On Health with Houston Methodist
On Health with Houston Methodist is for the health conscious, curious and even skeptics out there. Each week, our hosts are joined by a Houston Methodist expert to explore an everyday wellness trend or significant health topic.
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On Health with Houston Methodist
Cancer Screening: Can One Blood Test Really Detect 50+ Cancers?
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Cancer screenings are an important part of staying healthy. Still, they might feel inconvenient — and sometimes even uncomfortable. So what about tests that claim to detect dozens of cancers from just a single blood draw? In this episode, we dive into the rise of multi-cancer detection blood tests, breaking down how they work and what the science says — for now.
Expert: Dr. Brittany Barthelemy, primary care doctor
Notable topics covered:
- What multi-cancer detection blood tests are and why they’re getting attention
- Why aren’t these tests FDA approved?
- Key findings from the PATHFINDER study, including false-positive rates
- The high out-of-pocket cost and lack of insurance coverage
- Shield: FDA-approved blood testing for colon cancer
- What to know about “silent” cancers, like pancreatic and ovarian cancer
- Practical ways to reduce cancer risk, including proven screenings and lifestyle habits
If you enjoy these kinds of conversations, be sure to subscribe. And for more topics like this, visit our blog at houstonmethodist.org/blog.
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ZACH MOORE:Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here and I'm also a longtime podcaster.
KATIE MCCALLUM:I'm Katie McCallum, former researcher turned health writer mostly writing for our blogs.
ZACH:And Katie, cancer is a scary thing. And I think we all know that at some point in our lives we're gonna have to get tested for it.
KATIE:Yeah, yeah, there are screenings and it, you now, depends on your gender and your age but there's quite a few cancers that we screen for. Cervical cancer for younger women, you know, then you start moving into breast cancer, colorectal cancer, lung cancer, if you have a history of smoking.
ZACH:Yeah.
KATIE:Like, it's very unnerving to think that something could be lurking in your body and you have no idea about it and it kinda gets sprung on you, and when maybe it's either too late or when really aggressive treatment is needed. Yeah, totally agree it's very scary.
ZACH:And recently, in the last few years there has been a development of blood tests for cancer.
KATIE:Yeah, it's really interesting. There's these consumerized almost, sort of, blood tests that, you know, say or claim, however we wanna word it, that they can detect, you know, 50-plus cancers from a single blood draw.
ZACH:Mm-hmm.
KATIE:You know, it does require a prescription.
ZACH:Yeah.
KATIE:But, I mean, you can go on the website and telemedicine with one of their doctors on the site and they'll, you know, provide you the prescription. So, essentially, it's available to anybody who, you know, has the money to pay for it, wants to pay for it. It's out there, it's right in front of us now. It begs the question, like, should we be doing this?
ZACH:Yeah. Well, I understand the appeal because you can just send in some blood and get a result back in the mail, yes or no? Like, getting screened, you know, in its various forms can be intimidating in and of itself.
KATIE:Yeah. I mean, I think, you know, screenings are tightly defined things, right? There's certain age criteria that need to be met if you're - especially if you're not high risk and stuff like that. And sometimes, you kinda maybe just don't wanna wait. You're too scared to wait and you just -- especially in this very data-centric world we live in now when we want everything right now, right now, right now."I wanna know right now." Yeah, it sounds -- like, I'm interested. It sounds nice to kind of just do a blood draw and be like,"Okay, yeah, no, we didn't find any signals for cancer." Or, "Hey, we found something concerning. You should go get checked out." Like, I'm interested in it too. I think I have a lot of questions.
ZACH:Yes.
KATIE:I think, "How often would I need to do this?" You know, it's a snapshot in time. Like, "How often would I need to do it? Like, how effective are these things?
ZACH:Right.
KATIE:Like, are they gonna tell me that I might have cancer and then it turns out I don't? And that's really -- it's even more scary, almost. Than not knowing anything. ZACH: Yeah. So, lots of questions over here on my end for sure.
ZACH:Lots of questions and who did we talk to who will give us some answers today, Katie?
KATIE:We talked to Dr. Brittany Barthelemy, she is a Primary Care Physician here at Houston Methodist. So, she's actually, probably gonna be the first person if you have questions like me, that you'd go to and talk to and just be like, what's the deal with these? Hi, Dr. Barthelemy, so glad to have you today.
DR. BRITTANY BARTHELEMY:Thank you. So happy to be here.
KATIE:We're talking about cancer detection blood tests. And you know, cancer brings out a pretty visceral reaction in people, I think. For obvious reasons. I think we all probably know someone affected by cancer, whether it's ourselves, a loved one like a spouse, a parent, a child sometimes. It's a disease that can be very sad, and so naturally, when we hear about something like multi-cancer blood tests or multi-cancer detection blood tests, you know, your ears perk up.
DR. BARTHELEMY:Yeah. KATIE: You wanna know more. So, we're gonna talk about that today. I wanna start with the question of, how do these tests work? So, they're really interesting. So, it's a blood draw, right, so you just go to your lab, they just draw a vial of blood and then they're looking specifically for DNA that is shed by cancer into the bloodstream. KATIE: Okay. And they're looking at DNA changes, whether that's methylation or mutations, or even RNA, or proteins, or what have you. It depends on, like, the type of test. But they're specifically looking for those DNA fragments that are shed by cancer. KATIE: Okay. And they're able, essentially, to find the signal of origin. So, like, they're trying to find where did this, like, DNA come from? KATIE: Mm-hmm. And they're able to distinguish that from normal DNA, essentially. And so, there's like 50 or more cancers that they say that they can test for, which is pretty remarkable. And the thing that they're like, looking at specifically is that a lot of these cancers can shed DNA before you even have signs or clinical symptoms, really. And so, they have this preclinical window that they're looking at, right? And so, you'll be able to test for cancers before you even have signs of cancer.
KATIE:Yeah, I think that's the piece too that is so enticing. Like, for instance, when I read about them, or see them, or get an ad for one, honestly, it's like, yeah, I wanna find it before there are symptoms. Or even, you know, I'm not even eligible for some of the screenings yet, so it's like, "Wait, I could find something even earlier? Like, sign me up." DR. BARTHELEMY: Yeah. You know, I guess a follow up question to that and how they work is, you know, when they detect something, do you know -- can they tell you like, what they think it is? Or is it just,"Hey, something's here"?
DR. BARTHELEMY:Yeah, so it's more like,"Hey, something's here." And so, it is really kind of a predictive of, like,"We think this is the signal of origin." And so, if they find that and it's positive then you would have to go through more workup. Whether it's more lab work for more cancer markers or imaging, per se. Hopefully, not biopsy or surgery but really, kinda going through more diagnostic workup when they say"It is positive," to find out is this truly the source of origin, essentially. KATIE: Gotcha. I read they're not FDA approved, so that kind of triggers the other side of things. Where you're like,"Well, why not? This sounds so awesome." DR. BARTHELEMY: Yeah, yeah.
KATIE:So, can you talk to me about what that means and sort of how that's different from other screenings that are sort of approved or standard of care?
DR. BARTHELEMY:Yeah, so having an FDA approval is pretty important, right, and so having an FDA approval makes it a lot easier to be covered by insurances. I think that's a really important thing. And so, FDA has their own like really rigorous process to kind of test these, like, products that are like, are they safe? Are they effective? What are the utility for the clinic? You know, is it going to reduce mortality? And x, y, z kind of things. And so, these are fairly new and there are some new studies. That being said, I believe they are under FDA review they just haven't been FDA approved yet. And so, it's just that, "Hey, we just don't have enough data to say that this is going to help the general public, essentially. KATIE: Right. And so, that being said, most physicians aren't going to bring up non-FDA approved things to their patients. KATIE: Yeah. So, that's a great segue into my next question. Because my next question was gonna be about, what happens when, you know, you have a patient that comes in and they're like,"Hey, I wanna do this." Like, what do you say to them and what's sort of your guidance there? I think the really important question is asking the patient what they know, right? And so, lot of times like you mentioned we see ads on Instagram or, you know, any social media things.
KATIE:Like me. DR. BARTHELEMY: Yeah, yeah. That "I find this really cool. Like, I really wanna get this done." And so, I think it's really understanding, okay,"What do you know about these tests?" And also, understanding like,"What are you most worried about? Like, which kind of cancers are you concerned about? Like, do you have a family history of certain kind of cancers?" And really talking about that type of things that they're looking for because, you know, we do have FDA approved tests and preventative measures, right? We have screenings for breast cancer. We have screening for cervical cancer. We have screening for lung cancer, for colon cancer. But I know it's scary because, you know, even though we have all these screenings, those only account for 40% of our cancers that we find, right? And so, we have a lot of silent cancers that people are worried about. And I think, I mean, I'm not sure if you're aware, but people are really scared about liver cancer, pancreatic cancer, ovarian cancer because those are silent and those are type, we find when they're stage 4. And so, patients do get really worried about those kind of things. But I think providing what we know about these tests and their sensitivities and things like that and providing that information to the patient would be really important and help them make an informed decision. Yeah. I think one question I would have is like, how often do I need to do this? You know, like right now I just had my annual appointment last week. DR. BARTHELEMY: Yeah. I do my blood work. I do that every year, right like -- so, I guess without the FDA approved -- it's part of the FDA approval then you get the guidance on like how often and what age. Like, when would we start this? Or like, I'm 37, is that too early to do something like this? Or is 25 too ear -- like, I mean, what are you -- like, does age matter? I don't know if you have the answers but I'm just curious.
DR. BARTHELEMY:So, I think just backtracking a little bit and looking at one of the major studies that we have on one of the tests. It's called the PATHFINDER Study. And it's kind of like an intro study into these tests. And it was a relatively smaller population of like 6,600 people were enrolled in this and it was just random, right? So, they didn't necessarily have cancers that they knew about. It was the general population that did it. And one thing that we have to think about is that unfortunately, there was a very false positive rate in these patients. And so, I think only out of those 6,600 people like 92 were positive and of those 92 positive, 57 of them didn't truly have cancer.
KATIE:Woah. Super high.
DR. BARTHELEMY:That's a higher percentage like 62% had a false positive, right? And so, now you have these patients that are undergoing more workup and a little bit of anxiety, yeah. And unfortunately, these patients that had false positives had a longer time to kind of resolution, right? They figured out they didn't have cancer. It was like something like a five months, essentially, of figuring out what the answer was. Versus the patients that were like truly positive, it was a very quick turnaround, like 50 days. So, it was a very different kind of workup. And so, we do have to think about that when we're kind of looking into that. And so, unfortunately, with knowing that stuff, there wasn't a clear like,"Hey, this may have been positive, maybe not. Let's do it in three years, let's do it in five." There's not a clear picture. KATIE: Right. So, really, the recommendation is if you do get it done you need to be getting it done every single year. And that also being said is if you look at some of them, they really say like 50 years and older, because once you turn like 50 and older, your risk of cancer is just typically higher. We don't see as many cancers in the younger population. And so, really, it's 50 and above with a higher risk. And so, if you have things like heart disease, diabetes, stuff like that, right? And potentially, yearly, but that's not something that we can go out and say like, "Yes, we know you need to get this done yearly." Because again, it is an expensive test, right.
KATIE:We haven't talked about that part yet.
DR. BARTHELEMY:So, we can definitely go into that segue. But yeah, so it is like almost, you know, 600 is the cheapest, 800, I think.
KATIE:Yeah, I think 800 with a coupon is like what I saw.
DR. BARTHELEMY:Yeah. Up to like $1,400. So, they're expensive tests to get done yearly, you know, when you think about that.
KATIE:Yeah. I mean, if you can even budget for that. You're budgeting for that. Yeah, that's kind of wild. I mean, I was gonna say if yearly is the answer, then I think it, unfortunately, probably wipes out a large portion of people. I mean, some people aren't ever, you know, are not even gonna be able to scrounge up the $800 once and then to say,"Oh, do that every year now." DR. BARTHELEMY: Yeah. On top of all your other kind of health premiums and things like that. DR. BARTHELEMY: Yeah. I think what's really important when you're talking about the cost of things is like, a lot of times when we're doing cancer screenings it's like the hope is to reduce mortality, right? We want the least amount of people dying from cancer as we possibly can. So, if we can get on top of it with their screenings, then fantastic. Unfortunately, there is not enough data to show that overall, this is going to reduce the mortality, right? So, now we paying all of this money to try to find cancer earlier, but in the long run, is this really going to reduce your mortality risk? And we just don't know that yet. And so, I can't in good faith be like, "Yes, get it done every single year. You know, it's definitely gonna help you." And so, that's kind of where that struggle lies too. Okay. Okay. Gotcha. I do wanna touch on another blood test for cancer that is FDA approved called Shield.
DR. BARTHELEMY:Yes.
KATIE:This one is for colon cancer specifically. So, unlike these kind of multi-cancer detection tests this one's for colon cancer, it's FDA approved. Can you explain how that one's different, first of all? And then, I think the big question everybody wants answered is, can it replace their colonoscopy when they turn 45?
DR. BARTHELEMY:Yeah, yeah. So, Shield is FDA approved like you mentioned and it is still a blood test and it's -- it works a very similar way. So, it's looking at the methylation of the DNA. The cells that are shed from the tumor that you might have from colon cancer. So, very, very similar. It does have a little bit higher sensitivity specificity. I mean, we don't have to go into the kind of math of it all. But that being said, it is not superior to even a FIT test, which is a yearly stool test. It's not superior to Cologuard, which is a stool test every three years. And it's definitely not superior to a colonoscopy. And so, when you compare them all the recommendation for doing a Shield will be like if you cannot convince a patient to do any of the ones I just mentioned, then it's better than nothing. It's like, "Let's just figure out if there is something that we need to workup," essentially. And so, really, the Shield should be used to bring those untested patients into the tested field.
KATIE:Gotcha.
DR. BARTHELEMY:There is some concern that if we start getting these patients that were getting colonoscopies and were getting Cologuard or what have you, and they go to the Shield, then the amount of colon cancer deaths would actually increase. And so, it really is meant to be like a screening tool to bring people in, not to change them over to the Shield.
KATIE:Yeah. That makes a lot of sense. You know, another question that I had is, I think a lot of us worry too, and you kind of mentioned it, it's these silent cancers. And so, correct me if I'm wrong, we kind of don't have screenings for some of these.
DR. BARTHELEMY:That's correct. We do not.
KATIE:So, the ovarian cancer, endometrial cancer. So, what would you say to someone who is truly really scared about that? And is just like, "I wanna spend the $800 every year." I mean, are we still -- like is that truly gonna help find that stuff sooner, you think?
DR. BARTHELEMY:Yeah. So, I think it's really hard and I think you need to go back and look, kind of, at the research that we do have on the study, and it's like again the PATHFINDER result and study was like the major one that we have so far. They're actually revamping it with even more people now. It's gonna be like 35,000 people in the United States. I think they're also doing it in the UK, maybe, and it's something like 100,000 people. So, we're gonna have a lot more data hopefully, in the near future. But even then, when you look at that, the sensitivity of these tests for Stage 1 cancer is very, very low. Something between like 13 to 17%.
KATIE:Which is kind of what you wanna find.
DR. BARTHELEMY:Right. But it's like you're not really getting everybody in that field, right? And so, you're gonna miss a lot of cancers, unfortunately, because they're early stage and are not getting picked up by the tests. And that provides a false reassurance, unfortunately, right? So, you're like,"I got this test done, it was negative." But unfortunately, with early stage cancers, it's just not very sensitive at picking them up. So, it's just like we're not out of the woods just yet, right, we have to continue with what we can know. And even these silent cancers like ovarian cancer, specifically. So, like, if you have a family history, if you know that you're BRCA1 or BRCA2 positive, you know, that's something that your provider would kinda go with you through and figure out what screenings. But there is some data that says, "Hey, even if you do have these and we're doing screenings with ultrasounds and stuff like that, the mortality hasn't been decreased, unfortunately. And so, we're -- they really are trying to figure out, how do we decrease this mortality from these cancers? But there just hasn't been a proven way just yet unfortunately.
KATIE:Well, I mean, it makes sense. It's a complicated thing, right, it's kind of yourself but it's diseased, you know, the diseased cells that are your own. So, like, that's a tough thing to catch. I mean, in your perspective, I always kind of go in my brain to sort of the Elizabeth Holmes story, when any time you think of blood-based detection. Do we think it's ever gonna really be possible to rely on something like, you know, just a single blood draw to get true answers? Is it just technology, you know, needs to -- time needs to catch up with technology? DR. BARTHELEMY: I think so. I think, you know, again, just going back to that same study. They looked at -- I think one of the things we haven't talked about is this is a blood-based test. And as you can imagine, the cancer that was most detected was a blood-based cancer. Oh, yeah. That makes sense.
DR. BARTHELEMY:Because it's just where you're getting a lot of the DNA from. And so, they looked at that and they went and put it into an algorithm, and they were able to, you know, lower that threshold for solid tumors, so that maybe they're gonna pick up solid tumors a little bit better, and raise the threshold for blood cancers, essentially. So, they already took that small thing that they saw, changed it and then improved on follow up testing. So, I think, yes, every time they do these tests like the PDSA cycle is right, and so you plan, you do all this stuff, you make it better and then you do it again. And so, every time they do these studies it seems like it is getting better and better, I just don't know what that timeline's gonna be.
KATIE:So, maybe a little too soon perhaps and especially if, you know, you don't have a spare $1,000 lying around, which I think a lot of us probably don't. Okay, I think I wanted to segue into other ways or just ways to prevent cancer. Unless you had something else to kind of weigh in on.
DR. BARTHELEMY:No, nothing.
KATIE:Okay. DR. BARTHELEMY: Yeah. I'm huge on preventative medicine so I'm super excited. Yeah. Okay, cool. Yeah. Because I think the whole reason we even, you know, wanna do these multi-cancer detection tests is because we kinda wanna make sure we're healthy and we're good. So, I mean, I guess my question is and it's very broad so, you know, you can kind of dive into which part is most interesting to you, maybe. What are those like "free ways" -- I know nothing, technically, is free these days. But what are those free ways to help prevent cancer that you would kinda recommend to a patient that walks in?
DR. BARTHELEMY:I love this because I love when patients come in and they're like,"I'm here for my free exam." And that's like, that's perfect, right? I'm here to talk about all the prevention measures. And so, before, again, that we've mentioned briefly before is breast cancer, right? So, your insurance is going to cover getting a mammogram, your insurance is going to cover getting any further workup that you might need if this is, like, positive. And so, now, there is also a lot of, you know, women's clinics around the area where it's like, "Hey, come get your breast exams. You know, get those done." So, there's a lot of more opportunity for breast cancer screening.
KATIE:And that starts age 40 now?
DR. BARTHELEMY:Correct. KATIE: Okay. So, they have decreased that age to 40. It is getting covered by insurances at a younger age, right? And so, we've started seeing it at a younger age more and more and so they definitely decreased that age. And so, that's been good. Same thing with colon cancer, it used to be 50 and now it's 45. And so, we've briefly talked about those too, but colonoscopies are your like, bread and butter. And you know, if they don't find anything, it's every 10 years. If they do find something, depending on what they find, it's every three to five years possibly. Cologuard is also a really good colon cancer screening. The only way you can get it though is if you do not have an immediate family member with a history of colon cancer. So, if your mom, dad, brother, sister, as long as they've all never had colon cancer and you've never had an abnormal colonoscopy then you can get a Cologuard. And that's just a kit that gets sent to your house, you do a little stool sample, you just like swab it and send it back and they test. The same way they test for like these DNAs, right? And so, that's another way. And then, there's something called a FIT test, which is just like in-office, or you can take it home. But it's every year for colonoscopy. Cervical cancer screening, so that starts at age 21 now. And so, this is like something interesting too to think about, is when I started getting Pap smears, they were every single year, but then they saw the data and was like,"Well, we're doing a lot of unnecessary biopsies and things like that and it's causing more harm than good." And so, you know, as we learn more things, we're able to kind of space things out. And so, now, when you're in your 20s it's every 3 years and then when you're 30 and older it's every 5 years because now we're doing co-testing with HPV. And so, HPV is like a virus that causes cervical cancer. And so, that -- because those are both negative, right, you're checking if your cervical cell changes and the virus and they're both negative, that could spread out your screenings a little bit longer. And then, lung cancer is a little bit tricky. You do have to have a smoking history of about 15 pack years and so -- a recent smoker or currently smoking and that is what -- you're gonna get a low dose CT scan. And so, that is also covered by insurance for our smokers.
KATIE:Okay, so a lot of kind of things we can do that insurance covers. You know, I always find the hesitancy about a colonoscopy interesting. Like, I understand that the prep sounds awful, but like, I especially -- when I turn 45 that's like the first thing I'm gonna do. I wanna know what it looks like in there so I can be totally sure. And then, maybe if everything's good I would switch to, you know, to the fecal test or something. But like, I want those images and I want someone to be in there looking and being like,"Nope, everything looks good. You're good." Because that's your first chance to kinda like --
DR. BARTHELEMY:I think, you know, polyps are more common than not. A lot of times they do end up becoming benign. But you know, I would rather know, is there something that they can -- especially, because when you're doing a colonoscopy and they find a polyp, they can go ahead and snip it and biopsy it then and there, right?
KATIE:Right.
DR. BARTHELEMY:And so, with Cologuard if that does come back positive, like the stool test, then you still have to go back and get the colonoscopy. And insurance will cover the colonoscopy before. And so, it use to be like, this was maybe five, six years ago. If your Cologuard was positive and you had to get your colonoscopy, then they considered the colonoscopy diagnostic, and it wasn't covered by insurance. That has since changed.
KATIE:Okay. Yeah.
DR. BARTHELEMY:And so, now, if your Cologuard is positive then your colonoscopy is still considered screening and it is covered by your insurance. So, there's always a lot of changes for the good, luckily.
KATIE:Yeah, gotcha. Okay. Aside from screenings, any other kind of healthy habits you'd recommend? I literally this morning was scrolling my news feed and saw an article that was like,"These two habits account for 30% of all cancers," or something. I didn't click on it because I probably can guess what they are. I would guess like smoking and drinking.
DR. BARTHELEMY:Yeah.
KATIE:To that note, not smoking, limiting alcohol intake, what else do you got for us?
DR. BARTHELEMY:So, I think those two are majors, right? There's a lot of data that smoking and alcohol definitely increases your risk of cancer especially drinking in alcohol-- I mean, sorry, liver, right. So, you have liver cirrhosis and liver cirrhosis can progress to liver cancer.
KATIE:How can you check for that?
DR. BARTHELEMY:For liver cirrhosis?
KATIE:Yeah.
DR. BARTHELEMY:So, unfortunately, that's one of those things that is kind of later stage. And so, one of the biggest things I think especially if you drink more than the recommended amount. So, for women it's two standard drinks, right? So, your 12 oz not your tall boy of beer or one glass of wine a day. And for men, it's three. And so, no more than that per day. And so, a lot of times if you're having patients that are drinking more than that when they come in for their annual exam, we're typically getting screening labs, and part of those screening labs are your liver markers. And so, any time there's a liver marker elevation then we need to figure out what's causing this. And so, then those patients will go through an ultrasound of the liver. They might go through more lab testing as well and that's when we're gonna kinda see that bigger picture. Do you have fatty liver changes? Do you have fluid around the liver? And so, we'll know more or less but there's not like a screening measure per se that we're trying to do. Like, "Hey, you're drinking a lot we need to figure this out," you know?
KATIE:Not condoning drinking beyond what you just recommended. DR. BARTHELEMY: Yeah. But are you saying that if someone were to, they could feel sort of comfortable that if they're keeping up with their annual exams like probably some early changes might be able to get caught-ish?
DR. BARTHELEMY:Yeah. KATIE: Okay. It's hard to tell too, unfortunately, because sometimes you have, you know, heavier drinkers but obesity can also increase those risks too. And so, obesity is a risk factor for cancers as well, unfortunately. And so, a lot of times patients that have, you know, a higher obesity and those liver markers are elevated, then those -- and maybe they're not drinkers, those are likely gonna be more fatty liver changes. And fatty liver can like proceed to cirrhosis, which again, can further go to cancer. And so, it is all something we need to be keeping an eye on. And so, yes, back tracking… KATIE: Okay. Yeah, sorry, I'm just like that's the one I needed answered, thank you. Smoking, alcohol, definitely weight is a big factor too. And then, you know, things we eat is really important. And so, a lot of processed foods and stuff like that. That's the majority of our diet and we're not getting a lot of like fruits and vegetables then probably not good for your cell and cell changes, right? And so, it's just, you know, be mindful of what we're eating. I'm not saying avoid all processed foods, but you know, if we can have less and less of it, the better.
KATIE:Yeah, those processed foods are so good.
DR. BARTHELEMY:Yeah. No, it's-- you know, my dad worked for Frito Lay growing up, and so I ate chips a lot. So, I just -- it's hard to avoid and they can become addictive, right, just like sodas are, just like alcohol, just like smoking. And so, it is definitely something we need to keep an eye on. KATIE: Gotcha. Okay. How much does kind of being -- you know, I've seen lately a lot of like, the benefits of being, like, outside and outdoors. Do we -- I mean, what do you tell people who are like, "I exercise, but I'm indoors all day"? Like, are you ever like,"Hey, get outside, that helps too." Or do we know enough about that? I think we do know that for sure being outside helps with vitamin D levels and we are seeing so much low vitamin D. We're just like not getting outside as much as we used to.
KATIE:Mine is like non-existent levels.
DR. BARTHELEMY:Yeah, mine was like 13 when I was in medical school so very, very low. And normal is 30 and above. And so, definitely being outside is helpful for that. At the same time, part of the skin cancer realm of like being outside too much can definitely be a concern since we are talking about cancers as well. So, wearing your sunscreen is gonna be super important. That is, you know, part of the recommendation, wearing shaded type of clothing so they have longer sleeves. Any hats or things that are gonna cover your neck and your ears. So, commonly are -- common areas for skin cancer are tip of the ears and feet because people don't think about putting lotion on them or covering them up, right? And so, it is a very common spot.
KATIE:I've never thought of the tip of my ears.
DR. BARTHELEMY:Yeah. KATIE: So tiny. Yeah.
KATIE:So, just do like a tiny, like dab on the finger and…
DR. BARTHELEMY:Yeah. KATIE: Okay. Okay, I'm gonna add that in. This is also sidenote. So, like the recommended amount of -- nobody ever uses this amount, but the amount of sunscreen you should be using is like a shot glass worth. KATIE: Woah! That's a lot of sunscreen. Like, nobody's putting that much on their body. So, really, the important thing is gonna be reapplying. Make sure you do use the bottle recommendations of reapply every so often, you know?
KATIE:Face sunscreen every day?
DR. BARTHELEMY:Yes, definitely.
KATIE:Okay. DR. BARTHELEMY: I know. I mean, this might be a little bit more superficial, but women are really concerned about wrinkles and stuff like that, but yes, wearing sunscreen can help prevent wrinkles and things like that, right? And that's a bonus.
DR. BARTHELEMY:Prevent a lot of sun damage.
KATIE:Yeah. We'll take it. Okay. Any other kind of healthy habits to think about with cancer prevention? I know we covered quite a few.
DR. BARTHELEMY:Yeah, I think -- I mean, really watch what we're putting into our body. So, if we can limit our smoking and we can limit our alcohol, we can limit, you know, the processed foods we eat. It's gonna be really important. Exercising is always gonna be super important. And really staying up to date on the screenings that we do have available, I think that's gonna be the most important thing until we get more data. Again, I think these tests are really meant to kind of bridge that gap for the screening tests that we don't have. You know, there's not other option for pancreatitis or sorry, pancreatic cancer, or liver cancer, ovarian cancer, right, other than getting this like imaging done. And so, I really see the utility in this in the future, and hopefully as these kind of tests grow and we get more information with these larger studies, that we can really help target these cancers that we're missing, that we don't have screening tests for. KATIE: Yeah. I love that. And also coming to see you, probably. I think one thing I have a lot of friends who don't go to their annual checkups. I'm just like, "Why? It's free. You pay for it in your premiums and then you get like to have this person give you the peace of mind or, you know, help you through like some results that need work and improvements." DR. BARTHELEMY: Yeah. Yeah.
KATIE:But yeah, I think --
DR. BARTHELEMY:I do wanna make this little caveat.
KATIE:Yeah.
DR. BARTHELEMY:Is that your annual exam is free, but depending on your insurance, not all insurances cover screening labs. We still order them, but there may be a chance that you may get a bill for the lab work depending on the type of insurance you have. KATIE: Gotcha. That's a very good caveat. DR. BARTHELEMY: Yeah.
KATIE:I think I've been lucky and so far haven't had to worry about that so yeah. DR. BARTHELEMY: Again, it is really dependent on the insurance, unfortunately, yeah. All right, well anything else? This has been great. Anything else that you wanna leave us with regarding these tests? I know you kind of mentioned hopeful for the future that these get even better. Anything else to leave us with?
DR. BARTHELEMY:Nope. I think that's it. Just stay healthy. KATIE: Yeah. You know, that's like the mantra of this podcast so that's perfect. Perfect way to end. Thank you so much for being here. Thank you for having me.
ZACH:So, a very informative conversation, Katie. Based off what y'all said though, I don't think the blood tests are for me yet for cancer. I just need them to be a little more established, a little more accurate, right, because that false positive rate alone was like, to me, a red flag.
KATIE:Yeah. I think those initial studies, which, you know, maybe things have gotten better since they were studied in the one she mentioned. But it was like 60%. And then, on top of that, the amount of time it would take to sort of rule out cancer from this, you know, false positive, that later it turns out to be false positive, but you get a positive result. It's ruled out three plus months later.
ZACH:Just sitting there waiting thinking you have cancer for how long.
KATIE:Yeah, that's scary too, right?
ZACH:Yeah.
KATIE:So, I got the sense from her that there's a lot of hope that these things are gonna just keep getting better, more accurate, and can be something that people use in the future. But maybe a little too soon. They are also incredibly expensive, not covered by insurance, and there's a lot of questions that still remain on the, how often should you do it? I mean, in theory, every year she said. This is an $800 test, so you know, I think still a little too soon. But we all know how fast technology moves especially these days. So, you know, I mean we might be looking at something in the near-ish future that could be worthwhile.
ZACH:Yeah. And look, it's an exciting technology, right? I just want it to be a little more established, a little more reliable. Now, the Shield testing appealed to me because it could potentially take the place of a colonoscopy.
KATIE:I mean, I think that's a little --
ZACH:Is that wishful thinking or…
KATIE:Yeah, I would say I think what I heard from her is colonoscopy is still the screening test that is the most efficient, effective, accurate way to know your current status of colon cancer. The other benefit is, if there is a polyp there they can remove it right away, right? I think what I heard from her is that if you refuse colonoscopy they would rather you then do this blood based test called Shield, which is FDA approved. So, I think she kinda said it as it's a way to bring those people into the fold that just will not do a colonoscopy.
ZACH:Yeah. Look, I haven't had to have a colonoscopy yet. Been fortunate enough not to have to take one. My parents have and I've heard what they do and it doesn't appeal to me. So, if there is an alternative, that excites me and interests me. But of course, I'm always gonna do the medically recommended one first. KATIE: Yeah. I mean, yeah. I get it though. But I'm interested in these tests because I'm not eligible for screening for several of these cancers yet. So, in my mind I'm just like,"Well, wouldn't it be nice to know right now and not have to wait for the screening." But there's a reason those screenings come later in life. These things just aren't common enough yet to say like, "Let's screen earlier." So, I get why people are interested. But I'm glad we got some of these questions answered so we can all now make sort of an educated decision. It is an expensive test, so make an educated decision for ourselves of whether we would be interested. Absolutely. And like you said, technology is always evolving and in the next few years, who knows where this could be? So, it's exciting to be on the front lines of this sort of thing. KATIE: True, yeah. All right, that's gonna do it for us this time on, On Health with Houston Methodist. Be sure to share, like and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings, so until next time, stay tuned and stay healthy.♪ ♪