The changing distribution of colorectal cancer in Barbados: 1985-2004

Epidemiology of neoplastic colorectal polyps in a Caribbean country

Screening is practiced to identify and remove neoplastic colorectal polyps prior to their transformation into colorectal cancer (CRC). The aim of the present study was to document the epidemiology of neoplastic colorectal polyps in order to obtain important data that may then be used to guide screening protocols in Jamaica. For this purpose, an audit was performed to identify all consecutive patients who had neoplastic polyps detected at a screening colonoscopy at a facility in Jamaica from January 1, 2015 to December 30, 2018. The following data were collected: Patient demographics, polyp location, polyp synchronicity and histopathological information. The results revealed that a total of 480 colonoscopies were performed over the study period. With the exclusion of 2 patients with innumerable polyps as a part of polyposis syndrome, there were a total of 92 neoplastic polyps in 68 patients. Polyps were most commonly located in the right colon (55.6%), followed by the left colon (38%) and rectum (6.5%). Upon the histological evaluation, 63 polyps were found to be benign adenomas with mild to moderate dysplastic alterations, 15 were adenomas with severe dysplasia and/or carcinoma in situ and 14 had foci of invasive carcinomas. On the whole, the present study demonstrates that ~15% of the patients screened had neoplastic polyps that were recognized as precursor lesions for CRC. The majority of these were in the right colon. These results support the call for policy makers to institute national CRC screening programs, such as the National Comprehensive Cancer Network harmonized guidelines for the Caribbean.

Clinical yield of screening colonoscopies in Jamaica

There is still no organised national screening programme for colorectal cancer in Jamaica. We sought to evaluate the detection of colorectal cancer precursor lesions in patients who underwent opportunistic screening over three years. Patients with colorectal polyps were selected for further study. In 431 procedures, there were 84 (19.5%) patients with colorectal polyps identified at screening colonoscopy, which gave a 19.5% sensitivity to identify patients with polyps at risk of developing colorectal cancer, 9.5% being <50 years of age. At the time of examination, 16.7% had already developed invasive adenocarcinoma. We conclude that it is time for policy makers to develop a national colorectal cancer screening programme to diagnose patients early and improve their therapeutic outcomes.

Colorectal cancer demographics in Barbados

Barbados is an island in the Eastern Caribbean that is reported to have the 8th highest incidence of colorectal cancer (CRC) worldwide. However, these figures are based only on estimates, and there is little available epidemiological data collected from Barbadians with CRC. The present study sought to collect epidemiologic data from patients in Barbados diagnosed with CRC. This information is considered important to shape national public health policies. For this purpose, hospital admission registers at all tertiary care facilities in Barbados were retrospectively audited over a four-year period from January 1, 2014 to December 31, 2018 to identify patients who underwent operative treatment for CRC. The following data were extracted: Age, sex, ethnicity, the location of the primary tumour and tumour stage. Descriptive statistical analyses were generated using SPSS version 21.0. The results revealed that there were 97 patients with CRC at a mean age of 64.9 years (SD ±12.2) and a male preponderance (1.3:1). The majority (93.8%) were from the African diaspora. Only 18.5% of diagnoses were made at (opportunistic) screening. Consequently, two thirds of the patients had advanced-stage disease at diagnosis. The disease staging of the patients was as follows: Stage 0 (1%), stage I (10.3%), stage II (23.7%), stage III (38.1%) and stage IV (26.8%). Right-sided primary tumours were most common (44.3%), followed by left-sided (41.2%) and rectal lesions (14.4%). Women were significantly more likely to have right-sided lesions (55 vs. 45%) and males were more likely to have rectal lesions (77 vs. 23%). On the whole, the present study highlights the need to implement a national screening programme in this high-risk population of African origin with a predominantly right-sided distribution of CRC primary tumours. This is reinforced by the fact that 10% of patients will be diagnosed before the age of 50 years with more aggressive disease.

Overall survival in elderly patients with colorectal cancer: A population-based study in the Caribbean

BACKGROUND

Population-based Cancer registries (PBCR) play an important role in cancer surveillance and research. The aim of this study was to examine overall survival in elderly patients with colorectal cancer (CRC) by analysing data from the Martinique PBCR between 1993 and 2012.

METHODS

The log-rank test was used to assess the statistical differences of the survival curves by each categorical variable: age at diagnosis, sex, histology, zone of residence, subsite, stage at diagnosis, and chemotherapy. A multivariable Cox model was performed to identify independent prognostic factors for overall survival in elderly patients with colorectal cancer.

RESULTS

Among 2230 patients included in the study, 60.8% were aged≥65years; mean age at diagnosis of these patients was 75.7±7.2years. For the period 2008-2012, 532 elderly patients were analysed; mean age of those receiving chemotherapy was 73.0±0.4 versus 77.9±0.4years for those not receiving chemotherapy (p<0.0001). Stage at diagnosis was evaluated in 87.8% (467/532) of patients; 63.0% (294/467) had stage III-IV and 49.3% of these patients (145/294) received chemotherapy. Chemotherapy was less frequently prescribed in patients aged 75-84 and ≥85 years as compared to those aged 65-74 years (41.1% and 15.0% versus 64.6% respectively; p<0.0001). Stage III-IV at diagnosis (HR=5.25; 3.70-7.45; p<0.0001), and not receiving chemotherapy (HR=3.05; 2.23-4.16; p<0.0001), were independent prognostic factors for overall survival.

CONCLUSION

Our study highlights the role of PBCR in evaluating cancer survival and patterns of care in elderly people of the French West- Indies. Chemotherapy was less frequently prescribed among the elderly.