Breast Cancer Burden inJamaica
Dr. Jason Copeland MBBS DM MRCS Ed
Breast Surgeon & Breast Surgical Oncologist
Breast cancer is the most common cancer occurring in women worldwide and it accounts for the greatest cancer related deaths, morbidity and economic loss. While the incidence of breast cancer continues to increase globally, the burden of the disease is disproportionately distributed with low to middle income countries accounting for almost 60% of the global breast cancer deaths despite having much lower incidence rates than high income countries. As a region, the Caribbean has the fourth highest breast cancer death rate in the world and has seen the greatest increase in breast cancer related death rates over the past three decades. It is expected that as the populations in low-and middle income countries continue to age and their lifestyles become more westernized, the incidence and deaths rates will similarly increase. In many ways, low or middle income countries are facing a breast cancer epidemic.
In Jamaica, breast cancer accounts for more than 1 out of every 3 cancers that are diagnosed in women, conferring a lifetime risk approaching 7%. We had approximately 1208 new breast cancer cases diagnosed in 2020 according to data from the Global Cancer Observatory, up from 974 cases diagnosed in 2018. This trend of increasing breast cancer incidence is in-keeping with the epidemiological transition of diseases, from communicable to non-communicable, as the country becomes more developed and the reproductive patterns of our women change resulting in delay in the age of onset of child birth, decrease in the number of off-springs per woman and diminished regular breast feeding habits.
Jamaica’s breast cancer death rates have worsened, rising from 56.8 to 66.9 per 100,000 women over the past few years. More significant is our high breast cancer case fatality rate (proportion of women diagnosed with breast cancer who die of their disease), which averages between 41 and 51 percent. As a result, the average Jamaican woman is approximately three times more likely to die as a result of being diagnosed with invasive breast cancer compared to a woman in the United States. These differences in mortality and case fatality rates result from various issues which may be related to the patient, the health care delivery systems and/or national policies regarding breast cancer screening and therapy.
The average age of presentation for breast cancer in Jamaican women is 54 years, much younger than what is reported in the United States (62 years). These younger women are often in their reproductive, family rearing or economic prime and suffer significant social as well as family life disturbances during breast cancer treatment. They are also more likely to suffer from depression, anxiety, body image disturbances and sexual dysfunction than older women. Breast cancer in our women tend to be diagnosed at more advanced stages and exhibit more aggressive biology (twice the rate of triple negative breast cancer) than the average patient presenting in high income countries such as the USA. Therefore, our women are intrinsically worse off from the time of their diagnosis and are burdened with higher recurrences and inferior long-term survival.
Myth 1. If I don’t have a family history of breast cancer, then I won’t get it.
FACT – most women diagnosed with breast cancer have no family history of breast cancer .Only 5-10% of patients have genetic mutations
Myth 2. Wearing a bra or antiperspirant can cause breast cancer
FACT – No scientific evidence that bras or antiperspirant cause breast cancer
Myth 3. Breast cancer always causes a lump that you can feel
FACT – Breast cancer may not present with a lump or the lump may present late (after disease spread)
* breast cancer screening is vital!
Myth 4. All breast cancers are treated the same and results in a mastectomy (removal of the breast)
FACT – Treatment plans vary widely
1) characteristics of the cancer
2) patient preferences 50% of breast cancers that we see in Jamaica can be managed without mastectomy!
Myth 5. – Breast cancer only happens in middle-aged and older women
FACT – 36% of our patients presenting with breast cancer are under 50 years old
- more aggressive
- poorer outcomes
Average age of breast cancer is 54 years in Jamaica