November 18, 2024 • 56 mins
We're thrilled to share this interview with Dr. Bill Dahut, Chief Scientific Officer of the American Cancer Society.
Dr. Dahut is a renowned oncologist and researcher who is helping set the vision for the world’s most innovative cancer research initiatives.
In this interview, we cover a wide range of topics, including the groundbreaking research the American Cancer Society is supporting, the critical role of early cancer detection, and how lifestyle choices like diet, and exercise can significantly reduce cancer risk.
Dr. Dahut is both inspiring and empowering, because he gives us an inside view for how we can all make an impact —not only by fundraising but also by living healthier lives to reduce our risk of getting cancer.
After all, an ounce of prevention is worth a pound of cure.
Huge thanks to Dr. Dahut for his leadership and taking the time to share so much with us.
Also a huge thanks to everyone at the American Cancer Society for leading the charge in the fight against cancer, and for giving us all the opportunity to be a part of it.
Head to American Cancer Society to learn more and find out how you can join the fight.
Click here to download Charity Miles and get moving for the American Cancer Society.
#EveryMileMatters!
Time Stamps:
0:00 Intro
0:28 Meeting Dr. Bill Dahut
3:46 Dr. Dahut’s Journey to Oncology
6:12 The Role of Lifestyle in Cancer Prevention
9:03 Advances in Early Cancer Detection
12:16 The Connection Between Obesity and Cancer
15:54 How ACS Supports Cutting-Edge Research
22:10 Modifiable Behaviors That Reduce Cancer Risk
35:39 Innovative Treatments and AI in Cancer Care
54:14 Final Thoughts and Calls to Action
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:27):
Hello, Dr. Dayhut.
I think you're on mute.
You can hear me?
(00:51):
Hello, Dr. Dayhut.
I can hear you okay.
Can you
(01:49):
see me okay?
Yeah, sure can.
How are you?
I'm well, thanks.
Nice to see you.
Thank you for joining.
Sure.
And where are you?
I'm in the great state of New Jersey.
How about you?
Yeah, I'm in the free state of Maryland,
so our weather is probably pretty similar.
What part of Maryland?
Bethesda.
Very nice.
(02:11):
I was supposed to go down to Annapolis
this week to see my father-in-law,
but we're not making it down there this
week.
We're going to go to the Navy game,
but unfortunately, can't do it.
But thank you for joining.
Yeah, I'm actually giving a talk at Navy
next week, as a matter of fact.
(02:32):
And I was in the Navy.
You were in the Navy?
Yeah.
Okay, excellent.
Well, that might be something to talk about.
So, leaf blower instructor on by me.
So, we're recording now, if that's okay with
you?
Yeah, of course.
Yeah.
Excellent.
Yeah, I'd like to just kind of jump
into it and start, if you wouldn't mind,
(02:55):
describing where it is that you're walking right
now in Bethesda for all the people who
are walking or running along with us right
now.
So, I'm in Bethesda, Maryland, which is a
suburb outside Washington, D.C. It's about a
mile and a half from NIH, about a
mile and a half from Bethesda Navy Hospital.
(03:16):
It's a neighborhood called Edgemoor, which was built
in 1915, 1820, and typical suburban neighborhood.
Very nice.
Yeah, I'm in a similar neighborhood, Montclair, New
Jersey, suburb of New York City, I think
(03:36):
very similar to Bethesda.
And beautiful day here.
So, hopefully you're having a good walk.
And then the next question is to just
introduce yourself to everybody who's walking and running
along with us right now.
Yeah, so I'm Bill Dahut.
I'm the chief scientific officer of the American
Cancer Society.
I'm a medical oncologist.
(03:57):
I spent most of my career at the
NIH, so that's why I'm in Bethesda.
And in my role at ACS, I oversee
all of our research, which includes our extramural
grant funding, our fellowship program, and then our
intramural program, which is, we have one large
cohort studies, we look at, we develop guidelines,
(04:19):
we come up with what we call our
cancer facts and figures, programs, and we have
journals.
So, it's a good position.
Thank you.
All right.
If you don't mind, I usually don't do
any editing on this, but you broke up
a lot in there.
It got a little weird with the reception.
Okay.
So, would you mind just saying that again?
(04:40):
Sure, sure.
Yes.
And let me know if we're breaking up
at all.
So, my name is Bill Dahut.
I'm the chief scientific officer for the American
Cancer Society.
And in that role, I oversee both our
extramural research, which is our grant funding.
We're the largest non-profit funder of cancer
(05:00):
research outside the U.S. government.
A large program of fellows in the pre
-doctoral space.
And we also have intramural research program, which
is largely housed in Atlanta, which includes our
very large cohort studies, our work, which we
look at population-based information out of a
(05:20):
public available database, such as our cancer facts
and figures.
We run our guidelines work in our journals.
And I'm a medical oncologist who spent most
of my career at NIH.
I focus largely there on prostate cancer in
my own research career.
Wow.
So, are you mostly a research doctor or
like a practicing oncologist that, you know, patients
(05:42):
would say?
So, I'm a physician.
And in my career, almost all the work
I did was running clinical trials.
So, when you're at NIH, every patient you
see there is on a research study.
So, all my work was research, but most
of it was patient touching.
(06:05):
Excellent.
And you might maybe share a little bit
of your journey as to how you became
an oncologist and or why you became an
oncologist and then how that led you to
the American Cancer Society.
Yeah, sure.
You know, it's sort of interesting.
So, I went to school in Georgetown, grew
up in Washington, D.C. area.
(06:26):
Actually grew up not too far from here,
went to high school about two miles from
here.
So, it's all kind of a small world,
as they say.
But my first medical school rotation when I
was at Georgetown as a first year student,
I got assigned to oncology.
I didn't even know what that word meant.
I actually had to look it up in
my dictionary what oncology meant.
(06:49):
You were a med student and didn't know
what oncology was yet?
Yeah, I was only been there for maybe
six weeks.
And, you know, this is like, this is
the late 80s.
And I don't think people use the word
oncology.
Like, you know, it's kind of funny now.
It's such a common term.
But I bet if you went back and.
(07:09):
You know, so, you know, it just wasn't
a term that people use, you know, so
it's pretty amazing.
Right.
So so I looked it up and sort
of the long and short of it, the
Navy was paying for medical school for me.
So as part of my time, I was
at Bethesda Naval Hospital and they had a
(07:29):
combined program with the National Cancer Institute or
actually.
And so for me, I think I was
really attracted to taking care of patients with
more serious illnesses where and oncologists have a
very special relationship with patients because because the
focus is on their cancer during that during
(07:51):
that time period.
So so I think that attracted that profession
to me in a way, you know, different
than some other fields.
And then I became involved in prostate cancer
almost purely by chance.
I was going back to Georgetown as a
faculty member after my Navy payback was done,
planning on doing some work in lung cancer.
(08:12):
And then the person I was going to
replace decided not to leave.
So they said, you want to do prostate
cancer?
And I sort of thought about it and
said, sure, why not?
Because I had done some fellow and, you
know, there was very little available for patients
with prostate cancer back.
This was the mid 90s.
So so that's kind of so I think
(08:33):
I think it tells you that, you know,
that career paths are not linear.
You know, a lot of we work with
a lot of our young trainees and other
folks and so much of their life has
been linear.
You know, high school, you take the right
courses, they get the right college, you volunteer
over the summer, you go to medical school.
But having that flexibility to do things a
(08:55):
little different is, you know, makes life much
more interesting.
Right.
So, you know, I'm really excited to speak
with you today because I know that, you
know, I do a lot of miles for
ACS and other cancer organizations.
I know a lot of our members are
walking for ACS and other cancer organizations.
(09:16):
And, you know, how often does an ordinary
person like me get to ask about all
the cutting edge research an organization like ACS
is helping to support and that all of
our miles are supporting?
So can you maybe what does it mean
to be the chief scientific officer of an
(09:37):
organization like ACS?
And what are some of the exciting research
that you guys are doing and supporting?
Yeah, so I think, first of all, it's
what's really nice about being at ACS is
the way we get to work with so
many other great organizations, you know, such as
yours, but also, you know, scientific partners, other
(09:58):
foundations, other nonprofits.
So I think that's that's a one nice
thing about having, you know, such kind of
a, you know, I say the words overused,
but an iconic branch, shall I say.
And so my role is really to to
really create a scientific vision for what we're
doing.
And, you know, I've given this some thought.
(10:21):
And ultimately, what we are research is kind
of breaks down into four major categories.
So innovative ways of finding new cancer mechanisms.
So that's really discovering new targets, new drugs,
new ways to treat patients.
Better ways for cancer outcomes and survivorship.
(10:41):
So we know there's over 2 million people
being diagnosed with cancer every year.
Many of them will then become cancer survivors.
So it's really important to really understand their
journey in a way that wasn't thought of
it in, I think, in years past.
A lot of work on really training the
scientists of tomorrow today, because so many folks
(11:05):
are going to have really their, you know,
their most inspirational ideas early in their career.
But funding and other and other barriers right
now is making things much more complicated.
So we're really committed to that space.
And then a lot of time and effort
about the science of cancer early detection, cancer
(11:28):
prevention, and cancer recurrence, because I really think
that's a spot that ACS is particularly strong
in, because we have the ability to study
the science, study the new technologies, come up
with the guidelines.
And then, you know, the fact that we
have an advocacy arm finds ways that folks
have it covered, and ultimately find ways that
(11:49):
it can be implemented in the patients.
So, so much more emphasis, I think, on
that part of the spectrum, that maybe traditionally
was not.
How long have you been the chief science
officer of ACS?
Or how long have you been with ACS?
So it's the same answer to the question.
A little over two years now, actually about
two and a half years before, you know,
(12:12):
so it was May of 2022.
Got it.
And ACS, how old is ACS?
It's about 111 years old.
111 years old.
Yeah, so they were there before I got
there, to put it that way.
Right.
Yeah.
So I'm curious, like, how has science or
the science that ACS is doing changed in
(12:34):
111 years?
If you know that, if you can think
about the way that ACS has approached the
science of cancer in 111 years?
Well, I think probably better thinking back, maybe,
you know, we'll bite off the last 50
years anyway.
Okay.
And interesting, ACS was really the first organization
(12:55):
to come up with doing peer review on
science.
You know, I mean, so it's so part
of our vernacular now, that, you know, peer
reviewed research.
And, you know, you know, being on a
scientist, you know, having served, you know, reviewed
multiple, multiple grants, put grants in, it's so
much of our life.
But ACS really was really some of the
(13:15):
first folks to come up with that, that
NIH and others sort of modeled after it.
And then the other thing, some things we're
doing are somewhat similar, are these large cohort
studies.
So ACS will follow folks, large numbers of
folks, prior to having a cancer diagnosis, and
(13:36):
then following them for 30 or 40 or
50 years, to understand what's really driving cancer.
And actually, their first cohort studies was in
the 1950s.
It was only in men, only in white
men.
And it was really looking at a link
between tobacco and lung cancer.
And in three years, they found the link.
(13:58):
And then the leaders of the study, which
were all men, all smokers, switched to pipes,
because they thought that one actually was a
good one.
But, you know, and so over time, we've
enrolled over a million and a half people
on these cohort studies, and currently have just
(14:18):
launched our newest, which will be 100,000
black women.
So that part hasn't, you know, it's something
we've done.
And we've always had a focus also on
young investigators.
We have funded 53 Nobel Prize winners.
Three were awarded this year.
Almost all were early on in their careers.
(14:41):
Almost all were people who said, you know,
ACS took a chance on me when nobody
else would, because I think the fact that
we're interested in funding, you know, innovation, which
isn't always funded in traditional funding sources, because
people tend to be concerned about doing things
that are sort of a little bit less
traditional.
You know, obviously, things are deeper in basic
(15:04):
science.
I think there's a much greater bond between
basic science and the clinic than there used
to be that used to be separated significantly.
We now know finding discoveries in cancer can
much more quickly impact patients.
When I started in training, there was a
huge gap between what happened in the laboratory
(15:24):
and what happened in the clinic.
So I think that's changed significantly.
And then the fact on the immune system.
I mean, the fact that we have immune
-based treatments that are curing people with diseases
that were fatal in months in the past
is something else that is really markedly, markedly
different.
I'm not sure how to ask this question.
(15:44):
It's probably not going to come out right.
But when you think about that example that
you gave of the tobacco detection or the
link between tobacco and cancer and how that
was discovered in three years, you didn't need
30 years to discover that link.
That one came pretty quick.
I think maybe we've gotten to a point,
(16:05):
although I don't know, that a lot of
the obvious links for cancer would be kind
of obvious to a layperson like me in
the way that I've heard of the word
oncology.
I would think about lifestyle, tobacco, diet, exercise.
There's probably a lot of links there between
how healthy someone is living and their risk
(16:29):
of getting cancer.
Are there still links in those areas that
are left to discover?
Or is it like pretty, we know that
if you eat a bad diet, don't exercise.
Let's go back to diet.
We know that obesity is linked significantly with
(16:52):
cancer and with certain cancers more than others.
So gastric cancer, pancreatic cancer, colorectal cancer, breast
cancer.
Other cancers, the link is not so much
there.
Head and neck cancer, not so much.
Even prostate cancer is not quite as clear.
But it's oftentimes less clear, is it simply
(17:13):
calories?
Is it something in the diet?
Is it time of day?
So I think there's a lot of science
that we don't really understand about some of
the broad categories which are driving cancer, even
things such as obesity.
And then I'm sure there are other things
in the environment more broadly that we don't
(17:40):
know, but probably has an impact.
And the problem is that is much more
difficult to discern because it's hard to quantify
the level of exposure.
So, you know, whether it's, so things that
we know that are carcinogenic in the laboratory
and, you know, and it's smaller doses, you
(18:01):
know, may or may not be toxic, or
they could only be toxic to people that
have a certain inherited genetic predisposition or combination
of genes.
So I do think there are other things
going on.
And that's why some of these large cohort
studies that look at zip codes and neighborhoods
and occupations, I think we'll uncover things too.
(18:25):
So hopefully an answer that gave me something.
The other thing I did want to mention
that has changed dramatically is sort of the
acceptance of lifestyle changes more broadly on the
ability to have a positive outcome on cancer
(18:48):
prevention and actually even cancer treatment.
But when I started in oncology, things like
diet and exercise, we kind of get that,
yeah, yeah, you should sort of do that.
You know, it's like, but there's really significantly
more data that can actually impact how well
(19:10):
you do on treatment, how likely your cancer
is to come back.
You know, things much more beyond simply, you
know, you feel a little better because you're
eating well and, you know, exercising some.
So I think that's important.
And also, I think the realization of the
importance of detecting cancer early and preventing it
(19:34):
is actually much more of the forefront in
people's minds than I think it might have
been, you know, 15 years ago when really
all the emphasis was on therapies.
Interesting.
So I'm going to go into both of
those things a little bit, hopefully maybe more
than a little bit.
(19:55):
But, you know, with Charity Miles, you know,
we're all trying to raise money for things
like cancer research.
And that was why I started Charity Miles
was to raise money for actually for Parkinson's
research, but also, you know, I know a
lot of our members want to raise money
for cancer research as well.
But one of the things that I kind
of, I don't know if figured out is
(20:18):
the right term, but one of the things
that I kind of came to early on
is that raising millions or billions of dollars
for something like Parkinson's or cancer is great.
But these are, you know, hundred billion dollar,
trillion dollar problems.
And there's that old saying that an ounce
of prevention is worth a pound of cure.
(20:38):
So for me, the greatest impact that I
think that we have with Charity Miles isn't
the money that we're raising, but it's the
way that we're changing our lifestyle to be
healthier, to walk more, to run more, to
eat healthier, so that we prevent, we decrease
our risk of getting something like cancer.
So I just, you know, just, but I
don't have any scientific data to back that
(20:59):
up.
What does the science say about how a
healthier lifestyle can reduce your risk of getting
something like cancer?
Yeah.
So our data overall is that about 42
to 44% of cancers are preventable by
modified behaviors and about 50% of cancer
(21:24):
deaths.
Now, a large proportion of that remains tobacco.
Right.
So that's, and then that's maybe half of
that.
The rest is diet, exercise, you know, getting
your vaccination such as HPV, which can prevent
cancer.
(21:45):
But the fact it, you know, we had
a drug that was out there that could
prevent, you know, half of cancer deaths.
If you think about it that way, prevent
44% of cancers by, you know, eating
right, minimizing alcohol, you know, exercising, not smoking,
you know, getting appropriate vaccinations.
I mean, we'd be leaping, you know, that
(22:06):
would be on every single newspaper.
And so, you know, what you're doing really
does make sense.
So, I mean, you should feel good about
it.
You're right.
The money is really important because it doesn't
take care of the other 55% or
whatever it is.
But getting people conscious of the fact that
(22:27):
they can really impact their cancer risk through
behaviors that they can largely control isn't really
an important message.
And so, just, I want to absorb that.
50% of cancer deaths and you said
40% of cancer.
Yeah, right.
Through modifiable risk factors.
(22:48):
Modifiable risk factors.
Diet, exercise, tobacco, you know, alcohol and HIV
vaccinations.
Yeah, assuming that nobody listened to this is
smoking or maybe somebody is, but I would
doubt it.
But if you're smoking, don't smoke.
What are the other modifiable behaviors would be
(23:10):
diet and exercise and what else?
Alcohol.
I mean, heavy alcohol use does lead to
cancer.
I mean, you know, I think people are
beginning to realize that obesity leads to cancer.
And, but alcohol, heavy alcohol use does increase
your cancer risk too.
So, and then, you know, if you're, you
(23:32):
know, if you're a young adult to make
sure you've had your HIV vaccinations to prevent
for women's cervical cancer and men and women,
you know, head and neck cancer.
So, so that's the other thing.
So.
And is there anything more specific on the
diet and exercise, like as far as what
you're modifying?
Yeah.
So the actual, you know, so the links
(23:56):
are closest with obesity.
So that's sort of step one.
So to have a healthy weight is the
most important, but within that, you know, particularly
looking at individual cancers, as it's called rectal
cancer and other factors, you know, the things
we've been talking about for 20 years, you
know, avoiding processed meats, you know, you know,
having, you know, you know, healthy amounts of,
(24:19):
you know, fruit and vegetables in your diet,
you know, minimizing, you know, certainly trying to
reduce, you know, processed sugars and things like
that.
You know, but folks find that much harder
to do.
You know, I think a lot of times
because, you know, so many meals an hour
eaten on the run or eaten out or,
(24:40):
you know, done through, you know, some of
the delivery services.
So, you know, whatever, you know, guidelines or
things we can do to sort of make
things easier, you know, we'd certainly be better
for folks, you know, overall.
I mean, it's sort of there.
Go ahead.
I was gonna say the obesity epidemic in
(25:00):
the country is like something that, you know,
we've sort of never seen before.
You know, it's changed so dramatically the number
of folks in the country with obesity compared
to, you know, 15 years ago.
I mean, it's really, so that's just sort
of a, you know.
Dr. Justin Marchegiani Yeah, I just saw today
a friend of mine who's also been a
(25:22):
guest on the podcast.
Also, he's also a mentor.
His name is Sammy Inconin, and he's the
founder of something called Virta Health.
I'm not sure if you've ever come across
Virta, but they have a program to reverse
type 2 diabetes through modifiable behaviors and diet.
And he posted on LinkedIn today that three
quarters of Americans are now obese.
(25:44):
Yeah, so we've only got 25% to
go with his sarcastic comment towards that.
Yeah, you know, I feel like everybody knows,
like, this is like one of those obvious
things like, there's a link between tobacco and
cancer that everybody knows.
But so why?
(26:05):
Why is this such a hard thing for
us to understand and interpret into our lifestyle?
Dr. Tim Jackson Yeah.
I mean, one thing, you know, I'm wondering,
you know, without data, so take that.
That's always hard to say.
Yeah.
You know, there are probably changes in what's
(26:28):
in our food beyond simply calories from, you
know, when I'm almost older than you, when
I was growing up.
So it's, you know, and so what are
those changes in those food due to, you
know, increase your need to continue to eat
or eat the wrong things?
It's not probably as simple to see sort
(26:51):
of this rapid increase as a fact as
we're eating so many more calories.
I think there's something else going on.
And that's why people talk about sort of
these, you know, I think you sort of
were asking about are there other things we
need to be studying, either driving cancer risk,
or maybe driving obesity risk, that is now
part of what we eat routinely, that is
(27:12):
sort of buried in the fine print and
some of the foods where we're eating as
far as processed food.
So but it's, I just don't think we're
eating four times as many calories as we
did back in the 70s.
When I was a kid, you know, it
wasn't like, you know, we're getting Twinkies and
mac and cheese.
And, you know, so it's, so the other
(27:33):
question that comes up is the impact of
things like GLP ones, you know, certainly in
combination with diet, I think that's very promising,
you know, even for cancer prevention.
So we'll have to sort of see how
that sort of plays out over time.
But Interesting.
Is there any sign like, scientific like line
(27:57):
as to what you don't want to cross
as far as obesity with regards to your
increased risk of getting cancer?
It's certainly a, it's a continuum, right?
And then I don't, at a certain point,
it probably sort of flattens out again.
(28:19):
So that I don't actually have that information
handy.
But you know, there's sort of, you know,
BMI is not obviously the greatest tool for
lots of reasons.
But you know, once people are in sort
of the obese range and a BMI, certainly
your cancer risk will go up.
So And is it, is it the obesity?
Or is it the lifestyle and the behavior
(28:41):
that, that is increasing or decreasing your chance
of cancer?
Um, certainly there are aspects of obesity that
are likely linked to driving cancer risk.
You know, things again, you know, which your
colleague would talk about to the insulin receptor
growth factor and other aspects, you know, working
through insulin, how it affects cancer, but we
(29:03):
don't really know exactly what's driving it.
So it's, what we do know is that,
you know, uh, looking at obesity and then
looking at cancer risk, there's a correlation.
And then there is some science about, you
know, what's doing it exactly, but we don't,
(29:25):
we can't say this is exactly what it
is.
We also know that exercise independent of obesity
can decrease, um, cancer risk too.
So, so if, even if weight is stable,
weight is regardless of the weight exercise by
(29:46):
itself could decrease the number of cancer diagnoses
in the country.
So there are, there are separate variables that
obviously there's an interaction as we, one would
anticipate, but there are also separate ways to
prevent cancer.
God.
So the exercise is almost the independently beneficial.
Yes.
(30:07):
Are there, are there other behaviors like sleep
or drinking water or decreased cell phone usage?
Like, are there other behaviors that are being
studied that you've seen have or have not?
So we are studying sleep right now, um,
based on some work we're actually doing with
(30:29):
sleep number, who actually develops, you know, beds,
as you know, looking at sort of our,
uh, our large, uh, cohort studies, looking at
the effect on sleep on cancer risk.
There, there's a logic to things like that
because you wind up with, you know, increased
inflammation, inflammation drives cancer.
Um, so there is a sense there.
(30:49):
Um, there, there's less data on things like
cell phone risk.
Um, and, um, what was the other question
I think you asked me about?
It was, so I was just saying drinking
water.
I mean, all of these things, I think
there's a little, I think drinking, there's really
at this point, no significant linkage between drinking
(31:11):
water and overall cancer risk.
I'm sure you probably could parse it down.
If you had almost no water and inflammation
in a bladder cancer or something, I think
potentially, but, um, but again, you know, broadly
things that increase inflammation are things that are
likely to drive cancer risk.
(31:33):
So, um, so that's kind of, and you
also will see some of that, you know,
with other sort of, you know, medical illnesses
or whatever that increase inflammation, cardiovascular disease, for
example, the same sort of risk factors you
would see for cardiovascular disease, you would see,
(31:55):
um, of inflammation would also increase your risk
in that way too.
So I've, you know, I've heard that in
other podcasts and things that I've read about
inflammation.
I don't really, what is, I think of
inflammation, like I get a bruise or I
bump my knee and like things get swollen
or I have like a stuffed nose.
(32:16):
Like my, you know, I've got, my sinuses
are inflamed.
What does that mean?
Inflammation?
And what does it mean to like lower
your inflammation?
Yeah.
So it's basically, if you think of one's
immune system, it's, it's designed to fight something
foreign.
Um, so if you have an infection, um,
(32:37):
that's why, you know, your skin turns red,
you know, it's infected because, because that's the
inflammation in your knee or your inflammation somewhere
else.
And then there are either T cells or
B cells sort of driven to that to
basically fight the infection.
So what that would mean on sort of
a, a local level is increase of cells
(33:00):
that, um, are part of the immune system
that, that operate at a different level.
And that appears to be driving, you know,
um, aspects, which increases ones, whether it's cardiovascular
disease or cancer.
So it's not as easy to sort of
quantify as we'd like to.
(33:21):
And again, the term is sort of thrown
around in a lot of ways, you know,
I think as you're perceptively noted, it's very
non-specific, but there are sort of at
least aspects of the immune system that one
can, can either see on a biopsy or
measure in the blood that shows, um, you
(33:43):
know, changes in the immune system.
So this chronic inflammation is one of the
drivers of cancer or is the chronic inflammation?
One of the symptoms It's one of the
drivers.
Yeah.
So, you know, basically, you know, if you
give an example, like if you just basically
(34:05):
took your arm and all day long, you
rubbed a stick on a day after day,
after day, after day, sort of that inflammation
over time, you know, could potentially lead you
that one area.
This is all we were talking like maybe
years ago could actually see, you could see
changes in the skin changes over time could
actually lead then to cell damage, which would
(34:27):
then increase the risk of cancer in that
area.
So again, that's sort of chronic stress, chronic
inflammation, you know, does increase the risk of,
uh, of, of cancer.
Got it.
And then, so things that reduce that chronic
inflammation, obviously reduce your chance of getting cancer.
(34:48):
Right.
So that's an exercise jumps out there, right.
You know, obviously that, that is certainly one.
Um, and then sort of the way your
body reacts to obesity, again, driven through, you
know, increased insulin levels, and then sort of
the whole metabolic pathway, um, or other aspects
(35:08):
that certainly can drive, uh, you know, cancer
risk.
So as opposed, and then you wind up
when you get, you know, carcinogens, you know,
like, like what's in tobacco, again, you want
to get inflammation, stress at those sites.
Um, and then that's not the whole reason
because you see other aspects sort of in
DNA, but that's also something else that, um,
(35:31):
you know, broadly will change your cancer risk.
Got it.
Now, one of the things that, uh, my
doctor once told me is that because I
run a lot, that the running, the impact
of the running, I can't remember if it's
sympathetic or parasympathetic or whatever that is, is
(35:51):
inflammatory.
And that it would be important for me
to balance that out with something like yoga,
which is the opposite of sympathetic or parasympathetic,
whichever one running is to kind of lower,
lower the inflammation from the running.
Is there anything that doctor just kind of
(36:12):
in general about, or is there something to
that?
I think that probably makes sense.
I mean, you know, like any sort of
exercise, it's good to have some balance in
what you're doing, you know?
Um, so whether, you know, the exact reasons
why, but I think that's certainly, you know,
(36:33):
the crossfade in the house is probably sort
of makes sense on sort of general health.
So I think there's certainly not wrong with
these, you know.
Got it.
Okay.
And then, you know, all the time in
like pop mag, you know, popular magazines or
websites or blogs, they always have like top
five foods that'll reduce your risk of getting
(36:55):
cancer, or you should eat blueberries or this
or, you know, because there's something to that
where there's like a specific food, or is
it just generally eat healthy?
I think it's generally eat healthy.
I mean, certainly there's, it's been very hard
to, so just so you know, um, clinical
(37:16):
trials for cancer prevention that have tried to
pull out what was important about the dietary,
um, about something out of the diet have
often not been particularly effective.
So, you know, whether it was vitamin E
or vitamin D.
(37:37):
Um, and so often when they were studied
for cancer prevention and even a randomized trial,
sometimes actually the vitamins led to more cancer.
So it's probably something about the foods itself
rather than something that's isolated out of the
food.
Um, you know, not in that same, you
(37:59):
know, dietary meal or combination, which I think
is sort of interesting too.
So because yeah, it's because back in the
90s and afterwards or many sort of large
cancer prevention trials looking at vitamins and, you
know, they really didn't have the results that
people would sort of hope they would have.
Got it.
So maybe let's just, uh, switch gears a
(38:21):
little bit then.
Cause the other thing that you mentioned was
early detection, right?
This seems like another no brainer to me,
right?
Cause I like the same thing, like the
link between tobacco and cancer.
Like obviously early detection seems like a positive
thing to increasing survivorship, but I guess what,
what does the science say?
(38:43):
Yeah.
Well, well, you know, I think, um, so,
so to start off with, you know, I
do think early detection is important.
I do think that early detection is the
way we're going to decrease the number of
cancer deaths.
Okay.
The issues you sometimes run into is that
first of all, the studies to show that
(39:04):
in a particularly a screening test or a
test for early detection take a long time
to show benefits.
Um, and then also, um, there's always been
a tremendous concern about, um, false positive tests
and false positives for the anxiety, for the
(39:25):
patients, for additional biopsies, and then, you know,
ultimately for cost on the system.
So the medical community, rightly, probably rightly in
some ways, probably not, maybe it's been overreaction
and then been sort of very hesitant oftentimes
to recommend, um, early detection work or screening
(39:45):
tests, unless there are large studies oftentimes that
showed, uh, an impact on how long populations
live.
And, and those studies might take 30 or
40 years, you know, depending on, and, you
know, one thing we were saying is, you
know, 600,000 people in the U S
will die this year for cancer.
(40:07):
You know, if you think about that, that's
a baseball stadium, you know, every month.
And so whatever we're doing now, you know,
isn't working well enough.
Right.
So, so we, and there's a lot of
new technologies out being studied to look at
whether blood-based testing or testing you can
be done at home or multi-cancer testing,
where you can test for multiple cancers.
(40:29):
And so we're very supportive of really diving
deeply into that science.
And, you know, when we see evidence of
true patient benefit and FDA approval to having
a pathway forward for those things to be
supported, but, um, but others are much more
cautious and really want to wait until, you
(40:49):
know, there are very large studies, you know,
which we're just concerned it's just going to
take too much time.
Kind of like, yeah, we're doing the studies,
but there's not really that much of a
downside to getting early screening and probably some
good upside.
So even before we have the data, you
might as well get screened.
(41:09):
Well, I think if we, I think we'll
need, uh, you know, what we call intermediate
end points, end points that, that shows that
there's a benefit for a patient, you know,
even before it may not have the final
data that was, um, traditionally used.
So I think, I think that's one thing
we're looking at, you know, for a patient,
(41:31):
you know, finding a cancer earlier, if it
could prevent metastatic cancer from developing, um, or
eating chemotherapy, you know, even if maybe over
time they wound up living the same amount
of length because they had a heart attack
or something else.
So, you know, and I, you know, I
think that would be important for most patients
to sort of avoid, you know, an advanced
(41:52):
cancer.
And so how to sort of quantify that
in a screenings trial, I think is something,
something we really want to take the lead
on.
So.
I never even thought of like the, what
is the risk of false positives?
What is the downside?
Like how, how often does a false positive
happen?
And then what is the real downside of
that?
(42:13):
Well, you know, so I think you bring
up a great point because I think from
a patient's perspective, many patients would be, would
be willing to take sort of the risk
of a false positive.
Um, if they knew that they could find
a true positive, which could allow them to
live a better life.
Right.
So, um, you know, a lot of times,
(42:35):
you know, women, when they have mammograms will
have something abnormal on the mammogram.
Um, they'll get a call.
Well, they need to go back for another
mammogram and then have to have a biopsy.
And that, you know, oftentimes the biopsy won't
show cancer.
And so that's sort of the, you know,
this emotional rollercoaster, you know, the pain of
(42:57):
a pain of a biopsy, the cost of
a biopsy, potentially all for something that was
not cancer.
And so if you, the more you do
screening, the more you'd have to do these
testing, you know, there's some economic aspects.
There's sort of the, you know, other aspects
of that too.
Um, when I've talked to patients, um, and,
(43:18):
you know, and embarrassing to your perspective, yes,
there was two weeks or so when they
don't know about what they have, you know,
is, is not, you know, could be incredibly
stressful.
And then assuming the economic aspects are covered
in a way, which is something we would
advocate for, for sure.
Then once, once they know they don't have
(43:39):
cancer, they've moved on, you know, right.
Right.
This is good news.
I'm glad I had to test, even though
I'm glad I don't have cancer and they're
not like dwelling on it.
Oh my God, I had to go through
a biopsy.
I didn't need.
So I think sometimes folks in the medical
scientific field are more concerned about the false
positives than, than patients are knowing the alternative
(44:01):
is maybe I found something that now can
be treated and insured that if I had
not been screened, it would have been insurable,
which is good.
Way to look at it.
So, yeah, I mean, on an individual level,
like, isn't it my call, whether or not
I want to take that assume again, assuming
that the costs are covered, which is like
a separate thing, which I would ask about
(44:22):
in a second.
But like, I could say like, look, like
I want to get screened.
The doctor be like, I don't get screened.
We, we don't want you.
We don't want to give you the chance
of a false positive.
I can be like, look, I'd rather have
the chance of a false positive sit with
that for two weeks.
And I assume like, you don't just like
get, get the test results.
You're like, Hey, you've got cancer.
We need to give you chemo today.
There's probably something like time period where they
(44:43):
do another test to confirm that.
Right.
Of course.
Well, you might, you might have a real
positive.
Yeah.
And it might be a real positive.
Yeah.
And so in this country screening tests, some
in general, some are covered you know, mammography
is covered.
(45:03):
Colon cancer is covered.
Lung cancer is covered.
Screening all within parameters that are either approved
by Medicare or through something called the U
.S. Surveillance Task Force, which is basically, you
(45:23):
know, has worked with the government.
They're not a government agency to sort of
come up with cancer guidelines.
And then based on that, there tends to
be coverage.
American society also comes up with guidelines.
Our guidelines are oftentimes before the task force
guidelines.
We were really much earlier on in reducing
(45:44):
the age when people should have, you know,
colon cancer screening from 50 to 45.
And the other thing about any screening, it's
always, we think it's really important that there
is coverage then for the next steps along
the way.
You know, if you have a mammogram, but
there's no coverage for your biopsy, it doesn't
do you any good.
(46:04):
You know, the same thing with colon rectal
cancer.
So as much as possible through that continuum,
not just simply the test itself, but what
needs to be done afterward needs to be
covered.
Otherwise, it doesn't really have value for people.
All right.
So brass tacks, what are the screenings that
people should get and when should they get
them?
So, um, so right now, so basically women
(46:30):
should have, um, first of all, we recommend
everyone receives an HPV vaccination when they're, you
know, in their early teens or even as
early as nine.
And then starting at age 25, they should
be tested for HPV.
And if they're HPV- Every year?
Every five years, if they're negative, they've been
(46:51):
vaccinated.
So again, so that's, and then basically there
are now tests that are approved for self
-collection in health systems.
And we hope at some point there'll be
approved for self-collection at home, which I
think, I think is really been proven.
Um, breast cancer, we recommend starting at age
40.
You should certainly consider having mammography.
(47:13):
Um, but certainly everybody by age 45.
And I think one thing I want to
emphasize is this is women at average risk.
So if you have an inherited genetic mutation,
or if you have a strong family history,
um, you should certainly not wait until these
guidelines.
And really over time guidelines should really be
(47:33):
precision-based or personalized, but you probably should
be screened differently.
But so then we recommend, you know, yearly
mammographies until you're age 55, and then you
can go once a year or every other
year because post-menopausal cancer tends to grow
slower.
You could go to every other year or
once a year.
(47:54):
Colorectal cancer starting at age 45, you should
undergo either a colonoscopy, the Cologuard test or
a FIT test.
FIT testing called Cologuard, which is the at
-home testing only if you're at low risk
or have never had a polyp and no
family history.
And then those tests are usually every home
test every year, essentially, while the colonoscopy will
(48:17):
depend on what the colonoscopy says.
It could be that every five years or
every 10 years.
Prostate cancer, depending on your risk, somewhere between
age 40 and 45, you should begin to
talk to your doctor about whether you should
get the blood test, the PSA test.
And then certainly, everybody by the age of
50 should be talking to their doctor about
(48:39):
the PSA test, which is simply a blood
test, which tells you your risk of cancer.
And then those who have had a history
of tobacco use, 20-pack year history, which
is, you know, calculated on number of packs
times the number of years, so one pack
a year for 20 years or 20 packs
(49:02):
for one year.
Starting at age 55 should undergo a yearly
CT scan of the lungs.
So I think those are the screening tests
that we would generally recommend and then generally
would have coverage.
But again, if you're at higher risk for
the reasons that we talked about, you certainly
(49:24):
should talk to your doctors about being screened
earlier.
And, you know, we are seeing more cancer
in folks under the age of 50.
And so people shouldn't hesitate to be seen
if something they find abnormal.
And if they're told you're too young for
cancer, go see somebody else.
How about skin cancer?
(49:45):
So skin cancer, I think we really recommend
certainly that folks who've ever had a skin
cancer should certainly, you know, be seen routinely
by a dermatologist.
We don't have, you know, hard evidence that
a routine skin examination, you know, changes outcomes.
(50:06):
But certainly it should be done at every
one of your physicals.
You certainly should be careful for yourself.
And certainly if you're at higher risk because
of family history or significant sun exposure in
the past, you know, we certainly encourage you
to talk to your doctor about that, too.
And then what do you mean by higher
risk?
And I ask this because I feel like
we're all at higher risk these days.
(50:28):
I mean, you talk about family history, you
know, with the prevalence of cancer, like who
doesn't have cancer of one sort of another
in their family.
And even today, in beautiful Montclair, New Jersey,
I'm walking around and it smells like smoke
because we've got forest fires, you know, a
little, you know, 50 miles from here, there's
some forest fires and the whole town smells
(50:48):
like smoke for three days.
So aren't we all just like living in
like a general state of elevated risk?
Well, yes, I think.
It's where there's a risk is high enough
that it would trigger the same sort of
screening test that we do for people, which
(51:11):
we are currently calling average risk.
So that would be, you know, usually it's
a first degree family member in that cancer.
You know, so your breast cancer, lung cancer,
colorectal cancer, prostate cancer.
If you know you have a mutation like
the BRCA gene or Lynch family, that increases
(51:33):
your risk.
But I think you're right.
You know, and I think it doesn't account
for most of the cancers that we know
about.
And what you really, I think, need and
what we'd want to have and one thing
is something that's really easy to just say,
should I do something that's harder to do?
(51:53):
Like if you do something at home, get
spit in the tube or swap something and
send it in and say, OK, based on
this, you should probably do a test.
That would make it easier as opposed to
everybody getting a CT scan or MRI or
something else.
And having sort of a large funnel of
something that, again, would have more false positives,
(52:14):
would be easier to do.
That would then push you down into something
that was, you know, more invasive.
So that's where we should get in screening.
Okay.
So I know we have a little bit
of time left, maybe 10 minutes.
Real quick, a lot of this sounds like
the obvious stuff.
I'm curious if you could share maybe, you
(52:36):
know, one or two of the more cutting
edge, non-obvious things that you're working on
scientifically.
Let me think about that.
So I think some of the things scientifically,
I mean, and this is, I guess, you
know, a little bit sort of the term
that's on probably every podcast is sort of
(52:58):
the A.I. word.
Okay.
But basically, but basically
using A.I. technology, when you have a
colonoscopy, we'll be able to light up the
polyps so that the doctor, when they go
through, can actually see where to go in
(53:18):
biopsy.
And so that's actually a fairly cool thing.
And also based on simply looking at your
slides from a prostate biopsy, we'll be able
to look at the slide using A.I.
technology right now and tell you whether or
not, which of your treatments you should get.
And the advantage of that is those slides
(53:40):
are all digital.
So you can be in a small rural
hospital and, you know, away from the smoke
and you can go ahead and send it
off to a tertiary center.
They can go ahead and look at that,
you know, overnight and say, based on this
characteristics, you know, if there are two treatment
options for somebody, we can tell you which
one to get.
So I think that's one thing.
(54:03):
And then we are sort of delving deeper
into doing what we call payloads that attract
the cancer cells.
So cancer cells have proteins on the outside
of the cells.
And so now there are drugs that basically
(54:23):
will recognize those proteins.
And then on the other side of the
linkers, we would say, it's attached to a
toxin, like a small little bomb.
So basically we'll be able to, we can
now actually with some cancers, infuse an IV,
something that attaches to your, a protein on
(54:47):
your cancer.
And on the other side of it is
a very specific chemotherapy or radiation or other
toxin that directly treats that cancer.
So as opposed to just getting something that
goes into your blood and it's relatively nonspecific,
this will only go to those areas where
the cancer is.
(55:08):
So, and then it can be much more
targeted and much more direct.
So those are actually in the clinic and
I think we'll, they're called ADCs.
And I think we're going to see more
of those coming out in the future.
And then we continue to do stuff on
the immune system.
(55:29):
The mRNA vaccines are going to be, are
being tested to look at ways to prevent
cancer from coming back.
So you, again, look at what we call
an epitope or something unusual to one's cancer.
You can then develop a very specific vaccine
for that cancer.
(55:50):
And then using the mRNA technology, you can
inject a patient.
And then if the cancer cells start to
come back, it immediately recognizes it.
Works much better immune system when you have
fewer cancer cells or it's more targeted.
So I think that's, again, another way through
the precision-based treatment that I think actually
has some potential to have some impact.
(56:13):
That's exciting.
Well, I appreciate you sharing so much with
us and I very much am grateful for
the work that you and everyone at ACS
is doing to lead the charge here.
Are there any kind of final calls to
action that you want to make to the
(56:33):
people walking and running with us right now?
Yeah.
I mean, I think, first of all, I
think it's really important that you sort of
look at your own lifestyle and know that
you can actually change things that have an
impact.
I think that's really important.
Things you talked about, modify risk factors.
(56:54):
Again, be aware that cancer is really multiple
diseases, not just lung cancer, breast cancer, but
within those.
And that because of that, it's probably unlikely
we're going to have sort of one treatment
to treat everything.
But we are becoming much better at targeted
therapies for these individual cancers within a cancer.
(57:18):
And I think that's where we're going to
have our greatest impact.
And then, get screened.
Do what you need to do.
Don't be afraid to get the test and
be aware.
If you find something earlier on, it's much
more likely to be treated, much more likely
to have a good outcome and to live
a sort of normal life.
And I'm a big cyclist, so do whatever
(57:40):
you need to do.
Yeah, I was going to ask about that.
I forgot to ask about your cycling.
Whatever you'd like to do to make you
happy and it definitely will really improve your
own quality of life.
Do you have any big cycling events coming
up?
I forgot to ask.
It's getting a little cold for that in
the East Coast.
(58:02):
The last one I did, we did a
century, maybe about a month or so ago
in Virginia in Fredericksburg.
So that's not so bad.
And then we do a couple with ACS
has a couple of nice ones.
One, I don't know if you do any
cycling, they do a real nice one from
Philadelphia to the Atlantic City area.
(58:22):
They block up the road.
You go over the Ben Franklin Bridge early
in the morning.
Pretty easy rolling road.
It's the bike-a-thon there.
And then some big events in the rest
of the country.
So I do one in Ohio over four
days, which is pretty fun too.
Is that the Pelotonia that you do in
Ohio?
We certainly work with the folks in Pelotonia.
This is called the Pan-Ohio Ride, which
(58:42):
is actually a four-day ride.
Incredibly well supported.
And it's funny, when everyone's riding for cancer,
it has a different feel because everybody's been
touched by it.
So if any of your listeners want a
great bike ride, look for the Pan-Ohio
Ride, which goes from Cleveland to Cincinnati.
So you get to see parts of Ohio
(59:04):
you probably didn't know existed.
Excellent.
Well, thank you so much, Dr. Dahut, for
everything that you're doing, for being so generous
with your time today, as you're sharing so
much with us.
For everyone out there walking or running along
with us, I hope that you enjoy this
as much as I do.
Every mile matters.
(59:25):
Thank you, Dr. Dahut.
Thanks a lot.
I appreciate having you on today.
Take care.
All right.
Have a great day.
Come on, Gene.
Bye.
Thank you so much.
Yeah, that was great.
That was fun.
Yeah, reach out anytime with any questions you
have.
I should know.
We're going to try to get this up
on Monday.
Okay, sounds good.
Have a great day.
Appreciate it.
Take care.
Bye.
Hello, Dr. Dayhut.
I think you're on mute.
You can hear me?
(00:51):
Hello, Dr. Dayhut.
I can hear you okay.
Can you
(01:49):
see me okay?
Yeah, sure can.
How are you?
I'm well, thanks.
Nice to see you.
Thank you for joining.
Sure.
And where are you?
I'm in the great state of New Jersey.
How about you?
Yeah, I'm in the free state of Maryland,
so our weather is probably pretty similar.
What part of Maryland?
Bethesda.
Very nice.
(02:11):
I was supposed to go down to Annapolis
this week to see my father-in-law,
but we're not making it down there this
week.
We're going to go to the Navy game,
but unfortunately, can't do it.
But thank you for joining.
Yeah, I'm actually giving a talk at Navy
next week, as a matter of fact.
(02:32):
And I was in the Navy.
You were in the Navy?
Yeah.
Okay, excellent.
Well, that might be something to talk about.
So, leaf blower instructor on by me.
So, we're recording now, if that's okay with
you?
Yeah, of course.
Yeah.
Excellent.
Yeah, I'd like to just kind of jump
into it and start, if you wouldn't mind,
(02:55):
describing where it is that you're walking right
now in Bethesda for all the people who
are walking or running along with us right
now.
So, I'm in Bethesda, Maryland, which is a
suburb outside Washington, D.C. It's about a
mile and a half from NIH, about a
mile and a half from Bethesda Navy Hospital.
(03:16):
It's a neighborhood called Edgemoor, which was built
in 1915, 1820, and typical suburban neighborhood.
Very nice.
Yeah, I'm in a similar neighborhood, Montclair, New
Jersey, suburb of New York City, I think
(03:36):
very similar to Bethesda.
And beautiful day here.
So, hopefully you're having a good walk.
And then the next question is to just
introduce yourself to everybody who's walking and running
along with us right now.
Yeah, so I'm Bill Dahut.
I'm the chief scientific officer of the American
Cancer Society.
I'm a medical oncologist.
(03:57):
I spent most of my career at the
NIH, so that's why I'm in Bethesda.
And in my role at ACS, I oversee
all of our research, which includes our extramural
grant funding, our fellowship program, and then our
intramural program, which is, we have one large
cohort studies, we look at, we develop guidelines,
(04:19):
we come up with what we call our
cancer facts and figures, programs, and we have
journals.
So, it's a good position.
Thank you.
All right.
If you don't mind, I usually don't do
any editing on this, but you broke up
a lot in there.
It got a little weird with the reception.
Okay.
So, would you mind just saying that again?
(04:40):
Sure, sure.
Yes.
And let me know if we're breaking up
at all.
So, my name is Bill Dahut.
I'm the chief scientific officer for the American
Cancer Society.
And in that role, I oversee both our
extramural research, which is our grant funding.
We're the largest non-profit funder of cancer
(05:00):
research outside the U.S. government.
A large program of fellows in the pre
-doctoral space.
And we also have intramural research program, which
is largely housed in Atlanta, which includes our
very large cohort studies, our work, which we
look at population-based information out of a
(05:20):
public available database, such as our cancer facts
and figures.
We run our guidelines work in our journals.
And I'm a medical oncologist who spent most
of my career at NIH.
I focus largely there on prostate cancer in
my own research career.
Wow.
So, are you mostly a research doctor or
like a practicing oncologist that, you know, patients
(05:42):
would say?
So, I'm a physician.
And in my career, almost all the work
I did was running clinical trials.
So, when you're at NIH, every patient you
see there is on a research study.
So, all my work was research, but most
of it was patient touching.
(06:05):
Excellent.
And you might maybe share a little bit
of your journey as to how you became
an oncologist and or why you became an
oncologist and then how that led you to
the American Cancer Society.
Yeah, sure.
You know, it's sort of interesting.
So, I went to school in Georgetown, grew
up in Washington, D.C. area.
(06:26):
Actually grew up not too far from here,
went to high school about two miles from
here.
So, it's all kind of a small world,
as they say.
But my first medical school rotation when I
was at Georgetown as a first year student,
I got assigned to oncology.
I didn't even know what that word meant.
I actually had to look it up in
my dictionary what oncology meant.
(06:49):
You were a med student and didn't know
what oncology was yet?
Yeah, I was only been there for maybe
six weeks.
And, you know, this is like, this is
the late 80s.
And I don't think people use the word
oncology.
Like, you know, it's kind of funny now.
It's such a common term.
But I bet if you went back and.
(07:09):
You know, so, you know, it just wasn't
a term that people use, you know, so
it's pretty amazing.
Right.
So so I looked it up and sort
of the long and short of it, the
Navy was paying for medical school for me.
So as part of my time, I was
at Bethesda Naval Hospital and they had a
(07:29):
combined program with the National Cancer Institute or
actually.
And so for me, I think I was
really attracted to taking care of patients with
more serious illnesses where and oncologists have a
very special relationship with patients because because the
focus is on their cancer during that during
(07:51):
that time period.
So so I think that attracted that profession
to me in a way, you know, different
than some other fields.
And then I became involved in prostate cancer
almost purely by chance.
I was going back to Georgetown as a
faculty member after my Navy payback was done,
planning on doing some work in lung cancer.
(08:12):
And then the person I was going to
replace decided not to leave.
So they said, you want to do prostate
cancer?
And I sort of thought about it and
said, sure, why not?
Because I had done some fellow and, you
know, there was very little available for patients
with prostate cancer back.
This was the mid 90s.
So so that's kind of so I think
(08:33):
I think it tells you that, you know,
that career paths are not linear.
You know, a lot of we work with
a lot of our young trainees and other
folks and so much of their life has
been linear.
You know, high school, you take the right
courses, they get the right college, you volunteer
over the summer, you go to medical school.
But having that flexibility to do things a
(08:55):
little different is, you know, makes life much
more interesting.
Right.
So, you know, I'm really excited to speak
with you today because I know that, you
know, I do a lot of miles for
ACS and other cancer organizations.
I know a lot of our members are
walking for ACS and other cancer organizations.
(09:16):
And, you know, how often does an ordinary
person like me get to ask about all
the cutting edge research an organization like ACS
is helping to support and that all of
our miles are supporting?
So can you maybe what does it mean
to be the chief scientific officer of an
(09:37):
organization like ACS?
And what are some of the exciting research
that you guys are doing and supporting?
Yeah, so I think, first of all, it's
what's really nice about being at ACS is
the way we get to work with so
many other great organizations, you know, such as
yours, but also, you know, scientific partners, other
(09:58):
foundations, other nonprofits.
So I think that's that's a one nice
thing about having, you know, such kind of
a, you know, I say the words overused,
but an iconic branch, shall I say.
And so my role is really to to
really create a scientific vision for what we're
doing.
And, you know, I've given this some thought.
(10:21):
And ultimately, what we are research is kind
of breaks down into four major categories.
So innovative ways of finding new cancer mechanisms.
So that's really discovering new targets, new drugs,
new ways to treat patients.
Better ways for cancer outcomes and survivorship.
(10:41):
So we know there's over 2 million people
being diagnosed with cancer every year.
Many of them will then become cancer survivors.
So it's really important to really understand their
journey in a way that wasn't thought of
it in, I think, in years past.
A lot of work on really training the
scientists of tomorrow today, because so many folks
(11:05):
are going to have really their, you know,
their most inspirational ideas early in their career.
But funding and other and other barriers right
now is making things much more complicated.
So we're really committed to that space.
And then a lot of time and effort
about the science of cancer early detection, cancer
(11:28):
prevention, and cancer recurrence, because I really think
that's a spot that ACS is particularly strong
in, because we have the ability to study
the science, study the new technologies, come up
with the guidelines.
And then, you know, the fact that we
have an advocacy arm finds ways that folks
have it covered, and ultimately find ways that
(11:49):
it can be implemented in the patients.
So, so much more emphasis, I think, on
that part of the spectrum, that maybe traditionally
was not.
How long have you been the chief science
officer of ACS?
Or how long have you been with ACS?
So it's the same answer to the question.
A little over two years now, actually about
two and a half years before, you know,
(12:12):
so it was May of 2022.
Got it.
And ACS, how old is ACS?
It's about 111 years old.
111 years old.
Yeah, so they were there before I got
there, to put it that way.
Right.
Yeah.
So I'm curious, like, how has science or
the science that ACS is doing changed in
(12:34):
111 years?
If you know that, if you can think
about the way that ACS has approached the
science of cancer in 111 years?
Well, I think probably better thinking back, maybe,
you know, we'll bite off the last 50
years anyway.
Okay.
And interesting, ACS was really the first organization
(12:55):
to come up with doing peer review on
science.
You know, I mean, so it's so part
of our vernacular now, that, you know, peer
reviewed research.
And, you know, you know, being on a
scientist, you know, having served, you know, reviewed
multiple, multiple grants, put grants in, it's so
much of our life.
But ACS really was really some of the
(13:15):
first folks to come up with that, that
NIH and others sort of modeled after it.
And then the other thing, some things we're
doing are somewhat similar, are these large cohort
studies.
So ACS will follow folks, large numbers of
folks, prior to having a cancer diagnosis, and
(13:36):
then following them for 30 or 40 or
50 years, to understand what's really driving cancer.
And actually, their first cohort studies was in
the 1950s.
It was only in men, only in white
men.
And it was really looking at a link
between tobacco and lung cancer.
And in three years, they found the link.
(13:58):
And then the leaders of the study, which
were all men, all smokers, switched to pipes,
because they thought that one actually was a
good one.
But, you know, and so over time, we've
enrolled over a million and a half people
on these cohort studies, and currently have just
(14:18):
launched our newest, which will be 100,000
black women.
So that part hasn't, you know, it's something
we've done.
And we've always had a focus also on
young investigators.
We have funded 53 Nobel Prize winners.
Three were awarded this year.
Almost all were early on in their careers.
(14:41):
Almost all were people who said, you know,
ACS took a chance on me when nobody
else would, because I think the fact that
we're interested in funding, you know, innovation, which
isn't always funded in traditional funding sources, because
people tend to be concerned about doing things
that are sort of a little bit less
traditional.
You know, obviously, things are deeper in basic
(15:04):
science.
I think there's a much greater bond between
basic science and the clinic than there used
to be that used to be separated significantly.
We now know finding discoveries in cancer can
much more quickly impact patients.
When I started in training, there was a
huge gap between what happened in the laboratory
(15:24):
and what happened in the clinic.
So I think that's changed significantly.
And then the fact on the immune system.
I mean, the fact that we have immune
-based treatments that are curing people with diseases
that were fatal in months in the past
is something else that is really markedly, markedly
different.
I'm not sure how to ask this question.
(15:44):
It's probably not going to come out right.
But when you think about that example that
you gave of the tobacco detection or the
link between tobacco and cancer and how that
was discovered in three years, you didn't need
30 years to discover that link.
That one came pretty quick.
I think maybe we've gotten to a point,
(16:05):
although I don't know, that a lot of
the obvious links for cancer would be kind
of obvious to a layperson like me in
the way that I've heard of the word
oncology.
I would think about lifestyle, tobacco, diet, exercise.
There's probably a lot of links there between
how healthy someone is living and their risk
(16:29):
of getting cancer.
Are there still links in those areas that
are left to discover?
Or is it like pretty, we know that
if you eat a bad diet, don't exercise.
Let's go back to diet.
We know that obesity is linked significantly with
(16:52):
cancer and with certain cancers more than others.
So gastric cancer, pancreatic cancer, colorectal cancer, breast
cancer.
Other cancers, the link is not so much
there.
Head and neck cancer, not so much.
Even prostate cancer is not quite as clear.
But it's oftentimes less clear, is it simply
(17:13):
calories?
Is it something in the diet?
Is it time of day?
So I think there's a lot of science
that we don't really understand about some of
the broad categories which are driving cancer, even
things such as obesity.
And then I'm sure there are other things
in the environment more broadly that we don't
(17:40):
know, but probably has an impact.
And the problem is that is much more
difficult to discern because it's hard to quantify
the level of exposure.
So, you know, whether it's, so things that
we know that are carcinogenic in the laboratory
and, you know, and it's smaller doses, you
(18:01):
know, may or may not be toxic, or
they could only be toxic to people that
have a certain inherited genetic predisposition or combination
of genes.
So I do think there are other things
going on.
And that's why some of these large cohort
studies that look at zip codes and neighborhoods
and occupations, I think we'll uncover things too.
(18:25):
So hopefully an answer that gave me something.
The other thing I did want to mention
that has changed dramatically is sort of the
acceptance of lifestyle changes more broadly on the
ability to have a positive outcome on cancer
(18:48):
prevention and actually even cancer treatment.
But when I started in oncology, things like
diet and exercise, we kind of get that,
yeah, yeah, you should sort of do that.
You know, it's like, but there's really significantly
more data that can actually impact how well
(19:10):
you do on treatment, how likely your cancer
is to come back.
You know, things much more beyond simply, you
know, you feel a little better because you're
eating well and, you know, exercising some.
So I think that's important.
And also, I think the realization of the
importance of detecting cancer early and preventing it
(19:34):
is actually much more of the forefront in
people's minds than I think it might have
been, you know, 15 years ago when really
all the emphasis was on therapies.
Interesting.
So I'm going to go into both of
those things a little bit, hopefully maybe more
than a little bit.
(19:55):
But, you know, with Charity Miles, you know,
we're all trying to raise money for things
like cancer research.
And that was why I started Charity Miles
was to raise money for actually for Parkinson's
research, but also, you know, I know a
lot of our members want to raise money
for cancer research as well.
But one of the things that I kind
of, I don't know if figured out is
(20:18):
the right term, but one of the things
that I kind of came to early on
is that raising millions or billions of dollars
for something like Parkinson's or cancer is great.
But these are, you know, hundred billion dollar,
trillion dollar problems.
And there's that old saying that an ounce
of prevention is worth a pound of cure.
(20:38):
So for me, the greatest impact that I
think that we have with Charity Miles isn't
the money that we're raising, but it's the
way that we're changing our lifestyle to be
healthier, to walk more, to run more, to
eat healthier, so that we prevent, we decrease
our risk of getting something like cancer.
So I just, you know, just, but I
don't have any scientific data to back that
(20:59):
up.
What does the science say about how a
healthier lifestyle can reduce your risk of getting
something like cancer?
Yeah.
So our data overall is that about 42
to 44% of cancers are preventable by
modified behaviors and about 50% of cancer
(21:24):
deaths.
Now, a large proportion of that remains tobacco.
Right.
So that's, and then that's maybe half of
that.
The rest is diet, exercise, you know, getting
your vaccination such as HPV, which can prevent
cancer.
(21:45):
But the fact it, you know, we had
a drug that was out there that could
prevent, you know, half of cancer deaths.
If you think about it that way, prevent
44% of cancers by, you know, eating
right, minimizing alcohol, you know, exercising, not smoking,
you know, getting appropriate vaccinations.
I mean, we'd be leaping, you know, that
(22:06):
would be on every single newspaper.
And so, you know, what you're doing really
does make sense.
So, I mean, you should feel good about
it.
You're right.
The money is really important because it doesn't
take care of the other 55% or
whatever it is.
But getting people conscious of the fact that
(22:27):
they can really impact their cancer risk through
behaviors that they can largely control isn't really
an important message.
And so, just, I want to absorb that.
50% of cancer deaths and you said
40% of cancer.
Yeah, right.
Through modifiable risk factors.
(22:48):
Modifiable risk factors.
Diet, exercise, tobacco, you know, alcohol and HIV
vaccinations.
Yeah, assuming that nobody listened to this is
smoking or maybe somebody is, but I would
doubt it.
But if you're smoking, don't smoke.
What are the other modifiable behaviors would be
(23:10):
diet and exercise and what else?
Alcohol.
I mean, heavy alcohol use does lead to
cancer.
I mean, you know, I think people are
beginning to realize that obesity leads to cancer.
And, but alcohol, heavy alcohol use does increase
your cancer risk too.
So, and then, you know, if you're, you
(23:32):
know, if you're a young adult to make
sure you've had your HIV vaccinations to prevent
for women's cervical cancer and men and women,
you know, head and neck cancer.
So, so that's the other thing.
So.
And is there anything more specific on the
diet and exercise, like as far as what
you're modifying?
Yeah.
So the actual, you know, so the links
(23:56):
are closest with obesity.
So that's sort of step one.
So to have a healthy weight is the
most important, but within that, you know, particularly
looking at individual cancers, as it's called rectal
cancer and other factors, you know, the things
we've been talking about for 20 years, you
know, avoiding processed meats, you know, you know,
having, you know, you know, healthy amounts of,
(24:19):
you know, fruit and vegetables in your diet,
you know, minimizing, you know, certainly trying to
reduce, you know, processed sugars and things like
that.
You know, but folks find that much harder
to do.
You know, I think a lot of times
because, you know, so many meals an hour
eaten on the run or eaten out or,
(24:40):
you know, done through, you know, some of
the delivery services.
So, you know, whatever, you know, guidelines or
things we can do to sort of make
things easier, you know, we'd certainly be better
for folks, you know, overall.
I mean, it's sort of there.
Go ahead.
I was gonna say the obesity epidemic in
(25:00):
the country is like something that, you know,
we've sort of never seen before.
You know, it's changed so dramatically the number
of folks in the country with obesity compared
to, you know, 15 years ago.
I mean, it's really, so that's just sort
of a, you know.
Dr. Justin Marchegiani Yeah, I just saw today
a friend of mine who's also been a
(25:22):
guest on the podcast.
Also, he's also a mentor.
His name is Sammy Inconin, and he's the
founder of something called Virta Health.
I'm not sure if you've ever come across
Virta, but they have a program to reverse
type 2 diabetes through modifiable behaviors and diet.
And he posted on LinkedIn today that three
quarters of Americans are now obese.
(25:44):
Yeah, so we've only got 25% to
go with his sarcastic comment towards that.
Yeah, you know, I feel like everybody knows,
like, this is like one of those obvious
things like, there's a link between tobacco and
cancer that everybody knows.
But so why?
(26:05):
Why is this such a hard thing for
us to understand and interpret into our lifestyle?
Dr. Tim Jackson Yeah.
I mean, one thing, you know, I'm wondering,
you know, without data, so take that.
That's always hard to say.
Yeah.
You know, there are probably changes in what's
(26:28):
in our food beyond simply calories from, you
know, when I'm almost older than you, when
I was growing up.
So it's, you know, and so what are
those changes in those food due to, you
know, increase your need to continue to eat
or eat the wrong things?
It's not probably as simple to see sort
(26:51):
of this rapid increase as a fact as
we're eating so many more calories.
I think there's something else going on.
And that's why people talk about sort of
these, you know, I think you sort of
were asking about are there other things we
need to be studying, either driving cancer risk,
or maybe driving obesity risk, that is now
part of what we eat routinely, that is
(27:12):
sort of buried in the fine print and
some of the foods where we're eating as
far as processed food.
So but it's, I just don't think we're
eating four times as many calories as we
did back in the 70s.
When I was a kid, you know, it
wasn't like, you know, we're getting Twinkies and
mac and cheese.
And, you know, so it's, so the other
(27:33):
question that comes up is the impact of
things like GLP ones, you know, certainly in
combination with diet, I think that's very promising,
you know, even for cancer prevention.
So we'll have to sort of see how
that sort of plays out over time.
But Interesting.
Is there any sign like, scientific like line
(27:57):
as to what you don't want to cross
as far as obesity with regards to your
increased risk of getting cancer?
It's certainly a, it's a continuum, right?
And then I don't, at a certain point,
it probably sort of flattens out again.
(28:19):
So that I don't actually have that information
handy.
But you know, there's sort of, you know,
BMI is not obviously the greatest tool for
lots of reasons.
But you know, once people are in sort
of the obese range and a BMI, certainly
your cancer risk will go up.
So And is it, is it the obesity?
Or is it the lifestyle and the behavior
(28:41):
that, that is increasing or decreasing your chance
of cancer?
Um, certainly there are aspects of obesity that
are likely linked to driving cancer risk.
You know, things again, you know, which your
colleague would talk about to the insulin receptor
growth factor and other aspects, you know, working
through insulin, how it affects cancer, but we
(29:03):
don't really know exactly what's driving it.
So it's, what we do know is that,
you know, uh, looking at obesity and then
looking at cancer risk, there's a correlation.
And then there is some science about, you
know, what's doing it exactly, but we don't,
(29:25):
we can't say this is exactly what it
is.
We also know that exercise independent of obesity
can decrease, um, cancer risk too.
So, so if, even if weight is stable,
weight is regardless of the weight exercise by
(29:46):
itself could decrease the number of cancer diagnoses
in the country.
So there are, there are separate variables that
obviously there's an interaction as we, one would
anticipate, but there are also separate ways to
prevent cancer.
God.
So the exercise is almost the independently beneficial.
Yes.
(30:07):
Are there, are there other behaviors like sleep
or drinking water or decreased cell phone usage?
Like, are there other behaviors that are being
studied that you've seen have or have not?
So we are studying sleep right now, um,
based on some work we're actually doing with
(30:29):
sleep number, who actually develops, you know, beds,
as you know, looking at sort of our,
uh, our large, uh, cohort studies, looking at
the effect on sleep on cancer risk.
There, there's a logic to things like that
because you wind up with, you know, increased
inflammation, inflammation drives cancer.
Um, so there is a sense there.
(30:49):
Um, there, there's less data on things like
cell phone risk.
Um, and, um, what was the other question
I think you asked me about?
It was, so I was just saying drinking
water.
I mean, all of these things, I think
there's a little, I think drinking, there's really
at this point, no significant linkage between drinking
(31:11):
water and overall cancer risk.
I'm sure you probably could parse it down.
If you had almost no water and inflammation
in a bladder cancer or something, I think
potentially, but, um, but again, you know, broadly
things that increase inflammation are things that are
likely to drive cancer risk.
(31:33):
So, um, so that's kind of, and you
also will see some of that, you know,
with other sort of, you know, medical illnesses
or whatever that increase inflammation, cardiovascular disease, for
example, the same sort of risk factors you
would see for cardiovascular disease, you would see,
(31:55):
um, of inflammation would also increase your risk
in that way too.
So I've, you know, I've heard that in
other podcasts and things that I've read about
inflammation.
I don't really, what is, I think of
inflammation, like I get a bruise or I
bump my knee and like things get swollen
or I have like a stuffed nose.
(32:16):
Like my, you know, I've got, my sinuses
are inflamed.
What does that mean?
Inflammation?
And what does it mean to like lower
your inflammation?
Yeah.
So it's basically, if you think of one's
immune system, it's, it's designed to fight something
foreign.
Um, so if you have an infection, um,
(32:37):
that's why, you know, your skin turns red,
you know, it's infected because, because that's the
inflammation in your knee or your inflammation somewhere
else.
And then there are either T cells or
B cells sort of driven to that to
basically fight the infection.
So what that would mean on sort of
a, a local level is increase of cells
(33:00):
that, um, are part of the immune system
that, that operate at a different level.
And that appears to be driving, you know,
um, aspects, which increases ones, whether it's cardiovascular
disease or cancer.
So it's not as easy to sort of
quantify as we'd like to.
(33:21):
And again, the term is sort of thrown
around in a lot of ways, you know,
I think as you're perceptively noted, it's very
non-specific, but there are sort of at
least aspects of the immune system that one
can, can either see on a biopsy or
measure in the blood that shows, um, you
(33:43):
know, changes in the immune system.
So this chronic inflammation is one of the
drivers of cancer or is the chronic inflammation?
One of the symptoms It's one of the
drivers.
Yeah.
So, you know, basically, you know, if you
give an example, like if you just basically
(34:05):
took your arm and all day long, you
rubbed a stick on a day after day,
after day, after day, sort of that inflammation
over time, you know, could potentially lead you
that one area.
This is all we were talking like maybe
years ago could actually see, you could see
changes in the skin changes over time could
actually lead then to cell damage, which would
(34:27):
then increase the risk of cancer in that
area.
So again, that's sort of chronic stress, chronic
inflammation, you know, does increase the risk of,
uh, of, of cancer.
Got it.
And then, so things that reduce that chronic
inflammation, obviously reduce your chance of getting cancer.
(34:48):
Right.
So that's an exercise jumps out there, right.
You know, obviously that, that is certainly one.
Um, and then sort of the way your
body reacts to obesity, again, driven through, you
know, increased insulin levels, and then sort of
the whole metabolic pathway, um, or other aspects
(35:08):
that certainly can drive, uh, you know, cancer
risk.
So as opposed, and then you wind up
when you get, you know, carcinogens, you know,
like, like what's in tobacco, again, you want
to get inflammation, stress at those sites.
Um, and then that's not the whole reason
because you see other aspects sort of in
DNA, but that's also something else that, um,
(35:31):
you know, broadly will change your cancer risk.
Got it.
Now, one of the things that, uh, my
doctor once told me is that because I
run a lot, that the running, the impact
of the running, I can't remember if it's
sympathetic or parasympathetic or whatever that is, is
(35:51):
inflammatory.
And that it would be important for me
to balance that out with something like yoga,
which is the opposite of sympathetic or parasympathetic,
whichever one running is to kind of lower,
lower the inflammation from the running.
Is there anything that doctor just kind of
(36:12):
in general about, or is there something to
that?
I think that probably makes sense.
I mean, you know, like any sort of
exercise, it's good to have some balance in
what you're doing, you know?
Um, so whether, you know, the exact reasons
why, but I think that's certainly, you know,
(36:33):
the crossfade in the house is probably sort
of makes sense on sort of general health.
So I think there's certainly not wrong with
these, you know.
Got it.
Okay.
And then, you know, all the time in
like pop mag, you know, popular magazines or
websites or blogs, they always have like top
five foods that'll reduce your risk of getting
(36:55):
cancer, or you should eat blueberries or this
or, you know, because there's something to that
where there's like a specific food, or is
it just generally eat healthy?
I think it's generally eat healthy.
I mean, certainly there's, it's been very hard
to, so just so you know, um, clinical
(37:16):
trials for cancer prevention that have tried to
pull out what was important about the dietary,
um, about something out of the diet have
often not been particularly effective.
So, you know, whether it was vitamin E
or vitamin D.
(37:37):
Um, and so often when they were studied
for cancer prevention and even a randomized trial,
sometimes actually the vitamins led to more cancer.
So it's probably something about the foods itself
rather than something that's isolated out of the
food.
Um, you know, not in that same, you
(37:59):
know, dietary meal or combination, which I think
is sort of interesting too.
So because yeah, it's because back in the
90s and afterwards or many sort of large
cancer prevention trials looking at vitamins and, you
know, they really didn't have the results that
people would sort of hope they would have.
Got it.
So maybe let's just, uh, switch gears a
(38:21):
little bit then.
Cause the other thing that you mentioned was
early detection, right?
This seems like another no brainer to me,
right?
Cause I like the same thing, like the
link between tobacco and cancer.
Like obviously early detection seems like a positive
thing to increasing survivorship, but I guess what,
what does the science say?
(38:43):
Yeah.
Well, well, you know, I think, um, so,
so to start off with, you know, I
do think early detection is important.
I do think that early detection is the
way we're going to decrease the number of
cancer deaths.
Okay.
The issues you sometimes run into is that
first of all, the studies to show that
(39:04):
in a particularly a screening test or a
test for early detection take a long time
to show benefits.
Um, and then also, um, there's always been
a tremendous concern about, um, false positive tests
and false positives for the anxiety, for the
(39:25):
patients, for additional biopsies, and then, you know,
ultimately for cost on the system.
So the medical community, rightly, probably rightly in
some ways, probably not, maybe it's been overreaction
and then been sort of very hesitant oftentimes
to recommend, um, early detection work or screening
(39:45):
tests, unless there are large studies oftentimes that
showed, uh, an impact on how long populations
live.
And, and those studies might take 30 or
40 years, you know, depending on, and, you
know, one thing we were saying is, you
know, 600,000 people in the U S
will die this year for cancer.
(40:07):
You know, if you think about that, that's
a baseball stadium, you know, every month.
And so whatever we're doing now, you know,
isn't working well enough.
Right.
So, so we, and there's a lot of
new technologies out being studied to look at
whether blood-based testing or testing you can
be done at home or multi-cancer testing,
where you can test for multiple cancers.
(40:29):
And so we're very supportive of really diving
deeply into that science.
And, you know, when we see evidence of
true patient benefit and FDA approval to having
a pathway forward for those things to be
supported, but, um, but others are much more
cautious and really want to wait until, you
(40:49):
know, there are very large studies, you know,
which we're just concerned it's just going to
take too much time.
Kind of like, yeah, we're doing the studies,
but there's not really that much of a
downside to getting early screening and probably some
good upside.
So even before we have the data, you
might as well get screened.
(41:09):
Well, I think if we, I think we'll
need, uh, you know, what we call intermediate
end points, end points that, that shows that
there's a benefit for a patient, you know,
even before it may not have the final
data that was, um, traditionally used.
So I think, I think that's one thing
we're looking at, you know, for a patient,
(41:31):
you know, finding a cancer earlier, if it
could prevent metastatic cancer from developing, um, or
eating chemotherapy, you know, even if maybe over
time they wound up living the same amount
of length because they had a heart attack
or something else.
So, you know, and I, you know, I
think that would be important for most patients
to sort of avoid, you know, an advanced
(41:52):
cancer.
And so how to sort of quantify that
in a screenings trial, I think is something,
something we really want to take the lead
on.
So.
I never even thought of like the, what
is the risk of false positives?
What is the downside?
Like how, how often does a false positive
happen?
And then what is the real downside of
that?
(42:13):
Well, you know, so I think you bring
up a great point because I think from
a patient's perspective, many patients would be, would
be willing to take sort of the risk
of a false positive.
Um, if they knew that they could find
a true positive, which could allow them to
live a better life.
Right.
So, um, you know, a lot of times,
(42:35):
you know, women, when they have mammograms will
have something abnormal on the mammogram.
Um, they'll get a call.
Well, they need to go back for another
mammogram and then have to have a biopsy.
And that, you know, oftentimes the biopsy won't
show cancer.
And so that's sort of the, you know,
this emotional rollercoaster, you know, the pain of
(42:57):
a pain of a biopsy, the cost of
a biopsy, potentially all for something that was
not cancer.
And so if you, the more you do
screening, the more you'd have to do these
testing, you know, there's some economic aspects.
There's sort of the, you know, other aspects
of that too.
Um, when I've talked to patients, um, and,
(43:18):
you know, and embarrassing to your perspective, yes,
there was two weeks or so when they
don't know about what they have, you know,
is, is not, you know, could be incredibly
stressful.
And then assuming the economic aspects are covered
in a way, which is something we would
advocate for, for sure.
Then once, once they know they don't have
(43:39):
cancer, they've moved on, you know, right.
Right.
This is good news.
I'm glad I had to test, even though
I'm glad I don't have cancer and they're
not like dwelling on it.
Oh my God, I had to go through
a biopsy.
I didn't need.
So I think sometimes folks in the medical
scientific field are more concerned about the false
positives than, than patients are knowing the alternative
(44:01):
is maybe I found something that now can
be treated and insured that if I had
not been screened, it would have been insurable,
which is good.
Way to look at it.
So, yeah, I mean, on an individual level,
like, isn't it my call, whether or not
I want to take that assume again, assuming
that the costs are covered, which is like
a separate thing, which I would ask about
(44:22):
in a second.
But like, I could say like, look, like
I want to get screened.
The doctor be like, I don't get screened.
We, we don't want you.
We don't want to give you the chance
of a false positive.
I can be like, look, I'd rather have
the chance of a false positive sit with
that for two weeks.
And I assume like, you don't just like
get, get the test results.
You're like, Hey, you've got cancer.
We need to give you chemo today.
There's probably something like time period where they
(44:43):
do another test to confirm that.
Right.
Of course.
Well, you might, you might have a real
positive.
Yeah.
And it might be a real positive.
Yeah.
And so in this country screening tests, some
in general, some are covered you know, mammography
is covered.
(45:03):
Colon cancer is covered.
Lung cancer is covered.
Screening all within parameters that are either approved
by Medicare or through something called the U
.S. Surveillance Task Force, which is basically, you
(45:23):
know, has worked with the government.
They're not a government agency to sort of
come up with cancer guidelines.
And then based on that, there tends to
be coverage.
American society also comes up with guidelines.
Our guidelines are oftentimes before the task force
guidelines.
We were really much earlier on in reducing
(45:44):
the age when people should have, you know,
colon cancer screening from 50 to 45.
And the other thing about any screening, it's
always, we think it's really important that there
is coverage then for the next steps along
the way.
You know, if you have a mammogram, but
there's no coverage for your biopsy, it doesn't
do you any good.
(46:04):
You know, the same thing with colon rectal
cancer.
So as much as possible through that continuum,
not just simply the test itself, but what
needs to be done afterward needs to be
covered.
Otherwise, it doesn't really have value for people.
All right.
So brass tacks, what are the screenings that
people should get and when should they get
them?
So, um, so right now, so basically women
(46:30):
should have, um, first of all, we recommend
everyone receives an HPV vaccination when they're, you
know, in their early teens or even as
early as nine.
And then starting at age 25, they should
be tested for HPV.
And if they're HPV- Every year?
Every five years, if they're negative, they've been
(46:51):
vaccinated.
So again, so that's, and then basically there
are now tests that are approved for self
-collection in health systems.
And we hope at some point there'll be
approved for self-collection at home, which I
think, I think is really been proven.
Um, breast cancer, we recommend starting at age
40.
You should certainly consider having mammography.
(47:13):
Um, but certainly everybody by age 45.
And I think one thing I want to
emphasize is this is women at average risk.
So if you have an inherited genetic mutation,
or if you have a strong family history,
um, you should certainly not wait until these
guidelines.
And really over time guidelines should really be
(47:33):
precision-based or personalized, but you probably should
be screened differently.
But so then we recommend, you know, yearly
mammographies until you're age 55, and then you
can go once a year or every other
year because post-menopausal cancer tends to grow
slower.
You could go to every other year or
once a year.
(47:54):
Colorectal cancer starting at age 45, you should
undergo either a colonoscopy, the Cologuard test or
a FIT test.
FIT testing called Cologuard, which is the at
-home testing only if you're at low risk
or have never had a polyp and no
family history.
And then those tests are usually every home
test every year, essentially, while the colonoscopy will
(48:17):
depend on what the colonoscopy says.
It could be that every five years or
every 10 years.
Prostate cancer, depending on your risk, somewhere between
age 40 and 45, you should begin to
talk to your doctor about whether you should
get the blood test, the PSA test.
And then certainly, everybody by the age of
50 should be talking to their doctor about
(48:39):
the PSA test, which is simply a blood
test, which tells you your risk of cancer.
And then those who have had a history
of tobacco use, 20-pack year history, which
is, you know, calculated on number of packs
times the number of years, so one pack
a year for 20 years or 20 packs
(49:02):
for one year.
Starting at age 55 should undergo a yearly
CT scan of the lungs.
So I think those are the screening tests
that we would generally recommend and then generally
would have coverage.
But again, if you're at higher risk for
the reasons that we talked about, you certainly
(49:24):
should talk to your doctors about being screened
earlier.
And, you know, we are seeing more cancer
in folks under the age of 50.
And so people shouldn't hesitate to be seen
if something they find abnormal.
And if they're told you're too young for
cancer, go see somebody else.
How about skin cancer?
(49:45):
So skin cancer, I think we really recommend
certainly that folks who've ever had a skin
cancer should certainly, you know, be seen routinely
by a dermatologist.
We don't have, you know, hard evidence that
a routine skin examination, you know, changes outcomes.
(50:06):
But certainly it should be done at every
one of your physicals.
You certainly should be careful for yourself.
And certainly if you're at higher risk because
of family history or significant sun exposure in
the past, you know, we certainly encourage you
to talk to your doctor about that, too.
And then what do you mean by higher
risk?
And I ask this because I feel like
we're all at higher risk these days.
(50:28):
I mean, you talk about family history, you
know, with the prevalence of cancer, like who
doesn't have cancer of one sort of another
in their family.
And even today, in beautiful Montclair, New Jersey,
I'm walking around and it smells like smoke
because we've got forest fires, you know, a
little, you know, 50 miles from here, there's
some forest fires and the whole town smells
(50:48):
like smoke for three days.
So aren't we all just like living in
like a general state of elevated risk?
Well, yes, I think.
It's where there's a risk is high enough
that it would trigger the same sort of
screening test that we do for people, which
(51:11):
we are currently calling average risk.
So that would be, you know, usually it's
a first degree family member in that cancer.
You know, so your breast cancer, lung cancer,
colorectal cancer, prostate cancer.
If you know you have a mutation like
the BRCA gene or Lynch family, that increases
(51:33):
your risk.
But I think you're right.
You know, and I think it doesn't account
for most of the cancers that we know
about.
And what you really, I think, need and
what we'd want to have and one thing
is something that's really easy to just say,
should I do something that's harder to do?
(51:53):
Like if you do something at home, get
spit in the tube or swap something and
send it in and say, OK, based on
this, you should probably do a test.
That would make it easier as opposed to
everybody getting a CT scan or MRI or
something else.
And having sort of a large funnel of
something that, again, would have more false positives,
(52:14):
would be easier to do.
That would then push you down into something
that was, you know, more invasive.
So that's where we should get in screening.
Okay.
So I know we have a little bit
of time left, maybe 10 minutes.
Real quick, a lot of this sounds like
the obvious stuff.
I'm curious if you could share maybe, you
(52:36):
know, one or two of the more cutting
edge, non-obvious things that you're working on
scientifically.
Let me think about that.
So I think some of the things scientifically,
I mean, and this is, I guess, you
know, a little bit sort of the term
that's on probably every podcast is sort of
(52:58):
the A.I. word.
Okay.
But basically, but basically
using A.I. technology, when you have a
colonoscopy, we'll be able to light up the
polyps so that the doctor, when they go
through, can actually see where to go in
(53:18):
biopsy.
And so that's actually a fairly cool thing.
And also based on simply looking at your
slides from a prostate biopsy, we'll be able
to look at the slide using A.I.
technology right now and tell you whether or
not, which of your treatments you should get.
And the advantage of that is those slides
(53:40):
are all digital.
So you can be in a small rural
hospital and, you know, away from the smoke
and you can go ahead and send it
off to a tertiary center.
They can go ahead and look at that,
you know, overnight and say, based on this
characteristics, you know, if there are two treatment
options for somebody, we can tell you which
one to get.
So I think that's one thing.
(54:03):
And then we are sort of delving deeper
into doing what we call payloads that attract
the cancer cells.
So cancer cells have proteins on the outside
of the cells.
And so now there are drugs that basically
(54:23):
will recognize those proteins.
And then on the other side of the
linkers, we would say, it's attached to a
toxin, like a small little bomb.
So basically we'll be able to, we can
now actually with some cancers, infuse an IV,
something that attaches to your, a protein on
(54:47):
your cancer.
And on the other side of it is
a very specific chemotherapy or radiation or other
toxin that directly treats that cancer.
So as opposed to just getting something that
goes into your blood and it's relatively nonspecific,
this will only go to those areas where
the cancer is.
(55:08):
So, and then it can be much more
targeted and much more direct.
So those are actually in the clinic and
I think we'll, they're called ADCs.
And I think we're going to see more
of those coming out in the future.
And then we continue to do stuff on
the immune system.
(55:29):
The mRNA vaccines are going to be, are
being tested to look at ways to prevent
cancer from coming back.
So you, again, look at what we call
an epitope or something unusual to one's cancer.
You can then develop a very specific vaccine
for that cancer.
(55:50):
And then using the mRNA technology, you can
inject a patient.
And then if the cancer cells start to
come back, it immediately recognizes it.
Works much better immune system when you have
fewer cancer cells or it's more targeted.
So I think that's, again, another way through
the precision-based treatment that I think actually
has some potential to have some impact.
(56:13):
That's exciting.
Well, I appreciate you sharing so much with
us and I very much am grateful for
the work that you and everyone at ACS
is doing to lead the charge here.
Are there any kind of final calls to
action that you want to make to the
(56:33):
people walking and running with us right now?
Yeah.
I mean, I think, first of all, I
think it's really important that you sort of
look at your own lifestyle and know that
you can actually change things that have an
impact.
I think that's really important.
Things you talked about, modify risk factors.
(56:54):
Again, be aware that cancer is really multiple
diseases, not just lung cancer, breast cancer, but
within those.
And that because of that, it's probably unlikely
we're going to have sort of one treatment
to treat everything.
But we are becoming much better at targeted
therapies for these individual cancers within a cancer.
(57:18):
And I think that's where we're going to
have our greatest impact.
And then, get screened.
Do what you need to do.
Don't be afraid to get the test and
be aware.
If you find something earlier on, it's much
more likely to be treated, much more likely
to have a good outcome and to live
a sort of normal life.
And I'm a big cyclist, so do whatever
(57:40):
you need to do.
Yeah, I was going to ask about that.
I forgot to ask about your cycling.
Whatever you'd like to do to make you
happy and it definitely will really improve your
own quality of life.
Do you have any big cycling events coming
up?
I forgot to ask.
It's getting a little cold for that in
the East Coast.
(58:02):
The last one I did, we did a
century, maybe about a month or so ago
in Virginia in Fredericksburg.
So that's not so bad.
And then we do a couple with ACS
has a couple of nice ones.
One, I don't know if you do any
cycling, they do a real nice one from
Philadelphia to the Atlantic City area.
(58:22):
They block up the road.
You go over the Ben Franklin Bridge early
in the morning.
Pretty easy rolling road.
It's the bike-a-thon there.
And then some big events in the rest
of the country.
So I do one in Ohio over four
days, which is pretty fun too.
Is that the Pelotonia that you do in
Ohio?
We certainly work with the folks in Pelotonia.
This is called the Pan-Ohio Ride, which
(58:42):
is actually a four-day ride.
Incredibly well supported.
And it's funny, when everyone's riding for cancer,
it has a different feel because everybody's been
touched by it.
So if any of your listeners want a
great bike ride, look for the Pan-Ohio
Ride, which goes from Cleveland to Cincinnati.
So you get to see parts of Ohio
(59:04):
you probably didn't know existed.
Excellent.
Well, thank you so much, Dr. Dahut, for
everything that you're doing, for being so generous
with your time today, as you're sharing so
much with us.
For everyone out there walking or running along
with us, I hope that you enjoy this
as much as I do.
Every mile matters.
(59:25):
Thank you, Dr. Dahut.
Thanks a lot.
I appreciate having you on today.
Take care.
All right.
Have a great day.
Come on, Gene.
Bye.
Thank you so much.
Yeah, that was great.
That was fun.
Yeah, reach out anytime with any questions you
have.
I should know.
We're going to try to get this up
on Monday.
Okay, sounds good.
Have a great day.
Appreciate it.
Take care.
Bye.
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