"Taking aspirin improves lung cancer prognosis"
Taking regular aspirin is effective for lung cancer. And quitting smoking brings more benefits in the fight against a malignant tumor than the most modern drug therapy. At the same time, alcohol increases the chances of developing cancer. Mass vaccination against human papillomavirus can completely solve the problem of the spread of cervical cancer. This was stated in an exclusive interview with Izvestia by David Zaridze, Head of the Department of Clinical Epidemiology at the N.N. Blokhin National Research Medical Center of the Ministry of Health of the Russian Federation. This year, the scientist celebrates his 85th birthday.
"Quitting smoking reduces kidney cancer mortality by half"
— Please tell us about your current research. What are you doing now?
— I continue to study the etiology or causes of cancer and develop preventive measures based on them. We have shown that smoking, which is known to be the main cause of the development of malignant tumors, affects the effectiveness of treatment of this pathology. Lung cancer and kidney cancer patients who quit smoking had significantly higher survival and lower mortality rates than patients with the same cancers who continued to smoke. The survival rate of lung and kidney cancer patients who quit smoking is 22 and 36 months higher than that of patients who continue to smoke. However, according to the recommendation of the American Society of Clinical Oncologists, an improvement in survival by 2.5–6 months is sufficient for the drug to be approved and recommended for implementation in practice.
We compared the effectiveness of smoking cessation in patients with kidney cancer and lung cancer with the effectiveness of modern anticancer drugs. I'll give you a couple of examples. Quitting smoking in patients with kidney cancer increases three- and five-year survival and reduces mortality from kidney cancer by two times, while the effectiveness of modern drugs approved for use by the FDA, immune checkpoint inhibitors, does not exceed 30%.
Lung cancer patients who quit smoking live 22 months longer than patients who continue to smoke, and patients receiving one of the most advanced anticancer drugs live only 11 months longer than patients who received a placebo. Therefore, the effectiveness of tobacco withdrawal in lung and kidney cancer is at least equivalent to or even superior to the significant results obtained in clinical trials of innovative cancer therapies.
— What if a person stopped smoking and started using this therapy?
— The effect of such a "combination" will be higher than immunotherapy and smoking cessation separately. In this regard, we recommend combining the use of anticancer drugs with smoking cessation. This will lead to an increase in the effectiveness of therapy. I would like to emphasize that in addition to the clinical effect, quitting smoking is economically beneficial for the healthcare system. The savings that would have been spent on the treatment of progression, the frequency of which is significantly lower when quitting smoking, on average amounts to more than 4 million rubles per patient.
— But if a person can't quit smoking, is there any way to minimize the harm from this habit?
— Of course, it is better to completely give up smoking. However, we have proven that the risk of developing lung cancer depends on the concentration of tar in cigarettes. Based on these results, we recommended that the USSR Ministry of Health limit the concentrations of tar and nicotine. In 1988, the Ministry of Health introduced the maximum permissible concentration for resin — 15 mg, and then 12 mg and below. And this led to a decrease in the incidence and mortality from lung cancer — from 72 deaths per 100,000 population to 40 per 100,000 — in a very short period of time. This preventive measure has saved 400,000 lives. Before the introduction of MPC, the concentration of tar in cigarettes reached an astronomical 30 mg or more per cigarette.
"Alcohol increases the risk of laryngeal cancer"
— But smoking is not the only dangerous habit. You've also studied the effects of alcohol, right?
— In the early 1990s and 2000s, Russia experienced a demographic crisis. Life expectancy among men has decreased to 57.7 years. To find out the causes of the death rate increase, we conducted a large multicomponent epidemiological study and proved that alcohol is the cause of this "super mortality".
Our results contributed to the development and implementation of the Concept of combating alcoholism. The ideologist and initiator of this document was the Minister of Health Tatyana Golikova. The concept was introduced in 2009, and it worked. Alcohol consumption dropped from 15 to 9 liters per capita. As a result, mortality has decreased and life expectancy among men has increased from 57 to 68 years. This scientifically based preventive measure has saved the lives of 3.5 million Russians, mostly young men.
— And how is alcohol related to cancer?
Alcohol increases the risk of developing cancer of the larynx, pharynx, esophagus, stomach, liver, colon.
— Is there a safe dose of alcohol?
— The European guidelines suggest drinking no more than 22.5 grams of pure alcohol per day, which is one glass of vodka, whiskey, cognac or the appropriate amount of wine, beer. For wine, this is 130 g or a mug of beer. This can make many of our people laugh. Unfortunately, we have a different mentality.
There is an idea that a small amount of alcohol reduces mortality or prevents the development of cardiovascular diseases. This is a myth.
— It is believed that the prevalence of cancer can be significantly affected by the human papillomavirus, is that so?
— Smoking is primarily responsible for more than half of deaths from malignant tumors, alcohol is responsible for the second, and overweight and viruses are responsible for the third.
HPV causes cancer of the cervix, vagina, vulva, anal canal, penis, and oropharynx. Vaccines have been developed against this virus. They reduce the incidence of precancerous and cervical cancer. In 2019, we held the international conference "Prevention of human Papillomavirus-associated malignant tumors: vaccination and screening" in Moscow, during which leading international experts presented the results of their research.
A thorough analysis of the data on the effectiveness of HPV vaccination was carried out, as a result, we came to the conclusion that vaccination prevents the development of precancerous and cervical cancer. In addition, vaccination is absolutely safe.
In 2025, the Russian pharmaceutical company Nanolek began production of the Tsegardex HPV vaccine. In this regard, it becomes obvious that there is a need to resolve the issue of organizing mass vaccination of adolescents as quickly as possible. Such a measure will significantly reduce the incidence and mortality from cervical cancer.
In addition, the introduction of HPV vaccination will lead to significant savings in funds allocated for the treatment of cervical cancer and other diseases associated with the human papillomavirus. WHO believes that vaccination coverage of 90% of girls will lead to the complete elimination of cervical cancer. Currently, we have an incidence of 16 cases per 100,000 women.
"Drugs alone will not solve the problem of cancer patients"
— Your research has shown that such a familiar drug as aspirin can also be an effective remedy against cancer. Can you tell me in more detail?
— Recently, we found that taking aspirin improves the prognosis of lung cancer. In this regard, I believe that the identification of new intervention methods, the introduction of which will contribute to improving survival and mortality rates, is relevant.
Currently, the main focus in improving cancer treatment outcomes is the development of new drugs, the effectiveness of which, unfortunately, does not always match the stated value and the use of which is limited by their astronomical prices and unavailability. Only this area, in which most of the resources allocated for cancer care are invested, cannot solve the problem of improving the prognosis of cancer patients.
The new model of health protection proposed by Deputy Prime Minister Tatyana Golikova - the transition from reactive to proactive (preventive) medicine — will ensure a reduction in mortality and an increase in life expectancy, once again emphasizing the priority of prevention. Only scientifically based prevention can ensure a reduction in mortality and an increase in life expectancy for Russians.
However, the priority of prevention is not obvious to many, which is reflected in the quality of scientific expertise and the policy of financing prevention research. In addition, it jeopardizes the prospect of achieving the goal set by President Vladimir Putin to increase life expectancy to 78 years by 2030.
— After the pandemic, they continue to study the health effects of the SARS-CoV-2 virus. Could it have something to do with cancer?
— This virus has nothing to do with cancer. After the pandemic, there was idle talk that it causes cancer. But there was no increase in the incidence of lung cancer. There was frequent use of CT scans to detect pneumonia caused by the virus. Changes unusual for the eyes of radiologists were revealed, which were interpreted as cancer. In fact, these are areas of pulmonary fibrosis caused by past inflammatory processes.
— What other common cancer risk factors are there that we haven't mentioned yet?
Overweight and lack of physical activity increase the risk of developing breast, prostate, uterine, and colon cancers. In order to avoid excess weight, you need to eat more vegetables and fruits, more poultry, fish, and take 40 minutes a day for a walk.
— What advice would you give to young scientists working in your field?
— Be critical of your scientific work. Evaluate it in comparison with the best samples. Be attentive to the comments and wishes of senior colleagues, for the most part they are more qualified and experienced. In conclusion, I'll give you James Watson's advice, which I've always followed unknowingly: "Avoid boring results." I would add: trivial results.
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