Results from a ten-year surveillance have revealed that 79% of the persons diagnosed with cancer receive no treatment; a fact that should be of major concern to all Guyana, according to Director of Disease Control at the Ministry of Health Dr Morris Edwards who also revealed that the second most affected group is made up of persons between the ages of 15-39.
“We should hang our heads in shame,” Dr Edwards said yesterday when he released the information. He suggested that this should be an area for further study as it is not clear why those persons had not accessed treatment.
Titled ‘Cancers in Guyana (2003-2012),’ the study was done with data compiled by the Cancer Registry, a population-based collection office, which is headed by Penelope Layne. The registry was created in 2000 and it was the brainchild of the well-known late Dr Walter Chin.
Other key findings of the study, which was done by the Ministry of Health in collaboration with PAHO/WHO, are that breast cancer is the leading cancer killer and while Guyanese of African descent have the highest incidence of cancer, Guyanese of Chinese descent have the highest cumulative rate followed by Guyanese of African descent. Interestingly, Guyanese of Amerindian descent have the lowest incidence of cancer and Dr Edwards said this would come as a surprise to many of his colleagues who have repeatedly said that Amerindian women have the highest incident of cervical cancer. However, he said, data does not lie.
According to the findings, presented at the Herdmanston Lodge in Queenstown, in the ten-year period, Guyana recorded 6,518 cases of cancers with an overall cumulative incidence rate of 867.7 per 100,000 population with an annual incidence rate of 87.3 per 100,000 population.
Dr Edwards, in his power-point presentation, revealed that of the recorded cases 3,956 (60.7%) were females and 2,561 (39.3%) were males. The cumulative incidence rate for females was 1,054 while for males it was 681.
For the period there were 3,415 deaths representing 52.4% of all cancers and mortality in women (62.2%) was more than twice that in men (27.4%).
Dr Edwards stated that about one fifth (1,268) of the cancers were in persons older than 75 years of age with the second most affected age group being persons between the ages of 15-39 years with 597 of the cancers. Persons aged 55-59, 50-54, 65-69 years had 10.0% of cancers respectively with the paediatric age group (age less than 15 years) recording 2% of all reported cancer cases.
According to PAHO/WHO Country Representative Dr William Adu-Krow the study found that males had higher numbers of cancer in the paediatric age group and in persons aged 75 years and older. In the latter age group, he said, males had almost twice the number of cancers as females. The PAHO/WHO country head importantly pointed out that the study revealed that staging of cancers is highly inadequate with almost a third of cancers not being staged.
“Staging of cancers is important for treatment purposes as well as in terms of prognosis. Uptake of treatment for cancer in Guyana was poor as the vast majority of cases (79%) had no treatment recorded,” Dr Adu-Krow stated.
He pointed out that this may have impacted on survival data from the registry which showed that breast, cervical and uterine cancers are the leading causes of death from cancers in women, while prostate and colon are the leading causes of cancer deaths in men.
He said that PAHO/WHO supported the study in a quest to improve the quality of data produced by the Guyana Cancer Registry and as such responded to a request from the Ministry of Health for technical cooperation for the improvement of the general functioning of the registry and support for organisation and analysis of raw data.
The study indicated that the gender distribution of cancers in the Guyanese population changed compared to the situation in the period 2000-2004 which reflected that females accounted for 57.9% of cases and males 42.1%. It was stated that this was likely due to the increasing number and proportion of prostate cancers in men, relative to the other cancers. The present study revealed that women account for 60.7% of the cancers recorded for the 10-year period while 39.3% were among men. Breast cancer was the most common cancer recorded in the period (16.7%) followed by cervical cancer (15.6%), prostate (13.3%), colon and rectal (6.7%), uterine (5.0%), stomach (3.7%), lung (3.6%) and other (3.3%). It was pointed out that the order and proportion of the top seven cancers were different in the 2000-2004 report.
Right direction
Minister of Public Health Dr George Norton in his remarks pointed out that by developing the ten-year profile, Guyana is moving in the right direction in addressing the information gap. He pointed out that data from most of the developing world is severely lacking in quality and completeness and as such poses a major challenge for individual countries to effectively plan and implement prevention and control programmes.
“For too long, we have had to rely on patchy information or information that is provided by individuals and organisations that are external to our country,” the minister said adding that it was good that the profile was produced by local professionals.
He said that cancer is one of the Non-Communicable Diseases (NCDs) that is responsible for 70% of the morbidity and mortality in Guyana. The disease has also been consistently ranked among the top four causes of mortality in Guyana for the past decade. The Public Health Minister also indicated that cancers are associated with certain risk factors such as smoking, physical inactivity, dietary patterns, reproductive behaviours and infectious agents.
He noted that from the data presented there is a high prevalence of modifiable risk factors that significantly contribute to cancers and other NCDs in Guyana. He said while these are amenable to behaviour change, this requires commitment and hard work. To this end, the minister said, the ministry will ensure that Guyana develops a comprehensive cancer prevention and control programme.
“A programme that will ensure that common risk factors for cancer such as tobacco use, alcohol use, physical inactivity and unhealthy diets are addressed,” the minister said.
Additionally, he said they will seek to address other behavioural risk factors that contribute to cancers that are caused by chronic infections, such as infection with the Human Papilloma virus (HPV) that causes cervical and other cancers and infections with Hepatitis viruses which cause liver cancer.
The minister also said that the media is needed to get the messages out as they seek to inform and to change behaviour. More importantly, he said, the media have to keep the ministry and its officials honest about the efforts they are making and the progress in their prevention, treatment and control efforts.
“For that we need to ensure that information gets out there to the media. The previous culture of not sharing information has to stop, that has to be a thing of the past,” the minister said in a clear jab at the previous administration.
Leading cause
Meantime, Dr Adu-Krow noted that cancer is a leading cause of death in the Americas as in 2012 cancer accounted for 1.3 million deaths, 47 of which occurred in Latin America and the Caribbean. The overall cancer mortality rate in this region is 107/100,000 and the highest rates are observed in Uruguay, Barbados, Peru, Argentina and Chile. The most common cancer in this region include; stomach; prostate; lung and colorectal cancers in men; and cervical, breast, stomach and colorectal cancers in women.
“With an aging population and epidemiological transition occurring throughout Latin America and the Caribbean, the cancer burden is projected to increase significantly in the near future,” the PAHO/WHO representative said.
On Guyana, the PAHO rep said it is anticipated that the recently developed study profile “will call attention to the need for more available and accurate information on the country situation with respect to (the) epidemiological status of NCDs and the capacity for public health programmes for prevention and control in keeping with the WHO Global Monitoring Framework which includes specific indicators related to cancer, and which requires ongoing monitoring and reporting on global progress towards reducing the burden of NCDs.”
