Advancing Cancer Control Through Research and Cancer Registry Collaborations in the Caribbean.

BACKGROUND: Few national registries exist in the Caribbean, resulting in limited cancer statistics being available for the region. Therefore, estimates are frequently based on the extrapolation of mortality data submitted to the World Health Organization. Thus, regional cancer surveillance and research need promoting, and their synergy must be strengthened. However, differences between countries outweigh similarities, hampering registration and availability of data. METHODS: The African-Caribbean Cancer Consortium (AC3) is a broad-based resource for education, training, and research on all aspects of cancer in populations of African descent. The AC3 focuses on capacity building in cancer registration in the Caribbean through special topics, training sessions, and biannual meetings. We review the results from selected AC3 workshops, including an inventory of established cancer registries in the Caribbean region, current cancer surveillance statistics, and a review of data quality. We then describe the potential for cancer research surveillance activities and the role of policymakers. RESULTS: Twelve of 30 Caribbean nations have cancer registries. Four of these nations provide high-quality incidence data, thus covering 14.4% of the population; therefore, regional estimates are challenging. Existing research and registry collaborations must pave the way and are facilitated by organizations like the AC3. CONCLUSIONS: Improved coverage for cancer registrations could help advance health policy through targeted research. Capacity building, resource optimization, collaboration, and communication between cancer surveillance and research teams are key to obtaining robust and complete data in the Caribbean.

Global patterns of prostate cancer incidence, aggressiveness, and mortality in men of african descent.

Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.

Prostate cancer characteristics and survival in males of African Ancestry according to place of birth: data from Brooklyn-New York, Guyana, Tobago and Trinidad.

BACKGROUND: Prostate cancer mortality rates for African-Americans are much higher than Caucasians and a similar trend is observed for prostate cancer survival. Data on recently immigrated African-descent men are lacking. METHODS: Using cancer registry data from Brooklyn, NY and two countries in the Caribbean (Guyana and Trinidad and Tobago), survival rates were estimated. We also examined whether Black race or Caribbean birthplace predict prostate cancer survival among males living in the United States (US). RESULTS: The Caribbean cases were diagnosed at a later age than those in the US (Guyana: 74.5 years, Trinidad and Tobago: 72.4 years, Brooklyn: 65.8 years). Patients in the Caribbean had a worse 5-year survival rate compared to those in the US (41.6% vs. 84.4%) but for immigrant Caribbean-born males living in the US the 5-year survival rate was not significantly different from African-Americans (78.1%, 95% CI: 70.9-83.7% vs. 81.4%, 95% CI: 69.5-89.1%, P = 0.792). The risk of death for Caribbean-born was more than three times higher than US-born men (HR: 3.43, 95% CI: 2.17-5.44, adjusted for ethnicity, stage, and mean age of diagnosis). A mean age of diagnosis >65 years old and stage IV disease, but not ethnicity, were found to be independently associated with the risk of death. CONCLUSION: The survival disadvantage for Caribbean-born patients may be partly due to later diagnosis. Interventions focused on screening, education about the disease and early detection could potentially reduce cancer mortality in this population.

Breast cancer survival in women of African descent living in the US and in the Caribbean: effect of place of birth.

In order to shed light on genetic and environmental factors contributing to breast cancer health disparities, anonymous data from the cancer registry in Brooklyn, NY and two countries in the Caribbean, have been analyzed and compared. De-identified data were obtained on 3,710 women from three cancer registries in Brooklyn (New York), Guyana, and Trinidad, all having been diagnosed with breast cancer between 1995 and 2007, with follow-up through to early 2009. There was a significant difference in breast cancer survival according to race, place of birth, and place of residence. Women of African origin had a significantly worse survival than White women. Women born in the Caribbean had significantly worse survival in comparison to their counterpart born in the US, independently from their ethnic background (adjusted hazard ratio: 1.6; 95% CI: 1.2-2.1). A significant lower breast cancer survival was observed in African Caribbean women living in the Caribbean (HR: 1.8; 95% CI: 1.6-2.1) versus African-Caribbean women born in the Caribbean and living in the US (HR: 1.3; 95% CI 1.1-1.7), versus African-descent women born and living in the US. This study suggests that biological, behavioral, environmental, and clinical factors play a significant role in the observed difference in breast cancer outcome in women of Afro Caribbean descent.

Ethnicity and cancer in Guyana, South America.

BACKGROUND: The Cancer Registry of Guyana, a population-based registry was established in 2000. Over the past eight years, data has been collected from the national referral hospital and other public and private institutions. METHODS: A comprehensive review of the Registry's database was undertaken, focusing on the ethnic and site prevalence of the three major reported cancers. The data was then subjected to summary statistics and the frequencies of cases by ethnicity and age-group were subjected to chi squared analysis. A 0.05 level of significance was applied to all tests. RESULTS: There was a clear ethnic distribution of the three major cancers (breast, cervical and prostate) within the database. Afro-Guyanese men accounted for over 65% of prostate cancers. Among women, Indo-Guyanese presented with the most cases of breast cancer (45%) while Afro-Guyanese had the majority of cervical cancer cases (39%). When the proportion of cervical cancer cases for all cancers in an ethnic group was analysed however, cervical cancer was significantly more common (p < 0.0001) among Indigenous Amerindian women. Similarly, by age-group analysis, there were significantly more cases of cervical than breast cancer (p = 0.014) among women under 30 years of age. CONCLUSION: The Cancer Registry of Guyana reflects a high incidence of prostate, cervical and breast cancers among Afro-Guyanese. Socio-economic, dietary and genetic influences on the observed pattern of incidence within this ethnic sub-group, as well as those of Indo-Guyanese and Indigenous Amerindians warrant further investigation.