A Clinical Profile of A Clinical Profile of Male Health in the Male Health in the

BahamasBahamas

“Real Men Die “Real Men Die from Prostate from Prostate

Cancer” Cancer”

Dr. Robin Roberts MD MBA

Urologist , Associate Lecturer

University of the West Indies, Bahamas Campus

Copyright ©2003 American Cancer Society

From Jemal, A. et al. CA Cancer J Clin 2003;53:5-26.

FIGURE 3 Annual Age-adjusted Cancer Incidence Rates* Among Males and Females for Selected Cancer Types, US, 1973 to 1999

Pienta, K. J. et. al. Ann Intern Med 1993;118:793-803

Prostate cancer incidence rates for the years 1973 to 1990

Prostate Cancer Death Rates* by Race/Ethnicity,United States, 1992–2001 (CDC National Center for Health Statistics)

Developed CountriesDeveloped Countriesvs.vs.

Developing CountriesDeveloping Countries

HEALTH CARE HEALTH CARE DISPARITYDISPARITY

vs.vs.HEALTH CARE HEALTH CARE PARADOXPARADOX

Vol. 159, 1984-1987, June 1998 Printed in U.S.A

THE EPIDEMIOLOGY OF PROSTATE CANCER IN JAMAICAFRANK E. GLOVER, JR., DONALD S. COFFEY, L. LAWSON DOUGLAS, MARK CADOGAN, HOPE RUSSELL, TREVOR TULLOCH, TIMOTHY D. BAKER, ROBERT L. WAN AND PATRICK C. WALSH From the School of Hygiene and Public Health, The Johns Hopkins University and The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, and the University of the West Indies, Mona, Kingston, JamaicaUnited States 1992

•White men 182/100,000•Black men 249/100,000

Jamaica men: 304/100,000

High Prevalence of Screening-detected Prostate Cancer among Afro-Caribbeans: The Tobago Prostate Cancer Survey:

Cancer Epidemiology, Biomarkers & Prevention

Vol. 11, 726–729, August 2002

2484 men ages 40 to 70 yrs ( 50% of all the men in Tobago) Sept 1997 to June 2001

Screening detected Prevalence Rate:

3 to4X higher than the US Caucasian population

Prostate Cancer

•Incidence & Mortality

•Clinical Profile

•Early Detection

Campaign

METHODOLOGYMETHODOLOGY

Patient Data:Patient Data: Records PMH, Doctors Hospital, MD officeRecords PMH, Doctors Hospital, MD office Logs: OR, PathologyLogs: OR, Pathology

Health Information & Research Unit Health Information & Research Unit MOH: MOH:

Country health profile studiesCountry health profile studies Morbidity & Mortality dataMorbidity & Mortality data

Cancer Society: US TOOCancer Society: US TOO Prostate Cancer Awareness WeekProstate Cancer Awareness Week Patient QuestionnairePatient Questionnaire

0

20

40

60

80

100

120

140

1993 1995 1997 1999 2001

HeartDisaese

AIDS

MalignantNeoplasms

Accidents,Violence, &Poionings

DiabetesMellitus

Cerebrovascular Disease

Trends in Selected Leading Causes of Death

All Ages, Both Sexes( rates per 100,000 Population), Bahamas, 1993-

2003

0

20

40

60

80

100

120

140

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

HeartDisease

AIDS

MalignantNeoplsams

Accidents,Violence &PoisoningsDibetesMellitus

Cerebrovascular Disease

Trends in selected Leading Causes of death for Males (rates per 100,000 Population,

Bahamas 1993 - 2003

0200400600800

10001200140016001800

1990

1992

1994

1996

1998

2000

HeartDisease

MalignantNeolplasm

DiabetesMellitus

Cerebrovascular Disease

Pneumonia

Trends in Selected Leading Causes of death For the Elderly 65 years and older (rates per

100,000 Population, Bahamas 1993 - 200316

0

0

20

40

60

80

100

120

1994 1996 1998 2000 2003

All Cancers

Prostate

Breast

Lung

Cervical

stomach

Colon

Bahamas Cancer Mortality Trends

Death rates per 100,000

0

200

400

600

800

1000

1200

1400

1600

1990 1992 1994 1996 1998 1999 2000 2001

Total 15-44 years

Total 45-64yrs

Total 65+years

Prostate 15-44yrs

Prostate 45-64yrs

Prostate 65+

Rates (100,000 Persons) of Deaths Due to Prostate

cancer and Total Cancers for Males by Age

Cancer Prostate: Total Cases: 735(Biopsy Proven 1987-2003)

01020304050607080

1987

1989

1991

1993

1995

1997

1999

2001

2003

PMH Lab Private Lab

Prostate Cancer: Prostate Cancer: BahamasBahamas

Total New cases 2005 – 60Total New cases 2005 – 60:: AA: 40,000 (40-AA: 40,000 (40-70yrs)70yrs)

1991 to 1995: 321991 to 1995: 32 AA: 80/100,000AA: 80/100,000 1996 to 2000: 49.21996 to 2000: 49.2 AA: 123/100,000AA: 123/100,000 2001 to 2005: 53.62001 to 2005: 53.6 AA: 134/100,000AA: 134/100,000

Age 2005: Ave 67yrsAge 2005: Ave 67yrs 1990: 75yrs1990: 75yrs 2000: 65yrs2000: 65yrs

Family IslandsFamily Islands: 31.6%: 31.6% (2/60 non-Bahamians)(2/60 non-Bahamians)

Prostate Cancer: Prostate Cancer: BahamasBahamas

Risk Profile: PSA, Gleason Score, Risk Profile: PSA, Gleason Score, StageStage

1990: <10% Low risk1990: <10% Low risk2000: <10% Low Risk2000: <10% Low Risk2005: 16% Low risk2005: 16% Low risk2005: 70% High risk 2005: 70% High risk

Young Men And Prostate Young Men And Prostate CancerCancer

2005 Series:2005 Series:8/60 (13%) <60 years8/60 (13%) <60 years3/8 were low Risk, 4 Advanced3/8 were low Risk, 4 Advanced

1987 to 20041987 to 20048 men were <50 years of age8 men were <50 years of age 4/8 were advanced Disease4/8 were advanced Disease

African Decent: Start screening African Decent: Start screening at 40 yearsat 40 years

0

2

4

6

8

10

12

14

# of Patients

1 -10 10-20 20-50 50-100 >100 NS

PSA

PSA

Bahamas Prostate Cancer 2000

Cancer Society: US TOOCancer Society: US TOOProstate Screening Clinic Prostate Screening Clinic

AttendanceAttendance

0

100

200

300

400

500

600

1995 1998 2000 2002 2004

Pt. Visits

Cancer Society: US TOOCancer Society: US TOOProstate Screening Clinic Prostate Screening Clinic

AttendanceAttendance QuestionnairesQuestionnaires

Means of Influence 2005Means of Influence 2005Radio AdvertisementsRadio Advertisements 32%32%Spouse or male Friend: Spouse or male Friend: 31%31%

Return Annual CheckupsReturn Annual Checkups Visited Last yearVisited Last year 40%40% At least once in 5 YearsAt least once in 5 Years 30%30%

0

200

400

600

800

1000

1200

1400

1600

1990 1992 1994 1996 1998 1999 2000 2001

160

Male Health: Stark Male Health: Stark Realities!!Realities!!

Developed World:Developed World:1990 to 2000: Incidence PCA 1990 to 2000: Incidence PCA IncreasedIncreased

Mortality DecreasedMortality Decreased Bahamas: Bahamas:

1990 to 2000: Incidence PCA 1990 to 2000: Incidence PCA IncreasingIncreasing

Mortality IncreasedMortality Increased

Prostate Cancer Charity UK 1996

Our Male Culture:Our Male Culture:Caribbean/Bahamian/African Caribbean/Bahamian/African

AmericanAmerican

Sunday Christian Sunday Christian ManMan ResponsibleResponsible ProviderProvider LeaderLeader ProtectorProtector Family manFamily man

The “Real Man”The “Real Man” Don’t Visit Don’t Visit

doctorsdoctors Don’t get sickDon’t get sick Risk seeking Risk seeking

behaviorbehavior Don’t fell & Don’t fell &

Express EmotionsExpress Emotions Renowned for his Renowned for his

female Exploitsfemale Exploits

The Digital Rectal The Digital Rectal Examination????Examination????

Homophobia:Homophobia:

THE REAL THE REAL CHALLENGECHALLENGEEducation & Education &

AwarenessAwareness

Change of BehaviorChange of Behavior

X

Prostate Cancer in the Prostate Cancer in the Bahamas/CaribbeanBahamas/Caribbean

A Major Public Health issueA Major Public Health issue Minimal Impact of PSA Screening Minimal Impact of PSA Screening

ProgramsPrograms Ideal Treatment? Volumes vs. Expertise?Ideal Treatment? Volumes vs. Expertise? Advanced disease and high mortality Advanced disease and high mortality Outcome of the “Real Man” Cultural Outcome of the “Real Man” Cultural

EthosEthos Need for a more aggressive and Need for a more aggressive and

innovative male health initiatives…..Ripe innovative male health initiatives…..Ripe old age!old age!