SILENT SPREAD
Expert sounds alarm on the growing crisis of late-detected breast cancer in Jamaica
Published:Sunday | October 19, 2025 | 12:09 AMSashana Small - Staff Reporter
When Ashley*, 53, started experiencing a sharp pain in her stomach and bleeding from the breast where she’d had a lump removed seven years earlier, she instinctively knew something was seriously wrong.
“Because I know the God that I serve, I said, ‘God, position me that if it is Your will that I should go from this disease, then there is nothing I can do but position myself that I will have eternal life’,” she recalled.
In 2016, Ashley had discovered a lump in her right breast. Tests came back benign or non-cancerous, and though the lump was removed, she never felt at ease.
Then in 2023, she began having a persistent pain in her stomach and blood coming from the breast which had had the lump seven years earlier. She was also experiencing severe back pain – so bad that she had to work from home.
After a series of tests, the devastating news came: not only was she diagnosed with breast cancer this time, but it had spread to her spine. It was her first official diagnosis, and it was already stage four – metastatic.
Ashley had a mastectomy and was placed on a strict treatment plan, including expensive medications to strengthen her bones. Thankfully, through the Max Foundation, a nonprofit that helps cancer patients in low-income countries, she’s been receiving some of that treatment at no cost.
“I am being honest with you, from after surgery, I don’t have to be wearing the back brace,” she told The Sunday Gleaner, adding that she wears it as a precaution when doing intense activities like cleaning – or “I will start to feel a little nudge in my back.”
She also follows a strict schedule of checkups, tests and medication, seeing one of her two oncologists every month. Appointments with the other have gradually shifted from every two months to every six months.
GROWING CRISIS
Ashley’s story is not unique – and that’s what frightens experts the most.
An alarming number of Jamaican women are now being diagnosed with breast cancer for the first time at the metastatic stage, when the cancer has already spread to other parts of the body.
Dr Jason Copeland, head of the Breast Oncology Unit at Kingston Public Hospital, revealed that 28 per cent of women who come to the clinic show signs of metastatic disease from the outset.
Describing this figure as “pretty high”, Copeland emphasised that it is particularly concerning given the fact that early detection significantly improves survival rates.
Metastatic breast cancer, or stage four, occurs when cancer cells spread beyond the breast to other parts of the body such as the bones, liver, lungs, lymph nodes, or brain. In rarer cases, it can also affect the skin, ovaries, or abdomen.
“If a patient has what we call localised breast cancer, which is cancer confined to the breast only, the five-year survival [rate] for that patient is about 95 per cent,” Copeland explained. “Now, if the cancer has spread to the lymph nodes, then that five-year survival drops to about 85 per cent. If the cancer is now metastatic, or stage four, then that five-year survival drops down to about 40-50 per cent.”
One particularly aggressive form – triple-negative breast cancer (TNBC) – is especially common in Jamaica. In fact, the country has one of the highest rates of TNBC in the world, accounting for 30 per cent of local breast cancer cases. TNBC is more likely to spread quickly and recur after treatment, Copeland said, which, he reasoned, is one of the factors contributing to the high rate of breast cancer metastasis.
FEAR, CULTURE, DELAY
While biology plays a part, cultural factors, fear and a general lack of knowledge around breast cancer also delay diagnosis.
“Some women will find a lump in their breasts and will not present to their physician. They will try everything else. They will try bush remedies and even seeking solace and relief and so forth and not come,” Copeland said.
He noted that reactions like these are often steeped in “fear of breast cancer – fear of the diagnosis, fear of being stigmatised or ostracised, or fear of losing their breasts. A lot of fear”.
But time is critical, he warned. The longer women wait, the greater the risk the cancer will become metastatic.
There are some instances where there is breast cancer recurrence. This is when cancer returns after initial treatment, caused by cancer cells that survived and later begin to grow again. The recurrence can be local in the area where surgery was done or it can be a distant recurrence in other parts of the body.
To minimise this, Copeland urges active surveillance after the patient has completed comprehensive treatment; this involves regular physical clinical examinations, and can also include CT and PET scans, and even mammograms.
In the past three years, blood tests that detect cancer DNA have become available. Elevated levels of cancer DNA can signal a higher risk of developing metastatic breast cancer, allowing for early intervention and treatment before the disease progresses.
TEAM-BASED COMPREHENSIVE CARE
“The best way to decrease the risk of developing metastatic breast cancer is to ensure that the index cancer – the first occurrence of the cancer – is properly and effectively treated. Now, that treatment usually involves a multidisciplinary approach where you have your breast surgical oncologist, your medical oncologist who deals with the chemotherapy, the radiation oncologist, reconstructive surgeon and adjunctive team members,” Copeland said.
He stressed the importance of more than doctors attending to a patient with metastatic breast cancer, noting that those with a combination of surgery in some cases – which may include chemotherapy in some cases, special targeted treatment, special immune treatment, and even the use of radiation therapy – have a better outcome.
“And these patients have been living longer and longer and longer,” he said.
While he’s encouraged by the growing number of cancer specialists on the island, Copeland believes Jamaica still lacks comprehensive cancer treatment centres where all services are coordinated.
“I think that is a significant drawback for us, a significant challenge for us, because you want a facility where you have all the specialists working together upfront,” he said.
NATIONAL PUBLIC HEALTH THREAT
He noted that breast cancer remains a serious public health issue in Jamaica. It is the most common cancer among Jamaican women, accounting for approximately 35 per cent of all cancers affecting women. The average Jamaican woman faces a lifetime risk of about seven per cent or about a one in 15 chance of developing the disease.
Meanwhile, stating that there are over 1,500 new cases of breast cancer in Jamaica annually, Jamaica Cancer Society Executive Director Roshane Reid-Koomson stressed the need for routine checks and for support for persons who are currently undergoing treatment for the disease.
“We want persons to check it, catch it, and beat it. We don’t want you to stay home with the symptoms and continue to experience the symptoms. We would much prefer routine screening for persons over 40 – and those under 40 who have a referral because of family history – to do their mammograms annually,” she said.