Armenia Examines Its Record on Cancer

A recent report caught public attention in Armenia for claiming the country has the world’s highest rate of death from cancer. Though flawed, the news nonetheless shone a spotlight on the country’s standards of diagnostics and treatment.

In January 2016, the World Life Expectancy website published data saying that Armenia had the highest cancer death rate out of the 172 countries it had surveyed.

The website claimed it based its figures of 229.84 deaths per 100,000 people in 2014 on research from the World Health Organisation (WHO).

But the WHO said its data differs, having recorded only 188 deaths attributed to cancer per 100,000 people in Armenia in 2012, the last year for which they had information. 

The figures used by Armenia’s ministry of health are similar, putting the country in the mid-range of global death rates from cancer.

However, the media storm led to a public debate in Armenia’s media on the state of cancer treatment in a country where deaths from the disease appear to be on the rise.

In 1995, 3,384 people in Armenia died of cancer. The figure rose to 4,665 in 2005 and reached 5,685 in 2014. 

This means that the rate went up by 68 per cent in less than 20 years.

According to the ministry of health, this steep rise has been misleading.

“It turns out that earlier figures were not [genuinely] low, only the registration of the causes of death was not carried out at the proper level,” said Alexander Bazarchyan, director of the ministry’s National Institute of Health. “Today, the picture has changed dramatically,”

Similarly, 4,705 people in Armenia were diagnosed with malignant tumours in 1995, compared to 6,396 in 2005 and 7,877 in 2012.

The most common form among men in Armenia is lung cancer, followed by prostate and colon cancer.  For women, the most common cancers are breast and uterine.  According to the WHO, risk factors associated with the disease are smoking, alcohol consumption, physical inactivity and obesity.

In Armenia in 2010, over 60 per cent of males between the ages of 15 and 47 were smokers. (See Armenia Struggles to Cut Nicotine Habit)

Rates have fallen but 47 per cent of men currently smoke.

“[It’s] not surprising that the most common form of cancer among Armenian men is precisely lung cancer,” said Bazarchyan.

According to the ministry of health, the frequency of cancer and related deaths were highest in the regions of Lori, Syunik, Shirak and the capital Yerevan. 

The economies of the Lori region in the north and the Syunik region in the southeast are dominated by the mining industry.

 “It is known all over the world that the development of metal deposits contains high health risks,” said Inga Zarafyan, head of the NGO EcoLur.  “Heavy metals can cause a variety of illnesses, most frequently cancer.”

HARD TO SPOT SIGNS

Cancer is a leading cause of death worldwide, but mortality can be reduced with early detection and treatment.

According to Hovhannes Vardanyan, a radiologist at the Armenian-American Health Centre, proper diagnosis is a problem in Armenia. Even leading medical institutions often lack qualified specialists. 

“In Armenia, they are weak on proper diagnostics.  Every year, about ten sick people come to us in very serious condition, ie, they were initially given the wrong diagnosis,” he said. 

That was the experience of Astghik Martirosyan’s 13-year-old son Abraham, now undergoing treatment for lung cancer.

Although he first complained of pain one-and-a-half years ago, doctors failed to reach the right diagnosis.

Over time, Abraham got significantly worse.

“It was thought to be pneumonia, then said there was some kind of growth, but they could not understand what it was,” his mother told IWPR. 

The family could not afford a computer tomography, which would have cost 50,000 dram (100 US dollars).  Martirosyan said that the hospital had told them to wait their turn for a free state examination.

“We could not wait any longer, since the child was getting worse every day,” she said.  “We had to borrow the money.”

In Armenia, cancer treatment is free for certain sections of the population including people with disabilities, children, veterans and military personnel.  But they are put on a sometimes lengthy waiting list.

The state also pays for the cost of medical treatment for cancer patients with low income up to 150,000 drams (300 dollars) per person annually. This is the average monthly salary in Armenia. 

According to the ministry of health, the cost for one course of chemotherapy is about 30,000 drams (60 dollars). 

“The state basically takes over the hospital expenses and finances the purchase of medicines on the basis of additional payments,” Armen Avagyan, an oncologist at the Muratsan hospital complex, told IWPR. “The state is not able to cover the expenses of all patients.  In [some] developed countries, these expenses are covered by insurance.”

For example, in early 2016 the National Centre of Oncology received 780 doses of the drug Avastin, which will be provided free of charge. The market value of a single dose is between 800,000 to 1 million drams (1,600 to 2,000 dollars).

This was made possible by the joint efforts of the ministry of health, the National Oncology Centre and the Fund for Armenian Relief.  The drug is used for target therapy, which is carried out along with chemotherapy for other cancers.

Without this state support, paying for such a treatment would be far beyond the means of most Armenians.

PREVENTION BETTER THAN CURE

One way to improve cancer rates would be to shift the focus from treatment to early detection and promoting a healthy lifestyle.

The state has doubled its expenditure on its anti-smoking and environmental protection from some 50 million drams (122,000 dollars) in 2013 to 100 million drams (241,500 dollars) in 2014.

Bazarchyan, of the National Institute of Health, said Armenia also needed to invest in regular screening programmes. 

Since 2015, the ministry of health has been running one for non-communicable diseases. There is a particular focus on the early diagnosis of cervical cancer, and screening is available free of charge for all women between 30 and 60 years of age.

Some cancer patients who can afford it seek treatment abroad.  

Hayrapet Galstyan, Armenia’s chief oncologist, said that this was largely driven by psychological reasons. 

“The patient thinks that by leaving the country, he will have a better chance of recovery, but this is not so.  The national centre of oncology gives the same radiation therapy as abroad,” Galstyan said.

Half of all the patients they treated at the centre survived, he added.

Armen Tananyan, director of the National Oncological Centre, agreed.

“Ten to 15 years ago, our country did not buy medical devices and equipment but received them in the form of humanitarian aid.  And now there are lots of medical institutions that compete [between themselves] over their diagnostic devices,” Tananyan said. 

The state has been investing in more state-of-the-art equipment, spending over 2.5 million dollars in both 2013 and 2014 to modernise its oncological centres.   

The newly-built Radioisotope Production Centre is scheduled to open in June 2016, which will have the capacity to treat up to 1,000 patients each year.

Observers note, however, that there has been very little attention paid to improving the training of doctors and specialists. Without this, the benefits of introducing high-tech equipment might be limited.

Arpi Harutyunyan is a freelance journalist in Armenia.