26 June 2012

Cancer in Russia: the truth from the first hand

Oncological mythology and reality
Cancer mortality in Russia is declining,
but there is no merit of healthcare in thisIndependent Newspaper

David G. Zaridze is a corresponding member of the Russian Academy of Medical Sciences, Deputy Director of the N.N. Blokhin Cancer Research Center, visiting Professor at Oxford University.

It is a common misconception that cancer mortality is increasing in Russia. In fact, the opposite is true: overall cancer mortality is reduced primarily due to a decrease in morbidity, and, accordingly, mortality from stomach cancer. There is no merit of medicine in this – the methods of food storage have simply improved. Now they are stored at very low temperatures, and not in cellars and not with the help of salting. The type of food has also changed in the direction of increasing the proportion of fresh vegetables and fruits. In addition, significantly fewer people live crowded, in communal apartments, which reduces the likelihood of infection with Helicobacter pylori – a bacterium that can cause stomach cancer.

Mortality from lung cancer is also decreasing, most likely due to a decrease in the concentration of tar in cigarettes, and, accordingly, carcinogenic substances as a result of regulations adopted in the late 80s on the maximum permissible concentrations of tar in Soviet cigarettes. However, this decrease is temporary. Further reduction in the incidence of lung cancer depends on whether the prevalence of smoking will decrease.

Mortality from breast, cervical, colon and colon cancer is increasing. In the USA and Western Europe, the incidence of breast and colon cancer is higher than in Russia, but mortality from them is lower, which depends on the stage at which the tumor is detected and the quality of treatment.

The reduction of cancer mortality can be achieved only as a result of the methods of examination approved in controlled clinical trials. For breast cancer, it is a mammographic examination of women over 50 years old, for cervical cancer – cytological tests or screening with the detection of human papillomavirus, for colon and rectal cancer – examination of the rectum and lower part of the colon. The expected effect is achieved only with careful implementation of all components of the examination program. Examination of a healthy person "from head to toe", no matter how attractive it may sound, will not affect cancer mortality.

Annual fluorography, or chest X-ray, does not contribute to the detection of lung cancer. This has been known since the time of Brezhnev's general medical examination of the population. Moreover, our specialists (myself, in particular) revealed that among people who underwent annual fluorographic examinations, the incidence of lung cancer was increased.

The expert Commission "Europe against Cancer", of which I am a member, recommends mammographic examination in women over 50 years old (every two to three years) for the purpose of early detection of breast cancer; cytological screening in women over 25 years old (every two to three years) for early detection of cervical cancer; detection of colon cancer – examination in men and women over 50 years of age (in the absence of pathology – once every five years).

Based on the results of clinical studies conducted in the USA and Europe, experts concluded that the effectiveness of the PSA (prostate-specific antigen) test for detecting prostate cancer has not been proven, and did not recommend its introduction into the mass screening program in Europe. The mass use of the PSA test in Russia is not only undesirable, but also dangerous. Firstly, the incidence of 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 (the life expectancy of men in our country is 63 years). Secondly, the PSA test does not have a high specificity, that is, the percentage of false positive results is high, which is absolutely unacceptable for using this test for mass screening. And finally, the choice of treatment (surgery or 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. Let me remind you that the Russian program offers to conduct PSA testing for all men after 40 years. The described disadvantages of the PSA test do not exclude individual, unlike mass screening, its use in the clinic in combination with other examination methods for the diagnosis of cancer and other prostate diseases.

WHO and the Europe against Cancer Commission recommend vaccination against human papillomavirus (HPV) for girls aged 12-14 years. It is assumed that they have not yet started sexual activity. The vaccine prevents infection with the virus, and does not cure it. Given that there is no experience of HPV vaccination not only in Russia, but also internationally, vaccinated girls need constant monitoring, including screening for HPV infection and cytological examination. It is necessary to restore the system of cytological examination of cervical cancer, the mortality rate from which in our country began to grow after falling for almost 20 years. After all, vaccination against HPV girls will not protect unvaccinated women. 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.

Recently, there has been a lot of talk about oncological alertness. It means that a doctor should suspect cancer in every patient, even if he 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. A district doctor may not meet a single cancer patient for a year. What is needed is not abstract alertness, but a scientifically proven examination program. And, of course, knowledgeable, educated doctors.

Portal "Eternal youth" http://vechnayamolodost.ru26.06.2012

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