Susanna
Welcome to the Cancer SIGNAL, a podcast presented by GRAIL where we discuss topics relating to early cancer detection, including multi-cancer early detection testing, cancer genomics and risk, barriers to cancer screening, and much more. I’m your host, Susanna Quinn. It’s the new year and with that brings a revitalized focus on our goals which, more often than not, includes our health and wellness. That makes it perfect timing for a conversation with Dr Ummat, a preventative medicine physician who is passionate about changing the approach to aging. She has dedicated her career to helping patients maintain optimal vitality, both inside and out. Welcome to the Cancer SIGNAL Dr Ummat.

Dr Ummat
Thank you. Susanna, it’s a pleasure to be here, and Happy New Year.

Susanna
Thank you so much. What led you to specialize in longevity and wellness?

Dr Ummat
You know, I am trained as a physical medicine and rehab specialist, and in the course of my training, I’ve met many patients that have had significant disabilities. And as I helped manage their care, I often wondered, what if we had picked this up before it happened? That would have changed the trajectory of their future. So say, for example, you know a stroke patient. Stroke is a devastating illness. It happens quickly and within a span of minutes and hours, it literally changes that whole person’s life. Not just that person, but their family and everybody in their immediate society that is affected by them, and then it has a longer reach. And as I was working with my team to manage their medical problems, to help them discharge them from rehab facilities, to get them back home safely, to prevent complications of their stroke, the contractures that can happen, help them walk better, speak again, swallow so they don’t aspirate and get pneumonias. 

And as the therapist provided them with devices that would help them walk, or bars that would help them keep them safe in their home, the thought of what if this didn’t happen in the first place was always paramount to me. And so, you know, stroke is one but head injury, traumatic brain injury, cardiac rehab, pain management, amputation, spinal cord injuries, all of these people, and it affects a lot of people. If only we knew that some of this was coming down the pipeline. You know, it’s like that train coming down your way. Wouldn’t you want to step out of the way and prevent all of this disaster that is going to come upon you? And most of this involves picking it up early. Preventing has to begin with early detection. And the way we have medicine today, we are reactionary. We respond to an acute presentation and an acute problem. And you know, hats off to my colleagues that manage those emergent situations. We all need that. We need them there to do what they do, because they do it best. They take care of infections, heart attacks, cancer, surgeries and a whole host of other things. But once they’re done, what then? How do we manage the chronic problems that are now present, and how do we impact on not only that person, but on society as a whole? This takes such a huge emotional toll, physical, mental, financial burden. How can we help prevent that and for that, I think we have to go inwards. 

We have to go back to the physiology, the biochemistry. We have to look at what caused the stroke. How could we have stopped the clot from forming? How could we have maintained the vascular tree better? How could we have maintained the health of that cholesterol panel? Could we have picked it up earlier? How would we have prevented it? Could we have protected, protected that patient, if we had picked up the cancer signals? So, you know, those kind of thoughts always were at the back of my mind. And then I attended a conference at the American Academy of Anti-Aging Medicine that changed the trajectory of my future, and I knew that I had to learn more. And that happened almost two decades ago, and I went back and got my board certification, I relearned physiology, and this time, I learned it with a different emphasis. It wasn’t going to be treat after it happened, it was going to be focused on, how can you prevent what is coming down the road, what is inevitably going to happen.

Susanna  

Thank you. And this is specifically very, very important for cancer, because many of the diseases that you mentioned do have cures, unlike cancer, so early detection is really our only tool at this point. [Dr Ummat: Absolutely right.] Yeah, could you help our listeners understand what you mean when you talk about longevity?

Dr Ummat
Yeah, longevity, it’s a very good question. Longevity, to me, means dying young at a very old age. 

Susanna
Oh, I love that. 

Dr Ummat
And that just means defying ageism. It means not accepting the normal but undesirable changes of aging. You know you’re going to get slower, degenerative joint disease, joint pain, arthritis, dementia, memory loss, insulin resistance, type two diabetes, hypertension, it’s all coming, and the question is, what can you do to prevent it? What can you do to slow down the rate of decline so that in your 60s, you can act and behave like you’re in your 50s, in your 70s, you can act and behave like in your 60s. That gives you vitality and it allows you to pursue whatever is important to you.

Susanna
What are the main factors that impact one’s longevity? Which of these are in our control?

Dr Ummat
Yeah, that’s a very good question Susanna, because for the longest time, we always said, well, it’s in my genes. Mom had diabetes, I’m going to have diabetes. Mom had cancer, I’m going to get cancer. But that doesn’t have to be our reality. We have progressed. We have advanced. Some of the things are basic and some of them require active participation from each and every one of us. But if we have the knowledge and we actually believe that this knowledge can change our future, then we must act upon it. I cannot write a pill. A lot of times, my patients will say, well, why don’t you give me a pill for this and I’ll do it, and that’s great, but there isn’t a pill. So first and foremost, it has to do with food. There is no perfect diet for everybody, but everybody can have a perfect diet for themselves. We know for a fact that deeply pigmented fruits and vegetables provide nourishment and nutrition to you. How you eat them, how frequently, what times, how much intermittent fasting you do is variable. 

Whether you eat whole foods without meat, or whether you add meat for protein depends upon your individual circumstances, but we know for a fact that saturated fat, processed food, high intake of sugar, high intake of salt, which is present in a lot of the things that we eat day to day, are dangerous and detrimental to our health. So diet is something that we can all participate in actively. It will make a difference. And then the second important thing that I tell my patients is your ability to exercise, every day, some component of exercise, both aerobic conditioning and resistance training, is important because muscle, as I like to say, is the currency of aging. The muscle builds brain derived neurotropic factors that help heal and repair. Muscle will help you recover faster. It supports your bones and it supports you. So if you pay attention to your cardiovascular system with exercise, and then your bone structure and your muscle mass, because normal aging means that we are going to lose muscle as we get older. So preventing sarcopenia is important, and focusing on these two is very critical. 

Then another thing that as when you’re younger, you don’t focus on is sleep, right? When we went through medical school, when we were in college, we could work all day, play in the evenings, do a second job, go party with friends, and then go back to class in the morning. But as we get older, we recognize that good sleep is the way our body heals and repairs, so a restorative sleep pattern is important, and on average, between five to seven hours, some people at the lower end of that spectrum, some at the higher end, is really important to help you rejuvenate, recover, and improve your chances of longevity. Then there’s something else that is very important, and that’s your social connections, your family, your friends, your relationships. Good relationships will enhance your longevity, and those are critical, and so you have to be mindful about building those and maintaining and keeping them, and they will help you during times when you can’t take care of yourself. So we all help each other. We’re tribe. You know, our network is what helps us maintain wellness. And then there are every other things that we can specialize in and focus in on specific needs of patients. So if cancer is a risk factor, then how do we prevent cancer risk? If heart disease or dementia, how do we focus on that, but a few basic things that we can do are diet, exercise, sleep, relationships and also avoiding factors that are detrimental to our own personal health, whether it come from people or environment. And just being cognizant of what is useful and what is not, and removing the factors that are not helping you is just as important as engaging in helpful activities.

Susanna
Thank you so much. That’s a very thoughtful answer. To give you a real life anecdote I had stage four ovarian cancer. I had to have a nine hour surgery that took 49 words on my medical chart to describe, and my doctor said that I would not have survived it if I was not in such good physical shape, because exercise has always been such an important part of my life.

Dr Ummat
Yes, you’re absolutely right, even, even you know, to survive such an acute episode and then to go through the care that comes afterwards. If you, sometimes we think that exercise, it’s we don’t have the energy to do it, but the more that we do do it, we know that our body is spewing out factors that help us fight for our immune responses, reducing the risk for progressive disease. And so you’re absolutely right. It is so, so important to be able to do that for ourselves.

Susanna
Yeah, and the social network I remember going into my cancer diagnosis and surgery, my doctor said he remarked on what an incredible community that I had around me, which is true. My doctor said, almost without exception, his patients who had support and community and family around them fared so much better, and studies have shown that. So what health issue is biggest on your patients minds as it relates to aging?

Dr Ummat
Yeah, as we are getting older, the you know, aging itself is a risk factor for disease, for chronic disease, the biggest risk factor. And I think of that some that are very sobering. The first one, I would say maybe, is dementia, simply because you lose yourself twice there. First, when you lose your identity and you don’t recognize and then secondly, when you finally pass. So I think of dementia as detrimental, not just to you personally, but also to everybody else that you have been a part of their life. So that, and then I think the second most, as I talk to my patients is cancer. And it’s simply because there’s such a huge stigma and fear about cancer and a lot of people, unfortunately younger people nowadays, are experiencing malignancies and cancer, and we know that it affects a lot of people, and so I am also seeing that and to me, the important thing is, how do we pick it up early enough so that we can literally change the future that they, that could happen to them if it wasn’t picked up? So those are some of the important things. And then the usual ones, I think, are affected. The other ones are usually affected by what they’ve seen in their family. So if there is a family history of, for example, heart disease or diabetes, then that will be their fear. But the big ones are memory and being able to remember, being able to pick up cancer as a disease, and being able to live the life they had envisioned themselves to live. And many of them will say, you know, I watched my parents and my grandparents get sick, and I don’t want to be like that. I want to do everything possible to prevent that from happening to me.

Susanna
What is some of the most common guidance you give to patients to increase their chances for a long healthy life?

Dr. Ummat
Yeah, you know, we are very proactive in early detection. We do do a lot of screening. We check labs frequently. We look for minimal markers. To me, it’s not okay if, in the kidney function, the GGT, which I’m sorry, in the liver function, if the GGT is rising and I ignore it till it becomes a problem. Similarly, I know that, you know, fasting glucose level is normal till about 120 but to me, it’s not okay if it is reaching 120 fasting insulin levels. So I look at markers a little bit more critically, and as I see trends over time, I start initiating changes, not by just educating them about where this is going and for them to institute their own lifestyle changes, but also by helping them treat educating them about the physiology, maybe helping with certain nutrients, supplements that may make a difference in reducing the rate of progression. So a lot of different things can be done, removing toxic exposures, you know, mold and environmental toxins are a huge factor as well. So just being cognizant of what all is involved over here and what little things can be done to basically give them a better outlook for the future. 

And we pay attention to all the new research that is coming out. So a lot more is known today than we did know earlier. And one of the newer things is about managing and treating senescent cells, and what do they mean, and how do we do it? So those are all things that are up and coming and very important in helping us, along with the personal tools that the patients can do in their diet and exercise.

Susanna
I think it’s interesting because you hear people say, oh, well, you know, my father smoked two packs of cigarettes a day and drank bourbon, and he lived till he was 87. You hear people say, you know, my mother was did yoga and her diet, she hadn’t didn’t eat cholesterol and didn’t eat sugar, and she got cancer. But I often think, how much worse would the cancer have been? How much sooner would it have appeared if people weren’t making healthy lifestyle choices?

Dr Ummat
Yeah, you’re absolutely right. You know, there will always be people on the extremes, and some, unfortunately, we can’t help but we got to catch the bell curve. The vast majority of us sit in the bell curve, and these changes can help the vast majority of us, you know. So instead of sitting in front of a device, eating, you know, something that’s not healthy, if we were up and mobile and focusing on a diet that is better, then, yes, you have prevented things that could have happened to you.

Susanna
Could not possibly know. [Dr Ummat: Yeah, exactly.] So we know, we know that age is the greatest risk factor for cancer, with risk for developing cancer increasing over the age of 50. [Dr Ummat: Yes.] How much of a focus is cancer of your work?

Dr Ummat
It’s a huge focus. You know, I’ll tell you a story. One, the way we got into early cancer screening. Galleri was something that was very important to us, and we instituted and wanted to offer it to our patients early. But I have an amazing 80 year old gentleman in my practice. He works out all the time. He looks healthy, no hearing aid, no eyeglasses, no cane, drives himself and he came into the office one day and he said, what cancer screening do you do for me? And I said, Well, you know, we check your PSA all the time for prostate cancer. And he said, what did you do for my colon? And I said, well, we’ve looked at your labs. I haven’t really seen anything that I’m worried about. Why do you ask? And he said, well, my doctor said I’m over 80, and I don’t qualify for a colonoscopy anymore, but I had polyps last time they did a colonoscopy. I have a history of colon cancer, and it really bothers me. And that was the first patient that we did our Galleri screen on, and I know that the recommendation is up to 80 and not past. And so I had to think about it. 

You know, this is a new thing for us, and I didn’t know whether we would do him a favor or not, but he asked for something, and he requested it. And to me, it was shocking that he can’t have a service given his age, even though to look at him, he has more muscle than fat, he’s healthy, he has no other risk factors. And so why are we declining this for him? And so we did the Galleri screen for him, and it came back negative. And from since then, you know, he’s been doing it every year with us. I have also told him that that is not the only thing he needs to do. And then anything else that is offered as a screening tool, he will, he should accept it, and he does. But at his age, they’re not offering him a whole lot of other things. And so this is very important to him. And so yes, cancer screening is important. The sooner we pick it up, the better it is, not just for our patient, but as a broader picture for society, as a general, because we can do something about it.

Susanna
Can you remind listeners about the guideline recommended cancer screenings and who should get them? 

Dr Ummat
Yes, absolutely. So we do mammograms for breast kind of breast cancer screening, and the recommendation for mammograms is starting at the age of 40 to 74 every two years for women, unless if there is a lesion that is detected, and in that case, then it is based on the discretion of the provider. Some women may get them sooner, even every six months. And sometimes we also change direction and do MRI scans at high risk cases. So but mammography starting at age 40 to 74 every two years, for breast cancer detection. Then for women, we also do pap smears for cervical cancer screening, starting at age 21 to 29 every three years, and then from 30 to 65 every three to five years. And then after the age of 65 again, depends upon what the previous screening had shown. So if it’s somebody at high risk, they might need a screen, but usually, most people that are not at a risk will not need a pap smear after that. And then we do PSA, which is a blood test for men for prostate cancer, and the recommendation for that is starting at the age of 55, till 70. 

The United States Task Force for Cancer Prevention does not recommend we screen after the age of 70 for men for prostate cancer, but that is the current recommendation. And then we do colonoscopies for both men and women, starting at the age of 45. The previous recommendation was 50. They have changed that and lowered the age now to 45 from 45 to 75 years, every 10 years, as long as it is normal and clean. If there is a lesion, then they do do them more frequently, sometimes every five years, sometimes every three years, just depending upon what they found. And then after the age of 85 they don’t recommend them anymore. And then lastly, the current screening is for smokers, for early detection of lung cancer, and we do low dose CT scan for them, and depending upon how, the frequency will depend upon the physician’s discretion and what they find, but that screening starts at about age 50 and onwards, 50 to 80 years.

Susanna
You also recommend multi-cancer early detection testing. [Dr Ummat: Yes.] What role does this kind of testing play in your focus on longevity?

Dr Ummat
You know it is about early detection. There are two scenarios if you think about the last decade of a person’s life, you can either be vibrant and enjoy what is important to you, or you can be sick and be in and out of institutions taking care of chronic diseases. That, you know, somebody recently said to me that modern medicine can be a blessing and a curse all at the same time. He’s taking care of his elderly parents, and he said, you know, they’re unhealthy, yet they’re so dependent, yet they’re he’s grateful that they’re alive. But that is the scenario that I’m trying to change. This requires a paradigm shift. That is what I mean about picking it up early so that even as you’re getting older, you’re not dependent, you have some semblance of dignity, and you can basically enjoy what is important to you.

Susanna
Absolutely, I can tell you from personal experience that you are correct. So Dr Ummat, what do you tell patients who have no symptoms of cancer why they should be doing early cancer screening testing?

Dr Ummat
Yeah, great question Susanna, again. You know, think about this for a minute. Hypertension has no symptoms. Diabetes doesn’t present with any symptoms, and so a lot of times, our ability to detect disease happens after the disease has been present for a very long time. Multi-cancer early detection is very important tool that we now have that can pick up cells that are going to be a problem for us. They are early cancer cells, the cell free DNA that is being spewed out by an organ that is undergoing change that is very important for us to pick up. And the beauty about this test is that it’s not just looking at one screening, which is what our screening tools are right now. This test looks for more than 50 different types of cancers with one blood draw. There is no other tool like this that can help us in detecting early signals that can then be important and you know, say something like pancreatic cancer, for example. It doesn’t present with any symptoms. By the time we find it, it is so late and there’s not much that we can offer our patients. But if we are able to pick up the lesion before it becomes so expansive, then we can actually have some therapies – my oncology friends are telling me now that they are defining new treatments for pancreatic cancer, because with the help of GRAIL’s test, they’re picking it up much earlier than it was ever picked up. And that is so important, because without it, we know the future. We know that is going to be fatal unfortunately. 

Susanna
Incredible. So Dr Ummat, thank you so much for sharing such wisdom with us. What are your personal goals for 2025?

Dr Ummat
That’s a great question. And thank you for asking me that I have some of my patients that’ll call me by my first name and go, did you exercise? Did you go to the gym? And I just love that. I love that I build that relationship with my patients. But yes, my personal goal is to continue to help as many people as I possibly can. And my personal goal is the same that I teach them every single day. Go out and exercise. Eat what is right. Eat smart. You know, obviously, if it’s Thanksgiving or the New Year, you know, fine, but just be smart about the choices you make, because it is going to affect how you age, and that is very important to me. As I am getting older, I want to make sure that I’m not a burden or dependent or that I don’t lose my dignity, and to me saving that at all cost is very important, but that means that I have to work at it.

Susanna
Yeah, being healthy is another job.

Dr Ummat
Indeed it is. And you know, for all of us that have a day job, sometimes it really does become onerous Susanna. You know, it’s like, it’s so easy to just pick up something on the way home from a takeout rather than go home and then start the process and then clean it. You’re tired, you’re hungry, but just making that effort and having the right people in your life that kind of just push you on is just such an important key to success.

Susanna
It’s very hard. I have so many friends who are working moms, and I encourage them to take a walk when they’re on their conference call. Any excuse to get outside, get some fresh air and exercise. My personal health goals for 2025 are less alcohol, less sugar, and more swimming. I’ve discovered swimming as I’m trying to swim a few times a week as a very sort of meditative full body workout, which is easier on the joints as we get older.

Dr Ummat
You’re absolutely right. It definitely is. And then, you know, one other thing I tell women particularly, is that if you feel well yourself, then you’re in a better position to help everybody else in your orbit, because that’s what women do. We’re caretakers. But if you don’t feel that wellness, then everything that you care about that’s in your orbit is going to feel the consequences of that. And so taking a deep breath and saying, this makes me happy. Whatever your happy is, is really important.

Susanna
You touched on a really important point. Women take care of everyone else, and they often neglect their own health. I was so busy taking care of my husband that I had these ovarian cancer symptoms and waited and waited and waited to go to the doctor because I thought, well, it’s stress. My diet’s not great. And that’s one of the reasons why I was diagnosed so late. So we really do need to listen to our bodies. Thank you so much Dr Ummat for coming and sharing your thoughts and your wisdom and your research with us today.

Dr. Ummat
Thank you for having me. Susanna, it was a pleasure. It was very nice to meet you, and I’m happy to share this, because I think it is really a very important factor for all of us. And thank you for helping me spread the message.

This is the Cancer SIGNAL presented by GRAIL. I’m your host Susanna Quinn. Subscribe to the podcast so you don’t miss an episode, and you can also watch this episode on GRAIL’s YouTube channel. Until next time, thanks for listening. 

Based on a clinical study of people ages 50 to 79 around 1% are expected to receive a Cancer Signal Detected result, which includes predicted cancer signal origins. After diagnostic evaluation, around 40% of people are expected to have a confirmed cancer diagnosis.

The Galleri test is prescription only. The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those age 50 or older. It is not recommended for individuals who are pregnant, 21 years or younger, or undergoing active cancer treatment. Galleri should be used in addition to routine cancer screening. Galleri does not detect a signal for all cancers. False positive and false negative results do occur.

For more information, including Important Safety Information, please visit Galleri.com.

Important Safety Information
The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those aged 50 or older. The Galleri test does not detect all cancers and should be used in addition to routine cancer screening tests recommended by a healthcare provider. Galleri is intended to detect cancer signals and predict where in the body the cancer signal is located. Use of Galleri is not recommended in individuals who are pregnant, 21 years old or younger, or undergoing active cancer treatment. Results should be interpreted by a healthcare provider in the context of medical history, clinical signs and symptoms. A test result of No Cancer Signal Detected does not rule out cancer. A test result of Cancer Signal Detected requires confirmatory diagnostic evaluation by medically established procedures (e.g.,  imaging) to confirm cancer. If cancer is not confirmed with further testing, it could mean that cancer is not present or testing was insufficient to detect cancer, including due to the cancer being located in a different part of the body. False positive (a cancer signal detected when cancer is not present) and false negative (a cancer signal not detected when cancer is present) test results do occur. Rx only.

Laboratory/Test Information
GRAIL’s clinical laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and accredited by the College of American Pathologists (CAP). The Galleri test was developed, and its performance characteristics were determined by GRAIL. The Galleri test has not been cleared or approved by the Food and Drug Administration. GRAIL’s clinical laboratory is regulated under CLIA to perform high complexity testing. The Galleri test is intended for clinical purposes.