Speaker 1: Throughout this series, we'll be discussing many aspects of cancer
Speaker 1: diagnosis and treatment, and we will be sharing several personal
Speaker 1: stories related to cancer. Some listeners might find this content upsetting.
Speaker 1: Please listen with discretion.
Speaker 2: My name is Christina and I'm a healthy, cancer free,
Speaker 2: thirty year old woman who was about to undergo a
Speaker 2: double mistact tomy. Let me tell you why. My aunt
Speaker 2: Helen was diagnosed with breast cancer at age thirty four
Speaker 2: and ultimately passed away ten years later when I was thirteen.
Speaker 2: Just a few years later, still relinking the loss of
Speaker 2: our beloved Helen, another aunt was diagnosed with ovarian cancer.
Speaker 2: My whole life, I had looked at my aunts and
Speaker 2: saw myself fall blue eyes and big foreheads and curly hair.
Speaker 2: If their fate was cancer, it was bound to be
Speaker 2: mine too. And it wasn't just my aunt's. Six other relatives,
Speaker 2: from great aunts to distant cousins had been diagnosed with
Speaker 2: either breast or ovarian cancer. It was high time for
Speaker 2: genetic testing, and we discovered that my aunt and father
Speaker 2: carry the Brocketuo mutation. This mutation is associated with a
Speaker 2: forty to eighty five percent lifetime risk for breast cancer
Speaker 2: and fifteen to forty percent risk for a varian cancer,
Speaker 2: along with increased risks for other cancers including prostate, pancreatic,
Speaker 2: and melanomas. As a teenager, I wanted to be tested immediately.
Speaker 2: This was around when the Affordable Care Act was being passed,
Speaker 2: and my doctors recommended that I wait until protections for
Speaker 2: pre existing conditions were fully in effect before diagnosing myself
Speaker 2: with one. Finally, at nineteen, I received confirmation of what
Speaker 2: I had felt for years. Just like my aunts, I
Speaker 2: was positive for rokutwo. I heard constantly at the time
Speaker 2: that nineteen was too young to test, years before any
Speaker 2: screenings would be recommended, but I wanted those years to
Speaker 2: sit with my diagnosis and process it as slowly as
Speaker 2: I wanted to. I'm so grateful for the protections that
Speaker 2: allowed me to do so. My cancer screenings began at
Speaker 2: twenty four, and for six years, I dutifully scheduled breast
Speaker 2: exam skin checks, and an annual date was a clunking,
Speaker 2: thumping MRI. I'm treated by an excellent hereditary cancer clinic,
Speaker 2: and my team is optimistic that any breast cancer would
Speaker 2: be caught early and be survivable. But that's not good
Speaker 2: enough for me. I don't want to survive breast cancer.
Speaker 2: They never have it at all. Hereditary cancer causes incalculable
Speaker 2: loss in trauma to the families that it tears. Through
Speaker 2: both modern genetic testing, younger generations can use that trauma
Speaker 2: to ford a different path forward. My journey has always
Speaker 2: been mapped onto my aunt Helens. The age I started
Speaker 2: cancer screenings and planning for my mistectomy is all based
Speaker 2: on her timeline and the hopes that mine can be different.
Speaker 2: My double mistectomy will reduce my lifetime risk of cancer
Speaker 2: by ninety to ninety five percent. It's not one hundred percent,
Speaker 2: but it's nothing less than a gift.
Speaker 3: Hi.
Speaker 4: I'm clear from South Africa and I'm undergoing treatment for
Speaker 4: cholorectal cancer. I knew something was wrong for at least
Speaker 4: a year before I did anything about it. As a
Speaker 4: friend said, we're more scared of the treatment than the disease.
Speaker 4: When I finally went for colonoscopy, I'm pretty sure I
Speaker 4: knew I had cancer. It's always been my biggest fear,
Speaker 4: But in a way, it's freeing knowing that the waste
Speaker 4: has happened after barely interacting with a medical system. For
Speaker 4: forty one years of my life. I have now had
Speaker 4: two major surgeries, spent weeks in US. You have an
Speaker 4: iliostomy and am undergoing chemo. Finding chemo very frustrating because
Speaker 4: no one knows how each person will react, so hard
Speaker 4: to tell if it will get worse or better. I'm
Speaker 4: trying to stay very positive and interested in the biology
Speaker 4: of it all, and also trying to be a good
Speaker 4: example and educate my students. I teach high school science
Speaker 4: and bio. I really wish people were more open about
Speaker 4: gross body processes because I'm sure if we talked more
Speaker 4: about poo, more people would be diagnosed earlier. As it is,
Speaker 4: I'm telling everyone to go for krodnoscopies.
Speaker 1: Thank you all again so so much for sharing your
Speaker 1: stories with us. We are truly touched and cannot believe
Speaker 1: how many people wrote in We're willing to be vulnerable
Speaker 1: and share such an intimate part of their lives with us,
Speaker 1: because it really adds more than we can possibly say
Speaker 1: to the series, So thank you, it really does. Thank you.
Speaker 5: We have a lot more stories that will also be
Speaker 5: sharing that we have shared throughout this series and throughout
Speaker 5: this episode. We really wish that we could have included
Speaker 5: every story. Thank you so much to everyone who wrote
Speaker 5: in and who recorded your stories and who shared them
Speaker 5: with us. We really just can't say thank.
Speaker 1: You enough, even though we've tried.
Speaker 2: We tried.
Speaker 3: Hi, I'm Aaron, and I'm Aaron aman Updyke and.
Speaker 1: This is this podcast will kill you.
Speaker 5: Welcome to episode four and final for and final of
Speaker 5: our series on cancer.
Speaker 3: It's been a journey.
Speaker 1: Yeah, that's that's the word. Yeah. Yeah, We've covered a
Speaker 1: lot of ground so far in this series. If this
Speaker 1: is your first time tuning into the Cancer series, you
Speaker 1: can listen to these out of order.
Speaker 5: Honestly, this would not be a bad place to start.
Speaker 5: We could have started here, we could have, but we're
Speaker 5: ending here instead.
Speaker 1: The point is that these are all pieces of a
Speaker 1: big puzzle, and there are still pieces that we haven't
Speaker 1: filled in yet, pieces that remain to be filled in
Speaker 1: by science and medicine. But we can tell you what
Speaker 1: we've covered so far. So the first episode we talked
Speaker 1: about what cancer is, both conceptually and clinically, kind of
Speaker 1: the definitions of cancer. The second episode we talked about
Speaker 1: the evolution of cancer and cellular aspects of cancer, So like,
Speaker 1: what's actually happening within that cancer cell to make it cancerous.
Speaker 1: Third episode, last episode all about treatment, history of treatment,
Speaker 1: existing treatments today, possible treatments in the future. And today
Speaker 1: we're talking about kind of the big picture of like
Speaker 1: what the status of cancer is around the world today
Speaker 1: and ways that we might be able to see that
Speaker 1: status change in the future thanks to things like screening
Speaker 1: and prevention.
Speaker 3: Some of our favorite things to talk about, Yes podcast, public.
Speaker 5: Public health, and as much ground as we have covered
Speaker 5: so far in the series and as much as we're
Speaker 5: covering today, it is not everything that has to do
Speaker 5: with cancer. So we want everyone to know that. First
Speaker 5: of all, we have a very very long list of
Speaker 5: sources for every one of these episodes. So if you
Speaker 5: are inspired to learn more about cancer, about cancer, treatment,
Speaker 5: about the epidemiology, about any aspect of cancer, go to
Speaker 5: our website, this podcast with Hey dot com and check
Speaker 5: out the sources list. And these are not the only
Speaker 5: cancer episodes that we're going to do.
Speaker 1: Correct.
Speaker 5: This is sort of what we see as is sort
Speaker 5: of laying the foundation and a jumping off point for
Speaker 5: us to be able to explore individual cancers in the future. Yeah,
Speaker 5: So we would also love your feedback on what episodes
Speaker 5: you'd like to hear more about, what topics you really
Speaker 5: want to learn more about.
Speaker 1: Yeah, it really, it really does help us. Like we
Speaker 1: are already planning next episodes, not just for cancer, but
Speaker 1: for many other things. And it's like, what do what
Speaker 1: do you all want to know about?
Speaker 5: Yeah, what questions arise? Yes, tell us right, see what.
Speaker 3: We can do.
Speaker 1: We'll see what we can do. Also, you know, we
Speaker 1: we're approaching cancer from a very biological perspective, historical perspective.
Speaker 1: The focus is on cancer as this phenomenon, thing, this thing,
Speaker 1: and so in throughout these episodes, we haven't really touched
Speaker 1: very much on the personal experience of cancer and what
Speaker 1: that can look like for somebody, whether that's somebody who
Speaker 1: has been diagnosed, someone undergoing treatment, someone who's loved one
Speaker 1: has been diagnosed. Maybe you're a caretaker, maybe you're the
Speaker 1: friend or colleague. And our first had accounts have been
Speaker 1: so invaluable for to share aring just some of those
Speaker 1: perspectives on that experience. So again, thank you.
Speaker 3: Thank you.
Speaker 5: We really truly can't say it enough. These first hand
Speaker 5: accounts mean so much to us and they make this
Speaker 5: series what it is and our podcast and our podcast
Speaker 5: in general.
Speaker 1: Yeah, so thank you, thank you. One piece of business
Speaker 1: before the last piece of business and that so last week,
Speaker 1: if you listened to our treatment episode, I shouted out
Speaker 1: a couple of episodes of Advances and Care, which is
Speaker 1: another podcast that I host that interviews physician scientists at
Speaker 1: New York Presbyterian and talks about some of the incredible
Speaker 1: cutting edge work that they do. And I want to
Speaker 1: shout out another episode that's related to kind of the
Speaker 1: topic today, which is Screening Prevention, Epidemiology of Cancer, and
Speaker 1: that is episode thirty five titled rise in Early onset
Speaker 1: colon Cancer being Studied through single cell Sequencing. Oh very cool.
Speaker 1: It features research done by Joel Gabrie to look for
Speaker 1: clues that underlie this issue, like why are we seeing
Speaker 1: colon cancer rise in younger adults?
Speaker 2: Right?
Speaker 1: Because it's a scary thing.
Speaker 5: It really is, and it's a lot of headlines. So
Speaker 5: there's a lot of good information there. So check out
Speaker 5: Advances and Care.
Speaker 1: Advances and Care available wherever you get your podcasts.
Speaker 3: Last, but not least, Quarantine any time if.
Speaker 5: You were this is the last time we're going to
Speaker 5: say that, yes, then it will just be taken for
Speaker 5: granted after.
Speaker 1: That starting Yes, we figured this was this series was
Speaker 1: a good time to stop including alcohol in our quarantini recipes.
Speaker 1: We're still going to call them quarantinies because it's too
Speaker 1: good of a name to pass up.
Speaker 3: Nice.
Speaker 1: This week's quarantini is the Crab.
Speaker 3: The Crab, the crab. It's an afo gatto, which means
Speaker 3: espresso and ice cream delicious, so good.
Speaker 1: It just sounded good to us.
Speaker 6: It did.
Speaker 1: That's the whole thing.
Speaker 3: There's nothing deeper behind it.
Speaker 1: The crab means cancer like that is, if you listen
Speaker 1: to the first episode you would know. But anyway, I
Speaker 1: think a.
Speaker 5: Lot of people know that because it's like a what
Speaker 5: do you call it? Star sign thing?
Speaker 1: Astrology?
Speaker 5: Yeah, astrology, yeah, astrology, not astronomy that start sign.
Speaker 1: Yeah, yes.
Speaker 5: Anyways, So check out our social media like Instagram and
Speaker 5: whatever all those other ones to see that recipe, and
Speaker 5: also check out our website, this podcast with killia dot com,
Speaker 5: where you can find I already said the sources to
Speaker 5: all of our episodes, but also transcripts.
Speaker 3: And mermobile and merch and linked links.
Speaker 1: First account contact us form.
Speaker 3: There's more.
Speaker 1: There's got to be something cool that's there that we've missed.
Speaker 3: Anyways, moving on, we should update our website.
Speaker 1: Moving on break.
Speaker 5: Sure, yeah, yeah great, but then tell me all about
Speaker 5: where we got to how we I'll do all that.
Speaker 1: Yeah, thank you.
Speaker 7: My story of brain cancer starts when I got COVID.
Speaker 7: COVID was still at best. Weeks after I developed a
Speaker 7: weird loss of my voice that wouldn't go away. After
Speaker 7: seeing an E and T and getting tests, I was
Speaker 7: diagnosed with focal cord paralysis, most likely from the virus.
Speaker 7: One scain done was an MRI. I took it home,
Speaker 7: took a look, and that's when I saw a hazy
Speaker 7: blob in my frontal lobe, which I named abby normal.
Speaker 7: I could tell from my doctor's reactions it was serious.
Speaker 7: I was shuffled from doctor to doctor, and a couple
Speaker 7: of weeks ended up at a brain tumor center, being
Speaker 7: told it's most likely brain cancer and they recommended surgery.
Speaker 7: During that time, I was convinced I was dying. All
Speaker 7: I could think about was I'll be dead that year.
Speaker 7: I wanted Abby out. I wanted surgery yesterday. I needed
Speaker 7: to know what this was. A month later, I was
Speaker 7: in surgery, having a two and a half centimeter piece
Speaker 7: of my frontal lobe removed. Recovery was rough, between the
Speaker 7: brain healing effects and very high doses of steroids. I
Speaker 7: gained twenty pounds and had an odd urge to steal
Speaker 7: stupid things. I still remember the half dead plant with
Speaker 7: a post a note that said plant on it. I
Speaker 7: so desperately wanted to steal from a local smoothie place.
Speaker 7: Three and a half years later, I no longer want
Speaker 7: to steal. That was short lived, and I don't notice
Speaker 7: my missing friend. I have oligodendroglioma, and probably had it
Speaker 7: for several years before discovering it accidentally. I consider myself
Speaker 7: lucky finding it so small before seizures. After recovery, I
Speaker 7: went on my surviving death tour. I said yes to everything,
Speaker 7: and I had a blast. I realized who my friends are.
Speaker 7: I saw how amazing of a support system I have,
Speaker 7: and I will always remember and be grateful. I will
Speaker 7: also always remember that plant. I see my doctors two
Speaker 7: times a year looking for growth, and chances are i'll
Speaker 7: have more treatment. While I do believe it will one
Speaker 7: day kill me, that knowledge is oddly freeing. Even if
Speaker 7: it sucks. My cancer doesn't define me, doesn't define my life.
Speaker 7: I'm still living it to its fullest.
Speaker 6: Hello. My name is April Rideout. My brother James Carl
Speaker 6: ride Out was diagnosed with a acute lymphoblastic leukemia all
Speaker 6: in twenty seventeen, and the cancer returned in twenty twenty one.
Speaker 6: He passed in March to twenty twenty three from complications
Speaker 6: related to graph versus host disease. I like to share
Speaker 6: his story of his first cancer diagnosis and his own
Speaker 6: words from twenty eighteen to twenty nineteen at a dinner
Speaker 6: honoring the nurses who cared for him with love, kindness,
Speaker 6: and understanding. Before I was diagnosed, I was a happy,
Speaker 6: go lucky staff accountant doing motor fuel tax, married to
Speaker 6: my beautiful wife Amanda, and we just got a wonderful
Speaker 6: dog named Indy. But come the beginning of July in
Speaker 6: twenty seventeen, I started not feeling right. I had dizzy spells,
Speaker 6: I had pain in my right foot along with other
Speaker 6: symptoms as well as lightheadedness. I started to look like
Speaker 6: Uncle Fester, to be honest, and on July nineteen, twenty seventeen,
Speaker 6: my boss Larry told me to leave because I looked
Speaker 6: like crap and I had to go to the doctor,
Speaker 6: and my wonderful wife suggested that they do a blood test.
Speaker 6: Come to find out, the doctors there told me to
Speaker 6: go to the er, and then from that er they
Speaker 6: did an additional blood test and found out that I
Speaker 6: have leukemia because I had over one hundred and ninety
Speaker 6: seven thousand white blood cells in my body, and if
Speaker 6: I waited even one day, I would have passed away.
Speaker 6: Lying in the hospital in complete terror. I seriously thought
Speaker 6: my life was going to end that day. Horror was
Speaker 6: all across the room, from my immediate family to my wife.
Speaker 6: But after the news had struck, we started working on
Speaker 6: a treatment plan. One week later, we determined for research
Speaker 6: and diligence that Virginia G. Piper was the answer and
Speaker 6: we moved me there from the hospital I was at.
Speaker 6: For the course of my many stays there, the constant
Speaker 6: pleasure was the nursing staff, and because of them and
Speaker 6: the doctors and the treatment plan, which was a stem
Speaker 6: cell transplant, I have been remissioned for for a year
Speaker 6: and beat the crap out of cancer. Thank you for
Speaker 6: the opportunity to share James's words. He always wanted to
Speaker 6: publish a book on his experiences with cancer, and this
Speaker 6: is a lovely way to honor that wish of his.
Speaker 6: Every year, my family keeps James's memory alive by attending
Speaker 6: and raising donations for Blood Cancer United's Light the Night event.
Speaker 1: Thank you. Let's spend a moment taking stock of what
Speaker 1: we've learned so far.
Speaker 3: I love that idea.
Speaker 1: Okay, we have learned what cancer is, uncontrolled cell proliferation.
Speaker 1: We've learned why it's so common. It's an unavoidable consequence
Speaker 1: of multicellularity. We've learned how we treat the forty percent
Speaker 1: of the population that will develop cancer in their lifetime.
Speaker 1: And we've learned that, despite these treatment advances, seventeen percent
Speaker 1: of the population will die from cancer. But what we
Speaker 1: haven't addressed yet in any great detail are those numbers
Speaker 1: forty percent and seventeen percent. For much of the twentieth century,
Speaker 1: cancer research efforts were directed towards finding a cure for
Speaker 1: that forty percent, and as you shared with us last week, Aarin,
Speaker 1: we have made incredible headway in that regard for many,
Speaker 1: though not all, types of cancer. Despite these innovations, cancer
Speaker 1: treatment can be grueling. It can be expensive, prohibitedly so
Speaker 1: in some cases, and that expense mostly refers to the US.
Speaker 1: It often includes debilitating side effects, It can lead to
Speaker 1: long term issues, including increasing the risk of developing a
Speaker 1: second cancer, and it comes with no guarantee. What has
Speaker 1: received far less attention in cancer research historically is how
Speaker 1: to reduce the number of people getting cancer or needing treatment,
Speaker 1: or needing advanced treatment in the first place. Right, Like,
Speaker 1: that's received a much smaller piece of the pie as usual.
Speaker 3: With public health.
Speaker 1: Yes, yes, which and there's more, there's understandable blah blah blah.
Speaker 1: People need solutions right now. Yeah, I know there's a
Speaker 1: lot that goes into it. Yeah, given what we know
Speaker 1: about what we've learned so far about the evolution of cancer,
Speaker 1: we're unlikely to ever bring that forty percent all the
Speaker 1: way down to zero, that lifetime risk of forty all
Speaker 1: the way down to zero. But with prevention, we can
Speaker 1: make it part of the way there. Cutting edge treatments
Speaker 1: might increase survival for those with cancer, giving people more
Speaker 1: precious time with their loved ones. But if we can
Speaker 1: intervene earlier through screening, we may be able to shrink
Speaker 1: that's seventeen percent significantly significantly. Prevention and screening, though cornerstones
Speaker 1: of cancer care fail to get the appreciation they rightfully
Speaker 1: deserve naps. I mean, and that's historically as well as today.
Speaker 1: It continues to today. This is not surprising again, like this,
Speaker 1: this concept about public health being invisible until it fails.
Speaker 1: So I'm gonna spend We're gonna spend this episode making
Speaker 1: cancer prevention and screening more visible.
Speaker 8: Ah.
Speaker 1: I love this. Cancer prevention, prevention of any kind requires
Speaker 1: linking cause to effect. Yes, yes, Why did death from
Speaker 1: infectious diseases drop over the twentieth century? Largely because germ
Speaker 1: theory gave us the mechanism, and then we applied that
Speaker 1: knowledge to prevention via vaccines, sanitation, and hygiene. Cancer's cause
Speaker 1: and effect relationship is quite a bit more complex than that.
Speaker 3: If we didn't make that clear in episode two.
Speaker 1: Yeah, and namely because there isn't just one cause and
Speaker 1: one affect one mechanism, but there's a dizzying number of
Speaker 1: all of these different things, some of which are completely
Speaker 1: beyond our control, or at least beyond our control as
Speaker 1: we know it right now, or as individuals. As individuals, Yes,
Speaker 1: like a random mutation that might just happen It happens
Speaker 1: all the time. Actually, so how can we ever prevent
Speaker 1: that or link that? So disentangling that web has proven
Speaker 1: quite the challenge, but we have had some success. And
Speaker 1: as I go through a few case studies in our
Speaker 1: centuries long quest to understand the drivers of cancer, I
Speaker 1: want you to take note of two things.
Speaker 3: Okay.
Speaker 1: Number one, establishing a causal relationship is often difficult and
Speaker 1: it takes time. And number two, knowledge alone is not enough.
Speaker 3: Oh my gosh.
Speaker 1: There also has to be political will and public buy
Speaker 1: in for it to have an impact.
Speaker 3: I already love this.
Speaker 8: That's it.
Speaker 1: I mean, that's the end of the episode. Now, okay,
Speaker 1: if you lived in London in the eighteenth century, you
Speaker 1: probably kept your home warm by burning coal see our
Speaker 1: London smoger. So in which case you probably had a chimney,
Speaker 1: in which case you probably hired a chimney sweep to
Speaker 1: clean out the accumulated soot. That chimney sweep was probably
Speaker 1: between four and ten years old.
Speaker 3: Oh my gosh.
Speaker 1: Yes, oh, was forced to work naked and bathed about
Speaker 1: once a year.
Speaker 3: Oh wow wow. Okay, yeah, four and ten year olds
Speaker 3: four and ten year olds.
Speaker 1: Yeah, there are many issues with the situation. Yes. Yeah, So,
Speaker 1: as English physician Percival Pot described in seventeen seventy five, quote,
Speaker 1: in their early infancy, they are most frequently treated with
Speaker 1: great brutality and are almost starved with cold and hunger.
Speaker 1: They are thrust up narrow and sometimes hot chimneys where
Speaker 1: they are bruised, burned, and almost suffocated, and when they
Speaker 1: get to puberty, become peculiarly liable to a most noisome, painful,
Speaker 1: and fatal disease. End quote. That disease was chimney sweeps cancer. Okay,
Speaker 1: have you ever heard of cancer?
Speaker 6: Okay?
Speaker 1: Pot's description of the quote unquote sootwart and subsequent metastasis.
Speaker 1: So it started out as a footwart and then metastasized.
Speaker 1: It ranks among the earliest, if not the first observations
Speaker 1: of occupational cancer. Really really yeah, in babies and baby So,
Speaker 1: what would happen was that these chimney sweeps would, uh,
Speaker 1: it would be exposed to all of the everything. Yeah, constantly,
Speaker 1: there would be like a sore that arose, a sootwart,
Speaker 1: and then that would eventually metastasize as they went into adolescence. Oh,
Speaker 1: was they went through puberty? Yeah, And so his report
Speaker 1: on this. He wrote a report that was like describing
Speaker 1: what happened, describing the inhumane conditions, and it spurred the
Speaker 1: publication of other case studies and people were like, oh, yeah,
Speaker 1: I've seen this. I had chalked it up to something
Speaker 1: else before. Yeah. So it was like a lot of
Speaker 1: these case studies that came out and came out and
Speaker 1: came out, and that like there was a public outcry.
Speaker 1: I was like, we have to do something about this.
Speaker 1: This is awful, and it's it's hard to imagine anyone
Speaker 1: making the argument that like, oh, these chimney sweeps are
Speaker 1: perfectly fine for four years old is plenty old enough
Speaker 1: to work in a chimney on your own, right, But
Speaker 1: people did make that argument, Oh yeah, yeah, And it
Speaker 1: took decades for any meaningful policy changing this to be passed.
Speaker 1: In seventeen eighty eight, so this is thirteen years after
Speaker 1: Pott's observation, the minimum age requirement for a chimney sweep
Speaker 1: was raised to eight years old. Oh my goodness, No,
Speaker 1: there's so much more, Like.
Speaker 5: There's so many weaves that is blowing my start. No,
Speaker 5: you know what I knew about chimney sweeps. Erin Mary Poppins.
Speaker 1: Yeah, no, that's all I knew. That would be like
Speaker 1: pasted eighteen seventy five, which is when the next legislation,
Speaker 1: meaningful legislation was passed, like one hundred years l one
Speaker 1: hundred years after his observation was published. Oh my, So
Speaker 1: this is when the Chimney Sweepers Act was passed, and
Speaker 1: this forbade any children from sweeping chimneys, and it introduced
Speaker 1: a licensing system that helped with enforcements, so like you
Speaker 1: could not sweep a chimney unless you were an adult,
Speaker 1: and it was at sixteen years old. I don't know, Okay,
Speaker 1: who knows, but still right, Pot's observation was just that
Speaker 1: it was an observation, okay, end of he didn't have
Speaker 1: supporting statistics. Soot was not proven as a carcinogen until
Speaker 1: nineteen twenty two, when researchers induced cancer in mice after
Speaker 1: exposure to soot.
Speaker 8: Wow.
Speaker 1: So it was sort of like there was this hypothetical tank,
Speaker 1: like this theoretical link that was like, well, clearly this
Speaker 1: is the exposure one to one.
Speaker 3: But they just never put that like directly together.
Speaker 1: And like what is it about soot? Yeah, that kind
Speaker 1: of thing would those laws have been passed sooner if
Speaker 1: he had that information earlier. The story of cigarettes and
Speaker 1: cancer would suggest that no, not necessarily.
Speaker 5: I mean, especially when it sounds like they were kids
Speaker 5: who weren't well taken care.
Speaker 1: Of marginalized communities.
Speaker 5: Yeah, yeah, yo, Aaron, Yeah.
Speaker 1: I mean and in fact, when you look at the
Speaker 1: timeline for like the initial observation of chimney chimney sweeps
Speaker 1: cancer to then you know, policy change for that, that
Speaker 1: timeline seems downright speedy compared to cigarettes and cancer.
Speaker 3: Just curious, by the way, what kind of cancer is
Speaker 3: chimney sweeps cancer?
Speaker 1: Chimney sweeps cancer?
Speaker 3: I mean does it have like is it testicular cancers?
Speaker 3: That love cancer?
Speaker 1: It's like scrodle cancer? Okay yeah yeah yeah sorry.
Speaker 5: I was like I thought that you said that in
Speaker 5: the first episode, but I couldn't remember.
Speaker 3: It's in the name chimneys.
Speaker 9: I know.
Speaker 3: We talked about how you have to define a cancer
Speaker 3: to go back.
Speaker 1: To page too.
Speaker 5: Yeah okay, thank you, No, that makes sense, yeah yeah yeah.
Speaker 1: And it's because they were sweeping chimneys naked like they
Speaker 1: were there was nothing.
Speaker 5: Yeah, and like as in development, you're like then with
Speaker 5: puber all of the hormones and.
Speaker 1: Okay, yeah, yeah, yeah, yeah, yeah, cell proliferation, et cetera. Yeah, Okay, So,
Speaker 1: of all the recognized carcinogens today, tobacco is probably the
Speaker 1: most well known. Like, if you ask someone lists some
Speaker 1: carcinogens for me, probably cigarettes woul be the number one
Speaker 1: for sure, number one.
Speaker 5: And I mean rightfully so in terms of the number
Speaker 5: of people it kills every year.
Speaker 1: Absolutely, yeah, yeah. And I think this is also a
Speaker 1: real demonstration of the power of awareness campaigns, all those ads,
Speaker 1: I remember those ads. Yeah. This notoriety, though, was incredibly
Speaker 1: hard won, with decades of big tobacco sewing doubt and
Speaker 1: obfuscating the facts, a reluctant public, and a government afraid
Speaker 1: to take a stance, even if that meant preventing tens
Speaker 1: of thousands of deaths. Someday we will cover the story
Speaker 1: in all its lord detail, but for now, I'm just
Speaker 1: going to give you the bare bones, Okay. Our first
Speaker 1: marker along the timeline takes us to seventeen sixty one,
Speaker 1: with John Hill's publication of his pamphlet titled Cautions against
Speaker 1: the Immoderate Use of Snuff.
Speaker 3: Seventeen sixty one.
Speaker 1: Oh boy, Okay, and in this pamphlet he argued that
Speaker 1: oral tobacco caused lip mouth and throat cancer. Wow. Yeah,
Speaker 1: Unlike percival Pots observation, people largely ridiculed or ignored Hill,
Speaker 1: tobacco was exceedingly popular, and he was telling them something
Speaker 1: that they didn't want to hear. Where's your proof for this, bro,
Speaker 1: don't take this away from pamphlet. Get real that, get real,
Speaker 1: and get out of here. Reaction would remain surprisingly consistent,
Speaker 1: startlingly so, over the next two centuries. In the late
Speaker 1: eighteen hundreds and early nineteen hundreds, Hill's pamphlet had largely
Speaker 1: been forgotten by that.
Speaker 3: Jome just kick it over this seventeen seventeen sixty one.
Speaker 1: I mean, and I wonder too whether anything about like
Speaker 1: imma under it, because like, was that was when did
Speaker 1: the temperance movement begin? Was it that sort of thing
Speaker 1: the woes of modern society, which is always a thing
Speaker 1: that always happens.
Speaker 5: It's just wow, yeah, because that's two hundred years until
Speaker 5: Mad Men where they're.
Speaker 1: Like smoking all the time. Oh my god. Oh, because
Speaker 1: you're watching that, yes, Because last year I was watching
Speaker 1: it was a series and I was like, there's so
Speaker 1: much relevant things for pregnancy. There's so many relevant things
Speaker 1: for cancers. Yes, yeah, so many relevant things for cancer. Yes,
Speaker 1: but yeah so by the time his by the like
Speaker 1: early nineteen hundreds, his pamphlet had long been forgotten, but
Speaker 1: scientists and medical you know, practitioners were forming their own
Speaker 1: suspicions of a tobacco cancer link, more specifically, cigarettes and
Speaker 1: lung cancer. Lung cancer by this time had begun to
Speaker 1: transform from a rarity to like a pretty common diagnosis.
Speaker 1: Research conducted over the first half of the twentieth century
Speaker 1: solidify the cigarettes lung cancer risk, using epidemiological data, animal experimentation,
Speaker 1: cellular research, and chemical analysis of cigarette smoke to show
Speaker 1: beyond a doubt, not just a reasonable doubt, no any doubt,
Speaker 1: that smoking greatly increased the risk of lung cancer. Proven. Yes, proven.
Speaker 1: In nineteen fifty four, cancer authorities in several countries around
Speaker 1: the world announced this unequivocal link, and even big Tobacco
Speaker 1: was convinced, although only privately in memos. Yes, it still
Speaker 1: took another ten years for the US Surgeon General to
Speaker 1: announce that cigarettes are a cause of lung cancer. Pressured
Speaker 1: by the tobacco industry to stay quiet, smoking declined a
Speaker 1: bit after this announcement in nineteen sixty four or so,
Speaker 1: but then it plateaued like it kind of went and
Speaker 1: went back up a little bit until nineteen eighty. And
Speaker 1: that's when broad cast ads ended for cigarettes. Wow yeah,
Speaker 1: because it was like again in mad Men, you know,
Speaker 1: oh well we have this filter. Oh well ours you
Speaker 1: can smoke, but like ours are clean, our health ours
Speaker 1: are this yeah yeah, And so it's like the laws
Speaker 1: had to catch up to like what was allowed to
Speaker 1: be said. And so clearly though, skepticism remained, both in
Speaker 1: the public in politicians everywhere, and this was partly the
Speaker 1: handiwork of big tobacco swing their seas of doubt. Partly
Speaker 1: it was also the lag time between exposure and cancer development,
Speaker 1: which can be decades in the making, and partly because
Speaker 1: cigarettes were well loved and highly addictive. In nineteen sixty five,
Speaker 1: so this is the year after the Surgeon General's announcement,
Speaker 1: fifty percent of men and thirty two percent of women
Speaker 1: in the US smoked wow yeah, okay yeah. The amount
Speaker 1: of cigarettes was also high, about ten per day on
Speaker 1: average something around there, half a pack, half a pack, yeat.
Speaker 1: And then there was a poll that had been conducted
Speaker 1: a few years prior so before the Surgeon General's announcement,
Speaker 1: but after the link had been.
Speaker 3: Very clear shown.
Speaker 1: Yeah, one third of US doctors believed that cigarettes were
Speaker 1: a major cause of lung cancer. Really one third? Only
Speaker 1: one third and forty three percent of doctors smoked regularly. Yeah,
Speaker 1: Tobacco is woven into the history and the culture of
Speaker 1: the US and in so many other countries, and uprooting
Speaker 1: it has proven to be quite difficult. But the decline
Speaker 1: in cigarette consumption since the nineteen eighties, driven by awareness
Speaker 1: campaigns and policy changes like age limits and smoking bands
Speaker 1: in restaurants. I still remember going into restaurants smoking or.
Speaker 3: Non smoking, hotels smoking non smoking. Yeah.
Speaker 1: Yeah. It has led to thousands of lives saved and
Speaker 1: estimated eight hundred thousand lung cancer deaths were averted between
Speaker 1: nineteen sixty four and nineteen eighty five because of reduced smoking.
Speaker 3: Wow, just in those like twenty years.
Speaker 1: In those twenty years, and lung cancer deaths are projected
Speaker 1: to drop seventy nine percent from twenty fifteen to twenty
Speaker 1: sixty five. Wow.
Speaker 3: Yeah, that's great.
Speaker 1: Lung cancer will never be eradicated because while cigarettes are
Speaker 1: the leading cause. They are not the only one, nor
Speaker 1: is sustained progress guaranteed. Smoking has increased in some parts
Speaker 1: of the world. Shock Like, it still blew my mind.
Speaker 3: Well, especially with e cigarettes and vaping.
Speaker 1: Even cigarette smoking has increased. Yeah, Yeah, And air pollution
Speaker 1: remains a major driver of lung cancer. Despite these present
Speaker 1: day hurdles, and despite the centuries long fight to put
Speaker 1: tobacco in the spotlight as a cause of lung cancer,
Speaker 1: this is still a remarkable success story. Yeah, remarkable. Over
Speaker 1: the twentieth and into the twenty first centuries, many other
Speaker 1: carcinogens have been idne Lifestyle factors such as alcohol, red meat,
Speaker 1: processed meats, UV, radiation, occupational exposures like asbestos and silica dust,
Speaker 1: infectious agents like epstein bar virus, Helicobacter pylori which is
Speaker 1: the cause of stomach ulcers, and human papalomavirus see RHPV
Speaker 1: episodes See RHPV episode. These are just a handful of
Speaker 1: known carcinogens. The list of probable carcinogens is much longer.
Speaker 1: What we've done with this information varies. It varies based
Speaker 1: on the individual and when whether you can modify your
Speaker 1: behavior to reduce your exposure. Maybe that means drinking less alcohol.
Speaker 1: Maybe it means that you can't afford to buy healthier foods.
Speaker 1: Maybe it means wearing sunscreen, maybe it means smoking. All
Speaker 1: of these different things that are individually modifiable or potentially not.
Speaker 1: It varies around the globe due to national policies, and
Speaker 1: it varies on whether we have the technology to do
Speaker 1: something about it. So, for instance, epstein bar virus EBV
Speaker 1: is one of the most ubiquitous viruses. I've infected ninety
Speaker 1: percent of adults. It's responsible for nearly three hundred and
Speaker 1: sixty thousand cancers annually across the globe. Yet at the
Speaker 1: time of writing, we do not have a vaccine for
Speaker 1: this virus. We do have several in the works. Also,
Speaker 1: EBV is thought to be linked to many other things
Speaker 1: in our MSMs EBV. Yeah, but we do have a
Speaker 1: vaccine for the hepatitis B virus we do, which can
Speaker 1: lead to liver cancer, and human pepeloma virus HPV, which
Speaker 1: can cause cervical other intogenital cancers and oropharyngeal cancers. It's
Speaker 1: amazing that we have these these vaccines.
Speaker 3: We can prevent cancers.
Speaker 1: With vaccines, we can prevent some cancers. Yes, these are
Speaker 1: incredible achievements that are projected to prevent millions of cases
Speaker 1: of cancer over the next few decades. And as with
Speaker 1: any success, there is room for improvement, you know, which
Speaker 1: is understated. Hopefully we will see HEPB and HPV vaccine
Speaker 1: uptake improve in their near future, include in policy changes
Speaker 1: that will reverse some of the horrific decisions made by
Speaker 1: this current head of HHS. But that is a major
Speaker 1: concern here in the US. Like we will see reversal
Speaker 1: in some of these trends, we will see cancer development
Speaker 1: because people elect not to use these vaccines if they can. Yeah,
Speaker 1: but before we had the HPV vaccine, we had ANHPV
Speaker 1: testing I'll throw that in there. We also had another
Speaker 1: powerful tool to reduce cancer deaths due to this virus.
Speaker 1: We did the paps mares, the pap smear. We again
Speaker 1: check out our episode. The pap smear was first developed
Speaker 1: in nineteen twenty eight by Georgias Pepa Nicolau. He was
Speaker 1: a physician and a scientist. He became interested in the
Speaker 1: menstrual cycles of humans and especially cellular changes throughout the cycle,
Speaker 1: like what's going on going on? What's happening Yeah, as
Speaker 1: we go through this twenty eight through twenty five to
Speaker 1: thirty seven days whatever this, Yeah, and he noticed that
Speaker 1: he as he was like observing these cellular changes, he
Speaker 1: saw that in certain samples the cells seemed oddly shaped,
Speaker 1: kind of like they were cancerous maybe, And he realized like, oh,
Speaker 1: I could use this test not just to like see
Speaker 1: what's happening, but also to detect pre clinical, pre symptomatic
Speaker 1: cases of cervical cancer. Wow. Amazing. And this was especially
Speaker 1: important because like symptomatic usually, as we discussed, meansmetastasis often
Speaker 1: and decreased or survival.
Speaker 5: Yeah, like just invasive, Like the cervix is in such
Speaker 5: a small area that it can go invasive, even just locally,
Speaker 5: very quickly, very quickly.
Speaker 1: So yeah, So detecting early means intervention early means higher
Speaker 1: chance of increased survival. Yeah. His wife, Andromache was not
Speaker 1: only worked alongside him at Cornell, but but was also
Speaker 1: his research subject. She volunteered to undergo a daily perhaps
Speaker 1: for two decades, two decades, twenty years.
Speaker 3: Twenty years of everyday perap smears.
Speaker 1: Yeah.
Speaker 3: I don't have words for that.
Speaker 1: I know, to help improve this test, what do normal
Speaker 1: cells look like? What do cancer cells look like?
Speaker 3: Yeah, oh, that's fascinating.
Speaker 9: Wow.
Speaker 1: And it took a few decades to catch on after
Speaker 1: he formally introduced the pap smere in nineteen forty one,
Speaker 1: but since being adopted as a routine screening tool, it
Speaker 1: has led to early diagnosis and treatment intervention for untold
Speaker 1: amounts of people around the world.
Speaker 3: Yeah, it really is. The papspeers incredible.
Speaker 1: Perhaps means pretty great.
Speaker 3: Yeah.
Speaker 1: So the papsmere falls under the category of cancer screening
Speaker 1: using early detection methods to improve treatment outcomes. The intention
Speaker 1: of cancer screening is not necessarily total prevention, but being
Speaker 1: able to intervene as early as possible. We have ways
Speaker 1: to screen for cervical, breast, colon, lung, prostate, skin, other cancers.
Speaker 1: Some screenings involve imaging, like with a colonoscopy. They might
Speaker 1: involve a blood test like the prostate specific antigen or
Speaker 1: PUS say blood test, or it might be a visual
Speaker 1: or physical exam. For skin cancer, for instance, screening methods
Speaker 1: might be combined. You might do a couple of them.
Speaker 1: You might have step one, step two yep. And while
Speaker 1: there are general guidelines for when to screen, what to
Speaker 1: screen for, and how often, you screen. These might vary
Speaker 1: depending on other factors, like if, for instance, you have
Speaker 1: a family history of cancer, your doctor might recommend you
Speaker 1: get screened earlier and more frequently. Some people might get
Speaker 1: genetic testing done to see if they are at higher risk,
Speaker 1: which could then influence care decisions. We'll talk more about that.
Speaker 1: On the surface, screening seems fairly straightforward. The earlier you
Speaker 1: detect cancer, the greater the chance that you have of
Speaker 1: successfully treating it. But you're listening to this podcast, so
Speaker 1: we know that you're not here for the surface level. No,
Speaker 1: early conceptualization of screening assumed that cancer progresses linearly, that
Speaker 1: the earlier you detect cancer and treat it, the smaller
Speaker 1: the tumor the means that this is more contained, the
Speaker 1: better the chance for survival. That is the case for
Speaker 1: certain cancers or for certain cases individual cases, But it's
Speaker 1: not always the case. While some cancers might be localized
Speaker 1: and it might grow slowly, others may have already spread
Speaker 1: at the time of detection, and so the benefit of
Speaker 1: early treatment might not be there. It might not be
Speaker 1: like that the earlier you catch it, the better the chance.
Speaker 1: It's not as clear as that screening, so I guess.
Speaker 1: In other words, early detection does not always equate to
Speaker 1: better survival, right, Yeah, Yeah, screening might also lead to
Speaker 1: false positives or false negatives. Screening is not diagnostic, but
Speaker 1: your results could be abnormal, which means you need to
Speaker 1: go get further testing. And then so that could mean
Speaker 1: that if you have abnormal results when you don't have cancer,
Speaker 1: that means that you're about to undergo a bunch of
Speaker 1: additional tests, which can be expensive, it can be really distressing,
Speaker 1: it can be invasive, there are side effects to those,
Speaker 1: so that those are some of the risks of a
Speaker 1: false positive. And then of course there's false negatives, which
Speaker 1: means that your results from screening show no signs of
Speaker 1: potential for cancer, you don't get additional testing, but you
Speaker 1: do have we miss something. Yeah. These are risks that
Speaker 1: happen with any medical test, and it's especially important to
Speaker 1: minimize the rate of false negatives missing something, and that
Speaker 1: sometimes comes at the cost of increasing false positives. A
Speaker 1: false negative means missing someone's potentially treatable cancer, which could
Speaker 1: cost them their life, and a false positive means unnecessary
Speaker 1: additional testing that can be time consuming, expensive and distressing.
Speaker 1: So all this is to say again that it just
Speaker 1: comes down to the same thing. On a case by
Speaker 1: case basis, the benefits of screening might not always outweigh
Speaker 1: the cons, but it's so hard to know that upfront.
Speaker 3: Yep.
Speaker 1: And that being said, you know, early detection does not
Speaker 1: always equate to longer survival, but often it does.
Speaker 3: Often it does.
Speaker 1: Often it does. And the fact that screening doesn't eliminate
Speaker 1: the risk of dying from cancer entirely does not mean
Speaker 1: that physicians are out here recommending these screening tests willy nilly, right, go,
Speaker 1: oh yeah, they're not like, oh, I better better cover myself.
Speaker 1: So let's get you screen for this, that and the
Speaker 1: other thing. It is, there decades of data to support
Speaker 1: this there, and there are important guidelines that must be
Speaker 1: followed before a screening test is incorporated into standard care.
Speaker 1: If you listen to our Newborn screening episode, this might
Speaker 1: sound a bit familiar to you. So in the late
Speaker 1: nineteen sixties, I'm going to repeat it here.
Speaker 3: I love it. I love it.
Speaker 1: It's a good refresher. I feel like it's like because
Speaker 1: I think there's been a lot of Again, it kind
Speaker 1: of comes down to public health being invisible until.
Speaker 3: It until it fails until it fails.
Speaker 1: And it's like screening is. And I'm not saying screening
Speaker 1: is always positive, no, but I think sometimes the benefits
Speaker 1: of screening are get drowned out by the very real
Speaker 1: cons that.
Speaker 5: Exist or the limitation, mystery diagnoses or whatever it is.
Speaker 5: You know, like, is mammogram perfect?
Speaker 9: No?
Speaker 3: But has it saved so many lives?
Speaker 5: Yes?
Speaker 2: Right?
Speaker 1: Is a colonoscopy prep very challenging and very uncomfortable? Yes?
Speaker 9: Yeah?
Speaker 3: Could it save your life?
Speaker 1: Also? Yes?
Speaker 3: Does everyone need it? Maybe not? Are there other ways
Speaker 3: we'll talk about talk about it, but tell me about yes?
Speaker 1: The guidelines so okay. Quarineteen sixties the who published the
Speaker 1: Principles and Practice of Screening for Disease, also known as
Speaker 1: the Wilson and Younger or Younger Screening Criteria, which outline
Speaker 1: ten rules that a screening test should follow, things like
Speaker 1: I'm not going to list them all here, but it's
Speaker 1: things like the test should be reliable and not harmful.
Speaker 1: There should be an effective treatment, and that treatment has
Speaker 1: been demonstrated to be more effective before symptoms. That's really important,
Speaker 1: really important. And there should be a standard policy for
Speaker 1: treatment and who receives treatment in the nearly sixty years
Speaker 1: sin these criteria were introduced, Biomedical technology has undergone a revolution,
Speaker 1: and we can know more about ourselves than ever before.
Speaker 1: And as we all know, technology moves too quickly for
Speaker 1: us to anticipate the full extent of its impact. These
Speaker 1: principles for screening, whether they are adjusted or not, will
Speaker 1: be foundational in continuing to minimize harm as much as
Speaker 1: possible as new screening is introduced. Yeah, Like, I really
Speaker 1: don't want to give the impression that screening does not work,
Speaker 1: or even imply that screening is perfect. I simply want
Speaker 1: to convey that the reality, as is often the case,
Speaker 1: is more complicated than that, because I.
Speaker 5: Mean there's also maybe you're going to talk about this,
Speaker 5: I don't like, jump on your feet.
Speaker 1: I think step on my feet, whatever, jump on the.
Speaker 5: But there's also like sometimes you know, you said that
Speaker 5: maybe screening won't necessarily prolong your life if we can
Speaker 5: detect it early. Sometimes we can also detect cancers that
Speaker 5: might have never really come to anything. Yes, right, And
Speaker 5: so then we give this impression that we are improving
Speaker 5: out comes when maybe we aren't. We're just you know,
Speaker 5: increasing how many case cancer cases we're detecting so yeah,
Speaker 5: there's a lot of complicated things that come with screening,
Speaker 5: which is why there's so many, you know, guidelines and
Speaker 5: decisions and data that has to go into deciding how
Speaker 5: to recommend screening and who to recommend screening for, like
Speaker 5: what populations.
Speaker 1: Right right, And it's like the thing too, is that
Speaker 1: there is one road, right, like for one person, there
Speaker 1: is one road, one suite of decisions that get you
Speaker 1: to where you are. And so you can't know what
Speaker 1: screening have done. This would if I if I hadn't
Speaker 1: gotten screening, would that have been better? You know, like,
Speaker 1: you just can't know these things, and so we do
Speaker 1: the best we can with the available data that we
Speaker 1: have with cancer screening, prevention, and treatment. We have the
Speaker 1: tools and the information to bring down those forty percent
Speaker 1: and seventeen percent numbers I mentioned at the top, So
Speaker 1: forty percent lifetime risk of cancer, seventeen percent chance of
Speaker 1: dying from cancer, but having this knowledge does not guarantee
Speaker 1: a decreased global cancer burden by any means. Throughout this series,
Speaker 1: we've discussed some reasons why government and action, even when
Speaker 1: faced with overwhelming evidence cases where screening can't improve survival.
Speaker 1: The biology of cancer itself. Lifestyle factors increase in cancer risk,
Speaker 1: genetic predisposition to cancer. And there's another enormous aspect that
Speaker 1: you touched on briefly last episode, and that is access, yes,
Speaker 1: both to knowledge as well as care, which includes screening
Speaker 1: and treatment. In the US as well as across the globe,
Speaker 1: substantial cancer disparities exist in terms of diagnosis and survival.
Speaker 1: You talked a little bit last week, and individual's experience
Speaker 1: with cancer is influenced by race, ethnicity, socioeconomic status, education level,
Speaker 1: so many different things. So, for instance, black women in
Speaker 1: the US diagnosed with cancer have a ten percent higher
Speaker 1: death rate compared to white women having a nine percent
Speaker 1: lower incidence rate. Wow, education levels also associated with cancer mortality.
Speaker 1: Lung cancer mortality is four to five times higher in
Speaker 1: those with the lowest education level compared to those with
Speaker 1: the highest. Geography, often tied to income, also plays a role,
Speaker 1: with those who are in more rural or poverty stricken
Speaker 1: areas experiencing higher cancer death rates. These disparities, and you're
Speaker 1: going to talk more about them in the numbers. Yeah,
Speaker 1: they represent long standing structural inequalities that lead to higher
Speaker 1: rates of preventable morbidity.
Speaker 3: And mortality.
Speaker 1: What good are cutting edge treatments to you if you
Speaker 1: don't have access to them. What good are screening tests
Speaker 1: to you if you can't afford them because you can't
Speaker 1: afford health insurance?
Speaker 5: Yep?
Speaker 1: What good are awareness campaigns if they never make it
Speaker 1: to your door. We have spent the last four episodes
Speaker 1: dissecting cancer, deciphering its many meanings, exploring its biology, understanding
Speaker 1: its treatments, and describing prevention and screening methods. It is
Speaker 1: a wealth of information, but in this country and around
Speaker 1: the world, we are not adequately leveraging this information for
Speaker 1: everyone to benefit equally.
Speaker 3: Yep.
Speaker 1: This is not a problem that will be solved through
Speaker 1: cutting edge technology, but through better access, better education, more
Speaker 1: affordable healthcare, and a willingness to scrutinize and dismantle the
Speaker 1: structural inequalities and systemic racism that drive these health disparities
Speaker 1: on Yep. Yep. Not all parts of cancer are within
Speaker 1: our control, but some are both. At an individual level,
Speaker 1: we can make individual changes and societal we can make
Speaker 1: societal changes.
Speaker 5: I think that's the biggest one, because I think people
Speaker 5: only like to focus on the individual level, like, oh,
Speaker 5: you should be doing X, Y and Z. What about
Speaker 5: we should all what about we should our country should be?
Speaker 5: What about our global community should be?
Speaker 2: Right?
Speaker 1: Yeah, and so choose what we do with all of
Speaker 1: this information. It is a personal it is a political,
Speaker 1: it is a medical, and it is a philosophical matter.
Speaker 1: And with that, Aeron, I'll turn it over to you
Speaker 1: to tell me that the status of cancer around the
Speaker 1: world today. That's not a big ass no, right, not
Speaker 1: at all, guys. Small potatoes, erin, super small, the tiniest potatoes,
Speaker 1: baby potatoes, new potatoes.
Speaker 5: Oh, Aaron, it's dark, yeah, yeah, yeah, Okay, no, I
Speaker 5: know we're going to go down. It's going to be
Speaker 5: dark for a moment, but hopefully I think there is
Speaker 5: some bright futures on the horizon.
Speaker 8: Okay, okay.
Speaker 10: My name is Sam and about four and a half
Speaker 10: months ago, at the age of thirty five, I was
Speaker 10: diagnosed with stage one triple negative breast cancer. My cancer
Speaker 10: journey began unexpectedly out of curiosity. I had enrolled in
Speaker 10: a research study that identified I have a BRAC of
Speaker 10: one mutation. This mutation affects DNA repair and increases the
Speaker 10: risk of various types of cancer, most notably breast and
Speaker 10: Ovriian cancer. That finding triggered additional screenings, including mammograms, ultrasounds,
Speaker 10: and ultimately a biopsy that led to my diagnosis. It
Speaker 10: feels strange to say I'm lucky to have been diagnosed
Speaker 10: with an aggressive form of cancer, but at the time
Speaker 10: of my diagnosis, I truly had no symptoms, no known
Speaker 10: family history, and I wasn't scheduled to begin routine screenings
Speaker 10: for another five years. So in that sense, I am
Speaker 10: incredibly fortunate that my cancer was still caught early at
Speaker 10: stage one. My treatment plan includes chemotherapy followed by a
Speaker 10: double mestectomy. At the time of this recording, I have
Speaker 10: completed sixteen out of eighteen weeks of chemo. Overall, chemo
Speaker 10: hasn't been as bad as I expected, but it hasn't
Speaker 10: been easy either. The main challenges for me have been anemia, fatigue,
Speaker 10: and some peripheral neuropathy or a loss of sensation in
Speaker 10: my fingers. The side effects build over time. The first
Speaker 10: couple of months were manageable. The side effects are absolutely
Speaker 10: wearing on me, and I am so ready to be done.
Speaker 10: That said, the hardest part of this experience so far
Speaker 10: hasn't been the chemotherapy. For me, it was actually the
Speaker 10: period between diagnosis and starting treatment. During that time, my
Speaker 10: treatment plan changed multiple times, and I was navigating the
Speaker 10: fear and uncertainty of a cancer diagnosis while still working
Speaker 10: full time and managing a whole host of other logistics
Speaker 10: scheduling second opinions, vaccinations, dentist appointments, all before I had
Speaker 10: told most of my friends and family about my diagnosis.
Speaker 10: Another unexpected challenge has been grieving the loss of my
Speaker 10: former identity as a healthy, fit person. Even knowing that
Speaker 10: most side effects of chemotherapy are temporary, I still really
Speaker 10: miss being someone who didn't need to memorize medication lists
Speaker 10: in doctor's visits or think twice about physical limits. At
Speaker 10: this point, I'm still very much in this journey. After
Speaker 10: my current chemotherapy regimen, I'll have surgery, potentially followed by
Speaker 10: another year of oral chemotherapy along with additional prophylactic surgeries
Speaker 10: due to my braco one mutation. Ultimately, I'm still learning
Speaker 10: how to live with uncertainty, how to advocate for myself,
Speaker 10: and how to redefine who I am while moving forward
Speaker 10: from this diagnosis.
Speaker 9: Hello, my name is Karen. I'm here to tell you
Speaker 9: about some of the barriers and frustrations my family have
Speaker 9: had since our adult son was diagnosed with stage four
Speaker 9: metastatic medullary thyroid cancer or MTC, four years ago. In
Speaker 9: case you are unaware, there are several types of thyroid cancer.
Speaker 9: Some are very common and not aggressive at all, and
Speaker 9: some are rare and aggressive. Unfortunately, MTC is the latter.
Speaker 9: Only about one thousand people in the United States are
Speaker 9: diagnosed with it each year. As such, research dollars are
Speaker 9: few and far between for such rare cancers, and therefore
Speaker 9: treatments are limited and few and rare. Cancer specialists are
Speaker 9: also rare and not typically in network for insurance companies.
Speaker 9: To additional frustrations and barriers to treatment because of the
Speaker 9: rarity of his cancer have been centered around multiple insurance denials.
Speaker 9: Some of these denials are for recommended treatments. I took
Speaker 9: over writing appeals as I have a medical background. I
Speaker 9: was thorough in my research, and in one case, ultimately,
Speaker 9: after three appeals for a type of radiation treatment that's
Speaker 9: recommended for MTC, was finally able to get the approval
Speaker 9: for it for our son. However, at one point the
Speaker 9: insurance companies oncologists wrote to me and stated, what does
Speaker 9: it matter as he's going to die anyway, you can bet.
Speaker 9: I reported her to the insurance company president and our
Speaker 9: state insurance commissioner. The lack of compassion and the delays
Speaker 9: in treatment because of denials and people like this are abhorrent.
Speaker 9: This is just one but terrible example when as as
Speaker 9: a family member, you are trying to do your best
Speaker 9: to cope with and fight for your family member with
Speaker 9: such a terrible disease. It is the red tape, the denials,
Speaker 9: the appeals, and more denials leading to extreme out of
Speaker 9: pocket expenses that I'm also reporting here. One medication is
Speaker 9: thirty thousand dollars a month out of pocket because of
Speaker 9: insurance denials. No one can sustain out of pocket expenses
Speaker 9: like that. No one fighting any disease like MTC should
Speaker 9: have to be subjected to such callousness delays and costs
Speaker 9: and treatment. I can only sympathize with families who have
Speaker 9: no one with a medical background to help them navigate
Speaker 9: these barriers to treatment. It's difficult enough to fight cancer.
Speaker 9: No one in this position should have to fight their
Speaker 9: insurance companies to or go bankrupt to receive treatment. Thank you.
Speaker 5: In twenty twenty three, which is the most recent global
Speaker 5: data that I could find. Eighteen and a half million
Speaker 5: people worldwide were newly diagnosed with cancer. That same year,
Speaker 5: cancer killed over ten million people worldwide and contributed to
Speaker 5: two hundred seventy one million disability adjusted life years.
Speaker 1: I can't it's you can't even wrap your head around.
Speaker 3: It's massive.
Speaker 5: Over half of these cases and deaths were in low
Speaker 5: and middle income countries. And I really think that we,
Speaker 5: and I include myself in this royal, we do not
Speaker 5: talk enough about cancer in low and middle income countries.
Speaker 1: Oh yeah, absolutely not at all.
Speaker 5: A lot of the data and the statistics that I
Speaker 5: have and that we've talked about through this series are
Speaker 5: from the US and from other high income countries where
Speaker 5: cancer is not treated the same way as it is
Speaker 5: in places with less resources, and of course in a
Speaker 5: lot of parts of the US, things are pretty bleak
Speaker 5: depending on who you are and where you live and
Speaker 5: what you have access to. These numbers are also projected
Speaker 5: to increase, not decrease. By twenty fifty, it's estimated that
Speaker 5: we'll be looking at over thirty million new cases of
Speaker 5: cancer every year and over eighteen million deaths globally. Cancer
Speaker 5: is the second leading cause of death after cardiovascular disease,
Speaker 5: which is such a contrast to what you said Aarin
Speaker 5: in our very first episode that.
Speaker 1: Hundreds of years ago, it was like nineteen hundred.
Speaker 3: Oh nice, I.
Speaker 5: Can't remember the eighth leading So that's a huge change, right,
Speaker 5: And it's really partly due to all of the incredible
Speaker 5: innovations that we've had in treating other causes of death
Speaker 5: like infectious disease and things like that.
Speaker 1: Yeah, yeah, yeah, longevity overall, et cetera.
Speaker 3: Exactly many things, many many things.
Speaker 5: All of these things can be true at once if
Speaker 5: we look at the US specifically, I do have a
Speaker 5: lot more data on the US. As of twenty twenty two,
Speaker 5: there were an estimated eighteen million people living in the
Speaker 5: US with cancer. Wow, which is about five five to
Speaker 5: six percent of the US population currently living with cancer.
Speaker 5: And as far as I can tell, that's like a
Speaker 5: no a known diagnosis of cancer. And all of these
Speaker 5: statistics do not include basal and sclamos cell carcinoma of
Speaker 5: the skin, which is really important.
Speaker 1: Is something that we haven't talked about.
Speaker 5: Yeah, lifetime risks all of these millions of people numbers
Speaker 5: that doesn't include those. Yeah, it does not include what's
Speaker 5: called non melanoma skin cancer.
Speaker 1: So that does the numbers become scarier?
Speaker 5: Oh gosh, Yeah, that's it's like everyone. When we're looking
Speaker 5: at trends in cancer over the last like thirty years
Speaker 5: or so, there's not one story that emerges. The trends
Speaker 5: that we have seen really vary depending on the type
Speaker 5: of cancer that you're looking at and depending on where
Speaker 5: in the globe that you're looking. So the incidences while
Speaker 5: we know like overall numbers are increasing, the incidences of
Speaker 5: specific types of cancer might be increasing, like prostate breast cancer,
Speaker 5: pancrettic cancer. Some of these might vary by sex, like
Speaker 5: they're increasing in males but maybe decreasing or stagnant in females,
Speaker 5: and viceversa. Cancer exactly exactly. And the same thing goes
Speaker 5: for trends in mortality.
Speaker 1: Though.
Speaker 5: The good news is that cancer mortality has been declining
Speaker 5: across the board, but that's not necessarily true for all
Speaker 5: populations or for all types of cancer. And you had
Speaker 5: talked about, and we've talked about now a lot these
Speaker 5: disparities that we see in cancer are not getting any better, No,
Speaker 5: they really are not. They're getting worse, if anything. For example,
Speaker 5: compared to white folks in the US, all other racial
Speaker 5: and ethnic groups are more likely to be diagnosed with
Speaker 5: later stages of cancer. And that's especially true for breast cancer,
Speaker 5: lung cancer, prostate cancer, cervical cancer, colon cancer. These are
Speaker 5: all the cancers that we can screen for that we
Speaker 5: could potentially catch earlier. We also see higher mortality rates
Speaker 5: compared to white counterparts for all cancers across the board,
Speaker 5: and in the case of Black Americans, we see a
Speaker 5: higher incidence of cancer for a lot of cancers, but
Speaker 5: not all cancers, compared to white Americans. And like you said,
Speaker 5: it's not just racial and ethnic disparities. Those are very striking.
Speaker 5: It is so there are so many levels on which
Speaker 5: we see these disparities, socioeconomics, whether or not your insurance
Speaker 5: covers anything, cancer can and does affect everyone. Yes, But
Speaker 5: what a lot of these inequalities show us is that
Speaker 5: a lot of the risk factors that contribute to the
Speaker 5: development of cancer, including the ability to identify and identify
Speaker 5: early and adequately treat cancers, are not equal, right, And
Speaker 5: the burden of these risks and the lack of access
Speaker 5: is falling on groups that have historically and continue to
Speaker 5: be disenfranchised, especially in this country, but also across the globe, right,
Speaker 5: And this is not something that's reflective of individual choices
Speaker 5: that people are making. This is, like you said, reflective
Speaker 5: of our systems that have failed people. Yeah, so that's
Speaker 5: all very depressing.
Speaker 1: It's just like so many different stages, right, Like there
Speaker 1: exactly prevention, screening, treatment, during treatment, like what sort of
Speaker 1: treatments do you actually get? Exactly are you able to
Speaker 1: take any time off work? Are you able to afford treatment?
Speaker 1: What is your insurance company decide to that they're going
Speaker 1: to cover for you?
Speaker 3: Or feel like you're disgusting?
Speaker 5: Yeah, yeah, so yeah, so there's a lot and if
Speaker 5: we're also looking at like what is the most prevalent
Speaker 5: type of cancer and those kinds of things that actually
Speaker 5: really varies globally, that makes sense and it's very it
Speaker 5: tells you a lot about how much environment really does
Speaker 5: play a role in cancer development, like.
Speaker 1: The age structure of a population till one.
Speaker 5: Percent, but it really can very like region to region
Speaker 5: across the globe. Lung cancer is still kind of one
Speaker 5: of the number one sometimes it's number two, depending on
Speaker 5: the specific area that you're looking at but lung cancer
Speaker 5: is definitely one of the top. Breast cancer and prostate
Speaker 5: cancer are also some of the top cancers in terms
Speaker 5: of how common they are as well as their deaths.
Speaker 5: Even though breast and prostate cancer, for example, have very high,
Speaker 5: like five and ten year survival rates compared to other
Speaker 5: types of cancers, but just because of how prevalent they are,
Speaker 5: we also see them having very high mortality rates. Like globally,
Speaker 5: childhood cancers, which I don't think that we spent enough
Speaker 5: time talking about because there's too much to cover. They
Speaker 5: account for about one and a half percent of all
Speaker 5: cancers globally and one percent of cancer deaths worldwide, but
Speaker 5: they also account for over three percent of the disability
Speaker 5: adjusted life years that we see. So childhood cancers really
Speaker 5: like we should do some specific episodes on some of
Speaker 5: those because there's a lot more detail there that we
Speaker 5: haven't covered. Yes, so improving our treatment we know can
Speaker 5: help with some of these numbers, especially when we look
Speaker 5: at mortality. But like you said, Aaron, we're never going
Speaker 5: to be able to prevent all cancers. So I want
Speaker 5: to talk a little bit more detail about what the
Speaker 5: future of screening and prevention might look like right, Like
Speaker 5: you said, we have pretty widespread screening programs for a
Speaker 5: number of types of cancer.
Speaker 1: Like more that I didn't even know some of these.
Speaker 1: I was like, WHOA, I didn't know we had a
Speaker 1: screening tool for that. That's great.
Speaker 5: Yeah, so breast cancer, cervical cancer, colorectal cancer, lung cancer,
Speaker 5: though only in very specific populations. All of these are
Speaker 5: specific populations, and prostate cancer. Not every country across the
Speaker 5: globe has robust screening programs in place for all of
Speaker 5: these cancers, but many have at least some type of
Speaker 5: screening program available for all of these types of cancers,
Speaker 5: even if the way that they implement them might be
Speaker 5: slightly different. Like other countries might use colonoscopy a lot
Speaker 5: less than we do here in the US, but they
Speaker 5: still screen for colon cancer in various ways. And like
Speaker 5: you said, the goal of cancer screening is to identify
Speaker 5: either pre cancerous conditions like we can with cervical cancer
Speaker 5: and colon cancer, which means that we could potentially treat
Speaker 5: something before it ever becomes cancer, or to identify early
Speaker 5: stage cancers if possible, and that's something that we do
Speaker 5: with like breast cancer and lung cancer screening and prostate
Speaker 5: cancer as well, and now because of advances that we
Speaker 5: have had in technology include things like genetic testing as
Speaker 5: well as a better understanding of you know, these tumor
Speaker 5: suppressor genes, these ANCA genes, all of these different genes
Speaker 5: and genetic markers that are associated with an increased risk
Speaker 5: of cancer. There's also a lot of interest in screening
Speaker 5: for those types of things, which wouldn't be identifying cancers
Speaker 5: or pre cancers. It's identifying individuals who might be at
Speaker 5: higher risk for developing cancer later on in your.
Speaker 1: Life, characterizing your individual lifetime risk exactly.
Speaker 5: And what is so interesting and different about this is
Speaker 5: that for that to be helpful, we have to then
Speaker 5: have a way to detect and treat or prevent the
Speaker 5: cancers that you might be at higher risk for right ideally,
Speaker 5: and that I think is where we still aren't as
Speaker 5: far ahead as I think that we would hope that
Speaker 5: we could be.
Speaker 3: If that is a lot of way of saying.
Speaker 1: That, I mean, I think, yeah, like using like leaf
Speaker 1: Remini syndrome as an example, like they can increase screening
Speaker 1: capacity a lot and have a better chance of catching
Speaker 1: cancers early, but like our treatment is still limited to
Speaker 1: the existing treatments today, and so it's like there's benefit,
Speaker 1: but yeah, we're there's so much more that we could
Speaker 1: do exactly exactly.
Speaker 5: And I think that being able to do this kind
Speaker 5: of genetic testing is going to allow us to develop
Speaker 5: better early screening and early treatment kind of protocols, right
Speaker 5: because we will have this data to be able to
Speaker 5: do this. But it already has reshaped the way that
Speaker 5: medicine decides who to screen and how to screen for
Speaker 5: certain cancers. For example, if you have a Braca mutation,
Speaker 5: then the recommendations for how often you are screened for
Speaker 5: cancers and what types of screening you are going to
Speaker 5: be recommended to get, and what cancers we are going
Speaker 5: to be screening for. That's vastly different than someone without
Speaker 5: a Braca mutation or who we don't know if they
Speaker 5: have a Brack mutation.
Speaker 3: Yeah, so it is.
Speaker 5: It has changed the game really entirely so far, though
Speaker 5: for a lot of cancers we still don't have any
Speaker 5: way to screen for it. We don't have any way
Speaker 5: to reliably screen large populations, especially for these types of cancers.
Speaker 5: Even if someone who has maybe a genetic mutation, we
Speaker 5: might do something specific like doing serial ultrasounds in someone
Speaker 5: to try and detect ovarian cancer. If you have a
Speaker 5: brac A mutation, that's still not going to be recommended
Speaker 5: for the general population because of what you mentioned about
Speaker 5: how we have to implement these screening protocols to make
Speaker 5: sure that we're not having too many false positives, too
Speaker 5: many false negatives, all of this stuff.
Speaker 1: I mean, it comes down to there has to be
Speaker 1: an individual. There has to be a benefit to the
Speaker 1: individual who is receiving the screening, not just this information
Speaker 1: will help society at large.
Speaker 5: Exactly, exactly. So for a lot of cancersly ovarian cancer,
Speaker 5: like stomach cancer, like brain cancers, like bone cancers, thyroid cancers,
Speaker 5: pancreatic cancers, head and net cancers, we don't have screening
Speaker 5: for a lot of these types of cancers. But the
Speaker 5: more research that we do, the more tests that we
Speaker 5: can develop. Yeah, and then we could potentially have screening
Speaker 5: for some of these cancers. So one of the things
Speaker 5: I probably haven't said, I don't think I've said it
Speaker 5: at all in this whole series is the words Ai.
Speaker 1: No, we haven't, so we.
Speaker 5: Haven't, So let me say it now, Ai. This is
Speaker 5: one of the places where AI and machine based learning
Speaker 5: like in general can really be helpful in coming up
Speaker 5: with and developing protocols for not just the diagnosis and screening,
Speaker 5: but also the treatment of cancers. And so that's like
Speaker 5: a huge area of research is how can we leverage
Speaker 5: AI in better detection, in coming up with screening protocols,
Speaker 5: in sorting through all of this data that we have,
Speaker 5: in coming up with treatment plans and things like that.
Speaker 5: But there also is a lot of research interest in
Speaker 5: developing new biomarkers to use as screening tools for cancers,
Speaker 5: both for cancers that we already have screening tools for,
Speaker 5: and I'll give one really great example, which is colon cancer.
Speaker 5: So colon cancer there typically we screen for it either
Speaker 5: with a colonoscopy, which is an invasive procedure that you
Speaker 5: have to prep for that a lot of people have
Speaker 5: quite a lot of difficulty with the prep and that
Speaker 5: has its own set of risks that come with it.
Speaker 5: Because it is invasive. You can have you know, injuries
Speaker 5: that happen, bleeding that happens during that procedure. It also
Speaker 5: is a wonderful thing because it can identify pre cancers
Speaker 5: and remove them. So it's not just screening. It's also
Speaker 5: diagnostic and it's therapeutic, but it's also time consuming and
Speaker 5: you have to have the resources. So we have a
Speaker 5: lot of other screening tools for colon cancer, including stool
Speaker 5: based testing where we can look for markers of tumors
Speaker 5: and blood, which is commonly found in people who have
Speaker 5: colon cancer, even or pre cancers. But there's also a
Speaker 5: new blood test because doing a stool test might be
Speaker 5: very very unpleasant for some people or might feel like
Speaker 5: not something that they want to participate in, or might
Speaker 5: be difficult to do. Sure, but a blood test a
Speaker 5: lot of times you're going to get that done at
Speaker 5: your doctor no matter what. So there is actually a
Speaker 5: new FDA approved colon cancer blood test that just was approved,
Speaker 5: like very recently in the last year or so. I
Speaker 5: don't know that anyone's covering yet because it's still expensive,
Speaker 5: but okay, that's a US issue, yes, and it's only
Speaker 5: a matter of time before we have more and more
Speaker 5: of these tests. There's also a lot of interest in
Speaker 5: what are called multi cancer Early Detection Tests or MCEED. Okay,
Speaker 5: to have another acronym for everything, but these are blood
Speaker 5: tests that look for markers of a bunch of different
Speaker 5: cancers rather than just one cancer at a time.
Speaker 1: I really want to know how what.
Speaker 5: Yeah, there's a lot, there's we could do a whole
Speaker 5: episode on these. There's two that I know of that
Speaker 5: are sort of they're not FDA approved for use in
Speaker 5: the US, which means that no one you have to
Speaker 5: pay for them out of pocket, no insurance is going
Speaker 5: to pay for them. They are both also still undergoing
Speaker 5: clinical trials. So one of them is a trials that
Speaker 5: are out in the UK, and it's called Gallery I
Speaker 5: think that's how you say it. And it looks for
Speaker 5: biomarkers of more than fifty different types of cancers, many
Speaker 5: of which we don't have any other screening tests for.
Speaker 3: How reliable is it? Yeah, so that's a it's a thing. Okay,
Speaker 3: it's a great question.
Speaker 5: So the specificity of these tends to be relatively high,
Speaker 5: like ninety percent ish, meaning that if it is positive,
Speaker 5: then it's likeli er that there is something there is
Speaker 5: that what that's beificed is that sensitive?
Speaker 1: What sensitivity then?
Speaker 5: So a sensitivity is quite low, which means that a
Speaker 5: negative test doesn't necessarily rule anything out.
Speaker 1: So still high rates of false negatives, false.
Speaker 5: Negatives, Yeah, Okay, So it's they're not perfect by any means.
Speaker 5: And the other issue with some of them is that
Speaker 5: they might not help Sometimes you might end up with
Speaker 5: this possible cancer but of unknown origin, like where are
Speaker 5: these cells? Because it's a blood test, and so you're
Speaker 5: looking for DNA fragments or you're looking for like methylation products,
Speaker 5: you're looking for these like kind of tumor marker type things,
Speaker 5: and we might not necessarily be able to identify all
Speaker 5: the time where that might be coming from in terms
Speaker 5: of the tissue of origin and things like that.
Speaker 1: And so would a test like a blood test like
Speaker 1: this be more useful based on of course, more useful
Speaker 1: based on how much we know about a particular cancer
Speaker 1: and the tumor antigens and stuff like that. But also
Speaker 1: I am assuming site of origin plays a big role
Speaker 1: in the likelihood that any of these products will end
Speaker 1: up in whatever quantities in the bloodstream large enough to
Speaker 1: be detected on that testing.
Speaker 5: Yeah, and they're different. So there's another one aside from
Speaker 5: the gallery that's called cancer Guard that was developed from
Speaker 5: a clinical trial at Johns Hopkins called Cancer Seek. This
Speaker 5: one also like you can buy it and you could
Speaker 5: get it done to have your doctor order it. You're
Speaker 5: gonna have to pay for it. But they're they're very
Speaker 5: interesting and I think that they It's what's interesting too
Speaker 5: to me about these is that they exist still in
Speaker 5: the research realm and yet you as an individual could
Speaker 5: go and buy this thing, and as clinicians and as
Speaker 5: medical professionals, I don't think we quite know how to
Speaker 5: bridge the gap yet because we don't have that data
Speaker 5: necessarily to back us up on, like what do we
Speaker 5: do with these tests once we get these results? And
Speaker 5: of course how are these going to be implemented? Who
Speaker 5: is going to get access to them? Because right now
Speaker 5: they're between seven hundred and one thousand dollars or so.
Speaker 1: They're not FDA approved, but you can get one yep.
Speaker 1: I mean I know a lot of things it's that
Speaker 1: you could still get.
Speaker 3: But like, yeah, they're.
Speaker 5: Approved under like a research license type of thing, so
Speaker 5: not through the FDA, but there's some kind of like
Speaker 5: research license that they have a clinical approval for. And
Speaker 5: so it's not like they're just I'm not saying that
Speaker 5: these are wild and wild wild West.
Speaker 3: They're very interesting.
Speaker 1: I think I'm just like, uh, suspicious because of Elizabeth
Speaker 1: Holmes and therapeus. Oh, you know, a hundred percent yeah
Speaker 1: panel at least it's like for everything, Yeah, a whole
Speaker 1: health panel.
Speaker 3: I mean, I know it is, but but it is
Speaker 3: really interesting, right.
Speaker 1: It's I mean and like and that also is the
Speaker 1: dream or it is the dream?
Speaker 5: It is one hundred percent, it is the dream? And
Speaker 5: how are these going to be implemented? Who's going right now?
Speaker 5: You would only have access to this if you have
Speaker 5: the means, because we also don't know how often do
Speaker 5: we need to be using these tests to accurately screen
Speaker 5: for cancers? Right, For mammograms, we have an interval on
Speaker 5: which we recommend, an age at which we recommend people start,
Speaker 5: and an interval at which we recommend that people get screened.
Speaker 5: Same thing for colon cancer, same thing for server cook cancer.
Speaker 5: And those guidelines might change based on where you live
Speaker 5: and how data has been interpreted in the UK versus
Speaker 5: the US or by you know, the American College of
Speaker 5: Radio all versus the USPSTF. Sure, but we still have
Speaker 5: these consensus guidelines. We don't yet have these for this,
Speaker 5: so you know, the companies are saying it's an annual test,
Speaker 5: doesn't need to be an annual test? Could it be
Speaker 5: in every three years, Like, well, there's just so many
Speaker 5: unknowns about these but I do think that this is
Speaker 5: the future of cancer screenings is going to be blood tests,
Speaker 5: and it's going to.
Speaker 1: Be invasive, fewer side effects.
Speaker 5: And that detect a wider range of cancers that we're
Speaker 5: able to screen for.
Speaker 1: Yeah.
Speaker 5: Right, it's there's a lot that has the potential in
Speaker 5: the future, especially because there are so many cancers, and
Speaker 5: I think that this has such a huge potential for
Speaker 5: rare cancers, for us to be able to identify them better,
Speaker 5: for us to be able to, you know, potentially do
Speaker 5: a lot more research on these rare cancers by identifying
Speaker 5: them early, by having a wider range of treatments available
Speaker 5: in clinical trials and things like that. Who knows, that's
Speaker 5: my I think that's my hope and dream is that
Speaker 5: these kinds of tools make it possible.
Speaker 1: Yeah, which we had a crystal I know, Yeah, but.
Speaker 5: I think it's probably the future. That's my guess. Okay, okay,
Speaker 5: multi cancer early detection to.
Speaker 1: Us, We'll check in ten years where we are five.
Speaker 5: Years probably honestly sure, And there's like there's so much
Speaker 5: more I think to the story of cancer there's so
Speaker 5: many types of cancers that deserve their whole own episodes.
Speaker 1: I mean every cancer does, not just so many, but.
Speaker 3: Every single Yeah. Well, but there are so many types
Speaker 3: of cancers, and.
Speaker 1: There were so many types of cancers. There are so
Speaker 1: many different types of approaches, stories of individual cancer discovery,
Speaker 1: stories of cancer treatment development.
Speaker 5: Like, there's so much going on with increasing incidents of cancers,
Speaker 5: especially in young people, for things like breast cancer, for
Speaker 5: things like colon cancer and things like this, like that
Speaker 5: is things that we need to cover in the future. Yeah,
Speaker 5: and for now, this is where I shall end.
Speaker 1: Yeah, God, I know it is. I don't even know
Speaker 1: what to say. I think we have said so many
Speaker 1: words words over the past few.
Speaker 3: Weeks, worded it out, worded it out.
Speaker 1: I think that like the again kind of like I'll
Speaker 1: echo what we talked about last episode, which was how
Speaker 1: many people have devoted their lives to understanding cancer, to
Speaker 1: better treating it, to preventing it, to participating in clinical
Speaker 1: trials in other ways, like to raising awareness and funding
Speaker 1: like it is. It blows my mind. And when we
Speaker 1: think about like and I think about the people in
Speaker 1: my life who have died of cancer, been affected by cancer,
Speaker 1: been diagnosed with cancer, undergoing cancer treatment currently. It is
Speaker 1: it's hard to like, I don't know like it. I
Speaker 1: was thinking about you all and all of our pertain
Speaker 1: account providers every with every word that I wrote.
Speaker 3: Trying to be like what is it that I want
Speaker 3: to know? What is it that?
Speaker 1: What is the information that is important to know? And
Speaker 1: so thank you for the opportunity. I guess you all
Speaker 1: for for letting us do this podcast, and we really
Speaker 1: do want to know what you think, and we really
Speaker 1: do want to know what you What else do you
Speaker 1: want to learn about? Yeah, that's always what That is
Speaker 1: what drives us.
Speaker 3: That is what drives us.
Speaker 5: Yeah, it's just like learning new things and being able
Speaker 5: to share them things that is like what gets me
Speaker 5: out of bed in the morning.
Speaker 3: Yeah, So thank you.
Speaker 1: Speaking of learning new things, learning new things, sources, I
Speaker 1: have several I have a lot for this, a lot
Speaker 1: for this. So if you want to there's a the
Speaker 1: where is it the American Cancer Society's Report on the
Speaker 1: Status of Cancer Disparities in the United States? They left
Speaker 1: that one one of those for every year is great
Speaker 1: maps and they are great information to kind of like
Speaker 1: piece apart what's going on and that's also in the
Speaker 1: US specifically, if you want to know more about chimney
Speaker 1: sweeps cancer perceval pot and chimney sweepers cancer of the
Speaker 1: scrotum by Brown and Thorn from nineteen fifty seven and
Speaker 1: then by Croswell at All from twenty ten. Principles of
Speaker 1: Cancer Screening Lessons from History and Study Design issues, great
Speaker 1: overview of like how we do this and why we
Speaker 1: do this, the decisions that go into it. And then
Speaker 1: the classic smoking can cigarette smoking and Lung Cancer paper
Speaker 1: by Doll and Hill from nineteen fifty six Lung Cancer
Speaker 1: and Other Causes of Death in relation to smoking.
Speaker 3: Wow, Yeah, nineteen fifty six, seventeen sixty one. Okay.
Speaker 5: I also have a couple different of the annual reports
Speaker 5: from the American Cancer Society. They're really great, so we'll
Speaker 5: have those. There also was paper from the Lancet, the Global,
Speaker 5: Regional and National Burden of Cancer nineteen ninety to twenty
Speaker 5: twenty three with forecast to twenty fifty yep. So that
Speaker 5: one was from the Global Burden of Disease study. There
Speaker 5: also was one also in the Lancet from twenty twenty
Speaker 5: two that was the Global Burden of cancer attributable to
Speaker 5: risk factors, and so this also looked a lot at
Speaker 5: those disparities and things like that. The I feel like
Speaker 5: I didn't do enough talking about like how much of
Speaker 5: cancer could potentially be preventable, and like lifestyle factors that
Speaker 5: contribute to cancer mortality it's like forty to sixty percent.
Speaker 5: And then I have a whole bunch like links to
Speaker 5: other the Global Cancer Observatory and the Seer statistics and
Speaker 5: things like that, and a bunch of other things about
Speaker 5: cancer screening. There was a great guide actually from twenty
Speaker 5: twenty six in Nature Reviews Clinical Oncology that's called The
Speaker 5: Guide to Cancer Screening that was super awesome overview.
Speaker 3: So you can find all of these courses on our website.
Speaker 1: Podcast Will Kill You dot Com. Wonderful. Thank you. Thank
Speaker 1: you again to the providers of our first stand accounts.
Speaker 1: You made these.
Speaker 3: Episodes yeah possible.
Speaker 1: Yeah, thank you really made them meaning so meaningful, so meaningful.
Speaker 3: Thank you.
Speaker 1: Thank you to John and Brett for listening to our
Speaker 1: cancer notes over and over again for hours on it.
Speaker 5: So they're never going to listen to these episodes, so
Speaker 5: then they were going to know that we thanked them.
Speaker 1: But I'll tell John that Tim I also have in person.
Speaker 5: Thank you also to Bloodmobile, who does the music for
Speaker 5: this episode, in all of our episode.
Speaker 1: Thank you to everyone at Exactly Right who helped us
Speaker 1: to record here in studio check us out on YouTube.
Speaker 1: Thank you to Leanna and Pete and Tom and Boomer
Speaker 1: and Jessica and Corey and Sabrina. I mean, it's been
Speaker 1: it's like so fun to come here and do this.
Speaker 1: It's great. It is I love it. Lunch is like
Speaker 1: the best time because.
Speaker 3: We have just in it for the lunch.
Speaker 1: I'm in it for lunch. So thank you, thank.
Speaker 5: You, and thank you of course to everyone listening and watching.
Speaker 5: We love making this podcast, so thank you for letting
Speaker 5: us do it, and for tuning in and telling your friends,
Speaker 5: and we really love for getting to do it.
Speaker 3: So thank you.
Speaker 1: Thank you to our patrons from the bottom of our hearts.
Speaker 2: Thank you.
Speaker 1: Thank you.
Speaker 3: Until next time, push your hands healthy animals.
Speaker 2: H u.
Speaker 5: U u
Speaker 2: U h