Know Your Risk. Then Screen for It.
For years, I called it my half-yearly I don't have cancer day.
Twice a year I got screened, and on those mornings I knew, with certainty, that I did not have breast cancer. Because I was high-risk, my doctors kept a low threshold for a biopsy: if they saw anything even possibly suspicious, they took a sample. I used to call myself a human pincushion. I was grateful, and I was annoyed, often in the same hour.
What I had, though I didn’t call it this at the time, was a screening plan built around me. Not the calendar, not my age. Me. That is exactly what Dr. Charles Balch wants for everyone, and it’s the heart of what he came on the show to say.
Balch built surgical oncology into a specialty, ran MD Anderson and City of Hope, led ASCO, and is now professor emeritus, while turning the last chapter of his career toward prevention through ISOPT. His message is simple: know your risk, then let that knowledge decide what screening is right for you.
He described a tumor the size of a dime, the kind we reassure ourselves is “early.” It already holds a billion cells and has been growing for five or six years. We built screening around symptoms and around age, screen at 45, at 50, when the guideline says so. But a symptom you can finally feel is usually late, and cancer is rising among people the guidelines call too young.
Colorectal cancer is now the leading cause of cancer death in men under 50 and the second in women under 50, and in 2022 nearly one in seven new colorectal cancers were diagnosed before age 50. My own sister heard a version of “you’re too young,” and had to push for the surgery that likely saved her from triple negative breast cancer. Age is too blunt an instrument.
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The Three Pillars of Precision Risk
Balch’s fix is precision, and precision needs a target. He wants three things from every one of us:
Know your family history, and not just your parents, but grandparents, aunts, uncles, cousins, several generations deep.
Know your lifestyle risk, the parts you can proactively change including vaccinations, screening schedules, and diet/exercise/smoking/drinking/vaping choices.
Know your inherited genetic risk, if you can, the genes that you can’t change but absolutely should understand.
