Key is detection say specialists

However, at the opening of the North West Regional Health Authority’s Therapeutic Care Unit 1 at the National Radiotherapy Centre on June 24 Health Minister Jerry Narace announced that three out of every five persons with cancer in TT die. This shocking statistic was based on data from the National Cancer Registry for January 1995 to December 2004 which showed that 18,136 cancer cases were recorded and 11,275 deaths.

The leading cancers in TT which result in death are: prostate (20 percent), breast (10.5 percent), colon and rectum (9.8 percent), bronchus and lung (8.1 percent) and cervix (5.5 percent). The news therefore is not good.

Dr Kavi Capildeo, Specialist Medical Officer, Oncology, in an interview after the official launch of the Dialysis Unit and Oncology Department of the Sangre Grande Hospital last Wednesday said prostate and breast carcinoma were “both very common and have very high death rates. It is well documented and published that for persons of African origin when breast cancer occurs it is more aggressive and likewise with prostate cancer.”

He said statistics from the UK and US point to breast cancer being a disease of women in their 50’s, 60’s and 70’s but the peak incidence among women in TT was in their 40’s and it was not “rare” in women in their 30’s.

Late detection is one factor contributing to TT’s breast cancer mortality. Dr Capildeo said, “What is really unfortunate is that many of those late presentations are not only due to patients developing breast lumps and hiding them as long as they can but also in too many cases women discovering breast lumps and symptoms and going to a provider, receiving false reassurance either because the provider feels they are too young or the lump feels too soft so it can’t be cancer.”

Capildeo said some physicians do not realise that “at least ten percent maybe more” of mammograms can give false negative readings. He said too many women who went to family doctors with a breast lump, are sent for a mammogram which returns with apparently nothing being detected.

He said: “they are told don’t worry about the lump, the mammogram says it’s not cancer and when it grows and they get another lump or when it starts breaking through the skin they realise that reassurance was misplaced and they seek further opinion or come into the casualty department and it is discovered.”

He stressed the importance of screening to detect pre-cancerous changes before symptoms appear. Pap smears for the cervix and a colonoscopy for the colon.

Screening can help detect precancerous changes before symptoms appear. “Both those methods are capable of detecting pre-cancerous changes, allowing intervention to prevent the development of cancer in the first place.”

Capildeo said while people were aware of the available medical screening for cancer they may not be aware of the “intermediate diagnostic steps”. He said men with positive PSAs (prostate specific antigen) may need to have a prostate biopsy and women may need a localisation biopsy if something is seen on the mammogram. “Sometimes those intermediate steps between picking up something in screening and making a firm diagnosis, we don’t always have those facilities as greatly as we would like.”

He said the new Sangre Grande Oncology Department has a urologist available so prostate biopsies can be done and prostatectomies when necessary.

“That step of confirming the diagnosis is something we need to get resources into.”

Capildeo said smoking is a contributing factor for cancer not only in the lung, neck and head but also in the oesophagus, pancreas and bladder. Smoking also contributes to heart disease, stroke and erectile dysfunction. Many smokers argue that they know someone or had a relative who smoked and lived to a ripe old age. However, Dr Capildeo sought to illustrate the error of such thinking.

“I am sure if some people decided to run across the highway in peak traffic with a blindfold on, some of them will make it to the other side. It does not mean the practice is safe.”

Capildeo said one area of active study should be the question: “To what extent are people getting their health information from alternative practitioners?”

He noted that several radio stations carried programmes promoting alternative medical treatments for a range of illnesses. “It’s hard to say how many late presentations of cancer are due to people getting symptoms, trying alternative medicine until they are at death’s door and then coming to the conventional medical system to see if anything can be done. Quite often very little beyond pain relief.” He said this information may not be something patients volunteer “up front”. In an interview on Monday Chairman of the TT Cancer Society Dr George Laquis said the death rate worldwide was one-third and the high figure for the country was “ridiculous” because at 60 percent it was double the international rate. Laquis linked the high death rate to lifestyle and not putting prevention into practice. He said public education was “critical” and making screening more widely available. Laquis said Trinidad was very “under-screened” and the Cancer Society, Family Planning Association and public health system screened approximately 30,000 to 40,000 people annually. “We should be doing about 300,000” Laquis said.

The TTCS has been trying to reach high risk groups in rural areas through its mobile units and half the pap smears collected are done through the outreach programme. Laquis said studies have shown that the greatest deterrent to screening was cost. The TTCS charges a small fee for the screening service provided at a “loss” for the Society. Government has been providing a subvention to the TTCS for more pap smears and mammograms to be done.

Laquis said TT needed a proper mass screening programme and it had to be “accessible and affordable”. He told Sunday Newsday that education has to begin in schools and parents also have to be taught about prevention. The TTCS has an officer who visits schools for lectures and it distributes pamphlets and brochures. Sponsored advertisements are carried on television and radio. Laquis stressed that there was only so much the Society could do with its limited resources and for a more effective education campaign “millions are needed”.

He said there is a response when the public received information about cancer prevention. “That’s the key in this whole thing. We have to get people to participate.”

So while the present position is somewhat frightening, the fact that could brighten the picture is early detection. This can make the difference between life and death.

Information and screening on cancer is available at the Cancer Society, 62 Rosalino St Woodbrook, 622-6827. The Cancer Treatment Foundation assists with funding for cancer treatment, 11 Havelock St, St Clair, 622-3957.