What We Get Wrong About Cancer

"Curing cancer," explained.

We’re not looking for a “cure for cancer” anymore. Cancer is hundreds of diseases, so we’re really in a multi front fight against all of them. Cancer is a problem for us today in a way it wasn’t for previous generations. But, luckily, we also have more and more ways to fight back.

I started this episode with endless questions: What is cancer? What causes it? How do we treat cancer? What are the symptoms? Why are some cancers easier to treat than others? Why is cancer so hard to cure? Why do so many people die of cancer?

What I found is an incredible, complex, inspiring effort to treat and stop an insidious killer. In this video, we dive deep into how we treat cancer today. But I also found that we may not be helping the greatest number of people we can.

In this episode of Huge If True, I want to make the case that while we have made enormous strides in the fight against cancer we have also largely ignored one of the single best ways to save the most lives.

Chapters:
00:00 Why do so many people get cancer?
02:06 What is cancer?
03:02 How do we treat cancer?
03:44 What is chemotherapy?
04:42 What is immunotherapy?
05:22 Thank you Riverside
06:27 How do we save more lives?
07:47 Does early detection save lives?
09:23 How do we detect cancer?
10:45 What are the downsides of cancer tests?
11:38 Why early cancer detection matter?
12:42 Can we cure cancer?

Sources and additional reading:

Bio:
Cleo Abram is an Emmy-nominated independent video journalist. On her show, Huge If True, Cleo explores complex technology topics with rigor and optimism, helping her audience understand the world around them and see positive futures they can help build. Before going independent, Cleo was a video producer for Vox. She wrote and directed episodes of Vox’s Netflix show, Explained, produced videos for Vox’s popular YouTube channel, was the host and senior producer of Vox’s first ever daily show, Answered, and was co-host and producer of Vox’s YouTube Originals show, Glad You Asked.

Music: Musicbed

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Typically here I’d do a “joke down low” - a joke with a key word you can use in the comments. But… well… for obvious reasons, a joke about cancer didn’t seem right. So, how about we just use the word “check” in the comments to tell me you’re a real one :)

[Akahoshi]

I'm not usually one for over sharing but I've just finished my first week of chemotherapy and I won't lie I'm scared of how it's affecting me, but your enthusiasm for the topic helped put my mind at ease. So thank you, you have no idea how much I needed this today

[jcolucci]

I got a full medical in Tokyo, Japan just because it was cheap, it was around $200. This medical included an ultrasound. They discovered a 7cm tumor on my left kidney. I hand absolutely ZERO symptoms, no pain, no blood in my urine, and normal blood work. Long story short, I hurried back to the US and had a radical nephrectomy (kidney removed). After pathology reports came back, it turns out it was stage 3 cancer. I will start immunotherapy in a few weeks. Apparently this was growing fast. And I think about why I got the test done in Tokyo - because it was "cheap". I am fortunate, and I wish this type of tests were accessible to everyone.

[readmore]

We found a small localized tumor in my wife's left breast....had it removed. Later, her liver numbers were suspicious so they MRI'd it. Said "it was fine but what's this on her kidney?" A potato-size, localized tumor... so out with her left kidney...."What's this on her left lung?" Nodules....(small) some cancerous, started new drug therapy with zero side effects. 3 months go by "lets do a PET Scan"... Nodules are gone....we won the war.

[johnjakson]

Wow, 5 years ago I had colorectal cancer at age 60, later found out it was stage 3c, several trips to the bathroom gave me the warnings and it was confirmed a few weeks later after the colonoscopy. I still have the endoscope pic, it was a monster. A few months later I had the radiation, surgery and chemo over the entire year and as of today I appear to be free after another cat scan. I'm eternally grateful to possibly hundreds of care givers and my team of surgeons, oncology and chemo people. I do have some post issues with the surgery and chemo, but that's a small price to pay for being alive. I likely would have died in 2019 had I not had treatment.

[mymax]

I am a stage 4 throat cancer survivor. I was diagnosed in September 2009. I've had numerous MRIs, CAT scans and PET scans. My treatment included 3 of the 4 types: poison, burn and melt. It was intense torture for 3 months but I was finally declared cancer free after a year. There were times during the treatment I wished I died from the cancer; it would have been less painful. But here I am even though my survival is considered rare.
Why am I telling you this? I recently became a subscriber of your videos because they are thorough and thoughtful. I had no idea you would touch on the subject of cancer. I would like to contribute some perspective from someone who has "been there". Your video mentions how you found out you don't have cancer and you seemed relieved. When I found out I had cancer my first reaction was, "what do we do now?". I had no idea how much the treatment would change my life. The treatment left me with the inability to swallow. I cannot eat food or drink fluids. I can speak but with much difficulty. 13 years into my recovery and my life is no longer the same.
So what? Why cry in your comments section? I wanted to add my experience to this topic. Current treatment for cancer has short and long term effects that are often downplayed and people are not aware. And to your point, my life might not be extended by a significant amount. But it is nothing like it was before cancer. I struggle with my post treatment conditions. But what my cancer diagnosis and treatment also gave me was a new way to find happiness. When I was faced with the real probability of dying I saw the opportunity to find a good new life.
I wanted to say that surviving cancer, more than anything, changes your perspective and life. It changes the things you do everyday and the way you approach them.
So, is there a cure for cancer? For me, the cure was letting go of the horror of the treatment and accepting the changes it gave me with gratitude.

[pande_vatsal]

It's been 8 months now that I was diagnosed with stage 4 cancer. I was cured with chemotherapy just a month ago. This video made me appreciate all the efforts humanity has made that helped me cure it. Thank you for making this video and spreading the much needed awareness about the topic.

[hiccupt]

My friends dad was saved by early detection of his cancer, ironically from scans to make sure he was not injured from his motorcycle accident. Its also notable that he had pancreatic cancer, which unless caught basically instantly, its fatal, check the chart she shows, its nuts. So getting in that motorcycle accident saved his life.

[Nels]

In 1990 I was 29 never used tobacco and didn't drink but they found cancer in my throat 13:42 . It was advance and yet I had no idea I had it. I had surgery and lots of radiation and was still given only a 10 % chance to make it a year. I fight the side effects from the radiation even now, 34 years later. I would say to those who find they have cancer, don't let the message get to you. I know I am alive today because I refused to believe it would end my life. The treatments today are better and you can win the battle, believe in yourself!

[whatisthedileo]

I also had no risk factors until I had tremendous back pain. It turns out I have metastatic cancer that started in my lung (I’m a nonsmoker) and spread to my axial-skeletal system. I’m 43 and have stage 4 cancer. This video is very impactful.

[philp]

I'm a cancer biologist and have have studied/researched & worked in the field for just over 5 years now, love this peice of content, and the effort you've put in is really great!

[robinhahnsopran]

Hi! Chronically ill person (without cancer) here. The paternalistic bias against telling people what's going on inside their bodies so as "not to scare" a patient is SO damaging, and leads to so many delayed diagnoses across illnesses, and I am SO glad you touched on that! Reframing the way the medical system thinks about prevention and/or early detection as a whole is so, so needed. Thank you for making this. 💜

[Langwidere]

I was with my mom when she got the call from her doctor. That moment was awful. Miraculously they caught it early, removed the tumor, and did a few months of radiation. She just got her 5 year scan and it was clean! Sometimes I forget she’s a cancer survivor. But then I remember and I get so anxious about the odds of it coming back. It seems like all the moms of the kids I grew up with have had breast cancers at some point, and it doesn’t get any easier. Every year we’re making casseroles for someone else, you know?

[michaelclark]

Someone else may have mentioned this but there is a fundamental problem that has to be addressed when considering early detection: Bayes' theorem. I'm surprised it didn't get mentioned, as it is central to understanding what medical test results mean. I learned about it from one of the best lectures I had in medical school. Basically, the prior probability of a patient having the condition being tested for has a profound effect on the positive predictive value of a test. We all have an inherent understanding of this idea, as the person giving the lecture illustrated (with an scenario that bears little resemblance to patients and no resemblance to how actual patent care is or was practiced, so please do not take it as such).

There is a patient speaking a language we didn't know and we were having trouble getting a translator for. We were able to get the idea that she thought she had syphilis. So we ran a VDRL test, which is an indirect test for syphilis that can be positive for other reasons. It was positive, and the lecturer asked do we treat? Some yes, some no.

He continued the scenario: a very confident med student who has been learning the language needed shows up and interviews the patient. They come back and say that the patient works as a prostitute and has unprotected sex with several men a day. Now everyone says treat.

But before we discharge the patient, the official translator shows up and just shakes their head at the med student. You see, she's not a sex worker, she's studying to be a nun at the convent in town, has never had any sexual contact with anyone, but had a sexual dream she thinks gave her syphilis. Now do we treat? Everyone says no.

Same test, three different prior probabilities of having the condition, 3 wildly different conclusions. This concept is critical for early detection, because we are often in a situation similar to the positive VDRL with no data on patient history. But we want to be more like one of the situations with more data. Preferably the one with correct information! Successful early detection programs depend on addressing Bayes' theorum..

When prior probability of the condition being present is low, even a very sensitive and specific test given to a random population, most positive test results will be false positives (a type one error in the lingo, think telling 65yr old man he's pregnant). Running the numbers with Bayes' theorem can tell you how many of them. I ran the numbers on a very accurate drug screen (99% sensitive, 99% specific) and based prior probability of a random person being a cocaine user, found that there were 9 false positives for every true one.This is the bane of all screening tests.

When the follow up is easy, cheap, with little or no risk that is not a big problem. When the follow is is expensive, invasive, and carries a non-negligible risk of 'therapeutic misadventures' (i.e. harmful follow-ups which are only harmful followups when something goes wrong) it is a big problem. With cancer, the problem is that by the time a tumor has grown to a 1cm^3 pea size and easy to see on scans, it has gone through 90% of it's life-span. So we really need to detect it before this time.

Often our followup involves biopsy or similar sample acquisition that is low but not no risk, and is aimed at a small target we may not hit (thus risking a type II error, think telling woman in labor, she's not pregnant). So we have to get the risk of type I errors down before follow up and risk of type II errors down on follow up down.

And we have to do it while also avoiding risky or invasive ways of doing iyt. As alludde to, but not quite said, current methods of screening identify a lot of stuff that looks like cancer but isn't. Simply seeing a nodule of 1cm^3 is pretty common on a full body MRI. Almost all of these are not cancer.

To be blunt, it is not a matter of using what we have now more often We need to apply more of what we have learned about cancer biology and oncogenesis to create tests that are not 99% sensitive and 99% specific, but 99.99% and beyond. And ways to turn MRIs looking for masses, into MRI's or other scanning technologies detecting the molecular markers of cancer even when there is no detectable mass yet. Along with this we also need, at least on followup, to detect markers for the potential for metastatic spread. This helps to ID those cancers that are or are not likely to progress.

That's hard, but it also means that the quest for more effective early detection looks a lot more like cancer treatment in terms of the glory to be obtained and knowledge base needed than it appears at first.Thjis helps create motivation to create such tests, but it also means more money and costs. And is another hornet nest of issues.

Edited to reduce blocks of text and other readability issues.

[chadwildclay]

Great video, Cleo. Early detection is absolutely the way to go. I recently found out I have 8 cancerous tumors in my spine, which likely started growing more than a decade ago. I sure wish we caught it earlier. One problem with early detection though is misdiagnosis. I got an MRI and doctors thought I had a cyst. We wasted 18 months trying to treat a cyst that wasn’t there and allowed the tumors to grow larger.

[NowIKnow]

This is absolutely top quality content. Extremely professional, engaging, and informative. You are a true talent!

[Pork-Chop-Express]

I DESPERATELY hope you read this, Cleo: I also am obsessed with Cancer. One thing I learned in academia is that there are literally HUNDREDS of companies across the U.S. that have patents and technologies relating to the fight against cancer. LET ME REPEAT THAT - "patents ... relating to the fight against cancer." Imagine a hurricane is headed for your home and all you need to secure your safety is hammer some plywood ... ONLY ... the guy across the street has the patent on nails, you have the patent on hammers, and someone else has the patent on plywood. THAT'S EXACTLY the state of things in the US, and HAS BEEN for 50 years or more. Husbands, wives, fathers, mothers, children, AND PETS ... all dying in agony because ... money.

[samihamchev]

9 months ago me and over 10 million other people lost a very important online figure in our lives - Technoblade. He passed away from sarcoma at the age of 23 and the main reason was that it was detected too late.

Long story short, his shoulder got extremely swollen, so he decided to check it out at the hospital and it turned out he had stage 4 cancer which at this point had spread to his lungs and despite the tumor in his shoulder was completely removed and he was being treated with the newest and best treatments, he and the cancer made a draw.

When we learned he passed away, it hurt. A lot. Many of us cried on that day - July 1st 2022. A day which will be engraved in our memories probably for the rest of our lives.

We all wish the cancer was detected earlier. We all wished, despite everything, he would pull out a massive dub and get over this. We all wish he, with his dry humor and his incredible gaming skills, was still here to bring us joy.
Sadly, that's not how things turned out.

But before he went off, he did it with a bang. He raised over $1, 000, 000 for the SFA(Sarcoma Foundation of America) to fund research and treatments.

He is a legend.

He will be remembered.
Forever.

TECHNOBLADE NEVER DIES!

[superwae]

For those of us who've lost a loved one to cancer, tough to not get emotional through this one. But this is important information and it makes me feel better knowing it could help others. Thanks, Cleo

[cjpatz]

I heard, our body is fighting cancer every day. And normally our immune system does a good job. It’s when these cancer cells slip through our defenses, that we notice it.

[cairoennis]

8:33 I had to stage 1A ovarian cancer and my survival rate was about 92% the only reason my cancer was caught so early is because I am a minor. I was 15 and doctors estimated that my tumour had started growing at the end of February, which makes a lot of sense that’s when my biggest symptoms started. I started chemo on 2 May I found out I had cancer about a month and a half after the tumour started developing. I’ve heard stories about women not finding out they had ovarian cancer until five years after the tour started developing my tumour was the size of a large watermelon and weighed 3.4 pounds when it came out of my body that was after doing chemo. I probably would have been dead by then. I’m 16 now and I am officially one year into remission.