I turned my pocket inside out.
"I hope I never end up as your patient, but if I get cancer, I'll come to you," I said.
"Who am I speaking with?" he said.
I introduced myself, thinking he would say "Oh," but he didn't even acknowledge me. In fact, he waited for an opportunity to hang up the phone, and finally, he politely said he didn't want to give an interview. Well, I have to bring you a story every week! Besides, I was curious about him. I had endless questions about cancer. I showed up at his door. It was a bit abrupt, 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 Turkey's best oncologists. When you think of chemotherapy, he's the one who comes to mind. He's also Mehmet Ali Birand's doctor. When his wife, Cemre Birand, was corresponding with hospitals in America, they said, "Why are you asking us? Sualp is in Istanbul, ask him." İsmail Cem, Osman Yağmurdereli, Ufuk Güldemir, and Özhan Canaydın were all his patients. Selma Ann Desmond is also his patient. /images/100/0x0/55ea3d57f018fbb8f873582d
He graduated from Istanbul Medical School. Then he went to the US and stayed there for 10 years. First, he specialized in internal medicine and medical oncology at Boston University teaching hospitals. Then he took on the role of director and advanced training coordinator at the chemotherapy clinic of those universities. He did such excellent work that he was deemed worthy of various awards. He then returned to Turkey but couldn't find a position at any university. He first opened a center, then a clinic, and has been treating patients ever since. But whether we recognize Sualp Tansan's value as much as the Americans do remains unknown...
Why do I have to beg you for an interview!
– Because whenever I give an interview, I get into trouble. I'm not a political person, I don't know how to twist words around, and then I suffer the consequences. Also, in our country, the more your name is heard, the worse it is. I've learned this the hard way. When I first came to Turkey, I did a TV show about cancer to be helpful to people. You did that! The only thing missing was someone throwing a tomato at my head. But since you've come to my door, go ahead and ask your questions...
Some time ago, there was a debate about vitamins A and E...
– Yes. I said that extra vitamin A and E intake could increase the risk of cancer in smokers. It wasn't my own opinion. It was the result of a number of studies on the subject. They came down hard on me, but after a while it became clear 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% in smokers. Vitamin E has also been found to have cancer-promoting effects. What I wanted to say was: Smokers, please don't take vitamins in pill form. When I first said this, all hell broke loose, and people said, "Where did he come up with this?" But then they learned the truth.
You've sparked another debate: you said, "Pharmaceutical companies in Turkey advocate the principle of high doses for cancer."
– That's exactly why I don't want to give interviews! Because I didn't say that. Look, let me explain what I said: Not in Turkey, but all over the world, pharmaceutical companies working on cancer treatment adopt the principle of "Let's give people the highest dose they can tolerate" for the drugs to be effective. That's what I object to. This principle is wrong. In some cases, it is necessary to determine the lowest effective dose and administer it to the patient. Oncology will develop in this direction from now on. We have been doing the opposite for years. That's why chemotherapy has gotten a bad name. Actually, if chemotherapy is done correctly, it doesn't cause so many side effects.
Chemotherapy patients are less battered than they used to be, aren't they?
– Yes. Because over the years, we've learned to use chemotherapy better. Then, supportive medications have greatly improved. There used to be no medication to stop nausea, but now there is. Blood counts would drop, patients would get infections, but now there are blood-boosting injections.
The nonsense of avoiding cancer by eating five tomatoes a day
In recent years, close links have been established between cancer and nutrition, such as "Eat this and you won't get cancer" or "After you get cancer, eat this and you'll get better"...
– As a society, we need to put an end to these conversations. "Eat five tomatoes a day and you'll be cured of cancer!" How ridiculous is that?
So, the burnt part of the steak...
– Well, in laboratories, it has been observed that some substances in those burnt parts have a negative effect on colon cells. But does this cause cancer? We don't know... The relationship between food and cancer is not very clear. But yes, for our general health, we must eat healthily.
What do you mean by healthy?
– In my opinion, the Stone Age diet... That is, the things we have been eating since the Stone Age: meat, fish, chicken, vegetables, fruit, and nuts. We have been eating like this for tens of thousands of years. But in the last 100 years, we have changed our eating habits. Bread, carbohydrates, sugar, and so on have entered our lives. Well, our bodies are not 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...
– It's everyone's own choice. But I think it's essential for children in their growth phase to eat meat. I'm struggling with this with my nine-year-old daughter. She loves animals and wants to be vegetarian. Wrong! Children in their growth phase must consume animal protein. After that, they can choose whether to eat meat or not. As for women, if they are vegetarians until menopause, they absolutely must take iron supplements afterwards. Iron deficiency is a serious issue.
/images/100/0x0/55ea3d57f018fbb8f873582f
What about vegans?
– They can also develop other diseases later on. Most aren't doing it for health reasons anyway; it's philosophical. Another group I specifically mention as needing to 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 recommended eating meat during chemotherapy to Mehmet Ali Birand, I even received emails from America saying, "Please warn Mehmet Ali Bey, the doctors here are absolutely against it"...
– Everyone is entitled to their own opinion, of course. I specifically recommend meat to those undergoing active chemotherapy. This is based on 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 the cancerous cell. As soon as glucose is administered, it goes to wherever there is cancer in the body. It concentrates there. What does this mean? It means that the cancerous cell uses the sugar to multiply, grow, and renew itself.
So, people who consume less sugar have a lower risk of cancer. Is that right?
– I'm saying that there is a great benefit in reducing sugar consumption during cancer treatment. Otherwise, I wouldn't tell anyone, "Don't eat sugar!" But I don't eat it.
Don't you use regular sugar?
– No.
So what do you use?
– Stevia. A fibrous plant native to South America. Something the ancient Incas used. It's sold in Turkey too. It tastes like sugar. But it's not synthetic.
All sweeteners contain aspartame, isn't that harmful too?
– Everything synthetic, everything artificial, everything that doesn't suit humans is harmful.
For example, as someone who knows this business inside 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 you need to have it done once a year?
– It depends on your age. If you are male, you need to have prostate cancer screening starting at age 50. If you smoke, you absolutely must have a low-radiation lung CT scan. Even after you quit, you will continue for five years. Eighty-five percent of lung cancers detected by tomography are curable. But if it appears on its own, unfortunately, the rate is only 15%. Other than that, I get a colonoscopy. One of the types of cancer that people should pay the most attention to is colon cancer. It is the third most common type of cancer in both men and women.
Mehmet Öz had it done and saved his life.
– Exactly. Because he had it done, a cancerous colon polyp was diagnosed. If he hadn't had it done, things could have gone wrong in a year or two. Colon cancer is one of the easiest types of cancer to diagnose early. Especially if you catch it at the polyp stage, treatment is quite easy.
Even the most aggressive tumors can be cured with early diagnosis.
Do great sorrows and great stresses invite cancer?
– I don't think they cause cancer on their own. Every day, thousands of cells in our bodies become cancerous. The body's immune system detects these abnormally behaving cells and destroys them. A cancer cell is a cell that has gotten out of control and is acting on its own. The immune system recognizes them. But here's the thing: under extreme stress, the immune system cannot do its job properly, and the likelihood of cancer cells forming increases in people under stress.
Can you tell someone who has "beat" cancer, "You need to change your life now. Never go back to that stressful environment"? Or could that person's passion for their work actually help in cancer treatment?
– I think it helps. I advise people to do what they love as much as possible. Let them continue with their work. Especially for people who live for their work, their personality, and their mind, the opposite situation definitely has a negative effect.
Which types of cancer are more severe, more serious?
– It depends on the stage. Even the simplest cancer can become incurable if it has spread to other parts of the body. On the other hand, even the most aggressive tumor can be cured if caught early.
Is pancreatic cancer the worst of the worst?
– It's one of the most important and most difficult cancers. It's also one of the most difficult cancers to diagnose early. Pancreatic cancer is like a car accident.
Because it hit me like a truck all of a sudden?
– Exactly.
So, Apple's Steve Jobs...
– His wasn't pancreatic cancer as we know it. It was a slow-growing but generally incurable pancreatic tumor. He had been suffering from this disease for a long time, and his liver had also changed. But it worked to a certain extent.
Does cancer reveal its damage gradually or insidiously?
– It varies depending on the type and the person. In some cases, breast cancer appears, and within a month, it's all over. In others, it can grow slowly over years. It also varies depending on where the disease is located. Those that appear in the right side of the large intestine are more insidious and show no symptoms. Those that develop on the left side manifest themselves through bleeding. In other words, they show symptoms earlier. Similarly, in pancreatic cancers, if the cancer is in the head of the pancreas, it immediately causes jaundice, which is a chance for relatively early diagnosis. If it's in the tail, it doesn't show symptoms for a long time, can spread to other areas, and can be more problematic.
Do you see cancer cells as your enemy?
– No, no, they are part of our body. They are out of control, that's different. But this is something created by God. We are flawless biological creatures, our only flaw is cancer. It's a signal error, a manufacturing defect.
What generalizations can be made about cancer? Smoking is 100% harmful, for example...
– Yes. It causes harm from the moment it enters the body until it exits. It starts in the oral cavity, then moves to 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 smoked get cancer?
– If you are human, you are at risk of cancer. Not smoking does not guarantee you won't get it.
If cigarettes were completely banned, would cancer disappear from our lives?
– More than half of lung cancer cases would decrease.
After cigarettes, what is the second most harmful thing?
– Stress plays a part. But it doesn't cause cancer, it just speeds up the process. Excess weight and sugar also play a part. But none of these are certain. In fact, we don't fully understand the causes of cancer. We are trying to learn. As we discover more about human DNA and learn more about genes, we will better understand why we get cancer.
Is "beating cancer" a stupid phrase?
– Yes.
"Arman Kırım lost, the other won"—no, that's not it...
—No. Statistics and chance play a role here. Arman Kırım received very intensive and good treatment. There was a 70% chance of recovery and a 30% risk of not recovering. He fell into that 30%. There's no reason. That's just how it is. Which 70% recovers and which 30% dies, medicine is just beginning to learn and determine that.
Breast cancer is on its way to becoming a non-fatal disease.
Are there any cases that surprise you?
– Of course there are. Recently, the number of our patients with end-stage lung cancer who have managed to live for more than five years has started to increase significantly. In cases of metastatic breast cancer, there are also patients who have lived for more than 10 years. And they have a very good quality of life.
Does treatment continue for 10 years?
– It continues intermittently. Sometimes they undergo treatment for six months, then they don't for a year. Breast cancer is becoming a chronic disease. It's a disease that doesn't kill you, but one we will have to live with.
It will drag on...
– No, it doesn't have to drag on. 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 besides that. If the patient's life is extended, that's wonderful. But there's no point in tormenting the patient just to extend their life. We don't do that. While I'm on the subject, let me say that in Turkey, in our culture, there is a very serious problem regarding death.
What is it?
– We are not at peace with death. It is not taught in our schools, nor do our parents talk about it. Death is taboo.
Like sex.
– Sex is still talked about, mentioned during certain periods of life. Death is never discussed. It's as if it doesn't exist. As if we are not mortal, as if we will never die. Yet, no one can escape it; we will all die. The Creator made us this way. After the age of 40, the countdown begins. Our hormones decrease, we start to fade, to run out. This is a fact. We die as we were born…
A patient with 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, it's more than just a conclusion. It's a very serious observation. Sociological research should be done on this. We are officially at war with death, and we need to give it up. For example, we treated a patient who was given three months to live, and he lived for three years but eventually passed away. The family came to me and said, "You couldn't save him!" But I explained to them step by step that even those three years were a gift, a lottery win, but they just couldn't accept it. There is always denial, always rejection. That's why I always warn their loved ones, "Thank God, things are going very well now, but this won't last forever." But people's brains don't register this. When we lose a patient, they say, "How could this happen! How could they die!" This stems from our culture. We need to stop fighting death.
Is it different in other cultures?
– Of course it's different. I worked in the US for 10 years, and there's no such thing there. People would come in and say, "Doctor, I don't feel well, I think I'm in my final stages." We would look and see that it was indeed true. They would say, "I have no one, admit me here, let me die in peace." They would stay for a week, we would give them their medication, they would be comfortable, and they would pass away peacefully. Here, we even have problems with the relatives of patients who are 100% certain to die, even when you communicate this very clearly. It's a common thing. It doesn't depend on the patient's intellectual level or anything like that, which is why I say it's cultural. We need to resolve our issue with death.
I was both impressed 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 cannot accept death.
– No, sir, that's how we Turks are! That's exactly what I mean. Even the most cultured, most intellectual people cannot face this, cannot accept it. One day, we will all die. Period. There is no beyond. We cannot act as if that were not the case. Who are we fooling? What matters is to depart from this world peacefully, humanely, without pain or suffering, preferably not languishing in a hospital corner, surrounded by our family and loved ones.
Do you feel more comfortable talking to patients or their spouses?
– It varies. Some patients want to learn and hear everything themselves. But this is much lower than the rates in the US. There, you tell all patients everything very clearly, and they accept it reasonably. Here, as I said, there is avoidance and denial.
I have a patient who comes from the Netherlands every week.
As for cancer drugs in our country...
– In this country, there is incredible ease in obtaining cancer drugs. 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...
– No, dear. For example, there's a lady who comes from the Netherlands every Monday. She has lung cancer and is receiving treatment here. She comes for the day and then goes back. Can you imagine? Because in the Netherlands, they don't give her the treatment she needs. We are much better when it comes to medication.
How is this possible?
– The government is doing a great job in this regard. Turkey is one of the countries where the cheapest oncology drugs are sold. But there is no trained workforce to administer these chemotherapies. Oncologists working for the state have to treat hundreds of patients. Can an oncologist see 100 patients a day? Many of our colleagues are working under these conditions. The numbers are insufficient. New oncologists are not being trained. That's why many patients are dying 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 area.
Why don't you start an institute or something...
– Where? I would love to have an academic career and train young doctors. I can't take on a second medical oncologist; I don't have permission.
Why?
– We are a private organization, we pay taxes, we provide employment, but the government decides which doctors we can hire and how many. You might say, "That's not right!" But it is. That's why I've been fighting alone for 16 years. But unfortunately, it's not possible; they won't allow it.
When I lose a patient I've been treating for a long time, I can't pull myself together for a week.
You are also a 'companion'. You accompany your patients on that thorny path; some reach a rose garden, others a rocky road. How do you feel during this process?
– An oncologist needs to maintain a certain distance from their patient.
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 remain objective, you need to maintain a professional distance. I try not to be friends and go out to dinner with them. At the same time, we are losing a significant portion of these patients.
Are there any figures?
– 110 people have died in the last year. But I treat thousands of patients. That's a very low rate. I feel incredibly sad about every patient we lose.
How do you find out that they have lost their lives…
– We don't abandon the patient after chemotherapy is over; we always provide terminal care or supportive treatment for that patient. Nurses and our doctors visit their homes, and I go too.
Is there a final conversation?
– It depends on the patient. Some want it, some don't. But we are in constant contact with their loved ones. So many years have passed, and I still can't get used to my patients dying. 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.
It is up to the doctor to ensure the patient does not suffer.
How can dying in pain be prevented?
– Nowadays, there is no reason for a cancer patient to die in pain.
But they always say things like, "He was in a lot of pain," and so on...
– No, a cancer patient can die completely pain-free. This is in the doctor's hands. What needs to be done in the final stages of life is very clear scientifically. For one thing, patients undergoing chemotherapy experience less pain. Beyond that, pain management science has advanced so much that we can keep these patients at home, comfortable and happy, with medication pumps.
Once cancer has occurred, will it return?
– If it is metastatic cancer and has spread to other organs via the bloodstream at the time of initial diagnosis, the likelihood of recurrence is generally very high.
