Trends in colorectal cancer in the Caribbean: A population-based study in Martinique, 1982–2011

Overall Observed Survival of Female Breast, Cervical, Colorectal, and Prostate Cancers in Antigua and Barbuda, 2017-2021: Retrospective Data from Four Study Sites

Understanding cancer survival is important for countries such as Antigua and Barbuda, where female breast, cervical, colorectal, and prostate cancers are burdensome to the healthcare system. This study therefore aimed to estimate the survival probabilities of patients diagnosed with these cancers between 2017 and 2021. A retrospective analytical study design was used to evaluate cancer cases abstracted from medical records at key study sites. Estimates of observed survival probabilities were determined using a Kaplan-Meier analysis. Significant differences between survival curves were assessed using the log-rank test. Hazard ratios were calculated using Cox regression. A p-value < 0.05 indicated significance. A total of 391 diagnosed cases were included in this study (2017-2021): female breast cancer accounted for 42%, cervical cancer accounted for 10%, colorectal cancer accounted for 20%, and prostate cancer accounted for 28%. Overall, the mean age of the participants was 61.5 (±12.9) years; 62% were female, 73% were aged > 55 years, 56% were from St. John's, and 82% were alive at the end of 2021. The median overall survival (years) was 4.8 for female breast cancer, 4.1 for cervical cancer, 4.5 for colorectal cancer, and not reached for prostate cancer. The cancer-specific overall observed 5-year survival probabilities were 44.9% for female breast cancer, 10.8% for cervical cancer, 19.6% for colorectal cancer, and 69.0% for prostate cancer. Significant associations between disease stage and overall survival were observed in female breast and colorectal cancers. This study provides important evidence for the 5-year observed survival probabilities of the studied cancers. Healthcare improvements that support cancer survival are required.

Incidence, trends and patterns of female breast, cervical, colorectal and prostate cancers in Antigua and Barbuda, 2017-2021: a retrospective study

BACKGROUND

Globally, estimates of cancer cases and deaths have increased since 2018, particularly in Latin America and Caribbean countries. In Antigua and Barbuda, understanding the burden of common cancers such as female breast, cervical, colorectal and prostate cancers is critical. This study aimed to assess the incidence, trends, and patterns of these four cancers from 2017 to 2021.

METHODS

Using a retrospective observational study design, information on these cancers was abstracted from medical records at four key study sites in Antigua and Barbuda. Estimates of age-specific and age-standardized incidence were determined using direct standardization. The KeyFitz method was used to derive standard errors and confidence intervals. Derived estimates were employed to analyze trends and Joinpoint regression modeling was used to determine annual percentage change.

RESULTS

Between 2017 and 2021, 391 cases of female breast (41.7%), cervical (10.2%), colorectal (20.2%) and prostate (27.9%) cancers were diagnosed. Overall mean age at presentation was 61.5 (± 12.9) years, ranging from 24 to 94 years, age-standardized incidence rate 65.2 (95% CI: 58.7-71.6) per 100,000 population. Age-standardized incidence rate for female breast cancer was 49.9 (95% CI: 42.2-57.8), annual percentage change in incidence a low of -0.2%. Prostate cancer had the second highest age-standardized incidence rate at 41.6 (95% CI: 33.8-49.4), annual percentage change showed a gradual but steady increase at 21.7%. Per cancer types, variations in age-standardized incidence rates were noted across age-groups, year-of-presentation, and parishes. Collectively, there was an 8.1% (95% CI: -14.9-37.6) annual percentage change increase in age-standardized incidence rates between 2017 and 2021. Incident cases, age-standardized incidence rates, and trends per cancer type are expected to gradually increase during 2022-2030 (average annual percentage increase is 3.4%).

CONCLUSIONS

This study is a first step in providing reasonable evidence on the incidence, trends, and patterns of four common cancers in Antigua and Barbuda. Female breast and prostate cancers were the dominant cancer types in terms of incidence, age-standardized incidence and predicted increasing incidence trends. Variableness in cancer-specific age-standardized rates across parishes and years of presentation were observed. Besides research, this study has importance for instituting cancer prevention and control measures, including surveillance and healthy lifestyles initiatives.

Geographical disparities in cancer and occupational exposure to pesticides in a French-West Indies territory (2006-2019)

BACKGROUND

In the French West Indies, previous studies have reported findings on pesticide exposure and cancer incidence. A new exploratory geographical study, including a more sensitive soil contamination indicator, will provide more detailed information on the link between cancer incidence and organochlorine pesticide exposure. This study aims to investigate the association between incident cases of cancer and chlordecone soil contamination at an IRIS scale over the period 2006-2019 in Martinique.

METHODS

Data on the 18 most frequent cancer sites were collected from the Martinique Population Based Cancer Registry. First, smoothed standardized incidence ratios at the level of the 141 IRIS were estimated, and then regression models including the smoothed standardized ratios  were performed between cancer incidence and soil contamination index by sex and cancer site, using the Besag, York and Mollié models. Models were adjusted using an index of social deprivation.

RESULTS

23,218 cancer cases were eligible for this study, with 21,920 cases included in the final analysis. Soil contamination was associated with a higher relative risk of cancer in women than in men, but no significant correlation was found for breast cancer in women or for prostate cancer. Lung, thyroid, stomach and rectal cancers in women, and melanoma in men, all increase significantly with the level of contamination. There was a significant increasing gradient in the incidence of multiple myeloma in men, from reference to highly contaminated areas.

CONCLUSION

Integrating the latest available data on soil contamination and cancer incidence will extend on-going knowledge of chlordecone exposure and cancer incidence, which remains a major environmental concern in Martinique. Unexpectedly, our results show that the female population of Martinique is the most affected by chlordecone soil contamination.

Burden of gastric and digestive cancers in the French Caribbean: perspectives from population-based cancer registries of Martinique, Guadeloupe and French Guiana (2007-2014)

OBJECTIVES

Data from population-based cancer registries contribute to improving our knowledge of digestive cancer trends worldwide. In this study, we present cancer incidence and mortality in Guadeloupe, French Guiana and Martinique for the periods 2008-2014, 2010-2014 and 2007-2014, respectively.

DESIGN

Data were extracted from population-based cancer registries. World-standardised incidence (WSI) and mortality (WSM) rates were calculated. Main digestive cancers were analysed, including oesophagus, stomach, colorectum, liver and pancreas cancers.

SETTING

This study was performed based on data from French Territories in the Caribbean.

RESULTS

We observed a lower-incidence compared with mainland France, except for stomach cancer for which the incidence is high, with significant standardised incidence ratios in men and women at 1.90 vs 2.29 for Guadeloupe and French Guiana and 1.58 vs 2.31 for Martinique. We found a lower-mortality, except for stomach cancer for which the mortality remains high, with significant mortality ratios in men and women at 2.10 vs 2.74 for Guadeloupe, 1.64 vs 1.79 for French Guiana and 2.05 vs 2.53 for Martinique. Overall, these three regions have similar WSI and WSM rates which remain lower than those in mainland France. We noticed an overall high incidence and high mortality in men compared with women as in France.

CONCLUSIONS

There is a high incidence of stomach cancer in French overseas territories. Publication of these data contributed to expanding knowledge on the epidemiology of world cancers with data from the Caribbean zone.

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.

Epidemiology of colorectal cancer in Barbados: A short report

Barbados is a Caribbean island with a high incidence of colorectal cancer. This study collected epidemiologic data from Barbadian patients with colorectal cancer. There was an opportunity for targeted screening in patients actively enrolled in clinics for management of chronic diseases, accounting for 72% of cases. We also identified areas of high incidence where resources should be directed in a screening programme.

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 of colorectal cancer by stage at diagnosis: Data from the Martinique Cancer Registry

Population-based cancer registries (PBCR) participate in epidemiological surveillance and in the evaluation of cancer types by enabling analysis of incidence and survival data over time. The aim of this study was to examine overall survival (OS) in patients with colorectal cancer (CRC) by analyzing data from the Martinique population-based cancer registry between 1993 and 2012. All colorectal cancer cases diagnosed in Martinique between 1993 and 2012 were included. Characteristics of CRC patients were analyzed according to age subgroups, namely: <50 years, 50 to 74 years and over 75 years.We recorded the following socio-demographic and clinical variables: year of diagnosis, age at diagnosis, sex, histology, zone of residence, and subsite of the cancer. Incidence of malignant neoplasms of the colon and rectum (ICD-10 C18-21) was extracted from the Martinique Cancer Registry database. Stage at diagnosis (localized: stage I-II, regional: stage III and metastatic stage: stage IV) were also analyzed for the 2008 to 2012 period.A total of 2230 cases of incident invasive CRC were included during the study period (1993-2012): 1171 were women (52.5%); 1588 patients (71.2%) had colon cancer. Stage at diagnosis was evaluated in 779 patients (89.6%): 486/779 (62.4%) had stage III-IV at diagnosis, including 285 (36.6%) patients with metastases at diagnosis (stage IV). One-year, 5-year and 10-year OS for the study period 1993 to 2012 was 74.6%, 43.8% and 33.0% respectively. There was a statistical difference in overall survival according to gender (P = .0153), age at diagnosis (P < .001) and stage (P < .001).Median OS was 2.0 years (95% CI [1.4-2.1]) in the stage III-IV group during the period 2008 to 2012, whereas it was unreached in the stage I-II group. Multivariable analysis confirmed that stage III-IV at diagnosis (hazard ratio (HR) = 3.70 [2.89-4.99]; P < .0001) and colon cancer (HR = 1.30 [1.01-1.69]; P = .04) were main prognostic factors for OS. Women had a HR of 0.78 [0.62-0.96], P = .02. CRC patients in the 50 to 74 years age group had a HR of 0.63 [0.50-0.80], P = .0001.This study underlines the importance of structuring management of CRC cancer patients.

Cancer burden in the Caribbean: an overview of the Martinique Cancer Registry profile

Background

Cancer indicators are essential information for cancer surveillance and cancer research strategy development. The Martinique Cancer Registry (MCR) is a population-based cancer Registry (PBCR) that has been recording cancer data since its creation in 1981. This article provides cancer incidence and mortality data for all cancers and for major tumor sites.

Methods

The registry collects all new cancer cases, details of the individual affected, tumor site and follow-up. World-standardized incidence and mortality rates were calculated, by tumor site and sex for solid tumors from the MCR database for the study period 2001–2015.

Results

Over the period 2001–2015, a total of 22,801 new cases were diagnosed; 13,863 in men (60.8%) and 8938 in women (39.2%). In 2011–2015, 1631 new cases were diagnosed per year. Age-standardized (to the world population) incidence rates for all cancers, were 289.8 per 100,000 men and 171.0 per 100,000 women. Breast, colon-rectum and stomach were the most common cancer sites in women. Prostate, colon-rectum and stomach were the main sites in men. Martinique has higher incidence rates of prostate and stomach cancer than mainland France.

Conclusions

Prostate and stomach cancers have high incidence and rank first among the four major tumor sites. Providing data for the French zone of the Caribbean is essential to contributing to the development of high-priority public health measures for the Caribbean zone.

Cohort profile: the Martinique Cancer Registry and the quality of life prostate cancer cohort (QoL Prostate-MQ): challenges and prospects for reducing disparities in the Caribbean

PURPOSE

Recording cancer data in cancer registries is essential for producing reliable population-based data for service planning, monitoring and evaluation. Prostate cancer (PCa) remains the most frequent type of cancer in terms of incidence and mortality in men in the Caribbean. The quality of life PCa cohort will assess quality of life and patient outcomes in Martinique using a digital platform for patient-reported outcome measures.

PARTICIPANTS

The Martinique Cancer Registry database is the largest clinical database among the French population-based cancer registries in the Caribbean, including more than 38 000 cancer cases, with 1650 new cancer cases per year, including 550 new PCa cases per year (2010-2014 latest period). In 2018, follow-up will include vital status, assessment of quality of life with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) Core 30 and the Prostate cancer module QLQ-PR25. Urinary incontinence and erectile dysfunction recorded prior to treatment will be analysed 1 and 5 years after treatment.

FINDINGS TO DATE

The registry includes data on circumstances of diagnosis, clinical stage at diagnosis. For PCa, the registry includes blood prostate-specific antigen level at the time of diagnosis, Gleason score and primary treatment.

FUTURE PLANS

Further studies will provide detailed data regarding the quality of diagnosis and management of patients with PCa in Martinique; analysing quality of care will be the next challenge.Quality of life and patient outcomes will be evaluated using a digital platform for patient-reported outcome measurement and electronic records.