How to Detect Cancer Early (before it's too late) — Transcript

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1. 0:00If you detect cancer early, it's far
2. 0:02easier to treat, and that's led to the
3. 0:03phenomenon of people getting full body
4. 0:05MRI scans. After all, why would you wait
5. 0:08for cancer symptoms to appear, at which
6. 0:10point it might be difficult or
7. 0:11impossible to treat? Why then does the
8. 0:13American College of Preventive Medicine
9. 0:15recommend against whole body scans?
10. 0:18Let's dive in. First of all, they say
11. 0:20that MRI scans are not very good at
12. 0:22detecting cancer in people that don't
13. 0:24have symptoms, that there are far better
14. 0:26tests and strategies to detect specific
15. 0:29cancers. And we'll get to those later in
16. 0:31the video. They go on to say that no
17. 0:33medical societies, so for example, the
18. 0:35American Cancer Society, recommend whole
19. 0:37body scans. And this is because often
20. 0:39whole body scans, they show up things
21. 0:41that do not look normal, and almost all
22. 0:43are harmless. For example, in one study
23. 0:45of patients that had no symptoms, but
24. 0:48they went through an MRI machine, 1/3 of
25. 0:50them had suspicious findings that needed
26. 0:52further tests, including further scans,
27. 0:54biopsies, and surgeries. And that's a
28. 0:56problem because biopsies and surgeries
29. 0:58are not harmless. I've got a very close
30. 1:00friend who used to work as an MRI
31. 1:02receptionist, and as part of the testing
32. 1:04of that machine, they asked her if she
33. 1:06wanted to go through and have a full
34. 1:08body MRI scan. They found something
35. 1:10suspicious in her liver, and despite
36. 1:12other biopsies and blood tests, they
37. 1:14couldn't figure out exactly what it was,
38. 1:15and she had to go through an operation
39. 1:17to remove half of her liver. And when
40. 1:19they looked under the microscope, the
41. 1:21lesion was benign. It was never going to
42. 1:23become cancerous. So she had to go
43. 1:24through that massive operation, have
44. 1:26half of her liver removed for nothing.
45. 1:29So any cancer screening program must be
46. 1:31validated to show that it does save
47. 1:33lives. So for example, when exploring
48. 1:35how to design a lung cancer screening
49. 1:37program, there was a large Danish study
50. 1:39completed, where they randomly assigned
51. 1:41people into two groups. One group had
52. 1:43their lungs scanned, and the other ones
53. 1:46had normal medical care. Shockingly, the
54. 1:48group that had their lungs scanned, they
55. 1:50actually had a worse death rate compared
56. 1:52to the group that had no scans. This
57. 1:55highlights the important point that any
58. 1:56cancer screening program is not just
59. 1:59about detecting the cancer, it's about
60. 2:01making sure that we're saving lives. And
61. 2:03when that lung cancer screening program
62. 2:05was tweaked to only include people
63. 2:06between the age of 50 to 80 who had a
64. 2:09strong smoking history, then that
65. 2:11program saved lives. Overall, that's one
66. 2:14side of the story against having a full
67. 2:16body MRI, that there are better existing
68. 2:18cancer screening programs that have been
69. 2:20validated to save lives. And any doctor
70. 2:22who recommends full body MRIs is going
71. 2:25against the recommendations of the
72. 2:26various cancer societies. But here's the
73. 2:29counter argument to have a full body
74. 2:31MRI. It is possible that these full body
75. 2:33scans can be used in addition to the
76. 2:35existing screening programs, and it does
77. 2:37provide a unique opportunity to detect
78. 2:39cancers that may have otherwise been
79. 2:41missed from the existing cancer
80. 2:42screening programs. And crucially, these
81. 2:44scans do not expose patients to
82. 2:46radiation or contrast injections. And in
83. 2:48a large study, cancers were detected in
84. 2:51nearly 2% of patients that went for
85. 2:53these full body MRI scans, which sounds
86. 2:55like a very convincing argument. But
87. 2:57remember, any cancer screening program,
88. 3:00it's not enough to just detect cancers.
89. 3:02We need to make sure that we're saving
90. 3:04lives, and full body MRI scans simply
91. 3:06don't have that data yet. We don't know
92. 3:09if the harms from biopsies and surgeries
93. 3:11because of the findings from full body
94. 3:12MRI scans will actually save lives. But
95. 3:15we absolutely need to investigate this,
96. 3:17and there are studies ongoing. At the
97. 3:19end of the day, it's your health, your
98. 3:21decision. And after looking at all of
99. 3:23this, you might elect to have a full
100. 3:25body MRI, and you have made an informed
101. 3:27decision. Personally though, I would not
102. 3:29have one of these scans until we've got
103. 3:31that research to show that it does save
104. 3:33lives, and I do not recommend these
105. 3:35scans to my patients. So, what can we do
106. 3:38to detect cancer early before symptoms
107. 3:40appear? Well, there's a heck of a lot
108. 3:42actually. The American Cancer Society
109. 3:44recommends that for breast cancer
110. 3:45screening, women of the ages between 40
111. 3:48and 44, they should have the choice as
112. 3:50to whether to start annual breast cancer
113. 3:52screening. And this is using mammograms.
114. 3:55Women 45 to 54, they should have
115. 3:57mammograms every year. And women 55 and
116. 4:00older, they should switch to having
117. 4:01mammograms every 2 years. For colon and
118. 4:04rectal cancer, the society recommends
119. 4:06that regular screening should start at
120. 4:07the age of 45. But if you do have a
121. 4:10strong family history of rectal cancer,
122. 4:12then that screening can start earlier.
123. 4:14So for example, if you've got a family
124. 4:16member that had colon cancer at the age
125. 4:18of say 40, generally your screening
126. 4:21should start 10 years prior. So when you
127. 4:23are 30 years of age, that's for you when
128. 4:26you should be starting your cancer
129. 4:27screening. The screening can be done
130. 4:28with either a stool test or a
131. 4:30colonoscopy. Now generally, I recommend
132. 4:33a stool test because it's a non-invasive
133. 4:35procedure. And this is for people
134. 4:37between the age of 45 to 50. So if there
135. 4:39is a positive stool test, then they need
136. 4:41to go on to a colonoscopy. And
137. 4:43regardless of what the results show,
138. 4:45from the age of 50, I do recommend to my
139. 4:47patients to get a screening colonoscopy.
140. 4:50For cervical cancer, screening should
141. 4:52start at the age of 25. And this
142. 4:54includes being tested for HPV as well as
143. 4:57a smear. Endometrial cancer is tricky.
144. 4:59There's currently no validated screening
145. 5:01program. However, all women should
146. 5:03report any unexpected vaginal bleeding
147. 5:05or spotting to their doctors. Moving on
148. 5:08to lung cancer, and we've touched on
149. 5:09this, this should include people who are
150. 5:11between the age of 50 to 80 and who
151. 5:14currently smoke or who have quit in the
152. 5:16past 15 years and who have got at least
153. 5:19a 20-year smoking history. This strict
154. 5:21criteria means that the program will
155. 5:23save lives. Prostate cancer is another
156. 5:25tricky one. There's currently no
157. 5:27validated screening program that has
158. 5:29been shown to save lives. So all men
159. 5:31starting at the age of 50 should talk to
160. 5:33their health care provider about the
161. 5:35pros and cons of testing. Now I want to
162. 5:37talk about ovarian cancer because
163. 5:39recently there was a massive study
164. 5:41published. Over 200,000 patients were
165. 5:43included and they were randomized
166. 5:45between a combination of ultrasounds and
167. 5:47blood tests or no screening. The study
168. 5:50ran for 16 years and unfortunately,
169. 5:52there was no reduction in ovarian cancer
170. 5:54deaths between the group who had the
171. 5:56screening compared to the group that had
172. 5:58no screening. And therefore, general
173. 6:00population screening cannot be
174. 6:01recommended, which is disappointing and
175. 6:04it does lead us to another interesting
176. 6:05point. There's a new blood test called
177. 6:07the Galleri blood test, which you can do
178. 6:09and it detects around 50 different
179. 6:11cancers. Almost 1% of people who do this
180. 6:14blood test will have a positive result
181. 6:16as in they're suspicion for cancer. But
182. 6:18of those people with a positive test,
183. 6:20they will go through additional scans
184. 6:22and find that there is no cancer. So for
185. 6:24those patients, they would have gone
186. 6:26through all of that anxiety for nothing.
187. 6:28This test has also not been cleared or
188. 6:30approved by the FDA. Overall, here is my
189. 6:33take for cancer screening programs.
190. 6:35There are a lot of existing cancer
191. 6:37screening programs that have been
192. 6:38validated to save lives and I wish all
193. 6:40of my patients would do them. When it
194. 6:42comes to whole body MRIs and blood tests
195. 6:45such as the Galleri test, they are very
196. 6:47interesting and I'll be following the
197. 6:48research closely. However, before they
198. 6:50can be recommended to the general
199. 6:52population, they need to be validated as
200. 6:54in they need to be shown to save lives,
201. 6:57not just detect cancer, but actually
202. 7:00save lives. And I'm very hopeful that
203. 7:02future studies do show that they save
204. 7:04lives and they can be used as part of an
205. 7:06overall screening program to help detect
206. 7:09cancer early. But in the meantime, I
207. 7:11highly recommend that you use the
208. 7:12existing cancer screening programs
209. 7:14because they are validated to save lives
210. 7:17and make sure to check out this next
211. 7:18video here where I explain all of the
212. 7:20things that you can do to prevent cancer
213. 7:22in the first place. A massive thank you
214. 7:24to do not age.org for their $10,000
215. 7:27donation to my rapamycin study. They are
216. 7:29a health research organization and to
217. 7:31benefit from the ingredients as well as
218. 7:33a 10% discount code, check out the
219. 7:35pinned comment.