By Dr Anesa Ahamad and Dr George Legall
There is much concern over the apparent increasing cancer problem in Trinidad and Tobago. Breast cancer is the commonest cancer among females. We studied cancer cases in this country to see if there was need for concern. We analysed 22,704 cancers from 1995-2006 and found 3,427 cases of female breast cancer. We were startled to find a continual increase from 233 cases in 1995 to 352 cases in 2006: a 50% increase. This contrasts sharply with the United States where breast cancer rates have steadily declined since 2000, but is similar to other developing countries.
Apart from rising breast cancer rates, another striking difference among the cases studied was that, unlike Europe and North America, the highest number of cancers occurs in the 40-49-year-old age group. This is true for both women of Indian and African ancestry. This is mainly due to the effect of race. The median age at which breast cancer is detected among white American women is 61-62 years and among African Americans is 52-57 years. In our study, among women of African ancestry it was 54.0 and among women of Indian ancestry it was 53.0 years. The most frequently occurring age at diagnosis was 45 years among women of African ancestry and 44 years among women of Indian ancestry.
It is common to blame this rising cancer trend on chemicals or pollutants in the air, water, food, soil or materials. However, many of the things that increase the chance of developing breast cancer are lifestyle related: being overweight and obesity, low physical activity, alcohol intake, delay of childbearing to age older than 30 years or no childbearing, less breast-feeding, use of the oral contraceptive pill and use of hormone replacement at menopause. These are all modifiable.
Other risk factors that are not modifiable are: female gender, increasing age above 40, family history of breast cancer, race (white women are more likely to get breast cancer than African or Indian women), non-cancerous breast conditions where there is overgrowth of the breast tissue, and having certain genes.
Some of the increase that was observed may be due to more women being diagnosed through greater screening using mammograms. However this does not account for all of the increase since many cancers are diagnosed after a lump is felt instead of after an abnormal mammogram.
A diagnosis of cancer is a devastating life experience. Can we reverse this upward trend? While we cannot guarantee a way to prevent breast cancer, there are things that might reduce the risk or find it at an early, more treatable stage.
You can lower your risk if you limit alcohol intake, exercise regularly, and maintain a healthy body weight. Women who choose to breast-feed for at least several months may also get an added benefit of reducing their breast cancer risk. Not using hormone therapy after menopause can help you avoid raising your risk.
Other than lifestyle changes, a woman can follow early detection guidelines to find breast cancer early. It will not prevent breast cancer, but it can help find cancers when the likelihood of successful treatment is greatest; 90-98% of women with Stage 1 breast cancer survive without even needing to remove the breast.
Beginning in their 20s, women should know how their breasts normally look and feel and report any breast changes to their doctor right away. Women in their 20s and 30s should have a clinical breast exam by a health professional, at least every three years. After age 40, women should have a breast exam by a health professional and a mammogram as often as advised by their doctor. Women at high genetic risk should get an MRI in addition to a mammogram every year. Special analysis by a trained professional needs to be done to determine if a person is high risk. Such women may also benefit from use of drugs or from removal of the breasts and ovaries.
There is need for more research on the causes, prevention, and treatment of cancer in the region and for the implementation of a comprehensive patient-centred strategy to manage this surge in cancer incidence.
–This research was conducted by a team based at the Department of Paraclinical Sciences, Faculty of Medical Sciences, UWI, St. Augustine: Anesa Ahamad. Oncologist and Senior Lecturer and George Legall, Biostatistician and Lecturer, School of Basic Health Science. Special thanks to Veronica Roach, SRN, SCM, HV, Registrar, National Cancer Registry of Trinidad and Tobago.
Data was collected by the Registry in strict accordance with guidelines set by the International Agency for Research on Cancer (IARC). The data does not include cases that were managed by private practitioners and private hospitals which do not permit access to their medical records for abstraction. Cancer notification is not yet mandatory in Trinidad and Tobago, as it is in Barbados. Information is collected actively by registry offices, which abstract data at health institutions, free-standing clinics and private hospitals from the medical, admission and discharge records and from death certificates.
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