Saving lives with early cancer tests

by George Alleyne

Incidents of breast cancer in Barbados are increasing but the number of deaths has not risen in tandem and in fact has been steady for over a decade, thanks to work of the Cancer Society and the willingness of women to come forward for frequent screening making early detection possible.

The frequency of screening has resulted in the Society’s clinic detecting an average of one woman per week on the island discovering she has early stage cancer, which can be successfully operated on guaranteeing long life.

This average is for detection at the Society only as many persons go to private clinics or the Queen Elizabeth Hospital and there is no national register collating the cases.

“The earlier the diagnosis is made the patient’s survival rate increases. If you’re diagnosed with Stage Zero or Stage One, your prognosis is almost 99 per cent survival compared with somebody who is diagnosed with Stage Four, that person’s prognosis is 15 to 20 per cent. This is why early diagnosis makes the difference,” explained gynaecologist and Medical Coordinator of the Barbados Cancer Society’s Breast Screening Programme Dr Shirley Hanuman-Jhagroo.

“The options for treatment that the patient will respond to is important. When you get to Stage Four, what are the options, very little because it’s already spread somewhere, metastasis.

“Once it’s metastasized it’s difficult to control the cancer. The whole objective of screening is to diagnose the breast cancer as early as possible.

“The ideal situation is to get it, screened, at a Stage Zero. In that case nothing is palpable, you can’t feel anything by hand. But the mammogram shows it up and it would be a tiny cluster.”

The driving force behind the clinic, itself a sub-committee of the Society, explained that after discovering a patient with Stage Zero or One, “what we look for in the mammograms is very specific. Mammograms have remained the gold standard. We look for what is called microcalcification which is always diagnostic of cancer. Then having found that we go after it, do the biopsy. Then those patients probably can have a little excision of the area.

“And they do very well maybe as a 20-year survivor, an 18-year survivor.

“A lot depends on the stage at diagnosis.”

This is breast cancer awareness month, Pink October, and Health TODAY is taking a look at the work of this non-governmental mainly volunteer-based organisation that has saved lives of many women in Barbados through encouraging them to come forward and be screened.

“Even though we’re finding so many cases the survival rate has remained stable. That explains why the [mortality] rate remains between nine and 11 per cent,” she said, pointing out that this death rate has stabilised for more than a decade because patients are being diagnosed early.

“And that’s owed to awareness. That is why there is so much emphasis on the side on the awareness.”

Women in Barbados coming forward for frequent screening and learning how to perform self-assessment represents a remarkable turn-around from what obtained last century and the beginning of this millennium.   

“Before this programme was started in 2002 Stage Four people hid. If they had anything in their breast, for them it is a stigma and there is no life after breast cancer. They looked at it as a death sentence and they knew there was no point telling anybody ‘let me just die with this thing’,” Dr Hanuman-Jhagroo said reflecting on the attitude of women here up to the opening of the Henry Lane, Upper Collymore Rock clinic in 2002 and some years after.

She became aware of this women’s malady while working in a gynaecologist office during training in the UK.

“The patient comes for a pap smear or whatever but you always examine the breasts so I used to see quite a lot of these and this is what motivated me or compelled me ‘you must do something because if these patients are diagnosed early there is a chance’. And that’s how we started”.

Now the doctor can say with a great sense of satisfaction, “we’ve come a long way. Most of the cases we see at Cancer Society clinic are Stage Zero and One, a few Twos but rarely do we see a Stage Four”.

“The stigma has gone because people go there [the clinic] like they didn’t in former years and talk about their breast cancer because they’re survivors.”

In addition to women visiting the stationary clinic there is a mobile one, but “it doesn’t do mammograms. It’s an outreach programme. It is managed by an experienced registered nurse. Her duties are to examine the breasts and teach breasts self-examination.”

“Then she refers the patient to the clinic if they need referral. It can go to any location in Barbados and do this.

A number of nurses take turns going to different organisations ranging from commercial banks, to church groups and to anywhere in the community. Organisations can call the Society and request a visit by the mobile clinic.

Cancer survivors have formed a support group, ‘Bosom Pals’ that meets monthly, discusses problems, the way forward and give moral support to newly diagnosed persons who are to undergo chemotherapy or surgery, “just to hold their hand. It’s a sisterly type of thing”.

“With early detection lives are being saved. That’s the emphasis of this whole thing to save the lives. We still can’t prevent the disease because we don’t know the cause.

“Barbados is a matriarchal society. Women just seem to take over all the duties they have to take over. We have to keep them healthy.”

“If men would pay that amount of attention to their prostate, we wouldn’t have the [large number of] deaths from prostate cancer today because early detection of prostate cancer is one of the things that could save their lives but they just wouldn’t do it. The stigma is still there and they wouldn’t do anything about it. But for our women the stigma is gone.”

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