Wed | Aug 23, 2017

Medical stakeholders want more persons screened for cancer

Published:Thursday | March 12, 2015 | 3:00 AMDaraine Luton

Amid a high prevalence of breast, cervical and prostate cancers in Jamaica, major medical stakeholders have suggested the State should put policies in place which would result in more persons being screened.

Dr Mathew Taylor, an obstetrician and gynaecologist, said during a Gleaner Editors' Forum yesterday, that while the State cannot make it mandatory for persons to be screened, there are steps that can be taken to have a greater number of persons made aware of their cancer status.

"Unfortunately, in Jamaica, a lot of our screening programmes are opportunistic screening, meaning that you educate a population but you are leaving it up to the population to come in and be screened," Taylor said.

"Screening works better when you actually call people. That is the difference in developed countries. In developed countries, for cervical cancer, you actually send out to the patient (and say) 'you are due to have your pap smear'," he added.

More active role

Dr Mike Mills, a gastroenterologist, said that in developed countries, governments take a more active role in the early detection of cancer.

"You don't wait for the patient to say 'I am having a problem' or that 'I have heard about this and I think we should do it.' You actually call the patient and ... they get a notification which says you are due to have this done," Mills said.

"That has been shown to be more effective when you actually call people and say you are due to have your screening, come and do it," he added.

Mills, however, said the system of doctors calling in people to be screened does not fit within the Jamaican reality.

"The primary problem is that individuals are not assigned a general practitioner automatically. For example, in the UK system where you have a GP assigned to you depending on where you live, so automatically everybody has a GP whom they go to. The GP is responsible for sending out notifications automatically and they get compensated for it. Each of them have targets and they have to screen a certain percentage of the locality and when they meet those targets they are paid accordingly," Mills said.

He noted that GPs in the UK, for example, screening for colon cancer, would send a packet to an individual who would then enclose a sample of their stool. That stool is then sent to the lab to examine whether there is blood which could indicate the presence of colon cancer".

Taylor said that in the fight against cancer, "what you want to have is a universal screening for the entire population and it has to be driven by the State".

The obstetrician and gynaecologist noted that the majority of cervical cancer patients in Jamaica are among poorer people and "they are the ones that don't access screening very well".

More accessible screening

He said the policy should be tailored in such a way that screening is more accessible at the primary health-care level.

"If we can't call them, we have to make sure that if they turn up for screening, it can be done on that day," Taylor said. "People can always access private care, but if the health centre can call them - everybody has a cell phone - and say 'come in, have your test done', that would be a way to go."

Statistics provided by the Jamaica Cancer Society indicate that the number of people being screened for breast, cervical and prostate cancers is on the increase but nowhere near the desired level.

Urologist Dr Belinda Morrison noted that countries such as the United States have been able to reduce the number of prostate cancer-related deaths through early detection.

US model

"If you use the US as a model, they do wide-scale screening. Almost all their men are screened for prostate cancer. Therefore, of men diagnosed with prostate cancer, 90 per cent of them are diagnosed at a localised level," Morrison said.

Localised prostate cancer is prostate cancer that is only in the prostate gland and has not spread to another part of the body. It is generally low risk and unlikely to grow or spread for many years.

Morrison said when the US introduced the Prostate-Specific Antigen (PSA) testing for prostate cancer in the early 1990s, they found that the number of men presenting with prostate cancer increased but overtime their death rate was decreasing.

"Those guys are seeing greater number of localised diseases so men are living longer. In our situation, we are still not seeing the number of localised diseases that we want just yet. If we look at our database from the university, I would say that about two-thirds of our men are diagnosed with more locally advanced or distanced prostate cancer," she said.

Morrison, however, conceded that "it is a hard sell to invite someone who is feeling well to screen for a disease, and to tell them they have cancer".

"The fear of a diagnosis is a major issue and that is why the health-seeking behaviour between men and women are different. Women are more likely to access the health-care system," she said.

Yulit Gordon, executive director of the cancer society, said her organisation works though faith-based institutions, schools and community groups in order to get persons screened.

daraine.luton@gleanerjm.com