"Modern man's lifestyle is a significant risk factor for cancer development"
The incidence of liver cancer and lung cancer should decrease in Russia, although not immediately, said Ivan Stilidi, chief freelance oncologist of the Ministry of Health and director of the Blokhin Oncology Center. Blokhin Ivan Stilidi. The share of liver oncology should decrease due to the fact that from 2023 the treatment of hepatitis C is included in the federal budget, and lung cancer - due to the current restrictions on tobacco consumption, including in public places. About the structure of disease incidence in the country, hopes for a vaccine and innovative methods of treatment - in an exclusive interview with Izvestia.
"Women get sick a little more often than men"
- What are the current trends in the incidence of oncology? Which cases are becoming more frequent and which are becoming less frequent?
- The number of people falling ill with malignant neoplasms is constantly growing - both in Russia and around the world. This is due to the development of medicine, improvement of the health care system and increased accessibility of medical care. Since the main risk factor for cancer development has been and remains the age of a person, the higher the life expectancy, the higher the risk of cancer for each of us. In Russia, as in all developed countries of the world, the average age of the diseased is about 60-65 years. But, of course, in addition to age, there are other risk factors that can significantly influence the prevalence of a particular type of cancer.
We expect a decrease in the incidence of liver cancer, because since 2023, the treatment of patients with hepatitis C is carried out at the expense of OMC funds allocated from the federal budget, and such therapy has become available to all segments of the population. The restrictions on tobacco use adopted in our country will reduce the number of lung cancer patients, but this will not happen immediately. There are a number of cancers whose risks are reduced or increased by lifestyle. These include breast cancer - some types are associated with late or low number of births, use of hormone replacement therapy. Obesity and low mobility also increase the risk of breast cancer and colorectal cancer. Prolonged tobacco use can lead to lung cancer, pancreatic cancer, and some types of kidney cancer.
That is, we see that the lifestyle of modern man is a significant risk factor for the development of a number of cancers. And we all, especially people after 40 years of age, need to remember this.
- What kind of cancer is the most common in Russia now - what is the situation for men, what is the situation for women?
- The most frequent cancers in Russia are breast cancer, lung cancer and colorectal cancer. The incidence of men is 452 per 100,000 people, women - 468 per 100,000 people. That is, women get sick a little more often, mainly due to breast cancer.
- How are things with treatment? Are all the drugs available, despite the departure of foreign partners?
- All antitumor drugs registered in Russia are available in our country in sufficient quantities, we do not experience any shortage, including targeting and immunotherapeutic drugs. Moreover, there are also original drug developments in Russia, and their number is growing.
"We have learned how to diagnose cancer in utero."
- What types of cancer are getting younger? It used to be said that this applies in particular to breast cancer. For which other types is this thesis relevant?
- We have begun to diagnose tumors at early stages more often. The resolution of modern diagnostic devices is so high that we can see tumors so small that clinically they would appear in a person in ten years, for example. But we can see them now, when our patient is still young and feels healthy.
The only neonatal oncology department in the country has been working at the Blokhin Oncology Center for three years - the youngest patient was three days old when he came to the Research Institute of Pediatric Oncology and Hematology at the N.N. Blokhin Oncology Center. N.N. Blokhin. If such a department has been opened, does it mean that babies have become more often sick with tumor diseases? No, we have just learned to diagnose in utero and organized medical care in such a way that these children receive competent anti-tumor treatment and are cured.
- Are there any difficulties with diagnostic equipment? Foreign equipment is rapidly aging, and there may be problems with consumables. But, for example, there are no Russian MRI machines with high resolution in mass production yet. What is the situation now, in your estimation? Are oncologists worried?
- During the period of the national project "Health Care" more than 16.5 thousand units of new medical equipment have been put into operation in oncology service. Including more than 1.1 thousand of heavy equipment. Today there are no unsolvable problems with diagnostic equipment. But, of course, we need to adopt the experience of countries friendly to Russia in this matter.
- What is the current cure rate for cancer depending on its type? How has it changed in recent years?
- There are over a thousand cancers! And each one has its own prognosis, primarily depending on the stage at which the disease is detected. But, of course, the overall survival rate of cancer patients is growing. Thanks to the whole set of measures within the framework of the national project "Health Care" we have already in 2023 reached the lowest mortality rates from cancer for the last 20 years! I am sure that thanks to the extension of this federal project, we will be able to save even more lives.
"Vaccine is not a panacea, it is another method in the arsenal of oncologists"
- Gamaleya NICEM together with the Blokhin Oncology Research Center. N.N. Blokhin Oncology Center, Herzen Cancer Institute and Sirius Center. Herzen Oncology Institute and the Sirius Center are developing a revolutionary cancer vaccine. Seven months ago, the President instructed the government to finance this project. What stage is it at now?
- You are talking about a neoantigenic mRNA vaccine, the development of which has begun at the N.N. Blokhin Oncology Research Center. N.N. Blokhin in 2018. In 2024, the Ministry of Health created a consortium of the four institutions you have listed to introduce this technology into practice as soon as possible. To date, we are completing trials of this vaccine in animal models with melanoma. The trials were successful, demonstrating the effectiveness of the technology against this disease.
- Can you tell us more about how such a vaccine will work?
- The goal of the vaccine is to reduce or prevent the risk of the disease returning. That is, it will be used only for people who have already fallen ill. In order to prepare a personal neoantigenic mRNA vaccine, we need to remove the tumor, sequencing it, that is, to get a huge array of genetic information, which will be analyzed by artificial intelligence programs and identify pathological proteins that are not typical for healthy cells. These proteins are used by the tumor to hide from the immune system. We call them neoantigens. There can be as many as 10, 20, or 30 of them in a tumor. Then we train the patient's T-lymphocytes - the cells of his immune system - to recognize the neoantigens and destroy the tumor cells.
- Would such a vaccine really be suitable for any type of cancer? After all, tumors are very different.
- This is an important point: tumors are indeed very different. Cancer is not one disease. As I have already said, there are more than a thousand cancers. That is why there is no universal remedy for cancer. The neoantigenic mRNA vaccine has been shown to be effective in animals with melanoma. And we suggest that tumors that respond as well as melanoma to immunotherapy may be among the indications for the neoantigenic vaccine. These tumors include non-small cell lung cancer and some cancers of the kidney and bladder. Perhaps some types of breast cancer and stomach cancer. It is important to realize here that the vaccine is not a panacea, it is another method in the arsenal of oncologists.
- Many people think that a vaccine is a drug for healthy people, and it is meant to protect against infection. But in this case, we are talking about immunotherapy. Will the drug protect against the development of cancer?
- Neoantigenic mRNA vaccine prevents relapse, the return of the disease. It is impossible to create a prophylactic vaccine against any cancer because there are a great number of cancerous diseases, and there are many causes of their occurrence, and they are all different. We can only indirectly reduce the risks of some cancers with vaccines. For example, the risk of cancer of the cervix, uterus, penis, anal canal, and oropharynx can be reduced by vaccination against the human papillomavirus. But this is not a cancer vaccine, but an antiviral vaccine that targets the virus potentially responsible for the development of the cancers listed above.
- What other innovative methods of cancer treatment are you currently developing?
- In December 2024, we at the Blokhin Oncology Research Center started using organ transplantation. In December 2024, we started using organ transplantation in patients suffering from liver cancer. Today we already have three such patients, and we will increase the number of these operations. This is not a panacea either, we are not talking about replacing an organ affected by cancer with a healthy one. Cancer is a systemic disease, so by performing liver transplantation, we give the patient an opportunity to receive and, most importantly, to undergo chemotherapeutic treatment, radiation therapy, and, therefore, to go into remission. This is another opportunity to save a life.
Our pediatric oncologists performed what we called a prophylactic bone marrow transplantation for the first time in a child with a solid tumor and a mutation in the bone marrow, thus preventing the development of leukemia in this patient. At the end of 2025, we plan to start clinical trials of boron-neutron-capture therapy (a type of radiation therapy. - Ed.) at our center.
Innovations in oncology are constantly appearing, inch by inch we are winning back the lives of our patients from cancer. It happens gradually, so it doesn't always impress the public. But if we compare the cancer treatment options available today with those available 20, 15, even 10 years ago, we see tremendous progress.
Переведено сервисом «Яндекс Переводчик»
