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Reining in cancer in Guyana

Apr 22, 2014 Editorial

Grim statistics present the deadly reality of the spread of cancer in India: one million new cases of different cancers are diagnosed every year in the country; an estimated 600,000 to 700,000 people were killed in 2012.
For every 1,200 Indians in India there is one Guyanese. However, the rate of cancer in Guyana seems higher than in India.
The fact that tobacco was singularly responsible for nearly 40 per cent of all cancers is also painfully underlined again. A few papers published recently in the journal Lancet Oncology point out that men were the most affected by tobacco, with the commonest cancers being those of the lung and of the lip and oral cavity. Tobacco companies continue to have a stranglehold over nearly 275 million tobacco-users in India — 35 per cent of the adult population and about 14 per cent of children in the age range 13 to 15.
All this reflects the miserable failure of the government in implementing tough and effective measures to counter the tobacco companies’ devious ways of attracting and trapping young minds.
Though it would take 10 to 20 years for the benefits to show, half the battle against cancer would be won if only tobacco consumption can be reined in.
Guyana closed down its last cigarette manufacturing company some years ago but instead of presiding over a decline in the ranks of smokers, the government paved the way for cigarettes to be imported. Today, in addition to the legal imports, bales of cigarettes are smuggled into Guyana. So deficient are our regulators that they have not busted any cigarette smuggling ring.
And unlike the United States where the government set about pricing cigarettes out of reach, Guyana still offers some of the cheapest cigarettes in the world. We are not even applying the legal restrictions that prevent the sale of cigarettes to minors.
In the case of women, breast cancer is the most common, followed by cervical cancer. Changed lifestyle is one of the reasons for the increase in breast cancer incidence — the incidence of this cancer type in rural areas is one-third of the total in urban areas, and the big metros have higher numbers than non-metro cities. India’s cancer burden is projected to increase to 1.7 million by 2035. Mortality will double to 1.2 million a year by 2035.
There is a need to take remedial steps, and quickly too. More cancer registries are needed to cover a greater percentage of the population. Those in place today cover less than 10 per cent of India’s population. However, each registry has good incidence data as it has its own methods of capturing them.
Guyana has one cancer registry. Indeed its record-keeping system is great but it also exposes a glaring limitation. Guyana simply cannot spend the needed funds to help its cancer patients. Many die before they could access treatment.
But cancer mortality data are at best sketchy and not quite reliable. The three pillars of reducing the mortality are prevention, early detection and more effective treatment.
Guyana also has a high rate of breast cancers due in part to hereditary conditions. Many of these are not detected until it is too late, simply because our women are steeped in the tradition which limits young women from examining their own bodies.
Concerted efforts with respect to the first two have been found wanting, and there are several challenges even in providing effective treatment. With only one cancer specialist for every 5,000 new cases, the total number of oncologists in India is frighteningly low in proportion to the increasing population of cancer victims. Guyana is no different.
The availability of doctors and facilities is skewed — the urban areas are better served than rural areas. There is also an imbalance in the distribution of cancer facilities and doctors.
There is no oncologist in rural Guyana. Sometimes we are left to wonder whether we have any in the entire country. Cancer deaths are grim reminders of the local reality.

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