The Alarming New Risks of Cancer Everyone Needs to Hear

I'm joined by world renowned oncologist, Dr. Siddhartha Mukherjee. So we're seeing younger and younger people diagnosed with cancer. So you're getting a spike in cases, and you're getting a spike in deaths. So that is real. You cannot really, you can't turn your eyes away from that, that is a real number. Joining us now is actress Olivia Munn. You learned you had breast cancer at what age? 42. 42. It was then diagnosed with multifocal, multi-quadrant bilateral breast cancer. When Chad Bozeman died after colon cancer, the world was stunned. Yeah, Chad was 38 when he was diagnosed with stage three colon cancer. He was at an age where, normally, he wouldn't have even been getting a colonoscopy. You can live a healthy lifestyle. You can eat well. You can exercise what is going on. That it turns out there are lots and lots of sleeper cancer cells in everyone's body. The new theory, or one new theory, is that they need to be woken up. And the sleeping beauty wake-up potion is, at least one of them, is chronic inflammation. This is very new research. Hi, everybody. It's great to be with you here on the Oprah Podcast. And I am really glad that you joined us for this episode because we're talking about a health issue that I know has impacted every single family in the United States in some way or another. And all over the world, it's the word that makes your blood run cold if you ever hear a doctor say it to you or to anyone you love. It's the big C. It's cancer. And now, doctors and researchers are seeing an alarming rise in the rates of cancer, in younger adults, in their 20s, in their 30s, in their 40s. And I have experienced that within my own family and circle of loved ones. The question is, why is this happening? And what does this mean now for how we live and at what age should people start paying attention? So I'm joined by world-renowned oncologists. These world-famous and author of the Seminole Pulitzer Prize winning book on cancer, "The Emperor of All Malities." Dr. Sid Hart the Mukherjee. And I just welcome you. And so really, really, really excited that you would be willing to sit with us and talk about it. - It's my pleasure. - Yeah. I first want to talk about your book because as we were just talking before, it's an astonishing work. And the Emperor of All Malities, you all, as I just said, won the Pulitzer Prize. It spans 4,000 years through the history of cancer. And in the author's note, you say, this is a chronicle of an ancient disease. Once a clandestine whispered about illness that has metamorphosed into a lethal shapeshifting entity imbued with such penetrating metaphorical medical scientific and political potency that cancer is often described as the defining plague of our generation. So that's what you say in the author's notes. But it helped me, and if you have read it or will read it, it will help you understand cancer. And particularly, if you have somebody who's going through it, help you understand it not just as a disease, but as a story, one that is deeply human, deeply complex and still unfolding. So the idea for this book came from one of your patients. - It came from one of my patients. Cancer is my Moby Dick. I've hunted it for 20 years. I will spend my last breath hunting it. I have spent every waking moment of my life thinking about cancer and thinking about cancer patients. But this book boils down, comes down as sometimes say, Moby Dick began with a journey and a question. And this book begins with a journey and a question. And the question was a very simple one. I was a fellow in the hierarchy of cancer doctors. A fellow is pre-lowed down on the list. I was a fellow attending my patients. And I had a patient that I had developed a very warm relationship with, a woman who was dying, who had gone from trial to trial to trial, extended out her life possibly by three or four years. And then she turned to me one day, and she knew, and I knew that the end had come. And she turned to me, and she said to me, where did all of this come from and where am I going? Very simple question. And to my astonishment, I realized that there was no book or a show or a podcast or anything on the planet that would tell the full story. What is this going from? Yeah. Where did it come from? Where, how old is this disease? Where am I going and why am I here? And it would seem to be, this book is almost a kind of-- it's a dedicated to her, because she sort of set me off on this journey and the question. And the journey for yourself. That's right. And that's how cancer became my Moby Dick. But you devoted the book to the three-year-old boy, Robert Tendler? Yeah. Yes. Tell us why. Who died of leukemia in 1948? Stories don't live in abstractions. Stories live in real lives. They live in real people. And books on medical books, medical textbooks tend to be very abstract. They take away names of people. They remove all the human qualities of a book. So I was looking for a human being, a real person, to begin the book, or to pin the book down on. And I knew that there must have been a first child who received chemotherapy for, in this case, leukemia, children's leukemia. And I kept searching for that child. I kept looking for that child. Ultimately, after a very long and sort of security journey, which took me actually from the Dana Farber Cancer Institute in Boston, back to India, back again, I ultimately found the name of this child. The name was buried in a newspaper clipping, which was in microfiche. There was not searchable. You couldn't have found it anyway. So I found the name of this child. And then I went to the home of this child. I learned about the child's family. And his name was Robert Stanley. Robert Stanley. And that's how the book came about. Wow. So last year, you released a new edition with four new chapters title, The Emperor's New Journey. And you wrote that it felt urgent to update this book. Why? Well, lots of things have happened since the book first came out in 2010. And so 15 years had passed. And it seemed to me that it needed an update. Now, it's a funny thing. As you know, people don't tend to ever green their books. Like, you don't go back and write your book again. Yeah. But what was interesting is, you know, cancer-- you couldn't do that because things were-- history was being made as we live. So this was a lived history. And so I had to update it in order to capture what had happened since 2010. And so much had happened in prevention, in detection, and in treatment that I had to write, almost write, and addendum or a new set of chapters. Even in chemotherapies, because I'm going through this with a family member now. And one of the things I've learned is that what chemotherapy used to be compared to what it is now is so much more improved, yeah? It's vastly different. People have a visceral reaction to that word or to that word. Yeah. I'll be caught in the words. I'll be throwing up. I'll have a vomit basin next to me lose my hair. My body will shrink. That's not true today. I mean, of course, there's still some chemotherapies that we still use that are sort of chemotherapies of old and days. Yes. But there are lots more new therapies, where you don't have all these side effects. You still have some, but you don't have these severe side effects. There's a whole new word of therapy that has emerged even in the last 15 years. So one of the things that I really appreciated about the impromalities is, as I was saying to you before, is that it tells the story of cancer. But even in the very beginning, what it clarified for me, that cancer isn't just one thing. It's many diseases. And it really is an abhorrent cell. The cells gone awry. So can you just give us the most basic definition of what cancer is? Because when we hear the word, everybody just goes, you know, fearful. It's a disease in which the disease, typically, is a disease of a single cell that is no longer able to respond to signals that tell it to stop growing. So just to give you an example, when you cut your hand and you have a wound, the wound cells start growing back into the wound. And they stop growing. That's normal. In cancer, it is as if those wound cells never begin, never have the signal to stop growing. Genetic mutations in the cancer cells, mutations in genes, tell the cells, normally tell cells, when to start and stop growing. Genes make proteins, those proteins act as signals. Those signals tell a cell, now you're done. You should stop growing and go back to being a non-growing cell. In a cancer cells, genetic mutations make proteins that are no longer able to respond to these stop growth signals. Therefore, the cancer cell is unable to stop growing. And it keeps growing. And ultimately, it keeps making a large and larger masses. It can take over your bones, take over your blood, take over other parts of your body, and even metastasize at migrates and starts growing in places where it should normally not be growing. I mean, why should a breast cell be growing the best cancer cell be growing in the bone. It's because it's co-opted, it's co-opted, it's environment, and made it an environment where you can actually start growing again in the case of a breast cancer cell inside bone. So it's a cell goner-y? It's a cell goner-y in multiple different ways, not just in the basic way that I said, well, you know, it can't stop growing. It's also goner-y because it's hijacked other parts or other signals from the cell, which enable it to move, to fantasize, to colonize other organs, to live in other places. It's all of that. A cell that's goner-y with this massive hijacking. Okay. The American Cancer Society found that I think I read the cancer incidents rates in women under 50 are now 82% higher than males. And you've said that the incidence of collectible cancer in young men in the United States has nearly doubled since 1995. What is going on? So it's very important, you're asking a very important question. This is this very particular to young men and women. So I'll give you three examples, and there are three concrete examples. Okay. The first one is colorectal cancer, cancer of the colon and rectum. So basically, in the lower bowels, colorectal cancer incidence has increased dramatically in young men and women. And it's colorectal cancer mortality, which is a statistic that never lies. colorectal cancer mortality in young men and women has increased dramatically as well. I'll come through the why in a second. But that's a clear signal that that's not just early diagnosis or early detection. Okay. Because early diagnosis. That was going to be my question. Is it that we're just getting diagnosed and detecting it sooner? That's not true. So that's not true, because if it was just early detection or early diagnosis, then you wouldn't have that. You wouldn't have the fact, usually, in statistical terms, you wouldn't have an increase in actual mortality. So it's a statistical, you know, when you have an early detection, you can get a spike in cases. But you don't necessarily get a spike in mortality. Yeah. But in this case, you're getting. So colorectal cancer, you're getting a spike in cases and you're getting a spike in deaths. So that is real. You cannot really. You can't turn your eyes away from that. That is a real number. I'll give you a second example, breast cancer in young women. So breast cancer mortality in young women was slowly coming down year after year after year. But for the past few years, it's being plateauing. Which means that something is happening such that the kinds of breast cancer that we're getting in these young women is either causing more mortality or is generally more aggressive. And we know both of these three two. And once again, it's not because of early detection. Number one, because most of these women are not being caught by mammography. They're not. No, they're detecting it often themselves. And number two, as I said, statistics don't lie. They're not being caught by mammography because they haven't even started the mammograms. That's right. They haven't been started the mammograms. So they are detecting by themselves, often coming to their doctors because of having detected it. And secondly, as statistics don't lie, and it's being reflected by the slower curve or slowing down of the gains that we've had in the past decades. I'll give you one last example. And that's also relevant. And that is endometrial cancer. So endometrial cancer, also in women and particularly in young women, has been rising in cases. Endometrial cancer, we don't usually have a detection for, we don't have any test for. It's usually when people come with bleeding or pain. That has been rising, so that's not an early detection problem. And thus far, usually endometrial cancer early stages is quite curable, so it's not been reflected in increase in mortality, but it may soon be reflected at some point of time in increase in mortality. So you have three different cancers with three different patterns, colorectal cancer, increase in incidence, increase in mortality, breast cancer, increase in incidence, particularly of the aggressive kinds, and it plateauing, or slowing down of gains in mortality, and endometrial cancer, increase in incidence, and no increase in mortality at all we'll see. So you can live a healthy lifestyle, you can eat well, you can exercise, you can get enough sleep, you can do all the things, I know people who have done this, they don't smoke and they don't drink excessively. And then it feels like, you know, you're 38 and it comes out of nowhere. So how much of this early onset is driven by what is inherited or by something in the environment, or do we know? So the sad story is that we don't know what we're getting to know. Okay. So virtually all cancers have some component in which, as I said, they're all genetic diseases, ultimately, but many cancers have a component of off the environment in it. So it's a genes plus environment phenomenon. So the problem is, when we talk about the environment, we talk relatively poorly about the environment. So you just said what you eat, what you do, what exercise and other things. But your real environment is much more complex. It is the things that you're exposed to as a child. It is things that are in your gut, the call microbiome that's in your gut. It is things that you eat, but you may not know that you are being exposed to because you might be thinking that you're eating a very healthy diet, but some aspect of your diet might be the problem. And finally, all the things that you're exposed to, the so-called exposed home. So again, there is that external environment, there is your genes, and there's one piece that is critically missing here. And that is your internal environment. The environment which actually bays your cells, your body, with whatever it glades it in. And one very major part of that that we've discovered is the inflammation in the internal environment. Oh, that's what I was going to ask. There's growing conversation around chronic inflammation as a root of many diseases. What does that mean actually when you have inflammation? So how does it connect to cancer? So inflammation is a sort of a bucket word. It means many things, it means different things to different people. You come and say, "Oh my god, my left cheek is inflamed because it's burning." Other people might say, "I have chronic inflammation." In fact, that's. If you have chronic inflammation, do you even know you have chronic inflammation? No, often you don't know that you have chronic inflammation. So just a great example of that is asbestos workers. I'll give you a historical example. Yeah. Asbestos workers were exposed to little particles of asbestos and they started having inflammation in their lung. It wasn't until much later when they started having cough and all these other symptoms. That's lung symptoms, that they realize that they had chronic inflammation in the lungs. Right. The point that I'm trying to make is that there are many different kinds of inflammation. Just like there are many different kinds of cancer. The inflammation means it's a chronic or acute activation of the immune system. Okay. And the immune system gets chronicly or acutely activated and it starts sending signals. Some people describe it as it's as if your immune system is saying your body's on fire. There's a kind of inflammation which is brought on by certain kinds of immune cells. Not every immune cell is the same. There's another kind of inflammation that's brought on by other kinds of immune cells. And so far, yeah. So far, we've been able to track down cancer risk to one kind of inflammation. Not all kinds of inflammation to one kind of inflammation. That's a very big advance because you could now ask the question if I can track that inflammation in your body. If I can make a test for that particular kind of inflammation in your body, can I make a potential test for future cancer? Hmm. You write research suggests that healthy people may have a cadre of potentially cancerous clones sleeping assassins. So I'm asking, is there a possibility that the part of what we're seeing is simply that cancer because it's rooted in our own cells is going to always find a new way to show itself? So this was another surprise from work done by many people, but really recent work. The surprise was people thought, oh, you know, cancer cells grew up. Got the mutations that acquired, you know, hijacked or commandeered the, it's genes and off it went. Yeah. It turns out that it's a little bit more complicated than that and a little more chilling than that. Yeah. Which is that it turns out there are lots and lots of sleeper cancer cells in everyone's body. I'm going to repeat that. There are lots and lots of sleeper cancer cells in everyone's body and they're just asleep. They're just dormant. Okay. So by the time the cancer shows up, it's been sleeping there for how long? We don't know, but it's sleeping there for a while. But we think that it needs something to wake up. Wow. An inflammation, chronic inflammation. We're realizing more and more is one of those sleeping beauty signals. So say that again. We all are carrying the sleeper cells. We're all carrying sleeper cells in various organs. But they're dormant. They're asleep. They'll probably do nothing to you for the rest of your life. The new theory or one new theory is that they need to be woken up. And the sleeping beauty wake up potion is at least one of them is chronic inflammation. It has to be validated over and over again. But it really changes the paradigm. It says, you know, it's not as if you had one morning you woke up. I'm sorry, someone woke up. I hope it's no one here, but someone woke up. And a cancer cell started having genetic mutations and off it went and became the tumor that the nasty tumor became. That would be one theory. Another theory is, actually, the morning that the night that we were asleep, there were thousands of dormant cancer cells sitting in your body. And something happened, in this case, what I call the sleeping beauty kiss, something happened that woke them up. And in this case, we're realizing that that one something is chronic inflammation. That's big. It is very big. It is a new theory, has to be tested, but it really changes the way we think about cancer. That's why I had to write the whole new chapter on it. Yeah. I see. I see. Yeah. Because it really switches around the way you think about cancer, or how that thought about cancer. I said, new theory, lots to be tested in it, but it is a powerful theory. That that inflammation is the kiss that wakes it up. Yes. And that's why now there are so many people talking about reducing your inflammation. That is why. And if we could test the particular kind of inflammation, it's not again, all kinds of inflammation, but if we test that particular kind of inflammation, we would have a biomarker, we would have a marker for future cancer and potentially even prevent it, potentially by stopping that inflammation. Do you think we will find a prevention in your lifetime? I think we will find a prevention my lifetime. Yes, it may not work 100%. Yeah. As I said, it is my moby dead. I will. I was going to get you going. You and Moby are going to be at it at it. So breast cancer, as many of you know, is one of the most common cancers in women across the world. It's now rising faster in women under 50 than in older women and younger patients are being denied knows with more aggressive forms of as we've been talking about. So joining us now is actress and activist wife and mother of two Olivia Munn. Welcome Olivia. Great to have you here. And thank you for zooming in. 42. 42. What happened? So I had been doing everything I was supposed to do. The mammograms, the ultrasound, I have dense breast. And also I think it's important for people to understand what dense breast means because we hear these terms a lot and don't really connect with it. So dense breast is when you like, it's like when you look at the sky and you see clouds and you see blue sky. Well, when you do a mammogram and you have dense breast, your tissue and your tumors all look like clouds. But when you have dense breast, you get an MRI or an ultrasound. It's a blue sky and then there's like one cloud and that's your tumor. So I was getting my mammograms done in my ultrasounds and I was cleared and I had genetic testing done as well just to be proactive. And my doctor said there's something called a lifetime risk assessment test and it gives you a score that tells you how likely you are to have breast cancer in your lifetime and anything above 20% is considered high risk. And it's like a few minutes, it's online, it's free. And I came back at 37.3%. So I went to get an MRI and after that MRI was off to the races, I was then diagnosed with multifocal, multi quadrant, bilateral breast cancer. Yeah, because it's a touching story. Wow. And you've had multiple surgeries. Tell us about that and how you're doing today. So along with the stuff that you do before DelMestectomy, like a lymph node dissection and Nipple Delay, I had a DelMestectomy and I also had my ovaries and my foloping tubes and my uterus removed as well. There's this, when you have a hormone positive breast cancer, like in minus ER positive, PR positive. Why would you have ovaries removed because I didn't have anything to do with your breasts? Exactly. So there's a medication called lupron that I had to take in that. Medication suppresses the estrogen production in my ovaries and it was debilitating. It was a shot every month and I had, my son had just turned one when I was diagnosed and I couldn't get out of bed. It was actually debilitating. I would get up, I would go get something to drink and I would just come right back to bed. I was probably out of bed maybe a total of 45 minutes for an entire day. And this went on for months and I just had to figure out a solution. So I said, "Can I just get an ophrectomy and have them removed?" And then when I was doing that, I said, "You know what? I don't want to have to worry about cancer coming into other places. Can we just go ahead and take out my foloping tubes and my uterus?" So we did that all just to be preventative and to help me get off of this medication. But there's also this other medication that I have to be on called an aromatase inhibitor. And that suppresses the testosterone in my body that turns into an estrogen that could feed my cancer. And you asked how I'm doing the day and I've always really maintained a positive outlook when I was talking about this. I think it was so important for me when I was talking about it publicly to come with a lot of hope. Also be very realistic and honest about the tough times. But there's so much hope in this journey because people are doing all this research and I have the ability to fight. I've been given the chance to fight where so many women in my position were told to get their fares in order. So I wanted to be really hopeful. In the middle of all of this, you stopped the cancer treatment to do in vitro fertilization and egg retrieval. So I had frozen my eggs in my thirties and we wanted to have another child. And so it was, I was diagnosed with breast cancer. And the next day we had already planned to turn those eggs into embryos. And my husband was like, what do we do? What do we do? And I said, I don't know what's going to happen to me. So just go, I don't even know because when you freeze your eggs, you don't know until they're turned into embryos if any of them work out. So I said, just go and just try to make the embryos and we'll deal with it later. And we were able to get a small amount of embryos but in order to ensure that we could have another baby, I said, I think I need to go and do more, do another round and get more eggs out. And so I spoke with my fertility doctor and he said, we're going to put you on to a breast cancer protocol. And that means that's a lot less hormones. And I was putting myself at risk. And my fertility doctor, he's like, you know, we're just going to get you like just a couple more and then we're calling it. And it was just a, it was a calculator risk that I just felt I had to take. And my baby girl, Mame, it's 19 months and she's in the world because of that risk I took and when I would do it all over again, just to have her. What do you want other women to know? Because 42's scary. I want other women to know first and foremost that the lifetime risk assessment test is something that is free and it's online and it saved my life. And I think that every woman should know what it is. Something that every doctor takes for their, their patients that when you go in, they ask for your blood pressure and your family history, but they don't ask what your lifetime risk assessment score is. So we're working on legislation that will help make the standard of care for every doctor to also know that information. I think you've already done such a great job. They saw an increase in people taking that task after you told your story. And I'm sure it's going to go up even more now that you're sharing your story. Thank you for for helping to get out this message because that's the, I mean, as you know more than anyone, it's just like continuing conversation over and over the awareness that just has to keep going, which is why we want the owners to come off of women some to to know about this test and put it onto doctors to to be there in those offices and educate the patients about it. Yeah. So you sharing your story has already done so much for women. I thank you for that. Thank you. Thank you. Take good care. Thank you. Yeah. So more and more women, 30s, 40s are experiencing much of what you talked about. Absolutely. And as you can imagine, I mean, these are often, you know, young women with families. They have children to think about. They have future fertility to think about as Ms. Mundead. And so the decision becomes not just, you know, about yourself. It becomes about your family. So what are the current recommendations for breast cancer? I've been taking a mammogram now since I was 40 doing screenings. But if women in their 30s are big, I also have a family member who at 36, you know, developed breast cancer and wasn't, wasn't even through a mammogram just just through doing her own breast test. So what should be happening? Should we be screening earlier? Well, so the problem with mammograms is that the yield to discover a real cancer is very low, especially in young women. And that's complicated, of course, by women who have young breasts. By yield, I mean, there's a number, which is how many mammograms you need to need to take in order to save one breast cancer life. And you said, complicated by women who have dense breasts. Dense breast. Okay. Dense. Olivia talked a little bit about that. But leaving aside the question of dense breasts, which is particularly the case with young women, the yield in the mammogram is very low, especially in that group. And so doing mammograms early or doing more mammograms will inevitably yield lots and lots of false positive, lots more biopsies, lots more anxiety. And, you know, it'll obviously yield a few, a few real cases of breast cancer. So what I've been recommending is very much on the lines of what Olivia did, which is to say, if you're, first of all, if you're a young woman and if you have any history of breast cancer, of ovarian cancer, of pancreatic cancer, you should go and see a physician to potentially look at, to do some genetic cancer to see if you're at a genetic risk for breast cancer. And those are people who have, you know, will pick up people with so-called BRCA1, BRCA1, BRCA2 mutations among other things. Number two is that there is actually a genetic test. If you have a family history of breast cancer or of any of these cancers, there is a genetic test that even if you are not BRCA1 or BRCA2 positive, it will give you a score of the risk that you have genetic risk for breast cancer. It's a score. It's called a polygenic risk score. Again, it's not perfect. But if women who do have a polygenic risk scores, I'm, if they do have one, it's certainly if they have BRCA1, BRCA2 and some of these other breast cancer genes, I'm recommending them to enroll in a trial with intensive screening. There are many around some of them use a combination of MRI and mammograms, sort of alternatively. Some of them are MRI only. What I'm really hoping for is that there is a test that will come along, which won't be as invasive and will not have as many false positives as a mammogram that we can use that as a potential way to screen these younger women. OK. So when Chadwick Boseman, the actor who played the Black Panther died after a private battle with colon cancer, the world was stunned. Chadwick was just 43. And his wife, Simone Boseman, was by his side until the end. Simone, thank you for joining us. We were also stunned. And you all were able to manage to keep that private. And I read that his symptoms began just weeks before his diagnosis in 2016. What was going on? Yeah. Well, first, thank you for having me. Thank you. Chad was 38 when he was diagnosed. And he was diagnosed at stage three. So just before that, he had already been to the doctor a few times before I even found out about it. And essentially, he was just having trouble going to the bathroom. First, the frequency changed, and then it really slowed down altogether and stopped altogether, which just impacted his ability to move and operate and eat. He was on a really strict exercise regimen. So it was affecting him quite a bit. And there were maybe three or four weeks in between our first visit to the doctor together and him being diagnosed with stage three colon cancer. And so once you both found out, did he go into chemotherapy, what was the procedure for helping him? Yeah, there was chemo. There were surgeries, a few different rounds of chemo and a few different types of chemotherapy to see what worked on his particular type of colon cancer. And there was also Eastern medicine that we involved. We were doing all the research we could and trying all of the avenues that we could to get his immune system to fight the effects of the chemo as well. By the time you're stage three, though, what does that actually mean, Dr. McCurgeon? So it means the cancer has spread beyond-- certainly spread beyond the original local site. It's gone through the bowel wall. And in many cases, depending on what kind of cancer has started invading the lymph nodes. So it's called advanced cancer in the case of colorectal cancer. Now, astonishingly, I mean, I'm so sorry that you had to go through all of this. And the world is very sorry for it, I think. Stonitionally, immunological therapy still works in some cases. I'm sorry, didn't work in this particular case, but it really works. I mean, this is an incredibly important conversation we're having, because cases like this remind us that we have got to do better. We have just got to do better. And if we don't do better in diagnosis and in treatment, then shame on us. Yeah. And he was at an age where normally-- I mean, he wouldn't have even been getting a colonoscopy. No. I have a friend who's 42 who's going through this, also stage three, and also had to make up a story about it being in his family in order to even allow them to test him. They weren't going to test him. The doctor said, you know, you're too young. It's probably just stomach ache or whatever. Big misconception, by the way. What is the big misconception? The misconception is that, you know, we're saying we know the rise of colorectal cancer incidents and death in young men. So no doctor, if you come with abdominal-- lower abdominal pain or abdominal pain, should be saying to you, oh, it's just, you know, something you ate. Yeah, that's not the standard anymore. I know that caretaking is one of the most demanding jobs. And you were there by his side till the end. What is your advice to those who are supporting loved ones with cancer some own? Just love your way through it. It's going to be stressful. It's going to be overwhelming. But let the good times be good. And do as much research as you can. Try as many things as you can really leave no stone unturned because the guilt of grief is almost an impossible thing to deal with even when you do try all of the things. If you have even an inkling that something might have any kind of effect on your loved one's situation, you should try it. And you should push them to try things as well. I was interested in you were talking about the guilt of grief. Are you still carrying that? Are you still thinking that there was something else you could have done or should have done or might have done? I think I will always wonder if there were things we could have should have done. I think that's a reality of losing someone. You'll always wonder whether it's from cancer or from anything else. Could I have talked to them? Could I have kept them in the house for five more minutes and they didn't get in that car accident? Anything is going to come into your mind. And I think it's also survivor's guilt. I think for the first several years, I could not make sense of why I was still here and he was not when he was just such an incredible extraordinary spirit and person. And the edges are less sharp now, but they are still here. Yeah, and you know what? I was just thinking too. And I don't know four people in my immediate family and friends who are going through one form or another of cancer right now. And we know about it. We the family know about it. Other people know about it. I think it's even doubly hard when you have to keep it a secret or you have to not let other people know. So that adds to the stress because he was working and correctly so. If everybody knew he had cancer, there would have been a completely different reaction on set and all the other things. And so how absolutely courageous of him and of you to go through that when you're getting cancer treatment, it's just unimaginable. I just wanted to add an incredibly brave of you and to share this journey. You know, I think about the guilt of grief a lot. It really rests. The guilt of grief is something that resonates with many, many families. And I always return to the very famous quartet of things that patients want to do when they're facing death, which is to say to someone that they love them, to be told that they're loved, to say to someone that they forgive them and to be told that they're forgiven. And I can tell you for sure the way you took care of him, Simone, I'm sure that you received all for. So I hope that helps with you with your guilt of grief. Thank you. Thank you. And you say he was your greatest spiritual teacher. Tell us why. Oh, man, he was. Credit to my mother. She gave me my foundation for my own spirituality. But Chad, he was someone who did not just believe in spirituality, but he really lived it. And he showed me discernment. And he showed me what the feeling of truth was, what it means. How to understand when I know something that is right or good and when I know that it is not good, and when I know that I don't know. And then how to go to God and ask for guidance and most importantly, to be able to listen and wait for God to answer. And those are principles that I learned from him that I'll carry with me for the rest of my life. Well, it sounds like he was truly the Black Panther. He truly, with truly, truly what? It sounds like he was truly the Black Panther, really. Thank you. Thank you so much. Thank you. Thank you. So what can people do? Is there anything, first of all, what you just said, if you are under 50 years old and you go to your doctor complaining of stomach pain, rectal pain, and the doctor says it's just a stomach ache, you should fight like hell to get the test. Why did you get a different doctor? You should get a different doctor. Yes. So because you just said, doctors know that this is happening. This is a well-known phenomenon. It is published in national statistics everywhere around the United States. That you don't have to wait till you're 50 anymore. There's no reason to wait if you have symptoms. If you have symptoms. Yes. There is absolutely no. it doesn't matter. It's like saying, "My car is broken. I'm going to wait until the next 10 years to fix your car." -Yeah. -This doesn't make any sense. -Yeah. -So, yes. So, uterine cancer, I understand, is the most common cancer for female reproductive organs. And one young woman named Eve was recently diagnosed and shared her story on social media. Watch this. -My name's Eve. I'm 28 years old in an October of 2025. I was diagnosed with stage 4 endometrial adenocursinoma that has metastasized to other parts of my body. And the reason for this video is because I am starting a series to kind of talk about the symptoms that I had leading into this diagnosis. I've had tons and tons of women reach out to me via social media, asking, "How did you know? What did you do to find out? What are you doing now? I'm so scared." And the last thing that I want is for this circumstance that I'm walking through to cause fear and anxiety and other people. I remember before this diagnosis came out to lie the anxiety and the fear that I had just leading up to this moment was absolutely crippling. And I would never wish that upon anybody. -And he was joining us now from Texas. Hi, Eve. Hi. -Hi. How are you? -How are you? -How are you? -I'm good. Thank you. I heard you were dealing with symptoms for years, but you were dismissed by doctors. And what were those symptoms? Those symptoms were prolonged uterine bleeding. So I was having bleeding at that point for about three years now. I also was having urinary incontinence. And then the other one was extreme pelvic pain, which all of these, when I did present them to my gynecologist at the time, was dismissed and labeled as just PCOS, which is what I was diagnosed with over 10 years ago. -Interesting. Apologize on. -Your doctor should have known. You know, it's interesting that the three cases that I picked were colorectal cancer, breast cancer, and ametial cancer, because this is known. This is established. It's known. And so a young woman, particularly with PCOS, the syndrome that she has, who comes in with vaginal bleeding, pelvic pain, et cetera, needs to have a. -Your PCOS stands for what? -Policistic ovarian syndrome. Well, you can tell us more about it than I can, but this is well known. And you know, the sad, sad story about all of this is that if you catch endometrial cancer early in its first stages, it is highly curable. It is very, very, very curable. And so the idea is that as soon as someone comes in, particularly with this kind of history, with pelvic pain, et cetera, et cetera, they need to be assessed to see if they have endometrial cancer. I would say that the only piece of good news is that these cancers have become over time more and more. We've gotten more and more better and better therapies, chemotherapy, some of them. I can tell that you're probably on one of those chemotherapies already, but also their second line and third line therapies. So there's a lot of progress and treatment. But this is a case that should not have happened. Eve, so what did Dr. Seng is your prognosis right now? Right now, my prognosis is less than two years. And that changed over a span of, I want to say, four months. Initially, when we first found out about the cancer, I was given about five years. And the reason why there was such a long delay was because insurance companies weren't wanting to cover for treatment. So that played a big role, and by that time, the cancer, which was already stage four, grade three, it had already metastasized even more. And we actually found out about this after four years of infertility. So that was really hard to hear. But the prognosis, as I've been praying over myself, is not a promise. And so, even though I'm given less than two years, I'm going to live and believe that God still has more for me and that I'm here right now, it's for a reason. Absolutely. And one of those reasons is you wanted to share with other young women what you wanted them to know. And what is it you want them to know? I want them to know that it is extremely, extremely important to truly advocate for yourself. And like, like we just said, if one doctor is not listening to you, you have to push and find another one. Even if you go through 10 doctors, you have to find one until they finally sit down and hear what you have to say. Because I didn't do that. And I do feel like how did I spoke up earlier before I even knew that I had cancer? I wouldn't be in the situation today. So tell me this, Eve, every time you were told that you shouldn't be that concerned about it, was a part of you relieved. Because I think a lot of people, when their doctors say, let's keep an eye on it or let's watch it, which I don't believe in, let's keep an eye on it. I believe in, let's look at it right now. But when your doctors say that, there's a sort of a sense of relief that maybe it's not as bad as I thought, and therefore you buy into that. Is that what you did? It was actually not relieving for me at all, because I always kind of knew in my subconscious that something was wrong. I actually worked in women's health for a little over eight years. And so I talked to women who had these same symptoms. And every time I would bring them up, my doctor actually said, if you were a few years older, then I'd be concerned for cancer. But because you, at the time, I was 25 or 25 years old, it didn't cause any alarm. And so I do feel like, and it was always per a cog guidelines, per a cog guidelines. And I really would like for a cog guidelines to be updated at this point, because after posting about this on social media, it turns out that there are quite a lot of women, younger than me, that do you have very advanced stages of uterine cancer? So your advice would be, when you think something's wrong, as, you know, we've heard from Dr. McGurgey earlier, if the doctor says, no, you go find another doctor if you think something's really wrong. It's interesting to you. Because do our bodies tell us? Well, in this case, her body was telling her the full story, actually. Her body was telling her that she had risk factors. Her body was telling her that she was having pelvic pain, that she was having vaginal bleeding, that she was having, I think you said, you stopped your periods, you were having infertility. I mean, your body was telling you, your body was not telling you something. Your body was screaming from the rooftops. So I'm sorry. As I said, it's hard for me to put myself in every physician's shoes, but these are known facts. These are just, you know, there's something very well known about all of this. Eve, thank you so much for being courageous enough to share your journey with us. Thank you. Thank you. You know what? Someone is watching or listening right now who has had one or more of those symptoms, who's looked the other way. And because of you today, they won't. They will follow through. I believe that is true. Thank you so much. Thank you so much. Thank you. Thank you for sharing. So you're talking the book about all the various kinds of cancers. Is there one cancer when you hear that cancer that all doctors go on the alert? Well, the typical answer to that question is pancreatic cancer. Yes. And doctors go on the alert. But as you know, as of very recently, for the first time in human history, there was one medicine that changed the-- that in a randomized controlled trial. So in other words, in a fair statistically clean way, showed that it would increase the lifespan of patients with advanced pancreatic cancer. Now, the increase was from six months to 13 months, and you could say, who cares? But that's not the way to think about it. The way I think about cancer, all cancer, is it's like climbing a mountain. And the first cramp on you put into the mountain is very crucial, because it's going to hold up the whole journey upwards. And in this case, the first cramp on has been planted. From here on, we'll know how does it become resistant? Can we make another medicine? Can we combine it with a third medicine? And so for sure, that's that. And then, of course, my personal ennemesis has been acute myeloid leukemia, AML, which I've treated for many years, and still, Tatiana Schlossberg, who is very moving, since she died of AML, that same disease a few months ago. You write this on page 473. About the time you met with your book editor, you said, I sat in the editor's waiting room high above 6/7 and were looking outside. It was one of those magical New York afternoons. When the ballmenus in the air becomes intoxicating, and crowded gather on the streets, but I was a trainee in oncology in Boston, and all I could see was a landscape of future grief and anxiety. The woman laughing breezyly by the bakery might be diagnosed with cancer, ovarian or breast. In a few years, I imagine the man smoking a cigarette with evident pleasure in a hospital gown as he went for a long CT scan. The lenses with which I saw the world had forever been changed, you wrote. So my question is, how do you personally cope with the immersing of yourself with people fighting every day for their lives, and you don't know if you can save them? How have you managed to do that? What people say? that the way to manage to do that is by moving yourself a way to distance yourself from the fight. I think it's just complete nonsense. I think the way you survive being an oncologist, the way you survive, many of these intense professions that make deep demands of you is to lean in instead of leaning out. And by leaning in, I mean, you make that person's grief, your grief, you make that person's fight your fight, you make every fight your fight, and eventually if that explodes, it explodes, but you can't, you can't survive by leaning out, because that will always come back to haunt you. The only way you can survive is by leaning in. Well, what you described feels to me is the difference between having a good doctor and having a great doctor. Yeah. Yeah. And, you know, having people in my family going through it now, I mean, I see the difference between people who are really leaning in and the people who you're just another patient. Yeah. Yeah. Yeah. So, what is the future? It's like what that woman who started this whole book for you? What is the future? What do you see for where we're headed with cancer in the future? Will it be eradicated or is that just a pipe dream we're all having for ourselves? Well, I can tell you what I'm doing, you know, in some ways I think of myself in my own journey or fight against cancer as an as an opportunist. In other words, if new technology comes along and I can push it to use in cancer, I'll bring it along and make it useful for cancer. Has AI been helpful? AI is the single most revolutionary technology of our generation. And if we're not using it for cancer, we're losing the plot. So, in other words, people have all sorts of paranoias and fears about AI. They're worried about, you know, job loss and, you know, fake news and so forth. I think everything everybody agrees on is an AI optimist. And I think if there is one use case of AI that is optimistic, it's medicine. Medicine, yes. And I thought it a new effort company called Manus AI. Manus comes from the Sanskrit word for brain or mind. So, the idea is to turn the mind of AI to make new cancer medicines. Cheaply, better, more efficiently and superior medicines. And the way we do that is by is, you know, you can't go into Claude or, you know, Gemini and say, find me a medicine for breast cancer and out pops an answer. What you have to do is you have to go and teach it the basic rules of medicinal chemistry, physics and to some extent biology, but basic rules of medicinal chemistry to teach it how to build a medicine, just like humans build medicines. Humans don't build medicines by going into Claude code and writing a code for medicines. They make it molecule by molecule. They figure out what the what the targets are. They validate those targets. And then they build a medicine by stitching together, literally stitching together a molecule in space that can either, you know, jam a lock in a key in a cancer relevant target. So, that's what we're doing in Manus. We have taught the algorithm. The algorithm actually knows more medicinal chemistry than I do. And it speaks to us. It speaks back to us by producing, this is the funny thing about it, it speaks the language of medicinal chemistry. So, if you give it a potential target or a query, it will start generating not one, not two, not three, but series of medicines that it's been built using the laws of chemistry and physics, these constraints. And then, of course, we have to test them in real life and then feed that information back to AI and say, yes, you're wrong there, you're right there, you're wrong there. And that's called reinforcement learning. You learn. And I think that is the capacity to really change the game. We used to build medicines one at a time using human medicinal chemists. That's not good enough. We need to do better. So, we're making medicines many at a time using AI medicinal chemistry. Well, one of our guests today spoke of, you know, leaning in and also keeping a positive attitude, I think Olivia was talking about that, keeping in a positive attitude through the whole process. Have you found that the way a patient approaches their cancer diagnosis affects the outcome or not? Not in a simple way you think. I mean, I think the problem with, I mean, I applaud people who have incredibly positive attitudes through their cancers. I think it's wonderful, but it also, unfortunately, creates a kind of prison cell of optimism for patients who don't have a positive attitude. That's right. You may be suffering from terrible grief because, you know, you're worried about leaving your children behind and should you be blamed for that? No, you should be, you know, I do think that attitude makes a difference in terms of your capacity to cope with cancer. You know, it's something that brings you to the hospital day after day, night after night. I talk about Carla in my book and I, at one point, I wonder, you know, what, I was in traffic. I was going to her home one day and I said, what is it that brought her night after day after day, night after night to the hospital in this boiling traffic, you know, sitting. So a positive attitude, I think, you know, can become its own stigma. You have to have a positive attitude. You know, you've got to be, you've got to think positive, you've got to think better. I think that can become its own stigma. Some people are, you know, drenched with grief, but to them, I generally say, I understand. I understand you to have full right to be drenched with grief. I would be too. It would not be. But on the other hand, let me make sure that that, that you being immersed in sorrow and grief and anxiety does not prevent you from getting the medical care that you need. Right. That's the difference in the question about positive attitude. And is there anything we should be doing or, you know, adapting the way we live and eat and move and exercise to improve the, you know, inevitability of those sleeper cells being awakened? Well, there are small ways. I think I wish I could give you big ways. Yeah. But the small ways that are certainly, you know, I think that I'll give you a couple of associations that I think I think are alarming. I think there is a growing relationship between forever plastics and inflammation that I find alarming. So I don't, it's not been proven out yet, but there's enough. There's, there's the beginning of a smoking gun there. Obviously, obesity has been now connected with many kinds of cancer, including most importantly, endometrial cancer, cancer related to obesity. So, so, you know, forever plastics. So, yeah, forever plastics, you know, the standard things as best as, of course, you know, same inflammatory pathway, obesity and diet, appropriate risk assessment. So in other words, really think about, think through, if you are at high risk, you need to be seeing a different kind of doctor in terms of your risk for cancer. And, you know, in terms of diet, we've now known forever that diets that are that diets that are diverse and that actually are rich in fiber. Yeah. The better terrain in diet. I are much, much lower risk of colorectal cancer. So, I, you know, generally speaking, I always advise for all of this. On the end of there's some cancer that are caused by viruses, human papilloma virus, for instance, causes cervical cancer. The incidence of cervical cancer in patients who get the HPV vaccine women who get the HP vaccine is zero. So, in other words, it completely eliminates. There should be no cervical cancer left in the world. So, get the vaccines that are relevant. And those are the, you know, those are the very broad recommendations. I think as we explore the sole issue of chronic inflammation, we'll find more things that potentially cause chronic inflammation, we'll find things that are markers of chronic inflammation. That would be a big day. Cause that will mean that we can start, it's just, it'll be, it'll be like finding a cholesterol for cancer as in cholesterol for heart disease and chronic inflammation for cancer. It'll be, it'll be, that'll be a big day because we will then be able to say, I think that you have a heightened risk for cancer because there's chronic inflammation going on in the body. Let me try to see how I can help and figure out, you know, how to balance that, how to decrease that and potentially look for cancers. So, all these things we see on the market for anti-inflammatory, causing any, none of that means anything. No, they're usually not even attacking the right kind of inflammation. You know, the, the anti-inflammatory. That's just commercial marketing. Yeah. That's, that's the low fat of this era. That is the low fat of this era. Yeah, low fat of this era. Yeah. So, what keeps you up at night? What keeps you up at night is hope. I'm an, I'm, I'm a born optimist. I live, I eat off. My, my, my morning breakfast is optimism. My evening dinner is optimism. I'm an optimist. I think that we will make a difference and we will make a difference in this disease before I die. Thank you. Thank you. Thank you. Thank you. Thank you, Dr. Mukherjee. The book is the Emperor of All Malities. It's a biography of cancer and the new edition is available everywhere. Books are sold. Thank you, Olivia Munn. Simone, thank you. Simone Bozeman for sharing and Eve for sharing your stories with us. And thank you all for listening and watching. Take good care of yourself. Thank you. Dear listeners, it is with sadness that I share with either my guest on this episode, the young women, named Eve, who was fighting stage four, individual cancer, passed away just a few weeks after our conversation. It wasn't honor to have Eve on the Oprah podcast. She told us it was deeply important to her to share her story because she wanted to help other women facing similar medical challenges. We extend our sincerest condolences to Eve's husband, family, and friends. May her life continue to be a blessing to all who love her. Dr. Mukherjee says we're on the cutting edge of AI advances and research for cancer. To read more about this work, check out his New York Times article Can We Make AI Belong? The link is right there on your screen. If you want to dive deeper into the history and also the future of cancer treatment, the QR code for Dr. Siddharth Mukherjee's updated Pulitzer Prize-winning book The Improver of All Malatites is right there on your screen. It offers a deeply researched look into a disease that is touched nearly every person on earth in some way over the last 5,000 years. To order the book, just scan the QR code. It's that easy right now. Our listeners tell us that the podcast is resonating with you and is serving as a bright spot in your day. That means a lot to me. So, here's the thing. I would really appreciate it if you like and subscribe to the Oprah podcast on YouTube or wherever you podcast. It's just a quick tap of the subscribe button and that way you won't miss an episode in your queue. You don't have to pay anything. I know subscribe usually means you're paying something, but this time it means you just are notified when there's something new. There are many more to come that we're excited about, so thank you for watching and listening.