Overall survival of triple negative breast cancer in French Caribbean women.

To describe survival according to prognostic factors of women with breast cancer in French overseas territory (Martinique) during 2008-2017. We performed a Cox model for prognostic factors for OS in breast cancer patients. The cut-off date for the analysis was 13/10/2018. The main factors were demographic data, stage, hormone receptors (HR) status and HER2 status. Curves were compared with the log rank test to select candidate variables for the multivariate analysis. We included 1,708 patients; median age at diagnosis was 57 years. Triple negative breast cancer (TNBC) accounted for 20.9% (n = 332). Among the patients, 72.3% (n = 1015) had localised or local spread cancer. One-year OS was 95.2% and was 80.1% at 5 years. In TNBC, 1-year-survival was 90.4%, which fell to 70.1% at 5 years. Patients with metastatic disease at diagnosis had 1-year-survival of 74.5%, and 20.1% at 5 years. Multivariate analysis by Cox regression identified 4 factors significantly associated with an increased risk of death: metastatic disease at diagnosis (hazard ratio (HR) = 15, p<0.0001), TNBC (HR 2.84, p<0.0001), HR+/HER2- status (HR 2.05, p<0.0084) and age >75 years (HR 3.8, p<0.0001). This is the first study performed on breast cancer survival in Martinique. Our findings show that breast cancer has overall good prognosis in patients and also how prognosis factors are distributed in the population.

Urological Cancers in French Overseas Territories: A Population-Based Cancer Registry Pooled Analysis in Martinique, Guadeloupe and French Guiana (2007-2014).

PURPOSE: Prostate cancer is the most common cancer in the Caribbean. We present world-standardized incidence (WSI) and mortality (WSM) rates for urological cancers for French overseas territories. MATERIALS AND METHODS: Standardized incidence ratio (SIR) and standardized mortality ratio (SMR) were calculated for 2008-2014, 2007-2014 and 2010-2014 in Guadeloupe, Martinique and French Guiana. RESULTS: For prostate cancer, in Guadeloupe and Martinique, the WSI rates are among the highest in the world (173.0 and 164.5 per 100,000 person-years) and 94.4 in French Guiana. Mortality remains more than twice that observed in mainland France, at 23.0 in Guadeloupe and Martinique, and 16.9 in French Guiana. For bladder cancer, WSI rates were 5.9, 4.9 and 4.1 in men, and 1.9, 1.4 and 1.3 in women, in French Guiana, Guadeloupe and Martinique. WSM rates from bladder varied from 1.5 in French Guiana to 1.8 in Guadeloupe and 2.0 in Martinique in men. In women, it ranges from 0.2 in French Guiana to 0.5 in Guadeloupe and 1.1 in Martinique. Regarding kidney, WSI rates in men are 4.3 in Martinique, 5.2 in Guadeloupe and 6.1 in French Guiana, and 2.3, 2.5 and 3.4, respectively, in women. Mortality rates in men were 1.7 in Guadeloupe, 1.4 in Martinique, and 1.5 in French Guiana, while in women, rates were 0.8 in Guadeloupe and Martinique and 0.6 in French Guiana. All these rates are lower than in mainland France. CONCLUSIONS: Identifying the profile of patients with urological cancers is key to understanding the needs of patients in these regions.

Gynaecological cancer in Caribbean women: data from the French population-based cancer registries of Martinique, Guadeloupe and French Guiana (2007-2014).

BACKGROUND: For the first time, we present regional-level cancer incidence and world-standardized mortality rates for cancers for Martinique, Guadeloupe and French Guiana. METHODS: For Martinique, Guadeloupe and French Guiana, incidence data come from population-based cancer registries, and cover the periods 2007-2014, 2008-2014 and 2010-2014 respectively. Standardized incidence and mortality rates were calculated using the world population. RESULTS: In the 3 regions, all cancers combined represent 3567 new cases per year, of which 39.8% occur in women, and 1517 deaths per year (43.4% in women). Guadeloupe and Martinique present similar world-standardized incidence rates. Among gynaecological cancers, breast cancer, the second most common cancer type in the 3 regions, has an incidence rate 35 to 46% lower than in mainland France. On the other hand, cervical cancer has a higher incidence rate, particularly in French Guiana. For both endometrial cancer and ovarian cancer, no significant differences in incidence rates are found compared to mainland France. Regarding mortality, world-standardized mortality rates are similar between Guadeloupe and Martinique, and higher than in French Guiana. This situation compares favourably with mainland France (all cancers). Among gynaecological cancers, the mortality rate is lower for breast cancer in all regions compared to mainland France, and also lower for ovarian cancer in Martinique and Guadeloupe, but higher (albeit non-significantly) in French Guiana. CONCLUSION: The ethno-geographic and socio-demographic characteristics in this population of mainly Afro-Caribbean origin could partially explain these disparities. Major disparities exist for certain cancer sites: excess incidence and excess mortality for cervical cancer; lower, but increasing incidence of breast cancer.

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.

Long-term survival of patients with prostate cancer in Martinique: Results of a population-based study.

BACKGROUND: Martinique has one of the highest incidences of prostate cancer (PCa) worldwide. We analysed overall survival (OS) among patients with PCa in Martinique, using data from a population-based cancer registry between 2005 and 2014. METHODS: The log-rank test was used to assess the statistical differences between survival curves according to age at diagnosis, risk of disease progression including Gleason score, stage at diagnosis and Prostate Specific Antigen (PSA). A multivariable Cox model was constructed to identify independent prognostic factors for OS. RESULTS: A total of 5045 patients were included with a mean age at diagnosis of 68.1±9.0 years [36.0 - 98.0 years]. Clinical stage was analysed in 4999 (99.1% of overall), 19.5% were at low risk, 34.7% intermediate and 36.9% at high risk. In our study, 8.9% of patients with available stage at diagnosis, were regional/metastatic cancers. Median PSA level at diagnosis was 10.4 ng/mL. High-risk PCa was more frequent in patients aged 65-74 and ≥75 years as compared to those aged <65 years (36.6% and 48.8% versus 28.7% respectively; p<0.0001). One-year OS was 96.3%, 5-year OS was 83.4 and 10-year OS was 65.0%. Median survival was not reached in the whole cohort. High-risk PCa (HR=2.32; p<0.0001), regional/metastatic stage (HR= 9.51; p<0.0001) and older age (65-74 and ≥75 years - respectively HR=1.70; and HR=3.38), were independent prognostic factors for OS (p<0.0001). CONCLUSION: This study provides long term data that may be useful in making cancer management decisions for patients with PCa in Martinique.

Pattern of care of prostate cancer patients across the Martinique: results of a population-based study in the Caribbean.

BACKGROUND: The French West-Indies rank first for both prostate cancer incidence and mortality rates. Analyzing diagnostic and therapeutic procedures among patients with prostate cancer, using data from a population-based cancer registry, is essential for cancer surveillance and research strategies. METHODS: This retrospective observational cohort study was based on data from the Martinique Cancer Registry. Records of 452 patients diagnosed with prostate cancer in 2013 were retrieved from the registry. Data extracted were: socio-demographic and clinical characteristics, circumstances of diagnosis, PSA level at diagnosis, Gleason score and risk of disease progression. Stage at diagnosis and patterns of care among prostate cancer patients were analyzed. RESULTS: Mean age at diagnosis was 67 ± 8 years; 103 (28.5%) were symptomatic at diagnosis. Digital rectal exam was performed in 406 (93.8%). Clinical stage was available in 385 (85.2%); tumours were localized in 322/385 (83.6%). Overall, 17.9% were at low risk, 36.4% at intermediate and 31.9% at high risk; 13.8% were regional/metastatic cancers. Median PSA level at diagnosis was 8.16 ng/mL (range 1.4-5000 ng/mL). A total of 373 patients (82.5%) received at least one treatment, while 79 (17.5%) had active surveillance or watchful waiting. Among patients treated with more than one therapeutic strategy, the most frequent combination was external radiotherapy with androgen deprivation (n = 102, 22.6%). CONCLUSIONS: This study provides detailed data regarding the quality of diagnosis and management of patients with prostate cancer in Martinique. Providing data on prostate cancer is essential for the development of high-priority public health measures for the Caribbean.

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.

Pregnancy-associated-cancer in the French West Indies (Martinique): maternal and neonatal outcomes.

BACKGROUND: The management of pregnancy-associated-cancer (PAC) requires epidemiological evaluation of the pathways of care. The aim of this study was to describe maternal and neonatal outcomes of PAC in Martinique. METHODS: A retrospective study was conducted using data from medical records and the Martinique Cancer Registry for all PAC diagnosed between 1st January 2000 and 31st December 2014. RESULTS: Eighteen women were diagnosed with PAC: 17 during pregnancy and one during the postpartum period. Mean age at diagnosis was 35.7 ± 5.4 years. PAC were mainly gynecological cancers (12/18); the other sites were: lymphoma, brain, liver, colon, skin and unknown primary site. In most cases, PAC was detected in symptomatic individuals (72.2%). Nine women had nodal involvement or initial metastasis at diagnosis. No chemotherapy was administered in cases of preservation of pregnancy. Seven fetal losses caused by abortion and miscarriage were recorded, and 11 women conducted viable pregnancies. The main neonatal pathology observed was prematurity (58.3%). CONCLUSION: Cancer management during pregnancy is a challenge for French West-Indies territories. A Caribbean Observatory of rare cancers could help to ensure a coordinated approach to support and monitoring for these patients.