This Podcast Will Kill You - Ep 205 Cancer Part 4: Where do things stand today?

Episode Date: March 31, 2026

For the entirety of our species’ history, our approach to cancer has largely been to react, to design new therapies and better combinations of treatments. This energy has certainly been well-spent, but what if we didn’t have to use treatment at all? Or what if we could minimize the use of aggressive therapies? Prevention and screening represent two under-appreciated pillars of cancer care, and we’re using this final installment in our cancer miniseries to show some appreciation. To grasp the impact that screening and prevention can have, we also need to consider the global landscape of cancer prevalence and incidence - where is it decreasing? Where is it on the rise? Where can intervention or prevention make an impact? As we’ve shown over these four episodes, science and medicine has accumulated a wealth of information about cancer - but the striking racial and socioeconomic disparities in cancer incidence and mortality in the US and around the world demonstrates that that knowledge has not been applied equally. Any proposal to reduce the global cancer burden must address the systemic issues driving these disparities. Tune in for a thought-provoking reflection on the status of cancer today. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAuSee omnystudio.com/listener for privacy information.

This is exactly right. Hey, it's Alec Baldwin. This season on my podcast, Here's the Thing. I talked to composer Mark Shaman. It's about the hang. It's the pleasure of hanging out with the people that you're with. You know, Rob and I was always a great hang. And journalist Chris Whipple.

Every White House staffer, they work in a bubble called the West Wing. And it's exponentially more so in the Trump White House. Listen to the new season of Here's the Thing on the Eye Heart radio app, or wherever you get your podcasts. Hi listeners, I'm Annesonfield, the host of The Girlfriend Spotlight, and I've got some great interviews coming your way. I'm also excited to tell you that you can now get access to all episodes of season one, two, three, and four of the Girlfriends, and every single episode of The Girlfriend Spotlight, 100% ad-free, and one week early through the I-Heart True Crime Plus

subscription. exclusively on Apple Podcasts. Plus, you'll get access to other chart-topping true crime shows you love, like betrayal, paper ghosts, Pikeson Massacre, the Brothers Ortiz, what happened in Nashville,

hell and gone, the godmother, and more. So don't wait, head to Apple Podcasts, search for iHeart True Crime Plus and subscribe today. Movies can make you feel, make you dream.

Sometimes they even make you appreciate architecture. Is there any? Anybody who's been hotter in a doorway than Elizabeth Taylor? That's the kind of analysis you'll find every week on Dear Movies I Love You, the new podcast from the Exactly Right Network. Every Tuesday, we break down the films we're crushing on from blockbusters to deep cuts. Listen to Dear Movies I Love You on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. Just like great shoes, great books take you places.

Through unforgettable love stories and into comments, conversations with characters you'll never forget. I think any good romance, it gives me this feeling of like butterflies. I'm Danielle Robeye, and this is bookmarked by Reese's Book Club from Hello Sunshine and IHeart Podcast, where we dive into the stories that shape us on the page and off. Each week I'm joined by authors, celebs, book talk stars, and more for conversations that will make you laugh, cry, and add way too many books to your TBR pile. Listen to bookmarked by Reese's Book Club.

On the IHeart Radio app, Apple Podcasts or wherever you get your podcast. Brought to you by Cotton, the fabric of our lives. I'm Amanda Knox, and in the new podcast, Doubt the case of Lucy Letby, we unpack the story of an unimaginable tragedy that gripped the UK in 2023. But what if we didn't get the whole story? I've just been made to fit. The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story we chose to believe?

Oh my God, I think she might be innocent. Listen to Doubt, the case of Lucy Lettby on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. 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, 30-year-old woman who is about to undergo a double mastectomy. Let me tell you why. My aunt Helen was diagnosed with breast cancer at age 34 and ultimately passed away 10 years later when I was 13. Just a few years later, still reeling from 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, all 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 aunts. 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 Brochah 2 mutation. This mutation is associated with a 40 to 85% lifetime risk for breast cancer and a 15 to 40% risk for ovarian 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 preexisting conditions were fully in effect before diagnosing myself with one. Finally, at 19, I received confirmation of what I had felt for years. Just like my aunts, I was positive for Rocca 2.

I heard constantly at the time that 19 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 24, and for six years, I've dutifully scheduled breast exam, skin checks, and an annual date was a clumping, 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.

I'd rather never have it at all. Hereditary cancer causes incalculable loss and trauma to the families that it tears through. But with modern genetic testing, younger generations can use that trauma to forge a different path forward. My journey has always been mapped onto my Aunt Helens. The age I started cancer screenings and planning for my mastectomy is all based on her timeline. in the hopes that mine can be different. My double mastectomy will reduce my lifetime risk of cancer by 90 to 95%. It's not 100%, but it's nothing less than a gift. Hi, I'm Claire from South Africa, and I'm undergoing treatment for colorectal 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 a 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 worst has happened. After barely interacting with the medical system for 41 years of my life, I have now had two major surgeries, spent weeks in ICU, have an eleostomy, 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 colonoscopies. Thank you all again. So, so much for sharing your stories with us. We are truly touched and cannot believe how many people rode in, were 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 this series. So thank you. It really does.

Thank you. We have a lot more stories that we'll 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 try. Hi, I'm Erin Welsh. And I'm Aaron Oman Updike. And this is, this podcast will kill you. Welcome to episode four and final. Four and final.

Four and final. Of our series on cancer. It's been a journey. Yeah. Yeah. That's the word. Yeah. Yeah. We've covered a lot of grounds 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. 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 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 on this podcast in general. 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. Right. 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 you.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 a sort of laying the foundation and a jumping off point for us. 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 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're approaching cancer from a very biological perspective, a historical perspective. The focus is on cancer as this phenomenon.

This 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 whose loved one has been diagnosed. Maybe you're a caretaker. Maybe you're the friend or colleague. and our first-hand accounts have been so invaluable for sharing just some of those perspectives on that experience. So again, thank you. Thank you. We really truly can't say it enough. These firsthand 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 so last week, if you listened to our treatment episode, I shouted a couple of episodes of advances in 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 35 titled Rise in Early Onset Colon Cancer being studied through single cell sequencing. Oh.

Very cool. It features research done by Joel. Gabri 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 in care. Advances and care available wherever you get your podcasts. Last but not least. Quarantine time. If you, this is the last time we're going to say this. Yes. Then it will just be taken for granted after this. Starting. Yes. We figured this.

was this series was a good time to stop including alcohol in our quarantine recipes. We're still going to calm quarantinis because it's too good of a name to pass up. This week's quarantine is the crab. The crab. The crab. It's an affigado, which means espresso and ice cream. Delicious. It's 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. 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 sign? Yeah. Yeah. Yeah. Astrology. Not astronomy.

Star sign. Yeah. Yes. Anyway, 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, wakily.com, where you can find, I already set the sources to all of our episodes, but also transcripts and Merch. Transcripts. Merch.

And Merch. Links. Links. First-hand 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 hear. I'll do all that. Yeah.

Thank you. Ever feel like you're being chased by the marriage police? Welcome to boys and girls, the podcast where dating isn't dating. Arranged Marriage is basically a reality show. except the contestants are strangers, and your entire family is judging. You're sipping coffee with one maybe, grabbing dinner with another,

and praying your karmic Ken or Barbie appears before your shelf life runs out. Trust me, I've been through this ancient and unshakable tradition. I jumped in, hoping to find love the right way, and instead I found chaos, cringe, and comedy. And now, I'm looking for healing. Boys and Girls dives into every twist and turn. of the arranged marriage carousel.

The meet awkward, the near misses, the heartbreak, and let's not forget all the jokes. Listen to boys and girls on the I-heart radio app, Apple Podcasts, or wherever you get your podcasts. Hi, it's Alec Baldwin. This season on my podcast, here's the thing I'm speaking with more artists, policymakers, and performers.

My composer Mark Schaman. Once you've established that you have the talent, it's about the hang. It's the pleasure of hanging out with the people like, you're with. You know, Rob and I was always a great hang. We would sit in kibbets for hours and then eventually get around to the music. That's what I mostly think of when I think of him, the time together laughing. Lawyer at Robbie Kaplan. The great gift of being a lawyer is the ability to actually

change things in our society in a way that very few people can. I mean, you can really make a difference to causes in the United States if you bring the right case at the right time. Marriage equality. Yeah, Windsor's the perfect example. Chris Whipple. Every White House staffer, they work in a bubble called the West Wing, and it's exponentially more so in the Trump White House. Listen to the new season of Here's the Thing on the I-Heart Radio app or wherever you get your podcasts.

China's Ministry of State Security is one of the most mysterious and powerful spy agencies in the world. But in 2017, the FBI got inside. This is Special Agent Regal. Special agent Bradley Hall. This MSS officer has no idea the U.S. government is on to him. But the FBI has his chats, texts, emails, even his personal diary. Hear how they got it on the Sixth Bureau podcast.

I now have several terabytes of an MSS officer, no doubt, no question, of his life. And that's a unicorn. No one had ever seen anything like that. It was unbelievable. This is a story of the inner workings of the MSS and how one man's ambition and mistakes opened its fault of secrets. Listen to the Sixth Bureau on the IHeart Radio app,

Apple Podcasts, or wherever you get your podcasts. When you feel uncomfortable, what do you put on? Biggie. You put on Biggie when you feel uncomfortable? Because I want to get confident. This is DJ Hesterprin's Music is Therapy, a new podcast from me, a DJ and licensed therapist, that asks one simple question, who do you want to be, and what's the song that can take you there?

Music changes what you feel, and what you feel changes what you do, right? That moment where a song shifts something inside you, that's where transformation starts. This year, I'm talking to experts across every area of life, like personal finance icon Gene Chatsky, New York Times journalist David Gellis, relationship legend Dan Savage, human connection teacher Mark Groves, and the man who sheet my ear more than anyone, Questlove. They'll bring the strategies. I'll pair them with the right records and will teach you how to use the music to make change stick. This isn't just a podcast. It's unconventional therapy for your entire year. Listen to DJ Hesterprin's Music is Therapy on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi listeners. I'm Anistonfield, the host of The Girlfriend Spotlight, and I've got some great interviews coming your way. I'm also excited to tell you that you can now get access to all episodes of season one, two, three and four of The Girlfriends, and every single episode of The Girlfriend's

spotlight 100% ad-free and one week early through the I-Heart True Crime Plus subscription, available exclusively on Apple Podcasts. Plus, you'll get access to other chart-topping true crime shows you love, like betrayal, paper ghosts, Pikeson Massacre, The Brothers Ortiz, what happened in Nashville, hell and gone, Godmother and more. So don't wait, head to Apple Podcasts, search for Iheart True Crime Plus, and subscribe today. My story of brain cancer starts when I got COVID. COVID was sniffles at best. Weeks after, I developed a weird loss of my voice that wouldn't go away. After seeing an E&T and getting tests, I was diagnosed with vocal cord paralysis, most likely from the virus. One scan done was an MRI.

I took it home, took a look, and that's when I said. saw a hazy blob in my frontal lobe, which I named Abby Normal. I could tell if my doctor's reactions it was serious. I was shuffled from doctor to doctor and a couple 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 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 20 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 oligodendro glial. 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 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 Wrightout, was diagnosed with acute lymphoblastic leukemia, ALL, in 2017, and the cancer returned in 2021. He passed in March of 23 from complications related to Graf versus Host Disease. I'd like to share his story of his first

cancer diagnosis in his own words from 2018 to 2019 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 2017, 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 19th, 2017, 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 197,000 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. Through 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 in remissioned for over 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' 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. 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 40% of the population that will develop cancer in their lifetime. And we've learned that despite these treatment advances, 17% of the population will die from cancer. But what we haven't addressed

yet in any great detail are those numbers. 40% and 17%. For much of the 20th century, cancer research efforts were directed towards finding a cure for that 40%. And as you shared with us last week, Aaron, 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, prohibitively so in some cases, and that expense mostly refers to the U.S. 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 to reduce the number of people getting cancer or needing treatment or needing advanced treatment. Yeah. In the first place, right? Like, that's received a much smaller piece of the pie. As usual with public health. Yes. Okay.

Yes. Which, and there's more, there's, it'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 40% all the way down to zero, that lifetime risk of 40 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 17%. Significantly. Significantly. Prevention and screening, though cornerstones of cancer care fail to get the appreciation they rightfully deserve. Snaps. I mean, and that's historically as well as today. It continues to today.

And this is not surprising. Again, like this concept about public health being invisible until it fails. So I'm going to spend, we're going to spend this episode making cancer prevention and screening more visible. Oh, I love this. Cancer prevention, prevention of any kind requires linking cause to effect. Yes. Yes. Why did deaths from infectious diseases drop over the 20th century?

Largely because germ theory gave us the mechanism, and then we applied that knowledge to prevention via vaccine, 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 effect, 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. Right. Or as individuals as individuals, yes. Like a random mutation, that might just happen. It happens all the time, actually. It really does. 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. No. Okay. If you lived in London in the 18th century, you probably kept your home warm by burning coal, see our London Smog episode, in which case you probably had a chimney, in which case you probably hired a chimney sweep to clean out the accumulated soot. Okay. 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 1775, 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, disease was chimney sweeps cancer. Okay. Have you ever heard of Timmy's use cancer?

No, never. Pott's description of the quote unquote soot-unquote soot and subsequent metastasis. So it started out of soot and then it metastasized. Okay. It ranks among the earliest, if not the first, observations of occupational cancer. Really? Really? Yeah.

In babies, basically. So what would happen was that these chimney sweeps would be exposed to all these. breathing in a chimney. Yeah, constantly. There would be like a sore that arose, a soot, and then that would eventually metastasize as they went into adolescence. Oh, wow. As 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 hard to imagine anyone making the argument that like, oh, no, these chimney sweeps are perfectly fine. Four years old is plenty old enough to work in a chimney on your own. Oh, my God. Right. But people did make that argument. Oh, yeah. Yeah.

And it took decades for any meaningful policy changing this to be passed. Okay. In 1788, so this is 13 years after Potts observation, the minimum age requires. for a chimney sweep was raised to eight years old. Oh my. I know. I know. There's so much more.

There's so many ways that this is blowing my mind. No, I know. You know what I knew about chimney sweeps, Aaron? Mary Poppins. Yeah, no. That's all I knew. That would be like past 1875, which is when the next legislation, meaningful legislation, was passed.

Like a hundred years later. 100 years after his observation was published. Oh, my. So this is when the chimney sweepers act was passed. And this forbade. children from sweeping chimneys and it introduced a licensing system that helped with enforcement. So, like, you could not sweep a chimney unless you were an adult. An adult? Who was licensed?

I don't know. Okay. Who knows? But still. Right. Potts 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 1922 when researchers induced cancer in mice after exposure to soot. Wow. So it was sort of like there was. this hypothetical link or 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 so? Right. That kind of thing. Yeah. Would those laws have been passed sooner if he had that information earlier? The story of cigarettes and cancer would suggest that no. Yeah.

Not necessarily. I mean, especially when it sounds like they were kids who weren't well taken care of by the system. Yeah. Communities. Yeah. Yeah. Oh, yeah, you, 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 cancer? Is it lung cancer? Oh, yeah. It's like scrotal cancer. Oh, okay.

Yeah, yeah, yeah, sorry. I thought that you said that in the first episode, but I couldn't remember it's in the name chimney sweeps. No. We talked about how you have to define a cancer. Let's go back to page or two. Yeah. Okay, thank you. No, that makes sense.

Yeah. Yeah, yeah. Yeah, and it's because they were sweeping chimneys naked. Like, there was nothing, yeah. And like, as in development, you're like, and then with puberty, all of the hormones. And okay, yeah, yeah, yeah. Yeah, cell proliferation, et cetera. Okay, so of all the recognized carcinogens today, tobacco is probably the most well-known.

Like, if you ask someone, list some carcinogens for me, probably cigarettes would be the number one. For sure. 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 this story in all its lured detail. But for now, I'm just going to give you the bare bones. Okay. Okay. Our first marker along the timeline takes us to 1761. with John Hill's publication of his pamphlet titled Cautions Against the Immoderate Use of Snuff. 1761.

Oh, boy. Okay. And in this pamphlet, he argued that oral tobacco caused lip, mouth, and throat cancer. Wow. Yeah. Unlike Percival Potts 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 me. A pamphlet? Yeah. 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 1800s and early 1900s, Hill's pamphlet had largely been forgotten by that time. I just kick it over the 1761.

1761. I mean, and I wonder too whether anything about, like immoderate because like was that was when did the temperance movement kind of 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 200 years until madmen where they're smoking all the time oh my god because you're watching that right now because last year I was watching it I was watching it there's so much relevant things for pregnancy there's so many relevant things for cancer 100 yes yeah so many relevant things for cancer yes yeah so many relevant things for cancer

That's a good show. Yes. But yeah, so by the time his, by the early 1900s, 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. Okay. 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 20th century solidified the cigarette's 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. No. That smoking greatly increased the risk of lung cancer. Yeah. Proven. Yes. Proven.

In 1954, cancer authorities in several countries in several countries. around the world announced this unequivocal link, and even big tobacco was convinced, although only privately in memos. Yes. Uh-huh. It still took another 10 years for the U.S. 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 1964 or so, but then it plateaued,

Like it kind of went and went back up a little bit until 1980. And that's when broadcast 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. Ours are healthy. Ours are this.

Yeah. Right. Yeah. And so it's like the laws had to catch up to like what was allowed to be said. Mm-hmm. Mm-hmm. And so clearly, though, skepticism remained, both in the public, in politicians everywhere. And this was partly the handywork of big tobacco, sewing 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 1965, so this is the year after the summer. the Surgeon General's announcement. Okay. 50% of men and 32% of women in the U.S. smoked. Wow. Yeah.

Okay. Yeah. The amount of cigarettes was also high, about 10 per day, on average, something around there. Like half a pack. Half a pack, yeah. 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.

Yeah. One third of U.S. doctors. believed that cigarettes were a major cause of lung cancer. Only one third. Only one third. Okay. And 43% of doctors smoked regularly. Mm-hmm.

Yeah. Tobacco is woven into the history and the culture of the U.S. and in so many other countries, and uprooting it has proven to be quite difficult. Yeah. But the decline in cigarette consumption since the 1980s, driven by awareness campaigns and policy changes like age limits and smoking bans in restaurants, I still remember going into restaurants. Smoking, non-smoking. Hotels, smoking, non-smoking. Yeah, yeah.

It has led to thousands of lives saved. An estimated 800,000 lung cancer deaths were averted between 1964 and 1985 because of reduced smoking. Wow. Just in those, like, 20 years. In those 20 years. Jeez. And lung cancer deaths are projected to drop 79% from 2015 to 2065.

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. Shocking. Like, it still blew my mind. Well, especially with e-cigarettes and vaping and all of that.

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 this. spotlight as a cause of lung cancer, this is still a remarkable success story. Yeah. Remarkable. Over the 20th and into the 21st centuries, many other carcinogens have been identified.

Lifestyle factors such as alcohol, red meat, processed meats, UV radiation, occupational exposures like asbestos and silica dust, infectious agents like Epstein-Barr virus, helicobacter pylori, which is the cause of stomach ulcers, and human papillomavirus. See our HPV episode. CRHPV episode. These are just a handful of known carcinogens. The list of probable carcinogens is much longer. Yeah.

What we've done with this information varies. It varies based on the individual and 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 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-Barr virus, EBV, is one of the

most ubiquitous viruses. It affects 90% of adults. It's responsible for nearly 360,000 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. things. Oh, yeah. In our MS episode, we talked about EBV. Yeah. Mm-hmm. Mm-hmm. But we do have a vaccine for the hepatitis B virus. Yes, we do. Which can lead to liver cancer and human papillomavirus, HPV, which can cause cervical, other antigenital cancers and oropharyngeal cancers. It's amazing that we have 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 Hep B and HPV vaccine uptake improve in their near future, including 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 U.S. Like, we will see reversal in some of these trends. Yes, we will. We will see cancer development because people elect not to use these vaccines if they can. Yeah. Yeah.

Yeah. But before we had the HPV vaccine, we had an HPV testing. I'll throw that in there. Yeah. We also had another powerful tool to reduce cancer deaths due to this virus. Yeah, we did. The PAP smear. The PAP smear.

We, again, check out our episode. The Papsmere was first developed in 1928 by Georgius PEPa Nicola. He was a physician and a scientist. He became interested in the menstrual cycles of human. and especially cellular changes throughout the cycle. Like, what's going on? What's happening? Yeah. As we go through this 28, through 25 to 37 days, whatever it is. Yeah. And he noticed that as he was like observing these cellular changes, he saw that in certain samples, the cells seemed oddly shaped. Okay. 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 preclinical pre-symptomatic cases of cervical cancer wow amazing and this was especially important because like symptomatic usually as we discussed means metastasis often and decreased chance of 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 was also his research subject. She volunteered to undergo a daily pap smear for two decades. Oh, my God. Two decades. 20 years. 20 years of everyday pap 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? look like, yeah. Oh, that's fascinating. Wow. And it took a few decades to catch on after he formally introduced the PAPSmear in 1941, 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's It really is. The Papsmears is incredible. The PAPSmeer is pretty great. Yeah. And 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 PSA blood test, or it might be a visual or physical exam, like 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 it. 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 the same. successfully treating it. But you're listening to this podcast, so we know that you're not here for the surface level. No. 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. Right. That is the case for certain cancers or for certain cases, individual cases, but it's not always the case. Yeah. While some cancer might be localized and they 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 diagnosed.

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 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 cancer. But we miss something. We miss something. Yeah. 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. Yeah. But it's so hard to know that up front. Yep. And that being said, you know, early detection does not always equate to longer survival, but often it does.

Often it does. Yeah. 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. Oh, gosh, no. They're not like, oh, I better cover, I better cover myself. So let's get you screen for this, that, and the other thing. It is, there are decades of data to support this.

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 1960s, I'm going to repeat it here. I love it. I love it. You know 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 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. Right. Or the limitations or the missed diagnoses or whatever it is. Right. You know, like, is mammogram perfect? No, but has it saved so many lives? Yes. Right. Is it colonoscopy prep very challenging and very uncomfortable? Yes. Yeah. Could it save your life? Also yes. Yes. Yes. Yes. Yes. Yes. Yes. We'll talk about it. Yeah. But tell me about, yes. The guideline. So, okay, 1960s, the WHA published the principles and practice of screening for disease, also known as the Wilson and Younger or Junker screening criteria, which outlined 10 rules that a screening test should follow. things like, I'm not going to list them all here.

It's okay. 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 60 years since 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 must be able. 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. Oh, yeah. Like, I really don't want to give the impression that screening does not work or even imply that screening is perfect. I just simply want to convey that the reality, as is often the case, is more complicated than that.

Yeah. Because, I mean, there's also, maybe you're going to talk about this and I don't want like jump on your feet. That's my thing. Step on my feet. Whatever. You can jump on them too if you'd like. 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 outcomes when maybe we aren't. We're just, you know, increasing how many 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 would have happened. Would have done this? Would 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't. with the available data that we have. With cancer screening, prevention, and treatment, we have the tools and the information to bring down those 40% and 17% numbers I mentioned at the top. So 40% lifetime risk of cancer, 17% 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 in 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 U.S., as well as across the globe, substantial cancer disparities exist in terms of diagnosis and survival.

You talked a little bit last week. An 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 U.S. diagnosed with cancer have a 10% higher death rate compared to white women, despite having a 9% lower incidence rate. Wow. Education level is 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. A hundred percent. 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 health care, and a willingness to scrutinize and dismantle the structural inequalities and systemic racism that drive these health disparities. Oh, 100%, Erin. 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 our country should be? What about our global community should be? Right. Yeah. Right. And so choosing 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, Erin, I'll turn it over to you to tell me the status of cancer around the world today. That's not a big ass, right? No, not at all. Small potatoes, Erin.

Super small, the tiniest potatoes, baby potatoes, new potatoes. Oh, Erin. 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. Ever feel like you're being chased by the marriage police? Welcome to boys and girls, the podcast where dating isn't dating. Arranged marriage is basically a reality show,

except the contestants are strangers and your entire family is judging. You're sipping coffee with one maybe, grabbing dinner with another, and praying your karmic Ken or Barbie appears before your shes, shelf life runs out. Trust me, I've been through this ancient and unshakable tradition. I jumped in, hoping to find love the right way, and instead I found chaos, cringe and comedy.

And now, I'm looking for healing. Boys and Girls dives into every twist and turn of the arranged marriage carousel. The meat-awquard, the near-misses, the heartbreak, and let's not forget all the jokes. Listen to boys and girls on the I-heart radio app, Apple Podcasts, or wherever you get your podcast. Hi, it's Alec Baldwin. This season on my podcast, here's the thing I'm speaking with more artists, policymakers, and performers, my composer Mark Shaman. Once you've established that you have the

talent, it's about the hang. It's the pleasure of hanging out with the people that you're with. You know, Rob and I was always a great hang. We would sit in kibbits for hours and then eventually get around to the music. That's what I mostly think of when I think of him, the time together, laughing. Lawyer of Robbie Kaplan. The great gift of being a lawyer is the ability to actually change things in our society in a way that very few people can. I mean, you can really make a difference to causes in the United States if you bring the right case at the right time. Marriage equality. Yeah, Windsor's the perfect example. And journalist Chris Whipple. Every White House staffer, they work in a bubble called the West Wing, and it's exponentially

more so in the Trump White House. Listen to the new season of Here's the Thing on the IHeart Radio app or wherever you get your podcasts. China's Ministry of State Security is one of the most mysterious and powerful spy agencies in the world. But in 2017, the FBI got inside. This is Special Agent Regal, Special Agent Bradley Hall. This MSS officer has no idea the U.S. government is on to him. But the FBI has his chats, texts, emails, even his personal diary.

Hear how they got it on the Sixth Bureau podcast. I now have several terabytes of an MSS officer, no doubt, no question of his life. And that's a unicorn. No one had ever seen anything like that. It was unbelievable. This is a story of the inner workings of the MSS and how one man's ambition and mistakes

opened its fault of secrets. Listen to the Sixth Bureau on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. When you feel uncomfortable, what do you put on? Biggie. You put on Biggie when you feel uncomfortable? Because I want to get confident. This is DJ Hester Prynne's Music is Therapy, a new podcast from me, a DJ and licensed therapist that asks one simple question. Who do you want to be, and what's the song that can take you there?

Music changes what you feel, and what you feel changes what you feel. do, right? That moment where a song shifts something inside you, that's where transformation starts. This year, I'm talking to experts across every area of life, like personal finance icon Gene Chatsky, New York Times journalist David Gellis, relationship legend Dan Savage, human connection teacher Mark Broves, and the man who shaped my ear more than anyone, Questlove. They'll bring the strategies. I'll pair them with the right records and will teach you how to use the music to make change stick. This isn't just a podcast. It's unconventional therapy for your entire year.

Listen to DJ Hester Pryn's Music is Therapy on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Hi listeners, I'm Anistonfield, the host of The Girlfriend Spotlight, and I've got some great interviews coming your way. I'm also excited to tell you that you can now get access to all episodes of season one, two, three, and four of The Girlfriends. and every single episode of The Girlfriend Spotlight, 100% ad-free. And one week early, through the I-Heart True Crime Plus subscription, available exclusively on Apple Podcasts. Plus, you'll get access to other chart-topping true crime shows you love, like betrayal, paper ghosts, Pikeson Massacre, the Brothers Ortiz,

what happened in Nashville, hell and gone, the godmother and more. So don't wait, head to Apple Podcasts, search. for I-Hart True Crime Plus and subscribe today. My name is Sam, and about four and a half months ago, at the age of 35, 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 Braco 1 mutation. This mutation affects DNA repair and increases the risk of various types of cancer, most notably breast and ovarian cancer. That finding triggered additional screenings, including mammograms, ultrasound,

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 mastectomy. At the time of this recording, I have completed 16 out of 18 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 loss of sensation in my fingers. The side effects build over time, and while 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 and 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 Brachowin 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 4 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 1,000 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 approve. Additional frustrations and barriers to treatment because of the rarity of his cancer have been centered around multiple insurance denials. Some of these are 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 company's oncologist 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 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 $30,000 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 in 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 nor go bankrupt to receive treatment. Thank you. In 2023, which is the most recent global data that I could find, 18 and a half million people worldwide were newly diagnosed with cancer.

That same year, cancer killed over 10 million people worldwide and contributed to 271 million disability-adjusted life years. I can't, it's, you can't even wrap your head around. It's massive. Yeah. 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 U.S. and from other high-income countries where cancer is not treated the same way as it is in places with less resources. Yep. And of course, in a lot of parts of the U.S., things are pretty bleak depending on who you are and where you live and what you have access to. Right. These numbers are also projected to increase, not decrease. By 2050, it's estimated that we'll be looking at over 30 million new cases of cancer every year and over 18 million deaths globally. Cancer is the second leading cause of death after cardiovascular disease, which is such a contrast to what you said, Aaron, in our very first episode,

that hundreds of years ago. No, 1900. Oh, 19. I can't remember. The eighth leading. So that's a huge change. Yeah. 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. Longevity overall, et cetera. Exactly. Many things. Many, many things.

All of these things can be true at once. Mm-hmm. If we look at the U.S., specifically, I do have a lot more data on the U.S. as of 2022, there were an estimated 18 million people living in the U.S. with cancer, which is about 5, 5 to 6 percent of the U.S. population. Okay. Currently living with cancer. And as far as I can tell, that's like a known diagnosis of cancer. And all of these statistics do not include basal and squamous cell carcinoma of the skin, which is really important.

That is something that we haven't talked about. Yeah. The 40 percent lifetime risk does not include. All of these millions of people numbers, that doesn't include those. Yeah. It does not include what's called non-melanoma skin cancer. Right. So that doesn't count.

The numbers become scarier. Oh, gosh, yeah. That's like everyone. When we're looking at trends in cancer over the last like 30 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, pancreatic cancer. Some of these might vary by sex, like they're increasing in males, but maybe decreasing or stagnant in females and vice versa. Like lung cancer is a good example of this.

Exactly. Yeah. 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. Right. 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 U.S., 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. Yeah.

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. Right. 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's 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? Right. What is your insurance company decide to, they're going to cover for you or feel like you're.

Which is just disgusting. Yeah. Yeah. Yeah. So, yeah. So there's a lot. Yes. 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. And like the age structure of a population too. A hundred percent. Yeah. But it really can vary 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 death.

even though breast and prostate cancer, for example, have very high, like, five and 10-year survival rates compared to other types of cancers. Right. 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 1.5% of all cancers globally and 1% of cancer deaths worldwide.

But they also account for over. over 3% 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, Erin, we're never going to be able to prevent all cancers. No.

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, although only in very specific populations. All of these are in 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 U.S., 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, including things like genetic testing, as well as a better understanding of, you know, these tumor suppressor genes, these oncogenes, 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 long way of saying that. I mean, I think, yeah, like using like Lee-Framini syndrome as an example, like you 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 we're there's so much more that we could do in the future. 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 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 BRCA 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 BRCA mutation or who we don't know if they have a BRCA mutation. Yeah. So it is, 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 BRCA mutation.

That's still not going to be recommended for the general population because of what you, 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. It has, 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 cancers, like ovarian cancer, like stomach cancer, like brain cancers, like bone cancers, thyroid cancers, pancreatic cancers, head and neck 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 said. 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 better coming up with screening protocols, in sorting through all of this data that

we have and 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 cancer. both for cancers that we already have screening tools for. And I'll give one really great example, which is colon cancer. Mm-hmm. 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.

Mm-hmm. 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. Right. But there's also a new blood test because doing a stool. test might be 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 it because it's still expensive, but that's a U.S. 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 M-C-E-D. Okay. I have to have another acronym for everything. Okay.

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. 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 U.S., 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 trials that are out in the UK. And it's called Gallery. I think that's how you say it. Okay. And it looks for biomarkers of more than 50 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 90%-ish, meaning that if it is positive, then it's likelier that there is something there. Is that what that's specificity means? What's sensitivity then?

So a sensitivity is quite low, which means that a negative test doesn't necessarily rule anything out per se. So it's still high rates of false negatives? False negatives. Yeah. Okay. So they're not perfect by any means. Yeah.

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. Yeah. And we might not necessarily be able to identify all the time where that might be coming from in terms of the,

the tissue of origin and things like that. And so would a test like, 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'm 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 these tests. 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. You can have your doctor order it. You're going to 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 $700 and $1,000 or so. They're not FDA approved, but you can get one. Yep. I mean, I know a lot of things that they can still get, but like that is very interesting. 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 suspicious because of Elizabeth Holmes and Theranos and all that, you know, and I'm just like, a panel. At least it's like. For everything.

Yeah. Your whole health panel. I know it's not that. But it is really interesting. It's, I mean, and like, and that also is, is. the dream or like the dream. It is a hundred percent. It is the dream. And how are these going to be implemented? Who is 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 cervical cancer. And those guidelines, might change based on where you live and how data has been interpreted in the UK versus the U.S. Or by, you know, the American College of Radiology versus the USPSDF, 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. It's going to be blood tests. And it's going to be. Less 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, 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 and clearly. clinical trials and things like that. Who knows? I think that's my hope and dream is that these kinds of tools make it possible. Yeah. Wish we had a crystal wall. I know. Yeah. But I think it's probably the future. That's my guess. Okay. Okay. Multi-cancer early detection tests. Well, check in in 10 years, see where we are. Five years, probably, honestly. Yeah. 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 types. You're right, every single. Yeah. But there are so many types of cancers in the world. There are so many types of cancers. There's 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, things like this. Yeah. 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 know. We have said so many words over the past few weeks.

I'm worded out. I'm worded out. I think that like that, 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, have been diagnosed with cancer, undergoing cancer treatment currently, it is, it's hard to, like, I don't know. Like, I was thinking about you all and all of our first-taining cancer. account providers, 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 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 you want to learn about. Yeah. That's always what that is what drives us. That is 100% what drives us. Yeah. It's just like learning new

things and being able to share them. 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. 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. I love that one. One of those for every year is great maps in there, great information to kind of like, piece apart what's going on. And that's also in the U.S. specifically. If you want to know more about chimney sweeps cancer, Percival Pot and chimney sweepers cancer of the scrotum by Brown and Thornton from 1957.

Wow. And then by Croswell et al from 2010, 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, cigarette smoking and lung cancer paper by Dall and Hill from 1956 lung cancer and other causes of death in relation to smoking. Wow. Yeah. 1956, 1761.

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 a paper from The Lancet, the Global Regional and National Burden of Cancer, 1990 to 2023, with forecast. to 2050. Yep. So that one was from the global burden of disease study.

There also was one, also in the Lancet from 2022, 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. And like the, I feel like I didn't do enough talking about like how much of cancer could potentially be preventable in like lifestyle factors that contribute to cancer mortality. It's like 40 to 60 percent. And then I have a whole bunch like links to other, the global cancer observatory and the Sears Statistics and things like that and a bunch of other things about cancer screening.

There was a great guide actually from 2026 in Nature Review's Clinical Oncology. That's called The Guide to Cancer Screening. That was super awesome overview. So you can find all of these sources on our website. This podcast will kill you.com. Wonderful job, Erin. Thank you. Thank you again to the providers of our first hand accounts.

You made these episodes. Yeah. Possible. Yeah. Thank you. You really did. them meaning, so meaningful. So meaningful. Thank you. Thank you to John and Brett for listening to our cancer notes over and over again for hours on end. They're never going to listen to these

episodes, so they're never going to know that we thanked them. I'll tell John that I thanked him. I also have thanked him in person. Thank you also to Bloodmobile, who does the music for this episode in all of our episodes. Thank you to everyone at exactly right, who helped us to record here in studio. Check this out on YouTube. Thank you to Leanna and Pete and Tom and Boomer and Jessica and Corey and Sabrina. I mean, it's been, it's like so fun to come here and do this. It's great. It is. I love it. Thank you. Lunch is like the best time. Because we just like, I'm in it for the lunch. Yeah. I'm in it for lunch. So thank you. Thank you. And thank you, of course, to everyone listening and watching. We love making it.

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