Cancer Screening 101

Diane: The reason why we're not better is that we're not taking care of each other, and we're not doing the right stuff. We don't pay attention to prevention. Everybody wants a statin pill. Everybody wants Ozempic. We are creatures of habit that just want the quick fix to be able to move on to the next play. But, in health as in other walks of life, that just doesn't work.

Brent: Welcome to the Death Clock Show. I'm your host, Brent Franson. The mission of Death Clock is to improve quality and length of life globally by helping people change their behavior. This show is devoted to understanding how change happens. Today, we're joined by Doctor Dianne Reidy-Lagunas, a clinical oncologist at Memorial Sloan Kettering Cancer Center, where she specializes in gastrointestinal cancers such as neuroendocrine, colorectal, and pancreatic cancers.

Brent: Her research focuses on integrating molecular-based therapies into neuroendocrine tumor treatments and designing clinical trials to improve strategies for these rare cancers. Doctor Reidy-Lagunas is a key member of the National Cancer Institute's Neuroendocrine Tumor Task Force and the Neuroendocrine Tumor Biospecimen Consortium. In this episode, we delve into cancer prevention, exploring new approaches like full body scans—I actually got the results on the day of recording this—

Brent: from companies like Prenuvo, and early detection cancer screening blood tests such as the Galleri test from Grail. We discuss the advantages and challenges of these tests—and there are a lot of them—and the importance of proactive cancer prevention strategies. It's a really nice primer episode on how to think proactively about cancer prevention. Doctor Reidy-Lagunas also hosts the Cancer Straight Talk podcast, where she shares more insights into the fight against cancer.

Brent: She's an inspiring guest who's doing wonderful work. I hope you enjoy our conversation as much as I did.

Brent: Doctor Dianne Reidy Lagunas, welcome to the show.

Diane: Thank you so much for having me. It's great to be here.

Brent: I always love talking to oncologists because I'm very curious about all things cancer: cancer screening and cancer prevention. I've had a few of my own experiences recently that I'm hoping maybe you can help shed some light on. But before we jump into it, just give us a sense of your background.

Great. Well, again, I'm thrilled to be here, hoping one day I'll go out of business with some of the things that we're talking about today. I've been a medical oncologist for close to 20 years, did my training, and have been on faculty here since 2008. My research and clinical interests are in caring for patients with GI malignancies, particularly rare types of cancer,
Great. Well, again, I'm thrilled to be here. Hoping one day I'll go out of business with some of the things that we're talking about today. I've been a medical oncologist in America for close to 20 years, did my training, and then on faculty here since 2008, in my research and clinical interests, are in caring for patients with GI malignancies and particularly, rare type of cancer.

Diane: neuroendocrine and adrenal, and I do a lot of colon and pancreas cancer treatments as well.

Brent: Wonderful. MSK is Memorial Sloan Kettering. People know the brand of Sloan Kettering is really good. Can you tell us a little bit about why? It feels like a lot of people have heard the term and think of it positively as being associated with the treatment of cancer, but can you give us a sense of the organization?

Diane: Yeah, I think it's been such a tremendous honor to work here for so long, in part because the bench runs really deep here at MSK. What I mean by that is, I always say we're not necessarily smarter than everyone out there—we just do it all day long. It's like the book Outliers,

Diane: right? It's just how many times do you have to practice to do something exceptional. I'm very blessed to have a group of clinicians, doctors, nurses, nurse practitioners, and researchers that focus on cancer all day long. As a freestanding cancer institute, the eye is on the ball. We like to say that we help our patients of today and tomorrow: on one side of the street literally, we're caring for patients,

Diane: and on the other side of the street are our research laboratories. That allows us to preserve the mission of caring for our patients while also focusing on finding a cure.

Brent: Wonderful. How did you get into cancer treatment? What inspired you to become an oncologist?

Diane: It's a great question. I come from a simple family from Long Island. My dad was a New York City firefighter, and my mom was a math teacher. I think both of them always tried to focus on values of caring for others and pursuing whatever passion you develop. I always knew that I wanted to do something in healthcare.

Diane: It wasn't until college that I enjoyed math and science and wanted to start focusing on getting into med school. Ironically, I didn't get into med school right away—it took me a couple of tries, believe it or not. So for those out there who encounter a few hurdles here and there, keep going, because I think that made it that much more of a passion for me.

Diane: When I did finally get in, it was that much more rewarding. Many of us, particularly in academic medicine where we run trials while caring for patients, say that some people are closer to the bench, where my colleagues really focus on finding cures.

Diane: Then there are those of us who are much more comfortable at the bedside next to patients. I've always been more passionate about caring for patients directly. I run trials because I want to push the envelope, but really it's to help my patients find more treatment options and lead to more cures.

Diane: So that's kind of how I ended up in all of the medicine.

Brent: There's always that distinction between researchers who aren't interacting with patients as much day-to-day and focusing heavily on research, versus people who are actually steering the course of a patient's treatment. Doctors tend to fall into one of those two categories: you either want to sit with the patient along the way, or you want to focus on research.

Brent: How is that split? As an outsider looking in, it's not always obvious—you're just thinking about the doctor you're interacting with. At a place like Sloan Kettering, what's the split between doctors doing research and doctors providing clinical care?

Diane: Most of us have an interest in trying to push the needle and find advances in care. Being a cancer doctor, you have to understand the science, because there's a lot of science in cancer medicine, but you also really have to have empathy and recognize how terrifying it is.

Diane: This is one of the most terrifying diagnoses most patients will face in their lifetime. Cancer is a family disease—you're not just caring for the patient, because whether it's a child or a partner, loved ones are affected just as much as the patient.

Diane: I consider it an enormous privilege to help my patients and shepherd them through this journey. Most of my colleagues are here for that reason. We aren't here solely for the science—you could do that in many other walks of life.

Diane: Oncology demands compassion. Some of us have greater strengths at the bench, elucidating those mechanisms, while others do a better job at holding hands, giving warm hugs, and reassuring patients that we genuinely care about them.

Diane: Everyone cares about them, but whether you're a clinician who wants to enroll patients in clinical trials, someone developing clinical trials, or a researcher who discovered a molecule or gene in the lab that made the trial possible,

Diane: We're kind of all on the same team in that way. Okay.

Brent: Let's work our way from preventing cancer through to treating it, starting with the more common ways we think about prevention. What's the latest on the importance of behavior and lifestyle? Setting aside smoking—it's obvious not to smoke,

Brent: and fewer people are smoking than ever, though vaping is a growing concern. How should we think about sleep, diet, exercise, and alcohol in relation to preventing cancer?

Diane: I love that question. I studied nutritional biochemistry in undergrad, so this is a huge passion of mine. There's no question that eating well and exercise—especially exercise—are incredibly important. Healthy living means maintaining a healthy weight.

Diane: That is easier said than done. When patients get cancer, or when friends and colleagues want to prevent it, our society loves supplements, tablets, and vitamins.

Diane: I often tell people that it's not the vitamin C tablet—it's the orange itself. It's the fiber, structure, and nutrients in the whole orange that make it so healthy. The same goes for an apple. Taking a step back, eating well helps prevent metabolic syndrome: obesity, diabetes, and hypertension.

Diane: All of those contribute to cancer. Yes, there are specific things to avoid, like alcohol, smoking, marijuana, or CBD. But metabolic syndrome—obesity, hypertension, and an unhealthy, sedentary lifestyle—is very likely a key culprit behind cancer.

Diane: A recent study looked at patients taking Ozempic. Although it hasn't been used for weight loss and diabetes control for very long, patients lost a tremendous amount of weight and significantly decreased—by 80%—the incidence of tumors associated with metabolic syndrome, including breast, colon, uterine, thyroid, and certain blood cancers.

Diane: We know these cancers are associated with obesity, and reducing obesity decreases the risk of developing them. I'm not saying everyone should take Ozempic, but it illustrates how significant overeating and a sedentary lifestyle are.

Diane: That's when trouble starts to amount in multiple different diseases, including cancer.

Brent: Is it specific to obesity? I'm 6'4" and 190 lbs, so I've typically been tall and lean. My cholesterol and blood sugar are a little higher than I'd like them to be,

Brent: and those are things I'm working on. Should we be focused more on blood glucose, A1C, cholesterol, and blood pressure levels, which tend to be unhealthy in people with obesity? If someone is not obese or overweight, but their blood work isn't great,

Brent: should they be less concerned than an obese individual with similar blood work? Is it obesity itself, or can we rely on blood markers?

Diane: It's a great question. It's less about the blood work alone and more about metabolic syndrome—obesity leading to these issues. Some researchers discuss the concept of "healthy obesity," where individuals do not have high blood pressure or diabetes.

Diane: Being 6'4" and 190 lbs carries a different risk profile than being 5'2" with excess weight. We don't fully understand all the mechanisms leading to cancer, but we know that inflammation is critically important

Diane: in contributing to the pathogenesis of cancer. For example, patients with inflammatory bowel disease, such as ulcerative colitis, have a significantly higher risk of developing colon cancer because chronic inflammation causes cellular damage. Obesity operates similarly: it damages blood vessels through cholesterol buildup,

Diane: increases heart disease risk, and damages organs like the liver. That inflammatory process causes cellular damage, creating dysplastic, abnormal cells that can later transform into cancer.

Brent: So there is an obesity-specific concern around inflammation, and you want your blood markers in a healthy range regardless. How should we view lifestyle and behavior versus genetics? What's the breakdown?

Brent: Is it possible to maintain a perfectly healthy lifestyle and still get cancer? It seems like if we live long enough, most people will develop cancer eventually.

Brent: How do you evaluate the role of genetics versus what is within our control?

Diane: That is a critical question. Not to scare anyone, but my clinics are filled with young patients who did everything right in life and still developed cancer. I use an analogy to help patients understand why this happens.

Diane: By definition, cancer is damage to cells—specifically, damage to genes in the nucleus, known as mutations. Sometimes, though rarely, that gene damage is inherited from parents.

Diane: Inherited mutations account for less than 20% of cases. When an inherited gene is present, it's crucial to consult geneticists for earlier screening or preventive procedures.

Diane: The vast majority of cancers do not result from inherited mutations; they develop over time. Why is cancer risk so much higher as we age? I use the analogy of a bingo card: it's usually not a single mutation, but an accumulation of mutations over years or decades.

Diane: In colon cancer, for example, a mutation like KRAS might occur early in life. That cell remains damaged but non-cancerous. Years later, a second mutation occurs.

Diane: Over time, four or five mutations accumulate, and—bingo—the cell transforms into cancer. It gains the ability to grow, divide, proliferate, and potentially metastasize.

Diane: Why do those mutations accumulate? Is it the environment, microplastics, lifestyle, or simply errors made by our immune system during DNA replication?

Diane: While we don't know all the drivers, mitigating risk factors helps decrease overall risk. In my colon cancer practice, we are seeing an alarming rise in colon cancer among patients under 50.

Diane: Colon cancer rates in adults over 65 have declined because colonoscopies previously began at 50. Now, we see young adults in their 20s and 30s diagnosed despite being in picture-perfect health.

Diane: Extensive research is investigating the microbiome—gut bacteria that may cause inflammation, cellular damage, and mutations that lead to cancer.

Diane: We're exploring whether dietary factors affect the microbiome in ways that promote cancer. Fascinatingly, research suggests that the microbiome in utero might even influence early cellular damage.

Diane: Solving this puzzle requires understanding when specific bacteria develop and whether maternal factors during pregnancy influence cancer risk later in life.

Diane: Researchers are studying this intensely, and I hope we'll have clearer answers in the next few years.

Brent: Is the rise in colon cancer specific to the U.S., or is it a global trend? If it were tied strictly to diet, a U.S.-specific trend might point to Western diets, but is it increasing globally?

Diane: It is absolutely a global increase. I work closely with colleagues in Nigeria, where patients face a much higher risk of being diagnosed with advanced disease due to a lack of routine screening programs. As a reminder to listeners: screening colonoscopies are recommended starting at age 45, or earlier if symptoms arise.

Diane: In Nigeria, colon cancer is frequently diagnosed at stage 3 or 4, but incidence rates are rising there as well. The adoption of Western diets globally may be a contributing factor, though it remains complex to pin down exact causes.

Brent: The recommended age for colonoscopy screening recently lowered from 50 to 45. I'm 42. Why not begin screening earlier, at 35 or 40?

Diane: Screening guidelines rely on a metric called "number needed to treat." While complications from colonoscopies are rare, the risk is not zero.

Diane: Guidelines balance procedural risks against diagnostic benefit. Lowering the starting age from 50 to 45 was supported by data showing clear benefit over risk across the population level.

Diane: Colonoscopies identify and remove precancerous polyps, serving as primary prevention. Unlike mammograms or prostate exams, which aim for early detection of existing cancer, colonoscopies prevent cancer from developing in the first place.

Diane: Age 45 is appropriate for individuals without symptoms or family history. However, any changes in bowel habits, rectal bleeding, persistent constipation or diarrhea, or narrowing of stool warrant immediate evaluation.

Brent: A friend of mine recently lost his sister to colon cancer at age 40. For a proactive 35-year-old with access to good healthcare who wants to get screened, what are the potential risks?

Brent: Why wouldn't they like what might go wrong?

Diane: The primary severe risk is colon perforation, which can be life-threatening. Anatomic variations, such as a tortuous colon, can make the procedure technically challenging and increase perforation risk.

Diane: Non-invasive alternatives like stool DNA tests (FIT-DNA) offer low-risk screening options. For individuals with a family history of colon cancer,

Diane: guidelines recommend beginning screening 10 years earlier than the age at which the first-degree relative was diagnosed, to detect and remove polyps early.

Diane: Since his sister passed at 40, your friend should begin screening by age 30.

Brent: Traditional routine screenings focus primarily on colon, prostate, breast, and skin cancer, depending on age and gender.

Diane: Skin cancer is actually the most common cancer. Sun protection and regular skin checks are vital, as melanoma can be life-threatening.

Diane: Vaccines also play a key role in cancer prevention, such as the HPV vaccine.

Brent: You treat pancreatic cancer, which is particularly daunting. Standard screenings for colon, prostate, breast, or skin cancer won't detect pancreatic cancer. For cancers outside standard screening protocols, are we simply waiting for symptoms to appear?

Brent: Right? Like, so for all the cancers that are not those for we're just waiting for symptoms.

Diane: Pancreatic cancer is uniquely challenging. Research shows that pancreatic cancer learns to spread extremely early in its development, often around the time of initial onset. Unlike colon or breast cancer, which typically grow locally over many years before spreading,

Diane: pancreatic cancer biology makes early detection exceptionally difficult. In high-risk screening programs, patients undergoing imaging every six months can still develop liver metastases between scans due to aggressive tumor biology.

Diane: We need innovative screening approaches. Over the next 5 to 10 years, blood-based biomarkers and emerging technologies, such as breathalyzer tests, promise to detect aggressive cancers far earlier than CT or MRI scans, where a single centimeter tumor already contains a billion cells.

Diane: Unnecessary imaging can lead down a complex pathway of incidental findings, invasive biopsies, and potential procedural complications.

Diane: We must improve diagnostic accuracy. Advanced technology is evolving rapidly, but clinical validation takes time.

Diane: Catching pancreatic cancer before extensive surgery, such as a Whipple procedure, or aggressive chemotherapy is necessary remains our primary goal.

Diane: huge surgery and the chemo, which are really hard. But let's get it before, you know, we even have, those concerns there on imaging.

Brent: For cancers with standard screening guidelines—breast, colon, prostate, and skin—early detection significantly improves prognosis. However, with pancreatic cancer, even early detection remains challenging due to tumor biology.

Diane: Early detection improves outcomes overall, but pancreatic cancer biology presents unique hurdles. Advances in multi-modality treatment—combination chemotherapy, specialized surgery, and radiation—are improving five-year survival rates.

Diane: Developing alternative screening technologies will be essential to transforming early intervention for high-mortality cancers.

Brent: Let's discuss newer screening modalities. I received my results this morning from a Prenuvo full-body MRI. There were no major findings—one moderate finding related to vertebral alignment that might cause neck pain,

Brent: and a few minor findings, such as evidence of an ACL reconstruction from 15 years ago. Setting aside economic cost, would you recommend annual full-body scans for everyone in an ideal world?

Brent: Have you personally had a full-body scan, and what is your perspective on proactive whole-body scanning?

Diane: When whole-body imaging detects an early kidney or thyroid cancer, the value seems obvious. However, we must evaluate whole-body scanning at both the population level and the individual level.

Diane: For high-risk individuals with strong family histories, targeted imaging makes sense. But for an asymptomatic person, does whole-body scanning improve overall survival or quality of life?

Diane: The critical issue is how we manage incidental findings. For instance, small, benign lung nodules are very common, but finding one creates a dilemma: do you perform a invasive biopsy, which carries procedural risks?

Diane: While I fully support finding reliable early detection methods, population-level studies have not yet demonstrated a net mortality benefit for unselected full-body MRI screening.

Diane: Consider lung cancer screening in high-risk smokers: low-dose CT screening requires scanning hundreds of individuals to identify one operable lung cancer,

Diane: while generating numerous follow-up procedures for benign findings.

Diane: For that single individual, early detection is life-saving, but procedural complications like pneumothorax across the screened group must be weighed carefully.

Diane: It's just what about all those other people that have all those complications which, you know, could be life threatening? Thankfully, usually they're not, but they're, you know, you're getting a chest tube and you're doing these different things to those patients that require hospitalization, at least for at night.

Brent: So in high-risk current or former smokers, screening finds real cancers, but also leads to biopsies for benign nodules, some of which result in complications. The potential harm from invasive follow-ups must be balanced against diagnostic benefit when establishing guidelines.

Brent: And there's actually three of those biopsies have complications. And so basically like the some of the complications from the biopsies that we didn't need to do, actually it's exceeds the benefit of the one that we found. And this is the type of math we have to think about for how we provide recommendations.

Diane: Exactly. Targeted lung cancer screening is proven beneficial because lung cancer is so lethal in high-risk populations, making the net trade-off worthwhile.

Diane: However, expanding unselected screening to low-risk, asymptomatic populations significantly increases false positives relative to true cancer detections. The "number needed to treat" rises into the thousands, escalating unintended procedural risks.

Diane: If an individual chooses to pay out-of-pocket for whole-body imaging, they should review the results thoroughly with a physician

Diane: to evaluate the risk-benefit profile of any suggested follow-up imaging or biopsies.

Brent: That clarifies why many oncology advisors express caution regarding whole-body scans. The primary concern isn't technical accuracy, but rather ambiguous incidental findings that force patients to decide whether to pursue invasive workups for likely benign lesions.

Brent: It creates anxiety around findings of uncertain significance, where the risk of invasive follow-up may exceed the potential benefit.

Brent: And so it's kind of a it's it's a true positive in the sense like we've, there is a nodule on your lung and we can tell you truly we don't know what it is. And it could be something. And so there's nothing in incorrect about that. It's just what's the risk and reward trade off of the invasive. The next step to like answer that question.

Diane: That's exactly right.

Brent: How do you view liquid biopsies? I recently completed the Galleri multi-cancer early detection blood test from Grail. Do liquid blood biopsies carry similar concerns, or do you view them differently than full-body imaging?

Brent: Do you think the same thing applies here or for some reason, would you put the liquid biopsies via blood in a different category than something like the full body scan?

Diane: Circulating tumor DNA technology is incredibly promising, but large-scale clinical validation is still ongoing. We need more definitive evidence showing that multi-cancer detection assays lead to improved overall survival without excessive diagnostic workups.

Diane: False positive and false negative rates remain challenges, so a negative result shouldn't provide false reassurance. However, cell-free DNA detection holds immense potential, and future iterations of these assays will likely transform oncology screening.

Diane: It's important to understand that abnormal or mutated cells naturally arise in the body regularly, and a healthy immune system typically eliminates them before they develop into clinical cancer.

Diane: Detecting microscopic fragments of mutated DNA doesn't automatically mean a clinically significant, progressive tumor is present.

Diane: The key is determining whether detected cell-free DNA signifies an active malignancy that requires intervention. While the technology is advancing rapidly, clinical guidelines require further research before widespread adoption.

Diane: It's just they haven't perfected it yet.

Brent: These tests report "no cancer signal detected" rather than ruling out cancer entirely. A negative result is encouraging, but it isn't an absolute guarantee, as viewing cancer through a simple binary lens is oversimplified.

Brent: Like we kind of all have cancer in some way in the sense of like you've got some cell doing something that you don't want it to be doing.

Diane: Correct. Damaged cells arise routinely, but the immune system identifies and clears them.

Brent: Non-clinicians often view cancer as a simple binary—you either have it or you don't. In reality, the key question is whether abnormal cells are proliferating at a rate that threatens your health during your natural lifespan.

Brent: If an indolent tumor grows so slowly that it wouldn't cause clinical issues for decades, cardiovascular disease or other health factors may pose a far greater immediate risk.

Brent: Do you agree with that, or do you think I'm.

Diane: I totally agree with that. Yes, that's absolutely right.

Brent: Regarding blood tests, since blood draws carry minimal physical risk, are patients bringing positive Galleri results into clinic seeking guidance on next steps?

Brent: How are these commercial multi-cancer detection assays impacting clinical practice at institutions like Sloan Kettering?

Diane: At a tertiary cancer center, most patients present with an established diagnosis. However, surgical colleagues in fields like breast oncology frequently see patients presenting with positive blood signals without identifiable lesions on imaging, creating clinical dilemmas.

Diane: Unclear findings generate substantial anxiety. Patients receive positive screening signals and face uncertainty when follow-up imaging, such as mammograms or MRIs, shows no visible tumor.

Diane: A positive signal prompts extensive diagnostic workups, such as bilateral breast MRIs or repeated scans, searching for lesions that may be false positives or clinically insignificant.

Diane: Right. If you're otherwise healthy, you know, you have this test that you're not sure what it means. And now the next thing you know, you're doing bilateral MRI is because the mammogram doesn't show anything. But again, now you're kind of going down that slippery slope of looking for something that may or may not be something because there's always false, positive stuff that can come up on MRI.

Diane: Medical guidelines urge caution not out of resistance to innovation, but to protect patients from potential harms associated with invasive workups for unconfirmed findings.

Brent: When you refer to a "false positive," do you mean an inaccurate lab reading, or a true detection of an indolent cell group that poses no real clinical threat?

Brent: Like what? What do you mean by false positive. Both.

Diane: It includes both. Some detected lesions are indolent and would never affect lifespan—prostate and thyroid cancers are classic examples where individuals often die with the disease rather than from it.

Diane: Additionally, false positives occur in cell-free DNA assays, similar to issues encountered in prenatal genetic testing, where high false-positive rates caused unwarranted concern.

Diane: Relying heavily on assays that lack clinical trial validation carries risks. That is why the medical community emphasizes gathering robust data before recommending routine clinical use.

Brent: How much of this comes down to the tension between population-level healthcare policy versus individual preference? An individual who detects an early actionable finding through a Prenuvo scan cares about their personal outcome, not population statistics.

Brent: As proactive consumers, how do we navigate guidelines optimized for public health resource allocation versus personal health management?

Brent: Is there a genuine divergence between population guidelines and individual self-care, or are clinical recommendations aligned with individual safety?

Brent: And so how much of it is the tension population level versus individual level, or how much of it is like, hey, those things are one in the same. Like I wouldn't like trust the docs, trust what we're saying. We're going to tell you our interests are aligned. We're going to tell you when things are ready. There's that question.

Diane: That distinction is very real. Two main considerations arise for individuals considering whole-body scans:

Diane: First, a normal scan shouldn't offer false reassurance. Aggressive malignancies, like pancreatic or hematologic cancers, can arise rapidly within months of a clear scan.

Diane: A single clear image does not guarantee long-term protection.

Diane: Second, scanning can uncover non-cancerous vascular issues, such as asymptomatic arterial aneurysms, where early detection is genuinely life-saving. However, when ambiguous lesions appear,

Diane: monitoring over time with repeat imaging is often preferable to immediate invasive procedures, balancing potential risks against benefits.

Diane: Having thoughtful discussions with your physician regarding incidental findings is essential.

Diane: So I think having those conversations with your doc when it happens, I think is, is really, really great.

Brent: What preventive health strategies outside standard guidelines would you recommend for individuals who want to be proactive about their health?

Brent: And second, what emerging technologies or preventative screening tools excite you most for the near future?

Brent: The second way you can answer the question is just like what are you excited about that's coming that like we're not recommending today, but we might in the future. That's going to be very specifically around prevention.

Diane: First and foremost, fundamental lifestyle factors significantly improve long-term health and longevity: prioritizing sleep, managing stress, and taking regular rest.

Diane: People often look for a quick fix like an expensive scan while ignoring core health habits like getting eight hours of sleep or managing 100-hour work weeks.

Diane: Key recommendations include getting vaccinated against HPV and Hepatitis B. The HPV vaccine prevents cervical, anal, and head and neck cancers, yet vaccination rates remain lower than ideal.

Diane: Beyond oncology, cardiovascular screening is essential. Coronary artery calcium (CAC) scoring is an excellent, non-invasive tool to assess cardiovascular risk.

Diane: Heart disease remains the leading cause of death overall. A coronary calcium scan evaluates coronary artery plaque buildup and provides valuable risk stratification, particularly for those with a family history.

Diane: In cancer screening, PSA testing for prostate cancer remains valuable when combined with informed clinical discussion. Mammograms and breast ultrasounds starting at age 40 (or earlier with family history), alongside routine colonoscopies starting at 45, remain essential tools.

Diane: That's something that I'm really a big advocate for. In addition to sort of checking to make sure that your cholesterol lowering blood pressure and all that kind of stuff is good. What in the cancer space? Addition to that, can you check for I do think prostate a PSA, is something that there's still controversy on, again, in part because you can find a very small, indolent cancer and you have to worry about what you're going to do.

Diane: While multi-cancer liquid biopsies like Galleri are not yet recommended for routine screening, I expect blood-based screening technology to advance substantially over the coming years.

Diane: And I, I'm very, sort of full on that. Like, I think it's going to be it's going to be a good one.

Brent: Coronary artery calcium (CAC) scans are an excellent example of an affordable, low-risk, highly informative screening that isn't always routinely offered. It takes 15 minutes, measures arterial plaque, and provides clear actionability for adults over 40.

Brent: Your point about health fundamentals resonates. In the longevity space, there are two main mindsets: those focused on actionable habits to gain a healthy decade, and those seeking magical quick fixes to live to 150.

Brent: Ironically, people searching for shortcuts often neglect core lifestyle basics. Focusing on high-tech interventions while ignoring basic health habits is counterproductive.

Brent: Maintaining strong social connections, sleeping well, exercising regularly, and moderating alcohol consumption remain the most effective, evidence-based ways to reduce overall disease risk.

Brent: And like, you kind of think about the psychology of it and the research isn't that great. But also it might be taking your eye off the ball in terms of like have really good relationships, don't drink too much, sleep really well, exercise a lot. Like if you really don't want to get cancer, like those are the that's the best way that you can spend your time.

Brent: And don't get too distracted by the by the magic pill.

Diane: Exactly. There are no shortcuts to long-term health. As humans, we naturally seek quick fixes, but sustainable health requires consistent daily habits.

Diane: Nutrition and regular physical activity are foundational. Exercise provides mental, emotional, and physical benefits that no scan or pill can replace.

Diane: At the same time, medical technology plays an indispensable role in detecting disease early despite healthy habits. For individuals who understand the risks of false positives and choose elective imaging for peace of mind, that personal choice is understandable.

Diane: On a healthcare system level, our focus must shift toward prevention and addressing underlying metabolic health rather than relying solely on reactive treatments.

Diane: And it makes all the sense in the world. I think on a population basis, you know, our health care system is absolutely broken and we already pay enormous amounts and we're not any better. But I think it comes back to what we're just talking about, the reason why we're not better. We're not taking care of each other and we're not doing the right stuff.

Diane: GLP-1 medications can be helpful tools by enabling individuals with joint pain or mobility limitations to lose weight and establish healthier lifestyle momentum.

Diane: You know, I think it's a combination.

Brent: Thank you so much for your time. Please tell our listeners about your podcast and where they can find your work.

Diane: I host a podcast called Cancer Straight Talk, available on Apple Podcasts, Spotify, YouTube, and all major platforms. We discuss oncology topics openly to support and empower patients and families affected by cancer.

Brent: Thank you for coming on the show and for all the vital work you do on the frontlines of cancer care.

Diane: You're very welcome. Thank you for having me—I really enjoyed our conversation.

Brent: The Death Clock Show is recorded in Boulder, Colorado, and San Francisco, California. Produced by Patrick Gudino, with music by Patrick Lee, and hosted by Brent Franson, founder and CEO of Death Clock.