Interview with the oncologist: what three things you should do right tomorrow
The Russian oncologist-innovator told whether it is possible to see cancer in time, who and how can do it, whether it makes sense to collect millions of rubles for treatment, whether there is a chance to survive.
“Cancer of the poor” and “cancer of the rich”, “illness of offended people” and the patrimonial curse. All this is not myths and fairy tales, but the cruel 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 begin to pass convulsively onkotesty, and someone - it is possible - waving his hand and will begin to enjoy every single day. About why the death of Zhanna Friske was predetermined, which is why Russia will never get rid of the “Apanasenko syndrome” and why everyone needs to do three things right tomorrow, said the oncologist, Ph.D. Pavel Popov.
- Pavel Borisovich, the first question is the simplest and most complex at the same time: why does cancer arise?
- I am of the opinion that cancer is a self-destruct mechanism. Nature has created many such mechanisms, including atherosclerosis, diabetes and many other diseases. The evolutionary feasibility of such a mechanism lies in the fact that it allows for a change of generations and reduce intraspecific competition. Nature is interested in the subjects of active reproductive age, and as soon as this age ends (for a person it is 30-40 years old), a timer is activated, which begins to implement a genetic self-destruction mechanism. Therefore, the percentage of malignant tumors begins to avalanche increase after 40 years. In the language of science, this is called "phenoptosis" - the hypothesis of programmed death.
- Has science come to a common opinion 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. At least it indicates that oncogenes - DNA fragments that encode products necessary for the formation of a malignant tumor - are also involved in other biological processes. Without them, the human body would not develop from the very beginning.
So, the whole mechanism of carcinogenesis is created by evolution specifically. At least the previous opinion that a malignant tumor is the result of an accidental genetic failure does not hold water. In order for a cell to become malignant, six mutations must occur in it, which is impossible from the point of view of probability theory.
- If we agree with the fact that nature regulates the number of individuals that have left the reproductive age, then why is cancer so often found in young people and children? There are lots of examples ...
“Here we must understand that only certain types of cancer are“ younger ”. For example, cervical cancer is younger because it is directly related to the human papillomavirus (HPV).Since people enter sex life much earlier than, say, 30–50 years ago, and maintain many chaotic connections, many women become infected at 15–17 years old. For ten years, the virus is guaranteed to launch the genetic code of cancer, and if we add this term to the average age of the onset of sexual activity, then we have an incidence of cervical cancer among women younger than thirty years old. 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 at the stage of birth and feeding is no longer valid. Even in the last ten to twenty years, medicine has taken a big leap forward, and now even the most unviable babies are nursing, 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 a bio-negative selection, since these children live to adulthood and leave offspring.
It sounds harsh, but the high infant mortality rate at the beginning of the 20th century led to the fact that adults were generally healthier.
In addition, the structure of mortality has changed. In the first half of the 20th century, the main causes of death were infections, hunger and military injuries, respectively, the proportion of cancer was several times less. At present, such lethal factors as infections, hunger and war injuries are minimized in developed countries, and cardiovascular diseases and cancer have taken their place. In countries with a low standard of living, people still die mostly from infections, hunger and wars.
- This suggests the conclusion that common forms of cancer are provoked by the development of medicine. Let's fix it. 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 offended people." Can thoughts, deeds, moods provoke cancer of thoughts?
“Unfortunately or fortunately, we are not so powerful over our bodies that we can prevent or cause cancer by force of thought or something else.”Only the genetic constitution and a number of different factors work here. In fact, oncology is an illustration of popular wisdom about "written on the genus." Cancer can be predicted: for example, if previous generations suffered from oncology, then, most likely, in their descendants phenoptosis will work in a similar way. But at the same time there are no guarantees that atherosclerosis will not work earlier. But to choose a final man is not powerful. If he is not only an alcoholic or a drug addict, he wants to destroy himself long before his cancer phenoptosis works.
As for the “offended people”, let's see who we usually have offended. These are people after forty years with the syndrome of middle age crisis - they fall into the age category when phenoptosis begins to work. And if our pessimistic acquaintance over forty dies from cancer, then a person far from medicine and science can link these two factors together.
- Does the psychological mood somehow influence the outcome of the treatment? This is also a popular myth: believe in the best - and you will be cured. And if you did not recover and died, it means that you gave up.
- My experience of chemotherapy has shown that if a person is at the stage when the generalization of the process began, then neither nutrition, nor lifestyle, nor psychological mood can change the inevitable final.Alas. Moreover, the treatment that is sometimes used in the hope of a miracle, rather, brings the end rather than postpones. When Zhanna Friske went to America, I already knew the final of this trip and even predicted when it would all be over. No magic: there are statistics on how long the patient lives after making a diagnosis of glioblastoma. A year or two, depending on how he was treated.
- By the way, by the way, about Jeanne Friske. After her death, there was another burst of myth-making: even in the federal press they began to use the terminology “cancer of the rich” and “cancer of the poor” - they say that expensive anti-aging procedures are to blame.
- “Cancer of the rich” and “cancer of the poor”, of course, exist. Only he is expressed solely in how the patient will feel during the illness. A rich person can afford expensive treatment, decent care, some last pleasures in life. And the poor - no. But the final of both will be the same, believe me. If this cancer is cured at all, such as basal cell carcinoma (one of the types of skin cancer - ed.), Then the poor will be treated with a cheap and angry policy with a short focus X-ray and the rich will pay for photodynamic therapy from their own funds.But if the problem has no solution within the bounds of today's scientific knowledge, as is the case with pancreatic cancer, then the rich will not be able to “pay off”.
Remember at least Apple founder Steve Jobs, his whole condition did not help him to overcome the disease.
- What about nutrition and bad habits? On the Internet every now and then publish lists of "carcinogenic" products - scary to read.
- Nitrites, which are a mandatory additive in sausages, increase by two to three times the likelihood of stomach and colon cancer. So every day there is smoked meat and sausage is unsafe. About the same damage is caused by products of intensive roasting in fats. If we talk about vegetarianism, then those who do not eat meat, much more often develops stomach cancer in the background of gastritis. Yes, vegetarians are more likely to have gastritis on the background of the consumption of plant foods that do not contain buffer proteins that neutralize the effects of mucous acids. But there is a nuance: those who do not eat vegetables at all, often suffer from colon cancer.
With a low content of dietary fiber problems with stool, chronic colitis, which is also the background for the formation of malignant tumors in the intestine. However, it should be understood that this probability is not too great.Honestly I will tell you: you should not bother so much about food, its harmfulness and usefulness. There are no products that could protect you against cancer. And there is no one from whom cancer arises guaranteed if moderation is maintained in the diet and a balanced diet is prepared. And, of course, statistically lung cancer occurs more often in smokers. Make a choice.
- Overweight is also called one of the factors of cancer. It's true?
- Call, yes. However, there is no reliable dependence. Inside their age group, thin people suffer as often as obese people.
- Oncologists voice the same thought: cancer is curable, but in the first stages. But to reveal it at these stages is quite difficult. And what is the difficulty? Insufficiency of diagnostics or frivolous attitude of people to their health?
- Oncologists are absolutely right, cancer is really curable at an early stage, only they cunningly hold back what stage it is and what is meant by cure. If we talk about complete recovery, the 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 landed from the bloodstream into the tissue of the lymph nodes, liver, lungs, bones, brain, and they create new colonies - micrometastases, which are so small that they cannot be detected by routine examination, for example, by ultrasound or computed tomography. According to my data, melanoma is in the lead (due to 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 in the first and second stages cancer is curable, it means not a cure, but a remission - a bright period from 1 to 5 years (as someone lucky), after which 80% of patients recur in the form of growing metastases, and the final is known to all. And at the “zero” stage, the cancer does not bother the patient and he does not seek help.
The statistics collected by me says that more than half of patients seek medical care in advanced stages.Although it is not difficult to make a diagnosis visually, the outpatient physicians, who see patients first, rarely recognize this tumor even at stage 1-2, let alone “zero”.
I have encountered cases when a district therapist took a melanoma the size of a palm for a birthmark. This is due to the low level of professionalism.
If this is the case with the early detection of cancer of the external localization, then it is surprising that the cancer of the esophagus, cancer of the stomach or other internal organs is clearly detected late: such a tumor at an early stage does not cause the patient any inconvenience and can only be detected by chance, during endoscopic examination . But who among us just goes to endoscopy once a year? Yes, no one.
- What about tumor markers? Will they help identify cancer?
- Firstly, tumor markers are not early means of detecting a tumor. I think that this type of diagnosis works when it is already talking about dissemination (distribution - Ed.) Of the tumor. According to my data, in 80% of cases, an increased tumor marker of melanoma is indicative of tumor dissemination.However, the benefit of this tool is, as it allows you to evaluate the process of treatment in dynamics, look, the tumor progresses or the treatment goes to remission. But, for example, in prostate cancer, a PSA tumor marker can detect prostate cancer earlier than an ultrasound scan does.
- Only in Russia with our diagnostic system is it difficult to detect a tumor in the early stages? Or in other countries too? Do you have statistics?
- In general, oncological statistics of Russia is the most dishonest due to a number of circumstances, and we, oncologists, know this very well. The percentage may be underestimated at the request of the administration of a region or city in order to demonstrate the success of officials in the fight against cancer.
I am aware of a completely anecdotal case when a high-ranking official ordered the death of cancer patients to be registered in the affiliated funeral homes of the neighboring region, in order to demonstrate a reduction in mortality in his allegedly as a result of skilled health management. Everything was fine until the scandal broke out in the neighboring region: there the death rate grew in two!
Foreign statistics in this sense is much more honest.In America, with all its diagnostics and treatment, 95% of the patients die of esophageal cancer. The reason is the same as ours - late detection. This is an international problem. And this is connected not so much with the development of technology, but with the mentality of people.
The average Russian turns to a doctor when he has something sore, few people are engaged in the prevention of their health.
In Germany, due to voluntary clinical examinations, statistically more detected cancer is at an early stage, and the highest percentage of remissions for stomach cancer in Japan is where they buy a gastroscope for a family. Do you know people who would go to the doctor, regularly do gastroscopy, colonoscopy, bronchoscopy?
In Russia, prevention is as follows: distributing pamphlets in polyclinics where cancer symptoms are described - weight loss, poor appetite, persistent pain. A person with cancer has something to hurt and lose weight, which means that the disease has gone too far. And no longer a doctor should be treated, but a priest.
- There is an opinion that is being actively lobbied by Israeli clinics, noting that in Russia there are outdated treatment protocols, and it’s a disaster with diagnostics. What do you say about this?
- More outdated treatment protocols than in Israel, I have never seen anywhere else. Here is a good example: in 2004, the patient came to me for advice about colon cancer. We recommended to remove the affected part of the intestine and carry out chemotherapy according to the most modern scheme at that time. The patient, believing that they would not give good advice in Russia, flew to Israel. There he was operated on and prescribed chemotherapy according to the old as the world scheme. When the patient showed my oncology recommendation to Israeli oncologists, they answered that they were being treated 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 with melanoma with a Breslow tumor thickness of more than four millimeters, they offer a wide excision. For you to understand, the peculiarity of melanoma is that when its thickness reaches four millimeters, the probability of occurrence 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 two or three years, or even within a year after the operation.It is possible to prevent this explosive metastasis with the help of photodynamic therapy developed in Russia, which is still not present in the standards of Israeli medicine.
In general, if we compare Russian and Israeli medicine, then our diagnosis and treatment are in no way inferior to foreign analogues.
Another thing is that the budget of chemotherapy departments does not allow to treat 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 drugs for his own money and drip it into a vein in Russian clinics, which will cost less as a result of living in a foreign clinic costs a lot of money and prices for instrumental diagnostics , for example, computed tomography, simply fabulous.
- But after all, those people whom domestic medicine has refused to go to Israel and Germany often ...
- Refused because nothing can be done. Do you know a lot of people who got cured in such a situation and lived happily ever after? Let's at least remember the celebrities who, having a lot of money and connections, left for treatment in foreign clinics.Alexander Abdulov, Mikhail Kozakov, Raisa Gorbacheva, Zhanna Friske - there is not a single cured miraculously. There are none among those patients with advanced cancer who collect money for their treatment on the Internet.
Just because it is useless, unfortunately - in the last stages, the cancer cannot be cured. It is impossible not only to change the final, but often even otstrochit it.
Here is an example from my practice: relatives of a patient with stomach cancer, in whom metastases soldered the entire intestine into a tight cocoon, the so-called peritoneal carcinomatosis, turned to me for consultation. My verdict: symptomatic therapy and adequate pain relief is all that can be helped. In search of last resort, the patient’s spouse turned to an Israeli clinic, where, after reviewing the discharge documents, she was cheerfully told: “Bring us in, we will treat”. Examination, tests, etc., cost about fifteen thousand euros, one course of chemistry - the same amount. The patient became worse, and then the disreputable Israeli doctors advised his relatives to take him home to die, while he could still move, since it would cost more to carry the “load 200”.
Another example.A patient with melanoma of the lower third of the trachea, which was refused by German doctors, after applying photodynamic therapy in Russia, went home after the operation. The problem, deadlock for German oncologists in the hospital, was solved in our clinic on an outpatient basis, with minimal cost!
- Recently I read about one project that seemed interesting to me: you are passing a test, which, taking into account all the factors - age, bad habits, heredity - determines the likelihood that you will get cancer. Then you install the application in the 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 a general statistical probability. In people with elevated 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 simply increases the chance that not atherosclerosis will cause your end. And this means that no online tests can even approximately determine what your personal chance of getting cancer.And even more so, no application will diagnose you - only a highly qualified specialist. The latter is key because the outpatient physician may miss early cancer.
Of course, there is a lot of speculation on the topic of early diagnosis of cancer - all kinds of programs, applications, diagnoses from photographs. But all this is in a certain sense a profanation, because a well-trained oncologist will be able to make an accurate diagnosis with a 98% verification per minute. And the most sophisticated computer with a digital camera makes a diagnosis from a photo with verification of 50-70% and spends more time on it.
“Well, well, if things are not bad with diagnostics and treatment in Russia, then with palliative care, it’s quite a disaster.” There are still no federal programs to support hopeless patients, very few hospices. Something will change in this direction, do you think?
- Honestly? Nothing will change. First of all, no “budget aid for the dying” article is provided in any budget - this is too expensive. Secondly, the topic of death is still absolutely taboo for our society. People just do not want to know that 4 out of 5 cancer patients will die within a few years.
Until recently, as you remember, the patient was not even voiced his diagnosis.And now to the question of the patient, how long he has left to live, some oncologists shyly turn away. So that at the federal level, the question of supporting hopeless cancer patients is resolved, so that comfortable conditions are created for them, an appropriate atmosphere, which should be in the hospice, you need to start discussing death issues directly and bluntly.
- What do you usually advise to relatives whose relatives will die soon?
- It often happens that you look at tomography, tests and understand that the patient has less than a year. No treatment will help wherever it is conducted. I could tell the relatives of the patient: “Take him to rest in Antalya or the Maldives, while the person is active and can enjoy the world around him, because then there’s a famous ending”. But I know that they will not listen to my words. They will carry on to other doctors, wizards, wizards, will be taken to Israel. In due time, a person will still die and he will not even be able to prolong life.
But the aggravated methods of treatment can add to the torment of a man who has been fatigued by the disease. In the terminal stage, a person does not need anything other than painkillers.But before being cured, the incurable patient has six months or a year in the reserve, when he is still somatically active and the symptoms of the disease do not overwhelm him. Therefore, I recommend that the patient put in order pending cases, talk with loved ones with whom the patient rarely saw.
But people rarely listen to my advice and spend the rest of their lives in clinics for useless and painful treatment.
- By the way, about anesthesia. The term “Apanasenko syndrome” has already appeared, when a person commits suicide due to the fact that he could not get anesthesia. After a series of such terrible cases, officials stated that they would try to solve the problem, but literally in August there was a wild story in Chelyabinsk, when patients with pediatric oncology could not provide morphine. Is something being done to solve this problem?
- Nothing. Neither after the suicide of Apanasenko, nor after other cases, the procedure for issuing anesthetics has not changed. This is due to an artificial system that supposedly should prevent these funds from entering the black market. But all over the world, doctors who have a diploma 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 (as 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 it, because it is easier to twist the hands of doctors than to block the billion-dollar drug traffic.
- That is, stories about how relatives of cancer patients buy heroin from the Gypsies, still happen?
- Anything can happen. But mostly the man groans in pain, and his relatives go crazy.
- What a nightmare. Tell us better what to do to avoid such a fate.
- First, do not panic. Carcinophobia is also an extreme, there is little benefit and joy from this. Remember that the highest incidence of cancer is observed after 60 years. This means that if you are young, you should not constantly exhaust yourself with surveys without special indications. If there is evidence (poor heredity, background diseases of the gastrointestinal tract or respiratory tract), it is desirable to undergo gastroscopy or bronchoscopy once a year. And a colonoscopy if there is colitis and colon cancer in the family history. All the rest can be less.
Pavel Popov - oncologist, doctor of the highest category with 20 years of experience, PhD, laser surgeon. Practices in Krasnodar.
Women should visit the gynecologist every six months and demand an extended colposcopy of the cervix - this is how “Our Father”. If there are any tumors on the skin or mucous membranes, it is necessary to consult a doctor, and only highly qualified. Women after 35 years, it is desirable once a year to visit the mammologist and do a mammogram. Cancer prevention brochures often recommend self-diagnosis — that is, palpation of the breast on their own. However, a retrospective analysis shows that there is no sense in such a diagnosis. Men after forty, I would recommend to pass the tumor marker PSA.
Contrary to popular belief, the time interval between that stage of cancer that can be cured and hopeless is not at all half a year and not a year. This is five or even ten years. This means that there is enough time to identify the majority of tumors 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 the standards of treatment four years ago, allows us to defeat cancer in its early stages without losing the organ.Be attentive to your health.