:35:26,040
Speaker 1: cases of cervical cancer. Wow. Amazing. And this was especially

632
00:35:26,040 --> 00:35:31,600
Speaker 1: important because like symptomatic usually, as we discussed, meansmetastasis often

633
00:35:31,800 --> 00:35:34,880
Speaker 1: and decreased or survival.

634
00:35:34,960 --> 00:35:37,680
Speaker 5: Yeah, like just invasive, Like the cervix is in such

635
00:35:37,680 --> 00:35:42,080
Speaker 5: a small area that it can go invasive, even just locally,

636
00:35:42,360 --> 00:35:43,840
Speaker 5: very quickly, very quickly.

637
00:35:43,920 --> 00:35:48,600
Speaker 1: So yeah, So detecting early means intervention early means higher

638
00:35:48,719 --> 00:35:53,960
Speaker 1: chance of increased survival. Yeah. His wife, Andromache was not

639
00:35:54,000 --> 00:35:56,640
Speaker 1: only worked alongside him at Cornell, but but was also

640
00:35:56,680 --> 00:35:59,839
Speaker 1: his research subject. She volunteered to undergo a daily perhaps

641
00:36:00,200 --> 00:36:05,200
Speaker 1: for two decades, two decades, twenty years.

642
00:36:05,000 --> 00:36:07,320
Speaker 3: Twenty years of everyday perap smears.

643
00:36:07,400 --> 00:36:07,680
Speaker 1: Yeah.

644
00:36:07,760 --> 00:36:09,000
Speaker 3: I don't have words for that.

645
00:36:09,080 --> 00:36:11,680
Speaker 1: I know, to help improve this test, what do normal

646
00:36:11,680 --> 00:36:13,520
Speaker 1: cells look like? What do cancer cells look like?

647
00:36:13,600 --> 00:36:14,879
Speaker 3: Yeah, oh, that's fascinating.

648
00:36:15,680 --> 00:36:16,000
Speaker 9: Wow.

649
00:36:16,280 --> 00:36:18,440
Speaker 1: And it took a few decades to catch on after

650
00:36:18,480 --> 00:36:21,080
Speaker 1: he formally introduced the pap smere in nineteen forty one,

651
00:36:21,160 --> 00:36:24,360
Speaker 1: but since being adopted as a routine screening tool, it

652
00:36:24,400 --> 00:36:28,319
Speaker 1: has led to early diagnosis and treatment intervention for untold

653
00:36:28,360 --> 00:36:29,480
Speaker 1: amounts of people around the world.

654
00:36:29,600 --> 00:36:32,359
Speaker 3: Yeah, it really is. The papspeers incredible.

655
00:36:32,080 --> 00:36:33,600
Speaker 1: Perhaps means pretty great.

656
00:36:33,640 --> 00:36:34,040
Speaker 3: Yeah.

657
00:36:34,239 --> 00:36:37,000
Speaker 1: So the papsmere falls under the category of cancer screening

658
00:36:37,320 --> 00:36:41,640
Speaker 1: using early detection methods to improve treatment outcomes. The intention

659
00:36:41,800 --> 00:36:45,080
Speaker 1: of cancer screening is not necessarily total prevention, but being

660
00:36:45,120 --> 00:36:48,800
Speaker 1: able to intervene as early as possible. We have ways

661
00:36:48,800 --> 00:36:53,360
Speaker 1: to screen for cervical, breast, colon, lung, prostate, skin, other cancers.

662
00:36:53,400 --> 00:36:57,040
Speaker 1: Some screenings involve imaging, like with a colonoscopy. They might

663
00:36:57,080 --> 00:36:59,680
Speaker 1: involve a blood test like the prostate specific antigen or

664
00:36:59,680 --> 00:37:02,560
Speaker 1: PUS say blood test, or it might be a visual

665
00:37:02,640 --> 00:37:07,240
Speaker 1: or physical exam. For skin cancer, for instance, screening methods

666
00:37:07,320 --> 00:37:09,399
Speaker 1: might be combined. You might do a couple of them.

667
00:37:09,440 --> 00:37:12,440
Speaker 1: You might have step one, step two yep. And while

668
00:37:12,440 --> 00:37:15,279
Speaker 1: there are general guidelines for when to screen, what to

669
00:37:15,320 --> 00:37:19,000
Speaker 1: screen for, and how often, you screen. These might vary

670
00:37:19,040 --> 00:37:21,840
Speaker 1: depending on other factors, like if, for instance, you have

671
00:37:21,880 --> 00:37:24,640
Speaker 1: a family history of cancer, your doctor might recommend you

672
00:37:24,680 --> 00:37:27,799
Speaker 1: get screened earlier and more frequently. Some people might get

673
00:37:27,800 --> 00:37:30,160
Speaker 1: genetic testing done to see if they are at higher risk,

674
00:37:30,200 --> 00:37:33,840
Speaker 1: which could then influence care decisions. We'll talk more about that.

675
00:37:35,080 --> 00:37:39,360
Speaker 1: On the surface, screening seems fairly straightforward. The earlier you

676
00:37:39,400 --> 00:37:41,920
Speaker 1: detect cancer, the greater the chance that you have of

677
00:37:41,960 --> 00:37:46,160
Speaker 1: successfully treating it. But you're listening to this podcast, so

678
00:37:46,200 --> 00:37:48,120
Speaker 1: we know that you're not here for the surface level. No,

679
00:37:49,560 --> 00:37:55,359
Speaker 1: early conceptualization of screening assumed that cancer progresses linearly, that

680
00:37:55,400 --> 00:37:58,160
Speaker 1: the earlier you detect cancer and treat it, the smaller

681
00:37:58,200 --> 00:38:00,759
Speaker 1: the tumor the means that this is more contained, the

682
00:38:00,840 --> 00:38:05,120
Speaker 1: better the chance for survival. That is the case for

683
00:38:05,239 --> 00:38:09,239
Speaker 1: certain cancers or for certain cases individual cases, But it's

684
00:38:09,360 --> 00:38:12,960
Speaker 1: not always the case. While some cancers might be localized

685
00:38:13,000 --> 00:38:15,800
Speaker 1: and it might grow slowly, others may have already spread

686
00:38:15,840 --> 00:38:18,600
Speaker 1: at the time of detection, and so the benefit of

687
00:38:18,680 --> 00:38:22,200
Speaker 1: early treatment might not be there. It might not be

688
00:38:22,560 --> 00:38:24,760
Speaker 1: like that the earlier you catch it, the better the chance.

689
00:38:25,560 --> 00:38:30,240
Speaker 1: It's not as clear as that screening, so I guess.

690
00:38:30,600 --> 00:38:33,160
Speaker 1: In other words, early detection does not always equate to

691
00:38:33,200 --> 00:38:38,200
Speaker 1: better survival, right, Yeah, Yeah, screening might also lead to

692
00:38:38,280 --> 00:38:42,799
Speaker 1: false positives or false negatives. Screening is not diagnostic, but

693
00:38:43,000 --> 00:38:45,600
Speaker 1: your results could be abnormal, which means you need to

694
00:38:45,640 --> 00:38:48,200
Speaker 1: go get further testing. And then so that could mean

695
00:38:48,239 --> 00:38:51,280
Speaker 1: that if you have abnormal results when you don't have cancer,

696
00:38:51,360 --> 00:38:53,440
Speaker 1: that means that you're about to undergo a bunch of

697
00:38:53,440 --> 00:38:56,279
Speaker 1: additional tests, which can be expensive, it can be really distressing,

698
00:38:56,440 --> 00:38:59,959
Speaker 1: it can be invasive, there are side effects to those,

699
00:39:01,000 --> 00:39:02,759
Speaker 1: so that those are some of the risks of a

700
00:39:02,840 --> 00:39:06,279
Speaker 1: false positive. And then of course there's false negatives, which

701
00:39:06,320 --> 00:39:09,880
Speaker 1: means that your results from screening show no signs of

702
00:39:10,000 --> 00:39:13,360
Speaker 1: potential for cancer, you don't get additional testing, but you

703
00:39:13,400 --> 00:39:18,120
Speaker 1: do have we miss something. Yeah. These are risks that

704
00:39:18,160 --> 00:39:22,040
Speaker 1: happen with any medical test, and it's especially important to

705
00:39:22,160 --> 00:39:25,520
Speaker 1: minimize the rate of false negatives missing something, and that

706
00:39:25,760 --> 00:39:30,279
Speaker 1: sometimes comes at the cost of increasing false positives. A

707
00:39:30,320 --> 00:39:33,799
Speaker 1: false negative means missing someone's potentially treatable cancer, which could

708
00:39:33,840 --> 00:39:36,920
Speaker 1: cost them their life, and a false positive means unnecessary

709
00:39:37,040 --> 00:39:40,759
Speaker 1: additional testing that can be time consuming, expensive and distressing.

710
00:39:41,080 --> 00:39:43,799
Speaker 1: So all this is to say again that it just

711
00:39:43,800 --> 00:39:45,440
Speaker 1: comes down to the same thing. On a case by

712
00:39:45,480 --> 00:39:49,440
Speaker 1: case basis, the benefits of screening might not always outweigh

713
00:39:49,480 --> 00:39:53,960
Speaker 1: the cons, but it's so hard to know that upfront.

714
00:39:54,080 --> 00:39:54,319
Speaker 3: Yep.

715
00:39:56,480 --> 00:40:00,799
Speaker 1: And that being said, you know, early detection does not

716
00:40:00,800 --> 00:40:04,080
Speaker 1: always equate to longer survival, but often it does.

717
00:40:04,200 --> 00:40:04,839
Speaker 3: Often it does.

718
00:40:05,000 --> 00:40:07,880
Speaker 1: Often it does. And the fact that screening doesn't eliminate

719
00:40:07,920 --> 00:40:11,120
Speaker 1: the risk of dying from cancer entirely does not mean

720
00:40:11,280 --> 00:40:15,719
Speaker 1: that physicians are out here recommending these screening tests willy nilly, right, go,

721
00:40:16,320 --> 00:40:21,400
Speaker 1: oh yeah, they're not like, oh, I better better cover myself.

722
00:40:21,440 --> 00:40:23,120
Speaker 1: So let's get you screen for this, that and the

723
00:40:23,200 --> 00:40:27,400
Speaker 1: other thing. It is, there decades of data to support

724
00:40:27,400 --> 00:40:30,880
Speaker 1: this there, and there are important guidelines that must be

725
00:40:30,920 --> 00:40:33,719
Speaker 1: followed before a screening test is incorporated into standard care.

726
00:40:33,920 --> 00:40:36,319
Speaker 1: If you listen to our Newborn screening episode, this might

727
00:40:36,360 --> 00:40:38,440
Speaker 1: sound a bit familiar to you. So in the late

728
00:40:38,520 --> 00:40:40,359
Speaker 1: nineteen sixties, I'm going to repeat it here.

729
00:40:40,440 --> 00:40:42,200
Speaker 3: I love it. I love it.

730
00:40:42,200 --> 00:40:45,160
Speaker 1: It's a good refresher. I feel like it's like because

731
00:40:45,400 --> 00:40:48,200
Speaker 1: I think there's been a lot of Again, it kind

732
00:40:48,239 --> 00:40:50,840
Speaker 1: of comes down to public health being invisible until.

733
00:40:50,640 --> 00:40:52,600
Speaker 3: It until it fails until it fails.

734
00:40:52,640 --> 00:40:55,120
Speaker 1: And it's like screening is. And I'm not saying screening

735
00:40:55,160 --> 00:41:00,440
Speaker 1: is always positive, no, but I think sometimes the benefits

736
00:41:00,480 --> 00:41:04,040
Speaker 1: of screening are get drowned out by the very real

737
00:41:04,080 --> 00:41:04,640
Speaker 1: cons that.

738
00:41:04,640 --> 00:41:09,680
Speaker 5: Exist or the limitation, mystery diagnoses or whatever it is.

739
00:41:10,280 --> 00:41:12,080
Speaker 5: You know, like, is mammogram perfect?

740
00:41:12,200 --> 00:41:12,359
Speaker 9: No?

741
00:41:12,520 --> 00:41:14,120
Speaker 3: But has it saved so many lives?

742
00:41:14,239 --> 00:41:14,439
Speaker 5: Yes?

743
00:41:14,640 --> 00:41:14,759
Speaker 2: Right?

744
00:41:14,920 --> 00:41:19,200
Speaker 1: Is a colonoscopy prep very challenging and very uncomfortable? Yes?

745
00:41:19,280 --> 00:41:19,480
Speaker 9: Yeah?

746
00:41:19,560 --> 00:41:20,600
Speaker 3: Could it save your life?

747
00:41:20,640 --> 00:41:21,480
Speaker 1: Also? Yes?

748
00:41:22,040 --> 00:41:24,600
Speaker 3: Does everyone need it? Maybe not? Are there other ways

749
00:41:24,600 --> 00:41:27,239
Speaker 3: we'll talk about talk about it, but tell me about yes?

750
00:41:27,320 --> 00:41:31,239
Speaker 1: The guidelines so okay. Quarineteen sixties the who published the

751
00:41:31,280 --> 00:41:33,960
Speaker 1: Principles and Practice of Screening for Disease, also known as

752
00:41:34,000 --> 00:41:37,680
Speaker 1: the Wilson and Younger or Younger Screening Criteria, which outline

753
00:41:37,840 --> 00:41:40,880
Speaker 1: ten rules that a screening test should follow, things like

754
00:41:40,920 --> 00:41:43,239
Speaker 1: I'm not going to list them all here, but it's

755
00:41:43,280 --> 00:41:46,000
Speaker 1: things like the test should be reliable and not harmful.

756
00:41:46,160 --> 00:41:48,960
Speaker 1: There should be an effective treatment, and that treatment has

757
00:41:49,000 --> 00:41:52,840
Speaker 1: been demonstrated to be more effective before symptoms. That's really important,

758
00:41:52,880 --> 00:41:55,759
Speaker 1: really important. And there should be a standard policy for

759
00:41:55,840 --> 00:41:59,720
Speaker 1: treatment and who receives treatment in the nearly sixty years

760
00:41:59,760 --> 00:42:04,280
Speaker 1: sin these criteria were introduced, Biomedical technology has undergone a revolution,

761
00:42:04,600 --> 00:42:07,720
Speaker 1: and we can know more about ourselves than ever before.

762
00:42:08,360 --> 00:42:11,000
Speaker 1: And as we all know, technology moves too quickly for

763
00:42:11,120 --> 00:42:14,600
Speaker 1: us to anticipate the full extent of its impact. These

764
00:42:14,640 --> 00:42:17,560
Speaker 1: principles for screening, whether they are adjusted or not, will

765
00:42:17,600 --> 00:42:21,359
Speaker 1: be foundational in continuing to minimize harm as much as

766
00:42:21,440 --> 00:42:25,960
Speaker 1: possible as new screening is introduced. Yeah, Like, I really

767
00:42:25,960 --> 00:42:28,400
Speaker 1: don't want to give the impression that screening does not work,

768
00:42:28,800 --> 00:42:32,560
Speaker 1: or even imply that screening is perfect. I simply want

769
00:42:32,560 --> 00:42:34,719
Speaker 1: to convey that the reality, as is often the case,

770
00:42:34,800 --> 00:42:37,239
Speaker 1: is more complicated than that, because I.

771
00:42:37,160 --> 00:42:39,360
Speaker 5: Mean there's also maybe you're going to talk about this,

772
00:42:39,440 --> 00:42:41,879
Speaker 5: I don't like, jump on your feet.

773
00:42:41,719 --> 00:42:45,279
Speaker 1: I think step on my feet, whatever, jump on the.

774
00:42:45,680 --> 00:42:48,239
Speaker 5: But there's also like sometimes you know, you said that

775
00:42:48,360 --> 00:42:51,120
Speaker 5: maybe screening won't necessarily prolong your life if we can

776
00:42:51,160 --> 00:42:54,080
Speaker 5: detect it early. Sometimes we can also detect cancers that

777
00:42:54,200 --> 00:42:57,120
Speaker 5: might have never really come to anything. Yes, right, And

778
00:42:57,160 --> 00:42:59,719
Speaker 5: so then we give this impression that we are improving

779
00:42:59,760 --> 00:43:02,960
Speaker 5: out comes when maybe we aren't. We're just you know,

780
00:43:03,080 --> 00:43:07,040
Speaker 5: increasing how many case cancer cases we're detecting so yeah,

781
00:43:07,040 --> 00:43:09,360
Speaker 5: there's a lot of complicated things that come with screening,

782
00:43:09,360 --> 00:43:12,319
Speaker 5: which is why there's so many, you know, guidelines and

783
00:43:12,360 --> 00:43:15,279
Speaker 5: decisions and data that has to go into deciding how

784
00:43:15,320 --> 00:43:18,000
Speaker 5: to recommend screening and who to recommend screening for, like

785
00:43:18,080 --> 00:43:19,720
Speaker 5: what populations.

786
00:43:19,120 --> 00:43:22,200
Speaker 1: Right right, And it's like the thing too, is that

787
00:43:22,760 --> 00:43:25,799
Speaker 1: there is one road, right, like for one person, there

788
00:43:25,880 --> 00:43:28,120
Speaker 1: is one road, one suite of decisions that get you

789
00:43:28,160 --> 00:43:30,680
Speaker 1: to where you are. And so you can't know what

790
00:43:30,960 --> 00:43:34,320
Speaker 1: screening have done. This would if I if I hadn't

791
00:43:34,320 --> 00:43:36,120
Speaker 1: gotten screening, would that have been better? You know, like,

792
00:43:36,640 --> 00:43:39,239
Speaker 1: you just can't know these things, and so we do

793
00:43:39,280 --> 00:43:41,120
Speaker 1: the best we can with the available data that we

794
00:43:41,160 --> 00:43:47,080
Speaker 1: have with cancer screening, prevention, and treatment. We have the

795
00:43:47,120 --> 00:43:49,920
Speaker 1: tools and the information to bring down those forty percent

796
00:43:49,960 --> 00:43:52,480
Speaker 1: and seventeen percent numbers I mentioned at the top, So

797
00:43:52,600 --> 00:43:55,680
Speaker 1: forty percent lifetime risk of cancer, seventeen percent chance of

798
00:43:55,760 --> 00:44:01,040
Speaker 1: dying from cancer, but having this knowledge does not guarantee

799
00:44:01,040 --> 00:44:06,320
Speaker 1: a decreased global cancer burden by any means. Throughout this series,

800
00:44:06,400 --> 00:44:10,120
Speaker 1: we've discussed some reasons why government and action, even when

801
00:44:10,120 --> 00:44:15,640
Speaker 1: faced with overwhelming evidence cases where screening can't improve survival.

802
00:44:16,239 --> 00:44:20,920
Speaker 1: The biology of cancer itself. Lifestyle factors increase in cancer risk,

803
00:44:21,360 --> 00:44:26,480
Speaker 1: genetic predisposition to cancer. And there's another enormous aspect that

804
00:44:26,600 --> 00:44:31,600
Speaker 1: you touched on briefly last episode, and that is access, yes,

805
00:44:32,040 --> 00:44:35,440
Speaker 1: both to knowledge as well as care, which includes screening

806
00:44:35,440 --> 00:44:39,080
Speaker 1: and treatment. In the US as well as across the globe,

807
00:44:39,120 --> 00:44:43,560
Speaker 1: substantial cancer disparities exist in terms of diagnosis and survival.

808
00:44:44,040 --> 00:44:46,480
Speaker 1: You talked a little bit last week, and individual's experience

809
00:44:46,480 --> 00:44:50,959
Speaker 1: with cancer is influenced by race, ethnicity, socioeconomic status, education level,

810
00:44:51,320 --> 00:44:55,040
Speaker 1: so many different things. So, for instance, black women in

811
00:44:55,080 --> 00:44:58,160
Speaker 1: the US diagnosed with cancer have a ten percent higher

812
00:44:58,239 --> 00:45:01,320
Speaker 1: death rate compared to white women having a nine percent

813
00:45:01,440 --> 00:45:06,560
Speaker 1: lower incidence rate. Wow, education levels also associated with cancer mortality.

814
00:45:06,719 --> 00:45:10,160
Speaker 1: Lung cancer mortality is four to five times higher in

815
00:45:10,239 --> 00:45:12,960
Speaker 1: those with the lowest education level compared to those with

816
00:45:13,000 --> 00:45:17,640
Speaker 1: the highest. Geography, often tied to income, also plays a role,

817
00:45:17,840 --> 00:45:20,920
Speaker 1: with those who are in more rural or poverty stricken

818
00:45:20,960 --> 00:45:26,359
Speaker 1: areas experiencing higher cancer death rates. These disparities, and you're

819
00:45:26,360 --> 00:45:28,520
Speaker 1: going to talk more about them in the numbers. Yeah,

820
00:45:28,800 --> 00:45:33,000
Speaker 1: they represent long standing structural inequalities that lead to higher

821
00:45:33,120 --> 00:45:35,319
Speaker 1: rates of preventable morbidity.

822
00:45:35,360 --> 00:45:36,920
Speaker 3: And mortality.

823
00:45:37,680 --> 00:45:40,759
Speaker 1: What good are cutting edge treatments to you if you

824
00:45:40,840 --> 00:45:44,200
Speaker 1: don't have access to them. What good are screening tests

825
00:45:44,239 --> 00:45:46,839
Speaker 1: to you if you can't afford them because you can't

826
00:45:46,840 --> 00:45:47,760
Speaker 1: afford health insurance?

827
00:45:47,800 --> 00:45:48,040
Speaker 5: Yep?

828
00:45:48,800 --> 00:45:51,640
Speaker 1: What good are awareness campaigns if they never make it

829
00:45:51,680 --> 00:45:55,640
Speaker 1: to your door. We have spent the last four episodes

830
00:45:55,719 --> 00:46:00,880
Speaker 1: dissecting cancer, deciphering its many meanings, exploring its biology, understanding

831
00:46:00,920 --> 00:46:04,319
Speaker 1: its treatments, and describing prevention and screening methods. It is

832
00:46:04,960 --> 00:46:08,880
Speaker 1: a wealth of information, but in this country and around

833
00:46:08,920 --> 00:46:13,160
Speaker 1: the world, we are not adequately leveraging this information for

834
00:46:13,280 --> 00:46:14,880
Speaker 1: everyone to benefit equally.

835
00:46:15,000 --> 00:46:15,239
Speaker 3: Yep.

836
00:46:16,000 --> 00:46:18,120
Speaker 1: This is not a problem that will be solved through

837
00:46:18,200 --> 00:46:22,319
Speaker 1: cutting edge technology, but through better access, better education, more

838
00:46:22,360 --> 00:46:26,920
Speaker 1: affordable healthcare, and a willingness to scrutinize and dismantle the

839
00:46:26,960 --> 00:46:31,080
Speaker 1: structural inequalities and systemic racism that drive these health disparities

840
00:46:31,120 --> 00:46:35,839
Speaker 1: on Yep. Yep. Not all parts of cancer are within

841
00:46:35,920 --> 00:46:39,560
Speaker 1: our control, but some are both. At an individual level,

842
00:46:39,760 --> 00:46:43,520
Speaker 1: we can make individual changes and societal we can make

843
00:46:43,560 --> 00:46:44,600
Speaker 1: societal changes.

844
00:46:44,640 --> 00:46:46,320
Speaker 5: I think that's the biggest one, because I think people

845
00:46:46,360 --> 00:46:49,439
Speaker 5: only like to focus on the individual level, like, oh,

846
00:46:49,520 --> 00:46:51,800
Speaker 5: you should be doing X, Y and Z. What about

847
00:46:51,880 --> 00:46:54,799
Speaker 5: we should all what about we should our country should be?

848
00:46:54,880 --> 00:46:57,359
Speaker 5: What about our global community should be?

849
00:46:57,600 --> 00:46:57,799
Speaker 2: Right?

850
00:46:58,040 --> 00:47:01,960
Speaker 1: Yeah, and so choose what we do with all of

851
00:47:01,960 --> 00:47:05,600
Speaker 1: this information. It is a personal it is a political,

852
00:47:05,640 --> 00:47:08,320
Speaker 1: it is a medical, and it is a philosophical matter.

853
00:47:09,120 --> 00:47:11,040
Speaker 1: And with that, Aeron, I'll turn it over to you

854
00:47:11,080 --> 00:47:14,040
Speaker 1: to tell me that the status of cancer around the

855
00:47:14,080 --> 00:47:16,120
Speaker 1: world today. That's not a big ass no, right, not

856
00:47:16,200 --> 00:47:21,360
Speaker 1: at all, guys. Small potatoes, erin, super small, the tiniest potatoes,

857
00:47:21,400 --> 00:47:22,760
Speaker 1: baby potatoes, new potatoes.

858
00:47:22,800 --> 00:47:27,040
Speaker 5: Oh, Aaron, it's dark, yeah, yeah, yeah, Okay, no, I

859
00:47:27,080 --> 00:47:30,080
Speaker 5: know we're going to go down. It's going to be

860
00:47:30,160 --> 00:47:33,000
Speaker 5: dark for a moment, but hopefully I think there is

861
00:47:33,040 --> 00:47:34,440
Speaker 5: some bright futures on the horizon.

862
00:47:34,560 --> 00:47:49,240
Speaker 8: Okay, okay.

863
00:47:49,520 --> 00:47:51,200
Speaker 10: My name is Sam and about four and a half

864
00:47:51,200 --> 00:47:53,440
Speaker 10: months ago, at the age of thirty five, I was

865
00:47:53,480 --> 00:47:57,200
Speaker 10: diagnosed with stage one triple negative breast cancer. My cancer

866
00:47:57,280 --> 00:48:00,880
Speaker 10: journey began unexpectedly out of curiosity. I had enrolled in

867
00:48:00,920 --> 00:48:03,320
Speaker 10: a research study that identified I have a BRAC of

868
00:48:03,360 --> 00:48:07,640
Speaker 10: one mutation. This mutation affects DNA repair and increases the

869
00:48:07,680 --> 00:48:10,320
Speaker 10: risk of various types of cancer, most notably breast and

870
00:48:10,360 --> 00:48:15,759
Speaker 10: Ovriian cancer. That finding triggered additional screenings, including mammograms, ultrasounds,

871
00:48:15,760 --> 00:48:19,440
Speaker 10: and ultimately a biopsy that led to my diagnosis. It

872
00:48:19,440 --> 00:48:21,640
Speaker 10: feels strange to say I'm lucky to have been diagnosed

873
00:48:21,640 --> 00:48:23,919
Speaker 10: with an aggressive form of cancer, but at the time

874
00:48:23,960 --> 00:48:26,879
Speaker 10: of my diagnosis, I truly had no symptoms, no known

875
00:48:26,920 --> 00:48:29,920
Speaker 10: family history, and I wasn't scheduled to begin routine screenings

876
00:48:29,920 --> 00:48:32,719
Speaker 10: for another five years. So in that sense, I am

877
00:48:32,760 --> 00:48:35,279
Speaker 10: incredibly fortunate that my cancer was still caught early at

878
00:48:35,280 --> 00:48:39,480
Speaker 10: stage one. My treatment plan includes chemotherapy followed by a

879
00:48:39,480 --> 00:48:42,560
Speaker 10: double mestectomy. At the time of this recording, I have

880
00:48:42,640 --> 00:48:46,600
Speaker 10: completed sixteen out of eighteen weeks of chemo. Overall, chemo

881
00:48:46,680 --> 00:48:49,080
Speaker 10: hasn't been as bad as I expected, but it hasn't

882
00:48:49,080 --> 00:48:53,440
Speaker 10: been easy either. The main challenges for me have been anemia, fatigue,

883
00:48:53,680 --> 00:48:56,440
Speaker 10: and some peripheral neuropathy or a loss of sensation in

884
00:48:56,480 --> 00:49:00,279
Speaker 10: my fingers. The side effects build over time. The first

885
00:49:00,280 --> 00:49:02,759
Speaker 10: couple of months were manageable. The side effects are absolutely

886
00:49:02,800 --> 00:49:05,120
Speaker 10: wearing on me, and I am so ready to be done.

887
00:49:05,600 --> 00:49:08,520
Speaker 10: That said, the hardest part of this experience so far

888
00:49:08,640 --> 00:49:11,920
Speaker 10: hasn't been the chemotherapy. For me, it was actually the

889
00:49:11,920 --> 00:49:15,400
Speaker 10: period between diagnosis and starting treatment. During that time, my

890
00:49:15,440 --> 00:49:18,480
Speaker 10: treatment plan changed multiple times, and I was navigating the

891
00:49:18,520 --> 00:49:21,399
Speaker 10: fear and uncertainty of a cancer diagnosis while still working

892
00:49:21,440 --> 00:49:23,879
Speaker 10: full time and managing a whole host of other logistics

893
00:49:24,320 --> 00:49:28,279
Speaker 10: scheduling second opinions, vaccinations, dentist appointments, all before I had

894
00:49:28,280 --> 00:49:30,600
Speaker 10: told most of my friends and family about my diagnosis.

895
00:49:31,920 --> 00:49:34,600
Speaker 10: Another unexpected challenge has been grieving the loss of my

896
00:49:34,640 --> 00:49:38,480
Speaker 10: former identity as a healthy, fit person. Even knowing that

897
00:49:38,520 --> 00:49:41,640
Speaker 10: most side effects of chemotherapy are temporary, I still really

898
00:49:41,640 --> 00:49:44,200
Speaker 10: miss being someone who didn't need to memorize medication lists

899
00:49:44,200 --> 00:49:48,480
Speaker 10: in doctor's visits or think twice about physical limits. At

900
00:49:48,480 --> 00:49:51,000
Speaker 10: this point, I'm still very much in this journey. After

901
00:49:51,000 --> 00:49:54,520
Speaker 10: my current chemotherapy regimen, I'll have surgery, potentially followed by

902
00:49:54,520 --> 00:49:58,680
Speaker 10: another year of oral chemotherapy along with additional prophylactic surgeries

903
00:49:58,760 --> 00:50:02,400
Speaker 10: due to my braco one mutation. Ultimately, I'm still learning

904
00:50:02,400 --> 00:50:05,280
Speaker 10: how to live with uncertainty, how to advocate for myself,

905
00:50:05,480 --> 00:50:07,760
Speaker 10: and how to redefine who I am while moving forward

906
00:50:07,760 --> 00:50:08,799
Speaker 10: from this diagnosis.

907
00:50:10,520 --> 00:50:13,160
Speaker 9: Hello, my name is Karen. I'm here to tell you

908
00:50:13,200 --> 00:50:16,400
Speaker 9: about some of the barriers and frustrations my family have

909
00:50:16,560 --> 00:50:20,399
Speaker 9: had since our adult son was diagnosed with stage four

910
00:50:20,680 --> 00:50:27,000
Speaker 9: metastatic medullary thyroid cancer or MTC, four years ago. In

911
00:50:27,040 --> 00:50:30,280
Speaker 9: case you are unaware, there are several types of thyroid cancer.

912
00:50:30,680 --> 00:50:34,000
Speaker 9: Some are very common and not aggressive at all, and

913
00:50:34,080 --> 00:50:38,920
Speaker 9: some are rare and aggressive. Unfortunately, MTC is the latter.

914
00:50:39,719 --> 00:50:42,399
Speaker 9: Only about one thousand people in the United States are

915
00:50:42,400 --> 00:50:46,319
Speaker 9: diagnosed with it each year. As such, research dollars are

916
00:50:46,360 --> 00:50:50,520
Speaker 9: few and far between for such rare cancers, and therefore

917
00:50:50,800 --> 00:50:55,399
Speaker 9: treatments are limited and few and rare. Cancer specialists are

918
00:50:55,480 --> 00:50:59,600
Speaker 9: also rare and not typically in network for insurance companies.

919
00:50:59,640 --> 00:51:04,120
Speaker 9: To additional frustrations and barriers to treatment because of the

920
00:51:04,239 --> 00:51:09,600
Speaker 9: rarity of his cancer have been centered around multiple insurance denials.

921
00:51:10,360 --> 00:51:14,919
Speaker 9: Some of these denials are for recommended treatments. I took

922
00:51:14,920 --> 00:51:19,719
Speaker 9: over writing appeals as I have a medical background. I

923
00:51:19,800 --> 00:51:23,440
Speaker 9: was thorough in my research, and in one case, ultimately,

924
00:51:23,520 --> 00:51:27,680
Speaker 9: after three appeals for a type of radiation treatment that's

925
00:51:27,760 --> 00:51:31,600
Speaker 9: recommended for MTC, was finally able to get the approval

926
00:51:31,680 --> 00:51:34,960
Speaker 9: for it for our son. However, at one point the

927
00:51:34,960 --> 00:51:40,160
Speaker 9: insurance companies oncologists wrote to me and stated, what does

928
00:51:40,200 --> 00:51:44,919
Speaker 9: it matter as he's going to die anyway, you can bet.

929
00:51:44,960 --> 00:51:48,040
Speaker 9: I reported her to the insurance company president and our

930
00:51:48,080 --> 00:51:52,360
Speaker 9: state insurance commissioner. The lack of compassion and the delays

931
00:51:52,640 --> 00:51:56,120
Speaker 9: in treatment because of denials and people like this are abhorrent.

932
00:51:56,719 --> 00:52:00,120
Speaker 9: This is just one but terrible example when as as

933
00:52:00,120 --> 00:52:02,280
Speaker 9: a family member, you are trying to do your best

934
00:52:02,320 --> 00:52:05,680
Speaker 9: to cope with and fight for your family member with

935
00:52:05,760 --> 00:52:10,239
Speaker 9: such a terrible disease. It is the red tape, the denials,

936
00:52:10,360 --> 00:52:14,680
Speaker 9: the appeals, and more denials leading to extreme out of

937
00:52:14,719 --> 00:52:20,080
Speaker 9: pocket expenses that I'm also reporting here. One medication is

938
00:52:20,200 --> 00:52:24,279
Speaker 9: thirty thousand dollars a month out of pocket because of

939
00:52:24,400 --> 00:52:29,359
Speaker 9: insurance denials. No one can sustain out of pocket expenses

940
00:52:29,480 --> 00:52:33,880
Speaker 9: like that. No one fighting any disease like MTC should

941
00:52:33,920 --> 00:52:38,360
Speaker 9: have to be subjected to such callousness delays and costs

942
00:52:38,360 --> 00:52:41,799
Speaker 9: and treatment. I can only sympathize with families who have

943
00:52:41,880 --> 00:52:44,719
Speaker 9: no one with a medical background to help them navigate

944
00:52:44,800 --> 00:52:48,600
Speaker 9: these barriers to treatment. It's difficult enough to fight cancer.

945
00:52:49,160 --> 00:52:51,520
Speaker 9: No one in this position should have to fight their

946
00:52:51,520 --> 00:52:56,480
Speaker 9: insurance companies to or go bankrupt to receive treatment. Thank you.

947
00:53:21,280 --> 00:53:24,000
Speaker 5: In twenty twenty three, which is the most recent global

948
00:53:24,040 --> 00:53:27,720
Speaker 5: data that I could find. Eighteen and a half million

949
00:53:27,760 --> 00:53:33,040
Speaker 5: people worldwide were newly diagnosed with cancer. That same year,

950
00:53:33,560 --> 00:53:40,160
Speaker 5: cancer killed over ten million people worldwide and contributed to

951
00:53:40,360 --> 00:53:45,600
Speaker 5: two hundred seventy one million disability adjusted life years.

952
00:53:46,880 --> 00:53:50,279
Speaker 1: I can't it's you can't even wrap your head around.

953
00:53:50,280 --> 00:53:51,320
Speaker 3: It's massive.

954
00:53:52,400 --> 00:53:56,760
Speaker 5: Over half of these cases and deaths were in low

955
00:53:56,800 --> 00:53:59,640
Speaker 5: and middle income countries. And I really think that we,

956
00:53:59,719 --> 00:54:02,799
Speaker 5: and I include myself in this royal, we do not

957
00:54:02,960 --> 00:54:05,800
Speaker 5: talk enough about cancer in low and middle income countries.

958
00:54:05,840 --> 00:54:07,160
Speaker 1: Oh yeah, absolutely not at all.

959
00:54:07,560 --> 00:54:09,480
Speaker 5: A lot of the data and the statistics that I

960
00:54:09,560 --> 00:54:11,440
Speaker 5: have and that we've talked about through this series are

961
00:54:11,480 --> 00:54:14,399
Speaker 5: from the US and from other high income countries where

962
00:54:14,400 --> 00:54:17,120
Speaker 5: cancer is not treated the same way as it is

963
00:54:17,200 --> 00:54:20,120
Speaker 5: in places with less resources, and of course in a

964
00:54:20,120 --> 00:54:22,120
Speaker 5: lot of parts of the US, things are pretty bleak

965
00:54:22,200 --> 00:54:24,160
Speaker 5: depending on who you are and where you live and

966
00:54:24,160 --> 00:54:28,840
Speaker 5: what you have access to. These numbers are also projected

967
00:54:28,840 --> 00:54:33,120
Speaker 5: to increase, not decrease. By twenty fifty, it's estimated that

968
00:54:33,160 --> 00:54:35,960
Speaker 5: we'll be looking at over thirty million new cases of

969
00:54:36,000 --> 00:54:41,040
Speaker 5: cancer every year and over eighteen million deaths globally. Cancer

970
00:54:41,200 --> 00:54:45,200
Speaker 5: is the second leading cause of death after cardiovascular disease,

971
00:54:45,680 --> 00:54:47,719
Speaker 5: which is such a contrast to what you said Aarin

972
00:54:47,760 --> 00:54:49,120
Speaker 5: in our very first episode that.

973
00:54:49,760 --> 00:54:52,279
Speaker 1: Hundreds of years ago, it was like nineteen hundred.

974
00:54:52,360 --> 00:54:54,239
Speaker 3: Oh nice, I.

975
00:54:54,120 --> 00:54:58,280
Speaker 5: Can't remember the eighth leading So that's a huge change, right,

976
00:54:58,320 --> 00:55:02,280
Speaker 5: And it's really partly due to all of the incredible

977
00:55:02,280 --> 00:55:04,680
Speaker 5: innovations that we've had in treating other causes of death

978
00:55:04,800 --> 00:55:06,400
Speaker 5: like infectious disease and things like that.

979
00:55:06,480 --> 00:55:08,680
Speaker 1: Yeah, yeah, yeah, longevity overall, et cetera.

980
00:55:08,719 --> 00:55:10,680
Speaker 3: Exactly many things, many many things.

981
00:55:10,760 --> 00:55:14,200
Speaker 5: All of these things can be true at once if

982
00:55:14,200 --> 00:55:15,880
Speaker 5: we look at the US specifically, I do have a

983
00:55:15,920 --> 00:55:19,560
Speaker 5: lot more data on the US. As of twenty twenty two,

984
00:55:20,200 --> 00:55:23,360
Speaker 5: there were an estimated eighteen million people living in the

985
00:55:23,480 --> 00:55:27,040
Speaker 5: US with cancer. Wow, which is about five five to

986
00:55:27,160 --> 00:55:30,480
Speaker 5: six percent of the US population currently living with cancer.

987
00:55:31,760 --> 00:55:33,160
Speaker 5: And as far as I can tell, that's like a

988
00:55:33,560 --> 00:55:36,839
Speaker 5: no a known diagnosis of cancer. And all of these

989
00:55:36,880 --> 00:55:41,400
Speaker 5: statistics do not include basal and sclamos cell carcinoma of

990
00:55:41,440 --> 00:55:43,200
Speaker 5: the skin, which is really important.

991
00:55:42,960 --> 00:55:44,239
Speaker 1: Is something that we haven't talked about.

992
00:55:44,320 --> 00:55:49,080
Speaker 5: Yeah, lifetime risks all of these millions of people numbers

993
00:55:49,280 --> 00:55:51,799
Speaker 5: that doesn't include those. Yeah, it does not include what's

994
00:55:51,800 --> 00:55:53,400
Speaker 5: called non melanoma skin cancer.

995
00:55:54,360 --> 00:55:56,880
Speaker 1: So that does the numbers become scarier?

996
00:55:56,920 --> 00:56:01,080
Speaker 5: Oh gosh, Yeah, that's it's like everyone. When we're looking

997
00:56:01,120 --> 00:56:04,760
Speaker 5: at trends in cancer over the last like thirty years

998
00:56:04,840 --> 00:56:09,440
Speaker 5: or so, there's not one story that emerges. The trends

999
00:56:09,440 --> 00:56:12,760
Speaker 5: that we have seen really vary depending on the type

1000
00:56:12,800 --> 00:56:15,400
Speaker 5: of cancer that you're looking at and depending on where

1001
00:56:15,480 --> 00:56:18,600
Speaker 5: in the globe that you're looking. So the incidences while

1002
00:56:18,640 --> 00:56:23,040
Speaker 5: we know like overall numbers are increasing, the incidences of

1003
00:56:23,120 --> 00:56:27,280
Speaker 5: specific types of cancer might be increasing, like prostate breast cancer,

1004
00:56:27,320 --> 00:56:31,040
Speaker 5: pancrettic cancer. Some of these might vary by sex, like

1005
00:56:31,080 --> 00:56:35,239
Speaker 5: they're increasing in males but maybe decreasing or stagnant in females,

1006
00:56:35,280 --> 00:56:39,839
Speaker 5: and viceversa. Cancer exactly exactly. And the same thing goes

1007
00:56:39,880 --> 00:56:41,160
Speaker 5: for trends in mortality.

1008
00:56:41,480 --> 00:56:41,760
Speaker 1: Though.

1009
00:56:42,040 --> 00:56:45,520
Speaker 5: The good news is that cancer mortality has been declining

1010
00:56:45,680 --> 00:56:50,040
Speaker 5: across the board, but that's not necessarily true for all

1011
00:56:50,280 --> 00:56:55,640
Speaker 5: populations or for all types of cancer. And you had

1012
00:56:55,640 --> 00:56:57,799
Speaker 5: talked about, and we've talked about now a lot these

1013
00:56:57,840 --> 00:57:02,160
Speaker 5: disparities that we see in cancer are not getting any better, No,

1014
00:57:02,280 --> 00:57:05,920
Speaker 5: they really are not. They're getting worse, if anything. For example,

1015
00:57:06,000 --> 00:57:09,080
Speaker 5: compared to white folks in the US, all other racial

1016
00:57:09,080 --> 00:57:11,400
Speaker 5: and ethnic groups are more likely to be diagnosed with

1017
00:57:11,520 --> 00:57:15,560
Speaker 5: later stages of cancer. And that's especially true for breast cancer,

1018
00:57:15,719 --> 00:57:19,320
Speaker 5: lung cancer, prostate cancer, cervical cancer, colon cancer. These are

1019
00:57:19,360 --> 00:57:22,640
Speaker 5: all the cancers that we can screen for that we

1020
00:57:22,680 --> 00:57:27,400
Speaker 5: could potentially catch earlier. We also see higher mortality rates

1021
00:57:27,600 --> 00:57:31,160
Speaker 5: compared to white counterparts for all cancers across the board,

1022
00:57:31,840 --> 00:57:34,360
Speaker 5: and in the case of Black Americans, we see a

1023
00:57:34,440 --> 00:57:37,160
Speaker 5: higher incidence of cancer for a lot of cancers, but

1024
00:57:37,240 --> 00:57:40,479
Speaker 5: not all cancers, compared to white Americans. And like you said,

1025
00:57:40,520 --> 00:57:44,480
Speaker 5: it's not just racial and ethnic disparities. Those are very striking.

1026
00:57:45,960 --> 00:57:48,600
Speaker 5: It is so there are so many levels on which

1027
00:57:48,640 --> 00:57:52,800
Speaker 5: we see these disparities, socioeconomics, whether or not your insurance

1028
00:57:52,800 --> 00:58:00,280
Speaker 5: covers anything, cancer can and does affect everyone. Yes, But

1029
00:58:00,600 --> 00:58:03,080
Speaker 5: what a lot of these inequalities show us is that

1030
00:58:03,160 --> 00:58:06,520
Speaker 5: a lot of the risk factors that contribute to the

1031
00:58:06,560 --> 00:58:11,320
Speaker 5: development of cancer, including the ability to identify and identify

1032
00:58:11,360 --> 00:58:15,240
Speaker 5: early and adequately treat cancers, are not equal, right, And

1033
00:58:15,280 --> 00:58:19,480
Speaker 5: the burden of these risks and the lack of access

1034
00:58:19,960 --> 00:58:23,280
Speaker 5: is falling on groups that have historically and continue to

1035
00:58:23,280 --> 00:58:27,640
Speaker 5: be disenfranchised, especially in this country, but also across the globe, right,

1036
00:58:28,000 --> 00:58:30,800
Speaker 5: And this is not something that's reflective of individual choices

1037
00:58:30,800 --> 00:58:33,360
Speaker 5: that people are making. This is, like you said, reflective

1038
00:58:33,400 --> 00:58:38,080
Speaker 5: of our systems that have failed people. Yeah, so that's

1039
00:58:38,280 --> 00:58:39,400
Speaker 5: all very depressing.

1040
00:58:39,520 --> 00:58:42,680
Speaker 1: It's just like so many different stages, right, Like there

1041
00:58:42,680 --> 00:58:47,520
Speaker 1: exactly prevention, screening, treatment, during treatment, like what sort of

1042
00:58:47,520 --> 00:58:50,320
Speaker 1: treatments do you actually get? Exactly are you able to

1043
00:58:50,320 --> 00:58:52,400
Speaker 1: take any time off work? Are you able to afford treatment?

1044
00:58:52,960 --> 00:58:56,400
Speaker 1: What is your insurance company decide to that they're going

1045
00:58:56,440 --> 00:58:57,080
Speaker 1: to cover for you?

1046
00:58:57,240 --> 00:58:58,600
Speaker 3: Or feel like you're disgusting?

1047
00:58:58,720 --> 00:59:03,160
Speaker 5: Yeah, yeah, so yeah, so there's a lot and if

1048
00:59:03,160 --> 00:59:05,320
Speaker 5: we're also looking at like what is the most prevalent

1049
00:59:05,360 --> 00:59:08,240
Speaker 5: type of cancer and those kinds of things that actually

1050
00:59:08,280 --> 00:59:12,320
Speaker 5: really varies globally, that makes sense and it's very it

1051
00:59:12,680 --> 00:59:15,520
Speaker 5: tells you a lot about how much environment really does

1052
00:59:15,560 --> 00:59:17,880
Speaker 5: play a role in cancer development, like.

1053
00:59:17,840 --> 00:59:19,560
Speaker 1: The age structure of a population till one.

1054
00:59:19,840 --> 00:59:23,120
Speaker 5: Percent, but it really can very like region to region

1055
00:59:25,000 --> 00:59:28,000
Speaker 5: across the globe. Lung cancer is still kind of one

1056
00:59:28,000 --> 00:59:31,080
Speaker 5: of the number one sometimes it's number two, depending on

1057
00:59:31,120 --> 00:59:33,360
Speaker 5: the specific area that you're looking at but lung cancer

1058
00:59:33,400 --> 00:59:35,680
Speaker 5: is definitely one of the top. Breast cancer and prostate

1059
00:59:35,720 --> 00:59:38,240
Speaker 5: cancer are also some of the top cancers in terms

1060
00:59:38,280 --> 00:59:41,160
Speaker 5: of how common they are as well as their deaths.

1061
00:59:41,640 --> 00:59:45,720
Speaker 5: Even though breast and prostate cancer, for example, have very high,

1062
00:59:45,920 --> 00:59:48,160
Speaker 5: like five and ten year survival rates compared to other

1063
00:59:48,200 --> 00:59:51,080
Speaker 5: types of cancers, but just because of how prevalent they are,

1064
00:59:51,680 --> 00:59:54,600
Speaker 5: we also see them having very high mortality rates. Like globally,

1065
00:59:55,920 --> 00:59:58,320
Speaker 5: childhood cancers, which I don't think that we spent enough

1066
00:59:58,320 --> 01:00:01,520
Speaker 5: time talking about because there's too much to cover. They

1067
01:00:01,560 --> 01:00:04,600
Speaker 5: account for about one and a half percent of all

1068
01:00:04,640 --> 01:00:09,320
Speaker 5: cancers globally and one percent of cancer deaths worldwide, but

1069
01:00:09,680 --> 01:00:12,920
Speaker 5: they also account for over three percent of the disability

1070
01:00:12,920 --> 01:00:16,280
Speaker 5: adjusted life years that we see. So childhood cancers really

1071
01:00:16,360 --> 01:00:18,720
Speaker 5: like we should do some specific episodes on some of

1072
01:00:18,760 --> 01:00:21,440
Speaker 5: those because there's a lot more detail there that we

1073
01:00:21,480 --> 01:00:28,200
Speaker 5: haven't covered. Yes, so improving our treatment we know can

1074
01:00:28,240 --> 01:00:30,240
Speaker 5: help with some of these numbers, especially when we look

1075
01:00:30,240 --> 01:00:34,360
Speaker 5: at mortality. But like you said, Aaron, we're never going

1076
01:00:34,400 --> 01:00:37,840
Speaker 5: to be able to prevent all cancers. So I want

1077
01:00:37,880 --> 01:00:40,000
Speaker 5: to talk a little bit more detail about what the

1078
01:00:40,040 --> 01:00:44,920
Speaker 5: future of screening and prevention might look like right, Like

1079
01:00:44,960 --> 01:00:47,920
Speaker 5: you said, we have pretty widespread screening programs for a

1080
01:00:48,000 --> 01:00:49,400
Speaker 5: number of types of cancer.

1081
01:00:49,200 --> 01:00:51,800
Speaker 1: Like more that I didn't even know some of these.

1082
01:00:51,920 --> 01:00:53,360
Speaker 1: I was like, WHOA, I didn't know we had a

1083
01:00:53,360 --> 01:00:54,680
Speaker 1: screening tool for that. That's great.

1084
01:00:54,840 --> 01:01:00,720
Speaker 5: Yeah, so breast cancer, cervical cancer, colorectal cancer, lung cancer,

1085
01:01:01,160 --> 01:01:03,400
Speaker 5: though only in very specific populations. All of these are

1086
01:01:03,560 --> 01:01:07,920
Speaker 5: specific populations, and prostate cancer. Not every country across the

1087
01:01:07,960 --> 01:01:11,360
Speaker 5: globe has robust screening programs in place for all of

1088
01:01:11,400 --> 01:01:15,640
Speaker 5: these cancers, but many have at least some type of

1089
01:01:15,640 --> 01:01:18,400
Speaker 5: screening program available for all of these types of cancers,

1090
01:01:18,440 --> 01:01:20,360
Speaker 5: even if the way that they implement them might be

1091
01:01:20,400 --> 01:01:23,840
Speaker 5: slightly different. Like other countries might use colonoscopy a lot

1092
01:01:23,920 --> 01:01:25,600
Speaker 5: less than we do here in the US, but they

1093
01:01:25,600 --> 01:01:28,840
Speaker 5: still screen for colon cancer in various ways. And like

1094
01:01:28,880 --> 01:01:32,800
Speaker 5: you said, the goal of cancer screening is to identify

1095
01:01:32,960 --> 01:01:36,720
Speaker 5: either pre cancerous conditions like we can with cervical cancer

1096
01:01:36,760 --> 01:01:40,480
Speaker 5: and colon cancer, which means that we could potentially treat

1097
01:01:40,520 --> 01:01:45,960
Speaker 5: something before it ever becomes cancer, or to identify early

1098
01:01:46,120 --> 01:01:49,000
Speaker 5: stage cancers if possible, and that's something that we do

1099
01:01:49,080 --> 01:01:52,920
Speaker 5: with like breast cancer and lung cancer screening and prostate

1100
01:01:52,920 --> 01:01:57,440
Speaker 5: cancer as well, and now because of advances that we

1101
01:01:57,480 --> 01:02:01,840
Speaker 5: have had in technology include things like genetic testing as

1102
01:02:01,880 --> 01:02:05,080
Speaker 5: well as a better understanding of you know, these tumor

1103
01:02:05,160 --> 01:02:08,800
Speaker 5: suppressor genes, these ANCA genes, all of these different genes

1104
01:02:08,800 --> 01:02:11,200
Speaker 5: and genetic markers that are associated with an increased risk

1105
01:02:11,240 --> 01:02:14,640
Speaker 5: of cancer. There's also a lot of interest in screening

1106
01:02:14,720 --> 01:02:20,280
Speaker 5: for those types of things, which wouldn't be identifying cancers

1107
01:02:20,480 --> 01:02:25,080
Speaker 5: or pre cancers. It's identifying individuals who might be at

1108
01:02:25,200 --> 01:02:28,600
Speaker 5: higher risk for developing cancer later on in your.

1109
01:02:28,480 --> 01:02:31,640
Speaker 1: Life, characterizing your individual lifetime risk exactly.

1110
01:02:32,160 --> 01:02:35,280
Speaker 5: And what is so interesting and different about this is

1111
01:02:35,320 --> 01:02:40,400
Speaker 5: that for that to be helpful, we have to then

1112
01:02:40,520 --> 01:02:44,040
Speaker 5: have a way to detect and treat or prevent the

1113
01:02:44,160 --> 01:02:49,680
Speaker 5: cancers that you might be at higher risk for right ideally,

1114
01:02:49,920 --> 01:02:52,720
Speaker 5: and that I think is where we still aren't as

1115
01:02:52,800 --> 01:02:55,920
Speaker 5: far ahead as I think that we would hope that

1116
01:02:55,960 --> 01:02:56,440
Speaker 5: we could be.

1117
01:02:56,560 --> 01:02:58,360
Speaker 3: If that is a lot of way of saying.

1118
01:02:58,080 --> 01:03:01,200
Speaker 1: That, I mean, I think, yeah, like using like leaf

1119
01:03:01,240 --> 01:03:04,720
Speaker 1: Remini syndrome as an example, like they can increase screening

1120
01:03:04,760 --> 01:03:07,840
Speaker 1: capacity a lot and have a better chance of catching

1121
01:03:07,880 --> 01:03:11,520
Speaker 1: cancers early, but like our treatment is still limited to

1122
01:03:11,560 --> 01:03:15,400
Speaker 1: the existing treatments today, and so it's like there's benefit,

1123
01:03:15,560 --> 01:03:19,320
Speaker 1: but yeah, we're there's so much more that we could

1124
01:03:19,360 --> 01:03:20,680
Speaker 1: do exactly exactly.

1125
01:03:20,720 --> 01:03:23,360
Speaker 5: And I think that being able to do this kind

1126
01:03:23,400 --> 01:03:26,560
Speaker 5: of genetic testing is going to allow us to develop

1127
01:03:26,640 --> 01:03:31,480
Speaker 5: better early screening and early treatment kind of protocols, right

1128
01:03:31,520 --> 01:03:33,320
Speaker 5: because we will have this data to be able to

1129
01:03:33,320 --> 01:03:37,120
Speaker 5: do this. But it already has reshaped the way that

1130
01:03:37,200 --> 01:03:40,280
Speaker 5: medicine decides who to screen and how to screen for

1131
01:03:40,360 --> 01:03:43,840
Speaker 5: certain cancers. For example, if you have a Braca mutation,

1132
01:03:44,600 --> 01:03:47,680
Speaker 5: then the recommendations for how often you are screened for

1133
01:03:47,800 --> 01:03:50,560
Speaker 5: cancers and what types of screening you are going to

1134
01:03:50,560 --> 01:03:53,240
Speaker 5: be recommended to get, and what cancers we are going

1135
01:03:53,280 --> 01:03:56,920
Speaker 5: to be screening for. That's vastly different than someone without

1136
01:03:56,960 --> 01:03:59,480
Speaker 5: a Braca mutation or who we don't know if they

1137
01:03:59,480 --> 01:04:00,440
Speaker 5: have a Brack mutation.

1138
01:04:00,640 --> 01:04:02,200
Speaker 3: Yeah, so it is.

1139
01:04:03,640 --> 01:04:08,400
Speaker 5: It has changed the game really entirely so far, though

1140
01:04:08,520 --> 01:04:10,720
Speaker 5: for a lot of cancers we still don't have any

1141
01:04:10,720 --> 01:04:12,760
Speaker 5: way to screen for it. We don't have any way

1142
01:04:12,800 --> 01:04:19,320
Speaker 5: to reliably screen large populations, especially for these types of cancers.

1143
01:04:19,440 --> 01:04:22,000
Speaker 5: Even if someone who has maybe a genetic mutation, we

1144
01:04:22,080 --> 01:04:26,000
Speaker 5: might do something specific like doing serial ultrasounds in someone

1145
01:04:26,080 --> 01:04:28,440
Speaker 5: to try and detect ovarian cancer. If you have a

1146
01:04:28,480 --> 01:04:31,360
Speaker 5: brac A mutation, that's still not going to be recommended

1147
01:04:31,400 --> 01:04:33,560
Speaker 5: for the general population because of what you mentioned about

1148
01:04:33,600 --> 01:04:36,480
Speaker 5: how we have to implement these screening protocols to make

1149
01:04:36,520 --> 01:04:38,480
Speaker 5: sure that we're not having too many false positives, too

1150
01:04:38,480 --> 01:04:40,360
Speaker 5: many false negatives, all of this stuff.

1151
01:04:40,400 --> 01:04:42,280
Speaker 1: I mean, it comes down to there has to be

1152
01:04:42,320 --> 01:04:44,160
Speaker 1: an individual. There has to be a benefit to the

1153
01:04:44,200 --> 01:04:47,720
Speaker 1: individual who is receiving the screening, not just this information

1154
01:04:47,880 --> 01:04:49,920
Speaker 1: will help society at large.

1155
01:04:49,600 --> 01:04:53,360
Speaker 5: Exactly, exactly. So for a lot of cancersly ovarian cancer,

1156
01:04:53,400 --> 01:04:56,440
Speaker 5: like stomach cancer, like brain cancers, like bone cancers, thyroid cancers,

1157
01:04:56,480 --> 01:04:59,960
Speaker 5: pancreatic cancers, head and net cancers, we don't have screening

1158
01:05:00,080 --> 01:05:03,080
Speaker 5: for a lot of these types of cancers. But the

1159
01:05:03,120 --> 01:05:06,360
Speaker 5: more research that we do, the more tests that we

1160
01:05:06,400 --> 01:05:10,760
Speaker 5: can develop. Yeah, and then we could potentially have screening

1161
01:05:10,920 --> 01:05:14,680
Speaker 5: for some of these cancers. So one of the things

1162
01:05:14,720 --> 01:05:16,920
Speaker 5: I probably haven't said, I don't think I've said it

1163
01:05:16,920 --> 01:05:18,920
Speaker 5: at all in this whole series is the words Ai.

1164
01:05:20,040 --> 01:05:21,040
Speaker 1: No, we haven't, so we.

1165
01:05:21,000 --> 01:05:24,280
Speaker 5: Haven't, So let me say it now, Ai. This is

1166
01:05:24,280 --> 01:05:27,600
Speaker 5: one of the places where AI and machine based learning

1167
01:05:27,680 --> 01:05:32,520
Speaker 5: like in general can really be helpful in coming up

1168
01:05:32,600 --> 01:05:37,360
Speaker 5: with and developing protocols for not just the diagnosis and screening,

1169
01:05:37,600 --> 01:05:39,960
Speaker 5: but also the treatment of cancers. And so that's like

1170
01:05:40,000 --> 01:05:42,280
Speaker 5: a huge area of research is how can we leverage

1171
01:05:42,280 --> 01:05:46,200
Speaker 5: AI in better detection, in coming up with screening protocols,

1172
01:05:46,520 --> 01:05:48,800
Speaker 5: in sorting through all of this data that we have,

1173
01:05:49,000 --> 01:05:51,439
Speaker 5: in coming up with treatment plans and things like that.

1174
01:05:52,120 --> 01:05:54,920
Speaker 5: But there also is a lot of research interest in

1175
01:05:55,280 --> 01:06:00,800
Speaker 5: developing new biomarkers to use as screening tools for cancers,

1176
01:06:00,840 --> 01:06:03,160
Speaker 5: both for cancers that we already have screening tools for,

1177
01:06:03,880 --> 01:06:06,680
Speaker 5: and I'll give one really great example, which is colon cancer.

1178
01:06:07,560 --> 01:06:10,959
Speaker 5: So colon cancer there typically we screen for it either

1179
01:06:11,040 --> 01:06:14,400
Speaker 5: with a colonoscopy, which is an invasive procedure that you

1180
01:06:14,480 --> 01:06:17,120
Speaker 5: have to prep for that a lot of people have

1181
01:06:17,440 --> 01:06:20,880
Speaker 5: quite a lot of difficulty with the prep and that

1182
01:06:21,840 --> 01:06:23,680
Speaker 5: has its own set of risks that come with it.

1183
01:06:23,720 --> 01:06:27,000
Speaker 5: Because it is invasive. You can have you know, injuries

1184
01:06:27,000 --> 01:06:30,480
Speaker 5: that happen, bleeding that happens during that procedure. It also

1185
01:06:30,920 --> 01:06:34,280
Speaker 5: is a wonderful thing because it can identify pre cancers

1186
01:06:34,280 --> 01:06:36,560
Speaker 5: and remove them. So it's not just screening. It's also

1187
01:06:36,640 --> 01:06:41,440
Speaker 5: diagnostic and it's therapeutic, but it's also time consuming and

1188
01:06:41,520 --> 01:06:43,360
Speaker 5: you have to have the resources. So we have a

1189
01:06:43,360 --> 01:06:45,920
Speaker 5: lot of other screening tools for colon cancer, including stool

1190
01:06:45,960 --> 01:06:49,520
Speaker 5: based testing where we can look for markers of tumors

1191
01:06:50,000 --> 01:06:53,000
Speaker 5: and blood, which is commonly found in people who have

1192
01:06:53,040 --> 01:06:57,080
Speaker 5: colon cancer, even or pre cancers. But there's also a

1193
01:06:57,120 --> 01:06:59,800
Speaker 5: new blood test because doing a stool test might be

1194
01:06:59,880 --> 01:07:02,960
Speaker 5: very very unpleasant for some people or might feel like

1195
01:07:03,120 --> 01:07:05,120
Speaker 5: not something that they want to participate in, or might

1196
01:07:05,160 --> 01:07:07,320
Speaker 5: be difficult to do. Sure, but a blood test a

1197
01:07:07,320 --> 01:07:08,600
Speaker 5: lot of times you're going to get that done at

1198
01:07:08,640 --> 01:07:11,480
Speaker 5: your doctor no matter what. So there is actually a

1199
01:07:11,520 --> 01:07:14,360
Speaker 5: new FDA approved colon cancer blood test that just was approved,

1200
01:07:14,400 --> 01:07:16,960
Speaker 5: like very recently in the last year or so. I

1201
01:07:16,960 --> 01:07:19,320
Speaker 5: don't know that anyone's covering yet because it's still expensive,

1202
01:07:19,400 --> 01:07:22,880
Speaker 5: but okay, that's a US issue, yes, and it's only

1203
01:07:22,920 --> 01:07:24,800
Speaker 5: a matter of time before we have more and more

1204
01:07:24,880 --> 01:07:27,280
Speaker 5: of these tests. There's also a lot of interest in

1205
01:07:27,280 --> 01:07:32,600
Speaker 5: what are called multi cancer Early Detection Tests or MCEED. Okay,

1206
01:07:32,840 --> 01:07:35,760
Speaker 5: to have another acronym for everything, but these are blood

1207
01:07:35,800 --> 01:07:39,440
Speaker 5: tests that look for markers of a bunch of different

1208
01:07:39,480 --> 01:07:41,600
Speaker 5: cancers rather than just one cancer at a time.

1209
01:07:42,240 --> 01:07:45,000
Speaker 1: I really want to know how what.

1210
01:07:45,360 --> 01:07:47,080
Speaker 5: Yeah, there's a lot, there's we could do a whole

1211
01:07:47,080 --> 01:07:50,200
Speaker 5: episode on these. There's two that I know of that

1212
01:07:50,400 --> 01:07:54,640
Speaker 5: are sort of they're not FDA approved for use in

1213
01:07:54,680 --> 01:07:56,560
Speaker 5: the US, which means that no one you have to

1214
01:07:56,560 --> 01:07:58,400
Speaker 5: pay for them out of pocket, no insurance is going

1215
01:07:58,440 --> 01:08:01,560
Speaker 5: to pay for them. They are both also still undergoing

1216
01:08:01,600 --> 01:08:04,600
Speaker 5: clinical trials. So one of them is a trials that

1217
01:08:04,640 --> 01:08:07,680
Speaker 5: are out in the UK, and it's called Gallery I

1218
01:08:07,680 --> 01:08:10,520
Speaker 5: think that's how you say it. And it looks for

1219
01:08:10,560 --> 01:08:13,360
Speaker 5: biomarkers of more than fifty different types of cancers, many

1220
01:08:13,400 --> 01:08:15,720
Speaker 5: of which we don't have any other screening tests for.

1221
01:08:16,360 --> 01:08:20,120
Speaker 3: How reliable is it? Yeah, so that's a it's a thing. Okay,

1222
01:08:20,160 --> 01:08:21,080
Speaker 3: it's a great question.

1223
01:08:21,280 --> 01:08:26,599
Speaker 5: So the specificity of these tends to be relatively high,

1224
01:08:27,000 --> 01:08:34,200
Speaker 5: like ninety percent ish, meaning that if it is positive,

1225
01:08:34,520 --> 01:08:38,800
Speaker 5: then it's likeli er that there is something there is

1226
01:08:38,800 --> 01:08:40,679
Speaker 5: that what that's beificed is that sensitive?

1227
01:08:40,760 --> 01:08:41,720
Speaker 1: What sensitivity then?

1228
01:08:41,880 --> 01:08:45,160
Speaker 5: So a sensitivity is quite low, which means that a

1229
01:08:45,240 --> 01:08:49,080
Speaker 5: negative test doesn't necessarily rule anything out.

1230
01:08:49,320 --> 01:08:52,479
Speaker 1: So still high rates of false negatives, false.

1231
01:08:52,360 --> 01:08:57,360
Speaker 5: Negatives, Yeah, Okay, So it's they're not perfect by any means.

1232
01:08:57,760 --> 01:08:59,680
Speaker 5: And the other issue with some of them is that

1233
01:08:59,720 --> 01:09:03,920
Speaker 5: they might not help Sometimes you might end up with

1234
01:09:03,960 --> 01:09:07,599
Speaker 5: this possible cancer but of unknown origin, like where are

1235
01:09:07,600 --> 01:09:10,040
Speaker 5: these cells? Because it's a blood test, and so you're

1236
01:09:10,040 --> 01:09:14,719
Speaker 5: looking for DNA fragments or you're looking for like methylation products,

1237
01:09:14,720 --> 01:09:17,759
Speaker 5: you're looking for these like kind of tumor marker type things,

1238
01:09:19,040 --> 01:09:22,720
Speaker 5: and we might not necessarily be able to identify all

1239
01:09:22,760 --> 01:09:24,760
Speaker 5: the time where that might be coming from in terms

1240
01:09:24,760 --> 01:09:26,680
Speaker 5: of the tissue of origin and things like that.

1241
01:09:26,920 --> 01:09:29,280
Speaker 1: And so would a test like a blood test like

1242
01:09:29,320 --> 01:09:32,519
Speaker 1: this be more useful based on of course, more useful

1243
01:09:32,560 --> 01:09:34,920
Speaker 1: based on how much we know about a particular cancer

1244
01:09:34,960 --> 01:09:38,400
Speaker 1: and the tumor antigens and stuff like that. But also

1245
01:09:38,840 --> 01:09:41,479
Speaker 1: I am assuming site of origin plays a big role

1246
01:09:41,479 --> 01:09:43,640
Speaker 1: in the likelihood that any of these products will end

1247
01:09:43,720 --> 01:09:47,200
Speaker 1: up in whatever quantities in the bloodstream large enough to

1248
01:09:47,200 --> 01:09:48,320
Speaker 1: be detected on that testing.

1249
01:09:48,600 --> 01:09:51,000
Speaker 5: Yeah, and they're different. So there's another one aside from

1250
01:09:51,000 --> 01:09:53,639
Speaker 5: the gallery that's called cancer Guard that was developed from

1251
01:09:53,680 --> 01:09:57,320
Speaker 5: a clinical trial at Johns Hopkins called Cancer Seek. This

1252
01:09:57,360 --> 01:09:59,360
Speaker 5: one also like you can buy it and you could

1253
01:09:59,360 --> 01:10:01,160
Speaker 5: get it done to have your doctor order it. You're

1254
01:10:01,160 --> 01:10:05,120
Speaker 5: gonna have to pay for it. But they're they're very

1255
01:10:05,160 --> 01:10:08,240
Speaker 5: interesting and I think that they It's what's interesting too

1256
01:10:08,320 --> 01:10:12,080
Speaker 5: to me about these is that they exist still in

1257
01:10:12,120 --> 01:10:16,200
Speaker 5: the research realm and yet you as an individual could

1258
01:10:16,200 --> 01:10:20,080
Speaker 5: go and buy this thing, and as clinicians and as

1259
01:10:20,120 --> 01:10:22,479
Speaker 5: medical professionals, I don't think we quite know how to

1260
01:10:22,600 --> 01:10:25,439
Speaker 5: bridge the gap yet because we don't have that data

1261
01:10:25,479 --> 01:10:27,600
Speaker 5: necessarily to back us up on, like what do we

1262
01:10:27,760 --> 01:10:31,600
Speaker 5: do with these tests once we get these results? And

1263
01:10:31,720 --> 01:10:36,000
Speaker 5: of course how are these going to be implemented? Who

1264
01:10:36,040 --> 01:10:37,800
Speaker 5: is going to get access to them? Because right now

1265
01:10:37,800 --> 01:10:40,880
Speaker 5: they're between seven hundred and one thousand dollars or so.

1266
01:10:41,200 --> 01:10:45,080
Speaker 1: They're not FDA approved, but you can get one yep.

1267
01:10:45,240 --> 01:10:47,479
Speaker 1: I mean I know a lot of things it's that

1268
01:10:47,520 --> 01:10:48,280
Speaker 1: you could still get.

1269
01:10:48,280 --> 01:10:50,320
Speaker 3: But like, yeah, they're.

1270
01:10:50,160 --> 01:10:53,680
Speaker 5: Approved under like a research license type of thing, so

1271
01:10:53,800 --> 01:10:56,160
Speaker 5: not through the FDA, but there's some kind of like

1272
01:10:56,280 --> 01:11:00,760
Speaker 5: research license that they have a clinical approval for. And

1273
01:11:00,800 --> 01:11:02,600
Speaker 5: so it's not like they're just I'm not saying that

1274
01:11:02,600 --> 01:11:04,120
Speaker 5: these are wild and wild wild West.

1275
01:11:04,320 --> 01:11:05,519
Speaker 3: They're very interesting.

1276
01:11:05,640 --> 01:11:09,000
Speaker 1: I think I'm just like, uh, suspicious because of Elizabeth

1277
01:11:09,000 --> 01:11:12,360
Speaker 1: Holmes and therapeus. Oh, you know, a hundred percent yeah

1278
01:11:12,680 --> 01:11:15,559
Speaker 1: panel at least it's like for everything, Yeah, a whole

1279
01:11:15,600 --> 01:11:16,200
Speaker 1: health panel.

1280
01:11:16,479 --> 01:11:18,280
Speaker 3: I mean, I know it is, but but it is

1281
01:11:18,320 --> 01:11:19,559
Speaker 3: really interesting, right.

1282
01:11:19,680 --> 01:11:21,880
Speaker 1: It's I mean and like and that also is the

1283
01:11:22,000 --> 01:11:23,280
Speaker 1: dream or it is the dream?

1284
01:11:23,360 --> 01:11:26,519
Speaker 5: It is one hundred percent, it is the dream? And

1285
01:11:26,760 --> 01:11:29,120
Speaker 5: how are these going to be implemented? Who's going right now?

1286
01:11:29,320 --> 01:11:31,080
Speaker 5: You would only have access to this if you have

1287
01:11:31,160 --> 01:11:34,400
Speaker 5: the means, because we also don't know how often do

1288
01:11:34,479 --> 01:11:37,360
Speaker 5: we need to be using these tests to accurately screen

1289
01:11:37,479 --> 01:11:41,519
Speaker 5: for cancers? Right, For mammograms, we have an interval on

1290
01:11:41,600 --> 01:11:45,280
Speaker 5: which we recommend, an age at which we recommend people start,

1291
01:11:45,800 --> 01:11:48,639
Speaker 5: and an interval at which we recommend that people get screened.

1292
01:11:48,640 --> 01:11:51,000
Speaker 5: Same thing for colon cancer, same thing for server cook cancer.

1293
01:11:51,160 --> 01:11:54,000
Speaker 5: And those guidelines might change based on where you live

1294
01:11:54,040 --> 01:11:56,639
Speaker 5: and how data has been interpreted in the UK versus

1295
01:11:56,640 --> 01:11:59,600
Speaker 5: the US or by you know, the American College of

1296
01:11:59,680 --> 01:12:03,680
Speaker 5: Radio all versus the USPSTF. Sure, but we still have

1297
01:12:03,760 --> 01:12:07,559
Speaker 5: these consensus guidelines. We don't yet have these for this,

1298
01:12:07,680 --> 01:12:09,880
Speaker 5: so you know, the companies are saying it's an annual test,

1299
01:12:10,280 --> 01:12:11,920
Speaker 5: doesn't need to be an annual test? Could it be

1300
01:12:11,960 --> 01:12:13,679
Speaker 5: in every three years, Like, well, there's just so many

1301
01:12:13,760 --> 01:12:16,280
Speaker 5: unknowns about these but I do think that this is

1302
01:12:16,280 --> 01:12:19,439
Speaker 5: the future of cancer screenings is going to be blood tests,

1303
01:12:19,520 --> 01:12:20,320
Speaker 5: and it's going to.

1304
01:12:20,240 --> 01:12:22,519
Speaker 1: Be invasive, fewer side effects.

1305
01:12:22,040 --> 01:12:24,800
Speaker 5: And that detect a wider range of cancers that we're

1306
01:12:24,840 --> 01:12:25,600
Speaker 5: able to screen for.

1307
01:12:25,840 --> 01:12:26,520
Speaker 1: Yeah.

1308
01:12:26,600 --> 01:12:32,360
Speaker 5: Right, it's there's a lot that has the potential in

1309
01:12:32,400 --> 01:12:36,960
Speaker 5: the future, especially because there are so many cancers, and

1310
01:12:37,000 --> 01:12:39,080
Speaker 5: I think that this has such a huge potential for

1311
01:12:39,200 --> 01:12:42,439
Speaker 5: rare cancers, for us to be able to identify them better,

1312
01:12:42,960 --> 01:12:45,840
Speaker 5: for us to be able to, you know, potentially do

1313
01:12:45,960 --> 01:12:48,760
Speaker 5: a lot more research on these rare cancers by identifying

1314
01:12:48,760 --> 01:12:51,560
Speaker 5: them early, by having a wider range of treatments available

1315
01:12:51,600 --> 01:12:53,840
Speaker 5: in clinical trials and things like that. Who knows, that's

1316
01:12:53,840 --> 01:12:56,760
Speaker 5: my I think that's my hope and dream is that

1317
01:12:56,800 --> 01:12:58,760
Speaker 5: these kinds of tools make it possible.

1318
01:12:58,960 --> 01:13:02,360
Speaker 1: Yeah, which we had a crystal I know, Yeah, but.

1319
01:13:02,360 --> 01:13:05,679
Speaker 5: I think it's probably the future. That's my guess. Okay, okay,

1320
01:13:05,840 --> 01:13:07,320
Speaker 5: multi cancer early detection to.

1321
01:13:07,360 --> 01:13:10,040
Speaker 1: Us, We'll check in ten years where we are five.

1322
01:13:09,960 --> 01:13:13,439
Speaker 5: Years probably honestly sure, And there's like there's so much

1323
01:13:13,479 --> 01:13:17,479
Speaker 5: more I think to the story of cancer there's so

1324
01:13:17,479 --> 01:13:21,360
Speaker 5: many types of cancers that deserve their whole own episodes.

1325
01:13:21,600 --> 01:13:24,400
Speaker 1: I mean every cancer does, not just so many, but.

1326
01:13:24,400 --> 01:13:26,800
Speaker 3: Every single Yeah. Well, but there are so many types

1327
01:13:26,840 --> 01:13:27,559
Speaker 3: of cancers, and.

1328
01:13:27,479 --> 01:13:28,960
Speaker 1: There were so many types of cancers. There are so

1329
01:13:28,960 --> 01:13:32,240
Speaker 1: many different types of approaches, stories of individual cancer discovery,

1330
01:13:32,360 --> 01:13:34,680
Speaker 1: stories of cancer treatment development.

1331
01:13:34,840 --> 01:13:38,400
Speaker 5: Like, there's so much going on with increasing incidents of cancers,

1332
01:13:38,479 --> 01:13:41,320
Speaker 5: especially in young people, for things like breast cancer, for

1333
01:13:41,360 --> 01:13:44,880
Speaker 5: things like colon cancer and things like this, like that

1334
01:13:45,080 --> 01:13:49,200
Speaker 5: is things that we need to cover in the future. Yeah,

1335
01:13:49,240 --> 01:13:50,960
Speaker 5: and for now, this is where I shall end.

1336
01:13:51,240 --> 01:13:58,040
Speaker 1: Yeah, God, I know it is. I don't even know

1337
01:13:58,080 --> 01:13:59,800
Speaker 1: what to say. I think we have said so many

1338
01:13:59,800 --> 01:14:01,799
Speaker 1: words words over the past few.

1339
01:14:01,640 --> 01:14:04,320
Speaker 3: Weeks, worded it out, worded it out.

1340
01:14:04,520 --> 01:14:09,000
Speaker 1: I think that like the again kind of like I'll

1341
01:14:09,040 --> 01:14:13,799
Speaker 1: echo what we talked about last episode, which was how

1342
01:14:13,840 --> 01:14:19,080
Speaker 1: many people have devoted their lives to understanding cancer, to

1343
01:14:19,280 --> 01:14:24,400
Speaker 1: better treating it, to preventing it, to participating in clinical

1344
01:14:24,479 --> 01:14:28,080
Speaker 1: trials in other ways, like to raising awareness and funding

1345
01:14:28,160 --> 01:14:31,400
Speaker 1: like it is. It blows my mind. And when we

1346
01:14:31,479 --> 01:14:34,080
Speaker 1: think about like and I think about the people in

1347
01:14:34,120 --> 01:14:37,479
Speaker 1: my life who have died of cancer, been affected by cancer,

1348
01:14:37,520 --> 01:14:41,360
Speaker 1: been diagnosed with cancer, undergoing cancer treatment currently. It is

1349
01:14:41,800 --> 01:14:45,400
Speaker 1: it's hard to like, I don't know like it. I

1350
01:14:45,840 --> 01:14:48,360
Speaker 1: was thinking about you all and all of our pertain

1351
01:14:48,360 --> 01:14:51,200
Speaker 1: account providers every with every word that I wrote.

1352
01:14:51,040 --> 01:14:54,439
Speaker 3: Trying to be like what is it that I want

1353
01:14:54,479 --> 01:14:55,800
Speaker 3: to know? What is it that?

1354
01:14:56,000 --> 01:14:58,880
Speaker 1: What is the information that is important to know? And

1355
01:14:58,920 --> 01:15:02,680
Speaker 1: so thank you for the opportunity. I guess you all

1356
01:15:02,840 --> 01:15:08,040
Speaker 1: for for letting us do this podcast, and we really

1357
01:15:08,040 --> 01:15:10,080
Speaker 1: do want to know what you think, and we really

1358
01:15:10,160 --> 01:15:11,920
Speaker 1: do want to know what you What else do you

1359
01:15:12,000 --> 01:15:14,240
Speaker 1: want to learn about? Yeah, that's always what That is

1360
01:15:14,240 --> 01:15:14,880
Speaker 1: what drives us.

1361
01:15:14,880 --> 01:15:16,280
Speaker 3: That is what drives us.

1362
01:15:16,360 --> 01:15:19,040
Speaker 5: Yeah, it's just like learning new things and being able

1363
01:15:19,080 --> 01:15:21,840
Speaker 5: to share them things that is like what gets me

1364
01:15:21,880 --> 01:15:22,759
Speaker 5: out of bed in the morning.

1365
01:15:22,960 --> 01:15:24,120
Speaker 3: Yeah, So thank you.

1366
01:15:24,600 --> 01:15:30,519
Speaker 1: Speaking of learning new things, learning new things, sources, I

1367
01:15:30,600 --> 01:15:33,479
Speaker 1: have several I have a lot for this, a lot

1368
01:15:33,560 --> 01:15:37,559
Speaker 1: for this. So if you want to there's a the

1369
01:15:38,240 --> 01:15:40,920
Speaker 1: where is it the American Cancer Society's Report on the

1370
01:15:40,960 --> 01:15:43,400
Speaker 1: Status of Cancer Disparities in the United States? They left

1371
01:15:43,439 --> 01:15:45,719
Speaker 1: that one one of those for every year is great

1372
01:15:45,880 --> 01:15:47,800
Speaker 1: maps and they are great information to kind of like

1373
01:15:47,880 --> 01:15:51,160
Speaker 1: piece apart what's going on and that's also in the

1374
01:15:51,240 --> 01:15:54,320
Speaker 1: US specifically, if you want to know more about chimney

1375
01:15:54,320 --> 01:15:58,320
Speaker 1: sweeps cancer perceval pot and chimney sweepers cancer of the

1376
01:15:58,360 --> 01:16:02,680
Speaker 1: scrotum by Brown and Thorn from nineteen fifty seven and

1377
01:16:02,720 --> 01:16:07,240
Speaker 1: then by Croswell at All from twenty ten. Principles of

1378
01:16:06,720 --> 01:16:10,719
Speaker 1: Cancer Screening Lessons from History and Study Design issues, great

1379
01:16:10,760 --> 01:16:13,439
Speaker 1: overview of like how we do this and why we

1380
01:16:13,520 --> 01:16:16,519
Speaker 1: do this, the decisions that go into it. And then

1381
01:16:16,920 --> 01:16:21,400
Speaker 1: the classic smoking can cigarette smoking and Lung Cancer paper

1382
01:16:21,479 --> 01:16:24,280
Speaker 1: by Doll and Hill from nineteen fifty six Lung Cancer

1383
01:16:24,320 --> 01:16:26,599
Speaker 1: and Other Causes of Death in relation to smoking.

1384
01:16:26,720 --> 01:16:31,120
Speaker 3: Wow, Yeah, nineteen fifty six, seventeen sixty one. Okay.

1385
01:16:31,960 --> 01:16:34,439
Speaker 5: I also have a couple different of the annual reports

1386
01:16:34,439 --> 01:16:37,240
Speaker 5: from the American Cancer Society. They're really great, so we'll

1387
01:16:37,240 --> 01:16:41,839
Speaker 5: have those. There also was paper from the Lancet, the Global,

1388
01:16:41,840 --> 01:16:44,519
Speaker 5: Regional and National Burden of Cancer nineteen ninety to twenty

1389
01:16:44,560 --> 01:16:47,600
Speaker 5: twenty three with forecast to twenty fifty yep. So that

1390
01:16:47,640 --> 01:16:50,120
Speaker 5: one was from the Global Burden of Disease study. There

1391
01:16:50,200 --> 01:16:53,000
Speaker 5: also was one also in the Lancet from twenty twenty

1392
01:16:53,000 --> 01:16:55,200
Speaker 5: two that was the Global Burden of cancer attributable to

1393
01:16:55,320 --> 01:16:58,160
Speaker 5: risk factors, and so this also looked a lot at

1394
01:16:58,160 --> 01:17:01,720
Speaker 5: those disparities and things like that. The I feel like

1395
01:17:01,840 --> 01:17:03,920
Speaker 5: I didn't do enough talking about like how much of

1396
01:17:04,400 --> 01:17:07,920
Speaker 5: cancer could potentially be preventable, and like lifestyle factors that

1397
01:17:07,960 --> 01:17:10,759
Speaker 5: contribute to cancer mortality it's like forty to sixty percent.

1398
01:17:12,040 --> 01:17:13,479
Speaker 5: And then I have a whole bunch like links to

1399
01:17:13,520 --> 01:17:16,880
Speaker 5: other the Global Cancer Observatory and the Seer statistics and

1400
01:17:16,920 --> 01:17:19,080
Speaker 5: things like that, and a bunch of other things about

1401
01:17:19,080 --> 01:17:21,479
Speaker 5: cancer screening. There was a great guide actually from twenty

1402
01:17:21,520 --> 01:17:24,720
Speaker 5: twenty six in Nature Reviews Clinical Oncology that's called The

1403
01:17:24,720 --> 01:17:27,040
Speaker 5: Guide to Cancer Screening that was super awesome overview.

1404
01:17:27,520 --> 01:17:31,280
Speaker 3: So you can find all of these courses on our website.

1405
01:17:31,560 --> 01:17:35,920
Speaker 1: Podcast Will Kill You dot Com. Wonderful. Thank you. Thank

1406
01:17:35,920 --> 01:17:38,800
Speaker 1: you again to the providers of our first stand accounts.

1407
01:17:39,040 --> 01:17:40,839
Speaker 1: You made these.

1408
01:17:40,720 --> 01:17:42,759
Speaker 3: Episodes yeah possible.

1409
01:17:43,040 --> 01:17:46,719
Speaker 1: Yeah, thank you really made them meaning so meaningful, so meaningful.

1410
01:17:46,760 --> 01:17:47,080
Speaker 3: Thank you.

1411
01:17:47,640 --> 01:17:51,439
Speaker 1: Thank you to John and Brett for listening to our

1412
01:17:51,800 --> 01:17:54,120
Speaker 1: cancer notes over and over again for hours on it.

1413
01:17:54,200 --> 01:17:55,920
Speaker 5: So they're never going to listen to these episodes, so

1414
01:17:55,960 --> 01:17:57,360
Speaker 5: then they were going to know that we thanked them.

1415
01:17:57,400 --> 01:18:04,519
Speaker 1: But I'll tell John that Tim I also have in person.

1416
01:18:05,640 --> 01:18:07,720
Speaker 5: Thank you also to Bloodmobile, who does the music for

1417
01:18:07,800 --> 01:18:09,559
Speaker 5: this episode, in all of our episode.

1418
01:18:09,640 --> 01:18:13,080
Speaker 1: Thank you to everyone at Exactly Right who helped us

1419
01:18:13,160 --> 01:18:16,760
Speaker 1: to record here in studio check us out on YouTube.

1420
01:18:17,240 --> 01:18:22,439
Speaker 1: Thank you to Leanna and Pete and Tom and Boomer

1421
01:18:22,520 --> 01:18:25,280
Speaker 1: and Jessica and Corey and Sabrina. I mean, it's been

1422
01:18:25,479 --> 01:18:27,360
Speaker 1: it's like so fun to come here and do this.

1423
01:18:27,840 --> 01:18:31,320
Speaker 1: It's great. It is I love it. Lunch is like

1424
01:18:31,560 --> 01:18:33,879
Speaker 1: the best time because.

1425
01:18:33,680 --> 01:18:35,639
Speaker 3: We have just in it for the lunch.

1426
01:18:36,200 --> 01:18:39,880
Speaker 1: I'm in it for lunch. So thank you, thank.

1427
01:18:39,760 --> 01:18:42,679
Speaker 5: You, and thank you of course to everyone listening and watching.

1428
01:18:43,840 --> 01:18:45,760
Speaker 5: We love making this podcast, so thank you for letting

1429
01:18:45,840 --> 01:18:48,799
Speaker 5: us do it, and for tuning in and telling your friends,

1430
01:18:49,920 --> 01:18:52,400
Speaker 5: and we really love for getting to do it.

1431
01:18:52,400 --> 01:18:52,880
Speaker 3: So thank you.

1432
01:18:53,880 --> 01:18:57,200
Speaker 1: Thank you to our patrons from the bottom of our hearts.

1433
01:18:56,960 --> 01:18:57,240
Speaker 2: Thank you.

1434
01:18:57,320 --> 01:18:57,600
Speaker 1: Thank you.

1435
01:18:58,600 --> 01:19:01,719
Speaker 3: Until next time, push your hands healthy animals.

1436
01:19:03,120 --> 01:19:06,760
Speaker 2: H u.

1437
01:19:10,280 --> 01:19:17,680
Speaker 5: U u

1438
01:19:21,520 --> 01:19:28,600
Speaker 2: U h