UICC World Cancer Congress 2006

Tobacco is the leading preventable cause of death in Russia, but 35 million of Russians continue to smoke, despite of strong evidence linking cigarette smoking to cancer, vascular, lung and many other diseases.

Prevalence of smoking in Russia is among highest in the world. According to the large population-based surveys carried out in several regions of Russia 70% of young men and 30% of young women are current smokers. Smoking rate is very high among teenagers and young people. However small but steady decline in lung cancer mortality rates in men in Russia suggests that the modest success in tobacco control have been achieved.

There is a critical need in greater impact of Cancer Institutes in tobacco control efforts. We believe that the tasks of Cancer Research Institutes (Centers) in smoking control should include :

- plan and implement research projects concerning all aspects of smoking control

- disseminate scientific knowledge on hazards of tobacco smoking, methods of prevention and cessation including treatment, both behavioral and pharmacological

- create and promote facilities to help in cessation of smoking

- promote and support comprehensive health education, emphasizing avoidance of smoking

- collaborate with medical associations and specialty societies in educating physicians, medical students and nurses about health consequences of smoking, prevention and cessation methods.

Russian N.N. Blokhin Cancer Research Center (RCRC) plays a leading role in smoking control. In 1985 the RCRC, in cooperation with International Agency for Research on Cancer (IARC), organized and hosted the first international scientific meeting devoted to smoking control in Russia, which resulted in the IARC scientific publication "Tobacco. A Major International Health Hazard¨, edited by David Zaridze and Richard Peto. At this meeting first recommendations on smoking control have been developed for Russia. Among others, they included the recommendations regarding the regulation of tar deliveries in tobacco smoke: "although elimination of tobacco consumption should be the final goal, an upper limit, such as, perhaps, 15 mg, on cigarette tar deliveries be introduced as quickly as possible". At that time, tar levels in Russian cigarette smoke were as high as 30-35 mg/cigarette.

In 1991, after collapse of the Soviet Union, RCRC in collaboration with International Union Against Cancer ((UICC) organized and hosted in Moscow international meeting "Cancer prevention in Central and Eastern Europe". The participants of this meeting developed the recommendations for cancer control in the region, which included proposals for developing and implementing a comprehensive tobacco control policy. Suggested priorities included: complete ban on all direct and indirect promotion of tobacco goods and trade-marks, progressive increase of the price of tobacco products, protection of nonsmokers from exposure to other peoples tobacco smoke, adoption of European Community standards for health warnings on the packaging of tobacco goods, provision of help to smokers who wish to give up their habits.

Ever since, during past 30 years, RCRC through the Department of Epidemiology and Prevention has been alerting the nation about the dangers of smoking. RCRC played a key role in the development (drafting) the Federal Law on "Restriction of tobacco smoking in Russia¨, which have been passed by Russian Duma (parliament) in 2001 and amended in 2006. The Federal Law covers major aspects of tobacco control:

- Measures to protect children, teenagers and young people from tobacco promotion and sales (ban of advertising on electronic mass media, restriction of advertising in the vicinity of schools and other educational institutions, restriction of smoking on TV, prohibition of sales of cigarettes to young people less than 18 years of age, prohibition of sales of cigarettes in packs containing less than 20 units, prohibition of wending machines);

- Measures to protect the rights of non-smokers and to create the smoke-free common environment (prohibition of smoking at workplace, in all types of public transport, national and international flights, in all types of educational, cultural and health institutions);

- Effective government health warnings and information on tar and nicotine content;

- Measures to regulate tar and nicotine levels in tobacco smoke.

Recently we have proposed to set up upper limits for some major carcinogens in tobacco smoke in Russia. This proposal rests on the results of the chemical analyses, conducted in RCRC, of three global brands (Camel, Lucky strike, Marlboro), purchased in 29 countries. The analyses have shown three - to nine-fold differences in concentrations within the brand of two tobacco specific nitrosoamines (NNN and NNK).For policyclic aromatic hydrocarbons (PAH) also large (eight-fold) variations were observed. Thus three to nine-fold variation in carcinogen dose can be given to the smoker, without any warning, in products that are trademarked and globally advertised.

RCRC, through its Department of Epidemiology and Prevention have set up a consortia to study the causes of high mortality from vascular diseases and cancer in Russia. This project is carried-out in collaboration with IARC and Oxford University. Population based surveys on smoking prevalence and epidemiological studies (retrospective mortality and prospective) are carried out in several areas of Russia, in which the role of tobacco and alcohol in relation to high mortality from cancer, vascular and other diseases is investigated. These studies have shown very high prevalence of smoking in young men (70%) and women (30%), as well as high cumulative and attributable risks of developing cancer and vascular diseases in smokers.

We conduct the research in molecular epidemiology of smoking-related cancers to capture the molecular alterations caused by smoking, which would help to identify molecular mechanisms of tobacco carcinogenesis. For example, the analysis of mutations in TP53 in lung cancer from our recent case-control study of lung cancer conducted in cooperation with IARC has shown that TP53 mutation is strongly associated with smoking status. Our findings resolve the controversy on whether tobacco smoke compounds induce characteristic mutations in lung cancers. It is suggested that the higher prevalence of TP53 mutations in smokers reflect the increased clonal selection pressure on TP53 in cells exposed to tobacco components, with mutations occurring by chance. However in contrast to this hypothesis, the association between tobacco use with specific mutation provides clear evidence for the mutagenic effect of tobacco components. Another aspect of our molecular epidemiological studies includes identification of individual susceptibility via investigation of polymorphism of genes involved in metabolism of carcinogens, DNA reparation etc. These studies may help identify individuals with exceptionally high risk of smoking-related cancer.

RCRC via Department of Epidemiology and Prevention is involved in developing methods for helping in smoking cessation. These methods are tested in a facility for smoking cessation, affiliated to the Center.

To continue and intensify the effort and to develop methods of lowering cancer risk related to smoking RCRC carries out and coordinates varied tobacco research from basic research on molecular changes caused by smoking, to behavioral research on ways to keep young people from starting to smoke and help those who smoke stop, to population based research to help to develop public health measures.