David Zaridze, you have huge experience about cancer prevention, about epidemiology, specifically from the Russian perspective, and you’re talking here about the state of oncology in Russia but particularly prevention. Can you tell me what is happening to the landscape of cancer in Russia in the moment?

In fact, we have good news for you, for society. Cancer mortality is declining in Russia, as everywhere in the world, in most countries of the world. Usually the perception is that cancer is increasing, cancer incidence and mortality is increasing, but that’s not true. Cancer is decreasing mostly due to decreases in smoking related cancers like lung cancer, cancer of the upper aerodigestive tract, those cancers which are caused by smoking. And alcohol consumption, as a matter of fact, cancer of the upper aerodigestive tract is related to smoking and drinking. Those cancers, let me repeat, are decreasing because of the efforts and successes, I would say successes, in smoking control.

What have you done in Russia that has made this sort of thing possible?

Well, in fact there is a history of smoking control, it takes us back to 1985, and I would like to remind the audience that Richard Doll, the great British scientist, he influenced not only the epidemiology and prevention in the Western world but very much in Russia as well. So we started by... In fact, presently in Russia we have a regulation which includes the series of recommendations for smoking control, including a ban on smoking in public places. This is one of the most important, the measure for smoking control. Limitation of tar and nicotine levels in cigarettes and many others, those measures which are included in the WHO framework convention.

So you’ve implemented some tough legislation about smoking. In a minute I’ll ask you about diet but if I could ask you first of all on the issue of smoking, not all of the world has the advantages of Russia and America and Europe in being able to contain the tobacco consumption epidemic, does it? What kind of lessons might you give for low resource countries?

I wouldn’t say that we are very successful, we are somewhat successful but we have to continue our efforts in this direction. I think the most important measure is that the public should be aware that smoking is killing and this is very important that the perception and the public believes, takes this as granted, this knowledge from medical research that smoking is killing. Therefore that’s the most important.

Of course it’s not just logic, emotion comes into it, isn’t it? In many of the Western countries where tobacco is now you cannot smoke in public places, it’s becoming unfashionable. Now, how do you get that sort of thing going? It’s less fashionable to smoke now, that helps everything, doesn’t it?

Yes, that’s what I am saying, that’s what I am saying. People should believe that, first of all, smoking is not… this habit has nothing to do with human life…

And it’s not cool.

It is not cool, it couldn’t be cool. Why it should be cool with something which harms you.

And can this message be transmitted around the world? Because tobacco is still being smoked all over the world and in increasing amounts.

Exactly, it is still smoked in Western countries, it is still smoked in Russia. As a matter of fact, in Russia…

And in the developing world it’s growing.

Yes in women. Women smoke more and more, even in the United States, even in the Western world. I think that the UK is the only country where smoking in women has declined.

Have you got any tips as to how this might be contained, then? Any ideas?

That should be a comprehensive approach, there are no tips. This comprehensive approach is highlighted in the WHO framework convention.

I want to ask you very briefly about diet because some years ago diet was regarded as a key cause of cancer, although it was always very confused about which aspect of diet. What’s the picture at the moment in Russia and elsewhere?

The picture has changed somehow. Twenty years ago, as you are saying, we showed that diet is most important. New knowledge which we have acquired since suggests that probably either we don’t know, we are not going in the right direction to investigate the causes, the association between diet and cancer, or the association between diet and cancer is less important.

Or more confusing.

Or more confusing. However, I still think that we have to advise to eat more fresh vegetables and fruit.

And obesity is a factor, isn’t it?

Obesity is an important factor, the most important, obesity and lack of physical activity. These are very important.

They’re all related to cancer incidence, yes.

Yes, obesity and lack of physical activity is very much related to cancer.

Let me ask you about your take on early detection because a lot of people say don’t worry about the causes but let’s get cancer detected early. What’s your policy in Russia?

I think that prevention, primary prevention, is much more important. At least we know more about primary prevention than early detection. Of course screening, some screening methods are very successful, for example cytological screening for cervical cancer is very successful. It used to be very successful. Screening for cervical cancer has eliminated cervical cancer practically from most Scandinavian countries, specifically in Finland, the incidence and mortality is just negligible in Finland because they were detecting cervical cancer at an early stage, even at the stage of precancerous lesions, and this is very important.

And we mustn’t forget, of course, about vaccination for cervical cancer.

Vaccination is very important but vaccinating young girls we shouldn’t forget about cytological screening because the effect of vaccination today will show up in twenty or thirty years when these women, these girls, reach the age when cervical cancer is becoming a frequent disease. So therefore this should go together. But as far as detection is concerned, I think there’s a need for research, for looking for markers of early disease. This is very important. Proteomics, metabolomics, genomic markers, genetic markers of disease, this is the future. This is the future, not only in early diagnosis.

And you’re optimistic about that?

Yes, absolutely. I’m optimistic because this is a way where we are going and we should continue to go. Because, unfortunately, this field is yet unexplored so markers of disease, of early disease as well as markers for treatment which is targets for treatment. This is what we are talking a lot about, personalised medicine, about individualisation of treatment as well as detection.

Now, you’re Deputy Director of the Russian Cancer Research Centre but you’re a scientist of the world, you’re a Visiting Professor at Oxford University. How would you sum up then, finally, Russia’s contribution to cancer prevention at the moment? Could you give me just one or two main points that you’d like people to remember?

I think that we are successful in smoking control which is very difficult field, but we are still successful. Unfortunately there is another factor which kills the Russian population, that is alcohol consumption, excessive alcohol consumption. But we are reaching recently success also in this field; alcohol consumption is declining in Russia. This is a major success because this affects not only cancer but other non-communicable diseases as well as accidents and other external causes. So we already see the effect of declining alcohol consumption in Russia. Mortality from causes related to alcohol are declining, including those cancers of the upper aerodigestive tract and cancer of the liver.

And, of course, cancer and tobacco are additive, aren’t they, in the case of… Sorry, alcohol and tobacco are additive, yes.

Yes, tobacco and alcohol are additive, first of all for cancers of the upper aerodigestive tract, which include cancers of the lip, oral cavity, pharynx, larynx, oesophagus.

And finally to doctors who may not be thinking about the causes because they have their hands full thinking about the treatments of cancer, what would you say to them about advising to bear this in mind?

I would like to say, first of all, not to smoke themselves, which is important. Unfortunately in Russia many oncologists smoke, which is a shame, not only general practitioners but also oncologists. Not to smoke themselves but in addition I think that that’s a very important question. There is some evidence that effects, effects of treatment, especially those cancers which are smoking related depends if the patient continues to smoke or he gives up. Those who give up, the effects of treatment are better and their survival is better so that’s very important, to advise patients not to smoke, especially those who have cancers which are related to smoking. This doesn’t happen always because I think the doctors simply are not aware that smoking, continuation of smoking, may affect the results of treatment.

So information, then, is a big protector and that’s what you’ve been giving us today. David, thank you very much for joining us here on ecancer.tv.

Thank you. A pleasure.