COLUMN ONE : A Country in the Grip of Cancer : In Hungary, the disease’s high death rate is fueled by an unhealthy lifestyle, exacerbated by years of poor care and Communist neglect. Patients--and even doctors--often treat subject as a taboo.

It is a subject no one wants to speak about, not even doctors who have patients with the disease. But the sad truth is irrefutable: A startling number of people in this small Central European country are dying from cancer.

Hungarian men top international charts for males and Hungarian women place third in their category in per-capita rankings of cancer mortality, according to statistics from the World Health Organization. Last year, more than 30,000 people in this country of 10.3 million succumbed to the disease, accounting for one in five deaths.

The recent data reflect a decade-old pattern, Hungarian researchers say, in which cancer deaths have grown about 3% a year. The grim trend has made Hungary the cancer capital of the world, far worse off than the United States, where men rank 24th and women 11th in the worldwide figures.

“It is a terrible situation,” said Zoltan Peter, chief epidemiologist at the National Institute of Oncology in Budapest. “We are not just facing a health crisis, it is a social and political problem. We have been unable to persuade people to make good health a priority. A healthy lifestyle is not valued here.”

A Hungarian man is four times more likely than an American man to die from mouth cancer. A Hungarian woman is five times more likely than a Mexican woman to die from colon or rectal cancer.

From fatty meats in the nation’s favorite goulash dishes to a stiff shot of brandy before a day’s work on the assembly line, the Hungarians’ way of life is killing them. Add heavy cigarette smoking, industrial pollution, poor medical screening, years of social and medical denial and the question could easily be turned around: How have so many Hungarians managed to stay healthy?

“There is no single explanation for the dramatic statistics,” said Alan Pinter, deputy director of the Bela Johan National Institute of Hygiene, in Budapest. “It all comes down to a frightening combination of smoking, drinking, diet, lifestyle and environment.”

The average Hungarian brushes his teeth so infrequently that he uses fewer than two tubes of toothpaste a year. His appetite for vegetables rarely exceeds pickled peppers, cabbage and cucumber. Hungarians smoke almost a half pack of high-tar cigarettes a day per capita--more than any other European--and they down almost two gallons of hard alcohol a year.

To top it off, the stress of everyday life and the renowned national melancholia are so overwhelming that 4,000 Hungarians take their own lives every year--a rate exceeded by only Russia and the Baltic states, according to the World Health Organization.

“It is very hard to change people’s habits,” said Katalin Vasvary, secretary general of the Hungarian League Against Cancer, an educational and advocacy group that traces the problem partly to the country’s Communist past. Cancer mortality rates in several other countries, including the former Czechoslovakia and the former Soviet Union, are also high, a reflection of widespread Communist-era indifference to public health concerns.

“We have to undo all those years of communism, when people were told not to care about the wellness of their whole being,” Vasvary said. “People were viewed as bodies, not as human beings with souls.”

A trip to the Ministry of Health and Welfare illustrates the quandary. The glass-and-granite building near the center of town has been the hub of a nationwide cancer awareness campaign. Officials complain about disappointing results; once inside one can understand why.

At the main entrance, a doorman with a cigarette dangling from his lip scribbles passes for visitors. A security guard lights up as he directs traffic toward the elevators. Upstairs, the cloud of smoke thickens. The minister smokes, as do his secretary and his driver.

Down the hall, Erzsebet Podmaniczky’s office stands as an island in a churning sea of tar and nicotine. “No Smoking” signs from faraway places like the United States and Norway decorate the walls and tabletops. Don’t bother looking for the standard government-issue ashtray; it has been banned from the premises.

“Smoking is one of our worst problems, and we have made absolutely no progress,” said Podmaniczky, who heads the ministry’s department of international relations. “Just look around you.”

Podmaniczky has lost four family members to cancer. She was a founding member in 1990 of the Hungarian League Against Cancer. But like many Hungarian cancer activists, she expresses faint hope that the deaths of hundreds of thousands of her fellow citizens will jolt a nation seemingly resigned to a perpetual state of poor health.

“Hungarians are afraid to confront their problems,” Podmaniczky said. “When the father in a family dies of cancer, nobody speaks about it. People think, ‘If I put my head into the sand, maybe nothing will happen to me.’ ”

Getting Hungarians to begin talking about cancer would be a first step toward prevention, activists say, but even that modest goal has been beyond reach because of deeply entrenched social taboos about the disease.

Just as the mention of AIDS in parts of the United States creates public alarm, so does cancer in much of Hungary, particularly in small towns in the flatlands of the puszta , the great eastern plain. Only recently have many rural Hungarians even come to accept that cancer is not a communicable disease, health officials said.

Funeral notices seldom mention the disease, referring cryptically to death “after suffering” or following “a very serious illness.” Actors, politicians and other prominent personalities rarely divulge it if they have cancer, for fear of ruining their careers. Jozsef Antall, the country’s first prime minister after the collapse of communism, revealed he had Hodgkin’s disease about a year before his death, but the unusual disclosure came only after repeated official denials and trips to Austria for specialized medical treatment.

“I am told in the West that when you go into a doctor’s office you can even pick up publications about cancer,” said Grete Pavlik, 80, who started the first cancer sufferers’ support group in Hungary in 1986 despite an official ban on such organizations. “There has been nothing like that here.”

Since the Cancer League began openly organizing dozens of support groups in 1990, many patients have refused to appear on membership rolls for fear of being publicly identified. Others attend meetings only during the day so that family members are less likely to notice their absence. Husbands and wives routinely deny that their spouses have cancer when league members telephone to offer advice and comfort.

“Even when we have our meetings, some people won’t talk about cancer,” said Pavlik, who has undergone surgery for breast and cervical cancer and is now battling skin cancer. “They talk about cooking and housework and what the children are doing. Anything to skirt the topic.”

Thanks to donations and grants from abroad, the league has developed educational materials for schools in the hope of changing attitudes among the next generation. But Vasvary said it has been difficult to persuade many teachers to use them in the classroom.

“They are afraid,” said Vasvary, a former high school teacher who became head of the league after cancer researchers conducted a study among faculty members at her school. “Cancer is considered something shameful. It carries the stigma of death.”

At medical schools, prospective doctors shy away from oncology classes, and only a handful of nurses choose to specialize in cancer treatment. The lack of interest, doctors say, is caused in part by the country’s dismal track record in fighting cancer and aspiring physicians’ reluctance to sign on to a losing battle.

Because of decades of poor screening and detection, the disease was usually so advanced when diagnosed that having cancer almost always meant quick death. For years, morbidity and mortality statistics were virtually identical, making a cancer doctor a messenger of doom.

“It is a fact that 15 years ago, you would die after the first operation,” said Katalin Moskovics, who treats about 1,500 patients a year at a large cancer center in suburban Budapest. “But things are getting better. Now, after a third operation, people can still live a normal life. Unfortunately, the change in public attitudes has not kept pace with the advances in treatment.”

Even attitudes among doctors have been slow to change. Podmaniczky, the Health Ministry official, said one of her most frustrating assignments is to persuade doctors to talk to patients about cancer. Many doctors refuse to tell patients they have cancer, arguing that most would rather not know and that knowledge of the disease brings shame and undue stress.

Podmaniczky, herself a doctor, said many physicians are thinking only of themselves when they keep silent. She said they are avoiding the burden of counseling a patient, which can be both emotionally draining and time-consuming. The silence, she said, is undermining public trust in the medical profession, but it is slowly being broken.

“We are working on it,” she said. “The problem is that there is no framework for retraining the older doctors. The medical world does not readily accept advice or change.”

Marianne Szatmari, a general practitioner for 33 years, has been on both ends of the stethoscope. When she developed cancer seven years ago, she expected her doctor to lie about it. After all, Szatmari had done the same with many patients--including her mother.

But Szatmari’s husband and son had recently died, and her doctor had no one else to turn to with the information.

“In my case, I was told,” she said. “I didn’t want to know, but once I did know, I was thankful and relieved. I had to get cancer to change my opinion about telling.”

Szatmari, the World Health Organization liaison in Hungary, said better screening and detection methods are slowly working their way into former East Bloc countries, including Hungary, and are making it easier for doctors to be honest with patients.

“I didn’t tell people because it was more hopeless then than it is now. It was really like condemning someone to death,” she said. “I could have told my death patients--I mean cancer patients; you see, it is still deep within me--but if you take away the hope of someone, you leave them with nothing.”

At a recent meeting of Hungary’s oldest cancer support group, hope was also a main topic. Five women sat in white plastic chairs loosely arranged around a small table. They met in the oncology ward at the suburban cancer center where Moskovics, the specialist, treats many of them. Their meeting room doubles as a storage room for prostheses.

Over cups of apple juice, the women laid out plans for a party celebrating the birthday of Pavlik, the group’s founder and undisputed matriarch of Hungary’s emerging cancer awareness movement.

It has been 13 years since Pavlik had her first operation, and nine years since she made the extraordinary move to speak publicly about her illness. Since then, more than 200 people have joined her support group, and about 70 other groups have started up across the country.

The determined woman with wispy gray hair is living proof that cancer need not mean doom and gloom, her friends say, even in a country renowned for such things.

Pavlik said her successes have been heartwarming, but she is constantly reminded of how much more needs to be done.

“The poor doctor who saved my life,” she said. “Well, he has died of cancer.”

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International Cancer Deaths

Ten countries with the highest incidence of cancer-caused death. Rates per 100,000 population. MALE Hungary: 246.5 Czechoslovakia*: 232.8 Uruguay: 204.7 Poland: 203.5 France: 200.7 Scotland: 198.5 Soviet Union*: 198.3 Luxembourg: 197.6 Netherlands: 195.3 Italy: 192.3 United States: 164.4 FEMALE Denmark: 139.8 Scotland: 137.1 Hungary: 131.5 Ireland: 127.5 New Zealand: 126.8 England and Wales: 125.7 N. Ireland: 122.3 Czechoslovakia*: 121.0 Uruguay: 116.6 Iceland: 114.6 United States: 110.6 * Data from before the country’s division.

Source: 1994 Cancer Facts & Figures, American Cancer Society.

Based on World Health Organization statistics from 1988-1991.