Cancer: good news
Optimistically about oncology
Mortality from malignant tumors in the world and Russia is decreasing
David G. Zaridze – Professor, Corresponding Member of the Russian Academy of Medical Sciences,
President of the Russian Cancer Society.
Independent Newspaper
No disease is probably surrounded by such an ominous atmosphere as cancer. But oncology is largely mythologized.
The first myth: cancer is a death sentence. Absolutely unjustified! There are millions of people in the world who have been cured of malignant tumors. Many forms of cancer are curable: cancer of the breast, prostate, colon and rectum, cervix and uterine body. In the USA, 95% of breast cancer patients live for more than five years, and this is the criterion of cure. The five-year survival rate of prostate cancer patients in the United States is approaching 100%. Another thing is that in Russia, the five-year survival rates of patients with malignant tumors are much worse, but not because we do not know how to treat, but because the cancer care service in our country is hopelessly outdated.
Myth two: mortality from malignant tumors in Russia is growing. In fact, it is decreasing by an average of 3.5% per year. So the promise of the Ministry of Health and Social Development to reduce mortality from malignant tumors by 4% by 2012 is easily achievable and does not require any additional efforts. Cancer mortality has been declining for a long time (about 20 years), and primarily due to a decrease in morbidity, and, accordingly, mortality from stomach and lung cancer. Our contribution, I mean doctors and representatives of health authorities, in reducing the incidence of stomach cancer is not. The reduction is due to improved methods of storing food at very low temperatures, and not in cellars (and not by salting), as was done in the past.
As for reducing the incidence and mortality from lung cancer, there was not without science. Based on the recommendations of the international conference "Smoking is the main threat to health" (1986), the State Sanitary and Epidemiological Supervision of the Ministry of Health of the USSR adopted the first maximum permissible standards for the content of tar and nicotine in tobacco smoke. The decrease in tar levels in cigarettes has led to a decrease in lung cancer mortality observed in our country since the mid-90s of the last century.
Myth three: the medical examination of the population will lead to a decrease in mortality from malignant tumors. Medical examination in the form in which it is carried out in our country will not affect mortality. In fact, the general medical examination of the mid-1970s is being repeated. The scientific information received since those ancient times has not changed the ideology of the specialists who are responsible for the oncological service of the country in any way.
Since the last general medical examination, it is known that annual fluorography or chest X-ray does not reduce mortality from lung cancer. Moreover, we have proved that people who have had annual fluorographic examinations have an increased risk of getting lung cancer. However, annual fluorography is still included in the mandatory list of medical examination measures.
Recently, they have been talking about "oncological alertness" again, meaning that a doctor should suspect cancer in every patient who came to him with a cold, with a broken arm or leg. I should note that, unlike the entrenched view, cancer is a rare disease. About 400 people per 100 thousand people get sick a year. So a district doctor who sees two orders of magnitude fewer patients a year may not meet a single cancer patient during this time. What is needed is not an abstract "alertness", but a scientifically proven screening program.
The mandatory list of medical examination measures includes annual mammography for women over 40 years old. However, the expert commission "Europe against Cancer" recommends mammographic screening of breast cancer for women over 50 years of age and no more than once every two to three years. The medical examination program of the population suggests testing for PSA (prostate-specific antigen) for all men from the age of 40. But, firstly, the effectiveness of PSA screening to reduce prostate cancer mortality has not been proven, and accordingly this test is not recommended for prostate cancer screening. Secondly, the mass use of the PSA test in Russia is not only undesirable, but also dangerous.
The death rate from prostate cancer in Russia is much lower than in the West. Russian men, for the most part, simply do not live to the age when prostate cancer develops (let me remind you that the average life expectancy of men in Russia barely exceeds 60 years). The PSA test does not have high specificity, that is, the percentage of false positive results is high. And finally, the choice of treatment (surgery or observation and wait-and-see tactics) of small prostate tumors detected during screening requires considerable experience, which cannot be expected from a urologist who rarely meets with this pathology. As a result, as it was in the 80s - 90s in the USA, there are crippled men operated on without sufficient reason for this. The described disadvantages of the PSA test do not exclude its individual (as opposed to mass screening) use in the clinic in combination with other examination methods for the diagnosis of cancer and other prostate diseases.
Now – about vaccination against human papillomavirus (HPV). WHO recommends vaccination of girls aged 12-14 years. Given that there is no experience of HPV vaccination (not only Russian, but also international), vaccinated girls need constant monitoring, including screening for HPV infection and cytological examination. HPV vaccines are very expensive (as always, they are much more expensive in Russia than, for example, in the USA).
In my opinion, with vaccination, it would be possible to wait until vaccines become cheaper. Moreover, there are big priorities. Namely, it is necessary to restore the system of cytological screening of cervical cancer, the mortality rate from which has begun to grow in our country (after falling for almost 20 years). Cytological screening has practically reduced the mortality from cervical cancer to zero in countries where it was carried out according to all the rules, for example, in Finland.
Portal "Eternal youth" http://vechnayamolodost.ru24.03.2011