Belarus Struggles to Contain Cancer
In mid-June 2016 Belarus hosted a regional forum on oncology for the second time since 2004. It brought together leading regional cancer specialists from 25 countries.
According to the World Health Organisation (WHO) 14 million people annually get diagnosed with cancer. In Belarus this number reached 50,000 new patients in 2015. Belarus has achieved considerable progress in cancer screenings and diagnoses at the regional level.
However, it consistently falls behind in cancer morbidity rates when compared to Western Europe, including immediate neighbours like Lithuania, and Latvia.
Currently more than 270,000 Belarusians have registered as oncological patients. In addition to the usual risk factors associated with cancer, such as ageing, smoking, and diet, Belarusians have now been living for 30 years with the radiation fall out from the Chernobyl disaster. This accounts for the saddest peak in cancer data – thyroid gland cancer increased disproportionately among children living in the affected areas.
The number of people diagnosed with cancer in Belarus has doubled since 1990: from 26,000 cases to 50,000 in 2016 according to the Chief Oncologist of Belarus, Aleh Sukonko. This number will continue to rise and reach 70,000 people by 2020. And the overall number of cancer patients diagnosed and registered with the healthcare system has steadily increased from 2002 and reached 271, 000 in 2015.
16% of patients go to see a doctor when the disease has already advanced to stage four, that is most advanced stage, at which cancer is almost always terminal, says Dr. Sukonko. Only 5% among them will recover.
To put it into perspective, according to Dr. Sukonko the morbidity rate in Belarus for cervix cancer is as high as 36%, compared with 21% in Germany. Screenings could help maximise early detection of the disease, and bring the morbidity rates down. Cancer screening involves testing apparently healthy people of a certain age, typically 50-70 years old.
Belarus has introduced regular cancer screenings aimed at prevention and early detection, but progress has stalled. Cervix cancer screenings among women are an example. Annual screenings are recommended for all women during their regular doctor's visit.Yet the ratio of stage four cancer cases diagnosed during such screenings remains stable at 10% among Belarusian women. In neighbouring Poland, where similar screening procedures are in place, the ratio is less than 4%, according to naviny.by.
What causes cancer in Belarus?
The most common risk factors for cancer include ageing, smoking, sun and/or radiation exposure, alcohol, poor diet, lack of physical activity, and being overweight. In Belarus quite a few of these factors come into play, such as radiation exposure after Chernobyl, overall population ageing, and poor self care with widespread smoking and high alcohol consumption.
Smoking is the leading cause of cancer in Belarus, with around 30% of all cases attributed to it, according to the chief oncologist Dr. Sukonko. Poor diet is the next most common cause, with 25% of cancer cases. The numbers are expected to increase because of the longer life expectancy among Belarusians.
Thyroid cancer is usually rare among children, with less than one new case per million diagnosed each year. However, after the Chernobyl accident a striking increase in the disease was reported in children and teenagers in the most contaminated areas of Belarus and Ukraine. Scientists have estimated up to 5,000 cases of thyroid cancer among residents who were children at the time of the accident, according to the WHO.
Gender plays a role too. Belarusian men most often suffer from prostate (17% of all cases) and lung (15%) cancer. Women face diagnoses of breast (18%) and cervix (10%) cancer. And 10% of all cases among both men and women turn out to be colorectal cancer. Most of these forms of cancer are curable if diagnosed at stages one or two.
How people deal with it
Cancer takes it toll: every seventh Belarusian dies from cancer. It is the second most common cause of death in Belarus after heart disease. The government, recognising the cost to human life as well as the problems of population decline, has pledged to invest in combating cancer. According to Belstat, around 30% of the healthcare budget will go to fight cancer.
While this may mean potential improvement to the national cancer statistics, large gaps in patient care remain. Below is the account of a cancer survivor Ulia Liashkevich, who also lost her mother to cancer in 2007:
My mother was diagnosed with stage four. Little could be done in terms of treatment. But a dying person is not yet dead. They (the doctors) told me I should take her home, that her death will look bad for their statistics, they threatened that they would perform an autopsy on her body. I did manage to make her last weeks painless, but only thanks to my connections and her friends.
Whenever the government does not provide a certain much-needed service, people have to self-organise. Cancer support groups have sprung around the country. Many have an online presence, such as http://oncopatient.by/ and http://news.tut.by/tag/1814-onkomarker.html. Both were created by cancer survivors aiming to provide resources for fellow citizens fighting the disease.
As one Belarusian neurosurgeons, who preferred to remain unnamed, put it:
Say, I have a patient with a malignant tumour in his head, and he has come to see me with his wife. I do not know whom to console, him or his crying wife. And most importantly, I feel like it is not up to me altogether. I am a surgeon after all, not a psychologist.
Much fear stems from lack of information. Most people feel overwhelmed and lost when diagnosed with cancer. Many turn to God, some look for answers in science. But for now cancer patients in Belarus, it seems, need to rely on their immediate family and friends in dealing with the non-medical aspects of this disease.