David Zaridze: ‘Nicotine addiction must be treated in mandatory health insurance’

An oncologist who proved the link between giving up smoking and lifespan claims “stagnation in prevention” of tobacco addiction in the country

The situation with the fight of tobacco smoking is becoming tough in Russia — quite a big number of smokers among men doesn’t fall, while the growth of smoking women has already led to a greater lung cancer incidence by a third, doctors say. In an op-ed column for Realnoe Vremya, Doctor of Medical Sciences, Professor, correspondent member of the Russian Academy of Medical Sciences David Zaridze explains how to improve the situation, why the refusal from smoking should be included in clinical recommendations in treating cancer and treat nicotine addiction via the mandatory health insurance. This summer, the oncologist and his colleague academician Ivan Stilidi were given state awards for developing and introducing preventive and clinical technologies aimed to reduce the incidence and the birth rate of the population, improve the patients’ quality of life and achieve significant progress in the demographic situation in Russia.

“Stagnation” in prevention of smoking and growth of cancer incidence

In the last years, the number of smoking women has grown in Russia, this why the lung cancer incidence has increased by 29%. A consistent policy on fighting the nicotine addiction hasn’t been developed in the country. Also, there are other two promising areas to prevent cancer and increase the lifespan: lower alcohol consumption and vaccination against cancer causing viruses.

Giving up smoking is the most effective ways to reduce the incidence and death rate. However, sadly, the smoking rate falls in Russia very slowly, it has stopped in general in the last years. So the frequency of smoking among Russian women, which gradually decreased since 2009, has increased again and returned to the number of 2009, that’s to say, to 21% (data of the All-Russian Public Opinion Research Centre). These numbers are proven by the growth of the lung cancer incidence: from 2012, the lung cancer incidence among women started to grow for the first time since and grew by 29% by 2018.

The situation in the prevention of smoking in men doesn’t inspire enthusiasm either. From 2009 to 2016, the frequency of smoking among men decreased to 47% and remained unchanged during the next years. It is noteworthy that the decrease in the incidence and the lung cancer death rate since 1993 is a result of a fall in the concentration of tar in the tobacco smoke of Russian cigarettes, that’s to say, the harm reduced, and doesn’t show the smoking dynamics in our country.

Cigarette sales in Russia more than doubled from 1996 to 2006, while the incidence and lung cancer death rate reduced. All this indicates, to put it mildly, there is “stagnation” in smoking prevention in the country and questions the possibility of achieving the goal of lowering the rate of deaths from tumour set by the Russian president.

Photo: Maxim Platonov/realnoevremya.ru

To treat smokers via mandatory health insurance

What to do? It is necessary to continue focusing efforts on reducing the spread of smoking.

  1. Firstly, the tax policy needs to improve or, more precisely, the rate of cigarette excide needs to go up. This measure, according to the WHO, is the most effective in the fight against smoking.
  2. Secondly, it is necessary to create a network of affordable medical centres to treat tobacco (nicotine) addiction equipped with qualified drug therapist and psychotherapists.
  3. Thirdly, it is necessary to treat nicotine addiction via the mandatory health insurance. Given the results of research done in the Department of Clinical Epidemiology of the Blokhin Oncology Centre, smoking not only causes cancer but also has a negative impact on the outlook in patients with lung and kidney cancer, a refusal from smoking should be added to clinical recommendation.

The patients’ refusal of smoking must be an obligatory component at all stages of the cancer therapy. Oncologists together with psychotherapists and drug therapists should motivate their patients, help them to give up smoking by offering different methods o nicotine replacement therapy and nicotine replacement.

Prevention of alcoholism and other diseases

The use of results of population epidemiological research of the Department of Clinical Epidemiology of the Blokhin Oncology Centre and the adoption of the Concept of State Policy on Lowering the Scale of Alcohol Overconsumption and Prevention of Alcoholism in Population of the Russian Federation led to lower alcohol consumption and a fall in the death rate from all causes saving the lives of 3,5 million Russians, mainly young men. “In the last 10 years, alcohol consumption in Russia has decreased about by a third in ethanol (from 15,7 litres to 9,1 litres),” claimed the country’s Health Care Minister Mikhail Murashko. However, the minister added that alcohol continues having a “colossal impact” on the death rate in Russia’s population, especially men. The contribution of alcohol consumption to the men’s death rate in the country is up to 75%. Also, 80% of working population of Russia has more than one risk of developing non-infectious diseases, excessive consumption of alcohol and tobacco is among them.

What to do in this situation? It is necessary to tighten the control over alcohol turnover, develop and introduce evidence-based recommendations for safe alcohol consumption resting on WHO’s recommendations.

Photo: Oleg Tikhonov/realnoevremya.ru

The human papilloma virus (HPV) is another cause of developing cancer of uterus, vulva, vagina, penis, anus, throat. 12 types of HPV were proven to be cancerous: 16, 18, 31, 33, 34, 39, 45, 51, 52, 56, 58 and 59. Vaccines against human papilloma were developed and permitted. Their efficacy and safety were confirmed in clinical trials and real life, in the countries that started to vaccinate teenagers in 2006-2007. Vaccination prevents infections, the incidence of pre-cancer cervix diseases and reduces the cervical cancer incidence. On the basis of scientific data provided, we can conclude that the efficacy of vaccines in the prevention of cervical cancer has the highest evidence. In this regard, the necessity of organising mass HPV vaccination among teenagers from 9 to 14 as fast as possible and a screening based on DNA testing twice in life, at 35 and 45 years, becomes obvious.

Such a measure will allow significantly decreased the incidence and the rate of deaths from cervical cancer and other cancers associated with the human papilloma virus. The research done by a group of workers of the Department of Clinical Epidemiology of the Blokhin Oncology Centre showed that the vaccination of 24 million girls born from 2009 to 2038 will prevent about 350,000 cases of cervical cancer and more than 100,000 deaths from this diseases. Cervical cancer is young women’s disease. The high incidence and the rate of deaths from cervical cancer will influence the reproductive potential of several generations, consequently, the demographic structure of Russia.

David Zaridze

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The author’s opinion does not necessarily coincide with the position of Realnoe Vremya’s editorial board.