Prevalence of Risk Factors and Lifestyle Choices Associated with Increased Cancer in Participants in Trinidad and Tobago

In the Caribbean, cancer has been identified as the second leading cause of death and has created an immense challenge for healthcare services and expenses throughout the region. According to the World Health Organization (WHO), cancer incidence will increase by 58%, from 2015 to 2035, and cancer mortality throughout this period will increase by 67%. This research project outlined the socio-demographic risk factors and lifestyle choices known to increase the risk of developing various forms of cancer that are present in the population of Trinidad & Tobago. Knowledge of these risk factors will allow members of the public to evaluate their lifestyles. Subsequently, they can determine if they are putting themselves at risk for certain malignancies, since different types of cancers have specific socio- demographic factors and lifestyle choices associated with them.

Epidemiology, risk factors and histopathologic characteristics of the common cancers in Trinidad

Cancer is a leading cause of death worldwide and in Trinidad and Tobago occurring due to genetic factors, or certain external factors (carcinogens) including chemicals, radiation, aging, hormones and other endogenous and exogenous elements. A mutation causes by these elements in solid tissue may result in a tumor. The site of the developed tumor is used to classify the types of cancer. This project was undertaken to shed light on the prevalence of cancer, its risk factors and those of the population who are most susceptible.

A review of neoplastic and non-neoplastic canine skin tumours in Trinidad from 2010-2015

This retrospective study was performed on samples submitted to the Pathology Unit of the School of Veterinary Medicine, Faculty of Medical Sciences, St. Augustine, Trinidad, during the period 2010 to 2015. A total of 471 non-inflammatory cutaneous masses were analyzed, of which 225 (47.8%) were malignant, 202 (42.9%) were benign and 44 (9.3%) were non-neoplastic. The most common malignant tumors were haemangiosarcoma, 50 (22.2%); mast cell tumour, 49 (21.8%); soft tissue sarcoma 35 (15.6%), lymphoma, 20 (8.9%) and melanoma 20 (8.9%). The most common benign tumors were haemangioma, 39 (19.3%); lipoma, 27 (13.4%), trichoblastoma, 26 (12.9%), histiocytoma 25 (12.4%), plasma cell tumor, 23 (11.4%) and papilloma 9 (4.5%). Common non-neoplastic skin lesions included collagen naevi, 26 (59.1%) and follicular cysts, 11 (25.0%). Mixed breed dogs 241 (51.2%), was most frequently represented with neoplasms followed by Rottweilers 50 (10.6%) and Pit bulls 48 (10.1%).

Ethnic differences in cancer incidence among the Guyanese population

BACKGROUND: Globally, cancer is identified as a leading cause of morbidity and mortality. Trends suggest that ethnic and lifestyle factors are influential to its occurrence. In Guyana, cancers have been a leading cause of mortality over the period 2003 to 2012. However, the influence of ethnicity in the occurrence of cancer has not been examined extensively. OBJECTIVE: To investigate the occurrence of cancer among the different ethnicities in Guyana from 2003–2012. METHODS: Data from 2003–2012 from the population based Guyana Cancer Registry were analysed. Frequencies were determined for each cancer by patient demographics and cancer characteristics. Incidence and mortality rates were calculated using Guyana’s resident 2002 population. RESULTS: Of 6518 new cancers, 3956 were in females and 2561 in males. Mean age of females was 55.4 years, SD16.4 and males 62.2 years, SD 18.7 (p < 0.0001). Guyanese Chinese had the highest annual rate (129.9 per100 000); Afro-Guyanese had the highest absolute numbers(2892, 44.4%) and second highest annual incidence(127.4 per 100 000), followed by Indo-Guyanese 2505(37.9%; annual incidence 76.8 per 100 000) and Guyanese of mixed race 510 (7.8%). Male Afro-Guyanese were disproportionately affected by prostate cancer while the females had the highest rates of uterine and second highest rates of breast and cervical cancers. Guyanese Chinese had the highest rates of cervical cancer. Conclusion: Further research is needed to determine risk factors for cancers by ethnicity and aggressive campaigns need to be implemented targeting those risk factors to reduce the burden of disease.

A ten-year profile of cancer in Guyana from 2003–2012

OBJECTIVE: Only one cancer report (2000–2004) on Guyana has ever been published. We sought to establish the profile of cancers in Guyana to assist policy-makers indeveloping a comprehensive cancer programme. SUBJECTS AND METHODS: Data from 2003–2012 from the population-based Guyana Cancer Registry were analysed. Frequencies were determined for each cancer by patient demographics and cancer characteristics. Incidence and mortality rates were calculated using Guyana’s resident 2002 population. RESULTS: A total of 6518 incident cancers were recorded:3956 in females and 2561 in males. Mean age of females was 55.4 years, SD 16.4 and males 62.2 years, SD 18.7 (p< 0.0001). Average annual incidence was 86.8 per 100 000 population (females 105.4, males 68.1), age standardized rate was 139.3 per 100 000 population. In females, the leading sites were breast 1074, cervix uteri 1014 and corpus uteri 325; and in males, prostate 865, colo-rectum 206 and lung 157. By ethnicity, 44.4% of cases were in Afro-Guyanese and 38.4% in Indo-Guyanese. Death occurred in 52.3% (45% of females, 65% of males), for an average annual mortality rate of 48 per 100 000 population(females 47.6 and males 43.4). Lifetime risk of developing cancer was one in eight for females and one in 16 for males. CONCLUSION: Cancers placed a significant burden on the Guyanese population during 2003–2012. Females were affected at a younger age than males. Afro-Guyanese were affected more than other ethnic groups. Significant prevention, treatment and control efforts are required to reduce the morbidity and mortality associated with cancers.

Leading causes of cancer-specific mortality in the English and Dutch-speaking Caribbean region

OBJECTIVE: This study examined cancer-related mortality rates among the 21 Caribbean countries that submitted mortality data to the Caribbean Public Health Agency. METHODS: We calculated proportions and age-standardized mortality rates (ASMR) by cancer site and gender for each country using the most recent five years of mortality data available from 2003 to 2013. Calculations were completed using SEER*Stat software and the world (Segi 1960) standard million population. RESULTS: Age-standardized mortality rates for all cancers combined ranged from 46.1 to 139.3 per 100 000. Among males, prostate cancer was the most common cause of cancer deaths in all countries, accounting for 18.4–47.4% of cancer deaths, and an ASMR of 15.1 to 74.1 per 100000. Lung cancer (4.6–34.0 per 100 000) was the second or third leading cause of cancer deaths among males in most countries. Among females, breast cancer was the most common cause of cancer deaths in 16 of 18 countries(with > 6 reported cases), accounting for 16.1–30% of cancer deaths and an ASMR of 10.0 to 27.3 per 100 000. The ASMR of cervical cancer was higher than the world average (6.8 per 100 000) in 11 countries, and accounted for 4.5–18.2% of cancer deaths. CONCLUSION: There is great variability in cancer-specific mortality rates within the Caribbean region; however, prostate and breast cancers are consistently the leading causes of cancer-related deaths among males and females, respectively. Lung and cervical cancers–cancers for which World Health Organization “best buy” interventions exist–are also important causes of mortality in many countries.

Cancer in Barbados: first year of data from the National Cancer Registry in Barbados

OBJECTIVE: To describe the most common cancers diagnosed in Barbados in 2008. DESIGN AND METHODS: All malignant neoplasms diagnosed in 2008 were ascertained by trained data abstractors via ‘hot pursuit’, mainly at the single tertiary public hospital, the Queen Elizabeth Hospital (QEH), but also from private hospital and clinics. Demographic (e.g. sex, age, vital status) and other data, including site of primary tumour, histology and treatment, were collected and abstracted directly onto laptops, using the International Agency for Research on Cancer (IARC)’s CanReg software, version 5. RESULTS: A total of 1106 persons (597 men; 509 women) were diagnosed with malignant cancers in Barbados and registered with the National Registry in 2008. Skin was the second leading site among men and women (27% of cases). With the exclusion of skin cancer, prostate and breast cancers were the principal cancers in men (204; 49%) and women (131; 34%) respectively, followed by colorectal cancers (123; 15% of cases). The third most common site for women was the uterus (40; 10%), followed by the cervix (18; 5%) and stomach (13; 3%). For men, other top sites included the lung (21; 5%), stomach (18; 4%) and pancreas (12; 3%). The age-standardised incidence rates per 100,000 population (ASRs; world standard) for prostate and breast cancer in 2008 were 113.9 and 63.5, respectively. CONCLUSION: Prostate and breast cancers were the most common cancers diagnosed in Barbados in 2008

Analysis of cancer prevalence among women in Grenada

OBJECTIVE: To investigate prevalence of cancers affecting women in Grenada, a study was conducted using de-identified patient records from the Grenada General Hospital Histopathology Laboratory of women who visited hospital and clinic facilities during 2000 - 2010. DESIGN AND METHODS: De-identified records of 12,012 entries, 9,023 female (7,172 individuals) between ages 8 – 94 years presumably to seek preventative care or medical treatment were assessed during this cross-sectional study. Sampling without replacement resulted in approximately 3,000 entries for analysis. Prevalence of each type of cancer reported amongst women was determined. RESULTS: Of the 3,000 pathology diagnoses, 601 of the samples were classified as cancerous. The most prevalent cancer in Grenadian women from 2000 – 2010 was cervical cancer at (34%), followed by breast cancer at (31%). All other reported cancers were analyzed and their prevalence determined. CONCLUSION: Overall, the rate of cancer among Grenadian women for the ten-year period from 2000 – 2010 was determined to be 8.4%. There are implications for prevention and creation of health policies to address cancer burden in Grenada.

Adamantinoma of tibia presenting as a benign bone cyst

Adamantinoma (AD) is a very rare, low-grade, malignant bone tumour that accounts for approximately 0.4% of all primary bone tumours. In 1913, Fischer named the lesion "adamantinoma" because it resembles AD of the jaw. In Contrast to those found in the jaw, adamantinomas of the long bones metastasize in 20% of the cases, usually to the lungs and nearby lymph nodes. The tumour primarily occurs in patients aged between 20-40 years and 85-90% of cases, the tibia is affected [15]. Diagnosis of adamantinoma is clinically complicated except for typical cases because it is quite similar to other benign bone lesions, such as fibrous dysplasia (FD) and osteofibro dysplasia (OFD) of long bones with respect to radiological and pathological findings. The typical location of adamantinoma is the intracortical areal of the diaphysis. Plain film have shown a well circumscribed, cortical, multilobulated osteolytic lesion with intralesional opacities, septation and peripheral sclerosis. These findings imply the lesions' nature of slow growth [6,7]. Immunohistochemical and ultrastructural evidence have shown that the neoplastic cells in AD derives from epithelial lineage. Recent reports have described another clinical entity-differentiated or OFD-like AD that appears between OFD and AD along a spectrum of disease. Features resembling other lesions such as OFD or FD may lead to misdiagnosis and result in inadequate treatment of this tumour[9].

Raw foods and you Health

Raw foods are foods (usually plant foods) that have not been cooked (heated) of processed in any way. Such foods include fresh fruits and vegetables, grains, nuts, seeds and beans.

Fruits, vegetables and cancer prevention - 2

Plant foods, including vegetables and fruits, are a source of many micro-nutrients and bioactive compounds that may figure protecting against cancers of the mouth, pharynx, larynx, pancreas, stomach, oesophagus, colon, rectum, lung and prostate.

Fruits, vegetables and cancer prevention - 1

Cancer is the second highest cause of death in the Caribbean. There is a lot of evidence to show that our diets play a role in both the development and the outcome of cancer. Cancer experts report that around one third of cancers are preventable by good nutrition. This is because there are some foods and food constituents that probably decrease the chance of us getting cancer.

Physical activity and cancer

Cancer is one of the leading causes of death in the Caribbean. There are many kinds of cancer: in fact cancer is the general name given to a group of more than 100 diseases which all develop as a result of abnormal cell-growth. The abnormal cells usually form into a tumour (a lump or mass) but there are some cancers, like leukaemia, which do not form tumours, and it must be noted that not all tumours are cancerous. Some of the well-known types of cancer in the Caribbean include breast cancer, prostate cancer, cancers of the colon, cervix, stomach, rectum and lung cancer. Less frequently are ovarian and endometrial cancers, as well as leukaemia and cancer found in the thyroid, bladder, kidney and pancreas. Physical activity is said to reduce the chance of developing certain types of cancers, so in this issue of Nayam News, we will be taking a look at the evidence for relationships between physical activity and some types of the disease.

Inflammation, cellular and redox signalling mechanisms in cancer and degenerative diseases

Strategies for the intervention and prevention of cancers, diabetes, cardiovascular disease, HIV/AIDS and diseases of overt inflammation including neurodegenerative diseases (Alzheimer's and Parkinson's disease) require an understanding of the basic molecular mechanism(s) by prophylactic agents (dietary antioxidant factors from food plants and medicinal plants in this context) that may potentially prevent or reverse the promotion or progression of the diseases. Inflammation, cellular and redox signalling mechanisms play major roles in the pathophysiology of numerous disease states.Stem cell transplants may afford an alternative treatment for such debilitating neural diseases as Alzheimer's disease (AD) and Parkinson's disease, hormonal diseases such as diabetes mellitus, and traumas such as spinal cord injuries. This holds great promise for diabetes, given the associated complications such as heart disease, stroke, peripheral vascular disease, diabetic retinopathy, kidney disease and birth defects. With increasing constraints hindering the use of embryonic cells for neurotransplantation, stem cells, more particularly blood stem cells due to their differentiative potential and easy access, stand to be the method of choice. Advances in embryonic stem cell research however still hold much promise. Stem cells can now be indefinitely multiplied in number and cryopreserved without loss of their potential. Professor Hwang and his group at the College of Veterinary Medicine of the Seoul National University, South Korea have reported an impressive improvement in the efficiency of stem cell derivation from blastocysts from 5 per cent to 35 per cent and showed that the stem cell lines could differentiate into somatic cells of the ectoderm, mesoderm and endoderm lineages.

Management of cancer pain

Cancer remains a major worldwide health problem with an estimated nine million new cases occurring annually. The incidence is progressively increasing, especially in the Caribbean and Latin America. About one-half of all cancer patients and over 70-80% of those with advanced cancer experience moderate to severe pain. Several surveys have clearly shown that about 80-90% of patients can have their pain easily controlled with simple available resources. Yet sadly, pain is often under-estimated and under-treated, resulting in unnecessary suffering and a compromised quality of life. There are many obstacles to adequate cancer-pain relief (AU)

Age - specific incidence of cancer in Kingston and St. Andrew, Jamaica, 1993-1997

A total of 4285 malignant neoplasms were recorded in Kingston and St. Andrew during the period 1993-1997. 2344 in females and 1941 in males. The crude incidence rate per 100,000 (CIR) for males was 121.6 and for females 129.2. Age standardized rates per 100,0000 (ASR) were 156.7 and 176.7 for males and females respectively. In males, the leading sites for cancer were prostate (619 cases), bronchus (265 cases) and large bowel (144 cases) while in females the leading sites were breast (627 cases) cervix uteri (376 cases) and large bowel (204 cases). The crude and age standardized incidence rates have remained stable as compared to those for the previous five year period (1988-1992). The leading sites for both males and females have also been maintained in the same order but there was a marked increase in prostate cancer (ASR 56.4 versus 36). Invasive cervial cancer has shown no significant change in incidence (ASR 25.2 versus 26.3) but the rate for in-situ cancers has decreased (ASR 27.4 versus 43.8). The incidence of cancer of the female breast has remained relatively stable (ASR 43.2 versus 47.1). The trends exhibited by both prostate cancer and in-situ cervical cancer probably represent the influence of screening methods for prostate cancer and ablative management for low grade dysplastic lesions of the cervix uteri respectively.(Au)

The application of rapid analytical systems and sensors to the detection of cancers and other diseases

There is an advantage in combining knowledge of biosensor technology with that of immunological and molecular methods. This may enhance early diagnosis of cancers and other diseases and thus ultimately contribute to a better prognosis.(Au)

Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7 percent of total admission to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62 percent were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7 percent of admissions, the commonest being renal and/or hepatic impairment: anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35 percent of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).(AU)

Major controversies in chronic pain

Pain medicine is a relatively new speciality in clinical medicine. While it is widely accepted and recognized, there are some areas of controversy which makes this speciality interesting and open to diverse kinds of research opportunities and clinical innovations. In this presentation, several controversial areas have been selected for discussion because of their scientific merit, clinical applicability, and evolving status in the physician's armamentarium. EPIDURAL STEROIDS FOR LOW PAIN: Epidural steroid injections remain one of many modalities for managing chronic low back pain. The frequency, dose, kind of steroids used and management of complications are still open to discussion. Meta-analysis of the applicability of epidural steroids for low back pain leaves a lot to be desired. More importantly, the criteria for epidural steroid injection have not yet been clearly delineated. REFLEX SYMPATHETIC DYSTROPHY (RSD) AND NEUROPATHIC PAIN: Most clinicians propose that RSD has become a "legal phenomenon" rather than a medical one. This observation indicates the adversarial focus that the injured patient possesses as far as his recovery and rehabilitation are concerned. The different diagnosis techniques and the corresponding diverse therapeutic modalities available for treating RSD are still controversial. CANCER PAIN MANAGEMENT: Cancer pain management is very important in the overall management of the cancer patient, especially when dying and death appear inevitable. A proposed fourth step of the World Health Organization three-step ladder for pain management and its implication will be discussed. MORPHINE AS ANTI-ANALGESIC AGENT: Review of the pharmacological activity of morphine metabolities will be undertaken. A re-evaluation of morphine-3-glucuronide and its analgesic activity may help to explain some interesting physiological phenomena observed during morphine administration. PAIN EDUCATION AND PAIN CERTIFICATION: In the United States of America the education of medical and nursing students regarding pain therapy has been largely ignored. The situation is unfortunate since most young health care professionals have to deal with chronic pain problems as soon as they commence their practices. As pain medicine develops, it is important to have adequate credentialing.(AU)