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!