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