A Dime Is Not Small
Why "Early" Cancer Detection is a Dangerous Illusion
Dr. Charles Balch built surgical oncology into a specialty. He ran MD Anderson and City of Hope and led ASCO. When a man like that tells you the word “early” has been fooling all of us, it’s worth stopping to hear why.
The Reality of Tumor Growth
A tumor the size of a dime, the kind we call an early cancer, already holds a billion cells. It has been growing for five or six years. By the time you can feel it, you are not at the beginning of anything. You are somewhere in the middle.
Flaws in Traditional Screening
We built our idea of catching cancer early around symptoms and around age. Screen at 45, at 50, when the guidelines say so. The vast majority of cancer diagnoses are found in older adults. But cancer is showing up younger, in people the guidelines miss, and a symptom you can finally feel has usually been years in the making. Balch’s point, made without any drama: age-based, one-size-fits-all screening is missing people.
A Tailored Approach to Prevention
Dr. Balch’s answer isn’t more scans for everyone. It’s first to educate everyone about the lifestyle choices that reduce risk, and then to know your individual risk through extensive family history and privacy-protected genetic screening. That is how you develop a personalized prevention and screening plan. And that starts with a question almost no one gets asked at a routine physical: what are you actually at higher risk for?
Know your family history, not just your parents but cousins and grandparents.
Know your lifestyle risk and act on it.
And if you can, know your inherited genetic risk.
Put those together, and you and your doctor can build a screening plan tailored to you, instead of waiting for a symptom to make the decision for you.
I was screened twice a year for years because I was high-risk, and my care was built around that. Most people never get that conversation.
Topics Discussed with Dr. Charles M. Balch
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Know your risk: family history, lifestyle, genes
Why “early” cancer isn’t early: the billion-cell dime
Age-based screening is missing younger patients
Immunotherapy that treats you, not the tumor
Stage 3 melanoma cleared without a scalpel
The cheap FIT test your doctor skips
New blood tests: promise, and their limits
Why knowing your risk is a gift, not a sentence
A Roadmap to Get to Know Your Risk
I’m pleased to offer you a place to start taking control of your risk: gettoknowmyrisk.org.
Further Resources
For subscribers: the three things Balch says everyone should know about their own risk, the cheap test your doctor probably never mentioned, the blood tests that didn’t exist five years ago, and why the news you’re most afraid of might be the best news you get.
Listen to the full episode with Dr. Charles Balch:
YouTube | Spotify | Apple | EverywhereRead the subscriber piece: Know Your Risk. Then Screen for It.
Listen to More Episodes
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