Peter Attia· MD
cancer's outside the body versus cancers inside the body so we'll get into that a little bit um but i think it probably makes sense to start off with sort of in general i know you're you're a strategy person i know you love tactics too but uh i think just to be clear bob do we have three or four hours set aside for this podcast hopefully it's the hopefully it's the latter yeah i think this this could be a lot this could be a long one all right well um where would you like to begin um i i think we should begin from the top the first question was uh how do you think about cancer screening yeah so again i guess putting this in the context of what we're interested in clinically uh probably sounds repetitive but longevity has these two components and they're not independent um but sometimes it's helpful to think about them in isolation uh so so lifespan health span how do you live longer and then how do you live better and you know in many ways cancer versus the other major chronic diseases that rob a person of lifespan namely the atherosclerotic diseases and the diseases of dementia and neurocognitive decline the latter two tend to go more hand in hand with the reduction in health span in other words by definition when a person has alzheimer's disease their quality of life by either cognition is also deteriorating so they're experiencing both the slide and quality of life and eventually length of life and similarly in people that have advanced atherosclerosis while of course it's true that people die suddenly of heart attacks who are otherwise totally healthy a lot of times um the reduction in you know the ability to carry out activities of daily living kind of moves more hand in hand with that i would say that's a little less the case with cancer obviously cancer is still a disease whose primary risk factor is age so age is the greatest risk factor for cancer just as it is for the other two diseases but it's also in some ways a little bit easier to think of cancer in isolation from the health span stuff the decline in physical and mental and emotional state so if you're trying to imagine a world in which you can live longer as we've discussed many times previously that means living in a world where we delay the onset of chronic disease and or have better tools to live longer with chronic disease but you know that i much favor the former option because we've basically spent most of the history of modern medicine working on the latter option with very very limited success um so okay so let's let's now pause it for a moment that one of the pillars of longevity is minimizing mortality from cancer so where does screening fit into this well screening is one of three pieces that you would envision right the first piece would be how do you prevent cancer the second thing would be how do you screen for cancer and detect it early and i'll explain why i think that's necessary and the third is how do you treat it when you have it so we can talk a lot about the former how do you prevent cancer we've had many podcasts and we have many podcasts coming up where we're going to get into the treatments of cancer but i want to focus this one on the prevention piece so why do i believe that well this is a controversial topic i want to say first so not all people believe that screening matters but i think the simplest explanation for why screening matters is the evidence that suggests that a cancer that is caught earlier is easier to treat than a cancer that is cost later that is caught later in other words if you catch a breast cancer or a colon cancer when there are tens of millions or hundreds of millions of cancer cells your odds of treating that successfully are better than if you catch the same cancer years later when there are billions of cells and the evidence for that basically comes from examining how patients respond to the exact same drugs in the adjuvant setting versus in the