Have you noticed on TV the new way of handling flashbacks? No subtleties. No confusion. Rather, an announcement — 3 days earlier, 7 months earlier, 10 years earlier, 5 seconds earlier, and so on. Although too many flashbacks can be annoying, especially if it’s a flashback occurring within a flashback, I still think the definitive times plastered on the screen are helpful.

Recently, I had a “double flashback,” that is, 2 simultaneous events, unrelated except by the clock, each with its flashback best described as “25 Years Earlier.” Let me explain. During the first week of April 2026, I had two 25-year anniversaries.

The first flashback related to medical history made in April 2001 with the drawing of a blood sample on a patient at high-risk for breast cancer who was undergoing a breast MRI for screening purposes. Breast MRI was new at the time, used primarily for diagnostic problems, although asymptomatic screening was being tested (no official guidelines until 2007). But what we did at Breast MRI of Oklahoma, LLC, was unique. Under Institutional Review Board approval, my team started drawing blood on patients undergoing MRI, with a focus on the asymptomatic screener. I felt “risk assessment” to determine who gets an MRI was only half the solution to more efficient use of the expensive test. It took two decades before the radiologic community realized that breast density would be just as good a predictor of MRI benefit as risk levels. Indeed, we drew up a screening score based on both risk level and breast density wherein we found double the number of cancers than had we simply followed the new American Cancer Society guidelines. And, we varied the screening interval from 1 to 3 years, a move that would be validated in a large study in The Netherlands 10 years after our implementation. And, yes, we published this, yet our well-conceived point system fell by the wayside. Bottom line: even using risk and density together end up prompting many extra MRIs and false-positive biopsies.

So…from the beginning (before MRI was available), I promoted the idea of a blood test for screeners that would take us beyond risk, beyond density, and toward performing MRIs only if the mammograms were negative but blood test positive. I got the jump on this idea in 1993 when we invited Dr. Chaya Moroz to OKC to present her data supporting a screening blood test for breast cancer. With mammograms as the only available screening instrument at the time, the need for a blood test was not recognized as there was nothing else that could be done (ultrasound screening was still a few years away). But I recognized the potential immediately, having recently seen Dr. Steven Harms’ presentation in Dallas about the startling findings of what is REALLY in the breast with MRI. The future “father of Breast MRI” made it clear a revolution was on the way, but it would encounter major obstacles due to cost and false-positives.

I saw the answer as being a blood test to accompany mammograms, and if the mammos were negative, but blood test positive, then perform MRI. That simple concept drives most everything I’ve done in my career. So, it was 1993 when I merged the concepts of a blood test and MRI, but actual research could not begin until we had MRI in place (2001). And as soon as our unit was installed, we began the blood drawing research project. I recall that first patient in 2001 (a personal friend) who underwent that first screening MRI and having her blood drawn on the same visit. My reasoning was simple — how can you develop a blood test that is sensitive enough to detect early breast cancer if your gold standard reference of “normal” is mammography? We are trying to IMPROVE mammography, so the blood samples ought to be based on MRI results, that is, what’s REALLY in the breast.

By gradually accumulating quiality samples and creating a comprehensive database, we ended up as the largest collection of MRI-based samples in the world. When word spread of my unique biobank in OKC, we had researchers from all over the US and internationally accessing our supply. Over 2,000 women participated, and with multiple samples generated out of single blood tubes, we were able to distribute well over 10,000 samples to researchers around the world. (Most of the time, the researchers would be attending the mammoth symposium in San Antonio each year, then they would travel to OKC on the way home to validate what we had in cold storage.) The largest shipment was over 3,000 samples to the University of Nottingham where the principal investigator there would ask me every year at the San Antonio meeting: “Have they made a movie of Flatbellies yet?”

When the dust settled, my team had shipped samples to 13 research entities, and had collaborated with shared knowledge in most of these, culminating in formal clinical trials in 3 of them. Relationships were short-lived when the trials failed, but the company I work with now (Syantra, Inc) uses a novel approach, focused on the immune cells of the body rather than the cancer cells. Those companies now claiming success with circulating tumor DNA are not transparent when it comes to early breast cancer where it just doesn’t seem to work. My last several posts have elaborated on why this is the case, but the main point is that the performance characteristics are represented in such a tricky fashion, few clinicians can sort it out. And, heaven help the lay person.

The most popular of the multi-cancer blood tests (up to 100 cancer types at once!) was recently put to the test in a cohort where all 14 early breast cancers found on mammography were missed by the blood test. That’s a zero detection rate that you won’t find in the company brochures. (Some cancer types, did in fact, have helpful results). Another company based on the same science, includes breast cancer in their mutlti-gene profile, but there is a small asterisk — and if you look at the bottom of the page, the asterisk is explained: “Not indicated to screen for breast or prostate cancer.” Wow! The nerve!

Originally, my role for Syantra was generating those blood samples tied to MRI results in patients being screened, that is, doing what I’d done for many years. This meant clinical input as well. As plans were made for extending the clinical trial, the suggestion on the table was that I would serve as principal investigator for the United States (it’s an international trial), but it was not to be. My sponsoring hospital administration was always critical of our work (in spite of $250K generated from the samples), and when COVID hit, they took the opportunity to close down all the non-critical programs, which includes medical research.

My risk assessment/genetics program that included a longitudinal high-risk clinic, was streamlined more than any similar center in the country as far as I knew, including academia where “streamline” rarely exists. I worked with a board-certified medical geneticist, boarded genetic counselor, nurse practitioner/navigator, administrative assistant, and a research breast imaging tech with a lifetime of experience. The entire group was given their tickets home, not allowed to contact our patients to explain what was happening (leaving hundreds of high-risk women out in the cold). And when COVID was essentially over, the phone didn’t ring to call us back, and my far-reaching program, what was once called the “star in the crown” at my hospital, was tossed away — all gone, with hundreds of blood samples left in the freezer.

My consulting work with Syantra, Inc. is, by far, the longest association I’ve had, among the 13 research entities I’ve worked with in the past. A large clinical trial supports the use of the blood test, including my long-term indication for women with dense breasts and negative mammograms. It’s been 25 years since that first patient held out her arm for venipuncture, writing herself into the history books, sort of a silent partner in the war against breast cancer.

Switching Gears – what about the OTHER 25-year flashback? The very same week that Patient #1 donated her blood in 2001, my first novel — Flatbellies — was released by a small sports publisher, with a rapid rise to the top on Amazon Sports, generating such widespread enthusiasm that the novel was picked up by WW Norton & Co (New York/London), and it ended up with a review in USA Today while also named as a Barnes & Noble Hot Book For the Summer. So, why this new 25th anniversay version of Flatbellies?

One of the many surprises that both publisher and author had was the wide demographic net that was cast by the book. Golfer or not. Male or Female. Young or old. It transcended all groupings, and was at one point, placed next to the cash register of every Barnes & Noble in the world. The book was optioned for film on several occasions, each time with total assurance that the story would make it to the silver screen. But the reality was something different. Unexpected issues arose at every turn, and all options were finally allowed to lapse about 10 years ago.

Book clubs, social clubs, student groups, even “industry” groups, all seemed to have the same questions about Flatbellies. And people wanted answers, as if this were a true story. Were these real characters? Did the grain elevator scene really happen? How about the fireworks scene? Is Neander T a real person? And so forth. Another development was the original hardcover publisher going out of business years later, as this put an end to any royalties. But the looming issue was always TV/film, and two screenwriters worked without pay for these same years, trying to make the film happen. But the 2-hour screenplay wasn’t enough to capture the book, as so many things had to be left out. The same two individuals have started working now on an 8-episode teleplay that we hope will help resurrect the plans for a movie.

With all things considered, I decided that a 25th anniversary version should be published, this time anticipating the questions that so many readers have in a 30-page addendum, “The Story of Flatbellies.” The novel remains the same, but inside scoops, backstory, and photographs are added in this high-quality collector’s volume, titled, “the 25th Anniversary Edition of Flatbellies.“

So, if you look at the two unrelated pathways above, I’m standing now near the end of both careers, but still working along both pathways as before, as long as health holds out. And if someone were to ask me, “What did you accomplish during your career?” I’d have to answer: “Which one?” because 25 Years Earlier, I didn’t take the path less traveled….I took both paths.