The Cancer Episode

Cancer is a terrible word in any language for at least two reasons: It’s incredibly difficult to get rid of once it grows in the body, and there’s a very good chance that you or someone close to you will be diagnosed with it. But hope is growing. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  This is an iHeart Podcast. Guaranteed Human.

• 0:04Speaker 01

  Snoring, gasping for air during sleep, daytime sleepiness? I'm Shaquille O'Neal, and this shouldn't be anybody's experience. Ask your doctor about Zepbound Trisepotide, the first and only FDA-approved prescription medicine for moderate to severe obstructive sleep apnea in adults with obesity.

• 0:20Speaker 02

  Zepbound is a prescription medicine used with a reduced calorie diet and increased physical activity to help adults with moderate to severe obstructive sleep apnea, OSA, and obesity to improve their OSA. Zepbound is approved as a 2.5, 5, 7.5, 10, 12.5, or 15-milligram injection. Zepbound contains trisepotide and should not be used with other trisepotide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective for use in children. Don't share needles or pens, or reuse needles. Don't take if allergic to it, or if you or someone in your family had medullary thyroid cancer, or if you've had multiple endocrine neoplasia syndrome type 2. Tell your doctor if you get a lump or swelling in your neck. Stop Zepbound and call your doctor if you have severe stomach pain or a serious allergic

• 1:05Speaker 02

  reaction. Severe side effects may include inflamed pancreas or gallbladder problems. Tell your doctor if you experience vision changes before scheduled procedures with anesthesia, if you're nursing, pregnant, plant-to-be, or taking birth control pills. Taking Zepbound with a sulfonylurea or insulin may cause low blood sugar. Side effects include nausea, diarrhea, and vomiting, which can cause dehydration and worsen kidney problems.

• 1:27Speaker 01

  Talk to your doctor. Call 1-800-545-5979, or visit zepbound.lily.com.

• 1:34Josh Clark?

  Let's be real, eating is a huge part of our lives. It fuels us, it brings us together, and yes, it's one of life's great pleasures. But once a meal's over, we don't think much about what happens next, unless something starts to feel off. Introducing Eating Interrupted, a new podcast from iHeart Ruby Studio, hosted by longtime journalist and Crohn's patient Cynthia McFadden. Listen in to unpack what it means when your body doesn't always respond to food the way you expect, and what science is now revealing about why. Listen to Eating Interrupted on the iHeart app, Apple Podcasts, or wherever you get your podcasts. When you're in do-it-yourself mode, the last thing you want to do is drop everything to pick up that one part or tool that you need.

• 2:15Josh Clark?

  That's where MyLowe's Rewards and MyLowe's Pro Rewards come in. Place your order, and Lowe's handles the rest. Lowe's will make the run for you with free same-day delivery. Members get more at Lowe's: $25 minimum and loyalty membership required. Order eligible items by 2 p.m. Subject to weight and size restrictions and availability. Terms at Lowe's.com/shippingterms.

• 2:41Speaker 00

  Welcome to Stuff You Should Know, a production of iHeart Radio.

• 2:50Josh Clark?

  Hey, and welcome to the podcast. I'm Josh, and there's Chuck, and Jerry's here, too. And this is a good old-fashioned episode of Stuff You Should Know. I guess one that we hope helps people understand things better is the clumsiest way I can put it.

• 3:07Speaker 04

  Pretty clumsy.

• 3:08Josh Clark?

  Thanks.

• 3:09Speaker 04

  Nice. You did well, then.

• 3:12Josh Clark?

  Did you already know a lot about cancer before researching this?

• 3:18Speaker 04

  Yeah, I mean, I feel like I knew most of this stuff.

• 3:21Josh Clark?

  Oh, really?

• 3:22Speaker 04

  Generally. Like, obviously, you know, that we're gonna go over a lot of statistics and stuff early on, so I wasn't super dialed in, but, yeah, I mean, we have cancer in our family, on my mom's side.

• 3:38Speaker 04

  Like, my mom had breast cancer, her sister had some kind of cancer, one of her brothers had some kind of cancer, so it's sort of been around, and I've lost a couple of friends to cancer. So it's popped up here and there.

• 3:54Josh Clark?

  Yeah, I would say that's more than your fair share, based on some of these statistics.

• 3:58Speaker 04

  Yeah, and, you know, I was, I mean, not to spoil anything, but I did see that only 5% to 10% of all cancer cases could be attributed to genetic defects.

• 4:12Josh Clark?

  Yeah, I saw something like that, too.

• 4:13Speaker 04

  So that made me feel better, as far as, you know, knowing that I'm gonna die of heart disease.

• 4:20Josh Clark?

  Right.

• 4:22Speaker 04

  You know?

• 4:22Josh Clark?

  I mean, that is all-American, though, isn't it?

• 4:25Speaker 04

  Oh, baby, it is.

• 4:27Josh Clark?

  They give you a little American flag to hold in your casket when you die of heart disease.

• 4:33Speaker 04

  Yeah, but, you know, I mean, those are the two leading causes, especially if you're an American, so, you know, that's, one of the two is probably gonna take me out.

• 4:44Josh Clark?

  Well, that's the thing. It sucks to think about this kind of stuff, but you're gonna, there's 100% chance you're gonna go somehow, some way.

• 4:52Speaker 04

  That's right. And I think 40% of men and women in the United States will get a cancer diagnosis at some point. That's a lot.

• 5:02Josh Clark?

  Yeah, one in every 2.5 Americans.

• 5:05Speaker 04

  Yeah, that's a sobering stat.

• 5:08Josh Clark?

  And I feel bad for that 0.5 American, because they already have it hard enough.

• 5:12Speaker 04

  Right. I knew you'd find a way to get a little humor in here.

• 5:17Josh Clark?

  So let me kind of tell you what I learned about cancer that I just did not understand, okay? Which is kind of like the overview of what cancer is. It's, cancer is not just one disease, which I kind of knew, but I'd heard that, had no idea what people are talking about. What they're talking about is it's actually nowadays an umbrella term for a collection of more than 200 different diseases.

• 5:42Speaker 04

  Yeah.

• 5:43Josh Clark?

  And they all share two important things in common. One, they are, they come from genetic defects, not just inherited genetic defects like you were talking about. And then, two, the mechanism of the disease is uncontrolled cell growth. That's cancer. But the reason it's so insidious and difficult to treat and, you know, kills so many people is because it comes from your own body. It's not like a foreign invader. It's your body doing what it normally does, which is cells divide, and they don't do it quite right sometimes, and they can turn cancerous. And your body has ways to handle that stuff and get rid of it.

• 6:24Josh Clark?

  But if you, if your body starts to get overwhelmed, or your immune system starts to get depleted as you age, then the cancer can take hold, and then it goes from a normal byproduct of cell division to disease. I didn't really understand cancer in those terms until I researched this.

• 6:41Speaker 04

  Yeah, well, that's good. I mean, that probably means you haven't faced it a lot in your immediate surroundings.

• 6:46Josh Clark?

  Yeah, Ruby's brother, her older brother Bobby, has stage IV cancer right now, and he's been hanging in there for a really long time. He's living his best life and everything, but, you know, it's, it's just kind of this constant in our lives.

• 7:00Speaker 04

  Yeah, for sure. Yeah, so if 5% to 10% are attributed to genetic defects, then the other 90% to 95% are rooted in environment and lifestyle. Obviously, if it was lifestyle, we're talking about some obvious things like smoking and diet, alcohol, the sun exposure, stuff like that. Stress is one that's kind of scary to think about.

• 7:26Josh Clark?

  Yeah.

• 7:27Speaker 04

  Obesity. But then, you know, 15 to whatever, 20% are due to stuff like, you know, environmental pollutants and just radiation, like, that you can experience maybe in your workplace or where you live or something like that. That's all like, super, super sad. It's all sad, but, you know, the stuff that, like, you have no control over, but you live near a thing, that's just super scary.

• 7:55Josh Clark?

  Yeah, yeah, for sure. That UV radiation also can just come from being out in the sun over the course of your life, which I think is the reason why skin cancers are the most common type of cancer.

• 8:10Speaker 04

  Yeah, I think you're right. The name "cancer" is Latin for crab, so, you know, just like the Zodiac sign. So in the early days, doctors describing tumors that had, like, veins or extensions coming out of them, said they were crab-like, and the way they said that was, they called them cancerous.

• 8:29Josh Clark?

  Yeah, so there you go. That's the end of the episode.

• 8:33Speaker 04

  Should we go over some of these other stats?

• 8:36Josh Clark?

  Yeah, this is largely American stats, but we tried to extend them where we could to the UK, Australia, Canada.

• 8:43Speaker 04

  Yeah, places where people listen to us.

• 8:46Josh Clark?

  Exactly. Just wanted to make sure everybody could share in this depressiveness.

• 8:51Speaker 04

  No, I agree. At any point, about 17 million Americans are living with cancer, and about 5,800 new cases are diagnosed every day in the US, about 1,100 in the UK, and just 450 in Australia.

• 9:05Josh Clark?

  696 in Canada, I saw, too, later.

• 9:09Speaker 04

  Oh, so 450 to 696, it's a range, I guess?

• 9:12Josh Clark?

  No, no, that's Australia. 696 is Canada's.

• 9:15Speaker 04

  Oh, it's Canada. I thought you said Australia.

• 9:17Josh Clark?

  Yeah, no, uh-uh.

• 9:19Speaker 04

  And every year, about 600,000 Americans die of cancer, which accounts for about 17% of all deaths in the United States, with, far and away with lung cancer being the leader there.

• 9:32Josh Clark?

  Yeah, the UK has flipped to number five and Australia number three in Canada, but it's definitely up there, right?

• 9:39Speaker 04

  Yeah.

• 9:40Josh Clark?

  And lung cancer, not just in the US but worldwide, is the is most responsible for deaths from cancer. It's really prevalent because smoking was really prevalent and still is.

• 9:52Speaker 04

  Hmm.

• 9:53Josh Clark?

  And like you can chalk the vast majority of cancer deaths every year up to smoking. People who smoked make up the vast majority of people who die from lung cancer. And in the US, it's like 130,000 people every year. And something like 100,000 of those people smoked. So every decade, a million people die because they smoked cigarettes. And then every year, about 7,300 Americans die from secondhand smoke exposure, which is even worse.

• 10:25Speaker 04

  Yeah. Um, colorectal cancer is number two at about 55,380 deaths expected this year in 2026. But sort of the sobering part of colorectal cancer is that it's really, really, I mean, you could even say skyrocketing in young adults. It's up 51% since 1994 in people between 20 and 49. And they don't, I mean, you should go get colonoscopies in your 40s and I would even say by the age 40, but your insurance may not cover it. So there's a lot of work, obviously, in the insurance world when it comes to covering

• 11:07Speaker 04

  things like this, because as you'll see, getting ahead of the game in cancer is the name of the game with beating cancer.

• 11:14Josh Clark?

  Yeah, for sure. And that is actually a reason why deaths from cancer in the West are on their way down and have declined precipitously in some cases. It depends on the type of cancer. But like cancer death rates for all cancers declined by almost 30% in the US over the past 20 years.

• 11:35Speaker 04

  That's amazing.

• 11:36Josh Clark?

  Right. And the five-year survival rate, which as we'll see is pretty much for most cancers synonymous with cured, like your cure of cancer, that's that passed 70% in 2025. So like the numbers are pretty good. And there's other kinds of cancers that have like eye-poppingly positive survival rates.

• 11:55Speaker 04

  Yeah, breast cancer for sure is one. One of the highest at about 90.5%. Thyroid is really up there, 98%, prostate 96%, testicular cancer at 95% and skin cancer at almost 94%. So those are really, really encouraging numbers. It's, you know, one of the scariest words I imagine you can hear from a doctor. But, um, you know, if you look at the numbers, unless it's just sort of one of those rare worst-case scenarios where you get some kind of news that something is, you know, stage four and metastasized.

• 12:33Josh Clark?

  Right.

• 12:34Speaker 04

  And, you know, that just, that doesn't happen very often, thankfully.

• 12:37Josh Clark?

  No, typically pancreatic cancer is pointed to as kind of like the poster child for that.

• 12:43Speaker 04

  Yeah.

• 12:44Josh Clark?

  And the reason why is because you don't show symptoms until it's metastasized. And that means you're diagnosed typically at stage four, which is last stage cancer, which means that I think it has a five-year survival rate of 11.5% in the United States. Lung cancers is only 22%. So I'm going to get screened, hopefully this month, because I just turned 50.

• 13:08Speaker 04

  Oh, good.

• 13:09Josh Clark?

  Which means I'm now eligible for a lung CT because I smoked when I was younger and now I'm 50. So cross your fingers, because I don't want cancer.

• 13:19Speaker 04

  I don't want you to have cancer either, buddy.

• 13:21Josh Clark?

  Thanks, man. That's like maybe the nicest thing you've ever said.

• 13:25Speaker 04

  Well, you know, especially when you've done the right thing and improved your health so much. And anytime somebody works really hard to do something really, really hard, like quitting smoking, you hope that there's a real great payoff for that, you know? Emily smoked for a long time too, so she's, she's always just sort of worried and she has cancer in her family. So she is always getting tons of screenings for things.

• 13:49Josh Clark?

  Good. It's smart.

• 13:51Speaker 04

  Yeah.

• 13:52Josh Clark?

  So I think one out of every six deaths globally every year are from cancer. And it's, the rates are really boosted by lower income countries because they don't have a lot of access like we do in the West to services, to screenings, even HPV vaccinations.

• 14:12Speaker 04

  Yeah.

• 14:12Josh Clark?

  That's a huge preventative for a whole suite of cancers.

• 14:16Speaker 04

  Yeah.

• 14:16Josh Clark?

  And in the United States, it's very prevalent and it can save your sexual partner's life years down the road. And like they don't necessarily have access to that. And by the way, HPV, hepatitis, other viruses that can cause cancer called oncoviruses, like oncology.

• 14:36Speaker 04

  That's right. Should we talk about cells for a little while?

• 14:40Josh Clark?

  I mean, I don't see how we can talk about cancer and not talk about cells.

• 14:44Speaker 04

  Yeah, so I think it would help if we talked a little bit about how cell division and like healthy cells are supposed to work, which is cells divide and reproduce and they, you know, they do that when they should generally, and they do that where they need to do that generally. And they locate themselves in the body where they're supposed to go after they mature into a specialized cell. So a cell will divide and then once it matures, it gets an assignment, basically, to go perform a role. And, you know, it generally does that pretty well. And when it gets to the, and it's pretty miraculous when you think of just normal cell life, like how like kind of wonderful it is to look at, like when they get to the

• 15:28Speaker 04

  end of their life, they know that and they self-destruct and they say, we've done our job, it's time for us to exit the scene. And with cancer, all of that almost is flip-flopped.

• 15:38Josh Clark?

  It is. And again, like cancer are just cells in your body that have become damaged or you inherited them with damage and like they just happen. But your body has all sorts of defenses to get rid of them as like waste and it handles it, right? So this isn't just like tumors we're talking about. This actually applies to any kind of cancer cell. They never stop dividing, which is one of the things we said at the beginning. Uncontrolled cell division and growth is essentially how you die from cancer, right? Either the cells accumulate into a tumor that crowds out the healthy cells and keeps them from doing their thing. So if it's liver cancer, your liver can't filter enough stuff out anymore and that

• 16:23Josh Clark?

  you die from organ or systemic failure because the cancer cells have just crowded out the healthy cells.

• 16:29Speaker 04

  Yeah. So, you know, like we said, it's a genetic mutation that's going on and some DNA changes are going to like raise the levels of proteins to keep the cell growing. Others might lower levels of a protein that tells it when to stop growing. Sometimes it'll, you know, the ones that we talked about, it'll, it'll not have, and we'll talk about the specific protein, I guess is why we can, why, why wait? It's P53.

• 16:57Josh Clark?

  That was gonna be suspenseful for a second.

• 17:00Speaker 04

  I know. P53 is the one that basically is like the switch that tells a cell like, hey, it's, we've done our job, it's time to go.

• 17:06Josh Clark?

  Yeah.

• 17:07Speaker 04

  So one DNA mutation might not tell that P53 gene to express itself. And they think, scientists think that more than one DNA change has to occur.

• 17:19Josh Clark?

  Right.

• 17:20Speaker 04

  For a healthy cell to turn cancerous. So if you have an inherited genetic related change or something, you might need fewer additional changes to develop that cancer.

• 17:31Josh Clark?

  Yeah, because it's not like when you develop a carcinoma, a skin cancer, like that's the first time you've ever developed cancer right there or a potentially cancerous cell. Like it's not like you were just touched by the sun once and all of a sudden you have cancer. It's just not how it works.

• 17:48Speaker 04

  Yeah.

• 17:48Josh Clark?

  Instead, you have those cells happening all the time, but they have built-in mechanisms to reprogram themselves to basically take care of the damaged genes and turn them off or on. Or like you said, the wrong genes are offer on ones that have nothing to do with, with a cell turning cancerous. Or again, if it does turn cancerous, the body's immune system can come take care of it, right? And that's why you, why you have to have more than one genetic mutation because it's, a cell's pretty good at repairing itself. And if it's not, P53 comes up like a, like a boxing manager and like, you know, smacks your face and wants to see if you, if they need to throw in the towel.

• 18:32Speaker 04

  Yeah.

• 18:33Josh Clark?

  And if you have too many genetic mutations, it's gonna throw in the towel for you and you're gonna have to undergo apoptosis.

• 18:41Speaker 04

  That's right. Uh, you know, we talked about tumors, we're gonna be talking more about that, obviously. But there's also something like leukemia. There are cancers of the blood where you don't form a tumor, but the blood cells, again, they just replicate such that they crowd out the healthy ones. And it's all doing this because they express, how would you say that? Telomerase?

• 19:04Josh Clark?

  Yeah.

• 19:05Speaker 04

  Okay. And that keeps the telomeres lengthened. The telomere is what allows the cell to divide. And they, they, you know, kind of dwindle down over time, but if they're expressing that telomerase, it's lengthened and it wears out a little more slowly. So that tumor can just keep dividing and growing, basically.

• 19:24Josh Clark?

  Yeah. One of the other reasons they're so quick to divide is that they don't stick around long enough, or they don't wait to divide long enough to mature. And like you said, healthy cells divide, mature, and then become specialized. They get their assignment. And tumor cells or cancer cells just don't, they just divide too quickly to ever mature. And so as they're doing that, they pick up all sorts of new genetic mutations. So the cells of a tumor can have a bunch of different genetically different cells because it just starts getting so out of hand. Like, I guess, at the very beginning of a tumor, the cells are probably still relatively similar. But by the time you have a big old tumor, it's just this

• 20:09Josh Clark?

  big mass of a bunch of weirdo cells that kind of like multiplicity with Michael Keaton.

• 20:16Speaker 04

  Right. That's right. And this is, I mean, cancer can really be insidious when you think about what's going on. Cancer cells can also recruit normal, normal cells near a tumor to like, develop new blood vessels and stuff to help keep the tumor alive and like, help it kind of thrive and help it grow. It like, it's like, hey, here's more oxygen and more nutrients because cancer cells are recruiting other cells and like, turning them to the dark side.

• 20:44Josh Clark?

  Yeah. And there's one other thing that they found recently is not only can they recruit cells to create new blood vessels for them, they can recruit neurons nearby and they send phony messages to the brain, which then in turn sends out this, I can't remember the name of it, but it's an immune cell whose job is to basically tell all the other immune cells like, hey, you can just relax. Everything's all clear. So the brain sends those to where the tumor is and the tumor recruits them and surrounds itself with a bunch of immune cells that tell the body, nothing to see here, keep moving on. That's what cancer cells do. That's insane that like, something can evolve and adapt that

• 21:26Josh Clark?

  quickly because we're talking about it doing this on the order of like, months or a few years, maybe.

• 21:31Speaker 04

  Yeah.

• 21:32Josh Clark?

  It's just crazy what cancer is.

• 21:34Speaker 04

  Yeah, for sure. Um, all right. I think maybe we should take a break.

• 21:38Josh Clark?

  Yeah, I'm starting to get worked up.

• 21:40Speaker 04

  Yeah, that was, that was a good table setting and we'll come back and talk about types of cancer right after this.

• 21:59Josh Clark?

  Buy smart, drive for less, and trade for more. That's Toyota affordability. And it all starts with a great deal on a truck from your local Toyota dealer.

• 22:09Speaker 04

  That's right. Make a smart buy on the off-road, ready Tacoma or half-ton Tundra, two of Toyota's most capable and longest lasting trucks, built with the strength for the tough jobs, the tech to power your next big adventure, and the rugged style for everything in between.

• 22:22Josh Clark?

  Or discover Toyota's off-road lineup, including the iconic 4Runner and Land Cruiser, designed to go beyond the everyday. And with Toyota's proven reputation for quality and reliability, plus hybrid power on many models, you can get more for every mile and drive for less along the way.

• 22:37Speaker 04

  That's right. And long after you leave the lot, your Toyota keeps delivering with great resale value. So you could trade in for more when you're ready for your next Toyota. From a great deal today to a great value tomorrow, a Toyota is right for you. Shop toyota.com for deals and details, or stop by your local Toyota dealer today. Toyota, let's go places.

• 23:02Speaker 04

  You know, you're never done decorating your home. You know what I mean?

• 23:05Josh Clark?

  Sure.

• 23:05Speaker 04

  Yeah, because it's a process. There's always something you could do or buy or update. The only question is, what's next? For us, our animals just wear out our rugs so quickly, it's usually a new rug.

• 23:16Josh Clark?

  Well, Chuck, whether you need a rug or whatever is next for you, you can go to Wayfair. It's the smart place to get it.

• 23:22Speaker 04

  That's right. Whatever your style, whatever your budget, whatever you're looking for, Wayfair makes it easy to find it. And you can feel good about your purchases too, because Wayfair verified products go through a thorough 10-point quality inspection.

• 23:34Josh Clark?

  And with over 20 million five-star reviews, Wayfair must be doing something right. You can find pieces made for real life and get even more value with Wayfair Rewards. Join Wayfair Rewards today to get 5% back on every purchase. Head to wayfair.com to shop all things home. That's W A Y F A I R dot com.

• 24:00Speaker 04

  Hey, everybody. Cozy season is upon us. And that means crisp mornings, that means soft layers, and that means Bombas.

• 24:07Josh Clark?

  Yeah. Bombas makes your comfiest fall staples, so you can make the most out of one of the best seasons of the year. Bombas has new suede moccasins that are perfect for fall because they have cushy soles, a sheerling lining, and they're made of water-resistant suede.

• 24:21Speaker 04

  That's right. And their slippers are everything you'd want for a cozy night in, made with the softest, squishiest materials.

• 24:26Josh Clark?

  And of course, Bombas has socks. Not just any socks, socks for every type of weather, every type of occasion, because fall can be fickle. And Bombas makes socks that can handle it all. And the best part about Bombas, for every item you purchase, they donate an essential clothing item to someone facing housing insecurity. One purchased equals one donated, with over 200 million donations and counting.

• 24:48Speaker 04

  So head on over to bombas.com/sysk and use code SYSK at checkout for 20% off your first purchase. That's B O M B A S dot com slash SYSK, using code SYSK at checkout.

• 25:20Speaker 04

  All right. So we're back to talk about types of cancer. Like you mentioned from the jump, there are more than 200 types of cancer, because there are more than 200 types of cells in the body. And that's no coincidence, obviously. They're basically classified according to where they start in the body. But that also means that, you know, you can get cancer of almost anything, anywhere in the body.

• 25:45Josh Clark?

  Yeah. And again, I said, the most common one is a carcinoma. I think 85% of all cancers are carcinomas, and those start with epithelial tissue or cells, which are like the outside layer of your organs. They make up tissue, the skin. And again, it's just because all of us are exposed to the sun over the course of our lifetimes. And eventually, I guess it's just a game of odds that can, you know, some of those cancer cells can just overwhelm the immune system as we get older, because our immune system declines, which is one of the joys of aging, it turns out.

• 26:19Speaker 04

  That's right. Lymphoma makes up about 5% of cases. That starts, obviously, in the lymph glands, in the lymphatic system, and the lymphatic system obviously runs throughout your entire body. So lymphoma can start almost anywhere.

• 26:32Josh Clark?

  Yeah.

• 26:33Speaker 04

  If you've ever heard of non-Hodgkin lymphoma, which is the most common, or Hodgkin lymphoma, which is Hodgkin's disease, those are the two major subtypes of lymphoma. And, you know, there is some irony here for sure, because the lymph system clears out cancerous cells from your body as waste. So that's definitely a cruel, a cruel one.

• 26:59Josh Clark?

  There's also leukemia, which is cancer of white blood cells that begins in the bone marrow. And it's, that's where white blood cells are formed, along with red blood cells. And strangely, no one has any idea why, but this is the most common type of cancer in children. Adults can get it too. But if you are a child with cancer, it's most likely leukemia, and they don't, they just don't understand what the, what the problem is there.

• 27:27Speaker 04

  Yeah. The brain and spinal cord cancer is probably one of the scariest kinds when you just sort of hear those words, like brain tumor. But, you know, I have known people who have had brain tumors, who are doing just fine.

• 27:41Josh Clark?

  Yeah.

• 27:42Speaker 04

  They are central nervous system cancers. And then at, I think that's 3% of all cancers, right?

• 27:49Josh Clark?

  Yeah.

• 27:49Speaker 04

  And then what, what do we have at 1%?

• 27:51Josh Clark?

  Myeloma is another one that starts in the bone marrow. This is plasma cells, which make up the liquid part of your blood. But it's also a type of white blood cell. So it's created in the bone marrow. And I was like, wait, that's two types of bone marrow cancers. And it turns out the bone marrow is called a metastatic, yeah, metastatic niche, because it's a magnet for some types of cancer cells that go to the bone marrow and just set up shop there. That's like, an embarrassment of riches for all the stuff the cancer can use to recruit and protect itself.

• 28:25Speaker 04

  Yeah. And then also 1%, we have sarcoma. That begins in the connective tissue or the supportive tissue, like, maybe in your muscle and your blood vessels and your fat or cartilage or even bone.

• 28:38Josh Clark?

  Chuck, because there's so many different kinds of cancers and they do all sorts of different stuff, I've read that essentially every case of cancer is totally unique because every person's body is totally unique. And so they staged them, they basically described them in different terms. And the two things that they base the descriptions on most are size and growth. And the whole thing starts with stage zero cancer. It goes from stage zero to stage four. And stage zero is like you technically don't have cancer. It can be precancerous cells. You just have a spot that's acting a little weird. And it's mostly curable because the cancer hasn't undergone, one of the things that makes cancer so hard

• 29:21Josh Clark?

  to treat, it hasn't spread to the surrounding tissues. So you can just go in, cut out the little growth, and you just got all the cancer. You're not leaving anything behind.

• 29:31Speaker 04

  Yeah. Here at Stuff You Should Know, we love stage zero cancer.

• 29:36Josh Clark?

  It's our favorite kind of cancer.

• 29:39Speaker 04

  As far as cancers go, this is the one we're behind. And we're not afraid to say it.

• 29:43Josh Clark?

  For sure. It even looks pretty. It's got that nice round O in the middle.

• 29:46Speaker 04

  Yeah, with nothing in the center of that thing.

• 29:49Josh Clark?

  Right.

• 29:49Speaker 04

  Of course, you have stage one next. They go stage one, two, three, and four. Stage one is, you know, it's a little bit more cancer. It's smaller, obviously not smaller than zero, but smaller than two. It's contained to one area, has not spread to the lymph nodes or other areas, which is basically where you get to in stage two is the tumor is going to be larger, and it may have spread to the lymph nodes at this point.

• 30:17Josh Clark?

  Yeah, and it's almost certainly spread to the surrounding tissue too, but it's not, like, it's kind of invisible. The tumor is quite obvious, but the the spread around the tumor is not quite visible. So that makes it harder to get rid of through surgery. Stage three, it's grown even bigger and into deeper into the surrounding tissues. And it also has probably spread to nearby lymph nodes. And then, once it spreads, once it metastasizes, what it's called, you have entered stage four.

• 30:50Speaker 04

  That's right. That means it's definitely spread outside its original place, probably to other organs, or anywhere in your body, really. And that is metastatic cancer. You may also hear a letter sometimes in a diagnoses like stage two A, and the letter will describe an aggressiveness, with A being the least aggressive, all the way up to D being the most aggressive.

• 31:13Josh Clark?

  Right. And then, words like remission and cure are also used. Remission is where the cancer is, it basically describes how the cancer is responding to the treatment, right? If the cancer is on its heels, and it's shrinking, and it's doing all, it's all the stuff you want it to do through treatment, it's in remission. That would be partial remission. Complete remission is where you've treated the cancer, and it can no longer be detected in the body. But that doesn't mean that it's cured. That's like a whole different term.

• 31:47Speaker 04

  Yeah, I mean, cure is a sort of a dicey word when it comes to cancer. That's basically complete remission, meaning there's no evidence of the disease. And even though there may be a risk of recurrence, if you're cured, basically like five years is what you said. If you're in complete remission for five years, you can kind of stamp that cure on your forehead proudly.

• 32:12Josh Clark?

  Yeah. I think that doctors are kind of like, I don't like to use that word. They're just nervous about it coming back, you know?

• 32:20Speaker 04

  Yeah. I mean, I don't know any doctors first. Well, I do know some doctors, actually. But I haven't asked them, like, how they feel about the language around it, you know?

• 32:30Josh Clark?

  Yeah. We'll wait if you want to get in touch with them.

• 32:33Speaker 04

  No, but we'll, we'll hear from doctors, I'm sure.

• 32:37Josh Clark?

  Yeah.

• 32:37Speaker 04

  And patients. I'm looking forward to getting emails from all kinds of people on this.

• 32:42Josh Clark?

  For sure.

• 32:43Speaker 04

  So, the history is, you know, we're not going to get too in the weeds, because it's basically a situation where they thought black bile was what, you know, caused death and disease for many hundreds of years, probably thousands. And then there was a Dutch scientist, the father of anatomy, Andreas Vesalius, who finally said, you know what, I've looked at a lot of dead bodies, I even stole some corpses to make it happen. And guess what, everyone, there's no black bile in the body. And everyone was like, all right, well, why are people dying? That took a little bit longer. I think in 1793, there was an anatomist in London named Matthew Bailey.

• 33:26Josh Clark?

  That's what I'm going with.

• 33:27Speaker 04

  Yeah, who was like, all right, here's real proof, everyone, that cancer isn't black bile. It's, you know, we found out that tumors can grow in the body really fast. And for a long, long time, it was, let's, let's cut that stuff out of the body and see what happens.

• 33:44Josh Clark?

  Yeah, because surgeons were like, oh, it's a tumor, we can get rid of that. And I think at first, they thought, this is around 1850, when it really kicked off. They initially thought, like, we can totally take care of cancer from now on. But what they figured out over time, because some of their patients that they treated would come down with cancer again, like a year later, or something like that, was that that cancer would spread kind of invisibly deeper into the tissue. And that just getting rid of the tumor wasn't enough, because it left too much of the cancerous cells to reproliferate and grow again.

• 34:19Speaker 04

  Yeah. And, you know, very sadly, they were like, you know, because I think they were so thrilled by the advent of successful surgery, that they were a little scalpel happy, and were like, we'll just keep removing stuff then, because that's how you cure this thing. And that left, you know, some disfiguration a lot of times, when they just kept like, getting rid of, you know, pieces of your body.

• 34:43Josh Clark?

  Yeah.

• 34:44Speaker 04

  And it took a long time. It took decades before they finally figured out that it was a systemic thing, and finally understood what metastasization is. And then they came up with better treatments, starting with x-rays in 1895, right?

• 35:01Josh Clark?

  That's where, that's where they were discovered. And as little as a year later, an American medical student named Emil Gruber, he was like, I'm going to try to use those to treat cancer. And he was successful. He treated, successfully treated a patient with breast cancer using x-rays. So now you've got radiation, which can, you can go in and cut the tumor out, and then you can irradiate what's left. And now, things are starting to cook.

• 35:28Speaker 04

  Yeah, things are starting to cook a little bit. Chemotherapy enters the scene, thanks to, kind of a weird story, but in the US Army, doctors were conducting autopsies on soldiers who died from mustard gas exposure. And they're like, hey, this gas is attacking white blood cells. So they got a, developed a derivative of mustard gas called meclurethamine, and that became the first chemo drug in the 1940s. And they still use that sometimes for some types of lymphoma, I think.

• 35:59Josh Clark?

  Yeah, because it's a disease of your white blood cells, right?

• 36:02Speaker 04

  Yeah.

• 36:02Josh Clark?

  There's a guy who is basically synonymous with chemotherapy, his name's Sidney Farber. He, the Dana Farber Cancer Institute is named after him, and it is world renowned. And it's also, I found a really great resource for info, really understandable, but detailed info on cancer.

• 36:21Speaker 04

  Yeah.

• 36:21Josh Clark?

  He came up with a cancer drug for treating leukemia in children, amonopterin, I think is what it was called. And that was back in 1947. So if you see photos of him after 1947, he usually has a little halo over his head.

• 36:38Speaker 04

  Mm hmm.

• 36:39Josh Clark?

  The thing is, and we're going to see this after we take a break, but chemotherapy is a very blunt instrument, right? It, I've heard a kind of oncological gallows humor before, that basically says, with chemotherapy, you're trying to kill the tumor before you kill the patient.

• 37:00Speaker 04

  Yeah.

• 37:00Josh Clark?

  Because it just goes in, wipes out so much stuff that is, you don't want to wipe out. It's just not very targeted. But again, as we'll see, it's gotten a lot better over time.

• 37:14Speaker 04

  Yeah, and a lot better to take, thanks to some, some great new nausea drugs, because nausea and fatigue are two of the biggest rough parts of chemotherapy.

• 37:24Josh Clark?

  Yeah, I've, I've heard that for sure.

• 37:27Speaker 04

  All right, should we take our second break?

• 37:29Josh Clark?

  Yes, please.

• 37:31Speaker 04

  All right, we're going to come back, and we're going to talk about treatment, because there's a lot of great stuff going on, you guys. We'll be right back.

• 37:51Josh Clark?

  Buy smart, drive for less, and trade for more. That's Toyota affordability. And it all starts with a great deal on a truck from your local Toyota dealer.

• 38:01Speaker 04

  That's right. Make a smart buy on the off-road Ready Tacoma or Half-Ton Tundra, two of Toyota's most capable and longest-lasting trucks, built with the strength for the tough jobs, the tech to power your next big adventure, and the rugged style for everything in between.

• 38:14Josh Clark?

  Or discover Toyota's off-road lineup, including the iconic 4Runner and Land Cruiser, designed to go beyond the everyday. And with Toyota's proven reputation for quality and reliability, plus hybrid power on many models, you can get more for every mile and drive for less along the way.

• 38:30Speaker 04

  That's right. And long after you leave the lot, your Toyota keeps delivering with great resale value. So you could trade in for more when you're ready for your next Toyota. From a great deal today to a great value tomorrow, a Toyota is right for you. Shop toyota.com for deals and details, or stop by your local Toyota dealer today. Toyota, let's go places.

• 38:54Speaker 04

  Hey, everybody. Cozy season is upon us. And that means crisp mornings. That means soft layers. And that means Bombas.

• 39:01Josh Clark?

  Yeah. Bombas makes your comfiest fall staples, so you can make the most out of one of the best seasons of the year. Bombas has new suede moccasins that are perfect for fall because they have cushy soles, a sheerling lining, and they're made of water-resistant suede.

• 39:15Speaker 04

  That's right. And their slippers are everything you'd want for a cozy night in, made with the softest, squishiest materials.

• 39:20Josh Clark?

  And of course, Bombas has socks. Not just any socks. Socks for every type of weather, every type of occasion, because fall can be fickle, and Bombas makes socks that can handle it all. And the best part about Bombas, for every item you purchase, they donate an essential clothing item to someone facing housing insecurity. One purchased equals one donated, with over 200 million donations and counting.

• 39:42Speaker 04

  So head on over to bombas.com/sysk and use code SYSK at checkout for 20% off your first purchase. That's B-O-M-B-A-S dot com slash SYSK, using code SYSK at checkout.

• 40:01Josh Clark?

  You know, eating is a huge part of our lives. It fuels us, it brings us together, and it's one of life's great pleasures. But once a meal's over, we don't think much about what happens next, unless something starts to feel off. Because what we eat and how our bodies respond to it is complicated.

• 40:16Speaker 04

  That's right. From the very first bite, food kicks off a chain reaction, signals moving between the gut, the brain, and the immune system, the constant back and forth we can't see and often don't fully understand. So we want to introduce to you Eating Interrupted, a new podcast from iHeart Ruby Studio. It's hosted by longtime journalist and Crohn's patient Cynthia McFadden. Eating Interrupted explores everything from food allergies and intolerance, and why they seem to be on the rise, to how digestion changes as we age, and what it's really like to live with a chronic GI condition.

• 40:45Josh Clark?

  Through personal stories and expert insight, listen in to unpack what it means when your body doesn't always respond to food the way you expect, and what science is now revealing about why. Listen to Eating Interrupted on the iHeart app, Apple Podcasts, or wherever you get your podcasts.

• 41:19Josh Clark?

  So Chuck, two things. The first one is I've always wondered if cancer was actually a relatively recent thing, like maybe from the Industrial Revolution on.

• 41:29Speaker 04

  Right. Yeah, I used to wonder that, too.

• 41:31Josh Clark?

  Absolutely not. I mean, I think Imhotep described it 4,700 years ago, breast cancer. So it's been around a really long time. The reason it's only kind of recently come under investigation and study is because we used to die from a bunch of other stuff, mostly communicable diseases rather than cancer. It was pretty low on the list. And then as we started to take care of those other communicable diseases, then cancer suddenly became a much bigger problem than it had been before.

• 42:03Speaker 04

  Yeah, for sure. And the reason that we haven't, you know, developed like a complete just cure-all for cancer is because that no two cancers are the same. They all develop in different ways. And they're doing a lot of, you know, we'll talk about some of the like more breakthrough stuff they're doing. But right now, what the standard practice kind of still is, if you have a malignant tumor, is to shrink that tumor with targeted radiation and then remove that tumor, and then prescribe a course of chemotherapy, which is probably like more than one chemotherapy drug, to eradicate what cancer is remaining in your body and to hopefully stave off metastasis.

• 42:48Josh Clark?

  Yeah. And you'll do that round of chemotherapy, wait a little while, and then they'll test you and see what effects it had. And then if it's still there, you do another round, another round, and test after each time until eventually they're like, we can't detect cancer anymore. And now you're in full remission, hopefully forever.

• 43:08Speaker 04

  Yeah. If you don't have a tumor, like you said earlier, if it's like a cancer of the blood, chemotherapy is your main defense there, and probably radiation as well. And also, you've probably heard of like a bone marrow transplant or stem cell transplant.

• 43:24Josh Clark?

  Yeah.

• 43:25Speaker 04

  That's also used in cases like leukemia.

• 43:28Josh Clark?

  I was looking into that, and it's apparently not nearly as bad as it's been made out to be. Everyone's like, it's the most painful thing you could possibly do. And also, apparently only 10% of people who apply to be donors actually end up donating marrow. Most of the others, their plasma will do instead. So you end up basically donating blood.

• 43:48Speaker 04

  Chemotherapy, like I mentioned before the break, is a lot better than it was even like 10 or 15 years ago because this serotonin antagonist, which is a new class of anti-nausea drugs, really can help block the nausea receptors in the brain.

• 44:03Josh Clark?

  Right.

• 44:04Speaker 04

  And I know, you know, just from like family and stuff, that that's, that was one of the worst parts. And I'm sure it's still no picnic, but those have really helped.

• 44:13Josh Clark?

  Yeah. I mean, just what a horrible thing, going in to get chemotherapy, knowing that you're going to get horribly nauseated for a while. It's kind of, the dread has to be really serious, you know?

• 44:25Speaker 04

  Yeah. I mean, one of, one of our friends, like of you and me, have recently underwent cancer of the jaw surgery. And boy, the way he described just the pain of that surgery and what he felt like the next day was brutal. I don't think I have the exact words here on my text. I don't know if I'd read them anyway. But he basically was like, he felt like he'd gotten run over by a truck. And that was just like post-op.

• 44:55Josh Clark?

  I mean, jeez, that was just after the surgery, you say?

• 44:58Speaker 04

  Yeah, for sure. But he's doing great.

• 45:01Josh Clark?

  Good, good. I'm glad. So yeah, surgery is a big part of it. If it's a tumor, obviously, if it's a cancer of the blood, and there's no tumor, they're not doing that, like you said. But you promise cutting-edge stuff, right? And something that is still, you can kind of call it cutting-edge just because it's so gee whiz. But it's starting to become much more prevalent and available throughout the West. It's a form of immunotherapy, which is basically training your immune system to target cancer cells in the same way that it targets foreign invaders. Because again, cancer is not a foreign invader, and it's very, very clever

• 45:44Josh Clark?

  at using the body's own immune system to prevent it from being attacked, right? I was thinking about this, Chuck. Cancer is like one of those rogue agents in a movie that was trained by the very agency that now seeks to kill it.

• 46:01Speaker 04

  Yeah. It's a good metaphor.

• 46:03Josh Clark?

  Yeah. Thanks, man. I've been working on it for a couple of weeks now.

• 46:07Speaker 04

  So yeah, you know, your body generally does a pretty good job of doing that kind of thing, but not in the case of cancer. So they're working on therapies that, like you said, can train your body to do that. And I guess the leading, or I guess one of the leading methods is called CAR T-cell therapy. In this case, the CAR stands for chimeric antigen receptor, which is a targeted receptor for the type of cancer cells that invade your body.

• 46:34Josh Clark?

  Right. So they basically just take some of your blood. They separate the T-cells, your immune cells, out of it. And they use CRISPR. Did we do a whole episode on CRISPR, the gene editing technology? I feel like we did.

• 46:47Speaker 04

  It was either a whole episode or it was, came up pretty heavily in More Than One back in the day.

• 46:51Josh Clark?

  Okay. But it's a tool for basically using, you use a virus that has the genes you want in it, and the virus's, whatever disease it spreads is turned off. And you insert that into like a T-cell. And now the T-cell has the genes you want, and those genes get the T-cell to express the same proteins that are in that kind of cancer. So now you put the T-cells back in you after you proliferate them for a while. And there's a bunch of T-cells running around telling the rest of your immune system, look for this. Do you see this protein right here? This is what we're looking for. And in other cases, it can cause T-cells to grow the kind of receptors that need, that it needs to attack and latch on to cancer, just like it would any foreign invader.

• 47:36Josh Clark?

  So I have a neighbor friend who underwent CAR T-cell therapy.

• 47:41Speaker 04

  Yeah, that's amazing. Some other gene therapy techniques that are, I guess, still in the testing stage. They, you know, we mentioned that P53 protein. That's the one that says like, hey, it's, we've done our job. It's time to self-destruct. And that's the one cancer cells don't have. So some gene therapy techniques include turning on that P53 protein in cancer cells.

• 48:04Josh Clark?

  Yeah.

• 48:04Speaker 04

  So they either self-destruct or at least stop dividing.

• 48:08Josh Clark?

  Right.

• 48:08Speaker 04

  It's amazing.

• 48:09Josh Clark?

  Yeah, there's others that, there's genes that basically turn the cells into magnets for immune cells. And then I saw another one where they can turn the, they can make the cancer cell mature finally, right? And so they will.

• 48:27Speaker 04

  Have a job?

• 48:28Josh Clark?

  Basically. And get this, they found that the vast majority of those cells basically pull the plug. They undergo apoptosis, they self-destruct. So they'd rather die than have a job, the cancer cells would. Isn't that crazy?

• 48:44Speaker 04

  Cancer cells are Gen X, in other words.

• 48:47Josh Clark?

  Pretty much.

• 48:48Speaker 04

  Wow, that's incredible. I didn't know about that one. They also have on the horizon, personalized cancer vaccines.

• 48:55Josh Clark?

  Right.

• 48:56Speaker 04

  That's a new treatment designed to basically prime your immune system to target cancer cells to reduce recurrence risk. And, you know, obviously, hopefully, like, kind of fewer side effects than something like chemotherapy.

• 49:10Josh Clark?

  Yeah, and it's not good that they use the word vaccines because it suggests that you can go get the vaccine before you have cancer and it'll keep you from having cancer. And that's not the case. It's vaccine in the sense that it primes your immune system to fight cancer better, but it's personalized, right? So they take your cancer and examine it and then figure out like what, what treatment will best defeat your specific cancer. And that's part of a larger kind of push that's going on now. It's called precision oncology, which is you're studying the individual patient's cancer to defeat it. Like, now that we have genomic scans, that you can really kind of go through the DNA of a cell pretty quickly

• 49:54Josh Clark?

  and find the mutations and then figure out how to use those mutations against the cancer. That's, I mean, this is, it's a really great frontier that we're on right now. It's very hopeful.

• 50:05Speaker 04

  Yeah, for sure. You know, we do have done a lot of AI poo-pooing on this show, but one of the great benefits of AI is that it's already kind of stepped up in cancer treatment and in sort of cancer diagnoses, it seems like, like maybe having, along with a human radiologist, having AI looking at radiology scans to detect tumors that maybe a radiologist doesn't notice. Maybe also to help predict risk. I know there's an AI MIT model that's able to predict a person's risk of developing lung cancer six years in advance.

• 50:41Josh Clark?

  Yeah.

• 50:42Speaker 04

  And that's amazing because, you know, as we've kind of hammered home already, like, the whole trick to cancer is, is getting an early diagnosis and start going at it right away.

• 50:52Josh Clark?

  Yeah, and that's the, I mean, that's the big money part right there is detecting it early. And because of things like screening and other kinds of detection that we have and routinely use in the West, that's why cancer rates are going down. But, like I said before, the developing world is pushing cancer rates up, so much so that the World Health Organization is expecting cancer diagnoses to increase 77% by 2050 over 2023. So in just over 25 years, almost, well, almost 100% increase. I'm just gonna say it, 77% is close enough to 100% where we're talking about that level of increase of cancer diagnoses.

• 51:37Speaker 04

  Yeah, for sure. You know, we talked a little bit about risk factors already, things that you can control, like, you know, alcohol, obesity, certainly tobacco and sun exposure, things like that. There is an interesting emerging field called psychoneuroimmunology, which is a branch of Western medicine that acknowledges the effect of the brain.

• 52:00Josh Clark?

  Right.

• 52:00Speaker 04

  Or your mind, really, on the systems of the body. And, you know, it's, I don't think it's like woo-woo stuff to say that a real, real deep will to live can make a difference if you're, you know, up against cancer. And it can work the other way, too. And I've seen this as well, when someone is like, you know what, this isn't the life I want, and I'm, I'm, I'm done, because it's just, it's time for me. And I've seen people go very quickly after someone has sort of made that decision. So there's something to it, for sure.

• 52:36Josh Clark?

  Yeah, they definitely have started to research that more and more. It seems kind of thin, the amount of it that's out now, but this investigation into what the will to live is. And then, yeah, like, how to prime it in people is, it's definitely being investigated now. And it does seem to be a thing, for sure.

• 52:55Speaker 04

  Yeah. And, you know, on that sort of last note around the language, when someone has, has chosen to, to not continue treatment, the way people talk about it is changing, I think, probably for the better, because, you know, you shouldn't say, like, someone has given up the fight because it indicates that they're, like, quitting something or surrendering. And that, in fact, is like, one of the bravest things you can do, I think.

• 53:24Josh Clark?

  Yeah, that's, yeah, I mean, it's definitely, because you were just saying, like, okay, I'm accepting my fate. And that is incredibly brave. Yeah. And not just saying, like, giving up the battle with cancer, just using, framing cancer treatment and cancer disease in terms of fighting and battling implies things like that, that, you know, you don't have the guts to, to keep fighting, you know, or you're, you're quitting, or you're surrendering, is another way to put it. And for some people, yes, like, battle, fighting, it definitely inspires them. So no one's saying, like, don't use those terms anymore.

• 54:02Speaker 04

  Right.

• 54:03Josh Clark?

  It's just that for other people, they're like, I don't, like, this is making me feel bad. Like, I'm responsible for my own death. Those people, they're like, you know, call it your journey with cancer, living with cancer, treating your cancer, more neutral terms, less fighty terms. And they're, they just say, researchers say, follow the patient's lead on which way, like, how you frame the terms of, of cancer, living with cancer and treating cancer. And I mean, that's super valid.

• 54:35Speaker 04

  For sure. And if you know someone in your life that has, has accepted that it's, it's time for them, like, that's when they need, like, your, your support and love more than ever, I think. It's in, I mean, I would just recommend to not, not, like, be devastated in front of them, at least.

• 54:55Josh Clark?

  Right.

• 54:56Speaker 04

  And to try and, try and support that decision, you know, because that's a, that's a brave thing to accept.

• 55:01Josh Clark?

  That's gotta be tough for a kid to understand and accept, too, you know?

• 55:05Speaker 04

  Yeah.

• 55:06Josh Clark?

  There was a, remember that, that episode of The Pit that really dealt with that?

• 55:12Speaker 04

  Oh, yeah.

• 55:13Josh Clark?

  That was gut-wrenching. I've got one quick soapbox PSA, if that's okay.

• 55:20Speaker 04

  Yeah, let's do it.

• 55:20Josh Clark?

  So in the United States, mammograms are covered by insurance.

• 55:25Speaker 04

  Here we go.

• 55:26Josh Clark?

  The problem is, is that you very often need a follow-up, because they're like, this mammogram's good enough, but not quite. There's this thing in here I want to see closer. Let's take a look. And it's probably nothing. In the most cases, it is nothing. But they do that because they're like, we don't want to miss something that's really important. The follow-up imaging is not covered by insurance. So there's, you know, plenty of women out there who are like, I don't have the money to pay out of pocket for a CT scan, so I'm just not going to go get the follow-up imaging and cross my fingers. So there's bills floating around. They're basically like, insurance companies, you have to cover all follow-up imaging as well. Like, you can't just, just do the bare minimum.

• 56:11Josh Clark?

  It's just not going to work for people anymore, hopefully.

• 56:15Speaker 04

  Yeah. And mammograms suck.

• 56:18Josh Clark?

  Yeah.

• 56:18Speaker 04

  It's an awful process that's like, already, there's an incentive to avoid something like that. So insurance companies are, you know, we've ranted before, but they need to step it up in a lot of ways. That's certainly one of them. And also, as we mentioned before, with the increased rate of colorectal cancer, cancer in younger adults, make them available to be covered in your 30s. You know, there's probably not a lot of 30-year-olds that have the gumption to be like, you know what, I'm gonna go ahead and get a colonoscopy at 35 years old. But if they want to, then it should well be covered, you know?

• 56:54Josh Clark?

  For sure. Wow, that was a good one, Chuck. Nicely done.

• 57:00Speaker 04

  We made it.

• 57:01Josh Clark?

  I would say, do you have anything else about cancer? But I know you do. So we're just gonna say this one's wrapped up.

• 57:07Speaker 04

  That's right.

• 57:08Josh Clark?

  Since we just wrapped this episode on cancer up, that means it's time for listener mail, of course.

• 57:15Speaker 04

  That's right. I'm gonna finish with a very heartwarming story, which is a good way to end this one.

• 57:20Josh Clark?

  Awesome.

• 57:21Speaker 04

  This was from our phone books short stuff, when we talked about sort of randomly calling the wrong person with the same name. Hey, guys, when I was 15, I tried to call someone in our friend group. I looked up the last name, found a long list of entries, and put a small dot and pin next to each name of someone I thought lived in our school district. I still have that phone book with the markings, and you'll see why. Thankfully, two towns in our area had similar names but went to different school districts. I didn't know that at the time, so I called over a dozen numbers asking for my friend, who I never found. But one guy answered, and when I asked, can I please speak to name-redacted? He answered, well, he isn't here, but this is that name. And I answered, well, this is Amanda, which was actually a fake name, guys, because the Boston song Amanda was

• 58:05Speaker 04

  out at the time. And it was all I could think of on the spot. The story's getting good. I think you see where it's headed. We spoke for 30, 30 minutes on the phone about the Mets, who had just won the World Series, and hung up. I then called back that guy once a week for five months. And we eventually decided to meet under a streetlight on the corner. And dudes, we've been married for 33 years.

• 58:29Josh Clark?

  Awesome.

• 58:31Speaker 04

  Together for 39. And in December, our daughter is gonna get married. He is my person, my soulmate, my everything. I'm a weirdo, and he gets me and always has, all because of a phone book.

• 58:42Josh Clark?

  That is so great, man.

• 58:44Speaker 04

  To answer your question, yes, the other guy knows the story, and that he is the reason that I found my husband. I don't think he could believe it. And I sort of still can't really believe it myself, after all these years. Nowadays, it would be so unlikely to even pick up a call from an unknown number. So thank you again for consistently creating such polished, elite entertainment.

• 59:01Josh Clark?

  Polished?

• 59:01Speaker 04

  I know. Elite?

• 59:03Josh Clark?

  Wow.

• 59:04Speaker 04

  Not two words we usually associate with ourselves.

• 59:06Josh Clark?

  No, I think she's talking about the daily.

• 59:09Speaker 04

  I think so. But that is from Laura, and Laura sent pics of her and her huzz in 1987, 1993, and one from this year. And it is adorable. He had quite the mustache.

• 59:20Josh Clark?

  I saw that subject line. I haven't looked at the email yet, so I have to run over and do that. That's, what a great story, man.

• 59:27Speaker 04

  Yeah, I love it.

• 59:28Josh Clark?

  That was Laura?

• 59:29Speaker 04

  That was Laura.

• 59:30Josh Clark?

  Thank you, Laura. That was, I don't know, that's a contender for number one, maybe.

• 59:35Speaker 04

  That's right. You and name-redacted husband. I'm so glad you're still together.

• 59:40Josh Clark?

  Seriously, one of the best ever. So thank you for sending that email, Laura. And if you want to take your shot at the number one email spot, we love that. You can send it off to [email protected].

• 59:56Speaker 00

  Stuff You Should Know is a production of iHeartRadio. For more podcasts, iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 1:00:11Josh Clark?

  Buy smart, drive for less, and trade for more. That's Toyota affordability. And it starts with a great deal on an off-road-ready Tacoma or half-ton Tundra, two of Toyota's longest-lasting trucks, combining power for work, tech for adventures, and style in between. And they're built on a reputation for quality and reliability, which is why Toyota trucks are known for holding their value, which could mean big savings when it's time for your next Toyota. So get a great deal today and a great value tomorrow. Shop Toyota.com for more. Toyota, let's go places. With no fees or minimums on checking accounts, it's no wonder that Capital One Bank Guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also tell you about how Capital One cafes are

• 1:00:55Josh Clark?

  open seven days a week to assist with your banking needs. Yep, even on weekends. It's pretty much all he talks about, in a good way. What's in your wallet? Terms apply. See CapitalOne.com/BankGuy. Capital One, N.A., Member FDIC.

• 1:01:10Speaker 04

  Hey, everybody. You ever show up late to the game, and your friends have already saved your seat, and your drink, and even a plate? Well, that's looking out. And that's having your back. And that's exactly what AT&T does with the AT&T Guarantee. They know that staying connected matters, so they actually guarantee a network that comes through when it counts. AT&T has connectivity you can depend on, or they'll proactively make it right, just like that friend who takes care of things before you even ask. AT&T, connecting changes everything. Terms and conditions apply. Just visit att.com/guarantee for details.

• 1:01:42Speaker 05

  This is an iHeart Podcast. Guaranteed Human.