SciELO - Scientific Electronic Library Online

 
vol.57 issue2Suicide: a preventable public health problemClinicopathologic features of breast disease in Jamaica: findings of the Jamaican Breast Disease Study, 2000-2002 author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Article

Indicators

  • Have no cited articlesCited by SciELO

Related links

  • Have no similar articlesSimilars in SciELO

Bookmark

West Indian Medical Journal

Print version ISSN 0043-3144

West Indian med. j. vol.57 no.2 Mona Mar. 2008

 

ORIGINAL ARTICLES

 

Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 1998 – 2002

 

Incidencia específica por edad en relación con el cáncer en Kingston y en Saint Andrew, Jamaica, 1998 – 2002

 

 

TN Gibson; G Blake; B Hanchard; N Waugh; D McNaughton

Jamaica Cancer Registry, Department of Pathology, The University of the West Indies, Kingston 7, Jamaica

Correspondence

 

 


ABSTRACT

A total of 4737 cancers were recorded in Kingston and St Andrew during the period 1998 – 2002: 2387 in males and 2350 in females. Age standardized rates per 100 000 per year (ASR) were 188.6 and 144.2 for males and females respectively. In males, the leading sites for cancer were prostate (873 cases), bronchus (269 cases) and large bowel (176 cases) while in females, the leading sites were breast (639 cases), cervix uteri (318 cases) and large bowel (218 cases). The number of new cases has remained relatively stable, compared to the previous five-year period (1993–1997), but the ASR for females has fallen from 156.7 to 144.2 per 100 000 per year and that for males has increased from 176.7 to 188.6 per 100 000 per year. The leading sites of cancer for both males and females have also been maintained in the same order but there was a moderate increase in prostate cancer (ASR 56.4 vs 65.5 per 100 000 per year) and a moderate decrease in cervical cancer (ASR 25.2 vs 19 per 100 000 per year). The incidence of cancer of the female breast has remained relatively stable (ASR 43.2 vs 40.1 per 100 000 per year). In both males and females, colon cancer incidence rates remain high at ASR of 9.9 per 100 000 per year in males and 9.4 per 100 000 per year in females. These data support the continuation of existing programmes for prevention and control of cancers of the prostate, lung, breast and cervix uteri and the introduction of new programmes specifically for cancers of the large bowel in the Jamaican population.


RESUMEN

En el periodo 1998–2002, se registraron un total de 4737 cánceres en Kingston y Saint Andrew: 2387 en varones y 2350 en hembras. Las tasas ajustadas por edad (TAE) por cada 100 000 por año fueron 188.6 y 144.2 para los varones y las hembras respectivamente. En los varones, el cáncer estuvo localizado principalmente en la próstata (873 casos), los bronquios (269 casos) y el intestino grueso (176 casos), en tanto que en las hembras, los lugares principales fueron las mamas (639 casos), el cuello del útero (318 casos) y el intestino grueso (218 casos). El número de nuevos casos ha permanecido relativamente estable, en comparación con el periodo quinquenal anterior (1993–1997), pero la TAE para las hembras descendió de 156.7 a 144.2 por cada 100 000 por año, mientras que el de los varones aumentó de 176.7 a 188.6 por cada 100 000 por año. También se han mantenido los lugares principales de cáncer en el mismo orden tanto para varones como para hembras, pero hubo un aumento moderado en el cáncer de la próstata (TAE 56.4 frente a 65.5 por cada 100 000 por año) y una disminución moderada en el cáncer cervical (TAE 25.2 frente a 19 por cada 100 000 por año). La incidencia de cáncer de mamas en hembras, ha permanecido relativamente estable (TAE 43.2 frente a 40.1 por cada 100 000 por año). Las tasas de incidencia del cáncer permanecen altas a TAE 9.9 por cada 100 000 por año en varones y hembras, en los varones y 9.4 por cada 100 000 por año en las hembras. Estos datos apoyan la continuación de los programas existentes destinados específicamente a la prevención y el control de los cánceres de próstata, pulmón, mamas y cuello del útero, así como la introducción de nuevos programas para los cánceres de intestino grueso en la población jamaicana.


 

 

INTRODUCTION

Since the inception of the Jamaica Cancer Registry in 1958, the incidence of cancer in Jamaica has been monitored through regular five-year reports. The last report, published in 2001, covered the period 1993–1997, and included the incidence of cancer in males and females in Kingston and St Andrew, the population base of the registry, as well as cumulative rates and lifetime risk, not published in previous reports. This report covers the period 1998–2002 and includes the usual analyses of cancer incidence as well as a comparison with the previous report.

 

MATERIALS AND METHODS

The methodology of the registry has been previously stated (1, 2). Cases are registered from information gleaned from public and private hospitals and general practitioners in Kingston and St Andrew and verified by pathologists at the Cancer Registry in accordance with standard techniques of registration (3). We have continued the practice of using Kingston and St Andrew as the population denominator, given that the diagnostic services (pathology and radiology) and the facilities for treatment (oncology and radiotherapy) in Jamaica are concentrated in these parishes. By this means, case ascertainment can be maintained at the highest possible level, as the data required for the identification of cases is readily available from these sources.

This report includes all cases collected from the resident population in Kingston and St Andrew, over the five-year period 1998–2002, tabulated by age and gender. Age-specific incidence rates were calculated for each site, as per the ninth edition of the International Classification of Diseases (ICD-9), using the 2000 census figures for Kingston and St Andrew, provided by the Statistical Institute of Jamaica.

Terminology and Calculations

Age-specific incidence rate

Age-specific cancer incidence was calculated for each site by dividing the total number of cases for each five-year stratum by five times the population estimate for that stratum and multiplying the result by 100 000. The rate is therefore expressed per 100 000 per year.

Crude incidence rate (CIR)

The crude incidence rate was calculated in a manner similar to the above using the total number of cases for each site and the total population for each gender.

Age standardized rate (ASR)

The age standardized rate was calculated in a two-step procedure. For each site, the product of each age-specific incidence rate and its corresponding world standard population were obtained and then all were summed to produce the ASR.

Cumulative rate

The five-year age-specific incidence rates were multiplied by five and summed for each five-year stratum between 0 and 74 years. This rate is expressed as a percentage.

Lifetime risk

Lifetime risk (to age 75 years) was calculated by dividing 100 by the cumulative rate. This is a unitary expression of the number of persons at risk.

 

RESULTS

The average population for Kingston and St Andrew during the period of registration, 1998–2002, was obtained from the Statistical Institute of Jamaica. Figure 1 represents population pyramids for males and females in Kingston and St Andrew, using these figures. Figure 2 shows the population distribution of Kingston and St Andrew compared to the World Standard Population (4).

 

 

 

 

Cases

A total of 4737 new cases were recorded for the five-year period: 2387 for males and 2350 for females. The crude incidence rate per 100 000 for males was 154.6 and 137 for females. The age standardized rate per 100 000 per year for males was 188.6 and 144.2 for females. Cumulative rates for males and females were 16.2% and 23.4% respectively. Lifetime risk was 1 in 4.3 for males and 1 in 6.2 for females (Tables 1 and 2).

Leading sites

The leading cancer sites by gender are presented in Fig. 3. In males, the leading site was prostate (873 cases), followed by bronchus (lung) [269] and large bowel (176). In females, breast was the leading site (639), followed by cervix uteri (318) and large bowel (218). Overall, in males and females, the leading sites were prostate, breast and large bowel, followed by bronchus, cervix uteri and lymphoma.

 

 

The leading sites by age-group and gender are presented in Fig. 4. In males, prostate was the leading site in those aged 60 years and above; cancer of the lung in those in the 25–59-year age group and haematopoietic malignancies in those less than 25 years of age. In females, breast cancer was the commonest site in women aged 25 years and over. The majority of cases occurred in those between the ages of 25 and 59 years. This age group also accounted for the majority of cancers of the cervix uteri. As in males, the haematopoietic malignancies were most common in females less than 25 years of age, but, thyroid, renal and cervical cancers also contributed significantly to the total.

 

 

DISCUSSION

While the overall number of new cases has remained relatively stable when compared to the previous report (5), the ASR for females has fallen from 156.7 to 144.2 per 100 000 per year and that for males has increased from 176.7 to 188.6 per 100 000 per year. We believe that this increase in males is largely due to the increase in the incidence of prostate cancer (ASR 56.4 to 65.5 per 100 000 per year). The decrease in the ASR for females may be explained by a decrease in the ASR for cervical cancer (25.2 to 19 per 100 000 per year).

The leading cancer sites for both males and females have remained the same as compared to the previous report. In males and females, prostate cancer and breast cancer, respectively, remain the leading sites. In the previous report, we made reference to the disparity between our data on the ASR for prostate cancer (56.4 per 100 000 per year) and that published by Glover et al (6) [304 per 100 000 per year], stating that we could find no reasonable explanation for the difference. The increase in prostate cancers in this report is predictable, given the progressive increase that has taken place since 1983 when PSA testing first became available in Jamaica. The current ASR of 65.5 per 100 000 per year again does not compare with the extraordinarily high ASR reported by Glover et al. Others (7) and ourselves, however, have speculated as to whether Glover's figures represent the five-year cumulative rate rather than the yearly age-adjusted rate per 100 000 or whether the population denominators could have been incorrect. If the former theory is applied, the derived reduction in the incidence rate would bring Glover's figures more in line with ours. This may very well be the answer to what has been a perplexing anomaly.

The incidence of breast cancer has shown little change over the last report (ASR 43.2 per 100 000 per year, 1993– 1997) vs 40.1 per 100 000 per year (1998–2002). With the increasing use of screening mammography in Jamaica, despite the fact that there is no national structured screening programme, it is expected that an increase in the incidence of breast cancer should occur, as has been the experience of others (8, 9). In view of this, we will continue to monitor the registration of breast cancers over the next five-year reporting period.

It has long been established that screening programmes for cervical cancer are extremely effective in reducing the incidence rate (10, 11). Despite the fact that formal screening programmes for cervical cancer are only in their infancy in Jamaica, there has been a downward trend in this cancer, according to our calculations in this and the previous report (ASR 25.2 per 100 000 per year, 1993–1997) vs 19 per 100 000 per year (1998–2002). We suggested in the previous report that a decrease such as this could be due to ablation of pre-invasive (intra-epithelial) neoplastic lesions through the increasing popularity of colposcopic procedures, particularly in the hospital setting (5). With the advent of vaccination for human papilloma virus (HPV) (12, 13) and the likelihood of this being made available in Jamaica, it will be interesting to see, in subsequent reports, the effect that this will have on the ASR for cervical cancer.

Attention is drawn to the fact that colorectal cancer remains the third commonest cancer in both males and females, and the age-standardized rates have remained fairly stable since the last report. Given the effect that screening for colorectal cancer has had in reducing its incidence, primarily by the ablation of pre-malignant lesions in the adenoma-carcinoma sequence (14, 15), it would appear that the introduction of organized screening protocols for colorectal cancer in Jamaica is an urgent necessity if the incidence is to be reduced. In this respect, the proposals for screening, modified for the prevailing medical and economic resources in the Caribbean, outlined in the editorial by Lee in the December 2006 issue of this journal (16), need to be implemented.

Although there has been a change in the distribution of histological subtypes of lung cancer in Jamaica (17) and elsewhere (18, 19), with the ascendancy of adenocarcinoma over squamous cell carcinoma, the lung has maintained its place as the second leading cancer site in males, with an ASR of 22.8 per 100 000 per year. Current programmes aimed at the cessation of smoking will likely take time to show their effect in decreasing the ASR.

In summary, analysis of the cancer incidence data for 1998–2002 in Kingston and St Andrew has shown that the total number of new registrations has remained fairly stable since the last report (1993–1997). The leading cancer sites for both males and females have remained the same. There has been an increase in the ASR per 100 000 per year among males, attributed mainly to an increase in the ASR per 100 000 per year of prostate cancer while there has been a decrease in the ASR per 100 000 per year for females, mainly due to a fall in the ASR per 100 000 per year of cervical cancer. The continued high incidence of colon cancer underscores the need for the development of local screening programmes.

 

ACKNOWLEDGEMENTS

We would like to thank the staff of the Statistical Institute of Jamaica for providing data on the population denominators for Kingston and St Andrew.

 

REFERENCES

1. Bras G. Cancer incidence in Jamaica, Kingston and St. Andrew 1958 – 1963. In: Doll R, Payne P, Waterhouse J, eds. Cancer incidence in five continents, Vol. 1, Berlin: Springer Verlag; 1966: 84–9.

2. Brooks SEH, Wolff C. Age-specific incidence of cancer in Kingston and St Andrew, Jamaica. Part I: 1978 – 1982. West Indian Med J 1991; 40: 127–8.

3. Skeet RG. Quality and quality control. In: Jensen OM, Parkin DM, MacLennan R, Muir CS, Skeet RG, eds. Cancer registration: principles and methods (IARC Scientific Publications no. 95). Lyon: IARC; 1991: 101–7.

4. Doll R. Comparison between registries: Age standardized rates. In: Waterhouse J, Muir C, Correa P, Powell J, eds. Cancer incidence in five continents. Vol 3, Lyon: IARC; 1976: 453–9.

5. Hanchard B, Blake G, Wolff C, Samuels E, Waugh N, Simpson D, et al. Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 1993–1997. West Indian Med J 2001; 50: 123–9.

6. Glover F, Coffey D, Douglas L, Cadogan M, Russel H, Tulloch T. The epidemiology of prostate cancer in Jamaica. J Urol 1998; 159: 1984–7.

7. Ben-Shlomo Y, Evans S, Ibrahim F, Patel B, Anson K, Chinegwundoh F et al. The risk of prostate cancer amongst Black men in the United Kingdom: The PROCESS cohort study. Eur Urol 2007, In Press, doi:10.1016/j.eururo. 2007.02.047.

8. Garne JP, Aspegren K, Balldin G, Ranstam J. Increasing incidence of and declining mortality from breast carcinoma. Trends in Malmo, Sweden, 1961–1992. Cancer 1997; 79: 69–74.

9. Richardson A, Cox B, Brown T, Smale P. The impact of breast cancer screening on breast cancer registrations in New Zealand. N Z Med J 2005; 118: U1291.

10. Dunn JE, Schweitzer V. The relationship of cervical cytology to the incidence of invasive cervical cancer and mortality in Alameda County, California, 1960 to 1974. Am J Obstet Gynecol 1981; 139: 868–76.

11. Macgregor JE, Campbell MK, Mann EM, Swanson KY. Screening for cervical intraepithelial neoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer with concomitant rise in preinvasive disease. BMJ 1994; 308: 1407–11.

12. Zimmerman RK. HPV vaccine and its recommendations, 2007. J Fam Pract 2007; 56: S1–5.

13. Agosti JM, Goldie SJ. Introducing HPV vaccine in developing countries – key challenges and issues. N Engl J Med 2007; 356: 1908–10.

14. Winawer SJ, Zauber AG, Nah Ho M, O'Brien MJ, Gottlieb LS, Sternberg SS et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 1993; 329: 1977–81.

15. Citarda F, Tomaselli G, Capocaccia R, Barcherini S, Crespi M. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut 2001; 48: 812–5.

16. Lee MG. Colon cancer screening. West Indian Med J 2006; 55: 365–7.

17. Blake G, Hanchard B, Gibson T, Wolff C, Waugh N, Reynolds A. Trends in incidence and histological subtypes of lung cancer, Kingston and St. Andrew, Jamaica, 1968-1997. West Indian Med J 2006; 55: 13–8.

18. Travis WD, Travis LB, Devesa SS. Lung cancer. Cancer 1995; 75 (1 Suppl): 191–202.

19. Harkness EF, Brewster DH, Kerr KM, Ferguson RJ, Macfarlane GJ. Changing trends in incidence of lung cancer by histologic type in Scotland. Int J Cancer 2002; 102: 179–83.

 

 

Correspondence:
Dr TN Gibson
Department of Pathology, The University of the West Indies
Kingston 7
Fax: (876) 977-1811
e-mail: tracey. gibson@uwimona.edu.jm