Colon cancer up

By Cheryl Harewood

Barbados has one of the highest incidences of colorectal cancer globally and according to the Pan American Health Organisation (PAHO) and the World Health Organisation (WHO), the country has the second highest incidence in the Latin American region.

Recently appointed medical director of the Caribbean Colon Cancer Initiative (CCCI), Dr Alex Doyle, in an exclusive interview with the Nation said the latest statistics from the Barbados National Registry 2024 Report showed that colon cancer-related deaths recorded in 2022 were 116, up from the 2015 figure of 98. 

This was coupled with the age-standardised incidence rate for both men and women increasing between 2019 and 2020. The rate for men being 28.8 and for women, 26.6, in 2019, but increased to 34.6 and 31.5, respectively in 2020.

The report also confirmed that “Barbados placed eighth in the top ten countries with the highest colorectal cancer incidence rate, second and fifth in prostate cancer mortality and incidence rates, respectively, on the global scale” and that there were “increased mortality rates between 2020 and 2021 among prostate, breast, colorectal, endometrial and pancreatic cancers”.

Doyle, a graduate of the International Surgical Oncology Fellowship at Memorial Sloan Kettering Cancer Centre in New York and Nigeria, with advanced training in minimally invasive, open and endoscopic surgery, said traditionally, colorectal cancer was a disease of the older generation – people in their 50s, 60s and 70s.

“It has been recognised the world over that people in their 30s and 40s are now presenting with colorectal cancer, particularly persons of African descent.”

To this end, Doyle is urging individuals aged 45 years and older with average risk of colorectal cancer to get screened.

“This highlights an issue we want to address. A lot of the data we are using are based on First World countries and estimates and not our own data for the Caribbean and Barbados specifically. If as a region we can pool our research efforts so we can get an accurate assessment of the incidence and prevalence of the disease locally and regionally, that would be ideal. An up-to-date cancer registry is a must.”

Notwithstanding, Doyle said: “The cause of the high morbidity and mortality of the disease relates to the fact that many patients are being diagnosed at a late stage – often at Stage 3 and stage 4. This is because there is a lack of early screening on the island. Originally, there was not a national screening programme, but Government has started to introduce a screening programme throughout the polyclinics.”

The fellowship-trained general surgeon and surgeon oncologist, who is dedicated to elevating cancer care delivery in Barbados and the wider Caribbean through evidence-base surgery, research and system design, added that many people refused to use the fecal immunochemical test (FIT), which is a stool-based test.

“Persons are given the test packet to return a sample of their faeces, but they take the packet home and do not follow through. Our local experience has shown that we have distributed over 1 000 tests [in Barbados] through CCI. Less than half of those tests have been returned. Some people do not like to handle their own faeces. Because of these poor screening efforts, we are picking up cancers at more advanced stages.

“The other challenge we have is that if people get a positive result, they will need to have a colonoscopy performed and the issue with this is that in the public setting the waiting list can be long for persons seeking to get a date for this procedure. So, there is an issue with endoscopic capacity on the island. Before I started my surgical training, colonoscopies were only performed by gastroenterologists [but] surgeons began doing colonoscopies as well.”

Doyle disclosed that one of the initiatives the CCCI started last year in conjunction with the Caribbean Society of Endoscopic Surgeons was PROJECT SCOPE: Barbados National Endoscopy Advancement Initiative, whereby the CCCI sponsored an endo-laparoscopic course for surgical residents in Barbados and throughout the region.

“FIT tests were distributed to members of the service industry – the Barbados Police Service, the Barbados Fire Service, Barbados Defence Force, The Legionnaires, the Sanitation Services Authority and the Barbados Postal Service. 

Individuals who tested positive received free colonoscopies which were performed by the group of international experts who were on island for the endo-laparoscopic course as well as local surgeons.”

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