Dynamics of morbidity and mortality from malignant tumors in Russia
The article presents an analysis of the dynamics of the incidence of malignant tumors (MT) and mortality from them. An attempt has been made to analyze the causes of the growth or decrease in morbidity and mortality from some forms of MT. Based on the analysis of domestic and international experience suggestions on planning measures to further reduce MT mortality and morbidity in the Russian Federation were made. Mortality from MT in Russia reduces mainly by decreasing of mortality from lung cancer and other forms of cancer, the cause of which is smoking, as well as from stomach cancer. Primary prevention plays a dominant role in this decline. Reducing death rates from MT alone saved the lives of at least 300 000 Russians as well as many tens of thousands of citizens of other countries of the former USSR, in which the mortality from this disease also decreased. The observed increase in MT incidence is the result of an increase in the prevalence in the population of risk factors for a number of MT. However an important role in this growth is played by the use for early diagnosis of modern highly sensitive technologies that “reveal” clinically insignificant tumors that were not previously found in clinical practice. To further reduce death rates from MT it is necessary to expand the range of preventive measures. We need a program to vaccinate adolescents against human papillomavirus (HPV). The vaccinated generation will be cured of cervical cancer and this is one of the most common forms of cancer among women. In the next 2-3 decades it is necessary to conduct regular organized screening to detect HPV infection. A serious revision of our position on screening will allow reducing mortality from cancer of the cervix, colon and rectum and, possibly, the breast. It is necessary to introduce methods of so-called drug prevention. A convincing evidences of the effectiveness of taking aspirin for the prevention of colon and stomach cancer, tamoxifen - for the prevention of breast cancer. The future of early diagnosis is of tumor markers. It is necessary to test in the population the effectiveness of determining tumor markers, for example, circulating free tumor DNA and mRNA for early detection of cancer. Of course this does not mean that we must give up measures aimed at limiting smoking and promoting healthy lifestyles. Reducing alcohol consumption, changing the type of food to reduce consumption of processed meat products and meat and increasing consumption of fish, vegetables and fruits as well as increasing physical activity will undoubtedly lead to a reduction in morbidity and mortality from many basic forms of MT.