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In this “Ask Me Anything” (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests.

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We discuss:

• Why understanding cancer screening is crucial [2:45];
• The prevalence of cancer diagnosis and mortality rates [4:30];
• Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00];
• Data on how cancer screening impacts survivability of cancer [16:30];
• Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45];
• What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15];
• What are the arguments against population-level cancer screening? [42:00];
• Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00];
• Understanding sensitivity and specificity when reviewing screening results [52:30];
• Risks and complications associated with colonoscopies [55:45];
• Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30];
• The strengths and limitations of various types of cancer screening [1:02:15];
• Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45];
• Factors that influence an individual's pretest probability of cancer [1:13:45];
• How to interpret cancer screening results [1:18:15];
• The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30];
• How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30];
• Advice and guidance for making decisions related to cancer screening [1:31:15]; and
• More.

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