Eulalee Thompson
The big 'C', cancer, still triggers fear and dread. Maybe, it is because we have so little control over this disease. We can follow all the healthy lifestyle recommendations for weight management, diet, exercise and other risk-reducing behaviours and still have a cancer growing somewhere inside of us. I can't forget, for instance, that a local health expert told me some years ago that most of the women who develop breast cancer don't fall into any of the risk categories; what then is the purpose of establishing and publicising risk categories?
Anyway, it is not all grim and gloom. International research centres such as the US National Cancer Institute indicate that although much more needs to be done in cancer detection, diagnosis, care and treatment, there has been progress over the last 35 years or so. Thirty five years ago, for example, they say that the five-year survival rate for cancer among adults was 50 per cent, the current rate is about 65 per cent.
Incidence rates
The five-year survival rate is even more encouraging for some of the common cancers; as of 2001, the latest year for which the Institute has updated statistics, rates for breast cancer is 90 per cent; colon, 65 per cent; lung, 16 per cent; prostate, 100 per cent and rectum, 65 per cent. Bear in mind that I am quoting data from a US cancer centre that carries out research on its population.
Jamaica's Cancer Registry at the University of the West Indies' Department of Pathology publishes incidence and mortality rates of cancers in Kingston and St Andrew. The incidence publication which I was able to locate was published in the 2001 West Indian Medical Journal - 2001 Jun; 50(2):123-9; (Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 1993-1997 by Hanchard et al). The report indicates that between 1993 and 1997, a total of 4,285 malignant neoplasms were recorded in Kingston and St Andrew - 2,344 in women and 1,941 in men. The crude incidence rate per 100,000 for males was 121.6 and for females 129.2.
The leading cancers for men in Jamaica over the period were identified as prostate (619 cases), bronchus (265 cases) and large bowel (144 cases). The leading cancers in women were breast (627 cases), cervical (376 cases) and large bowel (204 cases). The report indicates that there has been no change, when compared to the previous five-year period, in the leading cancers for women and men but that there was a marked increase in prostate cancer. The incidence of breast cancer in women in Jamaica remained relatively stable.
See related article, 'Living and coping with cancer' by Wendel Abel. C3
eulalee.thompson@gleanerjm.com
Promising news
There is some promising news on cancer management from the US National Cancer Institute (www.cancer.gov):
Combination chemotherapy has contributed to increasing survival and cure rates for cancer and is now standard in the treatment of many cancers. For example, the introduction of combination chemotherapy, including the drug cisplatin, has led to cure rates for testicular cancer of about 95 per cent. Treatment for testicular cancer has become so effective that 80 per cent of patients with metastatic testicular cancer can now be cured. Thirty-five years ago, 95 per cent of these patients died, usually within one year of diagnosis.
Two vaccines have been approved by the US Food and Drug Administration (FDA) and these vaccines have the potential to prevent some forms of liver cancer (hepatitis B virus vaccine) and about 70 per cent of cervical cancers (this is the vaccine against the human papillomavirus strains 16 and 18). In addition, several cancer treatment vaccines are currently being evaluated in large-scale clinical trials, including vaccines for the treatment of non-Hodgkin lymphoma, melanoma, kidney cancer, multiple myeloma, and prostate cancer.
Therapies that target the specific molecular changes that cause cells to become cancerous or processes that are required for continuous cancer cell growth and metastasis are now part of our therapeutic arsenal. To date, the FDA has approved more than a dozen molecularly targeted agents for cancer-related indications, including trastuzumab and three different aromatase inhibitors for breast cancer; imatinib mesylate for chronic myelogenous leukaemia and gastrointestinal stromal cell tumours (GIST); sunitinib for advanced kidney cancer and imatinib-resistant GIST; bevacizumab for advanced colorectal cancer and advanced lung cancer; and bortezomib for multiple myeloma.
Refined radiation therapy techniques, such as three-dimensional conformal radiation therapy, stereotactic radiosurgery, and brachytherapy (radioactive seeds), which are designed to deliver high doses of radiation to tumours while minimising the doses delivered to nearby healthy tissue, are now widely used. These advances are allowing greater tissue, organ, and limb preservation.
Effective therapies to control the side effects of cancer and its treatment, including pain, nausea, vomiting, and mouth sores, are now available.
