Trinidad and Tobago has one of the highest cancer mortality rates in the Americas, according to a new report from the Pan American Health Organisation (PAHO).
The report links the country’s high incidence of cancer-related death to at least three cancer risk factors: obesity, cigarette smoking and human papillomavirus (HPV), a sexually transmitted virus. These factors reflect a prevalence of unhealthy decisions being made in terms of diet, recreation and sexual behaviour.
Obesity, an important cancer risk factor, is prevalent in the Caribbean, not just in Trinidad and Tobago but also in the Bahamas, Belize and Saint Kitts & Nevis. Obesity is described as a body mass index of 30 or above. According to the report, thirty per cent of Trinidad and Tobago’s adult population are obese and 21% of adults smoke. Among adolescents, smokers number over 18%.
“Smoking is a lifestyle decision, so most lung cancers are considered a lifestyle disease,” said Dr Jacqueline Pereira-Sabga, president of the Trinidad and Tobago Cancer Society.
“HPV is also a lifestyle disease, and we know it has been linked to cervical cancers.”
Education, prevention, screening and early detection, Sabga said, are critical to reducing cancer mortality.
“The global statistics on cancer state that an average of over 50% of persons diagnosed with cancer will die from the disease,” she said.
“But through education, people empower themselves to make better lifestyle choices, which we hope will lead to prevention.”
Mortality by cancer type
Sabga further explained that the report details the extent to which Trinidad and Tobago’s cancer-related deaths exceed the age-standardised mortality rate, or ASMR. The World Health Organisation uses the ASMR to estimate the acceptable or expected rate of deaths per cancer for a given population. For example, according to the report, Trinidad and Tobago’s breast cancer deaths for 2008 are listed as 155, while the ASMR is 21.96. The number of males to die of all cancer types in Trinidad and Tobago in the same year was 746, but the ASMR is listed as 173.32.
“So, how we look at this is that in our males, cancer deaths are much higher than the “ideal” population as purported by WHO,” Sabga said.
The report also showed that T&T provides limited access to opioids (less than 13 mg total morphine equivalents per capita).
However, it acknowledged that T&T was one of only 13 of 35 countries that reported having introduced vaccines for HPV—which causes cervical cancer—into its national immunisation program.
Although cancer mortality rates vary for men and women, it is typically higher in men, driven by high rates of lung and prostate cancers. In Latin American and Caribbean men, the majority of cancer deaths are due to prostate cancer, followed by lung, stomach and colorectal cancers; and in women, breast cancer, followed by stomach, lung, cervical and colorectal cancers.
“The large number of deaths from breast and cervical cancer in Latin America and the Caribbean is very disconcerting, since cervical cancer is largely preventable, and breast cancer can be detected early and treated successfully,’’ said Silvana Luciani, PAHO/WHO advisor on cancer prevention and control.
‘’This points to the need to improve screening and treatment, especially for women in rural and remote areas, where access to health services is especially limited.”
Health data needed to improve policy
The report is based on recent data compiled by PAHO about cancer mortality, risk factors, and cancer policies and services in the countries of North, South and Central America and the Caribbean.
For each country, data are presented for leading cancer types (ranked by mortality); trends in cancer deaths from 2000 to 2010; main cancer risk factors (tobacco, alcohol, diet, physical inactivity, obesity); key socio-demographic factors; and health sector plans, policies and services for cancer.
“The idea is to provide key information that can help countries monitor progress in cancer control and assess areas of need,” said Luciani. “This report contributes significantly to the evidence base for cancer policymaking and health care.”
Although T&T has a national, hospital-based cancer registry, the last year for which data are available is 2011.
An earlier version of this article was originally published on the Trinidad and Tobago Guardian website.