I turned his pocket over.
“"I hope I never have to see you as a patient someday, but if I ever get cancer, I'll come to you," I said.
“"Who am I speaking to?" he asked.
I introduced myself, thinking he'd say "Oh, really?", but he completely ignored me, even looking for an opportunity to hang up, and finally politely said he didn't want to give an interview. But I also need to present you with some work every week! Besides, I was curious about him. I had endless questions about cancer. I showed up at his door. It was a bit of a surprise, of course, but he couldn't refuse me; he couldn't turn away a woman who had come to his door. Dr. Sualp Tansan is one of Türkiye's best oncologists. When you think of chemotherapy, he's the first person that comes to mind. He's also Mehmet Ali Birand's doctor. When he was corresponding with hospitals in America, they told his wife, Cemre Birand, "Why are you asking us? There's Sualp in Istanbul, ask him." İsmail Cem, Osman Yağmurdereli, Ufuk Güldemir, Özhan Canaydın were all his patients. Selma Ann Desmond was also his patient. /images/100/0x0/55ea3d57f018fbb8f873582d
He graduated from Istanbul Faculty of Medicine. Then he went to the USA and stayed there for 10 years. First, he completed his internal medicine residency and medical oncology subspecialty training at Boston University teaching hospitals. Then he took on the role of director and subspecialty training coordinator at the chemotherapy clinic of those universities. He did such outstanding work that he received various awards. Then he came to Türkiye, but couldn't find a position at any university. He first opened a center, then a polyclinic, and has continued to see patients ever since. But whether we appreciate Sualp Tansan's value as much as the Americans do remains unknown…
Why do I have to grab you by the throat just to get an interview from you?!
– Because every time I give an interview, I get into trouble. I'm not a political person, I don't know how to beat around the bush, and then I suffer the consequences. Also, in our country, the more your name becomes known, the worse it gets. I've learned this the hard way. When I first came to Türkiye, I made a television program about cancer to help people. And then, I almost got a tomato thrown at my head! But since you've come all the way to my door, go ahead and ask your questions…
Some time ago, there was a debate about vitamins A and E…
– Yes. I had said that in smokers, taking extra vitamins A and E could increase the risk of cancer. It wasn't my own opinion; it was the result of several studies on the subject. They attacked me for it, but after a while, it was confirmed that I was right.
So, should smokers not take multivitamins? Do they really trigger cancer?
– Yes. Vitamin A, in particular, increases the risk of lung cancer by 20 percent in smokers. Vitamin E has also been shown to have cancer-increasing effects. What I wanted to say was: Smokers, please don't take vitamins in pill form. When I first said this, oh my god, all hell broke loose, they said, "Where is he making this up from?" But then they learned the truth.
You sparked another controversy by saying, "In Türkiye, pharmaceutical companies advocate for the principle of overdose in cancer treatment.".
– That's exactly why I don't want to give an interview! Because that's not what I said. Let me explain what I actually said: In Türkiye, and indeed worldwide, pharmaceutical companies, when working on cancer treatments, adopt the principle of "Let's give people the highest dose they can tolerate" in order for the drugs to be effective. That's what I'm objecting to. This principle is wrong. In some cases, it's necessary to determine and administer the lowest effective dose to the patient. Oncology will develop in this direction from now on. We did the opposite for years. That's why chemotherapy got a bad reputation. In fact, if chemotherapy is done correctly, it doesn't cause so many side effects.
Chemotherapy patients are less battered now than they used to be, aren't they?
– Yes. Because over the years, we've learned to use chemotherapy better. Then, supportive medications have improved a lot. Previously, there weren't medications to stop nausea, now there are. Blood counts used to drop, patients would get infections, now there are injections to raise blood counts.
THE NONSENSE OF CURED CANCER BY EATING FIVE TOMATOES A DAY.
In recent years, close links have been established between cancer and nutrition, with claims such as "Eat this and you won't get cancer" or "After you get cancer, eat this and you'll get better"...
– We, as Turkish society, need to put an end to these kinds of conversations. "Eat five tomatoes a day and you'll get rid of cancer!" How can such nonsense exist?
So, what about the burnt part of the steak...?
– Okay, in laboratories, it has been observed that some substances in those burned areas have a negative effect on colon cells. But whether this leads to cancer, we don't know… The relationship between diet and cancer is not very clear. But yes, for our overall health, we have to eat healthily.
What do you mean by healthy?
– In my opinion, it's the Stone Age diet… That is, the things we've been eating since the Stone Age: meat, fish, chicken, vegetables, fruits, and nuts. We've been eating like this for tens of thousands of years. But in the last 100 years, we've changed our eating habits. Bread, carbohydrates, sugar, and so on have entered our lives. But our bodies weren't designed for this. So what happens when our eating habits, which have been going on for thousands of years, change? New diseases emerge.
So you don't approve of vegetarianism either...?
– Everyone has their own preference. But I think it's essential for growing children to eat meat. I'm struggling with this with my nine-year-old daughter. She loves animals and is about to become vegetarian. Wrong! Growing children absolutely must get animal protein. After that, it's up to them whether they eat it or not. As for women, if they are vegetarian until menopause, they absolutely need to take iron supplements afterwards. Iron deficiency is a serious issue.
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What about vegans?
– They can also develop other illnesses later on. Most of them don't do it for health reasons anyway; it's philosophical. Another group I say "They should especially eat meat" are patients undergoing active chemotherapy. Because if they don't consume animal protein, their blood counts and overall condition can be negatively affected.
When I wrote that you suggested Mehmet Ali Birand eat meat during chemotherapy, I even received emails from America saying, "Please warn Mehmet Ali Bey, the doctors here are absolutely against it…"
– Everyone has their own opinion, of course. I especially recommend meat to those undergoing active chemotherapy. This is based on my 20 years of observation. The patient benefits greatly from it. It doesn't have to be red meat.
Is sugar more harmful than meat in cancer?
– Sugar is harmful. You know there's something called PET tomography. PET tomography is the best way to show that when sugar is ingested, it first goes to cancerous cells. As soon as glucose is administered, it goes to wherever cancer is in the body. It concentrates there. What does this mean? It means that cancerous cells use sugar to multiply, grow, and regenerate themselves.
So, those who consume less sugar have a lower risk of cancer, right?
– Reducing sugar consumption during cancer treatment is very beneficial, that's what I'm saying. I wouldn't tell anyone, "Don't eat sugar!" But I don't eat it myself.
Are you not using regular sugar?
- No.
So what do you use?
– Stevia. A fibrous plant native to South America. Something used by the ancient Incas. It's also sold in Türkiye. It gives a sweet taste. But it's not synthetic.
All sweeteners contain aspartame, isn't that harmful too?
– Everything synthetic, everything man-made, everything unsuitable for humans is harmful.
For example, as someone who knows this subject inside and out, what do you do to avoid getting cancer?
– I try to eat healthily and exercise. Most importantly, I get my screenings done on time for early diagnosis.
Do I need to have it done once a year?
– It varies depending on age. If you're a man, you need to get a prostate cancer screening starting at age 50. If you smoke, you absolutely need to get a low-radiation CT scan of your lungs. And you'll continue for five years after quitting. 85% of lung cancers detected by CT scans are curable. But if it develops naturally, unfortunately, the rate is only 15%. Besides that, I get colonoscopies. Colon cancer is one of the types of cancer that people should be most careful about. In both men and women, colon cancer is the third most common type.
Mehmet Öz had the procedure done and his life was saved.
– Exactly. Because he had the test done, the cancerous colon polyp was diagnosed. If he hadn't, things could have gone awry a year or two later. Colon cancer is one of the easiest types of cancer to diagnose early. Especially if you catch it in the polyp stage, it's quite easy to treat.
EVEN THE MOST MALIGNANT TUMOR CAN BE CURED WITH EARLY DIAGNOSIS.
Can great sadness and high stress levels invite cancer?
– I don't think they cause cancer on their own. Thousands of cells in our bodies become cancerous every day. The body's immune system detects these abnormally behaving cells and destroys them. A cancerous cell is a cell that has gone out of control and is acting on its own. The immune system recognizes them. However, there is this: under very high levels of stress, the immune system cannot perform its function adequately, and the likelihood of cancer cells forming increases in people under stress.
Can you tell someone who has 'escaped' cancer, "Now you need to change your life. Never go back to that stressful environment"? Or, conversely, could that person's passion for their work actually benefit them in their cancer treatment?
– I think it's beneficial. I advise people to do what they love as much as possible. They should continue with their work. Especially for people who live and breathe their work, their personality, and their intellect, the opposite situation definitely has a negative impact.
Which types of cancer are more severe, more aggressive?
– It depends on the stage. Even the simplest cancer can become incurable if it spreads to another area. On the other hand, even the most malignant tumors can be cured if caught in the early stages.
Is pancreatic cancer the pinnacle of this?
– It's one of the most important and challenging cancers. Early diagnosis is also one of the most difficult. Pancreatic cancer is like a traffic accident.
Because it hit him suddenly, like a truck?
- Exactly.
So, what about Apple's Steve Jobs...?
– His isn't the kind of pancreatic cancer we know. It's a slow-growing but generally incurable pancreatic tumor. He's been suffering from this disease for a long time, and he's had liver and other surgeries. But it only works to a certain extent.
Does cancer inflict its damage openly, or insidiously?
– It varies depending on the type and the individual. In some, breast cancer appears, and suddenly, all hell breaks loose within a month. In others, it can grow slowly over years. It also varies depending on the location of the disease. Those that appear in the right side of the large intestine are more insidious and show no symptoms. Those that appear on the left side manifest themselves with bleeding, meaning they give symptoms earlier. Similarly, in pancreatic cancers; if the cancer is at the head of the pancreas, it immediately causes jaundice, which is a chance for relatively early diagnosis. If it's at the tail, it doesn't show symptoms for a long time, it can spread to other areas, and it can be more problematic.
Do you see cancer cells as your enemies?
– No, no, they're part of our bodies. It's a separate issue that they've gotten out of control. But, this is something the Creator did. We are perfect biological creatures; our only flaw is cancer. It's a signal error, a manufacturing defect.
What are some acceptable generalizations about cancer? For example, smoking is 100% harmful…
– Yes. It causes damage from where it enters to where it exits. It starts in the oral cavity, then the throat, lungs, pancreas, kidneys, and bladder. It also increases the risk of all these cancers. Smoking is truly a nightmare of the 20th century. But I think its consumption will decrease. Thanks to these new policies, the situation is much better than before. The number of smokers has decreased.
Why do people who have never drunk alcohol get cancer?
– If you are human, you have a risk of getting cancer. Just because you don't smoke doesn't mean you won't get it.
If smoking were completely banned, would cancer also disappear from our lives?
– More than half of lung cancer cases would be reduced.
After cigarettes, what's the second most harmful thing?
– Stress does play a role. But it doesn't cause cancer, it accelerates its development. Excess weight and diabetes also contribute. But none of these are definitive. In fact, we don't fully understand the causes of cancer. We are trying to learn. As we discover human DNA and learn more about genes, we will better understand why we get cancer.
“Is "beating cancer" a silly phrase?
- Yes.
“"It's not like 'Arman Kırım lost, the other one won'..."
– No. Statistics and chance play a role here. Arman Kırım received very intensive and good treatment. He had a 70 percent chance of recovery, and a 30 percent risk of not recovering. He fell into the 30 percent category. There's no reason for it. It just is. Which 70 percent recovers and which 30 percent dies, medicine is only now trying to learn and determine that.
BREAST CANCER IS ON ITS WAY TO BECOMING A NON-FATAL DISEASE.
Are there any cases that surprised you?
– Of course it happens. Lately, the number of our patients with late-stage lung cancer who have managed to live for more than five years has increased significantly. There are also those with metastatic breast cancer who have lived for over 10 years. And they have a very good quality of life.
Will the treatment continue for 10 years?
– It continues intermittently. Sometimes they receive treatment for six months, then they don't have treatment for a year. Breast cancer is now becoming a chronic disease. It's a disease that doesn't kill you, but one we'll have to live with.
It will drag on...
– No, it doesn't need to drag it out either. As cancer doctors, our most important task is actually to improve the patient's quality of life. To eliminate the problems and complaints caused by cancer. For this, our most effective method is chemotherapy. Sometimes we need to use other things as well. If the patient's lifespan is extended, that's great. But there's no point in making the patient miserable just to prolong their life. We don't do that. While I'm on the subject, let me say that in Türkiye, in our culture, there is a very serious problem regarding death.
Why?
– We are not at peace with death. It's not taught in schools, nor do our parents ever talk about it. Death is a taboo.
Like sex.
– Sex is still talked about, mentioned, at certain stages of life. Death is never discussed. It's as if it doesn't exist. As if we are not mortal, as if we will not die. Yet, no one escapes this; we will all die. The Creator made us this way. After 40, the countdown begins. Our hormones decrease, we begin to wither and fade. This is a fact. We die as we were born…
FOR A PATIENT WHO HAD THREE MONTHS TO LIVE, LIVING FOR THREE YEARS IS A GIFT.
How did you come to the conclusion that Turkish people have a problem with 'death'?
– No, no, what I'm saying is more than just an opinion. This is a very serious observation. A sociological study should be conducted on this. We are literally at war with death, and we need to stop this. For example, we treated a patient who was given only three months to live anywhere in the world, and they lived for three years but eventually passed away. The family came to me and said, "You couldn't save him!" Yet I had explained it to them step by step, those three years were actually a gift, like winning the lottery, but they just can't accept it. There's always denial, always rejection. That's why I always warn the relatives, "Thank God, things are going very well now, but this won't always continue." But people's brains don't register this. When we lose the patient, they say, "How! How could he die!" This stems from our culture. We need to stop fighting with death.
Is it different in other cultures?
– It's different, of course. I worked in the US for 10 years, and there's nothing like this. There, people would come and say, "Doctor, I don't feel well, I think I'm in my final stages." We'd check, and it really was true. They'd say, "I have no one, admit me here, let me die in peace." They'd stay for a week, we'd give them their medication, they'd be comfortable, and they'd pass away peacefully. Here, even with patients whose death is known to be 100% certain, and you've communicated this very well, we have problems with their relatives. It's a frequent occurrence. This doesn't even depend on the patient's intellectual level or anything like that, that's why I say it's cultural. We need to solve our problem with death.
I was both amazed and surprised by Arman Kırım's answers in my interview with him, as if he would never die. Perhaps we humans are programmed this way; we can't accept death.
– No sir, that's just how we Turks are! That's exactly what I mean. Even the most cultured, most intellectual people have this inability to face it, to accept it. One day we will all die. Period. There's no ifs or buts about it. We can't pretend otherwise. Who are we kidding? What's important is to die humanely, without pain or suffering, preferably without being languished in hospitals, surrounded by our family and loved ones, and to pass away from this world in peace.
Do you feel more comfortable talking to patients or their spouses?
– It varies. Some patients want to learn and hear everything themselves. But the rates are much lower than in the US. There, you tell all the patients everything very openly, and they accept it reasonably. Here, as I said, there's an inability to confront the situation and denial.
I HAVE A PATIENT WHO COMES FROM THE NETHERLANDS EVERY WEEK.
What about cancer drugs in our country...?
– In this country, there is incredible ease in obtaining cancer medication. No other country in the world provides its patients with the most modern cancer drugs in this way. People need to know this.
What do you mean? Germany, France…
– Oh no. For example, I have a lady who comes from the Netherlands every Monday. She has lung cancer and is receiving treatment here. She gets the treatment on the same day and goes back. Can you imagine? Because in the Netherlands, they don't give her the treatment she needs. We are much better off in terms of medication.
How is it?
– The government is doing a very good job on this issue. Turkey is one of the countries where the cheapest oncology drugs in the world are sold. But there is a shortage of trained personnel to administer these chemotherapy treatments. Oncologists working in the state sector have to see hundreds of patients. Can an oncologist see 100 patients a day? Many of our colleagues are working under these conditions. The number is insufficient. New oncologists are not being trained. Therefore, many patients die without receiving proper treatment. An internal medicine specialist who worked with me for three years is now the most important medical oncologist in the Kosovo region.
Why don't you establish an institute or something...?
– No way! I would love to have an academic career, to train young doctors. But I can't take on a second medical oncologist; I don't have permission.
From where?
– We are a private organization, we pay taxes, we provide employment, but the state decides which doctors we can hire and in what numbers. You'll say, "This is unacceptable!" But it happens. That's why I've been fighting this alone for 16 years. But unfortunately, it's impossible; they won't allow it.
When I lose a patient I've been treating for a long time, I can't recover for a week.
You are also a 'companion'. You accompany your patients on that thorny path; some end up in a rose garden, others on a rocky road. How do you feel during this process?
– An oncologist needs to maintain a certain distance from their patients.
So you prefer not to be friends…
– Professionally, it's not the right thing to do. I'd like to be friends with all of them, but to be objective, a professional distance needs to be maintained. I try not to be friends and go out to dinner with them. At the same time, we're losing a significant number of these patients.
Do you have any numbers?
– 110 people have died in the last year. But I treat thousands of patients. That's a very low rate. I'm incredibly saddened by every patient we lose.
How did you learn that they lost their lives?
– We don't abandon patients after chemotherapy is finished; we always provide terminal care or supportive treatments. Our nurses and doctors go home, and so do I.
Is there a final conversation?
– It varies from patient to patient. Some want it, some don't. But we stay in constant contact with their families. Even after all these years, I still haven't gotten used to my patients dying. And I don't think I ever will. After losing a patient I treated for a very long time, I'm affected for a week. I want to go out to sea, I want to sail, I want to forget everything.
THE DOCTOR HAS THE RESPONSIBILITY TO ENSURE THE PATIENT DOES NOT SUFFER.
How can we prevent a painful death?
– Nowadays, there is no reason for a cancer patient to die in agony.
But they always describe it like this, "She was in a lot of pain," and so on...
– No, a cancer patient can die completely painlessly. That's in the doctor's hands. The things that can be done in the final stages of life are very well-defined scientifically. For one thing, patients who receive chemotherapy experience less pain. Besides that, pain science has advanced so much that we can keep these patients at home peacefully and happily with medication pumps.
Once cancer arrives, can it come back?
– If the cancer has spread and, by the time it is first diagnosed, has already reached unrelated organs via the bloodstream, then, as a general principle, the likelihood of it returning is very high.
