News News A Chat With Trapeznikov, Russia's Cancer Czar and rectal cancer." Stomach cancer remains a significant problem at 95,000 cases a year. He admitted the Soviets have not had a great deal of success with prevention. Although cervical cancer rates have gone down (from 34,000 cases in 1970 to 25,000 in 1988), implementation of a mass cytology exam program cannot be credited. "Tens of millions of female examinations are made annually," Trapeznikov said. "But, we are embarrassed that reduction of cervical cancer morbidity, after implementing a mass cytology examination program in 1960, doesn't differ from the reduction observed before the program." There has been no great success with smoking cessation either, despite
Downloaded from http://jnci.oxfordjournals.org/ at University of Michigan on June 19, 2015
There was snow on the cherry blossoms in Washington, and Soviet tanks rumbled through the capital of Lithuania. But in Daytona Beach it was 87 degrees and Spring Break. Surf was up, and four-wheelers roamed the beach. Nikolai Trapeznikov, M.D., director of the All-Union Cancer Research Center in Moscow, sat by the Hilton's pool as if there were no ripples in glasnost and chatted about cancer in Russia. "In our country, it is unusual to meet with the press for several days in such a pleasant place," he told reporters in the opening panel of the American Cancer Society's Science Writers' Seminar. He had joined Samuel Broder, M.D., National Cancer Institute director, and John Laszlo, M.D., senior vice president for research, American Cancer Society, to set the seminar's stage by discussing cancer research in the 1990s.
propaganda against smoking in the press, TV, and movies. He said that almost all men smoke and that "women's lib" may increase the problem in women. He thinks people don't pay attention to what may happen to them 20 years later. But the Soviets are not giving up. For example, new collaborative efforts are under way with the World Health Organization for a breast and cervical cancer early detection project in rural areas.
QandA The following are Trapeznikov's answers to questions about the USSR's increasing cancer incidence and its cancer programs: Q. Are you seeing any results of Chernobyl in the increased cancer statistics ? A. Not yet. But, it's too early. Longer follow-up is needed. Q. What about cancer cases from the recently acknowledged nuclear disaster
Gorky Native Trapeznikov is a native of Gorky. He became interested in cancer when he began seeing numbers of cancer patients as a surgeon. He has been to the States many times and is a seasoned emissary. He speaks with an accent and has a ready, husky laugh. The All-Union Cancer Research Center sees 140,000 cancer patients (inpatients and outpatients) a year and has 1,000 beds. Cancer incidence in the USSR is rising: there were 430,000 cases of cancer in 1970, and 700,000 cases in 1988. The largest increases have been in lung and breast cancer. "In the near future," Trapeznikov said, "we expect further growth of lung cancer, breast cancer, colon cancer, Vol. 82, No. 10, May 16, 1990
AMERICAN V CANCER Dr. Nikolai Trapexnikor addresses ideoce wrllen al ACS Mmlnar.
NEWS
815
News News Don't Tell
A. I know nothing about it. That was a "secret" time.
Q. Do you tell cancer patients that they have cancer?
Q. In this country there is public concern about adequate cleanup and disposal of nuclear waste like plutonium from nuclear weapons plants — is this also a concern in the Soviet Union?
A. Usually not. But that's changing. I think this is good from several points of view. I think in the moral view it's not correct that a patient not know... not know what will be happening to them. The patient does not have a choice. Now we have several clinical trials under way with U.S. pharmaceutical firms. One of the first points in the agreement that was made was that we completely inform patients. The drug companies are paying for four or five trials. We now have a model for informed consent. We have to change other institutions. All this will change, step by step.
A. I do not know about this. But such matters and the follow-up to Chernobyl would be the concern of a special institute of radiation safety that has been established.
Pollution Q. People worldwide are concerned about pollution of the environment, and a number of pollutants are carcinogenic. What is the dimension of the problem in the Soviet Union?
A. The concern about pollution is the same in my country as elsewhere. We discuss pollution all the time. It was one of the best points made by candidates in recent elections. Many of them won. It is like the "Green Movement." A lot of things contribute to increasing cancer incidence Modern technology is closely connected to air pollution.... More people smoke.... There are increasing numbers of elderly, and this is where the majority of cancer cases occur. All these things contribute to increasing cancer incidence since the 1970s. And, look at that pollution! [He pointed to Daytona's beach, which swarmed with cars and pickup trucks.]
Q. Do you think cancer patients know they have cancer?
A. Well, most patients know they are in cancer institutions—they are called "oncological dispensaries." And
816
Glasnost Q. How is glasnost affecting the world of cancer?
A. My institute gives grants to researchers. Each application goes to experts and their conclusions go to a special committee who have a secret ballot. Grant applications are rated. The medical system, medical service, and medical sciences are in the process of change. Previously, research was given an annual fixed budget—nonflexible. Now there are various ways to get grants—more like the U.S. grant systems. We're able to get funding from industry, government, and private companies like foreign drug companies. Direct approaches are now allowed to foreign markets. We no longer need to get permission. Another recent trend is toward private medicine. For several years, patients have been able to pay as private outpatients at medical cooperatives, allowing more choice for individual care. [The government treats free.] Discussing another area, I will be involved in establishing a counterpart to the American Cancer Society in the Soviet Union. Q. What is the most exciting area of research in the Soviet Union ?
A. Molecular biology. Q. When will it come to the clinic?
A. It's like a revolution. It perks along and then, suddenly, it will happen. Meantime, international cooperation continues to be extremely beneficial. Sharing information on drugs and clinical trial collaborative data not only eases the energy and money drain but provides answers faster. It brings us quicker results.
Q. What are some areas of progress in cancer treatment?
A. I have a special interest in bone tumors. Limb-sparing treatments can be counted as progress for sarcomas and lumpectomy and radiation for breast cancer. There has been success in testicular cancer and childhood cancer treatment.
if a woman had a mastectomy, what would she think?
— By Eleanor Nealon Dr. Nikolai Trapemlkov
Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at University of Michigan on June 19, 2015
that occurred in Kyshtym in the Urals in the 1950s?
Downloaded from http://jnci.oxfordjournals.org/ at University of Michigan on June 19, 2015
There was snow on the cherry blossoms in Washington, and Soviet tanks rumbled through the capital of Lithuania. But in Daytona Beach it was 87 degrees and Spring Break. Surf was up, and four-wheelers roamed the beach. Nikolai Trapeznikov, M.D., director of the All-Union Cancer Research Center in Moscow, sat by the Hilton's pool as if there were no ripples in glasnost and chatted about cancer in Russia. "In our country, it is unusual to meet with the press for several days in such a pleasant place," he told reporters in the opening panel of the American Cancer Society's Science Writers' Seminar. He had joined Samuel Broder, M.D., National Cancer Institute director, and John Laszlo, M.D., senior vice president for research, American Cancer Society, to set the seminar's stage by discussing cancer research in the 1990s.
propaganda against smoking in the press, TV, and movies. He said that almost all men smoke and that "women's lib" may increase the problem in women. He thinks people don't pay attention to what may happen to them 20 years later. But the Soviets are not giving up. For example, new collaborative efforts are under way with the World Health Organization for a breast and cervical cancer early detection project in rural areas.
QandA The following are Trapeznikov's answers to questions about the USSR's increasing cancer incidence and its cancer programs: Q. Are you seeing any results of Chernobyl in the increased cancer statistics ? A. Not yet. But, it's too early. Longer follow-up is needed. Q. What about cancer cases from the recently acknowledged nuclear disaster
Gorky Native Trapeznikov is a native of Gorky. He became interested in cancer when he began seeing numbers of cancer patients as a surgeon. He has been to the States many times and is a seasoned emissary. He speaks with an accent and has a ready, husky laugh. The All-Union Cancer Research Center sees 140,000 cancer patients (inpatients and outpatients) a year and has 1,000 beds. Cancer incidence in the USSR is rising: there were 430,000 cases of cancer in 1970, and 700,000 cases in 1988. The largest increases have been in lung and breast cancer. "In the near future," Trapeznikov said, "we expect further growth of lung cancer, breast cancer, colon cancer, Vol. 82, No. 10, May 16, 1990
AMERICAN V CANCER Dr. Nikolai Trapexnikor addresses ideoce wrllen al ACS Mmlnar.
NEWS
815
News News Don't Tell
A. I know nothing about it. That was a "secret" time.
Q. Do you tell cancer patients that they have cancer?
Q. In this country there is public concern about adequate cleanup and disposal of nuclear waste like plutonium from nuclear weapons plants — is this also a concern in the Soviet Union?
A. Usually not. But that's changing. I think this is good from several points of view. I think in the moral view it's not correct that a patient not know... not know what will be happening to them. The patient does not have a choice. Now we have several clinical trials under way with U.S. pharmaceutical firms. One of the first points in the agreement that was made was that we completely inform patients. The drug companies are paying for four or five trials. We now have a model for informed consent. We have to change other institutions. All this will change, step by step.
A. I do not know about this. But such matters and the follow-up to Chernobyl would be the concern of a special institute of radiation safety that has been established.
Pollution Q. People worldwide are concerned about pollution of the environment, and a number of pollutants are carcinogenic. What is the dimension of the problem in the Soviet Union?
A. The concern about pollution is the same in my country as elsewhere. We discuss pollution all the time. It was one of the best points made by candidates in recent elections. Many of them won. It is like the "Green Movement." A lot of things contribute to increasing cancer incidence Modern technology is closely connected to air pollution.... More people smoke.... There are increasing numbers of elderly, and this is where the majority of cancer cases occur. All these things contribute to increasing cancer incidence since the 1970s. And, look at that pollution! [He pointed to Daytona's beach, which swarmed with cars and pickup trucks.]
Q. Do you think cancer patients know they have cancer?
A. Well, most patients know they are in cancer institutions—they are called "oncological dispensaries." And
816
Glasnost Q. How is glasnost affecting the world of cancer?
A. My institute gives grants to researchers. Each application goes to experts and their conclusions go to a special committee who have a secret ballot. Grant applications are rated. The medical system, medical service, and medical sciences are in the process of change. Previously, research was given an annual fixed budget—nonflexible. Now there are various ways to get grants—more like the U.S. grant systems. We're able to get funding from industry, government, and private companies like foreign drug companies. Direct approaches are now allowed to foreign markets. We no longer need to get permission. Another recent trend is toward private medicine. For several years, patients have been able to pay as private outpatients at medical cooperatives, allowing more choice for individual care. [The government treats free.] Discussing another area, I will be involved in establishing a counterpart to the American Cancer Society in the Soviet Union. Q. What is the most exciting area of research in the Soviet Union ?
A. Molecular biology. Q. When will it come to the clinic?
A. It's like a revolution. It perks along and then, suddenly, it will happen. Meantime, international cooperation continues to be extremely beneficial. Sharing information on drugs and clinical trial collaborative data not only eases the energy and money drain but provides answers faster. It brings us quicker results.
Q. What are some areas of progress in cancer treatment?
A. I have a special interest in bone tumors. Limb-sparing treatments can be counted as progress for sarcomas and lumpectomy and radiation for breast cancer. There has been success in testicular cancer and childhood cancer treatment.
if a woman had a mastectomy, what would she think?
— By Eleanor Nealon Dr. Nikolai Trapemlkov
Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at University of Michigan on June 19, 2015
that occurred in Kyshtym in the Urals in the 1950s?
