CANCER PATTERNS IN RUSSIA AND UK
Russia has by far the highest population of any European nation (148 million) but in terms of cancer, it remains something of an enigma. In the period after 1960, there was a gradual decline in Russian cancer death rates but this reversed in the early 1980s. The major contributors to the reversal were male lung and female breast cancer. In the 1990s, however, the trend reversed again, mainly due to a drop in cancer deaths among the elderly. Broadly similar trends have also occurred in Ukraine (52 million), which was, of course, part of the Soviet Union until 1991. Analysing Russian data is particularly problematic partly because the quality of the information has varied over time and with the area from which it has been collected. There has also been a competitive effect from large rises in other causes of death, notably heart diseases and accidents. As in other countries, improvements in health care have also begun to make an impact. In addition, the turbulence of the twentieth century has produced marked birth cohort effects, a major example being those who reached their early teens during the Second World War when the living conditions for Russians were even more severe than usual. One can only guess whether history has been a driving factor but smoking in Russia is strikingly prevalent with about 40 million lighting up – that’s 63% of men and 12% of women. There’s no national anti-smoking campaign and Russia has not signed the World Health Organization (WHO) Framework Convention on Tobacco Control. To make the outlook even worse, a recent survey of doctors and nurses revealed that they smoke even more than the general population. Historically Russia has had a relatively low rate of breast cancer, the early age of first childbirth being a contributory factor but, in a contrary shift, the trend in the last decade has seen the mortality rate rise to 17.3/100,000. Russia is also slightly at odds with general worldly wisdom in producing one survey showing that a bottle of vodka a day keeps breast cancer at bay – that is, heavy drinkers have a lower breast cancer death rate. Unsurprisingly, this level of drinking greatly increases overall mortality, so that whether the effect is real or not, it is of little relevance to strategies for cancer therapy.
In the UK about 100 people die each day from lung cancer and another 33 from breast cancer. Within the European Union, there is a diagnosis of breast cancer every 2.5 minutes and a woman dies from the disease every 7.5 minutes. Altogether in Britain, there are over 400 cancer deaths every day. That’s roughly the number of people in a typical commuter train with all seats taken and the standing space full – dying every day. For students of twentieth-century European history the train analogy may have chilling resonances but perhaps that’s appropriate given, as we shall see, that cancer is a bit of a mixture, in part due to things beyond our control but with a hefty leavening of what human beings do to themselves and each other.