Younger women in Guyana being diagnosed with breast cancer By Michelle Nurse
Guyana Chronicle
October 12, 2003

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Younger women in Guyana are being diagnosed with cancer of the breast, among them at least two teenagers. One of those young women has already undergone a mastectomy at a City hospital raising concerns that the irreversible surgery has been performed on one so young.

Though it is extremely rare worldwide for breast cancer to manifest itself in females of that age group, Guyana has recorded a slight increase in women in their 20s, 30s, and early 40s with cancer, Chairman of the Guyana Cancer Board, Dr. Walter Chin has said.

Breast cancer is usually diagnosed in women in their 50s, but the trend here of younger women having breast cancer diagnoses was observed years ago, Dr. Chin said.

The Guyana Cancer Registry has been recording more cases of younger women being diagnosed with cancer of the breast, and President of the Guyana Cancer Board, Dr. Walter Chin, said that evidence of this trend emerged years ago.

Of the 206 patients on the Breast Cancer Register for the period January 2000 to December 2002, there are 57 in the 41-50 age group, a similar number in the 51-60 bracket and 35 in the 61-70 age group. There are 21 patients in 71-80 bracket and seven in the 81-90 age group.

There are five recorded cases of females with breast cancer between the ages of 21 and 30 and 24 between the ages of 31 and 40, according to the Cancer Registry. There are no females under 20 with breast cancer on the registry.

"We are tending to see a number of women with breast cancer at an earlier age than what obtains in the developed countries," he said.

Dr. Chin pointed out that the process of cleaning up the data is now underway but nevertheless indicated that there is some evidence that "a little over three per cent of girls under 20 are getting cancer of the breast."

Asked about specific areas in the country where breast cancer in young girls may generally manifest itself, Dr Chin said: "We're looking at that right now... it doesn't seem as if it is (manifesting) itself in a particular area...; it's spread out all over Guyana, but we have to look further into that. We're in a sense trying to clean up the data to see if anything comes out of the information we have."

Despite the unusual manifestation, The Cancer Board has not been in contact with regional epidemiological facilities. Dr Chin explained that "we are looking at the figures; we're trying to be absolutely certain that these figures are accurate."

At present, the Board is working along with an epidemiologist to ensure that the figures are reliable and can be trusted.

"If that is so, we can then, probably in the near future, have these figures published and then start to compare our figures with figures from the rest of the Caribbean, ... and the developed countries.

"It is extremely unusual in the developed countries for girls under 20 to have cancer of the breast. So we have to be quite certain that what we are seeing is absolutely true before we can begin talking about cancer of the breast in that age group - three per cent is a significant percentage in that age group.

"I think we noticed, this trend, I would say many years... ago I began to see women in their mid-20s; now we're seeing it before (age) 20. But I think it first struck me 20 years ago when someone in their 20's had cancer of the breast, and unfortunately, it was not diagnosed early. The reason being because at that time, we really didn't think that breast cancer should be occurring in women in their mid-20's. So although there was a lump then, it was probably though then that it was a benign lump and not cancer," Dr. Chin said.

According to the doctor, if a patient complains of a lump in the breast, it may be clinically possible to make a diagnosis of cancer of the breast without a histological examination. The next step is the histological examination (microscopic examination) of either the lump itself, or tissue from the lump to determine whether it is cancer or not. If it is cancer, depending on the size and whether it has spread, surgical intervention may be necessary.

A biopsy should always be done, Dr. Chin stressed.

But Dr Chin has also pointed to the unreliability of some of the local diagnoses.

"We are not in a position where we can rely absolutely on the histological diagnosis in Guyana, because there are times when we have had the histological diagnosis where it said that there is no cancer and then (the tissue) is re-examined overseas and found to be cancerous. And on the other hand, we've had occasions where a diagnosis of cancer has been made and when the specimen has been looked at overseas... there's no diagnosis of cancer made! So we've had both sides ... the end result of which is that there has been a mistaken diagnosis," he said.

It is his recommendation that there should be in place a system where the labs can send a certain percentage of specimens overseas to recognised labs for confirmation of the diagnoses. In other words, a quality control system must be put in place, he said.

"We haven't reached that point as yet in Guyana," Dr Chin said.

Laboratories in Guyana fall under the purview of the Guyana National Bureau of Standards which issues licences, but there is need for "another independent way" of ensuring there is quality control in the lab. He pointed out that the Bureau of Standards does not have the kind of expertise to confirm whether or not the diagnoses from the laboratories are correct.

A mastectomy is performed when the physician has determined that the cancer has spread. The size of the cancer of the breast is also a determining factor.

"If it's just a small lump, the surgeon might perform a lumpectomy - taking out the lump without taking off the breast. If, unfortunately, the cancer is quite large that it necessitates the removal of the breast, (the surgery is done), he said."

Where the cancer almost takes over the entire breast - Cancer society has been trying to alert women that if there is a hard lump in the breast for over six weeks that they should consult a doctor to see if it is a benign lump or whether it is cancer.

"Unfortunately, we still see women who have had lumps for months and because it isn't paining she doesn't think it is cancer. We've been trying to get across the message that a breast lump is not painful is a lump that needs to be looked at. When a breast lump gets painful it's probably that ... it is at an advanced stage.

"It is unusual for young women to get breast cancer, but we have seen it in Guyana. We have to accept that fact. And if the breast was removed it would suggest that it was quite a big lump that necessitated the removal of the breast," Dr. Chin said.

"We know that breast cancer can be found in families and there are families that I know of in Guyana where breast cancer has been found. About five per cent of breast cancer is hereditary," he added.

According to Dr. Chin, the Cancer Society has also been "seeing cancer of the cervix in women in their 20's" and the Board is "looking at carrying out surveys in certain regions of Guyana to see whether the rate of cancer of the cervix among young women holds true and then following up on that to also ascertain the epidemiological risk factors that may be involved...".

He cautioned, however, that that process will be long-term. "It will take a few years actually, before we begin to look at the epidemiological factors involved in cancer of the cervix and cancer of the breast."

Meanwhile, a woman who was diagnosed with breast cancer and recently underwent a mastectomy has brought a case before the Guyana Medical Council, citing the possibility that her breast may have been wrongfully removed.

Head of the Guyana Medical Council, Dr. M.Y. Bacchus, told the Sunday Chronicle earlier this month that the woman has also charged that the doctor who performed the operation at the Georgetown Hospital refused to offer her a medical report.

The Council has ruled that the doctor must produce a medical report. It has also indicated that it will re-examine the woman's tissue specimen to ascertain if she, indeed, had cancer. The services of a third pathologist are also to be sought, Dr Bacchus said.