How to live to old age and not get cancer?

Oncologist and I

Irina Krasnopolskaya, Rossiyskaya GazetaWill a cancer vaccine ever be created?

Which cancers are the most difficult to treat? Where and how are oncologists trained? Is it necessary to follow the example of Angelina Jolie, who suggests that for the prevention of cancer, women should remove not only their breasts, but also everything that is female?... These and other issues were discussed at a round table in the editorial office of Rossiyskaya Gazeta by leading oncologists of Russia.

Photo: Olesya Kurpyaeva

The conversation was not easy. Despite the fact that oncological diseases have been known since ancient times – thousands of years ago people were sick and died in agony from cancer, this disease does not leave us. There is still no complete solution to why, where it comes from, how to get rid of it. From time to time there are sensational reports that a cancer vaccine has been created, or that coffee reduces the risk of getting into cancer tentacles. Or quite the opposite: coffee drinkers are more at risk of catching the disease. Every "oncological thing" becomes hot on the move – so great is our desire to get rid of cancer.

At the meeting in the editorial office, they did not talk about miracles and predictions. They talked about something else: it all depends on when a person asked for help. The tumor detected in the early stages is cured either completely, or proceeds more calmly. For example, breast cancer in the first stage is cured in 90 percent of cases. Pancreatic cancer and esophageal cancer are the hardest to detect and treat.

– Most often people ask where to treat cancer?Mikhail Davydov: Only in oncological institutions.

– But according to the order of the Ministry of Health of Russia, oncological diseases can be treated in any multidisciplinary hospital, there would be surgery there.Mikhail Davydov:

This is wrong. But an order is an order, it is still being carried out. Why? Because there is a certain interest of some structures, including commercial ones, to engage in certain types of treatment of cancer patients. Most often these are surgical methods. Although, as a rule, combined complex treatment is required. It includes surgery, radiation therapy, and chemotherapy. And in each individual case, the question of the sequence of application of these techniques is solved.

– What to do with this order?Mikhail Davydov: It needs to be revised, from my point of view.

But this is my point of view, they may disagree with it.

Anatoly Makhson: It is impossible not to agree with Mikhail Ivanovich. Comparative data on the survival rate of patients treated in a specialized institution and in a non-specialized one differ by 10-15 and even 20 percent. Let's assume that the results of treatment of stomach cancer in the general network are 15 percent worse than those who were treated in a specialized oncological institution.

– And yet a patient with the same stomach cancer is often sent to a regular hospital?Anatoly Makhson: The patient can choose the place of treatment himself.

But earlier there was an order of the Ministry of Health of the Russian Federation, according to which oncological pathology should be treated only in specialized institutions. The whole world is coming to this now. But then that order was changed to another one, according to which an oncological patient can be treated everywhere.

Mikhail Davydov: A certain interest in this problem arose in commercial structures that want to receive money, and they lobbied for this order. There is such a dubious thesis: money goes for the sick. And when the money goes for the sick, the patient himself is no longer interesting. The money that goes after him is interesting. And the struggle begins for money, not for the patient's health. Therefore, those institutions that previously did not take up oncological pathologies are now actively taking up them, trying to treat them. And oncological institutions are inundated with relapses, the return of the disease. And it is much more difficult to treat these relapses.

Anatoly Makhson: Practically it looks like this. The patient was operated on. Further treatment was not properly prescribed. And there are no conditions for combined treatment there. And when complications begin, the patient is referred to an oncologist. But the time is lost. And the operation should be done not just by a surgeon, but by an oncologist.

Vladimir Polyakov: Children are a special contingent of cancer patients.

– By the way, since what year is the children's cancer center being built at the Blokhin Center? More than 20 years? ...Vladimir Polyakov: Construction has been frozen for a long time.

Now we have reanimated this construction site. According to the plan, a 250-bed children's center should start operating in 2017.

– It is believed that cancer is an acquired disease, that it is a gene breakdown. Then how to explain that cancer appears in babies, even in newborns?Vladimir Polyakov: There is a genetically determined cancer in pediatric oncology, in particular brain cancer.

In Russia, up to 5 thousand children under the age of 15 get sick. Under the supervision of about 15-19 thousand.

– When it comes to cancer, everyone feels anxious. But when it comes to the child... A fund is being created, close, distant relatives, acquaintances of acquaintances are being raised. And very often they say: Israel, Germany, China will help you... Is this a medical tourism business? Or are there some types of diseases that are not treated here, but are treated abroad?Vladimir Polyakov: This reminds me of the old days when they said: abroad will help you.

Our forms of treatment, our capabilities practically do not differ from those that exist in developed countries, in the same United States. We suffer in terms of drug provision. We have problems with new drugs, targeted therapy, and so on. Here we are slightly behind. This is especially true for children.

I have visited many countries, I have seen how they treat. In terms of surgery, Russian surgeons have no equal. As for accompanying, supportive therapy, and other conditions... Often they go for the conditions. There are 5 nurses and 4 doctors for one patient. We cannot afford this due to financial circumstances. The results of our treatment are almost close to those given to us by our Western colleagues. Pediatric oncology is more successful in treatment. And the results are much better than in adults. Most of the kids are recovering. More recently, 20-25 percent recovered. Now it's 80.

– Do we have adult statistics? For example, what are the results of treatment of the most common cancers: breast cancer in women, lung cancer in men? What step are we on here?Anatoly Makhson: We are ahead of someone, but we are lagging behind someone.

For example, for breast cancer, Americans give statistics of 95 percent of recoveries. We are 75. It all depends on the stage of the disease. It is necessary to identify the disease in a timely manner, properly treat with modern drugs.

– There is a new drug for the treatment of breast cancer...Daniil Stroyakovsky: There are a lot of drugs now.

If we are talking about her-2 positive breast cancer (this is 20 percent of all breast cancers), then there are as many as three new drugs that are very effective. And the situation in this group of patients could change. The drugs are only being registered. One of them will appear soon. But it will be difficult to get help with these drugs due to their cost.

– Many readers have heard enough, read enough, seen enough stories about Angelina Jolie, who suggests removing everything that is feminine for prevention... Follow her example? There is mass psychosis, there is cancer phobia. There are people who find cancer several times a day and write letters to the editor asking them to send them for treatment. What should I do? On the one hand, a person should be attentive to their health. And on the other?... After all, no car can pass THAT by itself. This should be done only by a mechanic and a specialist.Mikhail Davydov: There is a scientifically based practice, the so-called screening programs, which have been implemented all over the world.

There is no state screening program in Russia yet. This is a very expensive pleasure. There are regional programs that took place with our participation, for example in Tatarstan, about breast cancer. They gave good results. The essence of the programs: examination in certain age groups most susceptible to the frequency of a particular pathology for breast cancer. If a woman has such a cancer in one breast, then she may be shown the removal of the second. Because there will definitely be cancer in the second breast. This is the world practice today.

– Practice or is it an exception?Daniil Stroyakovsky: Angelina Jolie has a hereditary mutation that is rare.

Somewhere in 3-5 percent of women, depending on nationality. More often among Ashkenazi Jews, less often in other national groups. Put genetic screening of all women on stream? Very problematic. Do I need to do this? At what age should I do this? A difficult ethical question.

In women with this hereditary mutation, if it has already been identified and breast cancer has been detected, the question of preventive removal of both glands is justified. But also not always. There is a high probability that there may also be ovarian cancer. Everything is very individual. It should be decided by experienced specialists who are engaged in this. And it is not necessary to screen everyone, especially young girls, for the presence of this mutation. It can ruin their whole life. But if there is a cancer history for mom, grandmother, maternal side, then it's worth thinking about. After the age of 30, the risk is much higher compared to younger women. However, everyone in a row does not need to do this.

Mikhail Davydov: Epidemiological studies have revealed a population in which cervical cancer most often occurs. As a rule, these are women who have given birth a lot – 7-8 births each. This is explained by constant ruptures, inflammation in the cervical area. And when we looked at the population of virgin nuns, it turned out that they, who had not given birth, had cancer of the uterine body in the first place. The highest incidence of cervical cancer in India: not very surveyed population, frequent childbirth, uncircumcised male population, coupled with frequent change of sexual partners.

– Circumcised male population reduces the risk of cervical cancer?Daniil Stroyakovsky: Yes.

– And for men themselves, does it matter in protecting against cancer?Daniil Stroyakovsky: No.

– Are there age restrictions for surgery, for example, breast cancer?Mikhail Davydov: They don't exist.

There are functional limitations. When a person cannot be touched because of concomitant diseases.

– But one of our 76-year-old readers was not operated on...Mikhail Davydov:

It's not age. I operated on patients with esophageal cancer who are 89-90 years old.

Mikhail Lichinitser: Every year there is a Day of struggle against cancer. But it is necessary to fight the disease constantly. Here we are talking about new drugs, whether they exist or not. The main thing is that they are available to everyone who needs, regardless of the place of residence, the thickness of the wallet. And they were correctly appointed.

Have we made any progress in cancer treatment? Definitely. If earlier many wealthy people went to other countries to get treatment, today they are treated here. Now it is very important to create a national cancer center based on the Blokhin Cancer Center. This will help to make effective treatment available not only in Moscow, St. Petersburg - everywhere in Russia.

– What does "national" mean?Mikhail Lichinitzer:

This means answering all questions and solving problems throughout the year, and not just on International Cancer Day. Recently, Davydov and leading colleagues of our center visited an oncological dispensary in Tambov. We conducted master classes. In a day and a half, 14 demonstration operations were performed. The Blokhin Center is able to improve the situation with oncology throughout the country.

– Why doesn't it improve?Mikhail Lichinitser: Not everything depends on the center.

We are doing everything that is necessary to make this treatment affordable, so that it is free. People receive low wages. They are not able to pay for expensive treatment. There is a real insurance medicine all over the world. And the best examples of insurance medicine should be reproduced in Russia.

– We have been talking about this for a long time and constantly. But it's not being done! Insurance medicine does not pay for effective treatment. People cannot be treated for free.Mikhail Lichinitzer: They can.

Take Barnaul, our branches. The regions are doing a lot today. But they need methodical guidance.

– Cancer is a breakdown of the genome. But why does one have it, the other does not?Mikhail Davydov: It happens in virtually everyone.

Only at different times. The more we accumulate centenarians, the more cases of malignant tumors we will have. Everyone lives up to their cancer, there is such a theory. Only some die earlier from other causes – heart attack, stroke. In Japan, cancer mortality is in the first place, because the Japanese live a long time.

27 countries of the world today confirmed: their cancer came out on top, ahead of cardiovascular diseases. Our employee David G. Zaridze participated in the study of the committee of the World Health Organization. We examined 40 thousand patients who died in Barnaul, in the Altai Territory with a diagnosis of acute cardiac vascular death. Only 3 percent of these patients have a heart attack as the cause of death. In Switzerland, France – 70 percent. And our citizens have an excessive dose of alcohol in their blood, both men and women. That is, provocation of cardiac mortality. The hypertensive person drank low-quality alcohol in large quantities and ... provocation: coronary syndrome, death.

– Will there ever be a vaccine against cancer?Mikhail Davydov: It won't.

This is an acquired genetically determined disease.

– Who is at risk first of all?Mikhail Davydov: All people are over 50 years old.

Mikhail Lichinitser: Plus those who have bad habits. 70 percent of lung cancer occurs in smokers. Every year there are 14 million new cases of cancer in the world, and 8 million die from ailments associated with malignant tumors. The Russian government drew attention to the supermortality in the country from oncology. Measures are being taken to reduce the mortality rate to 60 thousand per year. So far, we have 500 thousand new cases of cancer every year. Approximately 300 thousand people die a year from cancer. About 27 percent of them are those who got sick this year. There is only one way to change the situation: early detection, primary and secondary prevention.

– In your opinion, the most evil cancer?Mikhail Davydov: They are all unkind.

There is the worst tumor melanoma. Or, for example, small cell lung cancer. A centimeter tumor, and the patient is all sprinkled with metastases.

– In our conversation, there is no getting around the problem of analgesia for cancer patients.Mikhail Davydov: When I was a resident on duty, they prescribed promedol in any quantity before the operation.

And after the operation, they were anesthetized with promedol. There were no problems – my record, and that's it. Today, the order is different: special commissions are being created, special groups that go to patients and anesthetize patients. The drug trafficking committee dictates.

– Isn't that ridiculous?Mikhail Davydov: We didn't invent it.

Anatoly Makhson: If you take and collect all medical drugs, it will be less than one percent of illegal drug trafficking. Official data – up to one hundred tons of heroin per year. And for morphine, promedol – less than a ton. And we are struggling with this. And the sick suffer.

Vladimir Polyakov: The most important thing is that none of us, no matter how many years we have been working in oncology, including in children's, no one has become a drug addict from these patients. Nobody! Children who have been using drugs for a certain period of time have not become drug addicts. In France, morphine taken by mouth is the norm. No need to give injections. This is a common practice.

– There are about 3-3.5 thousand oncologists missing in the country.Mikhail Davydov: In the regions, people who do not have specialization in this field often work as oncologists, there are many part-timers.

Oncologists are not trained in universities. They are trained at the departments of postgraduate education. All over the world, oncologists are trained not at departments, but on the basis of large specialized centers. There is a more rigid order. Our system is outdated. Doctors cannot be trained formally by giving him a series of lectures and showing him operations from afar.

Oncology is the most difficult of medical specialties. Why? Yes, because all our sighs about supermortality from cardiovascular diseases are outdated. For the last 30 years, fighting them has been a pattern. Stenting, aorto-coronary bypass surgery has been carried out for a long time, there are certain benefits that help prevent a heart attack or stroke.

In oncology, the situation is different. This is a multi-disciplinary giant task. It is no coincidence that either the president or one of the top officials of the state oversees oncology in the advanced countries of the world. In the USA, the director of the National Cancer Institute is appointed personally by the President. And resigns together with the president when the term of office of the president ends. That's the attention to oncology.

THE KEY QUESTION– Can a non-Muscovite be treated for free at the Moscow Oncological Hospital No. 62?

Nonresident patients often ask us about this.Anatoly Makhson: There is a CHI program and every patient can go to an oncological institution and be treated at the expense of CHI funds.

Another question is what level of assistance he will receive with these funds. There are types of assistance that cannot be paid within the framework of the compulsory medical insurance. Then we will use the funds allocated for high-tech assistance. But they may not be enough. Therefore, I repeat, everyone can get free help. But to what extent?

And a patient from another region is generally a whole problem. There is a law according to which everyone can choose an institution and a doctor. However, they forgot to say what it takes for this institution to have the opportunity to receive this patient. Let's take an Oncological center: 1200 beds, All-Russian, treats 15 thousand patients a year. And he can't treat 40 thousand patients, even if he wants to.

The second side of the question. If a person came to the 62nd hospital, we should be able to receive this patient. But 3 and a half million residents of four districts of Moscow are assigned to our 62nd. And it is clear that we cannot refuse our residents, Muscovites. And if a patient has arrived from Tambov, we cannot tell a Muscovite: we will take a resident of Tambov, and you go to Tambov. We are obliged to complete the task that we were given.

If it becomes possible to accept a nonresident patient, we accept him, and the Moscow CHI fund pays for his treatment. Except for chemotherapy, which costs a lot of money. It is not included in the MHI tariffs. The Moscow government allocated separate money and centrally purchased chemotherapy drugs for Muscovites. They cannot reimburse us for chemotherapy from another region. It's not that simple here. Maybe something will change.

Mikhail Lichinitser: Our task is to make the level of medicine the same: in Moscow, in Yakutsk, in Volgograd, in other regions. To do this, you need to have not only technical equipment, but also a professional base. Cadres need to be prepared.

– The patient should not care where he is treated?Mikhail Davydov:

This is a science-based classic. Do you remember in Soviet times, when you were admitted to the hospital, they asked you if you had an insurance policy? No. There was a passport of a citizen of the Soviet Union. And now try to go somewhere without an insurance policy. Who pays? Private insurance companies pay for you. That's the law.

– What is the oncological situation in the new subjects of the Federation – in Crimea, Sevastopol? Is there the same level of diseases there?Mikhail Davydov: The situation there is much worse.

Large financial injections will be required, because there is no material and technical base there. Everything is hopelessly outdated. And you need to prepare personnel, too.

Portal "Eternal youth" http://vechnayamolodost.ru06.02.2015