What We Get Wrong About Cancer

"Cancer? " "Cancer. " "Cancer!

" "We're gonna cure cancer -" "cure for cancer -" "the next frontier in the race to find a cure for cancer. . .

" At this point, you probably know that we're not looking for a cure for cancer anymore. Cancer is hundreds of diseases, so really  we're in a multi-front war against all of them. .

. "The war on cancer -" "The new frontier in fighting cancer -" "A new cancer vaccine -" "It's considered one of the most promising fronts in the battle against cancer-" "- but nearly no improvement in others" "Cases in people under 50 are rising dramatically -" What I didn't realize was that cancer is a problem for our generation in a way that it wasn't for  previous ones further back. Look at this: In the US, our grandparents' grandparents' died of all  kinds of things.

But slowly, we began to conquer the diseases that killed the most of us. And that's  how - with developments in vaccines and sanitation and modern medicine, just plain living longer. .

. We revealed cancer. It's the monster that was under the bed the whole time.

Worse - it's the monster that was inside our bodies the whole time. Here's the stat that really got me: Half of  all men and a third of all women in the US will be diagnosed with some form of cancer in their  lives. Around the world, out of every six people who die, one of them dies of cancer.

I don't say  that to scare you. I say it because if you think this topic doesn't apply to you - specifically you - you're wrong. And me.

There's an uncomfortably high chance that at some point in my life I might get  that call from a doctor. People I love already have. .

. So the question is: What can we do about it? Over  the past couple months, I've gotten obsessed with this topic.

I've spoken to doctors and patients. I  talked to the head of the Biden Cancer Moonshot. I got my brain scanned.

I'm going to show you how  we fight cancer, because it is amazing. But I also found something else. In this video, I want to make  the case that though we have made enormous leaps with new cancer treatments, we have also largely  ignored the single best way to save the most lives.

"Are we winning the war on cancer? " "War on cancer -" "The emperor of all maladies -" "A civil war in the body -" "We've made tremendous progress in  the war against cancer. .

. but we haven't won yet. .

. " Cancer is crazy. It's different than  talking about a virus or anything else really because cancer is.

. . us.

Too much us. Cancer takes a  thing that makes us live - a human cell that divides - and kills us because it can't stop doing that. It divides uncontrollably.

"What is cancer? Well, that's answered wrongly most of the time. " "Cancer is, to be  blunt, life in abundance.

" That's Greg Simon. He ran President Biden's Cancer Moonshot. He was in charge  of coordinating the whole US' massive but often messy cancer efforts.

Actually, when he was first appointed. . .

"They did not even know I had cancer! " Yeah. Greg has leukemia.

"And my doctor says, your PSA is fine, and your cholesterol is fine, but by the way you have leukemia. Now, even I know that's  not how you use "by the way. " It's more like, by the way there's something on your lip.

Not by the way  you have a deadly form of cancer. " If you ever get a similar call, you should know that there are four big ways we fight cancer today: cut, poison, burn, melt. In lots of cancers, when those uncontrolled  cells start to divide, they glom together, creating a tumor.

This is localized or early stage cancer. And if we catch it here, we cut it out. "If you can see the cancer and it's early that's always what they do.

Boom. We'll just cut it out before it spreads. " But with some cancers, like Greg's,  you can't do that.

And with others it gets too late. Cancers can spread into nearby tissue and  then later into other parts of the body. These are regional and then later distant or metastatic  cancers.

Once cancer has spread, the question that doctors have to deal with is: how do you tell  what's you and what's cancer? So what's "poison"? You know that one: That's chemotherapy.

"I get in a chair, nurse comes in, puts on a hazmat suit. and I'm like whoa, I'm the one getting the drugs! Why am I not covered up?

She said, well, I don't want it to be dripping on me. It's incredibly poisonous. " Here's a story: In 1943 German forces bombed an Italian port, sinking 17 Allied ships.

This one, an American  ship called the John Harvey, was carrying a secret cargo of 2,000 bombs filled with mustard gas. The  toxin spread into the water as soldiers swam to safety. And they died, horribly.

And when doctors  examined their bodies, they found that the gas had stopped certain cells from dividing. This moment is  sometimes cited as "leading" to chemo. It didn't.

It's an extreme early example of the chemical effect. Back in the US, researchers at Yale were already experimenting with ways to alter this poison  to stop cancer cells from replicating. Today, chemo is often paired with radiation.

That's the "burn" category - damaging the DNA of the cancerous tissue and killing cancer cells. "It's either burn, poison, or cut. .

. and now there's a new one: melt. So the drugs I get melt these cells.

. . so the new  immunotherapy drugs that activate the immune system, they de-mask or unmask the cancer cell and  the immune system goes, that's not a cop that's a crook!

How did we miss that? And they go get them. .

. " These methods have saved millions of lives. Cancer treatment is astonishing now and these are just the big categories!

So yes, technologically there is a huge breakthrough and it's happening every  year in all kinds of different cancers. But here's what's not happening: We're not detecting people early. Okay.

Let's take a second. I need to thank our sponsor here, because they helped make this story  possible. That interview with Greg, I recorded on Riverside.

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Which means that  the quality of your recording isn't affected by internet stability, which is huge for recording  interviews with experts all around the world. I don't have to tell you how annoying to ha--- big  pauses when someone--- is talking. And then after recording is done I just export those high  quality files in separate tracks.

If you want to try it out, I can give you 30% off. Just go to  riverside. fm and use code "CLEO" for 30% off any individual plan.

I'll also put a link to this  in my description. Now, back to the story. .

. I know it's better to catch cancer early. But  how much better?

How does it compare to a new treatment or something? in the course of  making this episode, I got invited to get a free screening for several different kinds  of cancer all at once. There are lots of ways to detect different kinds of cancer but the one  that I'm gonna get is a full body MRI.

By the way what I'm doing is controversial. I'm getting  screened for cancers with no symptoms and without a specific higher risk that I know about.  Many doctors would tell me this is a waste of my time or worse it could give me unnecessary  or even damaging care.

. . I'll come back to that.

I can't take my camera in with me but I'm going  in there alright here we go! I'm all done. .

. I've never gotten an MRI before. It was really  interesting.

It sounds a little bit like this BOOOM BUNGBONG DINGDINGGING "please hold your breath" WAHW- (what am I doing) DING! That's what it sounds like. I'm feeling  a little bit nervous about the results.

Like there's no evidence that I have  cancer. There would be no reason for me to get a checkup. There's - I don't.

But like  that's the point, isn't it? I wouldn't know. .

. I'm not going to string this out. They did not find  cancer.

Here's what my very normal body looks like. "Unremarkable" is the word that they use. This is  the company's founder, Emi Gal, and this is DrDan Sodickson, their Chief Scientific Officer and  - get this - one of the inventors of how modern MRIs work.

By the way, they didn't sponsor this video or  anything. You're always going to know when stuff is sponsored. They offered me a free trial and  I tested it out.

Okay, the reason why they care so much about early detection is that if you find  cancer, whether you survive depends a shocking amount on when you find it. Different kinds  of cancer differ wildly but broadly speaking "Metastatic cancer has a single digit percentage  survival rate for most cancers. Regional cancer has a slightly higher but still kind of around  20-25% survival rate.

Early stage cancers, so while still localized in the organ, has a 80-90 in some  instances 99% of survival rate. So like you can survive that cancer if only you can find it when it's localized. " These are general numbers.

Specific types of cancer different wildly. But just look at how survival rates drop across the same kind of cancer if you discover it later. Basically you  can have the same kind of cancer and have these completely different outcomes - and treatments.

If you detect cancer early, you can do surgery and most of the time you're done. If you detect cancer  late, you can you need to do surgery, radiotherapy, chemotherapy, and the five-year survival rates decrease significantly. I strongly believe we have a cure for cancer.

It's early detection. At this point in the episode I was expecting to be talking about cancer vaccines or kinase  inhibitors or immunotherapy - something that I keep hearing about in the news. Those things are  crucial.

But the number of lives that we could save if we just got the right people access to what we  already have. . .

my whole understanding of this topic just shifted. And because I'm always interested  in the tech angle let me nerd out for a sec: The detection tools that we have now deserve the same  kind of awe and like fawning headlines that we give our new cancer treatments. Like do you know  how an MRI works?

Until I made this episode, I did not. It is WILD. And it became widely available in  our lifetimes!

Just quickly: An x-ray is a shadow picture. Like a hand with a flashlight but for your bones. An MRI is a water map, made from radio emissions from your body.

"It turns out that the nuclei inside the atoms inside the water in you actually point in a certain direction. They have what's called a "spin" which you can think of like a compass needle. .

. So I was inside a big magnet which was moving and making those sounds DINGDINGDINGWAHWAAH-[I'M SORRY OK] which was then causing my little  water compass needles to go [what] and emit a radio signal that was detected and made the image. That is the signal, this radio signal that our bodies are emitting that we then detect.

How do we detect it? With a radio antenna. So we can see our smushy insides and detect possible tumors and that's just one tool!

There's so many options now for how we can better see ourselves. I started to imagine a world where getting cancer screenings was like getting an annual dental  checkup or something. You catch them early and you cut them out and you save lives.

But it's not that simple. . .

The problem is if I were to just do an MRI on everybody who walked in, I'd probably find a bunch of largely irrelevant stuff. Well then you're following up on lots and lots of nonsense, and you're terrifying patients, and your increasing expense to the medical system. " "So our medical system waits until you have a sign of cancer.

. . " But for many cancers by the time you have symptoms, you're past the early stages.

It's frustrating but there are good reasons to be cautious here. For  one thing, detecting someone early might mean that they live longer after their diagnosis but  not that they live longer total. Imagine detecting someone at 60 versus 67 and they both die at 70. 

This is lead time bias. Or you might catch a lot more cases that are mild, so it might look like  your survival rate went up but actually nothing changed. This is overdiagnosis bias.

These are good  reasons to treat the data with healthy skepticism. Early detection isn't good by itself. It's good if  it actually leads to better outcomes for patients.

And there's another conversation about costs. How do we make these tests cheaper? How do we make them more accessible?

How do we make sure that people don't go into medical bankruptcy? But if you hear people say that more information is worse  for the individual somehow. That it's scary or that it might cause harmful follow-ups.

. . I don't  get stopping there.

Like, first of all, keeping information from people is paternalistic. But more  importantly it's on us to develop a health care system that incentivizes proactive care and  doesn't incentivize harmful follow-ups. Not to say, "oh we can't get more information because we  might act poorly on it.

" Like, what? ? And don't get me started on the messed up incentives here.

I'll let Greg handle this one: "So why don't we go out and be more aggressive in the way we detect? Money. Lack of focus.

And there's not a lot of glory in creating an early detection program compared  to developing a new a new drug. " And as a result we're lagging on things that in the context of curing cancer should be straightforward. .

. . Cancer is deeply human.

And it seems to me like  the fight against cancer is too. We're fighting our own bodies. And we also need to fight our  tendency to look toward the next shiny thing.

"What does it gain society to develop more and more  expensive treatments for fewer and fewer people, if we don't find a way to treat the more and more  people who are dying of treatable cancers? " It's not that people should get tested all the time. It's the in the push for new treatments we've ignored a lot of people that could be helped  by what we have right now.

This story was really eye-opening for me and if I can leave you with one final thought: I said this story was relevant for specifically you. Now, after watching, if there's one thing that you should take away from this, it's: Ask your doctor about what tests you might benefit  from and when. I know I'm glad I did.