Liver Cancer Screening and 'We Caught It Too Late' with Dr. Bharat Tewarie

'We caught it too late' is the sentence Dr. Bharat Tewarie wants to retire. The Helio Genomics CEO joins Chris Hutchins to discuss liver cancer screening, surveillance and the barriers to earlier detection.

Bharat explains the HelioLiver blood test, the CLiMB study and the role of follow-up for people already at increased risk of hepatocellular carcinoma. The discussion moves from test performance to clinical workflow, rural access and the difference between raising awareness and making care easier to reach.

The study discussion concerns an at-risk surveillance population. It does not establish a mortality benefit or support screening the general population. Listen for the practical questions clinicians, researchers and health leaders need to ask when considering how earlier detection could fit into care.

IN THIS CONVERSATION
- Why liver cancer surveillance requires repeated follow-through
- What HelioLiver measures and how the workflow is described
- What the CLiMB study tested and which population it studied
- Rural access and barriers between testing and clinical action
- The sentence Bharat wants to retire and his message to founders

CHAPTERS
00:00 Welcome and episode introduction
00:19 Dr. Bharat Tewarie and the purpose of early detection
01:04 Why liver cancer can develop quietly
03:01 The surveillance gap
07:28 What HelioLiver measures
09:09 The clinical workflow and follow-up
11:24 What the CLiMB study tested
15:14 Who the test is for
17:01 Validation and real-world evidence
21:27 Rural access and the practical barriers
23:37 Awareness, policy and action
30:49 The sentence Bharat wants to retire
32:07 A message for researchers and founders
33:29 Resources and next steps

GUEST & RESOURCES
Helio Genomics: https://heliogenomics.com/
HelioLiver / CLiMB study: https://heliogenomics.com/providers/climb
Patient information: https://heliogenomics.com/for-patients
Bharat Tewarie on LinkedIn: https://www.linkedin.com/in/bharattewarie/
Awareness resolution discussed: introduced text: https://www.govinfo.gov/content/pkg/BILLS-119hres1591ih/pdf/BILLS-119hres1591ih.pdf

THE SIGNAL ROOM
Hosted by Chris Hutchins
https://signalroompodcast.com/

Transcript

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Chris Hutchins: 0:05

I'm really excited today to introduce Dr. Bharat Tewarie. He's going to talk to us about some really exciting work that he's been doing. But Doctor Tewarie, I'm excited to have you and welcome to the show.

Dr. Bharat Tewarie: 0:16

Thank you.

Chris Hutchins: 0:17

If you could just give folks a little bit of an idea who you are and what's your why.

Dr. Bharat Tewarie: 0:22

Yes, Bharat Tewarie. I am a physician executive, so I have an MD and MBA, had a career in big pharma, big biotech, and now I am the CEO of Helio Genomics.

Chris Hutchins: 0:34

Excellent. So to kind of set the stage, for a listener who's never really thought about liver cancer, how would you describe this disease and what makes it so different from the cancers that get more public attention?

Dr. Bharat Tewarie: 0:46

Yeah, good question, Chris. Let me start by saying that liver cancer almost never announces itself. There is no lump that you can feel, no early pains that sends someone to the doctor. Then that's because the liver has a lot of reserve. So people feel fine while a tumor is still small enough to cure, and they often still feel fine when there is no longer small enough also to cure, right? So and that's the whole strategy of the disease. If we find

Chris Hutchins: 1:15

Right.

Dr. Bharat Tewarie: 1:16

What it's called hepatocellular carcinoma while it's still small. So when it still fits in the criteria to resect or transplant, we can go for a cure. But if you find it later when it has spread, then you have to talk about other options and curative options are not on the table anymore.

Chris Hutchins: 1:33

So when you think about you know what the people that are living with the risk factors for liver cancer

Dr. Bharat Tewarie: 1:38

Mm-hmm.

Chris Hutchins: 1:40

Who are these type of people? What is their path typically look like as they're navigating their health care?

Dr. Bharat Tewarie: 1:46

Yeah. So most liver cancer develop in people who already have long term liver damage. And the biggest drivers are things that injure the liver over years and often lead to cirrhosis, which I would describe as like permanent scarring that replaces healthy liver tissue. And when cirrhosis is present The risk of liver cancer rises significantly, no matter what the original cause was. So cirrhosis is one of them, right? The second

Chris Hutchins: 2:18

Right.

Dr. Bharat Tewarie: 2:18

One is chronic hepatitis B or hepatitis C infection. The viruses can cause ongoing inflammation and damage, and that can raise cancer risk, sometimes even without that, there is full cirrhosis. Other new risk factors which are being recognized are heavy. Long term alcohol use, fatty liver disease, and obesity and type two diabetes.

Chris Hutchins: 2:44

Talk about the early detection piece of it if you would want.

Dr. Bharat Tewarie: 2:47

Mm-hmm. So, for those patients who are at high risk, so the ones with cirrhosis and hepatitis B, the guidelines are very clear. And the guidelines are very clear for years. People with these high risk factors should get an abdominal ultrasound every six months, often combined with AFP, which is a protein blood test. But this is where the issue comes. The problem is the tool, the ultrasound, And the system around the tool. Because you know, a lot of people have issues when it comes to completing ultrasound. Ultrasound requires a separate order, a new imaging appointment. For many patients, it's a travel to another facility, time away from work. And each of these steps gives another opportunity for surveillance to therefore fail. A blood test can be ordered during routine visit. And completed in the same familiar lab that patients already are using. And we know from real-world evidence that, you know, there is a study done among Medicare patients who later were diagnosed with HCC, which showed actually that only 21% of these people had received even one ultrasound in those three years, right? That's one. So starting with ultrasound, then follow-through is another important. Right? You have to come back every six months for life because you're at high risk for liver cancer. And that

Chris Hutchins: 4:18

Right.

Dr. Bharat Tewarie: 4:18

Doesn't happen. The last part of ultrasound is it's very operator-dependent, it's often least reliable in exactly the patients with the greatest risk, like cirrhosis, obesity or fatty liver. Why? Because these diseases can obscure the small tumors, and that's why basically. In surveillance, you want to have a test which actually people can actually complete. And evidence shows that routine blood draw are far more likely to happen than a separate ultrasound appointment.

Chris Hutchins: 4:54

What should be happening for people most at risk versus what's actually going on? It

Dr. Bharat Tewarie: 4:58

Yeah, so as I said before, right, once you are at risk, the guidelines state that you need to be under surveillance every six months for life. But the majority do not. And especially in rural areas, even if you would want to get imaging done, surveillance done through ultrasound, the problem is that those centers where you can actually go and get this done are so far away. That it is a lot of travel for a lot of people so that it doesn't happen too. So there is of course also not an equity which is equally present for people in the cities and in rural areas. It shouldn't be dependent on your zip code whether you're able to catch cancer at the stage that you can cure it, right? You want this to be available for everyone.

Chris Hutchins: 5:46

As a physician, how does that stuff affect things for you in terms of how you are able to interact with the patient?

Dr. Bharat Tewarie: 5:55

So, what you actually want is you want surveillance first to be done. So, as a physician, if you see a patient who has cirrhosis or hepatitis B in front of you should actually ask the question are you under surveillance? And if not, prescribe a surveillance. The next thing then is right, choose surveillance which you know that the patient can not only do one time. But can also do repeatedly, because the guidelines say that you have to do it every six months. And then you want the last thing I would say is then you then also want to have a surveillance possibility, a test, which also can detect cancer at such a stage that curative

Chris Hutchins: 6:43

Right.

Dr. Bharat Tewarie: 6:43

Options are still on the table. Because that now we are talking right about increasing survival. If you can catch it that early. So these three things are very important. So being in surveillance, the ability to have a system which makes you come back, and then detecting cancer as early as possible when cure is still on the table.

Chris Hutchins: 7:03

Talk to me about HelioLiver and

Dr. Bharat Tewarie: 7:05

Mm-hmm.

Chris Hutchins: 7:06

You know, for a referring physician hearing about it for the first time, what is it? How does it work and what makes it different from what's come before?

Dr. Bharat Tewarie: 7:14

So, HelioLiver is not imaging, it's a blood test. One simple draw. And what it does is it looks at several things together. It looks at what's called methylation patterns on cell-free DNA, protein markers in the blood, and a few simple clinical factors. An algorithm weighs all those signals and then returns a result that says that this pattern looks like hepatocellular carcinoma, so liver cancer. Or it does not. So it's a surveillance test for the people that I already was mentioning, right? Who already have cirrhosis and have another guideline reason to be watched. And what is amazing is that in a pivotal landmark study that we did, the study is called CLiMB, and CLiMB was recently published. We were able to detect cancer less than two centimeters where ultrasound. Current standard of care could not. And why is this important? For these people, curative option is still on the table. So imagine if we have, therefore, you know, when we when Helio Genomics would roll this out across the US, we actually now have a tool for surveillance, which is blood-based, so it is easier done than imaging. And not only that. You are able to detect cancer at the stage that the curative option is still possible.

Chris Hutchins: 8:46

Talk about the model for what you're doing with HelioLiver and how it works with the biological signals and how does the test measure.

Dr. Bharat Tewarie: 8:55

Yeah, so it's very simple. Well, as a physician, whenever you see somebody who is at risk for liver cancer, cirrhosis, hepatitis B, you prescribe the test because these people should be following surveillance with a certain frequency. As I mentioned, twice a year, right? They in the same visit you can do the blood draw, because that's already a part of the visit. The blood is drawn and we use the we are working together with Quest. Which therefore means that the blood draw is very easy. You can go to any Quest facility. Quest is the majority of cases even present in the facility of the doctor. And because of the collaboration that we have with Quest, we have a very easy way of not only having the blood drawn, collected, and sent to our central laboratory, where we are analyzing the sample coming in. And then in a matter of days, we can send the result back. To the physician who can read it actually in the same electronic medical record because we are through Quest integrated with all the different electronic medical records, which there are easy for the physician, easy for the practice. The result is there, and the doctor can then discuss with the patient what the test is saying. If it's negative, the doctor needs to ask the patient to come back for the next surveillance visit, which is six months later. If it's positive, you then need to, according to the guidelines, go and get A confirmatory MRI. And what is important is that in many cases, because HelioLiver is able to detect cancer at the stage that cure is still possible, when you then go and do the MRI, the doctors know exactly what the situation is, where the liver cancer is. And if it's small enough, you can then have an appointment made for curative option, which can be ablation, resection, or sometimes even a liver transplant. But then you see already. How you get into the next step of what the guidelines are saying, right? Then care happens at the right time, in the right way.

Chris Hutchins: 10:58

What you've done with HelioLiver is something called the CLiMB trial. You talk about what that study was designed to show and you know, how you want clinicians to be able to read the results.

Dr. Bharat Tewarie: 11:10

Yeah. So CLiMB, indeed, that's the name, is a landmark study when it comes to liver cancer surveillance. Why is that? Prospective study, blinded, 42 U.S. Sites, and a great mix between academic and community centers, and actually mostly community. What that means is real-world situation, right? And what we also did is very important. Everyone who was in the study. Got an MRI as a reference standard. And that design matters because a lot of ultrasound numbers may look better than they are because that's not a one-time test. It is done over time. And if you wait a long time, the cancer grows so one day the ultrasound is going to pick it up, right? What we actually did is we enrolled 1968 patients with cirrhosis in the study. And In the end, the results were phenomenal. We actually showed by a direct comparison to get ultrasound that HelioLiver could detect actually 48% of the cancers versus 28% for ultrasound. What is the most meaningful is that for lesions less than two centimeters or smaller, ultrasound had zero pickup. Zero pickup. And we look at stage one, which is also a stage. That you want to detect liver cancer in because a lot of the curative options are still possible. The difference was staggering. We could pick up four times more cancers than ultrasound. It was 40% versus 10%. So that's why

Chris Hutchins: 12:48

There's

Dr. Bharat Tewarie: 12:49

CLiMB is such a pivotal study. When you

Chris Hutchins: 12:52

Right.

Dr. Bharat Tewarie: 12:53

You really want to look at a real world conversation where everyone had an MRI, right? You look at CLiMB. CLiMB got published in a peer-reviewed journal in May of this year, so anyone can now look at the data because they are in the full page.

Chris Hutchins: 13:09

For clinicians who aren't kind of living inside of the lab world, looking at the things that you're looking at, maybe talk about what it means where HelioLiver sits today and

Dr. Bharat Tewarie: 13:20

Yes.

Chris Hutchins: 13:20

Where's the pathway gonna go from here.

Dr. Bharat Tewarie: 13:22

Yeah. So for a hepatologist, right, it's a way to see a patient who actually may never make the ultrasound, do it. And it is the best way actually today to find a small lesion that ultrasound keeps missing. For a gastrointestinal physician, right, a GI specialist, it's a practical answer. When ultrasound report says visualization was limited because of body habitus. And you see that a lot now, since fatty liver is dominating. You can imagine when the fatty liver is very difficult to image, actually, you know, the cancer. For primary care, it is the chance to act on a risk you already know. And what do I mean by that? If you have a patient who has cirrhosis, hepatitis B, long-standing diabetes with the liver disease, right? This is the time to ask yourself. Should this patient be in surveillance? And the answer is yes. Order a blood test in the same workflow as everything else. And then you can actually, based on the result, act accordingly. A positive results mean, don't panic, but go and follow the guideline which says now you need to do an MRI. If it's negative, call the patient back in six months. That's what the advantage is of this one.

Chris Hutchins: 14:42

You're having to balance catching real cancers against really providing a workup for people who don't actually have cancer. But how do you and your team think about that balance issue you've built to the HelioLiver and what do you want a clinician to be able to tell a patient as a positive result?

Dr. Bharat Tewarie: 15:01

So the first thing is that the study that I spoke about CLiMB was designed with input from the FDA. The second thing is the test HelioLiver is not designed for the general population to find out, you know, I'm healthy and you know all is good, but I still want to know if I have cancer. HelioLiver is designed actually for patients at risk. You have cirrhosis, which means you already have an organ which is damaged. And now comes the difficulty. Can you develop a surveillance test which is able to find cancer in an organ which already is damaged? And therefore, you have a lot of you know signals which are interfering with do you have cancer or not? So HelioLiver is a test for patient at risk developed for an organ which is sick. And now you want to find out you have a high risk for liver cancer because you have cirrhosis, you have already an organ which is damaged. Can I find cancer in it? So it's very important that when you say you don't have liver cancer, that you don't have liver cancer, right? So that's very important

Chris Hutchins: 16:07

Right.

Dr. Bharat Tewarie: 16:08

To be able to say that because you talk about a population which has a high risk for liver cancer. And that's exactly how CLiMB was actually designed for. And this is how a physician should look at HelioLiver too. It's not a test for the general population who wants to know do I have cancer? It's a test for patients at risk who have a high possibility to get liver cancer and now you want to know.

Chris Hutchins: 16:34

There's a number of aspects to it, but I'd say not the least of which is the validation of the results. Talk a little bit about how that's done and who really does that kind of work for, you know when you're dealing with clinical trials. I

Dr. Bharat Tewarie: 16:47

You know, in CLiMB, let's start there. We had forty two centers, right? The biggest centers in the United States participated in it. Eminent physicians were a part of that. Forty two, so that is a very large base. Today, when the test is already commercially available, we are rolling this out not only to the physicians who have been with us in the study CLiMB, but also physicians with a high volume. And we see the recognition already in the field of people who are coming back with their real world stories about where this test fit, right? You're not ultrasound didn't show any signal or test did.

Chris Hutchins: 17:31

Right.

Dr. Bharat Tewarie: 17:32

And we are collecting this as real world evidence today. So in addition to having done this landmark study, multi-year study, right? Took a long time to do it, get it published so that anyone in the world could read about it. We are now, while we are commercializing the test, also collecting the real world data while the test is being prescribed. And then this is now being presented also at conferences, right? As the possibility to tell people how in practice HelioLiver has a value.

Chris Hutchins: 18:05

Talk about what you see next you know, in terms of the evidence that's you know

Dr. Bharat Tewarie: 18:09

Mm-hmm. Yes. Very good point.

Chris Hutchins: 18:10

clearly starting to build Here.

Dr. Bharat Tewarie: 18:12

Now it's very important to collect data when physicians are prescribing it, they see results and making sure that people hear about it, right? You do that at conferences. There was a conference in San Antonio just on Friday where we were highlighting actually the uses coming. So one was, for instance, three cases where An abnormal HelioLiver result prompted imaging, so that means you go and do MRI after ultrasound had not identified the lesion. So ultrasound was negative. When HelioLiver was done, that immediately the HelioLiver was positive, and then immediately you know made the doctors then actually go after, we need now to do MRI, right? So this is a case where cancer would have been missed if the people would only have stayed with ultrasound. Other cases presented, again, real-world cases where we are demonstrating the utility when sometimes imaging is not sure is it a yes or a no. It's called indeterminate. And HelioLiver is abnormal in those stages. So here it's where it's used as a tiebreaker almost, right? So here is where you try to solve the ambiguity when you do. The standard test today, ultrasound, and you don't get a good answer. Here is where HelioLiver can be a tiebreaker. Another case which was presented, again, real-world cases, is basically that since we are measuring methylation signal in the blood, we are measuring what's called abnormal cell-free DNA. We can measure these signals in the blood long before the image can see it. Right? Sometimes it's even six months before the image can see it. And we already

Chris Hutchins: 20:02

Wow.

Dr. Bharat Tewarie: 20:02

Have cases. They were presented, two cases where HelioLiver picked up the abnormal biological signal before even it had appeared on imaging. The last one that was presented, because a lot of doctors are very interested in the real-world use of it, right? Was a simulation study which was evaluating whether surveillance. When HelioLiver is being used, could increase the detection of tumor while they are still able to go for, you know, curative options, right? What's called early stage treatment category. And that definitely is there. And you know, all of this is only possible because the biology, the change in biology when you have liver cancer, when you have HCC, begins long before the tumor is large enough to be clearly visualized on imaging. And this is one of the quotes of the doctor, right, who's involved in this. And this is very important because it can give a clinician valuable lead time to identify a disease while the patient still is in the window for cure, right? And that's very

Chris Hutchins: 21:11

Right.

Dr. Bharat Tewarie: 21:12

Important. Yeah.

Chris Hutchins: 21:13

I'd say access and you know reimbursement are some of the areas where these kind of new diagnostics could get stuck. Share your vision with the audience in terms of what access is you see looking

Dr. Bharat Tewarie: 21:27

Mm-hmm.

Chris Hutchins: 21:28

Like once you get to full scale with HelioLiver and what do we need to change in the system to get us there?

Dr. Bharat Tewarie: 21:34

Well, what you need to change is the ability for a doctor who sees a patient at risk to prescribe surveillance. Just do it twice a year, every six months, let the patient come back. And the next one is then choose a surveillance methodology, which makes the patients come back, like a blood test can do, like HelioLiver, but also a methodology we can pick up cancer so early. Right, that you can still cure it. And the last one is this. In I mentioned this before, right? In rural America, we have a bigger issue when it comes to imaging, because in many places it's not even available. That's why Helio Genomics is a part of the rural health transformation collaborative, which Microsoft co-chair. Because you know, in that program, we are very much trying in those towns, well, ultrasound is sometimes hours away. And therefore, people do not go to let people actually get the blood draw and a clinic that they already use, because the blood draw is easier done, right? And therefore get access to a surveillance methodology when you are at high risk. Because if you are in rural areas, you should also be able to do that cancer at the stage that you can still do something about.

Chris Hutchins: 22:52

Right.

Dr. Bharat Tewarie: 22:53

And that's a big part of the access, right.

Chris Hutchins: 22:56

It shouldn't matter where you live. It shouldn't matter what

Dr. Bharat Tewarie: 22:58

Yes, exactly.

Chris Hutchins: 22:59

Your economics are.

Dr. Bharat Tewarie: 23:00

Well said. And you know in liver cancer, Chris, every week matters. So any delay when you're at risk for liver cancer actually should not be acceptable. Because every week matters, right?

Chris Hutchins: 23:12

Tell us about House Resolution fifteen ninety one and that the letter to Secretary Kennedy.

Dr. Bharat Tewarie: 23:18

Yeah, so you know, what we are actually trying to do is the following. A federal nod is not going to help find a single tumor, but what it does is it makes it harder for the system to forget these patients. And that's what it's all about, right? We already have spoken

Chris Hutchins: 23:34

Right.

Dr. Bharat Tewarie: 23:35

About this. Surveillance fails quietly. Ultrasound never gets ordered, or if it gets

Chris Hutchins: 23:40

Right.

Dr. Bharat Tewarie: 23:41

Ordered, it gets ordered once and then life gets in the way. And nobody is sending a letter when that happens. The only thing what happens is the cancer just shows up later at the time, that survival rate is very poor, and then you have end-of-life care. So, what we are trying to do actually is with HHS and people who pay for care that How can we build a way to find cancer earlier? And a few ordinary things need to change, right? You want a physician to order surveillance. Without it feels is a specialty favor. You want to make sure

Chris Hutchins: 24:19

Right.

Dr. Bharat Tewarie: 24:19

That if the test is positive, it means you are in a guideline, go and do confirmatory imaging, right? So you don't want the result sitting in an inbox and nothing happens with it. You want also a test, which in the end gets paid for. Because that's what decides whether a community clinic will keep doing it. Now, what happened is a while back, and this was at the beginning of the year, I sat in a briefing that the American Liver Foundation had put together on the Hill. This was not a Helio event, right? It's patients, advocates, member of Congress, the usual mix getting together. But what I did after being that meeting was quite inspired. And I kept coming back to the same thing I say to clinicians too. The disease is rising, and a lot of people do not know even that they are at risk.

Chris Hutchins: 25:10

Right.

Dr. Bharat Tewarie: 25:10

And The test that we already recommend is one they never get. So we have been, you know, we kept going at it. I kept going at it. Lo and behold, you have seen in the press release, right? Representative Don Bacon from Nebraska and Nydia Velázquez from New York are leading a House resolution to make. October 15, liver cancer awareness day. We were asked for input, and what we pushed for was pretty plain. It's not a logo on a post, right? What we want is prevention, which means knowing who is at risk. And then when you know who's at risk, surveillance and a test done while there is still a possibility to do something about it. Awareness only

Chris Hutchins: 25:54

Great.

Dr. Bharat Tewarie: 25:54

Matters, right? If somebody books a test. They may have been putting off forever, right? Yeah, and then of course, you know, access is a big part of that. Through this awareness, we also want to see if we can solve the access part in the in areas where, you know, surveillance is very difficult to do logistically.

Chris Hutchins: 26:14

What are you hoping comes out of these next few days?

Dr. Bharat Tewarie: 26:18

Yes, so clearly, doctors, hepatologists, GI specialists, primary care, when you see a patient at risk, right?

Ask yourself: 26:30

is this patient already on a surveillance? And if so, what surveillance is that? Right? Is that a surveillance that people will come back in six months and do? So get them into surveillance. Make sure everybody knows. That the positive result means imaging. And if you have a negative result, make sure that they come back. What I also would want basically is that those of us who listen to this podcast, if you or a parent has cirrhosis, ask where the surveillance is happening. If it's not, go and ask your doctor for it. Don't wait for a symptom. There usually is not a symptom related to liver cancer, right? It doesn't give you an early warning.

Chris Hutchins: 27:14

Maybe talk about what you've learned, you know, working with Representative Bacon's office and briefing HHS in the congressional offices about what moves federal attention on a disease like this. What do you need us to do to get behind this?

Dr. Bharat Tewarie: 27:29

Well, you know, it's become aware, be curious, ask questions, look around and ask yourself, do you know someone who has confirmed cirrhosis and or hepatitis B? Be curious if this is a family member or a loved one to then ask whether they are. You know, under any surveillance program. And if they are they going regularly back? Because the guidelines state you need to be under surveillance and tested every six months. Are they? Do they? And you know, there are now possibilities to help get a surveillance methodology which improves the ability for people to do it in an easy way, for instance a blood test like HelioLiver, go and ask for it. That's what it would say. It's all about awareness, right? There is nothing magic about it than being curious and asking for it.

Chris Hutchins: 28:21

So maybe we talk to some of the folks that are colleagues of yours that are doing, you know, GI, hepatology, primary care, health system leadership or you know, digital health investments. What do you want those people to know and how do we get them activated?

Dr. Bharat Tewarie: 28:38

Well, the first thing is this liver cancer, as I said before, almost never announces itself. And that's the tragedy of the disease. So you need therefore to find out who can get liver cancer. And these are people with cirrhosis and or hepatitis B. Make sure that those people do get into a surveillance program. And the next thing then is that if something comes out of the surveillance program, like if you use HelioLiver and it's negative, come back after six months because liver cancer again doesn't announce itself. It grows very fast. If you don't have it in January, you may have it in June. So keep going back to surveillance. And if it's positive, stay in the system. Go and get your MRI done. And now comes the magic. Liver cancer, when detected, when it's small, that's amazing because you can still do something about it. There are curative options on the table. Right?

Chris Hutchins: 29:36

Right.

Dr. Bharat Tewarie: 29:37

Resection, ablation, liver transplantation. Make sure, therefore, that you do surveillance so you can catch liver cancer in this stage, so that you can actually help the patients, your family member, your loved one, whoever you know, help. The people in the US who are at risk for liver cancer to help them

Chris Hutchins: 29:56

Right.

Dr. Bharat Tewarie: 29:57

Detect it at the stage that the doctor can still do something meaningful about that. And that's also what I would like in, you know, if somebody would ask me, you know, what do you want in 10 years? Liver cancer found small on a blood draw, people actually complete is phenomenal, right? Because you can still help those patients improve their survival rate. Imagine how many years of life you can give back if you detect it so early. This is what this is all about, right?

Chris Hutchins: 30:26

But maybe talk a little bit about on a personal level, what drew you to the early detection in solving that problem.

Dr. Bharat Tewarie: 30:35

You know, in a clinic years ago, the visit I still remember is not a dramatic one. It's just the person who felt fine and the scan that said that we're already late. And after enough of those experiences, right? Strategy doesn't come abstract anymore. You actually want, or I wanted, one sentence to retire. And you know what it is? That is we caught it too late. I have heard it so much as a physician.

Chris Hutchins: 31:04

Right.

Dr. Bharat Tewarie: 31:05

You don't want families hearing it when there is a blood test on the market now, where basically you can detect it at such a stage that you can really do something about it, right? And that's what I keep saying every week matters. Every week does matter when you have a cancer

Chris Hutchins: 31:22

Right.

Dr. Bharat Tewarie: 31:23

Which goes so fast, and today it can be detected early enough to do something meaningfully about it.

Chris Hutchins: 31:30

If you could talk to the you know founders or researchers who are building something in the early detection stage, is there something that you would tell them that you picked up during you know, your path in the evolution of HelioLiver that you wish someone had told you about earlier in your work.

Dr. Bharat Tewarie: 31:50

Mm-hmm. Yes. So be driven by the fact that one of the best ways to treat cancer is to catch it as early as possible. So let's find all those markers, all those biomarkers, which enable us to catch it as early as possible. And now comes it. Once you have it, you're not there. Then you just have it. Now you have to make sure. That you disseminate this in society. And for that, you have to build what I call the coalition of the willing, which means not only the doctors, the patients, the insurance companies, you also have to get people who are in a position to write laws and resolution, politicians, everybody behind it, because it matters to all of us, right? We can really do something about cancer if we all are doing our best to catch it. As early as possible.

Chris Hutchins: 32:49

Tewarie, this has been an enlightening conversation and I'm really I'm coming out of this excited. Thank you for the work that you're doing.

Dr. Bharat Tewarie: 32:59

And thanks so much for the invitation, right? And giving us the ability to have this phenomenal conversation with you so that other people can hear this also, right? And we together

Chris Hutchins: 33:09

Nice.

Dr. Bharat Tewarie: 33:10

Can take some action to get early detection

Chris Hutchins: 33:12

Yes.

Dr. Bharat Tewarie: 33:13

Right? Disseminate it everywhere.

Chris Hutchins: 33:14

Yeah, and for listeners, I'm gonna make sure that you've got all kinds of information on the show notes. There's just gonna be a quick turnaround because I want to make sure that you find the opportunity to communicate with your representatives over the next few days. You can be part of making something really important like this happen. So Please, when you find the information that we'll give to you, please go ahead and follow up on that and reach out. And if you are someone who's working in this space and you want to do something about it, you'll have a way to get in touch with Dr. Tewarie as well. So

Dr. Bharat Tewarie: 33:46

Absolutely, right? Yeah. What I will say at the end, Chris, is let's all try to retire. We caught it too late. Thank you so much.

Chris Hutchins: 33:55

Yes, thank you so much for coming on the show. For our listeners

Dr. Bharat Tewarie: 33:58

[Brief indistinct acknowledgment.]

Chris Hutchins: 33:59

Thank you so much for tuning in. And one last plug. Please check the show notes and make sure that you take some action on this one. This is why we're here. Take care and I'll talk to you again soon.