https://youtubetranscript.com/?v=UwcFYrOcLZU
Let’s start with cancer, everyone’s favorite. Yeah, I think, you know, cancer is the second leading cause of death in the United States and globally. Of the, what I describe as these four horsemen of death, cardiovascular disease, cancer, neurodegenerative disease, and the metabolic diseases that we’ve already talked about, cancer hits its peak first. So the other diseases rise monotonically with aging, cancer actually peaks in late middle age. So cancer would be the leading cause of chronic death, or, you know, chronic diseases of aging in the 40s and 50s and 60s, before it’s supplanted by cardiovascular disease and even neurodegenerative disease. If you go back to the year I was born and you ask the question, what is the probability that a person with metastatic cancer, i.e. cancer that has spread from its primary organ to a distant organ, what’s the probability they’re gonna be alive in 10 years? The answer was 0%. Nobody was gonna survive that. Today, the answer is about 5%, maybe a little bit higher. But it’s really not been an enormous source of success. So let’s talk about what the bright spots are. The bright spots are leukemias, lymphomas, testicular cancer. These are areas where there has been great progress, and your survival today is so much higher than it was 50 years ago. When you talk about the big killers though, which are lung cancer, prostate cancer, breast cancer, colon cancer, pancreatic cancer, those are the top five causes of cancer death. Median survival, the length of time you survive, has increased by as much as a year, if not more. But overall survival has not. This is a very important thing to understand. The risk of being dead in 10 years if that cancer has spread is the same as it was 50 years ago. So if all that’s the bad news. Do you suppose that’s a possible consequence of the presence of cancer being a marker for cumulative systemic failure? Is that if there’s cancer somewhere, is it an indicator that many things have gone wrong at many levels, and so even if you treat the cancer, the probability that that’s going to be life-saving is quite low? Or is it just a consequence of the tremendous capacity of metastatic cancers to spread? So there’s a couple of things going on for cancer to take place. So the first critical step of a cancer is a genetic mutation has to happen. And largely speaking, these fall into two categories. There are genes that are promoting cancer growth, and then there are genes that suppress cancer growth. So anytime you get mutations in one of those systems, it becomes oncogenic. Now, fortunately, when a cell becomes cancerous, it starts to let out clues that it is not a normal cell. So when a breast cell goes from being a normal mammary cell to a cancerous mammary cell, it starts to look a little bit different. And the immune system, our immune system, the cellular immune system, is very good at patrolling the body for signs of things that are not self. That’s what it’s programmed to do. So it’s a very beautiful way to think about it, but the immune system is not programmed to recognize bad things. It’s programmed to recognize things that are not self. This is done through something called thymic selection when we’re basically very young. And by the way, too much of that problem leads to autoimmunity. So you can think about this through your own personal story, right? Which is there’s a very fine balance here. Too much of knowing what is not self, and too little of that are both equally bad. So there are always some cells that recognize this. In fact, Steve Rosenberg, who I did my postdoc with, recently published some really amazing data, I find one of the most staggering statistics of all of cancer, and also one of the most hopeful, which is that 80% of epithelial tumors, epithelial tumors are the ones that kill people. That’s the solid organ stuff, the breast, colon, prostate, et cetera. 80% of those tumors produce what are called novel neoantigens, meaning they produce peptides, small proteins, that are not self and are recognized by the immune system as not self. The problem is, the reason those 80% of patients don’t go into spontaneous remission, is they can’t mount a strong enough immune response to that. So it’s sort of like having some immune cells that recognize you have a virus, but not enough that they can actually kill the virus, and ultimately the virus kills them. To your broader question, which is, if you’re listening to this, what do you do about it? It starts to me with, what are the two most clear environmental triggers of cancer, and how do you avoid them? And then secondly, what’s the rest of your strategy? So when it comes to heart disease and neurodegenerative disease and metabolic disease, which are the other three horsemen, our ability to incorporate prevention is so significant, that it plays the lion’s share of our strategy. Because we have such an understanding of the risk factors for Alzheimer’s disease, the risk factors for metabolic disease, and the risk factors for heart disease, your prevention strategy is not doing those 25 things, or minimizing how much you’re doing those things. With cancer, there’s really just two big things, smoking and obesity slash insulin resistance. Now the literature would just say obesity, but I add insulin resistance, because I think that the literature is too blunt a tool to tease out what’s really going on. And what’s really driving it, I think, is the inflammatory and metabolic, i.e. the high growth factors such as insulin, that are coming with most, but not all cases of obesity. So what we really wanna avoid is being metabolically unhealthy and smoking. President Trump recently issued this warning from his Mar-a-Lago home. He said, and I quote, There are three reasons the central banks are dumping the U.S. dollar. Inflation, deficit spending, and our insurmountable national debt. The fact is, there is only one asset that has withstood famine, wars, and political and economic upheaval dating back to biblical times, gold. Birch gold can help you own gold in a tax-sheltered retirement account. That’s right, birch gold will help you convert an existing IRA or 401k, maybe from a previous employer, into an IRA in gold. And currencies fail, gold is a safe haven. How much more time does the U.S. dollar have? Protect your savings with gold. Birch gold has an A-plus rating with the Better Business Bureau and thousands of happy customers. Text Jordan to 989898 and get your free info kit on gold. Again, text Jordan to 989898. So that insulin overproduction also, in your opinion, facilitates cancer origination or growth once the cancer has propagated. Yeah, I think it’s a propagation issue, not an initiation issue. Propagation. Yeah, yeah. And we know that because there are more than 20 cancers for whom your risk goes up by about a 2X factor if you’re obese. And I think the only thing that makes sense in that sense in understanding that observation is the inflammatory and pro-growth environment that is in that individual. So do we want to avoid that? Absolutely. But my point is, think of how many people who are non-smokers who are metabolically healthy who still get cancer. That’s a very long list of people. So I wouldn’t be able to hang my hat on this as, well, my anti-cancer strategy is not smoking and being metabolically healthy and hoping that I don’t. I’m not being metabolically healthy and hoping that that’s enough. We have to have another tool in this toolkit. And that tool is a very controversial one, but nevertheless, I think it’s important and it’s very aggressive screening. And the reason for this is another observation that I don’t think gets enough attention, which is when you consider two different individuals with the same cancer, but at different stages, the exact same treatment, their survivals are very different. So if you take a person with stage four colon cancer, which means the cancer has spread to say the liver, and you treat them with the same cocktail of drugs that you give a person at stage three cancer, where it’s just spread from the colon to the lymph nodes, but no further, at least to the naked eye. The survival for the people for whom it’s spread to the liver is 0% at 10 years, whereas the ones to the lymph nodes, it’s gonna be about 60 to 65% at the same period of time. A fundamental difference, they’re getting the same treatment. So it’s the difference between treating somebody when they have a billion cells versus 100 billion or a trillion cells. And the problem is that there’s more mutational burden, the more cancer you have. You have more escape mechanisms for the cancer. That’s probably the best explanation for it. We could do this analysis for all other types of cancer, like breast cancer, et cetera. What it points to is early detection is essential. So what does that mean practically? What do people have to do with their physicians in order to ensure that they’re being optimally screened for the possibility of cancer? And at what age does that start to become more crucial? It’s very difficult for me to provide a blanket statement because even when I’m talking about this with my patients, I have a long discussion with them about the challenges of doing this. [“The Star-Spangled Banner”]