What disease does Darya Melekhova have. “Daria is no more”: a resident of Apatity, who told Putin about problems with doctors in the region, died of cancer. The doctors did their best

A resident of the Murmansk region, who died on May 22 at the Herzen Institute in the capital, was remembered by Russians after a dialogue with the head of state on June 15. The girl struggled with stage IV cancer in the almost complete absence of qualified medical care, but the forces were not equal.

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Dasha's story touched millions of people. Until recently, everyone believed that a miracle would happen, that soon her little daughter would again be next to her mother.

Dasha was left an orphan early - her mother died, and almost nothing is known about her father. She was raised by her older brother, and after 18 years she began to live independently and soon gave birth to a daughter. The father of the child refused to take part in the fate of the baby.

According to the girl's friend Svetlana Morozova, Dasha has always been a cheerful and cheerful person and laughed very contagiously. When her daughter grew up a little, Daria went to work. At first she worked as a conductor, and then became a seller in one of the local shops.

Aunt Lyubov Tulupova helped her with the child, who will now become the girl's guardian, Moskovsky Komsomolets reports. “It all started absolutely out of the blue. Dasha had a backache for no reason at all. Nothing helped, so she decided to go to the doctor,” recalled another friend of the girl, Maria. And then Dasha's medical history was known: she was misdiagnosed, because of which precious time was lost.

The diagnosis of cancer for Starikova was a shock, but she decided to fight to the end. “She always loved life very much, knew how to enjoy the little things, things that many others simply don’t pay attention to,” said Dasha’s friend.

Almost immediately after turning to Vladimir Putin, Daria was transported to Moscow for treatment, where the best oncologists in the country tried to save her. “At first, her messages were completely hopeless, it seemed that she did not believe that something could already help. But after the operation, before the New Year, it seemed to me that she had hope for recovery. She wrote that she began to gain weight, she feels feel better and even began to make plans. Everyone was thinking how she would come to her daughter for a holiday with gifts, "shared a friend.

According to a distant relative of Dasha, she dreamed of how on September 1 she would take her daughter to first grade. But the insidious disease won ... Daria Starikova will be buried in her native Apatity.

The name of a young resident of Apatit, Daria Starikova, became known throughout the country in the summer of 2017. The girl throughout the country, during the “Direct Line” with Vladimir Putin, complained about the quality of medicine in the provinces and asked for help from the head of state in this matter. As it turned out, the girl was treated for osteochondrosis, but in fact she had cancer.

On the eve it became known that despite all the efforts of the capital's doctors, namely, Dasha got to them after direct communication with the president, it was not possible to defeat cancer of the last stage - the woman died on May 22 right in the hospital.

The authorities of Apatit in the Murmansk region promised to help the girl's family. In particular, she left a seven-year-old daughter. With the help of the city administration, the aunt of the deceased was able to quickly arrange custody of the girl - Dasha herself was promised to be led on her last journey with dignity.

Daria Starikova - what is known

Only the laziest in our country does not know Dasha's story. During a Direct Line with Vladimir Putin in 2017, the girl did get through to the president and told that there was no medical care in her hometown - the old hospital was closed, and the new one was never completed. All local residents suffer from this, and she is in a critical situation. The diagnosis "Osteochondrosis" made by the doctors turned out to be cancer of the fourth stage. Daria Starikova said that residents of the city have to travel to the neighboring city of Kirovsk for treatment, since the hospital in Apatity was closed.

Vladimir Putin did not leave the situation of the girl without attention. The hospital in Kirovsk was simply bombarded with checks and investigations, because the Investigative Committee took up the matter. Tens of thousands of people offered Daria's help in treatment, the state also helped - a resident of Apatite was urgently invited to Moscow to undergo a full examination and receive free medical care.

Daria underwent treatment in the Department of Oncogynecology of the P. A. Herzen Moscow Research Institute of Institutions. By the end of 2017, her condition had improved significantly. She underwent a major radical operation to remove the tumor, as well as several courses of chemotherapy with combined drugs.

In December 2017, doctors let the patient go home to her daughter and other relatives so that she could celebrate the New Year with her family. At the same time, doctors warned that the treatment was not completed, and it would take many more months.

Daria admitted to reporters that she did not try for herself, as she considered time lost irrevocably, but for the residents of her city, who were left face to face with the problem, there was practically no medical care in the city.

As it became known the day before, a slight improvement in Starikova's condition was only an appearance - after the New Year she returned to the hospital and continued treatment, but her efforts did not give results. the cancer was too advanced, and therefore Daria had to live out her last months.

Daria Starikova - is she to blame?

It cannot be said that the situation around the story of Starikova was quite controversial, because the doctors of Apatit, who allegedly provided poor-quality medical care, found many defenders. Rumors spread on the Web that the girl became very ill not because of an incorrect diagnosis, but because of lost time - she did not follow the recommendations of doctors, for which she paid with her own health.

The chief physician of the Kirov-Apatity hospital, Yuri Shiryaev, a doctor with a brilliant reputation, a former military doctor, wrote a letter of resignation, believing that officials did not want to objectively understand this story, the website reports. The specialist and his defenders assured that the branch in Apatity was closed due to the fact that the building did not meet sanitary standards, and the new building was not completed due to lack of budget funds. Residents were provided with quality care in the neighboring city, where the hospital was more decent and provided with the necessary equipment and specialists.

Also, publications on the Web caused conflicting emotions, where “eyewitnesses” reported that Dasha was diagnosed back in 2014, but she ignored the doctors.

“It is important to note that in 2014 she was diagnosed with ‘precancer’ by a private doctor who strictly recommended that she be examined. But Starikova did not follow the advice of the gynecologist and for two years she never came to the hospital at all. This time, she also did not go to the examination room. Why? Probably “because” ... All sources agree on one thing - Dasha regularly ignored the recommendations ... She herself nevertheless appeared in the hospital later ... in January 2017. But with profuse bleeding and in critical condition. Doctors “dragged” her, examined her and found that she was already at the fourth stage of cancer, after which she was sent for “chemistry” to the oncologic dispensary.”

It can be summarized that Starikova's sentimental story undoubtedly has several sides, like every medal. Perhaps the girl really did not follow the recommendations of the doctors, but her single example does not mean that "everyone is like that." Many people in our country are really deprived of the opportunity to receive qualified help from specialists due to an elementary lack of extra funds, and that is why they “do not follow the recommendations of doctors”.

A briefing was held at the P. A. Herzen Moscow Cancer Research Institute, at which the patient and the doctor talked about how the treatment was carried out A photo: Andrey MINAEV

"MIRACLES DO HAPPEN"

I want to thank the magician who gave me a second life and hope for the future, - Dasha smiles, looking at the oncologist Andrey Kaprin. - Miracles do happen.

On Tuesday morning, a briefing was held at the P. A. Herzen Moscow Cancer Research Institute, at which the patient and the doctor talked about how the treatment went and what was achieved. Dasha was operated on by Doctor of Medical Sciences, Honored Doctor of the Russian Federation, Academician of the Russian Academy of Sciences, Head of the National Medical Research Center for Radiology of the Ministry of Health of the Russian Federation (the Center includes the Herzen Institute), surgeon-oncologist Andrey Kaprin.

Now I feel just fine compared to the state in which I came here for six months, - says Dasha. - Thoughts are completely different, I can look into the future, make plans. At the moment I'm planning to go home for the New Year holidays. I want to spend time with my family, my beloved 6-year-old daughter Sonya. Then I will return and continue the treatment.

Cancer patient from Apatity, who turned to Putin, will celebrate the New Year at home with her family

HOW TREATED

This summer, 24-year-old Dasha, who called the President's Direct Line, was brought to the Institute in serious condition. Herzen with an oncogynecological diagnosis. There seemed to be little chance of survival.

The tumor was large, it took a large operation, which took more than 4.5 hours, - says Professor Kaprin. - Before and after the operation, there were courses of chemotherapy, first - to reduce the tumor, and after - to consolidate the success after its removal. We used both imported drugs and Russian generic drugs.

In a few months, Dasha will have a reconstructive operation (to restore the removed tissues. - Auth.), which will be much easier than the first one, since the tumor is gone. Then rehabilitation and regular monitoring will begin. According to international standards, patients of this profile in the first year come for examination every three months, then every six months for 3 years, and once a year, starting from the 4th year.

The most important and inspiring news: as shown by a recent control PET study (positron emission tomography, the most reliable diagnostic method today. - Auth.), There is no tumor or metastases in the girl's body.

Dasha's patience, courage and her trust in us were of great importance - the patient's faith in doctors makes an important contribution to the victory over the disease, - emphasizes Dr. Kaprin.

WHO WAS IN THE "RESCUE TEAM"

As the professor said, in general, a large combined team of specialists of various profiles was involved in the diagnosis and treatment of Dasha Starikova.

There is a basic oncological law, according to which the fate of the patient's treatment should be decided by at least three, but more often four people, - Andrey Kaprin explains. The Rescue Team includes:

A morphologist, that is, a doctor who determines the type of tumor: he says what kind of tumor the patient has and how much it will succumb to one or another type of pre- or postoperative treatment, how it will respond to radiological treatment;

Clinical pharmacist (clinical oncologist) - decides on chemotherapy;

Radiation Therapist - determines if and what type of radiation therapy is needed.

We consulted, including remotely with colleagues from abroad, - Kaprin continues. - Now it is not uncommon, in this way we analyze about 12 - 15 of the most difficult patients a year. In the case of Dasha, our colleagues from South Korea, Gratz (Austria) participated in the extended consultation on the teleconference. Experts from the Institute, which is headed by Academician Gennady Tikhonovich Sukhikh(National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov. - Ed.), Our famous chemotherapists, including Vasily Ivanovich Borisov, chief chemotherapist of the Ministry of Health of Russia.

After the operation, specialists from the Institute of Nutrition joined in, because Dasha had a critically low body weight. Now the girl has gained 5 kg. Also helped clinical psychologists from the Institute. Serbian - they mentally prepared the patient for the operation and took her out of stress in the future.

QUESTION-EDGE

What are the chances of patients who do not get through to the president?

Given the 4th stage of cancer that Dasha Starikova entered, her salvation looks like a real miracle. But Professor Kaprin does not consider this case something extraordinary: "Every year I myself operate on about 25 patients with this diagnosis, and about 100 - 120 patients in this condition receive successful treatment in our Radiology Center."

And yet, Daria was saved by a large team of the best specialists - what are the chances for ordinary patients who do not get through to the President's Direct Line?

We are open and work according to federal quotas - we receive patients from all regions of Russia, - says Andrey Kaprin, head of the Radiology Center. - In severe cases, like Dasha's, we take patients promptly, because we understand that there is little they can help - after all, federal, national centers have a larger arsenal of methods and are designed specifically for difficult cases, so that later they can replicate the treatment experience throughout country.

At the same time, we often visit the regions and see that the situation is changing. Now there are regions very well equipped with equipment and specialists, from where we receive fewer and fewer severe patients - people can be successfully treated locally. In addition, a law on telemedicine has recently been passed, and Minister of Health Veronika Skvortsova constantly encourages us to conduct teleconsultations. For two years now, we have been organizing teleconferences with the regions twice a week, asking them to show us seriously ill patients, consulting, deciding who to take for ourselves.

Cooperation with foreign colleagues is also being actively established. In particular, we have a project with Japanese specialists, which starts just the other day. We will send glasses (with tumor cell samples. - Auth.) to each other for morphological consultations (that is, determining the type of tumors). Now this is done quite simply: the glass is scanned, and the picture is sent in any extension. We can do the same program with our regions. Because there are not enough morphologists, and everything starts with an accurate diagnosis, and the chances of successful treatment primarily depend on this.

NUMBERS

About 36 thousand people a year are treated at the institutes of the National Medical Research Center for Radiology of the Ministry of Health of the Russian Federation (the Center includes the Herzen Institute);

12 thousand people operate in the divisions of the Center.

Daria Starikova, a resident of Apatity, became aware during the Direct Line with President Putin in June 2017. A 25-year-old girl with cancer complained about the unavailability of treatment in her city. On May 22, the Russian woman died in a Moscow clinic, where she was later transferred. Unfortunately, the efforts of the capital's doctors did not lead to anything, even despite the successful operation to remove the tumor. Daria had stage 4 cancer. At home she left a little daughter.

Late diagnosis

The Russians first learned about Daria on June 15, 2017 during the Direct Line with the President. She told that in her native Apatity, doctors had misdiagnosed her as “intervertebral osteochondrosis”. It was later revealed that she actually had stage 4 uterine cancer. In a conversation with the president, the girl said that due to the negligence of local doctors, she was diagnosed with an accurate diagnosis late, at a time when the disease was already inexorably progressing.

Daria also drew attention to the fact that residents of Apatity, who need highly specialized assistance, are forced to travel to neighboring Kirovsk - the local hospital cannot be completed for several decades. After this story, Vladimir Putin turned to Daria with a request "not to lose hope for recovery."

The head of state expressed bewilderment at what guided those responsible for medicine in this region and promised to help solve the problem: “We will definitely look. Either this one needs to be completed, or the old hospital needs to be rebuilt. We'll work, I promise you. But, Dasha, with regard to your problem, we will also work on this. Okay?" Then the president's words gave hope to Daria and local residents.

hope dies last

After the Direct Line, Daria was sent to the intensive care unit of the district hospital. After that, she was transferred to a regional medical facility in Murmansk. A week later, on the plane of the Ministry of Emergency Situations, she was transported to the Moscow Institute of Oncology. Herzen. Here she was treated. After two courses of chemotherapy, the size of the tumor was reduced by more than half, which made it possible to perform an operation.

In December last year, doctors operated on her for 4.5 hours, after which she underwent another course of chemotherapy. Then Dasha was full of hope for the future, made plans and dreamed about how she would spend time with her six-year-old daughter. After she returned to Moscow, a reconstructive operation awaited her. As her attending physician, surgeon-oncologist Andrey Kaprin, said, this operation was easier, since there was no longer a tumor in the girl's body.

The operation went through. Messages about the health of Darya Starikova appeared less and less. On April 14, the VKontakte group, which was created in support of her, published a message that Dasha was still in treatment. Here, all the survivors were thanked for their support. As for Dasha herself, the last time she was on her personal page on the social network was on March 27.

Fourth stage

According to the doctors, the specialists did everything they could. But cancer of the fourth stage is a very complex disease, with almost zero curability, in this case, you can only make the patient's life easier by improving the quality of life. Another thing is the zero or first stage, when there is a chance to be cured completely.

“I remember that the girl had a malignant neoplasm, but what structure is very important. Her attending physician Andrei Kaprin is a leading oncologist, director of the radiology center of the Ministry of Health of Russia. Could he have missed something? I think everything was done right. The features of the biological behavior of the tumor played here, ”commented the professor of the Department of Oncology of the GBUZ MO MONIKI named after this case. M.F. Vladimirsky Lali Kogoniya.

She said that at some point Daria felt better, she managed to maintain her condition with the help of good drugs. The specialist also explained: “In oncology, you never have to guess, because there are biological features of the tumor. We do not yet have individual therapy that would be selected for each patient separately, like antibiotics.”

According to Kogonia, in December 2017, Starikova, a resident of Apatity, could have had so-called micrometastatic metastasis processes. “You can't even see them. The surgeons, when they operated, saw everything, looked, said - yes, everything is clean. However, no one knows how the body will behave, ”the doctor summed up.

Epilogue

Daria Starikova will be buried in her native Apatity. The girl's daughter will receive a survivor's pension, as well as "all payments necessary in this case." At least that's what the city administration said. In addition, as stated in the government of the Murmansk region, the city, the authorities of the region, as well as the local city-forming enterprise will jointly help Daria's family.

Dasha's appeal to the president during the "Direct Line" caused a great resonance not only in Apatity, but throughout Russia. First, the Investigative Committee conducted an audit on the fact of the failure to provide qualified medical care, then a case was initiated against the doctors under the article “negligence”.

Later, the governor of the region ordered to organize a reception of citizens in Apatity, which was attended by the head physician of the hospital, Yuri Shiryaev. There were many people, and they all asked for help, to find competent specialists, to cure chronic patients, or, for example, to perform an operation out of turn. A few days later, Shiryaev wrote a letter of resignation from the post of head physician.

In March of this year, during his address to the Federal Assembly, Vladimir Putin gave instructions to start developing a system to combat cancer. The head of state noted the need to modernize cancer centers and build the entire chain in this direction, from the ability to make a diagnosis at an early stage to effective treatment.

The name of Dasha Starikova from the city of Apatity in the Murmansk region is now known throughout the country. On a direct line with the president, the 24-year-old girl said that she had recently been diagnosed with cancer in the fourth stage, and before that, she had been treated unsuccessfully for "intervertebral osteochondrosis" for a long time. After this story, at numerous medical forums, they again started talking about the fact that normal treatment is not available to most Russians. First of all, because of the low quality of diagnostics. Oncology is now the second leading cause of death. However, the system for early detection of cancer does not really work not only in the provinces, but also in Moscow. Screening programs that are implemented all over the world do not work in Russia. About why this happens and whether screening will be a salvation from cancer, Lente.ru was told by a researcher at the N. N. Petrov Research Institute of Oncology of the Ministry of Health of Russia, executive director of the Association of Oncologists of the Northwestern Federal District Anton Barchuk.

Can screening reduce cancer deaths?

Anton Barchuk: Yes, screening saves lives. With its help, you can not only catch diseases at an early stage, but also find precancerous changes. We often confuse screening and early diagnosis. Screening is identifying something in people who have no symptoms at all, complaints, signs, and even desire to go for examination. They can either detect the disease at the earliest stage, thereby making it curable, or find precancerous changes. If they are eliminated, then the incidence can be reduced. A person will not get cancer at all.

Screening for cervical cancer in our country is now needed. An epidemic of HPV is approaching (the human papillomavirus is one of the causes of many tumors, including cervical cancer - approx. "Lenta.ru"). There is a growing number of young women under 40 dying from it. All of these deaths are preventable.

In the West, not everyone trusts screening. Some doctors recommend not to look for anything in advance. The best tactic is to go to the hospital only when something starts to hurt. Is it so?

The question is moot. There are tumors where the effectiveness of screening with low-dose computed tomography has been accurately proven: cancer of the cervix, breast, colorectal, lung cancer. And then the "buts" begin. Studies show that screening for prostate cancer reduces mortality from the disease. However, if a tumor is found in forty people, then only in one case is it really life-threatening.

In other cases, is the tumor benign?

Modern diagnostics has given scientists a new understanding of tumor biology. Oncologists have always believed that cancer is everything. It progresses - if nothing is done, it leads to death. It turned out that this was not the case. Now malignant neoplasms are being detected, which, however, will never lead to death. And they don't bother people. But looking at an already found tumor, it is not always possible to say whether it is dangerous. Therefore, everyone is treated. In the case of prostate cancer, we will definitely save one, and another 39 people, whom we operate on, we can cripple. This is a very traumatic operation, after which a variety of complications are possible, including urinary incontinence and impotence.

Is it not possible to analyze this tumor and find out that it is harmless?

At the moment it is very difficult. There are proposals to perform a biopsy, to look at the aggressiveness of the tumor. If the tumor is not aggressive, then we do nothing, we observe. But all this is difficult. After all, it is necessary to explain to the patient why it is better to wait. Therefore, now the general consensus of doctors is that it is better not to offer men a screening blood test for PSA (an oncological marker - approx. "Lenta.ru"), and if a man wants to be examined, discuss all the risks with him.

Does the danger of overdiagnosis exist for all types of oncology?

There are diseases for which screening is definitely effective. For example, cervical cancer. But here too, overdiagnosis can lead to the fact that a woman will undergo unnecessary conization of the cervix, that is, a part of the organ will be removed. This is a no-brainer operation. It certainly will not lead to death and the quality of life will not deteriorate much. But it can increase the risk of miscarriage during pregnancy. But if we thereby save a woman from cancer, this may not be the highest price.

In Russia, almost all studies found to be effective for screening are included in the medical examination program?

In addition to lung cancer screening among smokers using low-dose computed tomography. But it has not yet been mass-produced anywhere in the world. Russian clinical examination can be put a plus. She is progressing. Recently, the Ministry of Health proposed changes to the order for its implementation. And in the new version, the European recommendations for age groups, intervals and methods are almost reached.

Medical examination - is it the same screening or something else?

There are two definitions for cancer screening. Population to strive for and opportunistic. Opportunistic - spontaneous, unorganized, bringing less benefit, in some cases even harm. So far, medical examination cannot be considered a full-fledged population screening. One of its key principles is targeting. For example, a woman turns 30 - she receives a letter with an invitation to a certain examination. This is done in almost all European countries.

In Moscow, for example, in some entrances they hang out invitations for citizens to undergo medical examination.

This is a common call: come in somehow. The essence of an individual invitation: a specific person is recorded for a specific date and time. The problem with opportunistic screening is that it mostly goes to people with a low chance of getting sick and dying from cancer. For example, people with higher education, wealthy. One of the main risks of developing cancer is social status. It determines many other factors: alcohol, smoking, physical activity, access to healthy food. Socially vulnerable people often ignore preventive visits to the doctor, they do not have time for this. Individual invitation provides equal access to screening. Then these surveys are more effective.

You once said without enthusiasm that Russian diagnostic methods now meet international standards.

Because they correspond so far only on paper. In reality, this is not always what is needed. For example, take the same test for cervical cancer. If it is a cytology, then a smear is done, then the obtained cells are examined by a specialist. Since they are transparent, they need to be dyed. Scientific studies have proven that the Papanicolaou stain works in screening. There was a scientist who came up with this technique. It allows you to determine precancerous changes. In Russia, in most regions, this is not used.

Expensive or do not know how?

A little more expensive, a little harder. But I think the main factor is tradition: “it is customary for us”.

That is, almost all tests for cervical cancer that are taken in our clinics are profanity?

Cytologists beat their chests with their fist that their staining methods are no worse. But these are words. And you need scientific evidence. Many patients are not aware of this. In theory, this nuance may affect the effectiveness of the entire screening program. You can either skip something, or start treating those who do not need it.

There is a popular opinion in the West that the division of cancer into stages - from the first to the fourth - is outdated. There are slow types of oncology that can be identified at the very beginning of development. Are there fast ones?

Such a theory does exist. But this is a simplified representation. Division by stage does not go anywhere. It's just that new signs of aggressiveness are added to it.

So, if a person was healthy according to the results of the examination, and then he was suddenly diagnosed with cancer in the fourth stage, then the doctor can not always be blamed for this? It's just that cancer is so evil.

Everything can be checked. This is what quality control is for. Suppose a woman is examined every five years for cervical cancer. But between screenings, she is diagnosed with a tumor. Each such case is a reason for litigation. You need to understand: this is a really aggressive tumor that arose over several months and which was not there at the time of the examination, or this is a diagnostic error.

How to do it?

It is necessary that all biological materials that were taken from the patient be preserved. In this case, you can review the cytological glasses, double-check the biopsy, if it was done. In some countries this is all kept. Ours is not always. There are also indirect indicators. For example, to see how cytological studies are carried out in the laboratory, how cells are collected. Perhaps they are doing something wrong. Aggressive cancer, indeed, can be. But as for the cervix - this is extremely rare. Usually this tumor grows up to ten years. Colorectal cancer also usually does not appear immediately. With regard to quality control of examinations in the screening of colon tumors, you can see how many polyps are found and removed by the doctor.

How much should?

The bigger, the better. If you dig around, everyone over the age of 50 can find them. But you can draw a conditional line. For example, out of ten people who come for a screening examination, polyps should be consistently found in at least three. If not, there is a question of quality.

What types of cancer can occur unexpectedly?

So far, there are no effective screening methods for many tumors, for example, pancreatic cancer, brain tumors. At one time they tried to introduce a test for neuroblastoma. The analysis consisted of looking for certain substances in the urine of infants. But it turned out that the study found non-growing tumors. Usually they did not need to be treated, because they left on their own. But the "evil" neuroblastomas remained unidentified.

From an ethical point of view, saving one patient by examining hundreds and even thousands is wonderful. And with the economic? Is it beneficial for the state?

There are studies on the ratio of costs and effectiveness. There is a concept - how much we invest in one saved year of life. That is, by preventing death from cancer, ideally, we prolong a person's life to a conditional average value. Why is cervical cancer screening so effective? If we saved a woman at 30, she will conditionally live another 50. Or we will deal with prostate cancer and save a man at 80. But at 81 he will die of cardiovascular disease. In doing so, we will greatly spoil the quality of life of his last year. The question is not to refuse cancer screening in the elderly. We need to maximize the health benefits of each individual from the investment in screening. Almost all countries take this into account. Limits of allowable amounts are proposed, which are recommended to be spent on one year of life saved. Choose what has the greatest benefit at the lowest cost. In Europe, the conditional cost limit is 30-40 thousand euros per saved year of life. In the USA up to 100 thousand dollars.

But in Russia?

So far, no one has done it. It is necessary to build a complex mathematical model, where to describe the fate of a person who undergoes screening and not. This is a simulation. It is possible to simulate how screening will affect the health of residents throughout the country. Build different screening scenarios, compare them. We are trying to develop such complex mathematical models.

When you named such gigantic sums, it somehow immediately became clear that screening might not appear in our country soon.

Now our country is investing huge amounts of money in medical examinations. The benefit from these funds can be multiplied. And if cancer treatment becomes more expensive, it may even turn out that screening will save these funds. The sooner you find it, the lower the cost of treatment in the future. In addition, in countries where screening programs are launched, the overall quality of the entire medical service immediately improves. Because quality is the key to screening. A minimal deviation can turn an effective program into a useless one. But I urge everyone to be optimistic. If you set a goal, screening can be organized even in the poorest regions, where there are very few resources. What is Finland in the 1960s and 1970s? Everything was bad there in terms of health, there were not enough doctors. They took over and set up a cervical cancer screening program that eliminated the death rate from the disease. But at that time there were no computer technologies. There are difficulties. But it's no more difficult than hosting the Olympics or the World Cup.