Welcome back to Two Doctors Tell the Truth with Dr. Richman and Dr. Fiorillo — your trusted, no-BS source for real medical insights. In this first episode of our two-part cancer screening special, we take a deep dive into some of the most talked-about new cancer detection tests, separating fact from fiction to help you make informed decisions that could literally save your life.
🎙️ In this episode, we cover:
✅ Cologuard: An FDA-approved stool DNA test for colon cancer. Is it really as good as a colonoscopy?
🧪 GRAIL (Galleri Test): A $950 blood test claiming to detect 50+ cancers — but is it accurate or just anxiety-inducing?
🧲 Whole Body MRI: The trendy full-body scan some swear by. Is it worth it or just clever marketing?
Dr. Richman and Dr. Fiorillo — both board-certified surgeons — share data-backed analysis, personal experiences, and practical advice on how to approach cancer screening wisely, without falling into the trap of expensive and potentially misleading tests.
👀 Spoiler: Just because a test exists doesn’t mean it’s worth doing. Learn about false positives, downstream costs, and when you should stick with time-tested, evidence-based screening tools.
👉 Stay tuned for Part 2, where we’ll break down the standard, FDA-approved screenings like mammograms, colonoscopies, and PSA tests — and tell you which ones are non-negotiable.
📌 Subscribe to stay updated on real, unfiltered health advice — because when it comes to your health…
The truth does matter.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
Good morning, everybody.
This is Dr.
Michael Richmond, and I'm withmy friend and colleague, Dr.
Fiorello.
Good morning.
And we are so excited because,like I said, We've done some
podcasts already and we'vetouched on heart disease and
seed oil.
And yes, we're going to do a lotof topical things.
(00:21):
To me, our goal in Two DoctorsTell the Truth is ultimately,
can we make an impact and can wesave your life?
And today we're going to betalking, we're going to do a
two-part podcast.
And today we're going to talkabout The newer screening tests
for cancer, one of them is FDAapproved and two of them are not
(00:43):
FDA approved.
Specifically, we're going to betalking about the Galeri test,
which is a type of blood test, awhole body MRI.
We're going to reference Prenuvoand then Coligard, which
everybody knows is on thosecommercials and is embarrassed
about.
box and send it back, hopingyour UPS guy doesn't know what's
(01:04):
in it.
And then our subsequent podcast,which will be next week, will be
on What is standard guidelinesfor mammography, for
colonoscopy, for prostate cancerscreening?
What is time-tested, proven, andaccepted?
And I'm excited today, and so isMike, because as we're both
board-certified generalsurgeons, before I became a
(01:26):
cardiothoracic surgeon andbefore Mike became a plastic
surgeon, we know this stuff.
And we're providing you now withreal medical information, right?
SPEAKER_01 (01:35):
Yeah, and when I think about wellness and I think
about what we're trying to dohere and cut through, like we
said originally, cut through allthe nonsense and try and give
you stuff that really works,people tell me all the time,
hey, I'm going for a full bodyMRI, or hey, I just did this
blood test, it came backnegative, I don't have cancer.
And we started with heartdisease.
You know why?
(01:55):
It's number one killer, right?
We hopefully helped you a littlebit understanding your heart and
lipids and tests and that stuff.
Now we're gonna move on tocancer.
That's number two killer.
Right, exactly.
And I think, just like you said,one in three plots in the
cemetery is someone died fromheart disease.
I think we all know someonewho's either had cancer or has
died of cancer.
So what can we do screening-wiseto help figure out if you should
(02:21):
be doing these tests notpreventative and we'll touch on
a little bit more about that wealready covered a little bit
with fasting but we'll try andbasically go into these
screening tests and i think thefirst one why don't we start
with the colo guard because thatone is fda
SPEAKER_00 (02:37):
approved
SPEAKER_01 (02:39):
okay yeah and that's a really interesting one so you
want to kick it off with colorguard
SPEAKER_00 (02:43):
yeah Okay, I just want to give just some
statistics just because I thinkit's important.
So in 2024, there were so farthe data is two million one one
thousand and forty nine newcancer diagnosis okay and the
deaths were approximately sixhundred and forty thousand okay
(03:04):
and like we said there are ninehundred just under a million
cardiovascular deaths cancer'sstill substantial so six hundred
and forty thousand people aredying a year of cancer and the
number one cancer deaths in bothsexes is lung cancer okay it's
not The most in women, breastcancer is still more common than
(03:24):
lung cancer, but the number onekiller is lung cancer.
Okay.
And colon cancer is right upthere.
So Cologuard is an FDA approvedtest for people over 45 or at
average risk.
And what does that mean?
Average risk?
Average risk means you have nofamily history.
And you have no, as Mike knows,there are diseases that
(03:50):
predispose you.
So if you have ulcerativecolitis, predisposes you to
colon cancer.
Or if you have a familialsyndrome, in other words, do you
have what's called familialpolyposis, which is multiple
polyps in your family.
Okay, so a person who is ataverage risk, Cologuard.
And what they're doing isthey're doing a, basically
(04:11):
they're checking your, poop,you're giving them a poop sample
for tumor DNA and blood.
And it's phenomenally accurate.
It's been validated in multipleclinical studies and we'll give
you numbers in a sec.
So Cologuard to me, just so youknow, according to guidelines,
say for traditional colonoscopy,your first colonoscopy, unless
(04:34):
you have one of these high-risksituation, it should be at 45.
And by the
SPEAKER_01 (04:39):
way, they lowered that too, right?
So it used to be at 50.
They lowered it to 45.
And I will say, my brother's aGI doctor, so we talk about this
all the time.
He's seeing it in younger andyounger people.
And this is something, and Iknow a few people that died from
it, unfortunately, young.
And this is something that couldbe preventable, could be caught
(05:01):
early.
So the earlier, the better youget tested.
45 with no family history, getit done.
And the colonoscopy, everyone'safraid of it for some reason.
I get it, right?
But I've done two of them now.
It's really not bad.
The prep is so much easier thanit used to be.
And a little twilight anesthesiaand
SPEAKER_00 (05:25):
you're done.
I think we'll get into more ofthat on Monday, but we're
just...
Yeah, Monday, I guess it is.
But today, I just want to reallymore focus on the Cologuard.
Correct.
And so insurance pays.
I've had two of them.
Insurance pays, and they're doneevery three years as long as
(05:46):
they're negative.
Insurance pays 100% for them ifyou're above 45.
It's an accepted screening test.
But I also think Cologuard isnot expensive.
Let's say you're under 45.
and you're just a worried personand you're low risk, remember,
if you're low risk.
Yeah.
I think you can have it done,okay?
So there's a new Cologuard Plus,which is phenomenal.
(06:10):
Cologuard, aside from picking upcancers and the numbers, I can
give you the new Cologuard Plusnumbers because Mike and I
believe in precision.
So the Cologuard Plus, so in allstages, of one through four
colon cancer, the true positiverate is 95%.
(06:31):
The true negative rate is 94%.
So colonoscopy, the truepositive rate is 95%, okay?
So basically it's as good ascolonoscopy for low risk people,
okay?
Now, yeah, so those are peopleover 45.
(06:51):
So now if you take the subgroupof 45 to 59-year-olds, remember,
of all ages, it's 100%sensitivity.
So in other words, if it'spositive, you have colon cancer,
okay?
And the negative rate is 94%.
But what's great about the testis it also can find high-grade
(07:12):
dysplasia, which is precancer in73% of people.
So if it's positive, 73% chanceyou have colon cancer.
a high-grade dysplasia.
And if it's negative, you cancount on a 87% that you don't
have high-grade dysplasia and a99% that you don't have cancer,
(07:34):
okay?
SPEAKER_01 (07:34):
Would you, what are your thoughts on someone that is
just, because I know a lot ofpeople like this that just don't
want to get a colonoscopy at alland they're just doing this
test.
Would you say at some point youneed at least one colonoscopy?
SPEAKER_00 (07:46):
Yeah, my personal opinion, so I just had one a
couple months ago.
And mine was, and I think peopleneed to always, I think as
surgeons, it's not that we'reignorant because we know it's
more out of fear because to bequite honest with you, like
nobody's going to bullshit Mikeand I, like we know nobody's
(08:09):
going to say to you or me, don'tyou agree?
If you have stage four coloncancer, all is going to be well.
So doctors are horrible becausethey, It was like, I don't want
to know.
I've had two negative Cologuardsthree years apart.
I'm good.
I'm good.
My fear is that we're seeing,Mike and I aren't old, but we're
(08:31):
seeing colon cancer now advancedstage in 20-year-olds.
SPEAKER_01 (08:35):
Yeah, it's getting younger for some reason.
SPEAKER_00 (08:37):
It's, do I think everybody, I think that if you
ask Mike's brother and you askguys that are colorectal
surgeons, they're down forCologuards every three years,
but they also think if you havea net...
If you have a negativecolonoscopy, guidelines say
every 10 years.
That's guidelines.
I don't know.
(08:57):
But I think in the interim, Iwould feel comfortable getting
Cologards every three years.
Yeah, you
SPEAKER_01 (09:02):
know what?
And I totally agree with that.
And we agree on that.
And I think common sense woulddictate, get your first
colonoscopy at 45.
Can it pick up some other stuffthat...
Cologuard can't likediverticulitis or any sort of
diverticulosis and any sort ofabnormalities and maybe a polyp
(09:23):
that a Cologuard wouldn't pickup.
Yes.
And then they tell you, okay,you're good.
Come back in 10 years.
And if you want to be more of apreventative person and you say,
okay, I'm going to do twoCologuards in between, I think
that's reasonable.
SPEAKER_00 (09:37):
I think that's reasonable.
Such great advice, because atthe end of the day, Cola Guard
has been validated.
They have the Cola Guard Plus.
If it's negative, you can feelgood on this, that it's
negative.
And
SPEAKER_01 (09:50):
FDA approved, covered by your insurance.
So basically, we're fans of ColaGuard, and we support it.
SPEAKER_00 (09:58):
Correct.
All right.
Next topic.
Next topic, Galeri.
So Mike and I have differentfeelings.
Galeri...
is a blood test and what it ismade by a company called Grail.
And what it is, is it's a bloodtest where they're looking for
50 different types of cancer bydetecting circulating tumor DNA.
(10:24):
So in other words, the premiseis that tumor sheds DNA and by
checking it in your blood,you're gonna be able to pick up
cancer early.
Now, remember, all this stuff,it's not preventative, okay?
It's for early detection, okay?
(10:44):
The only thing that'spreventative-
SPEAKER_01 (10:46):
And it's not FDA approved.
SPEAKER_00 (10:48):
Right.
The only thing we, like we justtalked about with Coligard,
Coligard does have apreventative aspect because it's
going to pick up a certainnumber of- Sorry, my golden
retrievers, guys.
It's going to pick up a certainnumber of- pre malignant cancers
polyps in the colon.
(11:09):
Okay, so this stuff is strictlynot preventative.
It's early detection.
Okay, yes.
So what are your feelings aboutthe Larry from a standpoint of
should people have it?
And if you think they shouldhave it?
What are the limitations in yourmind?
SPEAKER_01 (11:29):
I'm on the fence on this one, not just because it's
not FDA approved.
Yes, we want to detect cancerearly, but I think there's some
things you have to understandwith this test.
So this particular one is$950,so there's a cost there.
If that's an issue, there's acost.
It's not covered by insurancelike Cologuard.
The other thing is...
SPEAKER_00 (11:50):
Tell people why that is, though.
It's not
SPEAKER_01 (11:53):
FDA approved.
SPEAKER_00 (11:54):
Right.
But I think it's important totell people why is stuff not get
FDA approved?
And it's because there is norobust evidence to show that it
works and it hasn't beenvalidated in clinical trials,
specifically with the Galarian.
Then I'll let Mike finish.
The initial trial with I'll talkabout was conducted by the
(12:16):
company.
And you always have to be leeryof studies.
SPEAKER_01 (12:19):
Right.
A paid study.
Here's the thing, too.
I'm all for early detection likewe all are, right?
So you'd say, wait, great, thisis great idea, right?
Let me take a blood test.
And if I catch something early,right?
Oral scare, pancreatic is thebig one.
They're all big, but let mecatch it early, right?
I'm all for that.
However, if you're going to dothis test, you have to
(12:40):
understand that there's issueswith it.
For example, the false positiveand the false negative.
It's not extremely accuratepicking up an early stage
cancer.
So you could fool yourself andhave a sense of false security.
Hey, I did the galerium, good.
And then maybe not follow up.
(13:00):
Time gets away from all of us.
And then two, three years later,you're like, oh yeah, I did a
glaring.
I'm negative.
You forget it was three yearsago.
Like we all do.
You forget when you hadsomething done and then
something's growing in there andyou're going to ignore it.
You might have a pain and say,it's probably nothing.
I did a glaring.
So that's one thing.
The other thing too, is thefalse positive.
SPEAKER_00 (13:20):
Yeah.
So you want me to say, so thetrial.
that gave everybody pause.
So this is technology that isestablished.
So if you have a solid tumordiagnosed, A good percentage of
solid tumors, the standard ofcare is what you get, which is
called a liquid biopsy.
(13:42):
You found a company calledFoundation One does it or
Guardant and Guardant 360.
It looks at 360 genes.
And that's for people who'vealready been diagnosed with
cancer.
And it's to see, do you have anactionable mutation?
In other words, do you have amutation that you would use
targeted therapy or do you haveyou hear on TV with Keytruda,
(14:04):
like they mentioned PD-L1.
Do you have PD-L1?
Do you need immunotherapy?
So it tells you what subtype youhave, and then it guides
therapy, okay?
That's standard of care.
Now, that doesn't mean thateverybody gets it, depending on
where you live in the country.
So this is doing it.
It's a liquid biopsy looking forcirculate, and then they use an
(14:25):
AI-generated model.
So the trial, which kind of blewit and gave everybody pause was
called pathfinder which was doneby grail paid for the false
positive rate was 62 percent wayunacceptable yes and the true
positive rate was 38 okay wayhigh okay so a lot of
SPEAKER_01 (14:49):
unnecessary anxiety is going to come with that for
sure
SPEAKER_00 (14:52):
and downstream testing and downstream testing
so unnecessary testing Mikeknows so let's talk about it the
data shows that for okay let'stalk what cancers it's not going
to show blood cancers or limbit's not going to show lymphomas
or things like that buteverybody worries about
(15:13):
pancreatic cancer and withadvanced stage pancreatic cancer
tumor DNA is only found in theblood, even with garlic, like 30
something percent of the time.
So with early stage cancer andmost early stage cancers don't
shed tumor.
Okay.
So
SPEAKER_01 (15:33):
I'm going to pick
SPEAKER_00 (15:34):
it up.
Okay.
So the point is to pick it upearly.
So let's say you have a Galaritest and it's a, it says
negative.
I just told you what the, whatthe true negative rate is.
Are you going to feel good?
And the answer's no.
You're going to say to yourself,I don't know if I have early
stage cancer.
I have no clue if I have earlystage cancer.
(15:56):
So then they went on to do whatwas called the STRIVE study, and
which is really weird to me.
There were 100,000 peopleenrolled in the completion date,
which was in 2022.
But the completed finalcompletion date was in April of
2024.
And they didn't report theirresults and there's nothing when
(16:17):
it was done by grail, which istelling you this is different
than being done in Columbia or.
UCLA, or wherever male clinicwhere they're going to report
the data.
Either way, true or false this,the company can.
Keep the data quiet, so theyhaven't published a thing.
There's no,
SPEAKER_01 (16:34):
I feel like.
It's an exciting field.
And I'm hoping that this isgoing to be the future.
I'm hoping they're going to beable to go in and get a blood
test and feel really good aboutit.
It almost seems like they jumpedthe gun a little bit.
And when people ask me, should Ido it?
It's hard for me to say no,because has Galeri probably
saved someone's life somewhere?
Yeah, it probably has.
(16:55):
But is it a really superaccurate and great test?
No.
So I think you have to know thatgoing in that you could, lead to
a lot of unnecessary anxietyunnecessary testing and it could
also give you a false hope thathey i don't have cancer and
maybe you do maybe you have acancer growing in your body and
(17:15):
then galeri did not pick it upso listen if you want to spend
the 950 dollars i'll never tellyou not to do it
SPEAKER_00 (17:22):
but let's talk about though like upstream costs so
let's say as we just said So you
SPEAKER_01 (17:28):
go in, you do it, and it comes back positive.
You say, shit, I might havepancreatic cancer.
Now you're flipped out.
You're thinking you're going tobe dead in six months.
So now what do you do?
SPEAKER_00 (17:37):
Remember, insurance isn't going to approve anything,
okay, on the basis of, oh, Ihave a positive galeria because
it's not even FDA approved.
So for the general...
SPEAKER_01 (17:48):
So now you're going to go see a cancer doc or a GI
or whoever, right?
SPEAKER_00 (17:52):
Right.
He's going to tell you...
There's no basis, okay?
Doctor, I want something done.
Okay, then I'll order you a CTscan of your abdomen.
You're going to have to pay outof pocket.
Now, your average person can'tafford it.
And let's remember, there's dataout.
I just wrote a paper on it.
(18:13):
Repeated.
CT scans, actually, there's93,000 cases of cancer diagnosed
each year from unnecessaryT-scanning, okay?
So are you going to go get a CTscan of your abdomen just
because you have positivegalerias?
No.
You may say yes, but it's notpractical.
Are you going to go get anultrasound of your abdomen?
I guess that's fine.
(18:33):
It's cheap.
But you understand what thepoint is.
This could be thousands ofdollars out of your pocket.
and a road to nowhere and theanxiety level is through the
roof
SPEAKER_01 (18:46):
yeah oh yeah for sure
SPEAKER_00 (18:48):
for sure so
SPEAKER_01 (18:49):
now couldn't but potentially still has a certain
degree that there could besomething there you could
potentially save someone's lifeso that's the hard part i have
is not telling someone no sosomeone went and it turns out
they did have a small pancreaticcancer in their pancreas and it
was found and somehow resectedand they were cured from it
SPEAKER_00 (19:08):
but still remember It doesn't justify, like, one
person, if advanced, and we'rejust taking pancreatic cancer
here, okay?
SPEAKER_01 (19:18):
Unless you're that person.
SPEAKER_00 (19:21):
But if you have an advanced cancer, stage three or
stage four pancreatic cancer,where you're done with anyways,
you're already having symptoms.
You're not getting the gallery.
But if it only sheds tumor 34%of the time, I can't give you a
number, but in stage one orstage two, maybe 10%.
two or 3% of the time.
Okay.
(19:42):
Like to me, it's not a, it's notan acceptable test.
SPEAKER_01 (19:45):
Yeah.
It's not a great, it's not agreat test, but I'm struggling
because I know a lot of peoplethat do it every six months and
I'm struggling to tell someonedon't do it.
I really am because as long asyou know, all this, we just told
you going in and you're finewith it.
Okay.
And you have the resources thendo it.
SPEAKER_00 (20:04):
Right.
And if you can deal with theanxiety, And that doesn't mean
becoming dependent on Xanax orAtivan to get through the next
year or two because you can'tdeal with the anxiety and you
become some maniac like on thisnever-ending quest to find out
what it is because, believe me,there are plenty of cancers.
(20:25):
And Mike and I can tell you thatWe never find out the primary.
Okay.
They have metastatic disease.
They have stage four and we cannever find out the primary.
And it's like, it'll come backto the pathology of a lymph node
GI cancer.
So we know it's somewhere in theGI tract with all these
(20:46):
limitations.
So I'm not a gallery guy.
I think it's too soon.
But it's
SPEAKER_01 (20:52):
exciting.
It is exciting, and I think it'sonly going to get better.
It's going to get better withAI, and it's going to get
better.
I think they jumped the gun alittle bit, but it's here, and
no buyer beware, like we say forother stuff.
All right, good.
I think we did a good job onthat.
Okay, our last one.
SPEAKER_00 (21:11):
Our last one is whole body MRI.
Which
SPEAKER_01 (21:13):
is very interesting to me as well.
I also know a lot of people thatdo that as well.
And there's a lot of companiesout there now that do this.
Dr.
Richmond, should I go and get afull body MRI?
SPEAKER_00 (21:25):
No.
So first, and I'm just usingPronova because they have a lot
of money.
So they've done tremendousmarketing.
They've hired a lot ofcelebrities.
They've offered me actually, ifI would be a spokesman being a
double board certified surgeonto get a free one.
And if I promote it and I justcan't.
(21:45):
So let's talk about whole bodyMRI.
What are the limitations?
So whole body MRI, justremember, this is just a
screening test.
Again, it will miss the majorityof breast cancers.
Correct.
Okay.
Especially if there's densebreasts, it will miss most
(22:08):
thyroid cancers.
Now, am I that concerned aboutthyroid cancers?
Not really because the majorityof thyroid cancers are curable
or treatable.
It'll miss the majority ofcolorectal cancers.
Okay.
It'll miss the majority ofesophageal cancers, diffuse
gastric.
(22:28):
It'll miss melanomas on theskin.
Okay.
Exactly.
Unless you have the reason whyit's not fda approved because
there is currently no robustevidence to support its use and
this is from good clinicaltrials for there's no robust
evidence to support its use forroutine screening okay and what
(22:54):
we're going to talk about now onour next podcast the u.s
preventative task force says youwant to do stuff where there's
robust evidence you domammography If you have an
extensive smoking history, youdo low-dose chest CT scanning
every year, you do PSA testing,and you do colonoscopy.
And we're going to talk aboutthose, okay?
Because there's robust evidence.
(23:16):
And, oh, and furthermore, thiswill miss early small prostate
cancers, okay?
So we've given you a bunch thatit'll miss because even though
guys are like, no, I heard MRI,the prostate is fantastic.
it's a different type of MRI.
It's called multi-parametric MRIfor prostate cancer.
(23:37):
So for all those reasons, again,it leads to, it's expensive, but
it leads to an unacceptably highlevel of downstream testing.
And yes.
And we
SPEAKER_01 (23:50):
can say the same thing that we just said on the
Galeri, anxiety, Okay, so youpick up a two millimeter nodule
in your lung, which is a goodchance it's benign and it's
always been there.
And now you're like flippingout.
You might have to get a lungbiopsy or further testing on
that.
So that's a problem as well.
That's the same thing we talkedabout before, right?
SPEAKER_00 (24:13):
Yeah, this kind of troubles me.
So this is imaging.
Okay, so you can see it.
So let's I'll give you twoexamples.
And Mike, you have a littleteeny solid tumor in the head of
the pancreas.
I'm not going to get into it,but there's something now that's
accepted.
We have out here at USC andHogue Hospital in Newport, the
(24:35):
largest registry of what'scalled IPMNs, which are
intrapapillary mucinousneoplasms of the pancreas.
And they're actually beingpicked up more.
And we used to do surgeryautomatically, if you see.
So it's a little tumor connectedto the duct.
We used to do what's called theWhipple procedure or distal
(24:57):
pancreatectomy.
Automatically, the majority ofthem are benign.
It's a massive surgery.
Okay, massive surgery.
So you see a little teeny tumorthere that most of them can be
needle biopsied, but let's saythis one can't be.
Okay, let's say it's in a placewhere they just can't get to it.
(25:18):
Are you prepared to sit withyourself that good chance it's
not pancreatic cancer, slightchance it may be, or are you
going to go have a Whipple whichaffects the quality of your life
forever and find out it'sbenign?
I'm not.
Are you?
SPEAKER_01 (25:35):
no no and that's the limitation of this as well right
so i'm more in the wellnessspace than you are so i'm people
ask me all the time and i know alot of people doing this right
so once again cost about 2500from what i've seen i've seen up
to 4 000 but i think 2500 seemsto be where it's at and then
false negatives and falsepositives and the thing that
(25:57):
always got me on this is i do itokay so i go in i get it done
and then i leave there I don'tthink I'm feeling as good as I
should because you think, okay,they didn't find anything.
Okay.
What happens if one, they misssomething or two, it starts
growing.
Like the day I leave the nextday, it's growing.
And I'm saying to myself, okay,because everything else, right?
(26:18):
When's the last time you everlooked back and say, oh, when's
the last time I did something?
And you look back and it was twoyears ago and you thought it was
six months ago.
Now, all of a sudden you'reignoring something because you
say, oh, I have a total bodyMRI.
It's nothing there.
is a false sense of security aswell.
And then you still need all theother tests.
So once again, for me, when Itell someone don't do it because
(26:40):
has it saved someone's life?
Yes, I'm sure it has.
I'm
SPEAKER_00 (26:43):
sure.
Absolutely.
SPEAKER_01 (26:44):
Yeah.
So I'm sure they picked upsomething and hey, save my life.
Okay.
That's great.
I love it.
So for the 1% of chance, There'sno radiation.
If you're okay paying the fee,then go ahead and do it.
But once again, just like theGaleri, understand that you
could have missed a lot ofthings, and you can't be 100%,
(27:06):
of course, as we said, but alsoit may lead to costly tests and
unnecessary surgeries, which ithas, too.
So you have to put
SPEAKER_00 (27:14):
this...
And it misses the numberthree...
colorectal cancers so you'regoing to still need a
colonoscopy yes like we saidit's going to miss breast
cancers regardless of i know wehear a lot of people who have
pancreatic cancer it'sincreasing but it's still
considered a rare disease okaythere's what i tell you like 63
(27:37):
000 new cases of pancreaticcancer a year in the united
states it may sound like a lotbut that's not a lot Okay?
That's not a lot of cancers.
SPEAKER_01 (27:46):
It's a lot if you get it or your loved one gets
it, of course.
SPEAKER_00 (27:49):
Exactly.
That's what makes thisinteresting.
Listen, here's the bottom line.
The other thing is, I don'tknow.
I never looked this up.
So MRIs, there's newer MRIs thatyou can go in if you have
foreign bodies or if you have apacemaker.
So in other words, if you've hadan artificial hip or you have
something metallic, a heartvalve, you can't go in an MRI
(28:10):
and you see how they always askyou.
Or if you have a pacemaker.
I don't know.
if these whole body MRIs are,you're able to go in if you have
a metallic form body.
I didn't look at it.
I'm thinking no, okay.
Probably
SPEAKER_01 (28:25):
no, correct.
SPEAKER_00 (28:27):
Because there's not a lot of places that do have
those machines.
They're becoming more common,but they're using
SPEAKER_01 (28:35):
it.
Here's the bottom line, right?
These tests are available.
And we can get them ourselves,right?
We're doctors.
I have not done any of thethree.
So I haven't done Cologuard,although I would do it, but I
get colonoscopies regularly.
I haven't done the Galeri, whichI could definitely do.
I could just, the rep's been inmy office, right?
(28:55):
So I easily could have said,hey, let me give you one.
And I haven't done a total bodyMRI.
I don't know.
These are three things that Icould do and I haven't.
And it's not that I'm just toobusy or negligent.
I just don't really feel I needto do it.
Now, I have a lot of friends andpatients that do it and and I
have no problem with it, but Iexplain to them what's going on
with it.
SPEAKER_00 (29:15):
How about you?
I do think what's morejustifiable, so for example,
BRCA2, everybody, women knowwhat BRCA1 is, okay?
BRCA gene is a tumor suppressorgene.
In other words, it preventstumor from growing.
So if you have a BRCA mutation,meaning that suppressor gene is
(29:36):
defective, and allows cancer togrow.
So BRCA1 is associated withbreast cancer.
And we're gonna
SPEAKER_01 (29:41):
definitely do one on breast cancer for
SPEAKER_00 (29:43):
sure.
Breast cancer, colon cancer,ovarian cancer.
So BRCA2 is associated withpancreatic cancer.
So let's say you had somebodythat had breast cancer in the
family or ovarian cancer andthey happen to have BRCA, okay?
And then you went on to havegenetic testing Male or female,
(30:05):
because they test for bracket 1or 2, and you have bracket 2,
and you had a relative in thefamily that had pancreatic
cancer.
I think that it's completely.
Acceptable if you wanted to havean ultrasound of your.
We call it right upper quadrantpancreas and everything like
that, or have a CT, I thinkthen, but I still wouldn't go
(30:25):
get a.
SPEAKER_01 (30:27):
So basically, I told you what I do for you as well.
You said you've done Cologuard.
You haven't done the other twotests, correct?
SPEAKER_00 (30:35):
Correct.
No.
So that's
SPEAKER_01 (30:37):
where we stand.
So Dr.
Richman is pretty much a no onthose, on the Pranovo MRI
imaging and the Galeri.
And personally, I'm a no.
However, I will not tell someonenot to do it.
And if you want to do it, listento what we're saying, understand
that, and then have at it.
SPEAKER_00 (30:57):
and i think mike and i are always available for
questions as long as we're notinundated but i think that the
best thing to do is if you haveany questions about cancer is to
really talk about talk to anoncologist and the one thing i
always tell everybody short of abig hospital system if you want
(31:20):
to know like the real factthere's 72 approved NCI, which
is National Cancer InstituteCancer Centers, United States
and 36 states and the Districtof Columbia.
And you always know you're goingto get the standard of care.
So if you go to a small privatepractice oncologist, They may
(31:41):
not give you the best advice.
If you really suspect, I wouldtalk to a university-based or a
big hospital-based oncologistand just get their feeling.
SPEAKER_01 (31:51):
Yeah, and then, so let's wrap this up.
This was part one, and then parttwo, we're gonna go through
FDA-approved, well-documentedscreenings that I've done,
you've done, and that werecommend that you should do.
So we'll do that on our nextpodcast, but I hope everyone got
some insight from this, and likewe said, We're here to just help
you out.
(32:12):
And hopefully we did.
So clarify a little bit.
Right.
All right.
It was good talking with youtoday.
That was a really nice one.
That was
SPEAKER_00 (32:18):
good.
All right.
Yeah.
And hopefully we'll save somepeople's lives because like we
always say at the end of everyshow, because when it comes to
your health, the truth doesmatter.
SPEAKER_01 (32:28):
Amen.
All
SPEAKER_00 (32:28):
right.
So everybody have a great dayand thank you for listening.
SPEAKER_01 (32:33):
Take care.
Good morning, everybody.
This is Dr.
Michael Richmond, and I'm withmy friend and colleague, Dr.
Fiorello.
Good morning.
And we are so excited because,like I said, We've done some
podcasts already and we'vetouched on heart disease and
seed oil.
And yes, we're going to do a lotof topical things.
(00:21):
To me, our goal in Two DoctorsTell the Truth is ultimately,
can we make an impact and can wesave your life?
And today we're going to betalking, we're going to do a
two-part podcast.
And today we're going to talkabout The newer screening tests
for cancer, one of them is FDAapproved and two of them are not
(00:43):
FDA approved.
Specifically, we're going to betalking about the Galeri test,
which is a type of blood test, awhole body MRI.
We're going to reference Prenuvoand then Coligard, which
everybody knows is on thosecommercials and is embarrassed
about.
box and send it back, hopingyour UPS guy doesn't know what's
(01:04):
in it.
And then our subsequent podcast,which will be next week, will be
on What is standard guidelinesfor mammography, for
colonoscopy, for prostate cancerscreening?
What is time-tested, proven, andaccepted?
And I'm excited today, and so isMike, because as we're both
board-certified generalsurgeons, before I became a
(01:26):
cardiothoracic surgeon andbefore Mike became a plastic
surgeon, we know this stuff.
And we're providing you now withreal medical information, right?
SPEAKER_01 (01:35):
Yeah, and when I think about wellness and I think
about what we're trying to dohere and cut through, like we
said originally, cut through allthe nonsense and try and give
you stuff that really works,people tell me all the time,
hey, I'm going for a full bodyMRI, or hey, I just did this
blood test, it came backnegative, I don't have cancer.
And we started with heartdisease.
You know why?
(01:55):
It's number one killer, right?
We hopefully helped you a littlebit understanding your heart and
lipids and tests and that stuff.
Now we're gonna move on tocancer.
That's number two killer.
Right, exactly.
And I think, just like you said,one in three plots in the
cemetery is someone died fromheart disease.
I think we all know someonewho's either had cancer or has
died of cancer.
So what can we do screening-wiseto help figure out if you should
(02:21):
be doing these tests notpreventative and we'll touch on
a little bit more about that wealready covered a little bit
with fasting but we'll try andbasically go into these
screening tests and i think thefirst one why don't we start
with the colo guard because thatone is fda
SPEAKER_00 (02:37):
approved
SPEAKER_01 (02:39):
okay yeah and that's a really interesting one so you
want to kick it off with colorguard
SPEAKER_00 (02:43):
yeah Okay, I just want to give just some
statistics just because I thinkit's important.
So in 2024, there were so farthe data is two million one one
thousand and forty nine newcancer diagnosis okay and the
deaths were approximately sixhundred and forty thousand okay
(03:04):
and like we said there are ninehundred just under a million
cardiovascular deaths cancer'sstill substantial so six hundred
and forty thousand people aredying a year of cancer and the
number one cancer deaths in bothsexes is lung cancer okay it's
not The most in women, breastcancer is still more common than
(03:24):
lung cancer, but the number onekiller is lung cancer.
Okay.
And colon cancer is right upthere.
So Cologuard is an FDA approvedtest for people over 45 or at
average risk.
And what does that mean?
Average risk?
Average risk means you have nofamily history.
And you have no, as Mike knows,there are diseases that
(03:50):
predispose you.
So if you have ulcerativecolitis, predisposes you to
colon cancer.
Or if you have a familialsyndrome, in other words, do you
have what's called familialpolyposis, which is multiple
polyps in your family.
Okay, so a person who is ataverage risk, Cologuard.
And what they're doing isthey're doing a, basically
(04:11):
they're checking your, poop,you're giving them a poop sample
for tumor DNA and blood.
And it's phenomenally accurate.
It's been validated in multipleclinical studies and we'll give
you numbers in a sec.
So Cologuard to me, just so youknow, according to guidelines,
say for traditional colonoscopy,your first colonoscopy, unless
(04:34):
you have one of these high-risksituation, it should be at 45.
And by the
SPEAKER_01 (04:39):
way, they lowered that too, right?
So it used to be at 50.
They lowered it to 45.
And I will say, my brother's aGI doctor, so we talk about this
all the time.
He's seeing it in younger andyounger people.
And this is something, and Iknow a few people that died from
it, unfortunately, young.
And this is something that couldbe preventable, could be caught
(05:01):
early.
So the earlier, the better youget tested.
45 with no family history, getit done.
And the colonoscopy, everyone'safraid of it for some reason.
I get it, right?
But I've done two of them now.
It's really not bad.
The prep is so much easier thanit used to be.
And a little twilight anesthesiaand
SPEAKER_00 (05:25):
you're done.
I think we'll get into more ofthat on Monday, but we're
just...
Yeah, Monday, I guess it is.
But today, I just want to reallymore focus on the Cologuard.
Correct.
And so insurance pays.
I've had two of them.
Insurance pays, and they're doneevery three years as long as
(05:46):
they're negative.
Insurance pays 100% for them ifyou're above 45.
It's an accepted screening test.
But I also think Cologuard isnot expensive.
Let's say you're under 45.
and you're just a worried personand you're low risk, remember,
if you're low risk.
Yeah.
I think you can have it done,okay?
So there's a new Cologuard Plus,which is phenomenal.
(06:10):
Cologuard, aside from picking upcancers and the numbers, I can
give you the new Cologuard Plusnumbers because Mike and I
believe in precision.
So the Cologuard Plus, so in allstages, of one through four
colon cancer, the true positiverate is 95%.
(06:31):
The true negative rate is 94%.
So colonoscopy, the truepositive rate is 95%, okay?
So basically it's as good ascolonoscopy for low risk people,
okay?
Now, yeah, so those are peopleover 45.
(06:51):
So now if you take the subgroupof 45 to 59-year-olds, remember,
of all ages, it's 100%sensitivity.
So in other words, if it'spositive, you have colon cancer,
okay?
And the negative rate is 94%.
But what's great about the testis it also can find high-grade
(07:12):
dysplasia, which is precancer in73% of people.
So if it's positive, 73% chanceyou have colon cancer.
a high-grade dysplasia.
And if it's negative, you cancount on a 87% that you don't
have high-grade dysplasia and a99% that you don't have cancer,
(07:34):
okay?
SPEAKER_01 (07:34):
Would you, what are your thoughts on someone that is
just, because I know a lot ofpeople like this that just don't
want to get a colonoscopy at alland they're just doing this
test.
Would you say at some point youneed at least one colonoscopy?
SPEAKER_00 (07:46):
Yeah, my personal opinion, so I just had one a
couple months ago.
And mine was, and I think peopleneed to always, I think as
surgeons, it's not that we'reignorant because we know it's
more out of fear because to bequite honest with you, like
nobody's going to bullshit Mikeand I, like we know nobody's
(08:09):
going to say to you or me, don'tyou agree?
If you have stage four coloncancer, all is going to be well.
So doctors are horrible becausethey, It was like, I don't want
to know.
I've had two negative Cologuardsthree years apart.
I'm good.
I'm good.
My fear is that we're seeing,Mike and I aren't old, but we're
(08:31):
seeing colon cancer now advancedstage in 20-year-olds.
SPEAKER_01 (08:35):
Yeah, it's getting younger for some reason.
SPEAKER_00 (08:37):
It's, do I think everybody, I think that if you
ask Mike's brother and you askguys that are colorectal
surgeons, they're down forCologuards every three years,
but they also think if you havea net...
If you have a negativecolonoscopy, guidelines say
every 10 years.
That's guidelines.
I don't know.
(08:57):
But I think in the interim, Iwould feel comfortable getting
Cologards every three years.
Yeah, you
SPEAKER_01 (09:02):
know what?
And I totally agree with that.
And we agree on that.
And I think common sense woulddictate, get your first
colonoscopy at 45.
Can it pick up some other stuffthat...
Cologuard can't likediverticulitis or any sort of
diverticulosis and any sort ofabnormalities and maybe a polyp
(09:23):
that a Cologuard wouldn't pickup.
Yes.
And then they tell you, okay,you're good.
Come back in 10 years.
And if you want to be more of apreventative person and you say,
okay, I'm going to do twoCologuards in between, I think
that's reasonable.
SPEAKER_00 (09:37):
I think that's reasonable.
Such great advice, because atthe end of the day, Cola Guard
has been validated.
They have the Cola Guard Plus.
If it's negative, you can feelgood on this, that it's
negative.
And
SPEAKER_01 (09:50):
FDA approved, covered by your insurance.
So basically, we're fans of ColaGuard, and we support it.
SPEAKER_00 (09:58):
Correct.
All right.
Next topic.
Next topic, Galeri.
So Mike and I have differentfeelings.
Galeri...
is a blood test and what it ismade by a company called Grail.
And what it is, is it's a bloodtest where they're looking for
50 different types of cancer bydetecting circulating tumor DNA.
(10:24):
So in other words, the premiseis that tumor sheds DNA and by
checking it in your blood,you're gonna be able to pick up
cancer early.
Now, remember, all this stuff,it's not preventative, okay?
It's for early detection, okay?
(10:44):
The only thing that'spreventative-
SPEAKER_01 (10:46):
And it's not FDA approved.
SPEAKER_00 (10:48):
Right.
The only thing we, like we justtalked about with Coligard,
Coligard does have apreventative aspect because it's
going to pick up a certainnumber of- Sorry, my golden
retrievers, guys.
It's going to pick up a certainnumber of- pre malignant cancers
polyps in the colon.
(11:09):
Okay, so this stuff is strictlynot preventative.
It's early detection.
Okay, yes.
So what are your feelings aboutthe Larry from a standpoint of
should people have it?
And if you think they shouldhave it?
What are the limitations in yourmind?
SPEAKER_01 (11:29):
I'm on the fence on this one, not just because it's
not FDA approved.
Yes, we want to detect cancerearly, but I think there's some
things you have to understandwith this test.
So this particular one is$950,so there's a cost there.
If that's an issue, there's acost.
It's not covered by insurancelike Cologuard.
The other thing is...
SPEAKER_00 (11:50):
Tell people why that is, though.
It's not
SPEAKER_01 (11:53):
FDA approved.
SPEAKER_00 (11:54):
Right.
But I think it's important totell people why is stuff not get
FDA approved?
And it's because there is norobust evidence to show that it
works and it hasn't beenvalidated in clinical trials,
specifically with the Galarian.
Then I'll let Mike finish.
The initial trial with I'll talkabout was conducted by the
(12:16):
company.
And you always have to be leeryof studies.
SPEAKER_01 (12:19):
Right.
A paid study.
Here's the thing, too.
I'm all for early detection likewe all are, right?
So you'd say, wait, great, thisis great idea, right?
Let me take a blood test.
And if I catch something early,right?
Oral scare, pancreatic is thebig one.
They're all big, but let mecatch it early, right?
I'm all for that.
However, if you're going to dothis test, you have to
(12:40):
understand that there's issueswith it.
For example, the false positiveand the false negative.
It's not extremely accuratepicking up an early stage
cancer.
So you could fool yourself andhave a sense of false security.
Hey, I did the galerium, good.
And then maybe not follow up.
(13:00):
Time gets away from all of us.
And then two, three years later,you're like, oh yeah, I did a
glaring.
I'm negative.
You forget it was three yearsago.
Like we all do.
You forget when you hadsomething done and then
something's growing in there andyou're going to ignore it.
You might have a pain and say,it's probably nothing.
I did a glaring.
So that's one thing.
The other thing too, is thefalse positive.
SPEAKER_00 (13:20):
Yeah.
So you want me to say, so thetrial.
that gave everybody pause.
So this is technology that isestablished.
So if you have a solid tumordiagnosed, A good percentage of
solid tumors, the standard ofcare is what you get, which is
called a liquid biopsy.
(13:42):
You found a company calledFoundation One does it or
Guardant and Guardant 360.
It looks at 360 genes.
And that's for people who'vealready been diagnosed with
cancer.
And it's to see, do you have anactionable mutation?
In other words, do you have amutation that you would use
targeted therapy or do you haveyou hear on TV with Keytruda,
(14:04):
like they mentioned PD-L1.
Do you have PD-L1?
Do you need immunotherapy?
So it tells you what subtype youhave, and then it guides
therapy, okay?
That's standard of care.
Now, that doesn't mean thateverybody gets it, depending on
where you live in the country.
So this is doing it.
It's a liquid biopsy looking forcirculate, and then they use an
(14:25):
AI-generated model.
So the trial, which kind of blewit and gave everybody pause was
called pathfinder which was doneby grail paid for the false
positive rate was 62 percent wayunacceptable yes and the true
positive rate was 38 okay wayhigh okay so a lot of
SPEAKER_01 (14:49):
unnecessary anxiety is going to come with that for
sure
SPEAKER_00 (14:52):
and downstream testing and downstream testing
so unnecessary testing Mikeknows so let's talk about it the
data shows that for okay let'stalk what cancers it's not going
to show blood cancers or limbit's not going to show lymphomas
or things like that buteverybody worries about
(15:13):
pancreatic cancer and withadvanced stage pancreatic cancer
tumor DNA is only found in theblood, even with garlic, like 30
something percent of the time.
So with early stage cancer andmost early stage cancers don't
shed tumor.
Okay.
So
SPEAKER_01 (15:33):
I'm going to pick
SPEAKER_00 (15:34):
it up.
Okay.
So the point is to pick it upearly.
So let's say you have a Galaritest and it's a, it says
negative.
I just told you what the, whatthe true negative rate is.
Are you going to feel good?
And the answer's no.
You're going to say to yourself,I don't know if I have early
stage cancer.
I have no clue if I have earlystage cancer.
(15:56):
So then they went on to do whatwas called the STRIVE study, and
which is really weird to me.
There were 100,000 peopleenrolled in the completion date,
which was in 2022.
But the completed finalcompletion date was in April of
2024.
And they didn't report theirresults and there's nothing when
(16:17):
it was done by grail, which istelling you this is different
than being done in Columbia or.
UCLA, or wherever male clinicwhere they're going to report
the data.
Either way, true or false this,the company can.
Keep the data quiet, so theyhaven't published a thing.
There's no,
SPEAKER_01 (16:34):
I feel like.
It's an exciting field.
And I'm hoping that this isgoing to be the future.
I'm hoping they're going to beable to go in and get a blood
test and feel really good aboutit.
It almost seems like they jumpedthe gun a little bit.
And when people ask me, should Ido it?
It's hard for me to say no,because has Galeri probably
saved someone's life somewhere?
Yeah, it probably has.
(16:55):
But is it a really superaccurate and great test?
No.
So I think you have to know thatgoing in that you could, lead to
a lot of unnecessary anxietyunnecessary testing and it could
also give you a false hope thathey i don't have cancer and
maybe you do maybe you have acancer growing in your body and
(17:15):
then galeri did not pick it upso listen if you want to spend
the 950 dollars i'll never tellyou not to do it
SPEAKER_00 (17:22):
but let's talk about though like upstream costs so
let's say as we just said So you
SPEAKER_01 (17:28):
go in, you do it, and it comes back positive.
You say, shit, I might havepancreatic cancer.
Now you're flipped out.
You're thinking you're going tobe dead in six months.
So now what do you do?
SPEAKER_00 (17:37):
Remember, insurance isn't going to approve anything,
okay, on the basis of, oh, Ihave a positive galeria because
it's not even FDA approved.
So for the general...
SPEAKER_01 (17:48):
So now you're going to go see a cancer doc or a GI
or whoever, right?
SPEAKER_00 (17:52):
Right.
He's going to tell you...
There's no basis, okay?
Doctor, I want something done.
Okay, then I'll order you a CTscan of your abdomen.
You're going to have to pay outof pocket.
Now, your average person can'tafford it.
And let's remember, there's dataout.
I just wrote a paper on it.
(18:13):
Repeated.
CT scans, actually, there's93,000 cases of cancer diagnosed
each year from unnecessaryT-scanning, okay?
So are you going to go get a CTscan of your abdomen just
because you have positivegalerias?
No.
You may say yes, but it's notpractical.
Are you going to go get anultrasound of your abdomen?
I guess that's fine.
(18:33):
It's cheap.
But you understand what thepoint is.
This could be thousands ofdollars out of your pocket.
and a road to nowhere and theanxiety level is through the
roof
SPEAKER_01 (18:46):
yeah oh yeah for sure
SPEAKER_00 (18:48):
for sure so
SPEAKER_01 (18:49):
now couldn't but potentially still has a certain
degree that there could besomething there you could
potentially save someone's lifeso that's the hard part i have
is not telling someone no sosomeone went and it turns out
they did have a small pancreaticcancer in their pancreas and it
was found and somehow resectedand they were cured from it
SPEAKER_00 (19:08):
but still remember It doesn't justify, like, one
person, if advanced, and we'rejust taking pancreatic cancer
here, okay?
SPEAKER_01 (19:18):
Unless you're that person.
SPEAKER_00 (19:21):
But if you have an advanced cancer, stage three or
stage four pancreatic cancer,where you're done with anyways,
you're already having symptoms.
You're not getting the gallery.
But if it only sheds tumor 34%of the time, I can't give you a
number, but in stage one orstage two, maybe 10%.
two or 3% of the time.
Okay.
(19:42):
Like to me, it's not a, it's notan acceptable test.
SPEAKER_01 (19:45):
Yeah.
It's not a great, it's not agreat test, but I'm struggling
because I know a lot of peoplethat do it every six months and
I'm struggling to tell someonedon't do it.
I really am because as long asyou know, all this, we just told
you going in and you're finewith it.
Okay.
And you have the resources thendo it.
SPEAKER_00 (20:04):
Right.
And if you can deal with theanxiety, And that doesn't mean
becoming dependent on Xanax orAtivan to get through the next
year or two because you can'tdeal with the anxiety and you
become some maniac like on thisnever-ending quest to find out
what it is because, believe me,there are plenty of cancers.
(20:25):
And Mike and I can tell you thatWe never find out the primary.
Okay.
They have metastatic disease.
They have stage four and we cannever find out the primary.
And it's like, it'll come backto the pathology of a lymph node
GI cancer.
So we know it's somewhere in theGI tract with all these
(20:46):
limitations.
So I'm not a gallery guy.
I think it's too soon.
But it's
SPEAKER_01 (20:52):
exciting.
It is exciting, and I think it'sonly going to get better.
It's going to get better withAI, and it's going to get
better.
I think they jumped the gun alittle bit, but it's here, and
no buyer beware, like we say forother stuff.
All right, good.
I think we did a good job onthat.
Okay, our last one.
SPEAKER_00 (21:11):
Our last one is whole body MRI.
Which
SPEAKER_01 (21:13):
is very interesting to me as well.
I also know a lot of people thatdo that as well.
And there's a lot of companiesout there now that do this.
Dr.
Richmond, should I go and get afull body MRI?
SPEAKER_00 (21:25):
No.
So first, and I'm just usingPronova because they have a lot
of money.
So they've done tremendousmarketing.
They've hired a lot ofcelebrities.
They've offered me actually, ifI would be a spokesman being a
double board certified surgeonto get a free one.
And if I promote it and I justcan't.
(21:45):
So let's talk about whole bodyMRI.
What are the limitations?
So whole body MRI, justremember, this is just a
screening test.
Again, it will miss the majorityof breast cancers.
Correct.
Okay.
Especially if there's densebreasts, it will miss most
(22:08):
thyroid cancers.
Now, am I that concerned aboutthyroid cancers?
Not really because the majorityof thyroid cancers are curable
or treatable.
It'll miss the majority ofcolorectal cancers.
Okay.
It'll miss the majority ofesophageal cancers, diffuse
gastric.
(22:28):
It'll miss melanomas on theskin.
Okay.
Exactly.
Unless you have the reason whyit's not fda approved because
there is currently no robustevidence to support its use and
this is from good clinicaltrials for there's no robust
evidence to support its use forroutine screening okay and what
(22:54):
we're going to talk about now onour next podcast the u.s
preventative task force says youwant to do stuff where there's
robust evidence you domammography If you have an
extensive smoking history, youdo low-dose chest CT scanning
every year, you do PSA testing,and you do colonoscopy.
And we're going to talk aboutthose, okay?
Because there's robust evidence.
(23:16):
And, oh, and furthermore, thiswill miss early small prostate
cancers, okay?
So we've given you a bunch thatit'll miss because even though
guys are like, no, I heard MRI,the prostate is fantastic.
it's a different type of MRI.
It's called multi-parametric MRIfor prostate cancer.
(23:37):
So for all those reasons, again,it leads to, it's expensive, but
it leads to an unacceptably highlevel of downstream testing.
And yes.
And we
SPEAKER_01 (23:50):
can say the same thing that we just said on the
Galeri, anxiety, Okay, so youpick up a two millimeter nodule
in your lung, which is a goodchance it's benign and it's
always been there.
And now you're like flippingout.
You might have to get a lungbiopsy or further testing on
that.
So that's a problem as well.
That's the same thing we talkedabout before, right?
SPEAKER_00 (24:13):
Yeah, this kind of troubles me.
So this is imaging.
Okay, so you can see it.
So let's I'll give you twoexamples.
And Mike, you have a littleteeny solid tumor in the head of
the pancreas.
I'm not going to get into it,but there's something now that's
accepted.
We have out here at USC andHogue Hospital in Newport, the
(24:35):
largest registry of what'scalled IPMNs, which are
intrapapillary mucinousneoplasms of the pancreas.
And they're actually beingpicked up more.
And we used to do surgeryautomatically, if you see.
So it's a little tumor connectedto the duct.
We used to do what's called theWhipple procedure or distal
(24:57):
pancreatectomy.
Automatically, the majority ofthem are benign.
It's a massive surgery.
Okay, massive surgery.
So you see a little teeny tumorthere that most of them can be
needle biopsied, but let's saythis one can't be.
Okay, let's say it's in a placewhere they just can't get to it.
(25:18):
Are you prepared to sit withyourself that good chance it's
not pancreatic cancer, slightchance it may be, or are you
going to go have a Whipple whichaffects the quality of your life
forever and find out it'sbenign?
I'm not.
Are you?
SPEAKER_01 (25:35):
no no and that's the limitation of this as well right
so i'm more in the wellnessspace than you are so i'm people
ask me all the time and i know alot of people doing this right
so once again cost about 2500from what i've seen i've seen up
to 4 000 but i think 2500 seemsto be where it's at and then
false negatives and falsepositives and the thing that
(25:57):
always got me on this is i do itokay so i go in i get it done
and then i leave there I don'tthink I'm feeling as good as I
should because you think, okay,they didn't find anything.
Okay.
What happens if one, they misssomething or two, it starts
growing.
Like the day I leave the nextday, it's growing.
And I'm saying to myself, okay,because everything else, right?
(26:18):
When's the last time you everlooked back and say, oh, when's
the last time I did something?
And you look back and it was twoyears ago and you thought it was
six months ago.
Now, all of a sudden you'reignoring something because you
say, oh, I have a total bodyMRI.
It's nothing there.
is a false sense of security aswell.
And then you still need all theother tests.
So once again, for me, when Itell someone don't do it because
(26:40):
has it saved someone's life?
Yes, I'm sure it has.
I'm
SPEAKER_00 (26:43):
sure.
Absolutely.
SPEAKER_01 (26:44):
Yeah.
So I'm sure they picked upsomething and hey, save my life.
Okay.
That's great.
I love it.
So for the 1% of chance, There'sno radiation.
If you're okay paying the fee,then go ahead and do it.
But once again, just like theGaleri, understand that you
could have missed a lot ofthings, and you can't be 100%,
(27:06):
of course, as we said, but alsoit may lead to costly tests and
unnecessary surgeries, which ithas, too.
So you have to put
SPEAKER_00 (27:14):
this...
And it misses the numberthree...
colorectal cancers so you'regoing to still need a
colonoscopy yes like we saidit's going to miss breast
cancers regardless of i know wehear a lot of people who have
pancreatic cancer it'sincreasing but it's still
considered a rare disease okaythere's what i tell you like 63
(27:37):
000 new cases of pancreaticcancer a year in the united
states it may sound like a lotbut that's not a lot Okay?
That's not a lot of cancers.
SPEAKER_01 (27:46):
It's a lot if you get it or your loved one gets
it, of course.
SPEAKER_00 (27:49):
Exactly.
That's what makes thisinteresting.
Listen, here's the bottom line.
The other thing is, I don'tknow.
I never looked this up.
So MRIs, there's newer MRIs thatyou can go in if you have
foreign bodies or if you have apacemaker.
So in other words, if you've hadan artificial hip or you have
something metallic, a heartvalve, you can't go in an MRI
(28:10):
and you see how they always askyou.
Or if you have a pacemaker.
I don't know.
if these whole body MRIs are,you're able to go in if you have
a metallic form body.
I didn't look at it.
I'm thinking no, okay.
Probably
SPEAKER_01 (28:25):
no, correct.
SPEAKER_00 (28:27):
Because there's not a lot of places that do have
those machines.
They're becoming more common,but they're using
SPEAKER_01 (28:35):
it.
Here's the bottom line, right?
These tests are available.
And we can get them ourselves,right?
We're doctors.
I have not done any of thethree.
So I haven't done Cologuard,although I would do it, but I
get colonoscopies regularly.
I haven't done the Galeri, whichI could definitely do.
I could just, the rep's been inmy office, right?
(28:55):
So I easily could have said,hey, let me give you one.
And I haven't done a total bodyMRI.
I don't know.
These are three things that Icould do and I haven't.
And it's not that I'm just toobusy or negligent.
I just don't really feel I needto do it.
Now, I have a lot of friends andpatients that do it and and I
have no problem with it, but Iexplain to them what's going on
with it.
SPEAKER_00 (29:15):
How about you?
I do think what's morejustifiable, so for example,
BRCA2, everybody, women knowwhat BRCA1 is, okay?
BRCA gene is a tumor suppressorgene.
In other words, it preventstumor from growing.
So if you have a BRCA mutation,meaning that suppressor gene is
(29:36):
defective, and allows cancer togrow.
So BRCA1 is associated withbreast cancer.
And we're gonna
SPEAKER_01 (29:41):
definitely do one on breast cancer for
SPEAKER_00 (29:43):
sure.
Breast cancer, colon cancer,ovarian cancer.
So BRCA2 is associated withpancreatic cancer.
So let's say you had somebodythat had breast cancer in the
family or ovarian cancer andthey happen to have BRCA, okay?
And then you went on to havegenetic testing Male or female,
(30:05):
because they test for bracket 1or 2, and you have bracket 2,
and you had a relative in thefamily that had pancreatic
cancer.
I think that it's completely.
Acceptable if you wanted to havean ultrasound of your.
We call it right upper quadrantpancreas and everything like
that, or have a CT, I thinkthen, but I still wouldn't go
(30:25):
get a.
SPEAKER_01 (30:27):
So basically, I told you what I do for you as well.
You said you've done Cologuard.
You haven't done the other twotests, correct?
SPEAKER_00 (30:35):
Correct.
No.
So that's
SPEAKER_01 (30:37):
where we stand.
So Dr.
Richman is pretty much a no onthose, on the Pranovo MRI
imaging and the Galeri.
And personally, I'm a no.
However, I will not tell someonenot to do it.
And if you want to do it, listento what we're saying, understand
that, and then have at it.
SPEAKER_00 (30:57):
and i think mike and i are always available for
questions as long as we're notinundated but i think that the
best thing to do is if you haveany questions about cancer is to
really talk about talk to anoncologist and the one thing i
always tell everybody short of abig hospital system if you want
(31:20):
to know like the real factthere's 72 approved NCI, which
is National Cancer InstituteCancer Centers, United States
and 36 states and the Districtof Columbia.
And you always know you're goingto get the standard of care.
So if you go to a small privatepractice oncologist, They may
(31:41):
not give you the best advice.
If you really suspect, I wouldtalk to a university-based or a
big hospital-based oncologistand just get their feeling.
SPEAKER_01 (31:51):
Yeah, and then, so let's wrap this up.
This was part one, and then parttwo, we're gonna go through
FDA-approved, well-documentedscreenings that I've done,
you've done, and that werecommend that you should do.
So we'll do that on our nextpodcast, but I hope everyone got
some insight from this, and likewe said, We're here to just help
you out.
(32:12):
And hopefully we did.
So clarify a little bit.
Right.
All right.
It was good talking with youtoday.
That was a really nice one.
That was
SPEAKER_00 (32:18):
good.
All right.
Yeah.
And hopefully we'll save somepeople's lives because like we
always say at the end of everyshow, because when it comes to
your health, the truth doesmatter.
SPEAKER_01 (32:28):
Amen.
All
SPEAKER_00 (32:28):
right.
So everybody have a great dayand thank you for listening.
SPEAKER_01 (32:33):
Take care.
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