I’ve taken most of my information from the most recent breast cancer report I could find concerning the Caribbean. Take a look at Breast Cancer in the Caribbean (2021) if you want to know more.
Firstly, health care quality right across the Caribbean is generally poor. The death rate for breast cancer is much higher in this part of the world than in North American and European countries, despite having much higher numbers of women diagnosed with breast cancer.
There are huge breast cancer variations within the Caribbean. However, we can say the following,
Poorer Caribbean countries are burdened with more advanced breast cancer disease with expected poorer outcomes (i.e., late diagnoses links to higher death rates).
Caribbean countries do not have enough NATIONAL CANCER REGISTERS but those that do, are doing better with breast cancer healthcare outcomes.
Cancer treatment programs in association with international non-profit groups are increasing healthcare quality for low-income breast cancer patients.
Not enough research has been carried out in the Caribbean. We need to know more.
The diversity of the Caribbean makes it an ideal part of the world to bring more focus and understanding in relation to breast cancer. Researching the similarities in breast cancer patterns between Africa and the Caribbean could be particularly useful for understanding what is happening to women and men of African heritage.
NOTICE HOW RELATIVELY LOW THE GLOBAL INCIDENCE RATE IS FOR THE CARIBBEAN
NOW LOOK AND CONTRAST THE MORTALITY RATES FOR THE CARIBBEAN WITH NORTH AMERICAN AND THE WEST
GIOBOCAN 2020 estimated approximately 685,000 breast cancer deaths globally 2020. There were about 15,000 new cases in the Caribbean in the same year. Breast cancer has been the second leading cancer after prostate cancer for the last two decades in the Caribbean.
Although breast cancer is considered, ‘a woman’s disease’, it is increasing among men who now have relatively higher mortality rates compared to breast cancer in women. This is probably due to delayed diagnosis owing to its rarity in men. To be clear, breast cancer in men represent 1 – 2 per cent of all breast cancers. See Black Men and Breast Cancer for more information.
The Caribbean can be compared to South America, which has similar incidence rates within the same geographical region. However, the Caribbean suffers higher mortality rates and is comparable to that of Africa.
By some measures, the Bahamas had the third-highest incidence rate of breast cancer, ranking higher than larger Caribbean countries such as Jamaica and Trinidad and Tobago. In Grand Bahama Island, breast cancer seemed to be particularly significant.
The Pan American Health Organization (PAHO) said Barbados was the highest in breast cancer mortality rates in the Caribbean along with The Bahamas, where mortality rates were approximately two times as high as those in Canada and the United States.
Breast cancer is reportedly the most common malignant tumor in women in all but one Cuban province with rising incidence since 1986, DESPITE A NATIONAL SCREENING PROGRAM. Although there is a continuous rise in incidence, Cuban women’s breast cancer survival rates are comparable to African Americans and Europeans.
FRENCH WEST INDIES (FRENCH GUIANA, GUADELOUPE, AND MARTINIQUE)
The incidence of breast cancer in the French West Indies was considerably lower in the French West Indies than among African Americans, European Americans, and Mainland France during the same period. Age-specific incidence rates were comparable to European and U.S. populations below the age of 45 and higher in Guadeloupian women aged between 45 and 55 years.
The incidence of breast cancer doubled 1999 – 2006 and called strongly for improved cancer management and control.
An increase in breast cancer in Martinique women as the leading female cancer (32.14%) gives rise to an upward trend and an urgent call for national interventions.
With 226 new cancer cases per year and 58 deaths per year, breast cancer is the prime tumor site in Martinique women in terms of incidence and mortality with a mortality rate of 14.4 per 100,000 for 2011 to 2015. This is analogous to Guadeloupe.
For the ten years from 2000 to 2009, there were 153 new female invasive breast cancer cases and 89 deaths – a 30 per cent increase. The incidence rate for breast cancer, the most prevalent of female cancers, was half the incidence rate for prostate cancer, the most common cancer overall. Not unlike elsewhere, we see an increase in breast cancer incidence up to 2013.
GLOBOCAN IN 2012 estimated an approximate mortality rate of 45%. In 2018, the estimated number of new breast cancer cases was more than 1,100, with a mortality-to-incidence ratio of more than 60 per cent.
From 1998 to 2007, breast cancer cases accounted for approximately 28 per cent of all female cancers in Kingston and St. Andrews, Jamaica. The highest proportion (55 per cent) of this breast cancer population was women between the ages of 25 and 59 years.
Between 2010 and 2014, a total of 1,634 Jamaican women died of breast cancer, which was 24 per cent of all female cancer deaths. Of the many reasons that could attribute to the increased breast cancer mortality rates, the highest mortality observed among the plus 75-year age group is a public health concern with the growing elderly population and limited clinical management offered to these breast cancer patients.
THE DUTCH CARIBBEAN (Netherland Antilles)
A study in 2020said life expectancies are lower in the Dutch Caribbean islands of Aruba and Curaçao than that of mainland Netherlands. Indications point to limited access to quality health care services in the Dutch Caribbean, particularly for lower-income communities. Despite the mainland having a principle of universal health care for its residents, this does not seem to be the case in Curaçao, for example. People with a lower educational level were less likely to have consulted a specialist or be hospitalized than those with higher education. It follows that the mortality rates for breast cancer in the Dutch Caribbean are higher than that on the mainland. On the other hand, breast cancer mortality rates have declined since the introduction of population screening programs (mammographies) and treatment with tamoxifen. However, there needs to be a greater emphasis upon EARLY INTERVENTION / DETECTION.
SAINT KITTS AND NEVIS
In Nevis, the smaller of the twin-island nation, it isn’t easy to accurately assess the situation. The most recent research I read was from 2009. At that time, it was reported that there were no breast screening facilities. Women were forced to leave the island to be breast-screened elsewhere. As a result, the data is unreliable. If someone reads this from Nevis, do let us know whether things have improved.
“Here in the Federation of St. Kitts and Nevis, data from the Ministry of Health pathology lab showed 25 new cases in 2019 and seven new cases recorded up until June of this year, with affected individuals ranging in age from their early 30s to late 70s.
TRINIDAD AND TOBAGO
There are 250 new cases of breast cancer reported on average annually, with 125 deaths per year.
TO BE CLEAR, THE DATA IS SAYING FOR EVERY TWO WOMEN WITH BREAST CANCER, ONE MAY DIE.
Ethnic and geographic disparities in incidence and mortality rates also exist, with most cases (53 per cent) occurring in women of African heritage and those living in urban, densely populated areas. There is a marginally higher mortality rate in women of Indian descent compared to those of African descent – also observed in Guyana.
There has been a pattern of increased mortality with increasing age that was considerably higher (two-thirds) for the age groups above 50 years than those less than 50 years of age; however, both showed an upward trend over the 35 years of age.
The highest breast cancer incidence in the Caribbean was seen in Barbados, followed by The Bahamas, with the lowest incidence in Haiti. However, in the most recent breast cancer statistics available, as seen in Figure 4 below, which represents GIOBOCAN 2020 estimates for the available Caribbean countries, Martinique is positioned in the lead, followed by Barbados and Guadeloupe.
BARBADOS NOT ONLY HAS THE HIGHEST MORTALITY RATE IN THE CARIBBEAN BUT IS SAID TO HAVE THE HIGHEST IN THE WORLD.
The graphs make it abundantly clear that the call for high-quality standardized cancer registries for each Caribbean territory should be a VERYLOUD ONE.
Many doctors and researchers argue that as people of African heritage, we have higher breast cancer rates because we carry the mutated BRCA gene at higher levels than almost everyone else. This movie does not involve us, but it helps us understand the BRCA gene and its discovery.