David Zaridze: ‘The incidence of all malignant tumours will go up’

The president of the Russian Cancer Society of dispelled myths about the increase in the detection of lung cancer and, on the contrary, warned of a surge in oncologic deseases

Russia has announced an increase in the detection of lung cancer in the early stages this week. The trend, according to a number of experts, took hold during the pandemic — thanks to mass MRI examinations of patients with suspected coronavirus. However, the president of the Russian Cancer Society, oncologist David Zaridze hastened to dispel this myth in the author's column for Realnoe Vremya. The Doctor of Medical Sciences, Professor emphasised that so far the Russian cancer statistics say the opposite and, most likely, this year a surge in the incidence of cancer awaits us.

Detection rate of all malignant tumours has decreased

There have already been several reports that computed tomography, conducted to assess lung damage in coronavirus, allegedly increases the detection of lung cancer. But it's not like that!

The thing is that in 2020 the detection of lung cancer has decreased significantly. The reason was just Covid-19, people were isolated, because of lockdowns, because they did not go to the doctor, as it would have been in the pre-Covid-19 time if they had symptoms. The detection rate of all malignant tumors, including lung cancer, has decreased.

In 2020, compared to 2019, by 7,000 fewer cases of lung cancer were diagnosed and by 98,000 fewer cases of all malignant tumours. There are no official data for 2021 yet.

The detections rate in 2020 was lower than the predicted figures. We have already warned that we expect an increase in morbidity. Where did the information come from that the detectability has increased? What is revealed on a CT scan are small nodes that have nothing to do with cancer.

There is a worldwide experience of CT screening of lung cancer. In Russia, we also use this technique. CT scans reveal nodes of various sizes. If their volume (not diameter, not length, not width) is less than 6 cubic millimetres, people are sent home, they have no cancer and cannot be. If they have these nodes larger — from 6 to 9 cubic millimetres — they are invited after 3-4 months for a second CT scan. But if the nodes are larger than 10 cubic millimetres, then cancer is suspected and the patient is prescribed an additional examination and so on.

We predict an increase in morbidity

Those who spread the news about an increase in the detection of lung cancer due to CT diagnosis of coronavirus, apparently, do not know about it. What is revealed on a CT scan are small nodes that have nothing to do with cancer. Moreover, the available statistics indicate, as I have already said, not an increase in the detection of malignant tumours, but, on the contrary, a decrease.

This year, the incidence of all malignant tumours and lung cancer, including, is likely to go up. We predict an increase in the incidence due to the detection of those tumours that were not detected in 2020 and in 2021. People did not go to the doctors even with the appearance of symptoms, the intensity of medical examination decreased.

I would like to emphasise once again that in order to carry out early diagnosis of lung cancer, special diagnostic parameters, a special system, appropriate organisations, very experienced doctors are required.

Now there are even talks that the coronavirus causes lung cancer — it's nothing at all! These are talks of people who do not know what cancer is, what the process of cancer development, carcinogenesis are. Sometimes this process takes 10, 20, 30 years. For example, the carcinogenesis of lung cancer caused by smoking takes two to three decades. While Covid-19 started two years ago. So this is neither theoretically nor practically impossible at all, and such conversations are the result of ignorance, misunderstanding of the problem.

It is necessary to create comfortable conditions for examinations

Since we expect a surge in the detection of malignant tumours in 2022-2023, due to that we did not detect them in 2020-2021, we recommend that the population consult a doctor when the first symptoms appear.

There are no typical cancer symptoms. For example, lung cancer, of course, it will be cough, shortness of breath. But these are the symptoms of a smoker, all smokers cough, everyone has a problem with shortness of breath.

Yet, no matter what symptoms appear, we are talking not only about lung cancer, but also about malignant tumours in general, it is necessary to consult a doctor. This means that in polyclinics and medical institutions it is necessary to create comfortable conditions for examination.

It shouldn't be like this — I came, got tired, slammed the door and left, because queues, rudeness and a bad attitude. There is no need to hide from problems, you need to know the problem, you need to predict it, you need to think about it and take measures to reduce its negative impact.

David Zaridze

The author's opinion may not coincide with the position of the editorial board of Realnoe Vremya.