World Cancer Day
Guyana committed to lowering mortality rate - Ramsammy
By Melanie Allicock
February 4, 2007
As Guyana joins the rest of the world in the observance of World Cancer Day, Health Minister Dr. Leslie Ramsammy has committed to lowering the mortality and morbidity rate due to cancer.
He noted that intensification efforts will be taken towards reducing these rates, although not significantly high in comparison to other countries and although many major steps have been taken by Government including the establishment of the oncology unit.
The Ministry of Health in Guyana considers cancer to be an important health problem, since it is among the principal causes of morbidity and mortality, Ramsammy said.
It was pointed out that the creation of National Cancer Control Programmes is recognised as an efficient and effective way to reduce the incidence of, and the mortality due to cancers. However, facilities are somewhat limited and their future development must be considered in the context of a country's health system, health financing and decentralisation initiatives.
The World Health Organization (WHO) foresees that the annual number of new cases of cancer will increase from 10 million in the year 2000 to 15 million before the year 2020, of which 60% will be in developing countries. Of the 10 million new recorded cases annually, 4.7 million is attributed to the developed countries, where cancer causes one of every five deaths, while in the developing nations this ratio is 1:10.
Cancer represents 12% of mortality at the world level, occupying the third place after cardiovascular diseases (30%) and the infectious and parasitic diseases (25.9%).
The regions with fewer deaths from cancer are Africa (9.2%), Middle East (6.1%) and South East Asia (8%). Various factors are associated with the increase in mortality from cancer (increase of smoking, changes in the diet, smaller physical activity, obesity and the reduction in the deaths from cardiovascular diseases).
Although cancer has frequently been considered a problem that affects especially the developed countries, what is certain is that more than half of the cases are already present in the developing countries.
Incidence of Cancer in Guyana 2000-2004.
In May 2000 the National Cancer Registry in Guyana was established. In the past four years efforts have been made to enhance the system of registration and the reporting of cases. Weaknesses and gaps still exist in the registry, but the system is being improved and today we have a database and can carry out periodic analyses of this health problem.
In the period, there have been 2236 recorded cases of cancer. It represents cumulative incidence rate of 301.3 per 100,000 inhabitants. The incidence rate in the period tends to increase per year, which can be related to a greater coverage of the system of registry of the cases. The principal cancers are breast, comprising 15.4 % of the total incidence; prostate representing 14.6 %; and cervical cancer with 12.9 %. Other most frequent cancers were the colon, the stomach, the lung, the uterus and the liver, varying from 5.6% to 3.1%. These locations contributed 64% of the total of recorded cases in this period.
Prostate, colon and lung cancers were most common in males. Breast and cervix were most common in females. The Cumulative Incidence Rate, calculated by regions, shows the highest to be Region 4 (369.5). In the second place was Region 10 with a rate of (324.4) and Regions 6 and 5 with rates of 261.3 and 254.2 per 100,000 respectively.
The most common cancer was breast cancer with 344 cases and a specific incidence rate of 142.2/10 5 , followed by prostate cancer with 326 cases and a rate of 136.0/10 5 pop. Third place was occupied by cervical cancer, with 288 cases and a specific incidence rate of 119.0/10 5 . Cancer of the colon was next with 125 registrations and a rate of 16.8 and finally cancer of the stomach with 115 cases and rates of 15.5/10 5 pop.
Analysis by sites
In the period 2000-2004, there were 344 recorded cases of breast cancer in Guyana with a cumulative incidence rate of 144.3/10 5 among women aged over 15 years. The greatest incidence rate at the present is in the group over 65 years of age (517), followed by the 45-64 years group with 489.7/10 5 . This pattern is similar to the majority of the countries of the area.
In Guyana , the cumulative incidence rate was very high in Region 4 (179.2/10 5 women over 15 years old), followed by Region 2 with 122.7; Region 5 with 117.2 and Region 3 with 99.8. These figures could be due to the fact that in some regions the health services are better and the levels of investigation, diagnosis and registration of cases are greater than others.
In Guyana, prostate cancer occupied the second place in the frequency in the period 2000-2004 with a total of 326 cases and a cumulative incidence rate of 136.0/10 5 . The greatest incidence was found in the group over 65 years of age with a cumulative incidence rate of 1839.0, followed by the group of 55-64 years with 97.0. This induces us to think that the diagnosis of this entity is being done much too late and it is necessary to improve the screening in men, starting in the 50 year age groups.
There was observed a high incidence rate in Region 10 (261.0/10 5 men over 15 years old), followed by Region 4 (161.4), Region 5 (160.4) and Region 2 (130.0). The lowest incidence was registered in Region 8 (36.2) which was significant. These results suggest the need to develop specific research in order to try to establish the factors that are affecting this pattern, especially in Region 10.
This is the second most common cancer of women worldwide with more than 470,000 new cases per year with about 230,000 deaths every year, more than 80 % of which occur in developing countries. Five-year survival rates are up to 70 %.
The incidence of cancer of the cervix begins to rise at ages 20-29, and then increases rapidly to reach a peak at around ages 45-49 in European populations, but often rather later in developing countries.
Risk factors for cancer of the cervix are primarily indicators of sexual behaviors. An increased risk of cervical cancer is associated with having multiple sexual partners, or a partner who has multiple sexual partners, and with early age of initiation of sexual activity. Risk is also related to the number of pregnancies, the presence of other sexually transmitted diseases and the use of oral contraceptives. More than 90 % of cervical cancers exhibit human papilloma virus infections. In addition, low socioeconomic status, smoking, diet and immune-suppression may be implicated.
In Guyana there were 288 registered cases, this represents a cumulative incidence rate for the period of 120.8/10 5 women above 15 years. It was noteworthy that all the diagnosed cases were less than 45 years old and those 88 women belonged to the age group of 15-24 years that tested positive; 79.2% of the cases were less than 35 years old. The highest rates were registered in Region 1 (152.7 /10 5 women above 15 years) and Region 4 (137.0), followed by Region 7 with 109.4 and Region 9 with 106.5 /10 5 women over 15 years old, respectively.
Diet is by far the most important exogenous factor so far identified in the etiology of colorectal cancer. There is convincing evidence that diet high in calories and rich in animal fats, most often as red meat, and poor in vegetables and fibre is associated with an increased risk of colorectal cancer. Alcohol intake and smoking have also been suggested to increase risk. Persons with an increased intake of Vitamin D and calcium have a reduced risk of colon cancer.
There were 125 recorded cases of Colon Cancer in the period 2000-2004, the cumulative incidence rate calculated was 16.8/ 10 5 . The higher incidence rates were observed based on 45 years old, with 51.5/10 5 in the group of 45-64 years and of 223.0/10 5 among the ones over 65 years of age
A discreet predominance was observed in the females, whose amount was 51.2%. In Guyana the highest incidence rate was found in Region 4 , followed by Regions 6, 5 and 10 with rates of 20.4 19.5 19.1 and 17.6/10 5 respectively.
More than 800,000 new cases occur every year and this was the fourth most common malignancy in the world in 2000. Mortality from stomach cancer is second cause of death from cancer (650,000) deaths per year. Incidence is declining worldwide due to markedly decreased consumption of salt-preserved food. Approximately 60 % of the incidence occurs in developing countries. The infection with Helicobacter pylori causes chronic atrophic gastritis and is considered a factor in the development of stomach cancer. Patients are often diagnosed with advanced disease and five-year survival rate are poor (< 30 %).
In Guyana , 115 cases of cancer of the stomach were diagnosed in the period; the cumulative incidence was 15.5/10 5 . Ninety percent of the incidence was found in patients older than 45 years and the incidence rates for these age groups were the following: 45.2 /10 5 in the group of 45-54 years and of 226.2/10 5 for those over 65 years.
The men contributed 51.3% to the incidence.
The regions with greater rates were Region 10 (25.1 /10 5 ), followed by Region 5 with a rate of 22.9 /10 5 and Region 4 with 20.4 /10 5 and in fourth place Region 6 with a rate of 11.3/10 5 .
In Guyana , the number of cases of lung cancer recorded was 87, which represents a cumulative incidence rate of 11.7/10 5 . Ninety one percent of the cases was more than 45 years old and the calculated rates by age were the following: 55-64 years (41.4) and 65 and more (153.1/10 5 )
A high predominance was seen in the incidence with the males, whose rate was 72.4% of total cases. The low incidence of lung cancer is noteworthy; the highest rate was Region 2 with 18.6, followed by Region 3 with 17.7, then Regions 4 and 5 with rates of 13.6 and 11.5 per 100,000. In three Regions (7, 8 and 9) there were no registered cases.
The cumulative incidence of cancer of the liver in these 5 years (2000-2004) was of 70 cases, the calculated incidence was of 9.4/10 5 .
80% of the incidence was diagnosed in people above 45 years. It was noteworthy that in the group of 25-34 years 10 patients were diagnosed at a rate of 12.1/10 5 for this specific group.
The rate of 45-64 groups was of 28.9/10 5 and that of the ones over 65 years of age of 109.8.
The incidences in males represent 61.4% of the total cases.
A significant finding was the high incidence of liver cancer in Regions 7 and 10, with rates of 25.1/ 10 5 ; both, followed in order of frequency by Region 6, with 13.0 and the Region 1 with 12.9/10 5 respectively.
In Guyana there were 99 registered cases, with 77 in the Uterus, 1 in the endometrial, one in the myometrium, 4 in the body and 77 in the uterus NOS. The cumulative incidence rate was 40.9/10 5
The highest incidences were recorded in Regions 6, 10, 7 and 5 with rates of 35.1, 30.0, 27.3 and 22.7, respectively, followed by Region 4 with 19.3 and Region 2 with 16.5/10 5 women above 15 years.
In Guyana 54 Ovarian Cancer cases were recorded in the period 2000-2004; the cumulative incidence rate calculated was 22.3/ 10 5.
75.9 % of the cases were registered in women aged above 45 years. The highest incidence rates were observed in the group of 45-64 years with 71.0/10 5 , while those over 65 years were 87.4/10 5 .
The highest incidences were reported in Region 2 (34.1), followed by Region 4 (31.9) and Region 6 (20.5).per 100,000 women over 15 years old.
In Guyana a total of 26 cases were reported in this period. The cumulative incidence was 3.5 / 10 5 and 18 of these were men. The male-female ratio was 2.25:1 and 76.9 % of the cases were patients over 45 years. The major incidence was found in the age group over 65 years with 33.3/10 5 , followed by the age group of 45-64 years with 12.5/10 5
The regions that had the highest rate were Region 6 (5.6) Region 4 (4.2) and Region 3 with 2.9 cases per 10 5 inhabitant, respectively.
Morbidity by Ethnic Groups
The study was able to account for the ethnic grouping in 2090 cases. The Afro-Guyanese group represents 47.6 % of the total, followed by the East Indian with 39.7%, the mixed group with 8.6%, the Amerindians with 3.7% and finally the Chinese with 0.4%.
The proportion of women to men was greater in all the groups; nevertheless between the East Indians and Amerindians the ratio was greater than the rest of the groups. Upon carrying out the distribution by sites of cancer and the ethnic groups, it was observed that breast cancer was predominant among the East Indians, while prostate cancer was frequent among Afro-Guyanese men.
In Guyana , during 2000-2004, 1387 deaths from cancer were registered with a rate of 186.9/10 5 inhabitant, showing the highest rates among the females (201.2/10 5 ). For men the rate was 172.9/10 5
The highest rates were registered in patients over 65 years old in both sexes, but in all age groups female rates were higher than men, except in the less than 15 group.
Prostate cancer showed the highest mortality rate, followed by breast and cervix, then colon, stomach and lung while the lowest was mortality by cancer of the liver.
An analysis of the cancer report shows that breast cancer is the most common cancer in women and exhibits a high case-fatality rate in all the age groups. It was noted that it is necessary to make an early diagnosis of this type of cancer.
It is important to educate women on self-examination of the breast along with mammography in order to improve the early diagnosis of this disease.
Cervical cancer, despite showing a low mortality and low case-fatality rate in comparison with other forms of cancer, must be diagnosed early, as this would lead to very good rates of cure .Early changes in the cervix can be detected before cancer develops, through pap-smears.
Pap-smears should be carried out regularly in women who engage in sexual activity, particularly those having multiple sexual partners. The highest case-fatality was observed in cancer of the lung, liver, esophageal and colon.
The most affected ethnic group was Afro-Guyanese (408 cases) with prostate and colon cancer being particularly frequent in this group. Breast cancer, stomach and cervical cancer were frequent among East Indians. In the period analyzed 1388 deaths were recorded (65.1%). Of these prostate, breast and cervical cancer were the commonest.
Morbidity in the pediatric age groups is relatively low. The most frequent locations in men were: prostate, lung, colon and stomach, while in women were breast, cervix, uterus and colon