The Painless Blood Test Outperforming Standard Scans | Dr Tarek Mouhieddine

[00:01] each one has a different mortality risk and each one has different rates of progression, different treatment options, and of course, that also depends on the stage at which you catch the cancer. And as

[00:16] you all know, the earlier you catch the cancer, the better because there's a higher cure rate when it's caught, for example, at stage one versus when it's at stage three and when it's at stage four really,

[00:29] it becomes incurable in most cases. [music]

[00:46] an instructor at Harvard Medical School, a physician scientist specializing in precision oncology and cellular aging at the world-renowned Dana-Farber Cancer Institute, and the chief medical officer of Palm Health. So, Dr. Moheddin,

[01:00] Thank you. Thank you so much for having me. So, thank you. So, Dr. Moheddin, Moheddin, where I'd like to start is to get an idea of the importance of cancer in the population and why having a way

[01:14] in the population and why having a way to screen for it is so important. So, like how prevalent is cancer? Where does it come in terms of the top mortality Yeah, well, first of all, I would say cancer is

[01:29] definitely one of the leading causes of death these days. Um, and it's, at least in the US, it's only preceded by cardiovascular disease really. So, cardiovascular disease comes as number one and then right after it, it's

[01:45] cancer. That's the second most leading cause of death. And so, basically, if if that is the case, you could really say that around maybe 1/5 or 20% of deaths

[01:58] are related to cancer these days. And that's at of course different age groups, but also it varies by the cancer type as you as you know. So, there are different types of cancer. So, each one has a different

[02:12] mortality risk and each one has different rates of progression, different treatment options and of course that also depends on the stage at which to catch the cancer. And as you all

[02:28] know, the earlier you catch the cancer, the better because there's a higher cure rate when it's caught for example at stage one versus when it's at stage really, it becomes

[02:42] incurable in most cases. So, um um you I could say that first of all, as as as I just said, cancer is one of the leading causes of death, but also

[02:55] it's a little bit worrying that it's also on the rise. So, you hear a lot from different people now that cancer is on the rise. There's more incidence of cancer and even

[03:09] more concerning is that you're seeing it in younger age groups. Specifically for cancers that we have always been used to seeing in older age groups. Now we're seeing in younger, specifically colon cancer. And um

[03:22] cancer. And um speaking even from personal experience and that was during my even training in oncology, oncology, I was seeing a lot of

[03:34] 20-something year olds with stage four metastatic colon cancer. And um you could say that yes, it can happen sometimes and usually in those cases there's a genetic predisposition where they have an inherited mutation

[03:50] and colon cancer is very prevalent in that specific family, but the what struck me the most was in a lot of those cases that was not the case. They were 20-something year olds, no history

[04:04] of uh or family history of cancer, no genetic mutations really that were genetic mutations really that were inherited, no specific weird exposures, environmental exposures, and yet they showed up at the hospital with

[04:17] the different symptoms. It could be uh severe abdominal pain or uh bleeding um uh in the stool, and we would discover colon and lesions everywhere in the body. And that's I would say that was

[04:33] the first thing that really stuck with me and pushed me more towards doing what we're doing these days with Palm Health. So, one of the key things is to catch cancer

[04:46] early. And so, there is screening for cancer, right? So, the standard of care has certain screening procedures that they do. Um can you talk about what are the standard of care type

[05:01] many like what percentage of cancers would Mhm. Yeah, so um as you know, there are a few cancer screening protocols that uh is are recommended to the general

[05:17] population, and those involve just a few cancers, and they're really the one of the common cancers, of course. Uh so, most importantly or famously uh Uh so, most importantly or famously uh breast cancer with uh mammograms for uh

[05:31] women, and usually that starts at [clears throat] the age of 40 and above, unless you have uh certain uh predisposing factors or um like genetics or strong family history where then they start earlier. Um and

[05:46] then you have uh colon cancer screening, which for a very long time uh used to be for people at the age of 50 and above until um more recently they lowered that age limit to 45 and above. And that's done

[06:00] by colonoscopies, and of course you do that uh depending on what they find, um it could be as frequent as every 6 months even and as infrequent as every 10 years. And then you have uh screening for cervical cancer, right? And that's

[06:17] through Pap smears. And also that is usually done every 3 to 5 years, but usually done every 3 to 5 years, but also that depends on um the results of your first Pap smear and the uh subsequent Pap smears. So, it changes

[06:31] with uh what you're finding. You have prostate cancer screening, which is uh prostate cancer screening, which is uh by PSA and uh digital rectal exam, and that's usually for people at the age of uh or men at the age of 50 and above.

[06:44] You have uh lung cancer screening, but that's only for uh people who were smokers throughout their lives, and that is basically if you've had 30 pack year smoking history and you uh hit the age

[06:59] of 55, you would be eligible for uh CAT scan of the lungs. Uh and of course there's skin cancer screening, but that's usually recommended for people who have a history of uh skin cancers. I mean, we recommend everyone make sure

[07:15] that their skin is okay and there are no weird lesions appearing, but you that's why for some people at least we recommend annual skin checks with dermatology. And so, these are just

[07:29] these are just a few things really that uh are out there as protocols and recommendations to screen cancer while we actually have more than 200 different types of cancers. And there are uh certain

[07:42] cancers. And there are uh certain limitations or age groups uh where you can start screening. You can't do before that if you didn't have any specific that if you didn't have any specific reason. And as you also would note,

[07:54] a lot of these procedures are invasive as well. Like a colonoscopy is invasive, a Pap smear is invasive, and a CAT scan is not so benign because you're also So if you're going to keep doing that, that's also radiation exposure over and

[08:10] that's also radiation exposure over and over again. And so with with these technologies, we're only basically detecting these detecting these only these types of cancers. And really

[08:22] it doesn't really get rid of cancer completely, right? Because sometimes people develop these things before any of these protocols are recommended. So have 20-year-olds presenting with colon

[08:38] cancer, right? So they don't they didn't even reach the age limit of 45 before they could be screened. And so with the current practice, we're really detecting

[08:50] out of all the cancers, really, I would say probably like um less than 20% really of what we eventually diagnose in terms of cancers. So there is definitely

[09:02] a benefit in the preventing cancer, but it's not perfect and it's still it's not perfect and it's still invasive. And the type of tests that we're doing right now are really time-consuming and they do create a

[09:16] burden on the health care system, which is something that I can definitely talk simply to simply break it down, if you want to get a colonoscopy to find an appointment, I mean, depends

[09:30] where you where you live, but usually it takes months to find an appointment for procedure that takes a significant amount of time. It uses up a doctor's time and an anesthesiologist's time. And so, to really put all of that together,

[09:47] it fills up this uh the doctor's schedule and the hospital's schedule very quickly. And so, if imagine if everybody is going to do that at all you won't find a colonoscopy slot for like 3 years, probably,

[10:01] >> [laughter] >> if everyone is uh is going to do that to >> if everyone is uh is going to do that to really look for cancer. And so, here's part of the problem. So, we want to detect cancer as early as possible, but

[10:15] can we really do it with the current methodologies? We can. They're not perfect, but they're also like a huge burden if you want to do it for everyone. So, that's why when they make recommendations, they actually

[10:29] pick age groups, of course, based on how risk is at that age group. So, you know, of course, the older you are, the higher the risk. But, at the same time, they like they want to make a limit to how low they can bring the age

[10:44] group because you have to think about how if the healthcare system is able to accommodate that many people. And how many cases are you really detecting if you lower the age limit? So, for example, it was

[10:58] already a big deal going from the age of 50 to the age of 45 for colon cancer 50 to the age of 45 for colon cancer screening because adding just 5 years, or a 5-year age group, basically makes a huge difference in terms of how many

[11:12] people are flowing into uh the doctors' uh appointments and getting colonoscopies. So, imagine if you lower that by another 5 years, there's even more and more people that who are going to

[11:25] flood into the clinics, and there's no room, really. Uh and then Then you think about it, yeah, we we bring the age limit lower, we see way more people and there's barely any room for it and we're

[11:38] basically going to detect just a few cases of cancer. So, when you think about it, it it it talks we we then think about it it it talks we we then think about cost and benefit or

[11:51] uh the number needed to treat basically uh statistically. And so, um it makes it very difficult to lower that age group. um this is why it is very important that we

[12:04] keep expanding or improving and developing our technologies and abilities to detect cancer. And if we can find a way that can detect all these can find a way that can detect all these cancers and more by a simple blood test,

[12:19] for example, that definitely would make all of this more feasible because going definitely way more manageable for the health care system versus oh, making everyone get a colonoscopy, for example. And this is

[12:36] why why another reason This was another reason for us to put this together and focus a lot on multi-cancer detection through blood assays, blood-based assays. Okay, and I think that would be a good

[12:50] time to talk about that. So, Pome Health offer different ways for people to be can get their cancer screened uh with a concierge service.

[13:02] Uh and one of the things that you use is this multi- multi-cancer early detection blood-based system. And I think it's called Gallery. Is that how you pronounce it? Gallery. So, could you talk about how that works? What are

[13:16] you looking for in the blood in terms of um cancer? Mhm. Yeah, that's a great question. So, um in our

[13:28] company, our actually our company is basically an online platform that connects people who don't have really a cancer diagnosis necessarily. They're cancer diagnosis necessarily. They're just um healthy people who are

[13:43] just um healthy people who are interested in making sure there is uh that first of all, knowing their risk of cancer in general, and second of all, detecting if there's anything already brewing that's not apparent yet. Because

[13:58] brewing that's not apparent yet. Because as you know, in most cancers at stage one, they it's asymptomatic usually. And that's why people miss it and don't feel anything and until it's already too late when the cancer has

[14:11] already developed and progressed and started causing symptoms. And so, what started causing symptoms. And so, what we do is we you get an appointment with an oncologist really, which is another benefit that people also without a

[14:26] cancer diagnosis don't have. So, you know, you in the real world you don't really see an oncologist until you have a diagnosis of cancer because you know, the first barrier or the first

[14:40] I don't know if I want to call them first responders basically or the first before you take the next step is basically your primary care physician. And those are usually the doctors who

[14:54] screen for cancer or detect cancer or suspect a cancer and then they refer you to an oncologist where you come in with a diagnosis of cancer and take it from there. So, you don't you can't really get an

[15:06] appointment with an oncologist just to talk about cancer and be screened for cancer and see what options you have. So, this is the first thing. So, you get to speak to an oncologist, talk about your cancer risk and everything, and

[15:19] we go over the tests that we do. So, the majority of our tests are blood based and one of them is the Gallery test from Grail. And that is in addition to a number of other blood based assays or tests, but

[15:34] those include some of the traditional tests which are the basics and of course before you jump on to the more advanced things you can sometimes find things with just a regular CBC and a metabolic panel. So,

[15:48] that's definitely included. There's a number of cancer markers that are also known to be produced in the blood produced in the blood like CA 15-3, CA 125, CA 27.29,

[16:03] and so these markers are known to be produced by cancer cells as well and so they are included in our panel.

[16:15] of the panel which looks and for blood cancers as well in the blood. And we do have urine tests that can look for signs of bladder cancer as well

[16:31] or another type of blood cancer called multiple myeloma that secretes proteins that can be dumped into the urine. And we have also an imaging option. And like I mentioned earlier, CAT scans are not great because they

[16:46] have radiation. So, in our case we go for an MRI which is magnetic waves which don't really have a risk of inducing cancer in your body. So, that is also

[16:58] um having a full picture of the body. And so going back to your question about Gallery. So, that is a blood based assay and it's it looks for DNA methylation

[17:13] which is a process that where the body actually or the cells, to be more exact, methylate pieces of DNA to in order to methylate pieces of DNA to in order to press certain genetic markers or certain

[17:28] proteins that aid the cancer cells in their survival and proliferation. And their survival and proliferation. And so, what Grail has done in the past was a lot of different types of cancers and or patients with

[17:43] different types of cancers and looked at the blood and looked at DNA that's floating around in the blood because we know that cancer cells can because we know that cancer cells can shed DNA. And they found that different

[17:57] cancers have different signals or signatures on their DNA. So, DNA being shed from lung cancer has a different methylation signature on the

[18:10] different methylation signature on the DNA versus DNA being shed from kidney DNA versus DNA being shed from kidney cancer or DNA shed from colon cancer. And so, they looked at the DNA or methylation signatures from different

[18:23] cancers and were able to make associations. And so, now what they do, they and they made a list of 50 cancer subtypes and now when we do that blood test, they look for these different signatures that they previously

[18:37] identified. And if they detect any of that, then they tell you, "Okay, you that, then they tell you, "Okay, you have a cancer signal in your blood that seems to be corresponding to lung cancer, for example." And so,

[18:51] when that result comes back, you take the next step, which is looking for lung cancer, which would involve imaging. And so, this is really how Gallery works, but because it's it only covers 50 cancers, that's why we included a

[19:08] much bigger panel of assays uh, that we combine together in a assays uh, that we combine together in a uh, a single blood draw. When we, uh, go to, because we partnered with Quest, so you go to a Quest lab and you just get

[19:22] all those tests drawn in in one setting. And so, when the results come back, they come to, um, the oncologist who goes through them and then connects with the patient again. Of course, based on the results, you can discuss

[19:36] the next steps. Uh, and so far, of course, uh, we've had both situations happening. So, peop- some people go through all the tests and everything comes back completely negative. Great news. We talk

[19:50] with the patient, tell them everything looks good. And then, a few cases where, um, things came back concerning for a few things and, um, we talked with them and told them about the next steps. So,

[20:06] one of them already was able to, uh, find uh, an oncologist to take the next steps of diagnosis because, you know, our job is to detect the cancer and then guide you with uh, next

[20:21] step. So, um, because this is a telehealth virtual, service, you can't be a treating oncologist. So, uh, because we we I I oncologist. So, uh, because we we I I could be here in Massachusetts and then

[20:36] I have I'm talking with a patient from California. I can't treat them from here. So, we our job is to, uh, detect their cancer and then connect them with a local oncologist who can, uh, start the treatment or do extra

[20:50] tests that are needed before they can begin treatment. And so, um, in one case, a patient already was able to directly find someone and started um, further identifying the cancer with

[21:05] them, a blood-based cancer. The another patient that I is coming to my mind patient that I is coming to my mind actually we were able to connect with them uh and uh talk with their primary care who's

[21:19] going to do referrals to doctors in uh to a doctor oncologist in their area. So, we take the first step and then we guide you through the next steps um until basically you find someone who can also

[21:33] take over uh the management of whatever we find in terms of cancers different cancer subtypes. Okay. So, Galleri. So, so Galleri you're looking in the blood,

[21:47] right? So, it it has to be a tumor that has blood flowing through it, right? And also will it catch I think it will catch uh the cancer potentially earlier than per- than perhaps like the standard of

[22:03] you know, the the the cancer has to get noticeable. Mhm. Yeah. Yeah. Um so, that's right. So, um

[22:16] because it's a blood-based assay, of course, the cancer needs to have blood flow through it and um that is the case for most cancers really and that's the benefit of uh using that. Uh that plus

[22:31] any other blood-based assay really. And that is basically the least invasive way right now to to try and detect all those cancers. You know, it's definitely still not perfect because, you know, there's always uh

[22:47] cases of cancers that might not secrete anything at all. And that's why Galleri doesn't detect all 200 cancers, right? It It has a list of 50 and that's why we add on top of it uh other blood uh assays and urine and

[23:03] even stool, um, and in general, a whole body scan, too, with MRI. Sometimes, you know, uh, either the cancer doesn't secrete anything at all, even if it's known to secrete something, and you know, there

[23:20] secrete something, and you know, there are some cases that are not so common, but they can happen because nothing in medicine is the same all the time. It's a spectrum. So, even though we know, for example,

[23:33] that colon cancer secretes, uh, CEA, you might find a few cases where that that's not happening, really. Where their cancer is mutated in a way that just doesn't secrete that protein into the blood. And so, even if the

[23:48] blood flows through it, it's still not secreting it, and that's why them, "Yes, blood is the best way, or the least invasive way to catch these things, but it's still not perfect. And,

[24:04] of course, there could still be, um, false negatives. So, it's not, uh, 100% accurate all the time. Uh, but Uh, but at least we are getting as close to 100%

[24:18] at least we are getting as close to 100% accuracy as possible. And that is why we use multiple modalities to overlap, uh, different cancer diagnoses, so we don't fully rely on just one thing only. Because even when we do Galleri, we're

[24:33] still looking, for example, for CEA in the, uh, as a traditional test. And Galleri, for example, looks for the methylation signature for colon cancer. And if you do the imaging, you're also looking at the colon. So, you have three

[24:49] ways to really catch the colon cancer, rather than just relying on one. And all rather than just relying on one. And all of them are not really invasive compared Um where, you know, there's a risk of bleeding, there's a risk with the

[25:05] you know, uh it's it's definitely different. have an AI system that does the combination or is that one of your doctors that kind of looks at the the three bits of data and decides the

[25:21] potential for the cancer? No, um so far we don't have an AI yet plan. Uh because AI usually or really um

[25:35] uh learns and becomes better based on data and more information. And at this point when we don't have a lot of patients yet, it's not going to be super patients yet, it's not going to be super accurate. So we rely on an oncologist

[25:49] discuss things with the patient because each case is different, you know? For if I if as an oncologist I look take a look at all the blood tests for uh young healthy male, there's nothing

[26:05] going on really. But then out of all the tests, one thing and this is a real case actually. One of the markers come back a little bit positive for breast cancer in a male

[26:20] in a male um who doesn't have symptoms. So um who doesn't have symptoms. So as AI, I don't it's going to be a little bit difficult for it to really say something accurate about this if

[26:33] you know, um you have to take a look at the past medical history, smoking history, um medication history, what they're taking, and of course

[26:46] put everything together, making sure that other markers look totally normal, kidney function is okay as well. It's not altering slightly the level of certain circulating cancer markers, and of

[27:01] course imaging. So, in this case for example, in this case for example, there was there wasn't easy explanation. Using, especially for men, using medications like

[27:15] finasteride and dutasteride actually, which helps with hair growth, and a lot >> [clears throat] >> can slightly increase the breast tissue

[27:27] in men. And so, that's why a lot of men who use it eventually say, "Oh, we have tenderness in our chest, in our breast." Or they get enlarged a little bit. And so, those then when that happens, that

[27:43] marker of usually breast cancer can bump up a little bit. And so, it's just because of breast tissue, not because they actually have the cancer. And so, as an oncologist, you're able you're able to

[27:56] look into all of that and make that conclusion versus AI, I think it needs a lot of cases like that first to learn before it can actually say, "Oh, okay,

[28:08] you're fine. You don't need to worry." So, that's just one case that comes to mind. Right. How small or how Yeah, how small Right. How small or how Yeah, how small can the MRI detect? Like, is it very

[28:22] early stage cancer? I mean, how big does it does the cancer have to come before it becomes visible? Yeah. Well, of course MRIs are also not perfect, and especially when it's whole body MRIs,

[28:36] right? When it's a whole body MRI, there's less When it's a whole body MRI, there's less details compared to a targeted MRI. So, that's just focused on the brain or just focused on the shoulder,

[28:49] So, those usually have definitely more details compared to a whole body MRI, details compared to a whole body MRI, but still a whole body MRI can detect um things that are starting um that are in the order of 1 mm, for example, which is

[29:06] very very tiny. But, I would say it would still miss something that's 0.5 mm, not centimeter, which is much bigger. So, that's why I still say nothing is

[29:20] perfect yet, but if I want to talk about a cancer that's less than a millimeter, really, even if we don't detect it, when we screen again in a year, let's say, and it grows to 1 or 2 mm, I don't think

[29:37] it's going to go to stage four. It's still going to be stage one. So, if you if it's really there, but uh below the detectable size, and you check again in the future, but you don't wait 20 years to check

[29:51] but you don't wait 20 years to check again, you're going to catch it again um when it grows a little bit more. So, this is also the importance of not just this is also the importance of not just screening once, but screening

[30:05] consistently throughout your life. I wish it was uh just a one-time thing where you screen yourself and you're you say, "Oh, I'm I'm I'm good. There's of my life." Unfortunately, that's not the case. So,

[30:19] with our technologies, thankfully, they're pretty good right now, but, you know, uh I think they're going to continuously improve over time, and uh could do. And even if we miss it the first time, I

[30:34] think it's very very minimal to an extent that waiting another year as it grows a little bit more and detecting it then will still give you a detecting it then will still give you a stage one cancer detection level

[30:48] and I don't think you will go beyond that staging because most cancers actually aren't that quick if we're starting with such a such a tiny nodule like they're yes they're quick but not quick as in oh within a

[31:04] few weeks it's going to turn from a point five millimeter nodule to five centimeters and metastasize so this is the same um

[31:16] that's what we look for when we do colonoscopies right and the reason why we wait 10 years from one colonoscopy to another is because we know that polyps they develop very slowly and when they do develop it takes

[31:32] them a long time to really grow and become cancerous and so it's kind of the same logic where if we don't catch it now when we check again we're going to catch it and it's still going to be at stage

[31:46] one it's we're not going to miss it till it becomes stage four how often should people get a scan and also

[31:59] when should they start like age wise and should the the frequency of scans change as you get older cuz as you said like cancer becomes more prevalent as you get older Mhm so

[32:14] um as of now there's no real concrete data to really tell us okay you should be getting a scan every one year or every two years or every five years really

[32:27] there's no real recommendation because it has not been done before and really to make a recommendation you have to run a trial and scan every year versus every two versus every five and see the level of detection between

[32:44] all three different ways and then assessing, "Oh, is it really beneficial to do screening that frequently or not?" So, from our standpoint, we say that in

[32:56] the blood it would be good to screen um once a year. Basically, because first of all, it's things in the blood can change pretty quickly and they it's very non-invasive.

[33:12] So, it's just a blood draw and you just get the uh tests back and you're done. Uh versus scans I mean, if you want to do it annually, we're not going to we won't say no. It's still reasonable, but you don't really I

[33:26] don't think you have to do it annually. Uh especially if you're on the younger Uh especially if you're on the younger side um with no risks at all and everything looked totally fine on your first scan, for example. So, doing it

[33:39] So, let's say if you're 30 years old and you're you don't have any risk factors at all and your scan came back very clean if you want to do a scan in three, four, five years, like that's going to be your

[33:54] next scan, that's fine. But, I would still do the blood once a year. Basically, similar to an annual physical with your primary care, where you get uh a set of blood tests every year. I would say I think

[34:09] um cancer screening by the blood should be also an annual thing, just like you do a full panel of things every year with your primary care. I would say it depends on the technology. Scan versus blood.

[34:25] Yeah, how invasive and and I guess expensive it is. Oh, yeah, for sure. mentioned the age group, of course, an older age group is definitely at a group. Um from our standpoint, the

[34:42] Um from our standpoint, the like we accept ages of 18 and above. So, uh below 18 it becomes a pediatric population. So, very different. 18 and above, we start dealing with adults uh and adult-type cancers. And so, so

[34:57] uh and adult-type cancers. And so, so really anybody can screen, but of course the recommendation is higher for older individuals. Um Definitely 50 and above, but similar to

[35:11] similar to or based on my experience and of course everybody's experience with cancer, we are seeing it in um very young age groups, too. So, 20s, 30s, 40s. So,

[35:25] and um detect things. And actually, yeah, one of the patients that we detected we detected something in recently was high 30s.

[35:40] So, yeah, so it happens. Not Not as common, but it's it happens. And that's why we can't say, "Oh, only 50 and above." Because it's happening in

[35:53] in younger people without prior signs, really. And it And there is a randomness to it. I mean, I I guess, you know, there's people and who have lifestyles or genetics that would make put them more

[36:06] at risk, but you can do all the right things and you can still get cancer. Mhm. Oh, yeah. Yeah. And that's that's a thing that I see a lot, unfortunately, in my clinic. Um when I see uh people with cancer and

[36:19] all my life. I didn't smoke. I didn't drink alcohol. I eat very healthy food, organic. What did I do wrong? Why do I have cancer? And I tell them, yeah, as well, you know, it's very unfortunate, but there are in

[36:35] life, there's a lot of randomness and luck and chance. It's crazy to say it, but it's chance and luck as well, you know? It's it so happened that that single cell in your body made a mistake in in how it

[36:50] was dividing and the error happened and it was not corrected and it just um perforated and created the cancer, everything uh you did was right. So,

[37:06] to make it maybe a little bit better for them, I well, it's honestly still not a waste what you did because some people start thinking that

[37:18] what they did is a waste and they start feeling that, oh, I should have just had about all of this. And I tell them, no, no, because healthy tell tells me that most likely you're going

[37:33] to tolerate your treatment extremely well. You you won't be suffering from still be able to live your life normally. And if somebody tolerates cancer therapy very well, that means we don't delay treatment. We have don't

[37:49] have to lower the doses. You won't get sick and be hospitalized. And the sick and be hospitalized. And the chances of getting rid of the cancer or curing the cancer is definitely much higher when there are no delays, no dose

[38:03] adjustments. And so, being healthy would allow you to do that. And so, you didn't do all of that in vain. And I think think um some people that um

[38:18] feels a little bit better, I guess, because if they're going down that I I wasn't healthy. I I shouldn't have cared." Then they think about it and I feel that it to them it makes sense that now,

[38:31] "Okay, at least I can tolerate the therapy and have a higher chance of curing myself." So, that's how I look at it. Mhm. Okay. I mean, I see being healthy as its own benefits. I mean, you know, and

[38:47] it's not it's not that difficult to do some of the most of the right things. Oh yeah, of course. As long as you view it kind of 80/20. As you You You don't have to go like uh what's-his-name Brian Johnson, but you

[39:00] do most of the good things. Yeah. Oh yeah, of course. We We all know and agree that being healthy puts you at a better spot, increases longevity, makes you live longer, decreases the chances of getting

[39:13] cancers, but I'm talking about the cases where you're super healthy and you still get cancer. I don't want them I don't want people to think that all what they did is for nothing because it it still is

[39:26] beneficial to be healthy even if you end up developing cancer. The likelihood of getting cancer, of course, when you're healthy is lower, but if you do get it, you're in a better in in better shape.

[39:39] Um and I always give an example of two patients that I treat and I have somebody who's in their 70s who's who've been healthy all their lives. They jog,

[39:52] they eat healthy, they're living their life to the fullest while getting treatment for their cancer. And he is in such good shape and doesn't want to stop working that he comes to clinic, brings his laptop, and while the

[40:09] away, and then once everything is done, he just gets up and goes to work again. Like it he doesn't take a day off, and he feels totally fine. Versus another patient who is 40 years old,

[40:23] who unfortunately didn't take care of his health, um has a lot of medical problems because of him not taking care of his health. We had to We have to every now and then either delay therapy, pause, lower the dose, and he's having a

[40:40] rough time, basically. But, all related to um his health status. And unfortunately, that person, for example, who was working had to stop working and just stay home.

[40:54] So, it really changes your life significantly how healthy you are when you when you have cancer. Yes. of cancer in both. Right. >> Same type of cancer, same treatment. So,

[41:07] I'm not talking about two different cancers. So, same same cancer, same treatment, opposite outcomes based on how healthy opposite outcomes based on how healthy they were throughout their lives.

[41:23] really follow this, but that you you get false positives, and that these cause uh people to unnecessary concern. And I guess also that that any false positive that you have would then

[41:36] need to be followed up, perhaps with more invasive um thing. I mean, perhaps liver cancer," then there would need to some further investigation and maybe a biopsy. So, do you

[41:52] Yeah. Well, definitely that's one of the limitations of uh the blood-based assays, right? And so, when we deal with a false positive, of course, or a positive result, whether

[42:07] it's positive or negative, we definitely want to take the next step. Unless we have a really good explanation why it came back positive, like the case that I just mentioned earlier with the breast cancer signal. Um and so when we see

[42:21] like uh a liver cancer signal, the next best thing to do is imaging. And so imaging with MRI on while it's not as simple as a blood

[42:33] draw, it's still not as invasive as a CAT scan or really a biopsy. And actually the I mean, liver cancer is a little bit different. So liver cancer actually you can even diagnose it with just an MRI

[42:48] because it has a certain signal to it which tells you, "Oh, this is definitely liver cancer." But let's say, I don't know, lung cancer. There's a or uh kidney cancer. There's something some nodule in the kidney over there. Um on

[43:03] and then you did imaging, you saw something on the kidney. The next step would be, of course, a biopsy. So and that's a discussion really. So

[43:17] if we see a cancer signal and then on imaging it's a very, very tiny nodule, you might say that I don't want to do anything right now if

[43:29] it's super tiny because even if it if it's super tiny, even a biopsy might So you can wait a little bit longer and then image again and see if that nodule then image again and see if that nodule is changing. If it's cancer really,

[43:42] it should continue evolving and growing. If it's not cancer, it should stay the If it's not cancer, it should stay the same more more or less. And so that is something that is doable. So you don't have to chase

[43:57] every single thing you see. You could hold off if it looks very minimal and then repeat a scan at some point in the future. But if when you do a scan it's already something huge,

[44:11] you know, I I think it personally it's better to know and make sure this is not cancer versus saying, I'll I'll hold off." I mean, it's similar to a lot of things really or a

[44:24] lot of ways where cancer is discovered because a lot of the times we discover cancer by accident. You're imaging for something like you have abdominal pain and diarrhea, for example, and you image

[44:39] the body and then you see a big lesion on the liver, for example, that has nothing to do with what you're going through right now. It we call it an incidentaloma.

[44:52] an incidentaloma. It's all from incident. Um and so, what do you do in that case? It's the same thing. You You find it, you go for it, and biopsy it because it looks worrisome.

[45:04] Um so, and and sometimes you'll find cancer and really, but you still went for it the biopsy. biopsy. So, I would say, yes, um false positives

[45:18] happen. False positives will cause anxiety, of course, but if we go through the process of really finding eventually finding out it's not, you'll be relieved

[45:33] and you know that I you don't have cancer. If you find something, you won't be relieved, but if you find it at a stage one where you can cure that's when you'll be relieved and say, "Oh, I'm I'm happy that I found it even

[45:48] though it took some an an invasive procedure eventually And that brings me back to saying what I said earlier that our current assays are not perfect, unfortunately. They do catch a lot of

[46:03] things in uh um a non-invasive way, but the technology is always improving. And I personally don't think we're going to stick with the same assays forever. That's and that's one of the good things about Palm Health because I'm always on

[46:19] the lookout for the next best thing in terms of detecting cancer early in the least invasive way. Actually, couple of companies already connected with us to tell us about their blood-based assay and how it's great.

[46:32] And my first answer to them is, "Prove to me that it's better than what we're to me that it's better than what we're adopting right now, and I'm very happy adopting right now, and I'm very happy to switch because I want what's the best

[46:45] out there to detect and have the least false positives and the least false false positives and the least false negatives um as much as possible. And I negatives um as much as possible. And I think eventually we'll get there, but um

[46:57] Right. >> And I'm always up for change when when that comes. Right. Because you're you're kind of sitting at the center and pulling in these different methods for screen-

[47:09] screening for cancer and then offering them to your your customers. I It's I'm not sure this is an unanswerable question, but if you get a clean bill of health from your system, right? You go in and you you do the full

[47:24] check. I mean, how confident should you be that you're cancer-free? You you Can you have like Can you put a percentage on that? Um well, it's

[47:44] absolute uh foolproof, right? That okay, you're you definitely don't have anything. And part of it is that part of it is that um

[48:00] somewhere is not secreting anything at all, all, or it's too too minuscule that whatever it's secreting is undetectable yet. It's not at a level that it's detectable.

[48:13] Or the size is too small that even the MRI can't see it. So, there's always a Like I was talking earlier about the 1 mm versus uh smaller than 1 mm uh nodule beginning to um

[48:28] to um form. And so, there's always going to be a risk. And I think that is also cancer-dependent, cancer-dependent, really. Because each type of cancer has

[48:41] a different sensitivity of being detected, right? So, um if I want to take Galleri on its own, um so, they have um

[48:53] a list of cancers, of course. And then, for each type of cancer, they have a different sensitivity level of how likely they are to catch it or not. None of them is 100% but some of them are in the '90s. So, there's more than a 90%

[49:11] chance that you definitely don't have this. And some of them are very very low, all right? And they can be around 50%. So, that is why I don't use Galleri

[49:24] on its own. I use it in combination with other things to have uh a comprehensive picture. And I even use um other blood-based markers of cancers that Galleri is also looking for.

[49:40] So, I don't want to trust one signal and ignore another. So, for example, like Galleri looks for uh a colon cancer signal, but I still look for colon cancer other colon cancer markers in the blood that could be

[49:54] secreted. So, if it's missed by one, it might not be missed by the other. So, I try as much as possible to decrease that likelihood of missing things by putting in more than one marker for the same cancer.

[50:08] percentage is difficult because it's cancer dependent, but it's um it's definitely not 100% foolproof. Let's just say that. And for some cancers, like I say, yeah, you'll you're

[50:23] cancers, like I say, yeah, you'll you're 90 or 95% sure it's not there. So, let's see. It's there's still a 5% chance, but it's definitely mhm definitely detecting things in a lot of

[50:35] cases, and you know, it's if you don't catch it the first time, that's why I say blood-based test is what I go for because we know that

[50:51] if you are negative now, if in 1 year, if the cancer increases a little bit, it might reach the threshold of being detectable. And then, you'll see it. And it it's very likely

[51:04] that it will still be at stage one because it's not going to grow like crazy uh from nothing. Most cancers really start with precursor lesions, and those lesions take a while really. And

[51:20] multiple hits in their DNA to really progress into a fully malignant clone. I I do like the idea of the the blood test and and the frequent because like

[51:32] beginning, the if you catch cancer early, you can do something about it, but if you catch it late, um even if you do something it like the the uh the intervention is so invasive that uh

[51:47] it it it's very expensive and it can bankrupt you. And and it's really really terrible for your health as well. Yeah. And can I mean cancer therapies these days have really progressed and

[52:00] advanced to unprecedented levels. The treatment outcomes are amazing. But you're still going through So instead of So stage four cancers for different cancers have different survival rates, but I know for uh some

[52:15] cancers like breast cancer, stage four a while ago you your survival was basically a year. Compared to now, you can live maybe a decade with stage four breast cancer

[52:30] decade with stage four breast cancer because the amount of new drugs and treatments that have come for breast cancer are so effective, so amazing that has become way better. But

[52:44] just take it out you don't even have to deal with all of those treatments because okay, yeah, rid of you're controlling the cancer, but

[52:58] affected. You still are dealing with side effects. Um energy levels go down. nausea, vomiting, can have recurrent infections. So it's also not

[53:11] great or perfect, right? Like the outcomes are definitely outcomes are definitely much better and amazing that you significantly increased the survival, but it

[53:23] in most cases, it's not um like side effect free. You're always dealing with something. And you're always going to see you're always going to the clinic, seeing the doctors. Um

[53:38] uh set aside time for all of these things, and it starts taking up space and time from your life, right? Compared to someone who doesn't have to always go to the doctor and be in an infusion center for several hours every week. So,

[53:54] that's how it starts affecting quality of life. And if you can prevent that perfect. Yes. So, Dr. Muhedin, thank you so much for coming today. So, if people want to

[54:09] services that you offer, where can they go? How do we We do have a website, yeah. Palm Health dot xyz. So, we have all the information on

[54:22] there, and you can even connect with us if you have more questions. So, the website tells you about who we are, what we do, how the service is, and there's also different tiers of the services because

[54:37] we we know that things are expensive expensive. So, we lump them into three different tiers to The first tier basically gets covers like 50 cancers, 60 cancers, sorry. And

[54:53] the second the higher tier covers around 100, and then basically the third one covers almost everything. And so, I wish we can lump everything together

[55:07] into one and be make it very cheap, but things are still pretty expensive with the current technologies. And so, hopefully in the future things become cheaper and cheaper over time. And so,

[55:20] you don't have to commit right away to any service between the three. You can reach out to us, ask questions, get clarifications before you commit to anything. We're happy to connect ahead of time, and that's been the case

[55:34] actually with several of our up, they connected with us just to clarify a few things, and we welcome that all the time, of course. Excellent. Do you

[55:49] Your service, is it a subscription only, or do you offer like one-off tests? one-time thing as well. It's It doesn't have to be a recurrent thing.

[56:01] And so, it basically after you sign up, get or you choose an appointment time to with the oncologist, and then you fill up also a questionnaire about your past

[56:16] medical history, what medications you're on, and everything, so that the doctor actually can look at everything as well ahead of time before the visit to prepare everything. And then,

[56:28] after you meet, discuss everything, the tests are ordered, you go to a Quest lab for the blood tests, and you go to a Prenuvo center for imaging if you pick that you want imaging as well. And then, all the

[56:43] results come back, and they're in that portal where you would have an account. And so, the nice thing about it is that if you keep doing the tests over time, you'll start seeing the trends as well, which we know are also important

[56:58] because a one-time a one-time point of results is good, but it's not perfect. Also, we know that the trend plays a role. So, if things are slowly rising over time, you know that, "Okay, there might be something there."

[57:13] Even if you haven't hit the danger level, let's say, or being outside the normal range. So, over time, you can see

[57:26] either data points or graphs to trend your markers. And so, you'll always have that account even if you don't continue getting the tests. But, at least it's there. But, to answer your question briefly,

[57:42] yeah, it can be a one-time thing. Okay, excellent. Thank you. So, Dr. us today. Thank you. Thank you so much for having me. It was a pleasure. And hopefully, we can continue

[57:56] connecting again in the future. Yes, thank you. thank you. >> [music]