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.

Sad statistics

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.




Chernobyl: Fact and Legacy

April 26 this year marks the thirtieth anniversary of the Chernobyl nuclear explosion, when tests at the power plant there went calamitously wrong.

Then in the Soviet Union and now in Ukraine, the consequences for Belarus have been disastrous. The accident occurred a generation ago, yet it continues to blight lives today. Future generations will find little respite.

The facts: a night of horrors

In the early hours of 26 April 1986, safety tests to the fourth reactor at the nuclear power plant adjacent to the city of Pripyat​ (population 43,000) caused a power surge. A steam explosion ensued leading to a fire, a further series of explosions and then nuclear meltdown. The core of the reactor was totally destroyed and the roof blown into the sky.

Chillingly, survivors who watched from apartment balconies in Pripyat itself, just two kilometres away, reported that the deadly pall billowing from the roofless reactor actively glowed. Yet none of the onlookers had any idea of the mortal danger they were in from this spectacular pyrotechnical display.

The state’s response: ‘What explosion?’

In the immediate aftermath the State responded by saying and doing very little. The concerns of the international community were met with silence and denial.

Other than the commencement of evacuation from the immediate area, little was done in terms of measures to address the effects of radiation on the general public, who received no information about what had happened.

The authorities had little idea of what they were dealing with. A massive clean-up campaign subsequently began, largely involving the sluicing-down of buildings and other structures. But the major consequence of this was to wash the radiation down into the ground, increasing the level of contamination.

The impact: questions without answers

Land covering approximately 20% of the territory of Belarus (most of it in the south-east) continues to be affected by radioactive fallout. Thirty years on, accessing reliable information as to the impact of this in terms of hard statistics continues to offer something of a challenge.

Statistics can always be selectively presented to ‘prove’ a particular point, and perhaps it comes as no surprise that conclusions in high profile reports published by the energy and green lobbies differ extravagantly.

One side of the debate claims that only 28 people died from acute radiation exposure. The opposite side attributes thousands of deaths to the explosion, with many thousands more apparently identified as suffering from carcinoma and related conditions.

Visits to ‘hot spot’ areas where rain dumped larger doses of radioactivity are only permitted with the prior approval of the authorities, and then only when accompanied by officials. Here, signage displaying the international warning logo is everywhere to be seen, though the extent to which the authorities continue to control access is subject to question.

Whole villages stand abandoned to the elements. Once a year the bereaved are permitted to visit cemeteries to honour the dead, on the occasion of Radaunica (Ancestors Remembrance Day), a public holiday that falls on the ninth day after Orthodox Easter.

Over time, a number of people (particularly the elderly) have returned to homes that are still capable of habitation. No reliable studies exist as to numbers or the extent to which risk to health remains.

The impact: indisputable fact

Some issues are beyond ambiguity, not least the stark reality of fallout 400 times greater than generated by the bomb detonated over Hiroshima in 1945, and 16 million times greater than the accidental release at Three Mile Island in Pennsylvania in 1978.

Around 135,000 people were forcibly moved from the immediate area. The town of Pripyat itself stands as an abandoned wasteland, crumbling, frozen in time and left to the mercies of the elements. Wildlife rules events here.

As the scale of the catastrophe began to emerge, the circle of evacuation widened. The State moved many hundreds of thousands more from their homes in towns and villages further afield (including my own adoptive family living 236 kilometres away in Vetka).

Between 300,000 and 600,000 people were engaged in the decontamination of the 30-kilometre exclusion zone around the plant (known as ‘liquidators’).

In the years that followed the explosion, instances of thyroid cancer rose dramatically amongst those living in the area or under the path of the radiation cloud, particularly children and teenagers.

Over 500,000 people in Belarus alone present thyroid problems to this day resulting from absorption of radioactive iodine into the thyroid gland. In my own circle of acquaintance in Belarus, I personally know more than a dozen people so affected. Yet swiftly administered doses of non-radioactive iodine on the part of the authorities would have significantly reduced the absorption of this radioactive isotope.

Today, almost two million people continue to inhabit areas within Belarus that remain subject to radioactive contamination, largely from caesium-137. When this and other noxious elements fell on the ground and into the watercourses they entered the food chain, perpetuated still by the circle of life.

Caesium-137 has a half-life of 30 years. So on this thirtieth anniversary of the disaster, the concentration of contamination from this isotope has reduced by just 50%. It will be another 30 years and another generation before it halves again.

Remembering Chernobyl

Outside the Church of St Simeon and St Helena in Minsk (the iconic ‘Red Church’) stands the poignant Nagasaki Memorial Bell erected in September 2000, a powerful symbol uniting two communities ravaged by the elemental power of nuclear energy gone wrong.

On the day of the anniversary itself I shall be in Vetka for the annual service at the memorial stone and adjacent church bell, deliberately and symbolically cracked when cast, fatally flawed forever.

The pain remains visceral, though acts of remembrance extend beyond commemoration of loss into areas of practicality.

In the whole of Belarus, Homiel region suffered the worst contamination of all. To assist with the mitigation of the explosion’s consequences, the State established the Paliessie Radiation and Ecology Reserve in the region to study the effects of exposure to radioactive material and to develop long-term contingency planning.

As for the stricken reactor itself, the concrete sarcophagus erected in 1986 has exhibited cracks for many years, in all probability causing more radioactive material to leach into the surrounding ground and the waters of the River Prypiać, one of the largest expanses of free-flowing water in this part of Europe.

The international community has come together to design a more sophisticated tomb on a massive scale, this time made of steel. Still under construction adjacent to the reactor, the new arch will be painstakingly wheeled into place some time in 2017 and the ends sealed.

The legacy: never again?

Until Japan’s own nuclear disaster at Fukushima in 2011, the environment affected by Chernobyl was like no other on earth, affording a unique opportunity to study one of the most significant issues facing the future of the planet.

The fact that Fukushima happened at all suggests that by 2011, the lessons of Chernobyl had still not been heeded. Even today, questions about nuclear safety continue to arise.

The government of Belarus has commissioned a new power plant close to the border with the European Union, just 50 kilometres from Vilnius. ‘Unsafe,’ cries Lithuania. Belarusian submissions of observance of the strictest international standards are met with counter-allegations that international requirements are not being met.

While the debate rages, Chernobyl radioactive isotopes with half-lives of tens of years remain present in the land and waters of Belarus, and symbolically within the national psyche of its people.

Thirty years have now passed and the insidious consequences of the calamity show little sign of abating. In 2016, there remains significant ‘fallout’ still.

Nigel Roberts

Nigel is a freelance travel writer specialising in Belarus and is based in the UK.