Don't call cancer oncology!

"Oncology is good. Cancer is bad"

Natalia Leskova, "Scientific Russia" Photo: Nikolay Malakhin

Chief Oncologist of the Ministry of Health of the Russian Federation,
academician Andrey Dmitrievich Kaprin

– Andrey Dmitrievich, today only a deaf person has not heard about cancer. Did she show up?

– Yes, it has appeared, both among doctors and patients, but we still lack general literacy. Today, you can often hear, for example, the phrase: "He got cancer." You can't get cancer. It's us who are sick of it. Oncology is our specialty, our bride, wife and lover. And a person can get cancer. Cancer is bad, oncology is good. Our main motto now is "Oncology against cancer".

We cannot completely cure cancer today. But we can achieve its transition to a chronic form, cause a long-term remission, when the patient will live a long and high-quality life. All this can be achieved only if there is an oncological attitude in society.

– Is it possible to reduce cancer mortality?

– Now there are more than three and a half million patients with various oncological diagnoses in the country. This means an increase compared to other years. But the increase is due to the fact that early diagnosis is generally improving. We managed to significantly reduce the one-year mortality from cancer, and this is a very important indicator. The number of primary disabilities is decreasing, that is, we are increasingly returning patients to social activity. This is extremely important. An oncologist needs to think not only about saving a person's life, but also about the quality of this life. Yes, he will live. But will he want to? The most important question. It is necessary to treat and rehabilitate in such a way that he wants.

– The increase in the detection of diseases is good. But in terms of mortality, there are countries where these indicators are significantly lower than ours.

– Thanks to modern technical means and constant attention from the Ministry of Health, the situation with morbidity and mortality is constantly monitored in all regions. In no case do we stop, do not calm down. Every week, all leading specialists in the field of oncology communicate online through conference calls held by the Minister of Health V.I. Skvortsova. And we see the most problematic regions. At the same time, there are regions where the situation is getting better every year. A lot depends on the regional authorities. If they are actively interested in oncological programs, find a common language with local oncologists, everything is on the rise: new technologies, new equipment, staff training… In addition, as part of the preparation of the national program, we began to work more closely with the institutes of the Russian Academy of Sciences. We have a very interesting search together with the Institute of Forecasting. Many important and useful tips come from them. With their help, in particular, we calculate cumulative risks, form a territorial approach to programs for regions – after all, the situation is different everywhere, so such forecasts are important.

And as for the comparison with European countries, we do not look so bad against this background. In general, we are almost not far behind. And on some indicators – for example, on mortality from prostate cancer – our indicators are lower.

As you know, screening programs are being introduced in our country for certain types of cancer – namely breast, colorectal and cervical cancer. We expect a significant effect for the early diagnosis of these diseases and the formation of a more complete picture in these nosologies.

In general, our task is to form a positive attitude towards the oncological service. It's already happening. We see thousands of appeals on our website a day after our specialists speak on radio, television, and in print. Cancer alertness can also be brought up with the help of constant reminders about the need to monitor your health, to be examined – fortunately, there are all possibilities for this now. In particular, Open Days are regularly held at our Herzen Cancer Institute, when you can undergo examinations for free and get advice from our leading specialists. To do this, you just need to go to our website and sign up for the necessary consultation.

Let's not forget that in many cases, cancer in the early stages is detected during the medical examination, when the patient still has no complaints.

– You have repeatedly said that there is an acute shortage of oncologists in the field. Is this problem solved somehow?

– Yes, there are still not enough primary oncology rooms. But we have many ways to help oncologists on the ground work more efficiently. We need digitalization of healthcare, which will help to close this deficit with the help of various programs – teleconferences, teleconferences, teleconsultations of specific patients. This should permeate the entire system, make it our national priority.

– A huge role is now being assigned around the world to the development of nuclear medicine, which is especially relevant in oncology. Are there any new developments here?

– It's true, oncology cannot develop today without nuclear medicine. We have considerable experience. In particular, the domestic proton accelerator for medical purposes is the only one in the country so far, installed and operating in Obninsk. Proton therapy is one of the promising types of radiation therapy. The medical beam there acts selectively, hitting the tumor with great accuracy, a gentle way of delivering the beam. A unique device, which has no analogues in the world.

And now we are making a table for him so that he becomes mobile and more accessible for the treatment of other organs, not just the head. This is especially important for pediatric oncology, because this method avoids the treatment of a tumor under anesthesia.

An ion complex is being developed, which is also very promising for oncology. We have won a grant and hope that this type of treatment will soon become available to many patients. Domestic drugs for the treatment of various types and forms of cancer are being developed. They are much cheaper than imported analogues, but no less effective.

Neutron therapy is developing on its own drugs. Three of the world's first pancreatic brachytherapy surgeries were performed. These were inoperable patients who found it difficult to help in any other way. Very good results have been obtained.

– I know that in the practice of oncologists there are difficult cases when it is not easy to identify a tumor. It is clear that in places where oncology may not be developed as well as in Moscow, such patients have little chance of being cured.

– Firstly, we have powerful oncological services in many regions. And they are developing systematically. Secondly, indeed, the problem of rare tumors exists, and therefore, for example, at our institute, we have created a special group on such diseases, and as part of the implementation of the May presidential decrees, reference centers will be formed (diagnostic centers with the ability to provide a second look, including the revision of ready-made drugs-glasses and blocks, conducting a remote consultation), allowing to determine with great accuracy the presence of an oncological process in organs and tissues. This way you can reduce the number of unconfirmed diagnoses and deaths from them.

– Cancer immunotherapy is developing all over the world. And how about us with this?

– The prospects for the development of immunotherapy are huge. A domestic cancer vaccine has appeared, and we are beginning to test it in preclinical studies. This direction should be developed in theranostic pairs: for example, radionuclide diagnostics plus radionuclide therapy.

– Andrey Dmitrievich, you are talking about domestic equipment and drugs, but, as I understand it, the proton accelerator in Obninsk remains an experimental medical development, and the drugs have not yet found their investor. When will all this enter mass healthcare?

– This is not really a question for doctors. We are a research center, we are ready to conduct research, and they have been successfully carried out with us for several years, there are cured patients, excellent results. We continue to expand the functions of our proton accelerator. And if we manage to make a horizontal table, it will be a very important step forward in general. We need to understand: we will not be allowed to conduct research on someone else's equipment. Therefore, we really need our own equipment and our own medicines. We made our 125th Iodine for brachytherapy. Previously, we could use an imported analogue only for brachytherapy for prostate cancer, because it has such an appointment. Now, if a clinical trial protocol has been issued, we can also deal with other locations, because this is our drug, and together with Rosatom we are deciding how to expand its scope of application. So for all medications. We must be masters of our research, of our production. What is it to be good medical customers? This is a situation where I say, "We need to expand the indicators to this," and our pharmacists do. This is how it should work ideally. And then your question will disappear by itself.

– I have no doubt that you want to have domestic equipment and drugs.

– I dream!

– But how much do those who are responsible for making appropriate decisions hear and understand you? It's clear that you don't have a magic wand, and nothing will happen by itself.

– There are responsible people, and, in my opinion, they hear us, but we face problems. One of them is that in recent years we have lost engineers who were involved in medical technology. It is clear that we have worked a lot on defense, and in such a multipolar world it is impossible otherwise, but now such specialists are desperately needed. And we hope that such groups of specialists will be allocated. We heard in the words of our president the task of creating an intersectoral program, and this is nothing more than the creation of our own equipment and our own pharmaceuticals.

– I think that this intersects with educational problems, both in terms of educating oncologists, including primary care, and in terms of educating techies who will produce and adjust medical equipment. Is this issue being solved somehow now?

– Now we are working on this issue with the Department of Personnel Policy and Education, where Tatyana Vladimirovna Semenova directs the program for the education of oncologists. We really do not have enough of these personnel. Now the medical institute has a nine-day course in the specialty "oncology".

– How is that?

– That's it. Then, of course, if a person decides to go to oncology, he will study this specialty in more detail, but if he has not decided, this is such a preparation. It is not surprising that the primary link, district therapists, understand little about this. Now we are solving this problem. Not only I am involved in this, but also our second chief oncologist Ivan Sokratovich Stilidi, head of the Blokhin Oncology Center. As for the training of engineering personnel in the medical field, we are not doing this, but I know that such work is also underway, and a number of technical universities have begun to train such guys. We really need them too.

– I have a rather difficult question for you as a scientist, researcher. It is clear that doctors are fighting cancer more or less successfully, but cancer continues to come. Probably, it would be more effective to influence not the consequences of the onset of the disease, but its cause. And the cause of cancer, as is known, has not yet been identified. Is there any news regarding the identification of the causes of cancer in order to cope with it once and for all?

– Not so much, but there is. Here it is necessary to emphasize how important the prevention of the disease is, and today we know that factors such as excess fatty foods, tobacco smoking, alcohol excesses significantly affect the development of some forms of cancer. That is why prevention and medical examination will be included in the national program for the fight against cancer.

– Genetic predisposition is also important.

– Yes, heredity also plays a huge role in the development of some forms of cancer, and this factor can be monitored, prevent the development of the disease. It is well known that asbestos production, aniline dyes also belong to risk factors.

– A question for you as a urologist. We have repeatedly written that a man from a certain age needs to be tested for prostate-specific antigen (PSA) for early detection of prostate cancer, the number of cases of which is inexorably growing. Very often this indicator is really increased. Then the man is sent for a rather invasive prostate biopsy procedure. Fortunately, cancer is not always found. In some cases, this is benign hyperplasia. After which the person is told: "Keep taking the PSA every six months, and keep doing the biopsy." But many men do not want to do it a second time. But in this way you can miss the cancer that has begun. What should I do?

– These problems have already been solved. We don't start with a biopsy. Experienced and intelligent oncourologists have prescribed a diagnostic standard that begins to take effect when it turns out that the PSA is high. The ratio of free and bound PSA is taken into account. This is an important indicator. Another marker appeared, clarifying the diagnosis. This is PSA 3. There is also a marker that we are now evaluating in a urine test. And now we are putting into practice the prostate health index as a percentage, based on the assessment of three PSA-associated markers. It is published on our website. In addition, we do an MRI before the biopsy to understand where this focus is. It is before the biopsy, because immediately after the biopsy, MRI is sometimes falsely informative. After all, the injury area of the prostate gland may look like a tumor or a tumor sprouting from it.

– But it still doesn't work without a biopsy?

– Ultimately, yes. But we now have so-called scores that allow us to judge the probability of cancer by MRI. If we see a high PSA with a good ratio of free and bound PSA, an MRI that does not confirm the focus, we can do PET-CT with gallium or with choline – drugs that are tropic to prostate cancer. Therefore, now in difficult cases it is possible to maneuver in diagnostics.

– Potential cancer patients are very often afraid of invasiveness during examination, then during treatment, so they often launch themselves.

– Together with the whole world, we are fighting for non-invasiveness in diagnostic and treatment methods. And now a number of procedures are done under anesthesia, and anesthetic aids are very modern and non-toxic. This allows for an informative and painless examination.

– At one time, there were an incredible number of charlatans around oncology offering to treat cancer with some decoctions and conspiracies. And people went to them willingly. How about it now?

– Now there is a large outflow of patients from these pseudo-colleges of ours. And this is due, firstly, to the fact that more and more competent, qualified information is being received on this topic - including from you, the media. We see how trust in oncologists is growing. There are fewer negative materials, and this also makes people believe. Secondly, there are more and more publications about specific cases: they helped this person, another, palliative departments are being opened, people even with terminal stages are not left to fend for themselves. Accordingly, the demand for the services of sorcerers and healers is falling. So, the offer also falls. We hope that due to our normal work there will be fewer of them. Although now there are experimental treatment clinics in the world. We are also planning to open such ones.

– What are the methods there?

– The so-called "Of label". There are various results of molecular, genetic studies applicable to certain models that can be affected by a drug or vaccine. Scientific protocols are important here. Such clinics should operate within the framework of research institutes and centers, this should be done specifically, but there needs to be very strict genetic control over the quality of treatment, individual toxicity.

– Do these clinics use natural oncoprotectors of plant origin, which abound in our pharmacies?

– I think not.

– As an oncologist, do you think that all this has no evidentiary value? Chaga, for example.

– Well, what does chaga mean? To understand how it works, you need to take a group of patients in the first stage of the disease, isolate it and do not treat it with anything else, only chaga. And watch how the tumor process will proceed. And treat the other group with modern methods. And compare the results.

– In relation to people, of course, it is unethical. But we can take the mice.

– You can take the mice. But in this case, someone has to invest a lot of money in the study of molecular, genetic mechanisms in order to conduct a preclinical experiment. Who will do it?

– That is, you have no reliable data here.

— no. Reliable data are not available when clinical studies are not possible. First you need a tumor model, or a grafted tumor in animals, or something else. Then you need to study the toxicity in animals. And then, even when we conduct animal studies, do we have the courage to give chaga to a patient in the first stage who can be operated on and cured? The Ethics Committee will not approve of this. And I wouldn't risk it, for example.

– And if we operate on him and give him chag, we won't know what helped.

– No, we'll know for sure. The one who releases the chaga will not know. It will seem to him that chaga helped.

– It's no secret that oncology is not the most popular medical specialty, because it is difficult psychologically, physically and not always grateful. If you were asked to contact the student medical community in order to motivate them to engage in oncology, what would you say?

– It's easy to agitate when you love your specialty. I always say that there is no such multisectoral direction as oncology in science anywhere else. These are cellular technologies, complex pharmacology, very interesting physical phenomena, radiation technology, and highly professional surgery. If a person, for example, wants to become an oncologist, he will find everything there. This is a multifunctional surgery. Now it is no longer just the removal of the affected organ – it is the creation of plastic replacements, the creation of artificial reservoirs instead of removed organs. The direction of plastic surgery, microsurgery is very interesting, so that the patient can then receive radiation therapy, for example, remotely on a particular organ. And it is also important that you always communicate with very intelligent and educated people. I mean not only oncologists, but also related people who work with us. These are physicists, pharmacists, engineers, programmers, really very interesting interdisciplinary teams that are formed with your direct participation. There you can find a very wide application for yourself. Oncology is an addictive job.

– Inexhaustible, in my opinion.

– Inexhaustible, worthy of respect. And in general, if you are a good oncologist and a decent person, you will always be needed. You will never feel unclaimed. Isn't that happiness?

Portal "Eternal youth" http://vechnayamolodost.ru