Surviving breast cancer in Jamaica

AS WE bring the curtain down on another busy Breast Cancer Awareness Month, one cannot help but ask the question: “Why is breast cancer still the leading cause of cancer-related deaths among Jamaican women?” The level of awareness increases with intensity each year along the corridors of academia, workplaces, communities; and this year we saw more churches hosting presentations to their congregations. Why, then, have our incidence rates been on an upward trajectory for the past 15 years?

THE CHALLENGES

• According to the Global Cancer Observatory, Jamaica recorded 1,327 new cases of breast cancer in 2022, which represented 35 per cent of all cancers. Approximately 684 women died from breast cancer for that period. These figures represented a 9.8 per cent increase over the previous year.

• The average age of presentation for breast cancer is 54 years, which is eight years younger than what is reported in the United States (62 years).

• Approximately 40 per cent of our women with breast cancer present with locally advanced disease. This diagnosis carries the heaviest financial and emotional burden on patients and their families, with the outcomes often resulting in death.

• According to reports from the Kingston Public Hospital, approximately 60 per cent of women presenting with breast cancer were between ages 25 and 59 years.

• The majority of women in our population are reported as having their first mammogram over the age of 55 years.

• Jamaica lacks a national breast cancer screening programme, which would increase opportunities for early detection, resulting in better outcomes and reduced mortality rates.

• Access to mammography screening is greatly hampered by the absence of mammography capabilities in our major public hospitals.

• There are two mammography units in the public setting; one at the Kingston Public Hospital and the other at Cornwall Regional Hospital. These units are primarily used for diagnostic purposes.

• The University Hospital has a 3D mammography unit, which is at a cost for ultrasound and mammogram to the patient ($17,000; prohibitive for many without health insurance).

THE SOLUTIONS

In a society where more than 60 per cent of households are headed by women, the health and welfare of our women and girls must be a priority. To change these poor health outcomes for our women and to reduce the burden on the families, the Government must invest in a mobile mammography unit, while upgrading the major hospitals with mammography services.

This unit would provide mammography screening to underserved women across the island. By providing access to the detection of early-stage tumours, mobile mammography services can help to prevent advanced-stage malignancies. An important component of an efficient mobile mammography programme is appropriate follow-ups. Patient navigation must be included in the policies and procedures across the cancer care continuum. A successful programme will require strategic partnerships to deliver successful outcomes for these women.

RESEARCH

Our data also highlight the critical need for research to better understand the biology of breast cancer among younger women, who are often diagnosed below the recommended age for breast cancer screening in keeping with our National Screening Guidelines. Has the time come for an evaluation of our screening guidelines? Additional studies are needed to focus on trends in incidence rates across age groups and their relationship to mortality as well as trends in the distribution of breast cancer subtypes among Jamaican women.

Is Jamaica capable of achieving reduced mortality rates in breast cancer? Yes, we are! With an established National Breast Cancer Screening Programme supported by the right partnerships, accountability, and a commitment to the mission of saving lives, we will begin to see a downward trajectory in three to five years if we act now.

Yulit Gordon is a management consultant and wellness coach. Email: Yulit.Gordon1@gmail.com