Dr. Süalp Tansan has recently returned from an annual congress in America where innovations in cancer research are discussed. We spoke with Tansan about global developments in cancer research and common misconceptions about the disease.
You've just returned from a cancer conference in America. What is the significance of this conference?
-This is a congress held once a year in America. It's a very important congress closely followed by doctors working in the field of cancer. This year it was held in Chicago and 25,000 doctors attended. The unique feature of the congress is that innovations and studies in the field of cancer are presented here every year. So you have the chance to hear about them firsthand, before they are even published in the literature.
THE GREEKS ARE AHEAD
Where are they going to fit 25,000 people?
-They can't fit everyone in. The congress lasted four days, from 8:30 in the morning to 6 in the evening. They used twenty large halls. They divide it into days, and you can't even see the speaker; you just watch the developments on giant screens. I've been attending the congress for 15 years; the first year there were only 5,000 doctors. Maybe they won't be able to hold this congress anymore because it's very difficult to gather so many people.
* Is this conference open to everyone, or do we need a special invitation?
-No, no invitation is needed. Anyone interested can attend, but it's more geared towards doctors, meaning there are technical terms and research involved. It might be difficult to understand if you don't follow world events.
* Is it being held there because America is the most advanced in cancer research?
-Absolutely. One thing that's now a certainty all over the world is that America is very, very advanced in cancer research. Europeans have made great strides in recent years, but economic power is still very important. For example, the Greeks have also made considerable progress.
THE RESEARCH IS LONG
Where does Türkiye stand in these studies?
-As I said, everything boils down to finances. Since I'm far from the university environment, it might not be accurate for me to give you statistics. We're ahead in application, though not in research. Turkish doctors closely follow developments around the world and apply them to their patients. For example, there were 80 Turkish doctors at this congress for the first time. I attend every year, but I've never seen so many Turks before.
Despite all the advancements, cancer research still takes a very long time, doesn't it?
-Absolutely. Let me give you an example. The first chemotherapy drug was actually discovered in 1977. Its name is Taxol. They found that a substance obtained from a plant on the Pacific coast offered a solution to cancer. However, to give that substance to humans, they first needed to dissolve it in water. They succeeded and tested it on mice. The result was positive. When it came to testing it on dogs, they failed and shelved the drug. However, in 1985, a doctor took an interest again and, by isolating the substance used in the dissolution process, they were able to achieve results.
BIOLOGICAL TARGETS
Is this medication currently in use?
-It was released in America in 1991. In Türkiye, I think it's been on the market for three or four years. We use it for all major types of cancer, mainly breast and lung cancer. It's not a complete cure, but it's one of the important treatments we have. Just think, it only took 15 years to discover it.
* How do newly released chemotherapy drugs differ from others?
-Chemotherapy drugs are chemical drugs. We use them to destroy cells that multiply and grow rapidly in the body. But unfortunately, they don't discriminate between cells and kill good cells as well.
* Especially hair follicle cells…
-Of course. That's why hair falls out. Also, cells in the stomach and intestines are damaged, leading to vomiting. And most importantly, cells in the bone marrow are damaged, which lowers blood counts. New medications help normal cells recover, thus eliminating all side effects.
* Were these drugs also promoted at the congress?
-We are aware of some parts of it, and we have just learned about others. What we learned at the congress is that these drugs will improve further every year, and side effects will be minimized. America is now working on targeted therapies.
What innovation impressed you most at this congress?
-Biological targets. There are two main biological targets. One is vascularization. That is, preventing the tumor from forming its own blood vessels by not being able to access the body's existing vessels. The second is stopping the tumor's growth and metastasis. Twenty biological drugs that block growth factors are currently in the trial phase. One of them significantly increased the effectiveness of chemotherapy in colon cancer.
How much progress is this?
-For example, if a patient with advanced disease can live for 13 months with chemotherapy, they can live for 20 months with this treatment. This rate is much higher with early diagnosis.
SIDE EFFECT: ACNE
* So, what is the quality of life like for someone who lives for 20 months in the advanced stage?
-This is the most important point. The quality of life can be kept extremely high. The revolutionary drug we have been using in Türkiye for the last year in lung cancer treatment also largely prevents vascularization. It shrinks the disease in 15% of patients, stops it in 65%, and reduces many side effects. You take one pill orally per day.
Are there any side effects?
-I'm laughing as I say this because the only side effect is acne. Seeing these things, following new research, makes me very, very happy. I can say that as a cancer expert, I am hopeful and that all the secrets of the disease will be deciphered in the near future. The government needs to allocate more budget for new drugs; that's what worries me. No vitamins for smokers: Dr. Süalp Tansan says that if smokers use vitamins A, B, C, D, and E, their risk of developing lung cancer increases by twenty percent.
What is the most common type of cancer in Türkiye?
-Unfortunately, there's been an explosion in lung cancer cases. I'm saying this based on observation, not statistics. Even I've doubled the number of lung cancer patients in the last seven years. Lung cancer is a type of cancer we fear because it's somewhat difficult to diagnose early.
* Doesn't it show up on the chest X-ray?
-By the time it becomes visible, it's already too late. Last year, the Japanese published the results of a very important study. Now, a simple spiral chest CT scan can provide us with early diagnosis. This can greatly reduce the risk of death. Of course, this needs to be made a state policy, explained to the public, and the cost needs to be reduced. However, what I value more is that, rather than tests, something needs to be done as a state policy to accelerate smoking cessation.
Is smoking the cause of lung cancer?
-Absolutely. The worst part is that passive smokers are even more affected because the exhaled part of cigarette smoke contains more carcinogens. In fact, we were all passive smokers when we were little.
* Let's say everyone in society quit smoking at once today, would lung cancer disappear?
-Even if we all quit today, we'll suffer from this disease for at least another 15 years before it's over.
* Is there no chance of someone developing lung cancer who has never smoked or even been in a smoking environment?
-Yes, but it's a very, very small percentage, a problem caused by pneumonia. Smoking is our biggest problem. The moment we eliminate smoking from society, this disease could become a thing of the past. The harm from smoking isn't just to the lungs. The smoke starts in the oral cavity, goes to the throat, then to the lungs. Then to the esophagus, breasts, kidneys, pancreas, and bladder. Can you imagine?
* Many smokers use vitamins as supplements…
-Here's the biggest mistake. Smokers absolutely shouldn't take vitamins A, B, C, D, and E. When these vitamins are combined with smoking, your risk of developing lung cancer, in particular, increases by 20 percent. That's a significant percentage. In America, vitamin supplements often say, "Do not take if you smoke.".
* In America, cigarette packs also say "Causes cancer," while in our country, they only say "Harmful to health.".
-At the entrances to the halls where we held our congress, there were signs that read, "Please refrain from smoking within thirty meters." Smoking is now banned in many places. America has progressed greatly, but it's foisting the cigarettes it can't consume on developing countries. This was one of the important topics of discussion at our congress. If we, as Turkey, don't take precautions against this, unfortunately, this situation will continue. Improvement is now easy.
* We all tend to assume someone is dead when they get cancer. Is this unique to Turks?
-Absolutely. Just because you have cancer doesn't mean you're going to die. It's possible to recover completely from cancer. In fact, I can say that cancer is such a disease that you can get better very quickly. You can't recover from high blood pressure or heart disease, but you can recover from cancer. I have many patients who have recovered from cancer and are completely well. It's not a miracle, and it's possible.
What types of cancer are easier to treat?
-Early diagnosis makes it easier to treat lymph node cancers, breast cancer, ovarian cancer, and testicular cancer in men. Good news: a cancer vaccine is on the way! By comparing genes, it will be possible to apply personalized treatment. Drug use will vary for each patient.
* The human genome has been mapped. How will this achievement affect cancer research?
-This is the biggest development of recent years that excites and gives hope to all of us because cancer is a disease of genes. By genes, we don't mean those inherited from parents. I'm talking about the genes located in the nucleus of each cell that determine its function.
Are there any types of cancer that are hereditary?
-It exists, but it's very rare to have it that's 100% hereditary. Cancer arises due to the effects of the environment, air pollution, smoking, and certain genetic changes that we don't know about. The human genome has been deciphered, so what will this be used for? Previously, for example, when I was talking about breast cancer, we could overlay gene maps and track their commonalities. This year, we saw its contribution to treatment. There are 74 important genes. If a patient shows a high concentration of these genes, we can predict beforehand whether they will respond to treatment.
What if those genes aren't there?
-If those are missing, there are another 206 genes. These are the individuals in the middle group who will benefit from treatment. If these are also missing, it is impossible for that patient to respond to any treatment. At this stage, giving the patient medication and tiring them out will no longer make sense. We will take a tissue sample from the patient, put it in the machine, and a gene map will appear. We will then apply treatment according to those genes, and give medications accordingly. For example, we will be able to say that this patient does not need chemotherapy, biological medication is sufficient. Therefore, the era of treatment focused on the patient, not the disease, is beginning. This is a breakthrough.
* All of these studies are focused on people who have cancer. But what about those who don't have it? Will a vaccine for cancer ever be possible?
-That's the next step. The changes between those with cancer and those without are being examined. The genetic map of healthy individuals will also be created and compared. Through comparison, we will be able to say, for example, "This person has a risk of developing cancer in the next 50 years." We will be able to know which cancers they are predisposed to.
* That's an unpleasant thing, isn't it? To know in advance which type of cancer you'll get...
-Yes, but it's very important to know and implement countermeasures if there are any. Vaccines will be developed. For example, vaccines against melanoma (related to moles on the skin) and kidney cancer are almost in their final stages.
* So, approximately how many years will it take for these vaccines to become available for use?
I don't think it will happen before 10 years.
