On November 4, 2003, a doctor gave Jon Gluck some of the worst news imaginable: He had cancer — one that later tests would reveal as multiple myeloma, a severe blood and bone marrow cancer. Jon was told he might have as little as 18 months to live. He was 38, a thriving magazine editor in New York with a 7-month-old daughter whose third birthday, he suddenly realized, he might never see.“The moment after I was told I had cancer, I just said ‘no, no, no,’” Jon told me in an interview just last week. “This cannot be true.”Living in remissionThe fact that Jon is still here, talking to me in 2025, tells you that things didn’t go the way the medical data would have predicted on that November morning. He has lived with his cancer, through waves of remission and recurrence, for more than 20 years, an experience he chronicles with grace and wit in his new book An Exercise in Uncertainty. That 7-month-old daughter is now in college.RelatedWhy do so many young people suddenly have cancer?You could say Jon has beaten the odds, and he’s well aware that chance played some role in his survival. (“Did you know that ‘Glück’ is German for ‘luck’?” he writes in the book, noting his good fortune that a random spill on the ice is what sent him to the doctor in the first place, enabling them to catch his cancer early.) Cancer is still a terrible health threat, one that is responsible for 1 in 6 deaths around the world, killing nearly 10 million people a year globally and over 600,000 people a year in the US. But Jon’s story and his survival demonstrate something that is too often missed: We’ve turned the tide in the war against cancer. The age-adjusted death rate in the US for cancer has declined by about a third since 1991, meaning people of a given age have about a third lower risk of dying from cancer than people of the same age more than three decades ago. That adds up to over 4 million fewer cancer deaths over that time period. Thanks to breakthroughs in treatments like autologous stem-cell harvesting and CAR-T therapy — breakthroughs Jon himself benefited from, often just in time — cancer isn’t the death sentence it once was.Our World in DataGetting better all the timeThere’s no doubt that just as the rise of smoking in the 20th century led to a major increase in cancer deaths, the equally sharp decline of tobacco use eventually led to a delayed decrease. Smoking is one of the most potent carcinogens in the world, and at the peak in the early 1960s, around 12 cigarettes were being sold per adult per day in the US. Take away the cigarettes and — after a delay of a couple of decades — lung cancer deaths drop in turn along with other non-cancer smoking-related deaths.But as Saloni Dattani wrote in a great piece earlier this year, even before the decline of smoking, death rates from non-lung cancers in the stomach and colon had begun to fall. Just as notably, death rates for childhood cancers — which for obvious reasons are not connected to smoking and tend to be caused by genetic mutations — have fallen significantly as well, declining sixfold since 1950. In the 1960s, for example, only around 10 percent of children diagnosed with acute lymphoblastic leukemia survived more than five years. Today it’s more than 90 percent. And the five-year survival rate for all cancers has risen from 49 percent in the mid-1970s to 69 percent in 2019. We’ve made strikes against the toughest of cancers, like Jon’s multiple myeloma. Around when Jon was diagnosed, the five-year survival rate was just 34 percent. Today it’s as high as 62 percent, and more and more people like Jon are living for decades. “There has been a revolution in cancer survival,” Jon told me. “Some illnesses now have far more successful therapies than others, but the gains are real.”Three cancer revolutions The dramatic bend in the curve of cancer deaths didn’t happen by accident — it’s the compound interest of three revolutions.While anti-smoking policy has been the single biggest lifesaver, other interventions have helped reduce people’s cancer risk. One of the biggest successes is the HPV vaccine. A study last year found that death rates of cervical cancer — which can be caused by HPV infections — in US women ages 20–39 had dropped 62 percent from 2012 to 2021, thanks largely to the spread of the vaccine. Other cancers have been linked to infections, and there is strong research indicating that vaccination can have positive effects on reducing cancer incidence. The next revolution is better and earlier screening. It’s generally true that the earlier cancer is caught, the better the chances of survival, as Jon’s own story shows. According to one study, incidences of late-stage colorectal cancer in Americans over 50 declined by a third between 2000 and 2010 in large part because rates of colonoscopies almost tripled in that same time period. And newer screening methods, often employing AI or using blood-based tests, could make preliminary screening simpler, less invasive and therefore more readily available. If 20th-century screening was about finding physical evidence of something wrong — the lump in the breast — 21st-century screening aims to find cancer before symptoms even arise.Most exciting of all are frontier developments in treating cancer, much of which can be tracked through Jon’s own experience. From drugs like lenalidomide and bortezomib in the 2000s, which helped double median myeloma survival, to the spread of monoclonal antibodies, real breakthroughs in treatments have meaningfully extended people’s lives — not just by months, but years.Perhaps the most promising development is CAR-T therapy, a form of immunotherapy. Rather than attempting to kill the cancer directly, immunotherapies turn a patient’s own T-cells into guided missiles. In a recent study of 97 patients with multiple myeloma, many of whom were facing hospice care, a third of those who received CAR-T therapy had no detectable cancer five years later. It was the kind of result that doctors rarely see. “CAR-T is mind-blowing — very science-fiction futuristic,” Jon told me. He underwent his own course of treatment with it in mid-2023 and writes that the experience, which put his cancer into a remission he’s still in, left him feeling “physically and metaphysically new.”A welcome uncertaintyWhile there are still more battles to be won in the war on cancer, and there are certain areas — like the rising rates of gastrointestinal cancers among younger people — where the story isn’t getting better, the future of cancer treatment is improving. For cancer patients like Jon, that can mean a new challenge — enduring the essential uncertainty that comes with living under a disease that’s controllable but which could always come back. But it sure beats the alternative.“I’ve come to trust so completely in my doctors and in these new developments,” he said. “I try to remain cautiously optimistic that my future will be much like the last 20 years.” And that’s more than he or anyone else could have hoped for nearly 22 years ago. A version of this story originally appeared in the Good News newsletter. Sign up here!See More: Health

Intrauterine devices, or IUDs, are an extremely effective and convenient form of birth control for many people—but it can also very painful to get one inserted. Current medical guidelines say that your doctor should be discussing pain management with you, and they also give advice to doctors on what methods tend to work best for most people. The newest set of guidelines is from ACOG, the American College of Obstetricians and Gynecologists. These guidelines actually cover a variety of procedures, including endometrial and cervical biopsies, but today I'll be talking about the IUD insertion portions. And in 2024, the Centers for Disease Control and Prevention's released new contraceptive recommendations that include a section on how and why providers should help you with pain relief. Before we get into the new recommendations and what they say, it’s important to keep in mind that that not everybody feels severe pain with insertion—the estimate is that insertion is severely painful for 50% of people who haven't given birth, and only 10% of people who have, according to Rachel Flink, the OB-GYN I spoke with for my article on what to expect when you get an IUD. (She also gave me a great rundown of pain management options and their pros and cons, which I included in the article.)  I’m making sure to point this out because I’ve met people who are terrified at the thought of getting an IUD, because they think that severe pain is guaranteed and that doctors are lying if they say otherwise. In reality, there’s a whole spectrum of possible experiences, and both you and your provider should be informed and prepared for anything along that spectrum.Your provider should discuss pain management with youThe biggest thing in both sets of guidelines is not just the pain management options they discuss, but the guideline that says there is a place for this discussion and that it is important! You’ve always been able to ask about pain management, but providers are now expected to know that they need to discuss this with their patients. The ACOG guidelines say: "Options to manage pain should be discussed with and offered to all patients seeking in-office gynecologic procedures." And the CDC says: Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management. A person-centered plan for IUD placement and pain management should be made based on patient preference.“Person-centered” means that the plan should take into account what you want and need, not just what the provider is used to doing or thinks will be easiest. (This has sometimes been called “patient-centered” care, but “person-centered” is meant to convey that you and your provider understand that they are treating a whole person, with concerns outside of just their health, and you’re not only a patient who exists in a medical context.) The CDC guidelines also say: “When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions, such as depression or anxiety.” The ACOG guidelines, similarly, say that talking over the procedure and what to expect can help make the procedure more tolerable, regardless of how physically painful it ends up being. (Dr. Flink told me that anti-anxiety medications during insertion are helpful for some of her patients, and that she’ll discuss them alongside options for physical pain relief.)Lidocaine paracervical blocks may relieve painThere’s good news and bad news about the recommended pain medications. The good news is that there are recommendations. The bad news is that none of them are guaranteed to work for everyone, and it’s not clear if they work very well at all. The CDC says that a paracervical block (done by injection, similar to the numbing injections used for dental work) “might” reduce pain with insertion. Three studies showed that the injections worked to reduce pain, while three others found they did not. The CDC rates the certainty of evidence as “low” for pain and for satisfaction with the procedure. The ACOG guidelines also mention local anesthetics, including lidocaine paracervical blocks, as one of the best options for pain management. Dr. Flink told me that while some of her patients appreciate this option, it’s often impossible to numb all of the nerves in the cervix, and the injection itself can be painful—so in many cases, patients decide it’s not worth it. Still, it’s worth discussing with your provider if this sounds like something you would like to try.Topical lidocaine may also helpLidocaine, the same numbing medication, can also be applied to the cervix as a cream, spray, or gel. Again, evidence is mixed, with six trials finding that it helped, and seven finding that it did not. The ACOG guidelines note that sometimes topical lidocaine has worked better than the injected kind. Unfortunately, they also say that it can be hard for doctors to find an appropriate spray-on product that can be used on the cervix.The CDC judged the certainty of to be a bit better here compared to the injection—moderate for reducing pain, and high for improving placement success (meaning that the provider was able to get the IUD inserted properly). Other methods aren’t well supported by the evidence (yet?)For the other pain management methods that the CDC group studied, there wasn’t enough evidence to say whether they work. These included analgesics like ibuprofen, and smooth-muscle-relaxing medications. The ACOG guidelines say that taking NSAIDS (like ibuprofen) before insertion doesn't seem to help with insertion pain, even though that's commonly recommended. That approach does seem to work for some other procedures, though, and may help with pain that occurs after an IUD insertion. So it may not be a bad idea to take those four Advil if that's what your doc recommends, but it shouldn't be your only option. Or as the ACOG paper puts it: "Although recommending preprocedural NSAIDs is a benign, low-risk intervention unlikely to cause harm, relying on NSAIDs alone for pain management during IUD insertion is ineffective and does not provide the immediate pain control patients need at the time of the procedure." Both sets of guidelines also don't recommend misoprostol, which is sometimes used to soften and open the cervix before inserting an IUD. The ACOG guidelines describe the evidence as mixed, and the CDC guidelines specifically recommend against it. Moderate certainty evidence says that misoprostol doesn’t help with pain, and low certainty evidence says that it may increase the risk of adverse events like cramping and vomiting. What this means for youThe publication of these guidelines won’t change anything overnight at your local OB-GYN office, but it’s a good sign that discussions about pain management with IUD placement are happening more openly. The new guidelines also don’t necessarily take any options off the table. Even misoprostol, which the CDC now says not to use for routine insertions, “might be useful in selected circumstances (e.g., in patients with a recent failed placement),” it writes.Don’t be afraid to ask about pain management before your appointment; as we discussed before, some medications and procedures require that you and your provider plan ahead. And definitely don’t accept a dismissive reply about how taking a few Advil should be enough; it may help for some people, but that shouldn't be the end of the discussion. You deserve to have your provider take your concerns seriously.

News Health & Medicine An at-home cervical cancer screening device was OK‘d by the FDA The Teal Wand is the first self-collection device of its kind for home use  The FDA has approved the Teal Wand, a new device for at-home cervical cancer screening. Nicole Morrison/Teal Health By Meghan Rosen 34 seconds ago Screening for cervical cancer many soon be possible within the privacy of your own home. On May 9, the U.S. Food and Drug Administration approved the Teal Wand, a tamponlike tool people can use to collect cells from their vagina. It’s the first self-collection device approved for at-home use in the United States and could broaden access to cervical cancer screening. The concept is simple. Patients swab themselves with the wand then send it back to Teal Health, the company that makes the device, for analysis. It’s looking for traces of HPV, the virus to blame for nearly all cervical cancer cases. According to Teal Health, Wand rollout will begin in June in California and later nationwide. The company’s medical providers will prescribe the device to eligible patients, who will be able to access their results via Teal Health’s telehealth service.  Sign up for our newsletter We summarize the week's scientific breakthroughs every Thursday.