There is not much difference in the incidence and mortality of cancer worldwide. The patterns are more or less similar. Lung cancer has the highest incidence and mortality virtually everywhere in the world.

And there are similarities because everywhere is now smoking.

Yes, everywhere people are smoking but the differences are that in the Western world, in the United States, in the UK, earlier in the UK than the United States, after Richard Doll discovered, Richard Doll and Ernest Wynder in the United States, after they discovered that smoking is causing lung cancer, immediately smoking rates have declined in the UK and in the United States. That was followed by a decline in lung cancer in these countries.

How are you doing in Russia now then?

We are doing now… we started to deal with this problem recently, unfortunately.

You’re behind us, aren’t you?

Yes, we are very much behind. Also in 1985 our group, me personally, we held the first conference on smoking and health in Russia, in Moscow. That was the first international conference which was attended by international experts and we were first to show that smoking causes cancer in Russia as well, not only in the United States, in America and the UK. And that was a starting point. However, nothing happened much since in terms of smoking control. However, what was important internationally, that was WHO framework convention which was adopted by Russia as well. This is a very important stage because Russia has started to fight. This is a war term but this is a real war against smoking. So it started to control smoking and in fact we already have some signs of decline in smoking.

That’s great. Now, there are other areas because you drink different kinds of alcohol from other parts of Europe, don’t you, as well? You like your vodka.

Alcohol is an even more important problem for Russia than smoking. Alcohol kills more people in Russia than smoking.

And cancer as well? Cancer related?

No, no. Yes, there are certain cancers related to smoking: head and neck cancer, liver cancer, oesophageal cancer.

The combination of smoking with drinking.

The combination. Breast cancer is related to...

Breast cancer too?

The risk of breast cancer is increased in drinkers, it’s associated with drinking. That’s important, yes.

Let me throw another one into the mix: stomach cancer too, because your diet historically has been different with not so easy availability of fresh fruit in winter.

Look, yes, stomach cancer has started to decline everywhere in the world, including Russia, ages ago, ages ago. And this is us, we have done nothing. Medical…

But diet has improved?

Diet has improved and, what is more important, food storage. Food storage has improved. Food is kept in low temperatures, under low temperatures and that has changed very much because before there were simply no fridges, even, in Russia.

OK, you’re describing a dynamic situation.

Yes, exactly.

Cancer incidence is changing. Could you sum up what you think what needs to be done not only in Russia but other countries to control and prevent cancer, then? Just in a few simple messages what are your words?

First of all, don’t smoke. That’s the message, most important message. Because if humanity gives up smoking 30% of cancers are prevented, that’s very important. What we have also very important discoveries, recent discoveries, is the viral etiology of cancer. HPV, hepatitis B viruses have been proven to cause cervical cancer and not only cervical cancer, as a matter of fact, recently we have heard a report from IARC, from the International Agency for Research of Cancer, that 30% of oropharyngeal cancer is caused by HPV, sexual habit.

So the message is?

The message is that oral sex increases your risk of developing oropharyngeal cancer.

And if you get vaccinated you can be OK.

Yes, if you get vaccinated at an early age, at 13, that eliminates practically all cancers related to infection with HPV: cervical cancer, some other cancers of the female genital system and, just very new story, oropharyngeal cancer. 30% of oropharyngeal cancer is related to HPV infection.

So David, you’re painting a very dynamic picture. It’s fascinating and I could go on for ever but we’re going to wait with baited breath for more developments coming out of Russia.

What is important, also early detection is very important.

Of course.

Early detection. We are talking now about primary prevention: vaccination is primary prevention, smoking control is primary prevention. If we are talking about dietary changes and even habits, even food storage techniques, that all is related to primary prevention. Early detection, screening, this is very important because if you look at the survival, for example, of breast cancer by stage. So if you detect it on stage 1 the five year survival is nearly 90%. If you detect breast cancer at stage 4 the five year survival is no more than 10%.

Some powerful messages there. David, thank you for joining us on ecancer.tv.