David Zaridze: ‘An influx of patients with cancer is expected this year’

“This isn’t the real fall in the cancer incidence”

105,000 fewer cases of malignant tumours were registered in Russia in 2020 than we have forecasted on the basis of the dynamics in the last 30 years. More than 600,000 cases of cancer are registered in our country every year. In other words, the number of patients in 2020 decreased by a sixth compared to 2019. First of all, this refers to skin cancer. 25,000 fewer diagnoses were made in 2020 than forecasted.

The tendency also applies to prostate gland cancer with 9,000 fewer cases, 11,000 fewer cases of breast cancer, 12,000 fewer cases of colon cancer. So the cancer incidence in Russia suddenly fell. Unfortunately, this isn’t the real fall in the incidence but just fewer diagnoses, first of all, because of the COVID-19 pandemic. I am talking about patients with cancer who weren’t diagnosed with cancer for some reason, and consequently, it wasn’t treated. In other words, they didn’t see the doctor because of the isolation regime, lockdowns.

Some don’t see a doctor because they are afraid of being infected. Also, the health care system itself is overloaded, and the coverage of the population with check-ups during the pandemic probably decreased. While the check-up programme includes breast, prostate gland, cervical, colon and rectum cancer screenings. However, the health care system had other things to worry about. Unfortunately, there isn’t accurate data on the coverage of the population with check-ups either before or after the pandemic.

So the cancer incidence in Russia suddenly fell. Unfortunately, this isn’t the real fall in the incidence but just fewer diagnoses, first of all, because of the COVID-19 pandemic

“The biggest death rate growth will be in 2023-2025”

The tendency I have defined above, unfortunately, was characteristic of 2021 too. Also, there is already data saying that malignant tumours started to be diagnosed later, in stages 3 and 4. There is some transition in the diagnostics of cancer from stage 1 or 2 to stages 3 or 4. Research done in 2021 note this.

These patients didn’t see the doctor themselves, while they have cancer. In other words, they will be diagnosed with cancer sooner or later but with a considerable delay, in stage 3 or 4 when the disease is difficult to treat or cannot be treated, which will lead to a higher death rate from malignant tumours. Consequently, a fall in the treatment efficacy, lower survival rates and growth in the cancer incidence should be expected in the next years. The axiom is the following: it is easier and more effective to treat cancer in stages 1-2 than in 3-4.

Cancer will steal considerable possibilities of health care, huge money for both diagnostics and treatment. I think an upsurge in the death rate will happen too. If in 2022-2023 we will see patients with cancer primarily in stages 3 or 4, during those years, we will see higher death rate from malignant tumours. The biggest death rate will likely be in 2023-2025.

There will be diagnosed a lot of patients in 2022 who weren’t in 2020 and 2021. An influx of patients with cancer is expected, another stress for the health care system, the next blow on oncologists. It is necessary to act in advance — good organisation, specialists, money are needed for this. Sadly, nothing happens without money. It is necessary to train staff and pay doctors well.

There will be diagnosed a lot of patients in 2022 who weren’t in 2020 and 2021. An influx of patients with cancer is expected, another stress for the health care system, the next blow on oncologists

What to do?

It is necessary to be armed to the teeth and prepare for such an outlook in advance. It is necessary to urge the population that if they have some complaints, they should see a doctor. Late presentation worsens recovery prospects.

However, cancer doesn’t have specific symptoms. Different types of cancer cause different symptoms. But in any case it is necessary to see your GP who will certainly sort the situation out and refer one to necessary specialists. Of course, lockdowns and isolation are important preventive measures against COVID-19. But the pandemic will end one day thanks to vaccination, while cancer will stay with us forever. This needs to be taken into consideration.

Comfortable conditions need to be created so that a person successfully goes to the polyclinic. We should think about it in advance, today. Of course, the fact that COVID-19 is raging and nobody cared about other things is a good reason for justification. However, such a situation is around the world. For instance, in small Holland, which is of course hard to compare with huge Russia, they quickly understood that they underdiagnosed patients with cancer. They urged their citizens to see the doctor, created conditions for this and resumed screening programmes. The result was not long in coming.

I think it is necessary to focus on screening of cancer with evidence based efficacy and the benefit-to-harm ratio of the screening

Screening on top

Check-up and screening programmes need to resume here. However, it is time to make serious changes to the check-up programmes so that they keep up with the international experience and recommendations of the World Health Organization. I have scientific foundation to criticise our check-up programmes.

I think it is necessary to focus on screening of cancer with evidence based efficacy and the benefit-to-harm ratio of the screening. The WHO recommends cervical, breast and colon cancer screenings. Precisely these three types of screening can be used widely. No countries of the world massively screen prostate gland cancer as we do.

The WHO recommends cervical cancer screening with an HPV test, which is used around the world and is more sensitive than a cytological examination. A screening with an HPV test is more economic than a cytological examination and can be done just twice in life, at 35 and 45 years.

In my opinion, cancer screenings need to be done by the cancer service. This needs to be discussed with the cancer community, but such an action is necessary. Competence is needed, while this is obviously absent in cancer in the check-up system.

Cancer screenings need to be done by the cancer service. Competence is needed, while this is obviously absent in cancer in the check-up system

“Do you want to wear nappies or become impotent at 50?”

I am convinced that it is necessary to refuse mass prostate gland cancer screening in Russia considering that the benefit-to-harm ratio in the prostate gland cancer screening isn’t in favour of the benefit. Mass prostate gland cancer screening carries more harm than benefit. This isn’t my fantasy and research, this was proven around the world.

What isn’t cancer is often diagnosed as cancer in the prostate gland cancer screening. So invasive diagnostic methods continue being used. It is both surgeries and prostatectomy, which leads to urinary incontinence and impotence. When I delivered a report in Sochi a few years ago, a Belarusian colleague disagreed, he said better safe than sorry. I asked him a question: “Are you ready to wear nappies if some unlearned urologist or surgeon removed your prostate gland or become impotent at 50?” Of course, he didn’t want it.

Still, there is a necessity of doing a prostate-specific antigen test. But it is done individually. A specific patient is explained the benefit, the harm, all the pros and cons are considered.

Mass prostate gland cancer screening carries more harm than benefit. This isn’t my fantasy and research, this was proven around the world

“All girls under 15 should be vaccinated against HPV”

It is absolutely necessary to vaccinate girls from 9-10 to 15 years against human papillomavirus (Editor’s note: 98% of cervical cancers are linked with this virus). Moreover, such a programme must be adopted at state level. By 15 years, all girls must be vaccinated against HPV. Vaccination is more effective if a non-infected teenager is inoculated.

One of the vice health care ministers of Russia assured me as early as several years ago that the next plan was to add the HPV jab to the national calendar. However, COVID-19 cut in. But COVID-19 will go, while cancer will stay with us.

Vaccinated girls are a new generation. But women who are older than 15 today will also live in the 21^st century. They also should be recommended vaccination. And it is necessary to do cervical screening with a HPV test I wrote about above. The screening with a HPV test is both cheaper and more effective than a cytology, which is usually done in Russia now.

Also, it can be done just twice in life, not every three years.

With vaccination against HPV, we can simply destroy cervical cancer, strike it off the agenda. Such countries as Australia, Sweden, Finland where girls started to be vaccinated in 2006 will achieve this effect soon. Other 110 countries that included their vaccination against HPV in their vaccination calendar will destroy cervical cancer by the middle of the century. Where are we? It is the conservatism and egoism of our health care system. But this is only one of the factors. Yes, the addition of the vaccination against HPV to the national calendar costs money. But doesn’t treatment for cervical cancer money? It does, it does huge money.

Prevention is always cheaper than treatment. What about people, human lives? According to our interim forecast, while we chose those groups of girls who still can be vaccinated (born from 2009 to 2038), 470,000 of them will have cervical cancer. While vaccination with screening can prevent over 400,000 of these cases. If this isn't done, the high cervical cancer incidence will negatively influence the demography.

I and my colleagues are asked all the time when we will cure cancer. It seems that people think that nothing changes in cancer treatment. Yes, huge progress was made in cancer treatment.

“There can be no universal pill for cancer”

I and my colleagues are asked all the time when we will cure cancer. It seems that people think that nothing changes in cancer treatment. Yes, huge progress was made in cancer treatment. Cancer immunotherapy and other new methods led to a situation when lung cancer, melanoma are almost curable. But there can be no universal, miraculous ampule for cancer.

There is one but. The results of our research can be considered this miraculous pill — the results of a refusal from smoking in patients after being diagnosed with cancer. We did the research for more than seven years with over 500 patients with lung cancer. Our research was published in an authoritative American journal and caused a huge response in the Western press. It turned out that patients with lung cancer who stopped smoking lived for two years longer. It was just an information bomb. Another two years mean a lot. Such patients should be treated even through nicotine replacement therapy. Smoking cessation considerable improves the treatment efficacy.

According to our data, while we studied patients with lung cancer and kidney cancer, in both cases we saw a protective effect. The refusal from smoking increases the lifespan of such patients. The literature describes research according to which smoking cessation increases the lifespan in other cancers, including breast cancer. In general smoking is the main cause of the disease in some 20-25% of all cancer cases.