When Cancer Strikes Close to Home: The Shocking True Cost of Protecting Your Peace of Mind Revealed

My brother’s eyesight started to fail in February 2024—first, texts blurred into indecipherable squiggles, then familiar faces faded into shadows. Suddenly, driving felt like stepping into a minefield. His eye doctor suspected the retina, but when nothing improved, an MRI was ordered “to be safe.” Safe? Hardly. That scan uncovered a tumor clawing away at his brain stem—the very core that keeps us breathing and beating. And just like that, life changed irreversibly. Watching Jon, once a Division I athlete full of vigor, lose himself step-by-step was brutal. It wasn’t just a tumor; it was a grim reminder that none of us are invincible. Losing him at 51 left a hole no birthday cake or warm family meal could fill. His journey forced me to confront an uncomfortable truth: When mortality stares us down, what tools do we really have to fight back? In 2026, with innovations like elective full-body MRIs and blood tests promising early cancer detection, are we arming ourselves with hope or just buying more anxiety? And at what cost does this pursuit of certainty come? Here’s my story—personal, raw, and a little bit real—about facing death, fear, and the elusive quest to stay ahead of the silent killers among us. LEARN MORE

Mhttps://guardanthealth.com/pro…Y BROTHER’S EYESIGHT started to fail in February 2024. The problem came on suddenly: Text messages were blurry, then faces. Soon he was afraid to drive. His eye doctor suspected a retina issue. But when the problem didn’t resolve on its own, he sent him for an MRI “to be safe,” which felt anything but. The scan would reveal a small tumor growing on his brain stem, the part of the body that regulates vital functions like breath control and heart rate. It was also pressing on a cranial nerve, which explained the changes in his vision—though that was a minor concern now.

Because of the tumor’s location, a biopsy was deemed too risky, let alone surgery to remove it. And my brother, Jon, started chemotherapy and radiation within days. Surgery eventually followed, and then two separate clinical trials, but his deterioration continued unabated. It was devastating to watch. A walker (for balance) gave way to a wheelchair. And Jon, a former Division I athlete, eventually lost so much motor control that he needed his food cut up for him. Soon, he was sleeping in a hospital bed in what had been his family’s guest room.

Eighteen months after his diagnosis, my brother was dead. He’d turned 51 a week earlier, and there was still leftover birthday cake in the freezer, which we had to throw out to make room for all of the food people started sending, which I appreciated but couldn’t bring myself to eat.

Before Jon got sick, I was never all that curious about my own health, a luxury of youth I was desperately clinging to despite all evidence to the contrary (the gray hair, that involuntary “oof” sound one makes getting out of the car). I don’t wear an Oura ring, and not just because I think they’re hideous (though they are). I don’t eat creatine chews or sit in an ice bath. And I run three days a week mostly so I don’t have to learn what a macro is.

But in the wake of my brother’s diagnosis, I largely stopped taking care of myself—skipping my own doctor’s appointments and eating garbage, which is a common refrain among caretakers. Who has the time? During Jon’s treatment, I was shuttling back and forth between my home in L.A. and his house in New Jersey, where I slept in the basement and drove him to appointments, sitting in an endless string of beige waiting rooms, helpless to do for him what he’d so effortlessly done for me: make me feel safe.

Courtesy Mickey Rapkin

Jon Rapkin was co-captain of the Cornell men’s tennis team from 1995 to 1996. The author with his brother Jon and nephew Corey in 2014.

The one thing I could do was keep a steady supply of Carvel on hand, which I did, one of the few things that made him happy besides spending time with his wife and kids. But three months after burying my brother, I started to worry: Was I next?

There’s a strange feeling of mortality that creeps up in middle age. It’s not just that a bunch of famous people who are basically my age are dying. Though the list is disturbingly long: Dawson’s Creek star James Van Der Beek (48, colorectal cancer) and Euphoria’s Eric Dane (53, ALS). Then there are the guys fighting for their lives: Ben Sasse, the Republican former senator from Nebraska (53, stage IV pancreatic cancer); the NBA’s Jason Collins (47, stage IV glioblastoma). No one wants to talk about it. But your late 40s is a time when people you know suddenly start to die—like my friend Miles Bingham, who passed away at 46 from pulmonary fibrosis.

When I started reporting this story, a colleague expressed his condolences on the loss of my brother, though he pointed out 51 was not “tragically young.” I wondered if he might be on the spectrum, but I knew what he was getting at. We have to start facing our mortality and figure out what, if anything, we can really do about it.

That conversation is nothing new. What’s different in 2026 is the existence of all of these diagnostic and preventive protocols that have come to market—a series of predictive tests that aim to detect cancer early enough to hopefully do something about it, like Prenuvo, an elective, full-body MRI you may have seen your favorite celebrity post about. (Kim Kardashian, dressed in hospital booties on Instagram, raved, “I recently did this @prenuvo scan and had to tell you all about this life saving machine.”)

Elsewhere, a pharmaceutical company called Grail has introduced Galleri, a blood test that purports to detect cancer long before symptoms arise—an emerging class of multi-cancer early-detection (MCED) tests that are not yet FDA approved or typically covered by insurance. Which, for the MAHA crowd, is probably a selling point.

But after losing my brother so quickly—and it was dizzying—I was increasingly paralyzed by the thought that some silent killer was coming for me. Would undergoing these tests help me take control of my health? Or would all of that information (and it was a lot of information) make me crazy? Put another way: What’s the out-of-pocket cost for peace of mind?

PRENUVO WAS FOUNDED in 2018 and offers an hour-long-ish MRI that scans your body for a long list of things that might kill you or, at least, seriously complicate matters: cancer, aneurysms, fatty liver, multiple sclerosis. Like you, I first heard about it when celebrities and fashion designers started posting about their experiences in 2023, prompting The New York Times to declare: “The New Status Symbol Is a Full-Body MRI.” It was an amusing headline. Though I wasn’t sure anyone was really getting the test for bragging rights. Like me, they were probably doing it because someone close to them died.

Prenuvo is certainly not cheap. The entry-level torso scan (which you might get if you’re particularly concerned about, say, pancreatic cancer) runs to $1,000. But the AI-powered full-body scan costs $2,500. There is also a third tier—an enhanced scan—that includes extensive blood work plus an assessment of your brain health ($4,000 to $4,500). Prenuvo has 26 locations in a bunch of major cities (Chicago, Denver, New York, London) and also one in Buffalo, New York, apparently to capture the Toronto market.

More clinics are set to open soon—in Charleston, North Carolina; Nashville; Pittsburgh; Singapore; and Dubai—with a lower-cost tier rumored to be in the works. But I made an appointment at the Pasadena location, which happens to be in the basement of an Erewhon. The proximity to a Hailey Bieber smoothie bar felt a little on the nose, though I will say it’s certainly the only medical office I’ve been to where I was offered multiple brands of bottled water.

Prenuvo’s CEO, Andrew Lacy, later hopped on a Zoom call to talk about how his company is empowering customers to take control of their own health care. Lacy just turned 50 in October, and like me, he isn’t a Huberman type either. He’s a serial entrepreneur from Australia who punished his body for years chasing returns. When he heard about a company in Canada that was offering MRIs on demand in 2019, he saw a business opportunity first. “There is so much wrong with the health system,” he says. “I think you almost need to reimagine it from the very beginning.”

MRI technology isn’t new (though Prenuvo’s software is updated monthly, Lacy tells me, including an additional diagnostic to better identify pancreatic cancer). What is new is asking for it. And some doctors think that presents its own problem. According to Ernest Hawk, MD, a vice president and head of the cancer prevention and population sciences division at the University of Texas MD Anderson Cancer Center, “Anytime we subject any population to testing, you’re going to find things you didn’t anticipate.” A nodule, a mysterious lump, whatever. Those tiny abnormalities lurking in your body generally turn out to be nothing. But they may require further (expensive and potentially dangerous) biopsies, turning otherwise healthy people into patients.

Dr. Hawk calls these “voyages” anxiety-inducing and also expensive. I know what he means. If I took my dog to the vet every time I felt a weird bump on his leg, we’d both be sleeping on the floor. Thankfully, my dog can’t Google his symptoms in the middle of the night. Which, come to think of it, is another problem with elective scans. This may sound counterintuitive, but not every cancer is worth treating. In 2012, a study in The New England Journal of Medicine revealed that among men with localized prostate cancer, total removal of the organ did not improve survival rates compared with men who adopted a wait-and-see approach. Those who’d had their prostates removed were maybe cancer-free. But they were now also incontinent. And (worse) couldn’t get hard. Is that empowerment or is it capitalism run amok? (In an adjacent example, doctors are increasingly pushing back on thyroid removal, because most types of the cancer are slow-growing and because removing the gland entirely forces the patient to be on hormone replacement drugs for the rest of their life.)

mri brain scan overlayed with data visuals and a barcode

Courtesy Mickey Rapkin

Perhaps in an attempt to satisfy Prenuvo’s critics, in May 2025 the company released the early findings of its ongoing clinical trial. Prenuvo enrolled 1,011 patients who underwent preemptive full-body scans. Most had no symptoms. But the test turned up potential signs of cancer in about 50 people, who later underwent biopsies. About 20 of those people really did have cancer. The rest merely lost a day of work for a procedure they never needed.

Thomas C. Kwee, PhD, a radiologist at the University Medical Center Groningen in the Netherlands, complained to The New York Times that this was a “nonrandomized study.” Which maybe isn’t the flex he thinks it is. Because 22 people who didn’t think they had cancer found out they did. And 19 of those people said they had no symptoms. There’s no way to know whether Prenuvo actually saved their lives without the kind of academic study that would satisfy Kwee. But who can afford to wait?

Even Sean Clifford, currently suing Prenuvo, admits the test works. (He had a debilitating stroke in March 2024, nearly eight months after Prenuvo declared no adverse findings with regard to the then 37-year-old’s brain health; it turns out his scan showed signs of an arterial narrowing, but he alleges the radiologist misread it.) The case is in early stages, but the defendants have denied the allegations. I tried not to think about any of that as I slid into Prenuvo’s MRI tube, wondering if my brother had felt this alone each time he was wheeled into a room for tests, once emerging from a machine called a Gamma Knife bleeding from the spot where a screw had been drilled into his face to keep him from moving.

It would be three long weeks before I got the results.

MANY SUCCESSFUL BUSINESSES are built on consumer insecurity. Without this skin cream, these sneakers, this hot dinner reservation, you’re missing out. Tests like Prenuvo’s—and those of its competitors, such as Ezra, simonONE, and Neko—certainly feed on that FOMO, taking advantage of our creeping sense of mortality. Except the sales pitch is even more compelling because the consequences are potentially life-or-death.

Not surprisingly, money is pouring in. Prenuvo (which has completed over 150,000 scans) counts former Google CEO Eric Schmidt, Nest’s founder Tony Fadell, and Casamigos’s Rande Gerber among its investors. The venture capital giant Andreessen Horowitz, meanwhile, has a stake in Function Health, cofounded by Mark Hyman, MD, a company that tests your blood for more than 100 biomarkers that your primary care doctor won’t typically check unless you have underlying symptoms. Dr. Hyman isn’t a fringe figure; in January, Sweetgreen introduced a new menu in collaboration with Function Health across its more than 280 locations.

Daniel Ek, cofounder of Spotify, is pushing Neko Health (which does a scan similar to Prenuvo’s and will open its first U.S. location in New York this spring). Meanwhile, Whole Foods cofounder John Mackey opened Love.Life in 2024, a holistic health and wellness center in El Segundo, California; the most popular membership costs $11,400 a year and includes (among other offerings) a longevity screening.

“Part of our mission is shifting from sick care into a preventative and well-care model,” says Love.Life cofounder Betsy Foster.

I can only imagine demand for services like these will grow as Robert F. Kennedy Jr.’s U.S. Department of Health and Human Services continues to sow distrust, putting the onus on consumers to care for themselves. Which—like everything in this country—is fine if you can afford it. Less so if you’re struggling. (I should say here, we were lucky that my brother and his wife could afford a part-time aide, a Ukrainian refugee who would be a gift to this country.) But in the aftermath of a loss I was powerless to prevent, I could certainly see the appeal of a growing sector that trades on a sense of control.

While I waited for the results of my own Prenuvo scan, I signed up for Grail’s Galleri blood test. Introduced in 2021, the test uses a standard blood draw to screen for more than 50 different types of cancer—including some (like pancreatic and liver cancer) that often go undetected until advanced disease progression. The Galleri experience costs $949, is not yet FDA approved, and requires a prescription, which you can get through Grail’s website after answering some basic medical questions. The whole thing took two minutes to fill out, and a few days later, a nurse showed up at my doorstep to draw my blood. It turns out health care is extremely convenient when you’re paying cash.

“CONTROL IS AN ILLUSION. I learned that the hardest way, by watching my brother BRING A GAMMA KNIFE TO A GUN FIGHT, which is the kind of joke he would have laughed at. And we managed to laugh a lot in those 18 months—THE ONE GIFT THAT CAME FROM THIS NIGHTMARE.”

Grail oncologist Eric Klein, MD, got on the phone to walk me through the science behind the test. Without getting too far into the weeds, he tells me Galleri uses “the same technology that was used to sequence the human genome,” adding it looks for DNA in the bloodstream that’s been shed by a cancer cell. This DNA “tells us two things,” Dr. Klein says: “Is cancer likely present or absent? And if it’s present—with better than 90 percent accuracy—what kind of cancer is it?” (Tests from Grail competitors such as Singlera Genomics, Burning Rock Dx, and Exact Sciences’ Cancerguard use similar technology.)

There’s reason to be optimistic. In October, preliminary results from a major study called Pathfinder 2 were released. This is the kind of legit, large-scale study that might convince skeptical scientists. And the data was pretty convincing: Some 35,000 people had their blood drawn, and according to Dr. Klein, the Galleri test increased the detection of cancers by sevenfold when combined with recommended preventive screenings compared to screenings alone. More than 50 percent of the cancers found by the test were stage I or II, he says, and more important, about 70 percent were stage I, II, or III nonmetastatic—meaning they were potentially curable.

Before you go popping the champagne emoji, MD Anderson’s Dr. Hawk threw some water on those early findings. The New York Times reported that the Galleri test missed 60 percent of cancers that went on to be detected within a year. “It actually kind of found more false negatives than it did true positives,” he says. (For context, Galleri reports a false-positive rate of 0.4 percent, compared with about 10 percent for mammograms, for example).

More studies are underway. Results from the largest of its kind on MCED tests recently found that the Galleri test didn’t reduce stage 3 diagnoses. But some doctors don’t think that’s the end of the conversation for this or other MCED tests, as the study was designed to look at only one endpoint and it may still be valuable for detecting some cancers at other stages. But for now, it’s too early for Dr. Hawk—or Memorial Sloan Kettering Cancer Center’s Larry Norton, MD—to endorse these MCED tests. Unlike long-established screenings for breast, skin, colon, and lung cancer, both say, there’s no evidence these tests reduce the risk of death from the cancers they do find.

medical imaging featuring anatomical views alongside heartbeat graphs

Courtesy Mickey Rapkin

Dr. Norton likens this whole thing to fighting forest fires. “To stop a forest fire, you’ve got to find exactly where it is,” he says. (If it’s not obvious, cancer is the fire.) “And you have to have the tools to put out the fire. Where we are in this field now is, we’re getting very good at sniffing smoke. But finding out precisely where it is—and finding what to do about it—is an evolution.”

And there’s a chance that early detection—without a plan to put out the fire—just gives you more time to worry. To extend the forest fire metaphor, he says, if a patient waited to see flames, Dr. Norton could “send a helicopter with water, and I could put it out. In other words, my intervention would have the same chance of eradicating the problem. It didn’t gain me anything to smell the smoke.”

So, those 22 mostly asymptomatic people from the Prenuvo study? They very well might have found their cancers later and had the exact same outcome. Also, if a test reveals you have cancer—but it’s too early to see where that cancer’s coming from—you’ve really just bought yourself more anxiety. And what good is that?

Still, I couldn’t shake a conversation I’d had with Roger Royse, a start-up lawyer in Silicon Valley. Royse had read about the Galleri test in a book coauthored by (of all people) Tony Robbins. Royse was 62 at the time and intrigued by this blood test purported to screen for so many cancers. He’d previously had some stomach pains, but after those had lessened, his primary care doctor had basically told him not to worry. But Royse dog-eared the page anyway and scheduled the test.

Shortly after his blood draw, Royse got a call from an oncologist telling him the Galleri test had shown a strong signal for pancreatic cancer and that he should seek further testing. An MRI revealed a large mass on Royse’s pancreas, and he was later diagnosed with stage IIB borderline resectable pancreatic cancer.

Royse began treatment at Stanford within days, calling his diagnosis a “four-alarm fire.” He’s in remission now, having beaten the odds. And in September, he testified on Capitol Hill, advocating for tests like Grail’s to be covered by Medicare (which could eventually lead to coverage by other health insurers). Without the Galleri test, “I’d be dead now,” he says plainly. The sad irony, he points out, is that while he beat a notoriously aggressive cancer (thanks to early diagnosis), his brother passed away from a more curable lymphoma after putting off an appointment. Says Royce, “My brother didn’t know he had cancer until he was wheeled into the emergency room on a stretcher.”

When I mention concerns from experts—about unnecessary biopsies and false negatives—Royse doesn’t mince words. “That is such bullshit,” he says. “We have the ultimate false-negative test now. When I went to my doctor, he said, ‘There’s nothing wrong with you. We don’t know why you’ve got stomach pain, but you sure as hell don’t have cancer.’ Talk about a false negative.”

I THINK WE’RE in an era where it’s better to have data than not have data,” says Grail’s Dr. Klein. Considering my own history, I’m certainly not an objective narrator. But I don’t know how anyone over 40 could hear Royse’s story and not want to take the test. Waiting for my own results—and waiting, and waiting—I half-joke to MD Anderson’s Dr. Hawk that there should be a German word for such a convincing anecdote.

He laughs. But MSK’s Dr. Norton is less entertained. “You’re going to hear anecdotes like that,” he says, before countering with his own—about a patient who’d taken a blood test that indicated “potential kidney cancer.” Subsequent imaging revealed a mass on one of this person’s kidneys, and the organ was removed. But the mass turned out to be benign. “Now the patient’s got one kidney,” Dr. Norton says, adding: “The term for that is overdiagnosis.”

“More information is not necessarily better than no information,” Dr. Norton adds, “if that more information doesn’t lead to a productive action but leads to excessive anxiety.”

Courtesy Mickey Rapkin

Jon Rapkin on the new center court in North Caldwell, New Jersey, March 2025. The town dedicated the court to Rapkin because he advocated for improving the town’s parks and facilities to provide better recreational opportunities for all.

Dr. Hawk has come to the same conclusion, and he takes no pleasure in telling me this. If he were in my shoes, he says, he might be tempted to take a test like Prenuvo’s himself. “We’re all rooting for these things to work just as they’re marketed right now,” he says. “But until we really have that solid data showing that more people are benefited than harmed, we’re going to be a little bit reluctant to recommend them to anyone.”

On an intellectual level, he is absolutely right. Both doctors are. I hoped that if anything weird turned up in my scan, follow-up testing would reveal it to be nothing. But I also knew that sometimes, that nothing turns out to be a brain stem glioma, and you watch your brother lose his strength and his independence. Soon, he needs help getting dressed and then help going to the bathroom. His speech, meanwhile, becomes harder and harder to understand, despite his intellect remaining perfectly intact, which is maybe worse. He was trapped in his body.

I was willing to take the risk.

Shortly before the New Year, I got the Galleri results—in an email I almost missed, buried beneath alerts from J.Crew about a year-end sale and instructions from my Airbnb host on what to do with the linens. The report was several pages long, but all I needed was the top line, which read: “No cancer signal detected.”

A week later, I had an hour-long Zoom call with Prenuvo’s Vikash Modi, MD, to go over the results of my MRI. Mercifully, he got right to it: There was no tumor lurking in my brain, no aneurysm, no silent killer. I exhaled deeply.

Nothing would bring my brother back. I knew that too. But I couldn’t stop myself from asking: Could these tests have made a difference? Dr. Klein was quick to respond. There’s something called a blood-brain barrier, he explains, and it’s unlikely a blood test would catch a brain tumor. I asked the same of Prenuvo’s Dr. Modi, and he sighed. “There’s no advantage in playing that game now,” he says kindly. A Prenuvo scan might have revealed the tumor sooner, but because of where it was located, the road was always going to be shit.

“That location is just fucking awful,” he says, apologizing for his language. Frankly, I wish others in the last two years had been so candid. Dr. Modi went on to share some interesting findings from my own scan and blood work (including an asymmetry in my piriformis muscle that I should work on). Halfway through the Zoom call, it occurred to me that I’d spoken with Dr. Modi for longer than I’d spoken with my primary care provider in a decade, which is maybe what you’re also paying for. How do you put a price on compassion?

“Some people are scared to know WHAT’S GOING ON INSIDE THEIR BODY. But whether you know or don’t know, IT’S STILL THERE. The difference is that knowing allows you to understand how PROACTIVE AND SERIOUS YOUR INTERVENTIONS NEED TO BE.”

The one thing everyone interviewed for this story can agree on is that the best way to treat cancer is not to get it. And I wasn’t honoring my brother’s memory by ordering a third glass of wine (my preferred carcinogen). Or getting fat—which I had, putting on almost 15 pounds in grief.

When it comes to health care, the choose-your-own-adventure approach may be expensive, but it’s nice to feel that you’re part of a team. After getting my Prenuvo results—where my blood work revealed a methylation issue that could be worsening my anxiety—I ordered a vitamin Dr. Modi suggested, and I vowed to do the work. While I don’t have the cash to join Love.Life (I wish), I can afford the $299 it cost to swab my cheek and send the sample to 3X4 Genetics, a Seattle-based company that promises to go deep on your DNA, revealing things like how much vitamin D you really need and how well your body tolerates fat and carbs. After reading the data lurking in your code, they’ll upload your results to their app along with personalized health and diet recommendations.

While I was waiting for my DNA findings, I scheduled an appointment to try Guardant’s Shield, an FDA-approved test for colorectal cancer that can be done with a standard blood draw. Nothing is considered as effective as a traditional colonoscopy, but Shield comes close, and it doesn’t require missing a day of work. (Or a messy clean-out.)

Control is an illusion. I learned that the hardest way, by watching my brother bring a Gamma Knife to a gunfight, which is the kind of joke he would have laughed at. And we managed to laugh a lot in those 18 months—the one gift that came from this nightmare, as I put as much work aside as I could, ignoring my friends and my marriage as I just sat with my brother, as he would have done for me if the situation were reversed. And I wish every day that it had been.

I’m still wrestling with a cloud of grief, and I would still rather stay home than talk to anyone. But I’d like to see my niece and nephew graduate from college and get married (or not!) and cheer them on, as I promised my brother I would. And for that, I need to be healthy. And I’m starting to see that fear’s only use is motivation.

As Jonathan Leary, DC, the founder of Remedy Place, a self-care wellness club—with locations in New York, Boston, and Los Angeles—told me, “Some people are scared to know what’s going on inside their body. But whether you know or don’t know, it’s still there. The difference is that knowing allows you to understand how proactive and serious your interventions need to be.”

Mickey Rapkin is a journalist and screenwriter whose first book, Pitch Perfect, inspired the film series. Previously a senior editor at GQ, he has written for The New York Times, WSJ, and National Geographic. He lives in Los Angeles.