Cancer: who is to blame and what to do?

Alexander Panchin: "Cancer treatment and placebo medicine are incompatible"

Yulia Suntsova, Novye Izvestia

The prevalence of cancer among Russians has increased by almost 40% in a decade. 3 million 762 thousand people live in Russia with a diagnosis of cancer – for comparison: this is a third of Moscow or two Novosibirsk or three Kazan. What is the reason for the increase in morbidity and how is science fighting cancer today?

This is an interview with Alexander Panchin, Candidate of Biological Sciences, member of the RAS Commission on Combating Pseudoscience, winner of the Enlightener Prize.

– Alexander, how close are scientists today to the "pill" for cancer?

– Cancer, malignant formations are not just one disease, it is a combination of a large number of very different diseases associated with the fact that certain mutations occur in cells that are intensively divided in different tissues, in different organs. Depending on which cancer is detected, which genes are broken in the cells that have become cancerous, and where these cells are located, various methods of treatment are used.

I must say that today we are seeing huge progress in cancer therapy, completely new approaches have been applied. Some oncological diseases have already been successfully treated. In my opinion, the most promising methods are based on the use of gene therapy. How does it work? Copies of the same genes are delivered to cells with broken genes that have become cancerous with the help of viruses. Thus, programmed cell death occurs at the sites of neoplasms – selectively cancer cells kill themselves.

In another method, cells of the human immune system are used, they are taken out into a test tube, supplied with some receptors, and, thus, they are endowed with the property of recognizing specific cancer cells in a particular patient, for example, with leukemia. The improved cells of the immune system return to the patient, they find cancer cells and destroy them. This method already has successful clinical research results. But it is still very expensive to use, because it is based essentially on the fact that an individual medicine is being developed for a specific patient with a specific type of cancer.

– Will we ever be able to completely stop cancer, or are all methods only about increasing the life expectancy of a patient with the disease?

– We would like to completely cure all types of cancer. But the process of the appearance of cancer is an evolutionary process that constantly has some probability of occurring in our body. Our cells divide, the genetic material doubles, the doubling of the genetic material is associated with errors in this copying, which causes mutations. Most often, these mutations do not lead to anything, but since there are trillions of cells in the human body, a certain set of mutations may appear in some cells that cause cancer.

Because of this mutation, cells begin to divide more actively and become more adapted to life inside our body and can, for example, learn not to trigger programmed cell death in themselves, which is an important natural anti-cancer mechanism, or they can learn to avoid cells of the immune system, which is just engaged in identifying strange, alien mutant cells and destroys them. Cells with mutations can still learn to make vessels grow better to them in order to get better nutrition. Cancer cells are highly adapted parasites living inside our body. There have even been examples in the animal world when this adaptation has reached the point where cancer cells have gone beyond the body of the organism. To date, venereal sarcoma of a dog has been identified – this is a cancer that is sexually transmitted in these animals. A unicellular organism turned out to be a unicellular parasite. The same story was with the facial tumor of the Tasmanian devil – also cancer, which is transmitted this time through bites from one individual of the Tasmanian devil to another. This is exotic, of course, but the examples actually show that cancer cells evolve so much that they can go beyond one organism (which has even died a long time ago), and live and multiply further and infect others.

No one has ever seen infectious types of cancer in people, so there is no need to be afraid of cancer patients and think that one of them will infect you.

– What is the reason for the growth of detected oncological diseases in Russia and in the world?

– You correctly focused on detectability. Not only in Russia, but all over the world, there is an improvement in diagnostic tools and methods for detecting cancer, which were previously unavailable, but are now being used, and people are being diagnosed with diagnoses that could not have been made before. The point is not that people have become more likely to get cancer, but that doctors have begun to understand more precisely what is happening to this or that patient, why the patient is dying.

A side effect was the problem of excessive diagnostics. Mass screenings are becoming popular in some countries. Mass screening increases the likelihood that a person who does not actually have cancer will be diagnosed with such a diagnosis. The tumor may be benign, but a person is prescribed hard–to-tolerate therapy, treated just in case - and there are already a number of such cases. There are a lot of difficulties in the diagnosis of cancer – there are obvious cases, but it is often very difficult to establish whether it is cancer or not cancer.

– They began to talk a lot about the psychosomatics of cancer. An army of specialists or pseudo-specialists are exploring this area. Do you believe in the psychosomatics of cancer? Is it true that people with a certain set of personality traits, character traits may be more susceptible to the disease?

– There is no scientific evidence that oncological diseases in humans are somehow related or caused by some psychological processes. Oncological diseases have an objective cause – these are cells that divide intensively due to mutations. Can a good attitude undo these mutations? Somehow it seems to me that there is no. Studies do not confirm this.

Unfortunately, the absolute "positive thinking", which is very much loved by supporters of alternative medicine, on the contrary, increases mortality in cancer patients. Patients, instead of being treated when it is shown to them, go to healers, to hypnotherapists, neglect normal treatment, lose precious time and find themselves at the point of no return. Placebo medicine really gives people effective methods to improve mood, but it does not affect the treatment of cancer itself in any way. I am skeptical about these trends.

– Cancer was detected, the diagnosis was announced, the patient reconciled with it, the second stage begins – the fight against the disease itself. Does psychosomatics play a role from now on?

– The right attitude for a sick person is very necessary in order to gather strength, thoughts and go through all the difficult medical trials, and in this sense, psychological comfort and support of loved ones are necessary for a person. It is important that he consistently takes all the necessary medications, does not skip therapy courses, is able to cope with stress – there are many psychological aspects. But this attitude itself does not kill cancer cells.

– Carcinogens No. 1. What is it possible for a person to do to avoid cancer?

– Quit smoking.

– That's it?

– This is the most well-studied example. Everything else against this background is of little importance.

– But what about different radiation, food additives, vegetables grown on nitrates-nitrites and other fertilizers, exhaust gases, ecology, which everyone trumpets as carcinogens?

– Cancer is a disease that occurs due to a certain set of mutations in genes. It can be said that excessive alcohol consumption, excessive consumption of very hot drinks may be associated with a side risk of esophageal cancer. Cells die due to strong exposure, neighboring cells begin to divide more actively, and active cell division is a source of new mutations, which can become a factor in the appearance of some diseases. But even in these cases, compared with the same smoking, cancer risks are not so pronounced here.

In general, I must say that people now live as long as they have never lived before, and the search for some terrible things everywhere is incomprehensible to me. We live in the safest time in the history of mankind from the point of view of everything: the risks of infection, poisoning, and something fatally ill.

– If parents or grandparents had cancer, how likely is it that the child will get sick? What role does heredity play in oncology?

– On the one hand, the appearance of a specific oncological disease is a sporadic, random process, in some one cell it so happened that a certain number of mutations occurred. But in some cases, we can see a genetic predisposition to cancer. It is associated with the breakdown of genes, for example, related to DNA repair, or the breakdown of genes that limit the growth of excessive cell division under certain conditions, that is, then there are too many divisions. In these cases, mutations are associated with an increased likelihood of cancer, despite the fact that the person as a whole exists normally. Genes in which mutations are associated with an increased risk of breast cancer have been sufficiently studied. Angelina Jolie underwent a mastectomy – there were many cases of breast cancer in her family on the maternal side, which increased the likelihood of breast cancer at the gene level in her.

– Do you believe in the hypothesis that as soon as we defeat cancer, a new incurable disease will immediately replace it. Cancer is a disease of civilized countries where medicine is highly developed, high–tech care is provided to the patient, a person lives longer, survives those diseases in which he did not survive before, the population of the planet as a whole is aging. Accordingly, the balance between those unable to reproduce and fertile individuals is disrupted, and nature triggers some kind of evolutionary leveling mechanism to preserve the population?

– Nature has no design, nature is not intelligent. There are principles of natural selection, when the fittest survive in certain conditions and leave more offspring. This is the basis of ordinary biological evolution. And then we can talk about the mechanisms that affect the population size, about positive and negative feedback in ecosystems. An example of negative feedback: the human population has grown, but because of this, some virus that has arisen in it spreads more easily. You have a person who lives alone in a hundred square kilometers – here he sneezes and does not infect anyone. But if you have a density of two people per square meter, then it is very likely that he sneezes and infects someone else (I exaggerate, but the essence is clear). The point is not that nature invents epidemics to combat the overpopulation of the planet, but that in overpopulated places the probability of certain diseases increases due to natural causes.

– But in the first world countries, cancer is more common. Is it really about the perfection of diagnostics again?

– With age, the risk of cancer increases. The longer you live, the more cell divisions there are in the body, the more mutations there are in them, the more likely it is that you will have cancer somewhere. As a result, in a country with an average life expectancy of 30 years, residents will almost never die of cancer, because no one will live to cancer. But if the average life expectancy in your country is 80 years, then a lot of people will die from cancer, because the cells of their bodies will accumulate a critical number of mutations in the genes that form cancer.

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