Eulalee Thompson, Health Coordinator

INCIDENCE RATES (JAmaica)

1988-1992 1993-1997 1998-2002

Females

Breast 47.1/100,000 43.2/100,000

Cervix 26.5/100,000 25.2/100,000 19/100,000

Colon 10.0/100,000

Males

Prostate 36/100,000 56.4/100,000

Bronchus 25.1/100,000 25.4/100,000

Colon 8.9/100,000

Increase in prostate cancer incidence rate is a result of increased screening.

Over the last week or so, the American Cancer Society (ACS) has been celebrating two consecutive years of decline in the actual number of cancer deaths.

The 2007 edition of its report, Cancer Facts and Figures, an annual estimate of cancer incidence and deaths, shows a drop of 3,014 cancer deaths in the United States between 2003 and 2004; in the previous period, 2002 to 2003, statisticians recorded 369 fewer deaths from cancer.

In terms of the cancer mortality rates, (that is, the number of deaths per 100,000 population) health statisticians in that country have been recording about a one per cent decline over the last 10 years or so. However, in spite of declining rates, the actual number of cancer deaths was still rising as a result of the ageing population and rise in overall population.

In 2003 and 2004, the cancer mortality rate declined by two per cent in each year, offsetting the effects of ageing and overall population growth. Hence, the cause for celebration.

In 2004, fewer people in America died from the four leading cancers - lung, breast, prostate and colorectal - and the five-year survival rate for all cancer patients between 1996 and 2002 was 66 per cent, compared to 51 per cent between 1975 and 1977. Epidemiologists believe that the downward trend in cancer deaths is related to efforts to control tobacco use, more aggressive early detection and screening campaigns and improvement in treatment.

Jamaica's cancer trends

What are the trends in Jamaica's cancer mortality and survival rates? It's difficult to say as no comparative, comprehensive document as published annually by the ACS could be found. This is so, in spite of the fact that cancer and cardiovascular diseases are the leading causes of death in Jamaica.

The Jamaica Cancer Society's administrative director, Marva Lee, indicates that the society depends on the Cancer Registry for mortality figures and that those data were last available for 1999.

However, director of the Cancer Registry, Professor Barrie Hanchard, explained that the research focus of the local registry is on incidence studies (new cases) and not mortality rates. In fact, he said that most registries worldwide focus on incidence surveys though the current tendency is to add mortality studies.

"The mortality figures are collected by the Registrar General on a yearly basis and the Ministry of Health does the collection and analysis. When we did a (mortality) survey, it was for one year, 1999 ... (that) study was an attempt to see whether we could regularly put out that information but we didn't have the resources to maintain that and this is my goal (to add mortality studies)," he said.

Requests from The Gleaner for cancer mortality data from the Health Ministry's public relations and epidemiology departments were not responded to, so let's fall back on the 1999 mortality study. It shows that the leading cancers for men are prostate, lung, stomach and colon; for women, it's breast, cervix, colon and stomach (see inset data). Since there is no subsequent data to compare, we can't say if the rates are changing.

Dreaded disease

What makes cancer such a dreaded disease is that, after all these years, scientists still have not been able to fully explain the uncontrolled growth and spread of abnormal cells (which is really what cancer is).

They have established risk factors and risk groups, but as leading consultant surgeon, Dr. Michael McFarlane, has repeated in the past, many (breast) cancer patients do not fall in the risk groups. He was quoted in The Gleaner's Health Section in October 2005 as saying that "breast cancer is a disease that selects people randomly. Despite risk factors, the overwhelming percentage of breast cancer patients have no risk factors, it's just a lottery, cells just begin to misbehave and there is a corruption of DNA".

That may not be very comforting, but still scientists have made a lot of strides that can be more reassuring. They say, for instance, that cancers caused by tobacco and heavy alcohol uses can be completely prevented. Also, certain cancers have been related to infectious agents such as the human papillomavirus (in the case of cervical cancer and there is now a vaccine available), hepatitis B virus, helicobacter pylori and the human immunodeficiency virus.

Regular screening for cervical and colorectal cancers, as Professor Hanchard indicated, can also locate disease processes in the precancerous stages and treatment effected. Regular screening can also detect early-stage cancers in the breast, prostate, oral cavity and skin for more effective management of the disease.

Please send your feedback to eulalee.thompson@gleanerjm.com

FEMALE MORTALITY RATE 1999
Breast	30.1/100,000
Cervix	15.8/100,000
Colon	10.0/100,000
Stomach	7.0/100,000