The Russian oncologist-innovator told whether it is possible to see cancer in time, who can do it and how, whether it makes sense to collect millions of rubles for treatment, is there a chance to survive.
"Cancer of the poor" and "cancer of the rich", "the disease of offended people" and the ancestral curse. All these are not myths or fairy tales, but a harsh reality that every third Russian will face. After this interview, your life will not be the same: someone will think about their lifestyle, someone will start convulsively undergoing oncotests, and someone - it is possible - will give up and start enjoying every day they have lived. About why the death of Zhanna Friske was a foregone conclusion, because of which Russia will never get rid of the "Apanasenko syndrome" and why everyone needs to do three things right tomorrow - oncologist, candidate of medical sciences Pavel Popov told in an interview.
Pavel Borisovich, the first question is the simplest and most difficult at the same time: why does cancer arise?
- I am of the opinion that cancer is a self-destruction mechanism. Nature has created many such mechanisms, including atherosclerosis, diabetes mellitus, and many other diseases. The evolutionary feasibility of such a mechanism lies in the fact that it allows the change of generations and reduces intraspecific competition. Nature is interested in subjects of active reproductive age, and as soon as this age ends (for humans it is 30-40 years old), a timer is turned on, which begins to implement the genetic mechanism of self-destruction. Therefore, the percentage of malignant tumors begins to increase like an avalanche after 40 years. In the language of science, this is called "phenoptosis" - the hypothesis of programmed death.
Has science reached a consensus about the causes of cancer? Or is this just one of the hypotheses?
- In science, by definition, there can be no consensus, otherwise it is not science, but religion. But the facts that are now known allow us to substantiate the opinion that I expressed - this is phenoptosis. You can disagree with him, you can criticize him, but there is no such criticism that could completely refute him. This is indicated at least by the fact that oncogenes - DNA fragments that encode products needed for the formation of a malignant tumor - are also involved in other biological processes. Without them, the human body would not have developed from the very beginning.
This means that the entire mechanism of carcinogenesis was created by evolution on purpose. At least the pre-existing notion that cancer is the result of an accidental genetic malfunction does not hold up to scrutiny. In order for a cell to become malignant, six mutations must occur in it in succession, which is impossible from the point of view of the theory of probability.
If we agree that nature regulates the number of individuals beyond reproductive age, then why is cancer so common in young people, in children? There are a lot of examples …
- Here you have to understand that only certain types of cancer have become younger. For example, cervical cancer has rejuvenated because it is directly related to the human papillomavirus (HPV). Since people enter sexual activity much earlier than, say, 30-50 years ago, and maintain many chaotic relationships, many women become infected as early as 15-17 years old. For ten years, the virus is guaranteed to launch the genetic code of cancer, and if you add this period to the average age of onset of sexual activity, then we have the incidence of cervical cancer among women under thirty. For cancer of the stomach, breast, the average age of its manifestation (manifestation) remains approximately the same as twenty years ago.
And one more thing: the development of medicine has led to the fact that we have practically eradicated infant mortality. As a result, natural selection no longer works during the birth and rearing stage. Even over the past ten to twenty years, medicine has made a big leap forward, and now even the most unviable babies are being nursed, which has significantly changed the structure of the population.
There is a paradox: the higher the level of development of medicine, the lower the health of the nation. By eliminating the factors of natural selection, we create bio-negative selection, as these children survive to adulthood and leave offspring.
It sounds harsh, but the high infant mortality rate in the early 20th century meant that adults were generally healthier.
In addition, the structure of population mortality has changed. In the first half of the 20th century, the main causes of death were infections, hunger and war injuries, respectively, the proportion of cancer was several times less. Today, lethal factors such as infections, hunger and war injuries are minimized in developed countries, and their place is taken by cardiovascular diseases and cancer. In countries with a low standard of living, people continue to die mainly from infections, hunger and war.
The conclusion suggests itself that common forms of oncological diseases are provoked by the development of medicine. Let's fix this. The question is different. People are very afraid of cancer, so they come up with all sorts of myths that somehow explain its appearance. For example, "cancer is a disease of resentful people." Can thoughts, actions, moods provoke thought cancer?
- Unfortunately or fortunately, we do not have so much power over our body that we can prevent cancer or cause it with the power of thought or something else. Only the genetic constitution and a number of different factors are at work here. In fact, oncology is an illustration of the popular wisdom about "the kind is written." Cancer can be predicted: for example, if previous generations suffered from oncology, then, most likely, phenoptosis will work in descendants in a similar way. But at the same time, there is no guarantee that atherosclerosis will not work earlier. But the person has no power to choose the ending. Unless he is an alcoholic or drug addict, that is, he wants to destroy himself long before his cancerous phenoptosis works.
As for the “offended people”, let's see who we usually get offended. These are people after forty years with a midlife crisis syndrome - they are the ones who fall into the age category when phenoptosis begins to work. And if our pessimistic friend in his forties dies of cancer, then a person who is far from medicine and science can connect these two factors.
Does the psychological attitude somehow affect the outcome of treatment? This is also a popular myth: believe in the best and you will be cured. And if he did not recover and died, then he gave up
- My experience with chemotherapy has shown that if a person is at the stage when the generalization of the process has begun, then neither diet, nor lifestyle, nor psychological attitude can change the inevitable ending. Alas. Moreover, the treatment that is sometimes used in the hope of a miracle is more likely to bring the end closer than to delay it. When Zhanna Friske went to America, I already knew the end of this trip and even predicted when everything would be over. No magic: there are statistics on how long the patient lives after being diagnosed with glioblastoma. A year or two, depending on how he was treated.
By the way, by the way, about Zhanna Frisk. After her death, there was another outburst of myth-making: even the federal press began to use the terminology "cancer of the rich" and "cancer of the poor" - they say, it's all the fault of expensive anti-aging procedures
- “Cancer of the rich” and “cancer of the poor” certainly exist. Only it is expressed exclusively in how the patient will feel during the illness. A rich person can afford expensive treatment, decent care, some last joys in life. And the poor one is not. But the ending will be the same for both, believe me. If this cancer is generally treated, such as basal cell carcinoma (one of the types of skin cancer - ed.), Then the poor will be treated according to the policy “cheap and cheerful” - short-focus X-rays, and the rich will pay for photodynamic therapy from their own funds. But if the problem does not have a solution within the boundaries of scientific knowledge of today, as is the case with pancreatic cancer, then the rich will not be able to "buy off".
Remember Apple founder Steve Jobs, all his fortune did not help him to overcome the disease.
What about food and bad habits? Every now and then the Internet publishes lists of "carcinogenic" products - it's scary to read
- Nitrite, which is a must-have in sausages, doubles to threefold the incidence of stomach and colon cancer. So it is not safe to eat smoked meats and sausages every day. Products of intensive frying in fats cause about the same harm. If we talk about vegetarianism, then those who do not eat meat are much more likely to develop stomach cancer against the background of gastritis. Yes, vegetarians are more likely to have gastritis while consuming plant foods that do not contain buffer proteins that neutralize the effects of acids on the mucous membrane. But there is a nuance: those who do not eat vegetables at all are more likely to get colon cancer.
With a low content of dietary fiber, problems with stools and chronic colitis occur, which is also a background for the formation of malignant tumors in the intestines. However, one must understand that this probability is not very high. I'll tell you honestly: you shouldn't bother so much about food, its harmfulness and usefulness. There are no products that can insure you against cancer. And there are no ones from which cancer is guaranteed, if you observe moderation in your diet and make yourself a balanced diet. And, of course, statistically, lung cancer occurs more often in smokers. Make a choice.
Being overweight is also called one of the factors causing cancer. It's true?
- They do, yes. However, there is no reliable relationship. Within their age group, thin people get sick just as often as overweight people.
Oncologists voice the same idea: cancer is curable, but in the early stages. But it is rather difficult to identify it at these stages. What's the difficulty? Lack of diagnosis or frivolous attitude of people to their health?
- Oncologists are absolutely right, cancer is indeed curable at an early stage, only they slyly keep silent about what stage it is and what is meant by a cure. If we talk about a complete cure, then cancer is 100% curable only at the zero stage (non-invasive cancer), when the tumor is a thin film within the upper layer of the skin or mucous membrane. The thickness of such a film is less than a millimeter. And already at the first stage of cancer, when the tumor grows only a few millimeters deep, the process of dissemination begins - circulating tumor cells appear in the blood. Some of them are parachuted from the bloodstream into the tissue of the lymph nodes, liver, lungs, bones, brain and create new colonies there - micrometastases, which are so small that they cannot be detected during routine examination, for example, with ultrasound or computed tomography. According to my data, melanoma is in the lead (because of the high lethality, skin melanoma is called the "queen" of malignant tumors), even with a thickness of 1.6 mm, micrometastases are present in every fifth patient.
So, when they say that cancer is curable at the first and second stages, it means not a cure, but remission - a light interval from 1 to 5 years (as anyone is lucky), after which in 80% of patients the disease resumes in the form of growing metastases, and everyone knows the ending. And at the "zero" stage, cancer does not bother the patient and he does not seek help.
The statistics I have collected say that more than half of patients seek medical help in advanced stages. Although it is not difficult to make a visual diagnosis, outpatient doctors, who are the first to see patients, rarely recognize this tumor even at stages 1-2, not to mention "zero".
I have seen cases when a local therapist mistook a palm-sized melanoma for a birthmark. This is due to the low level of professionalism.
If this is the case with early detection of cancer of external localization, then it is surprising that cancer of the esophagus, cancer of the stomach or other internal organs is detected deliberately late: such a tumor at an early stage does not cause any inconvenience to the patient and can only be detected by chance, during endoscopic examination … But which of us just goes to endoscopy once a year? Nobody.
What about tumor markers? Will they help detect cancer?
- Firstly, tumor markers are not early means of tumor detection. I think that this type of diagnosis works when it comes to dissemination (spread - ed.) Of the tumor. According to my data, in 80% of cases, an elevated tumor marker of melanoma indicates precisely tumor dissemination. However, there is a benefit from this tool, as it allows you to evaluate the treatment process in dynamics, to see if the tumor is progressing or the treatment is moving towards remission. But, for example, in prostate cancer, the PSA tumor marker allows detecting prostate cancer earlier than ultrasound does.
Is it difficult to detect a tumor in the early stages only in Russia with our diagnostic system? Or in other countries too? Do you have statistics?
- In general, oncological statistics in Russia are the most dishonest due to a number of circumstances, and we, oncologists, know this very well. The percentage can be underestimated at the request of the regional or city administration to demonstrate the success of officials in the fight against cancer.
I know of a completely anecdotal case in which a high-ranking official ordered the deaths of cancer patients to be recorded at affiliated funeral homes in a neighboring region in order to demonstrate a decrease in mortality in his, allegedly as a result of skillful health management. Everything was fine until a scandal broke out in the neighboring region: there the death rate doubled!
Foreign statistics in this sense are much more honest. In America, with all its diagnostics and treatment, 95% of cases die from esophageal cancer. The reason is the same as ours - late detection. This is an international problem. And this is due not so much to the development of technology as to the mentality of people.
The average Russian goes to the doctor when something hurts him, few people are engaged in the prevention of their health.
In Germany, due to voluntary medical examination, there is a statistically more detected cancer at an early stage, and the highest percentage of remissions for stomach cancer is in Japan - they buy a gastroscope for a family. Do you know people who would go to the doctor, regularly undergo gastroscopy, colonoscopy, bronchoscopy?
In Russia, the prevention is as follows: they distribute brochures in polyclinics, which describe the symptoms of cancer - weight loss, poor appetite, constant pain. A person with oncology has something in pain and is losing weight, which means that the disease has gone too far. And it is no longer necessary to go to a doctor, but to a priest.
There is an opinion that Israeli clinics are actively lobbying, noting that Russia has outdated treatment protocols, and there is a problem with diagnostics. What do you say about this?
- I have never seen more outdated treatment protocols than in Israel. Here's a good example: in 2004, a patient came to me for a consultation regarding colonorectal cancer. We recommended removing the affected intestinal area and conducting chemotherapy according to the most modern scheme at that time. The patient, believing that they would not advise anything good in Russia, flew to Israel. There he was operated on and was prescribed chemotherapy according to the old scheme. When the patient showed the Israeli oncologists my recommendation, they told him that they were treating according to their standard, and the recommended Russian scheme in Israel is still undergoing clinical testing.
The situation is similar with the treatment of melanoma in Israel. Even for melanoma with a Breslow tumor of more than four millimeters, they offer a wide excision. So that you understand, the peculiarity of melanoma is that when its thickness reaches four millimeters, the likelihood of micrometastases in the body is more than 80%. And as soon as we excise the tumor, their rapid growth begins and the patient dies in two or three years, or even within a year after the operation. This explosive metastasis can be prevented with the help of photodynamic therapy developed in Russia, which is still not in the standards of Israeli medicine.
In general, if we compare Russian and Israeli medicine, then our diagnostics and treatment are in no way inferior to foreign analogues.
It is another matter that the budget of the chemotherapy departments does not allow treating all patients with drugs of 200-300 thousand per course. But if a person has money for treatment in Germany or Israel, he can buy medicines at his own expense and drip them into a vein in Russian clinics, which will ultimately be cheaper, since living in a foreign clinic costs a lot of money, and the prices for instrumental diagnostics for example, computed tomography, just fabulous.
But after all, those people who have been rejected by domestic medicine often go to Israel and Germany …
- I refused because nothing can be done. Do you know a lot of those who recovered in such a situation and lived happily ever after? Let's at least remember the celebrities who, with a lot of money and connections, left for treatment in foreign clinics. Alexander Abdulov, Mikhail Kozakov, Raisa Gorbacheva, Zhanna Friske - not a single one has been miraculously cured. Nor are they among those patients with advanced cancer who collect money on the Internet for their treatment.
Simply because it is useless, unfortunately - in the last stages, cancer cannot be cured. It is impossible not only to change the ending, but often even to postpone it.
Here is an example from my practice: relatives of a patient with stomach cancer, whose metastases have fused the entire intestine into a tight cocoon, the so-called peritoneal carcinomatosis, turned to me for advice. My verdict: symptomatic therapy and adequate pain relief are all that can be done to help him. In search of the last hope, the patient's spouse turned to an Israeli clinic, where, after examining the discharge documents, she was cheerfully told: "Bring it, we will treat it." Examination, analyzes, etc. cost fifteen thousand euros, one chemistry course - the same amount. The patient became worse, and then the cheerful Israeli doctors advised his relatives to take him home to die while he could still move, since it would cost more to transport the "200 cargo".
Another example. A patient with melanoma of the lower third of the trachea, which was abandoned by German doctors, after using photodynamic therapy in Russia, went home after surgery. The problem, a dead end for German oncologists in the hospital, was solved in our clinic on an outpatient basis, with minimal costs!
Recently I read about a project that seemed interesting to me: you take a test that, taking into account all factors - age, bad habits, heredity - determines how likely you are to get cancer. Then you install the application on your phone and, according to the test results, you receive reminders. Does it have an effect?
- The probability of dying from cancer is 30% - this is the overall statistical probability. In people with increased risk factors, this probability is higher, but even with the worst heredity, it cannot be said that the probability will be, for example, 50%. It just increases the likelihood that atherosclerosis is not the cause of your end. This means that no online tests can even approximately determine what your personal likelihood of getting cancer is. And even more so, no application will diagnose you - only a highly qualified specialist. The latter is key because the outpatient doctor may miss early cancer.
Of course, there is a lot of speculation on the topic of early cancer diagnostics - all kinds of programs, applications, diagnoses from photographs. But all this is in a sense a profanation, because a well-trained oncologist will be able to make an accurate diagnosis in a minute with 98% verification. And the most sophisticated computer with a digital camera makes a diagnosis from a photo with 50-70% verification and spends an order of magnitude more time on it.
Well, well, if things are going well with diagnostics and treatment in Russia, then with palliative care, it is absolutely a disaster. There are still no federal programs to support hopeless patients, there are very few hospices. What do you think will change in this direction?
- Honestly? Nothing will change. Firstly, no budget provides for an item "helping the dying" - it is too expensive. Secondly, the topic of death is still absolutely taboo for our society. People simply don't want to know that 4 out of 5 cancer center patients will die within a few years.
Until recently, as you remember, the patient was not even given his diagnosis. Even now, when the patient is asked how long he has left to live, some oncologists shyly turn away. So that the issue of supporting hopeless cancer patients is resolved at the federal level, so that comfortable conditions are created for them, an appropriate atmosphere that should be in a hospice, it is necessary to start directly and bluntly discussing death issues.
And what do you usually advise your relatives, whose loved ones will soon die?
- It often happens that you look at tomography, analyzes and you realize that the patient has less than a year left. No amount of treatment will help, wherever it is. I could say to the patient's relatives: "Take him to rest in Antalya or the Maldives, while the person is active and can enjoy the world around him, because further is the famous ending." But I know that my words will not be heeded. They will be dragged to other doctors, magicians, wizards, taken to Israel. In due time, a person will still die and they will not even be able to extend his life.
But aggressive methods of treatment can add torment to an exhausted person. In the terminal stage, a person does not need anything other than painkillers. But before going to bed, the incurable patient has six months or a year in reserve, when he is still somatically active and the symptoms of the disease do not overwhelm him. Therefore, I recommend the patient to put in order the postponed affairs, to communicate with close people with whom the patient rarely saw.
But people rarely heed my advice and spend the rest of their lives in clinics for useless and painful treatment.
By the way, about pain relief. The term "Apanasenko syndrome" has already appeared, when a person commits suicide due to the fact that he could not get pain relief. After a series of such terrible cases, officials announced that they would try to solve the problem, but literally in August there was a wild story in Chelyabinsk, when patients of pediatric oncology could not be provided with morphine. Is there anything being done to solve this problem?
- Nothing. Neither after Apanasenko's suicide, nor after other cases, the procedure for issuing painkillers has not changed. This is due to a contrived system that supposedly should prevent these funds from entering the black market. But all over the world, doctors who have diplomas and practice have the right to prescribe such drugs. There are violations, but they are few: after all, doctors for the most part are responsible and decent people. If it were possible to return such a system (and it once was), there would be no such cases as with Apanasenko. But I do not believe that the Federal Drug Control Service will allow this, because it is easier to twist the arms of doctors than to cut off a billion-dollar drug traffic.
That is, there are still stories about how relatives of cancer patients buy heroin from gypsies?
- Anything can happen. But mostly a person groans in pain, and his relatives go crazy.
What a nightmare. Better tell us what to do to avoid such a fate
- First, don't panic. Carcinophobia is also an extreme, there is little benefit and joy from it. Remember that the highest incidence of cancer occurs after age 60. This means that if you are young, you should not constantly exhaust yourself with examinations without special indications. If there are indications (bad heredity, background diseases of the gastrointestinal tract or respiratory tract), it is advisable to undergo gastroscopy or bronchoscopy once a year. And a colonoscopy if there is a family history of colitis and colon cancer. Everyone else can be less often.
Women should visit a gynecologist every six months and require an extended colposcopy of the cervix - it's like "Our Father". If there are any neoplasms on the skin or mucous membranes, you must consult a doctor, and only highly qualified. For women over 35, it is advisable to visit a mammologist and have a mammogram once a year. Cancer prevention brochures often recommend self-diagnosis - that is, palpate the breast yourself. However, retrospective analysis shows that there is no sense in such a diagnosis. For men over forty, I would recommend taking the PSA tumor marker.
Contrary to popular belief, the time interval between the stage of cancer that can be cured and the hopeless stage is not six months or a year. This is five or even ten years. This means that there is enough time to identify most neoplasms at an early stage, when the outcome of treatment can be optimistic. And remember that science does not stand still. For example, photodynamic therapy, which was introduced into treatment standards four years ago, allows you to defeat cancer in its early stages without losing an organ. Be attentive to your health.