What We Get Wrong About Cancer

Summary

This video script delves into the multifaceted battle against cancer, emphasizing the importance of early detection over the search for a singular cure. It explores various treatment methods—surgery, chemotherapy, radiation, and immunotherapy—while highlighting the stark differences in survival rates based on when cancer is detected. The script challenges the focus on developing new treatments instead of improving early detection methods, advocating for a proactive healthcare approach to save more lives.

Takeaways

• 🛡️ Cancer is not a single disease but hundreds of different diseases, necessitating a multi-faceted approach to treatment and research.
• 📈 The rise in life expectancy due to advances in medicine has led to an increase in cancer diagnoses, as we are now living long enough to develop this disease.
• 👨‍⚕️ Greg Simon, who ran President Biden's Cancer Moonshot, emphasizes that cancer is a part of us, arising from uncontrolled cell division.
• ⚔️ The primary methods of fighting cancer today are surgery (cutting out tumors), chemotherapy (poisoning cancer cells), radiation therapy (burning cancer cells), and immunotherapy (melting cancer cells by activating the immune system).
• 🧬 The historical development of chemotherapy was influenced by the observation that mustard gas could stop cell division, although the connection was not direct.
• 🌟 Modern cancer treatments have made significant strides, but there is a lack of focus on early detection, which is crucial for improving survival rates.
• 🔍 Early detection of cancer is highly beneficial, with survival rates for localized cancers being much higher compared to those that have metastasized.
• 🤔 The script raises concerns about the medical community's approach to early detection, questioning why more resources aren't dedicated to this potentially life-saving strategy.
• 💉 The video discusses the potential of technologies like MRI for early cancer detection, highlighting the importance of innovation in diagnostic tools.
• 🏥 The script points out the challenges in early detection, such as the risk of overdiagnosis and the need for better healthcare systems that support proactive care without causing unnecessary stress or expense.
• 🌐 The importance of asking doctors about appropriate tests and their timing is emphasized, encouraging individuals to be proactive about their health.

Q & A

What is the current approach to dealing with cancer, as described in the script?

The script describes a multi-front war against cancer, acknowledging that cancer is not a single disease but hundreds of them. The approach includes developing new treatments and focusing on early detection.

Why is cancer considered the 'monster under the bed' or 'inside our bodies'?

Cancer is referred to as such because it was revealed as a major cause of death as we began to conquer other diseases through advancements in vaccines, sanitation, and modern medicine, leading to people living longer.

What startling statistic does the script present about cancer diagnosis in the US?

The script states that half of all men and a third of all women in the US will be diagnosed with some form of cancer in their lives.

What are the four main methods mentioned in the script for fighting cancer?

The four main methods mentioned are: surgical removal (cut), chemotherapy (poison), radiation therapy (burn), and immunotherapy (melt).

How did the script's author get involved with the topic of cancer?

The author became obsessed with the topic after speaking to various professionals including doctors, patients, and the head of the Biden Cancer Moonshot, and getting a brain scan.

What is the significance of early detection in cancer treatment according to the script?

Early detection is crucial because it significantly increases the survival rates and simplifies treatment, often to surgery alone, compared to late-stage detection which requires more aggressive treatments and has lower survival rates.

What does the script suggest about the current focus on new cancer treatments versus early detection methods?

The script suggests that while there has been a significant focus on developing new cancer treatments, the importance of early detection methods, which could save more lives, has been largely ignored.

What is the role of immunotherapy as mentioned in the script?

Immunotherapy, referred to as 'melt' in the script, works by unmasking cancer cells to the immune system, allowing it to recognize and destroy the cancer cells as foreign entities.

What potential issue does the script raise about widespread use of MRI for early cancer detection?

The script raises the issue of overdiagnosis and the potential for causing unnecessary stress and expense to the medical system by detecting many irrelevant findings.

What is the script's stance on the importance of proactive healthcare and early detection?

The script advocates for proactive healthcare, emphasizing that early detection is not just good by itself but is beneficial if it leads to better patient outcomes, and criticizes the healthcare system for not prioritizing this approach.

What advice does the script leave the audience with regarding cancer detection?

The script advises the audience to consult with their doctors about what tests they might benefit from and when, emphasizing personal involvement in one's health.

Outlines

00:00

🔍 The Complexity and Personal Impact of Cancer

The script addresses the multifaceted nature of cancer, emphasizing that it is not a single disease but hundreds, requiring a multi-pronged approach. It discusses the shift in public health focus from curing cancer to managing it as a chronic condition due to the rise in life expectancy and the subsequent 'unveiling' of cancer. The narrator shares personal reflections, including the startling statistic that half of all men and a third of all women in the US will be diagnosed with cancer in their lifetime. The script introduces Greg Simon, who led President Biden's Cancer Moonshot initiative, and his unexpected diagnosis of leukemia. It outlines the four main methods of fighting cancer today: surgery (cutting out tumors), chemotherapy (poisoning cancer cells), radiation therapy (burning cancer cells), and immunotherapy (melting cancer cells by activating the immune system).

05:00

🛡️ The Importance of Early Cancer Detection

This paragraph highlights the advancements in cancer treatment and the paradox of not detecting cancer early enough despite these technological breakthroughs. The narrator discusses the importance of early detection, comparing it to catching diseases at their earliest stages for better outcomes. The script includes a personal anecdote of the narrator getting a full-body MRI for cancer screening, which is controversial due to the lack of symptoms or higher risk. The results of the MRI are normal, and the script introduces the concept that early detection can significantly improve survival rates, with metastatic cancers having the lowest survival rates compared to regional and early-stage cancers. The narrator argues that early detection is a cure in itself and emphasizes the need for better detection tools and strategies.

10:02

💡 The Challenge of Balancing Detection with Overdiagnosis and Cost

The final paragraph delves into the complexities and challenges of early cancer detection, including the potential for overdiagnosis and the associated costs. It points out that early detection may not always equate to a longer life, introducing concepts like lead time bias and overdiagnosis bias, which can skew survival rate statistics. The script addresses the need for skepticism in interpreting early detection data and the importance of ensuring that it leads to better patient outcomes. The narrator criticizes the healthcare system's focus on developing expensive treatments rather than improving early detection methods. The script concludes with a call to action for individuals to discuss with their doctors the appropriate tests and timing for early cancer detection.

Keywords

💡Cancer

Cancer is a broad term encompassing a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. In the video, cancer is portrayed as a multifaceted disease that is not just one entity but hundreds, emphasizing the complexity of finding a 'cure'. The script mentions various aspects of cancer, including its prevalence and the different strategies for fighting it, such as early detection and treatment methods.

💡Cancer Moonshot

The Cancer Moonshot refers to a national initiative in the United States aimed at dramatically accelerating cancer research and treatment. In the script, Greg Simon, who ran President Biden's Cancer Moonshot, is mentioned as an example of a leader coordinating efforts to advance cancer research, highlighting the significance of such programs in the fight against cancer.

💡Chemotherapy

Chemotherapy is a type of cancer treatment that uses one or more drugs to kill cancer cells. It is referred to in the script as 'poison', illustrating the potent nature of these drugs that can also affect healthy cells. The script provides a historical context by mentioning the accidental discovery of the cell-killing properties of mustard gas, which contributed to the development of chemotherapy.

💡Radiation Therapy

Radiation therapy, or 'burn' as mentioned in the script, is a cancer treatment that uses high-energy rays to kill cancer cells and shrink tumors. The script explains that radiation damages the DNA of cancerous tissue, which is crucial for understanding how it works in conjunction with other treatments like chemotherapy.

💡Immunotherapy

Immunotherapy is a cancer treatment that helps the body's immune system fight cancer. The script describes it as 'melt', referring to how these drugs can cause the immune system to recognize and destroy cancer cells. The explanation of immunotherapy in the script provides insight into a newer and promising approach to cancer treatment.

💡Early Detection

Early detection is the identification of cancer at an early stage before it has spread. The script emphasizes the importance of early detection as a means to improve survival rates and treatment outcomes. It is presented as a critical strategy in the fight against cancer, with the script highlighting the stark difference in survival rates based on when cancer is detected.

💡MRI

Magnetic Resonance Imaging (MRI) is a medical imaging technique used to visualize detailed internal structures of the body. In the script, the narrator undergoes an MRI as part of a cancer screening, which serves to illustrate the role of advanced imaging in early detection. The explanation of how MRI works in the script helps to demystify the technology and its importance in medical diagnostics.

💡Lead Time Bias

Lead time bias is the misconception that screening for a disease improves survival when, in fact, it may only advance the time of diagnosis without affecting the overall lifespan. The script discusses this concept to highlight the complexities and potential pitfalls of early detection methods in cancer screening.

💡Overdiagnosis Bias

Overdiagnosis bias occurs when screening leads to identifying conditions that would never have caused symptoms or death during a person's lifetime. The script touches on this issue to underscore the importance of balanced perspectives when considering the benefits of widespread cancer screening.

💡Metastatic Cancer

Metastatic cancer refers to cancer that has spread from its original location to other parts of the body. The script uses this term to illustrate the severity of cancer when it reaches this stage, often resulting in lower survival rates and more aggressive treatment options.

💡Preventative Care

Preventative care involves采取措施 to prevent the development of diseases or conditions. In the context of the script, the emphasis on early detection and screening can be seen as a form of preventative care in the fight against cancer. The script suggests that a proactive healthcare system could improve outcomes by encouraging early detection and treatment.

Highlights

Cancer is not a single disease but hundreds of diseases, requiring a multi-front approach.

The 'war on cancer' has seen progress, but no definitive cure has been found due to the complexity of cancer.

Cancer incidence is rising, particularly in people under 50, making it a pressing issue for the current generation.

Advancements in medicine and sanitation have led to longer life spans, revealing cancer as a significant health threat.

Statistics show a high likelihood of cancer diagnosis in the US, affecting men and women differently.

The speaker's personal connection to cancer through loved ones and the potential for a personal diagnosis.

Cancer's unique nature as a disease that arises from uncontrollable cell division.

Greg Simon's perspective on cancer as 'life in abundance' and his role in the Cancer Moonshot initiative.

The four main methods of fighting cancer today: surgical removal, chemotherapy, radiation, and immunotherapy.

The historical context of mustard gas leading to the development of chemotherapy.

The importance of early cancer detection and its impact on survival rates.

The controversy and potential risks of early cancer screening without specific risk factors or symptoms.

The speaker's personal experience with a full-body MRI for early cancer detection.

The stark contrast in survival rates between early and late-stage cancer detection.

The technological marvel of MRI and its role in early cancer detection.

The challenges of early detection, including overdiagnosis, lead time bias, and the cost of medical tests.

The need for a healthcare system that promotes proactive care and avoids harmful follow-ups.

Greg Simon's call for more aggressive early detection programs despite the challenges and costs.

The societal implications of focusing on expensive treatments for fewer people versus early detection for many.

The speaker's final recommendation to viewers to consult with their doctors about beneficial tests and timelines.

Transcripts

"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. In fact, I now record nearly all of my  interviews on Riverside. It's great. I'd recommend  

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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 Dr  

Dan 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.