Medics concerned about increase in cancer cases among younger people
AMID the myriad challenges facing breast cancer patients in Jamaica, doctors are also worried about the increasing number of younger individuals being diagnosed with the disease.
Speaking at this week’s Jamaica Observer Monday Exchange, general surgeon and breast cancer surgical oncologist Dr Jason Copeland said that one of the problems facing the island, as well as other developing countries, is that the global burden for breast cancer is shifting, and due to the limited access to certain treatments and some newer drugs, mortality rates have been increasing signifi- cantly,comparedtothemortal- ity rates in developed countries. “So we face a double whammy here, where the incidents are going up and the mortality is also going up,” he remarked. He said data from the breast cancer registry at the Kingston Public Hospital showed that the 150 patients who presented in the first year of the registry with invasive breast cancer was presenting almost 10 years earlier than in persons in developed countries. “The average age of presentation in our population is 54 years and its about 63 in the United States; alarmingly we had about 40 per cent of our patients presenting before age 50, and it is quite interesting and it has implications for how we manage and how we go forward because it means screening in our population has to begin at age 40 and not at 50,” he stated. The registry was established two years ago to study patients in details and glean information on the characteristics of the disease presented in those patients.
Dr Copeland said 40 per cent of persons were also presenting with locally advanced disease, while data from the US has shown that only 15 per cent of patients were presenting at that stage. He said persons are coming forward at this stage oftentimes out of fear of the diagnosis, treatment or neglect. “Everybody thinks that the treatment can only be a mastectomy, that is not the case,” he said.
Dr Copeland also pointed to a significant component of cancers diagnosed here, having a genetic component, but that the requisite tests are not yet being widely conducted. He said generally five to 10 per cent of people with breast cancer do have genetic mutation which increases risk, and in the Jamaican ethnic context, this figure could be more.
“... The molecular details of the cancer we found have a very high rate of triple negative breast cancer …so we actually do believe that there is a significant component of our breast cancer that have genetic mutations. We have not been able to test it specifically because genetic testing costs a bit and we are looking to see if we can get research grants that will facilitate us to actually test these patients more widely,” he said, pointing to recent research in The Bahamas which looked at genetic testing, which found that a significant number of patients with breast cancer had genetic mutations.
General surgeon at the KPH Dr Hugh Roberts, who was among the panellists of medical and cancer experts at the forum, said most of the statistics prior used to be obtained from North America and Europe. “There is a significant difference in our population where we are predominantly black and minority races, as opposed to Caucasian, and even when you look at the minority populations in North America they will tell you that breast cancer among the black population tend to have earlier onset disease and is even more aggressive,” he explained. Dr Roberts said this led to a push about a decade ago for research locally and across the region, spearheaded by surgeons, radiotherapists and other medical experts, which found among other things, that 17 per cent of breast cancers here were diagnosed in people under the age of 40.