Cancer is the second leading cause of death in the Americas and is expected to continue to rise according to an associate professor of medicine and biochemistry at the University of Puerto Rico (UPR). With the five most frequent cancers in the Caribbean being prostate, lung, colon, stomach and laryngeal (larynx) for men; and breast, cervical, colon, lung and uterine cancers for women.
Dr. Marcia Cruz-Correa said the goal of the scientific world is to one day end cancer, but she said the problem the members of the scientific world face with cancer cells is that not only are there many different cancer cells, but the cells have the capacity to change and mutate. She said when that happens, something that worked before doesn't work anymore and therein was the challenge that scientists face. "The medication and treatment have to be working together against the cancer cells, so [finding a cure] is a beautiful dream and of course we strive to be able to do that," said Dr. Cruz-Correa at a recent cancer research in the media workshop in Puerto Rico.
"We hope that eventually we will be able to end cancer, but when you think about cancer you're not talking about one type of cancer... cancer is over 200 different cancers which go from cancer in the skin, cancer in the bone marrow, like blood cancer. It's a myriad of different cancer types. And depending on the cancer type, then the ability of the scientist to be able to diagnose early, treat and cure bears significantly," said the adjunct associate professor of surgical oncology at MD Anderson Cancer Center who also serves as the scientific director of the UPR Comprehensive Cancer Center.
According to Dr. Cruz-Correa, the first and most important research is the epidemiological research. She said the scientific and medical world of countries have to look at their respective populations and the data it yields as to what is happening in their communities as far as cancer is concerned. To get answers she said important questions that need to be asked include: What are the types of cancers? Who get affected -- women, men, people who live in the city, people who live in the country, people who are white, people who are black, people that are Indian?
And then she said patterns needed to be looked at to see whether or not there are areas that need to be studied first. As the burden of cancer varies by region, gender and age with cancers related to infectious agents more common in developing countries. "Of course anybody that has cancer you want to help, but as a country you need to strategize and identify the sources of interest and what to answer first," she said. Dr. Cruz-Correa said that the five most frequent cancers in the Caribbean for men are prostate, lung, colon, stomach and laryngeal (larynx); and for women, breast, cervical, colon, lung and uterine are among the top five.
But she said that science has noted that as a country becomes more industrialized that cancer goes down, but they have noticed that colorectal and breast cancers have increased. "Something happens between the environment, the exposures and the cancer burden in the society. In fact, stomach cancer in the United States is not even in the top 10 for some groups," she said "For us in the Caribbean, stomach cancer is still very high, among the top five and there is a bacteria that is associated with stomach cancer, so there is a relationship between our environment, and the cancers that the country experiences the most," said Dr. Cruz-Correa.
In the Caribbean, she said Martinique has the highest incidence for prostate cancer with Barbados second, followed by Guadeloupe, Puerto Rico, The Bahamas in the middle, and the Dominican Republic, with Jamaica at the lowest end of the spectrum for this type of cancer. In the instance of cervical cancer, she noted that Jamaica is number one followed by Central and South America, the Dominican Republic in the middle with Barbados at the rear. And in the instance of breast cancer general (not hereditary), Uruguay had the highest burden, followed, she said, by the United States, Barbados, Argentina, The Bahamas, Jamaica, Puerto Rico, Costa Rico, with Trinidad and Tobago having the lowest breast cancer incidence.
Argentina, Barbados and Puerto Rico were at the top of the spectrum from incidences of colorectal cancer for male and female, followed by The Bahamas, Jamaica and Brazil. Colombia was at the lowest end of that field, but its population had a high risk of stomach cancer. As the cancers are studied, Dr. Cruz-Correa said one of the difficulties for scientists and the medical field in the Caribbean is that not enough papers are being put out there from individual countries. The lack of scientific data from the Caribbean was not good she said, because without the data she said it appears people in the Caribbean do not have the disease. "If it's not published, it did not happen," she said.
Dr. Cruz-Correa whose research interests are in the areas of gastrointestinal oncology, including the study of epigenetics and genetics in gastrointestinal (GI) cancer, hereditary GI cancers and chemoprevention of gastrointestinal neoplasia said the facts show that the risks of developing and dying from cancer increase with age (and that most cancers occur in people older than 65 years) and that they expect to see an increase in cancer cases. She noted the need for more cancer prevention, early detection and access and availability to health services. "Cancer is a high priority for the Caribbean.
It is a high priority for the world. There are disparities, depending on the island or country. Efforts in cancer prevention and control with early detection and vaccination are key. I firmly believe that communication is key to be able to do that. Scientists can have the best clinical trial, showing that a measure or test works, but if the public does not know that, if the private providers do not know that, if the health insurance does not know that, we just spent millions of dollars for nothing," she said.
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