There are to date seven established cancer registries (Bahamas, Cuba, Guyana, Jamaica, Martinique, Trinidad and Tobago, and the Netherlands Antilles) as well as a prostate cancer registry in Grenada (Table ).
Existing cancer registries in the Caribbean
Cancer registration in Martinique has been mandatory since 1981 and the island's cancer registry was established in 1983 [17
]. Cancer cases are identified through a number of mechanisms: medical records, data from private and public hospitals, laboratory records, as well as regional insurance records of the national public medical insurance system. For the period 1981–2000, there were 8,992 cancer cases in males and 6,832 cancer cases in females. The highest ranking cancer type in males from Martinique was prostate cancer (3,518 cases, world standardized incidence (WSI) = 80.83/100,000) followed by stomach cancer (849 cases, WSI = 20.86/100,000). Females had the highest incidence of breast cancer (1,568 cases, WSI = 35.80/100,000), followed by cervical cancer (890 cases, WSI = 20.82/100,000).
In Cuba, the National Cancer Registry was established in 1964 and documents cancer cases through the hospital system where the clinicians report the diagnosed cases, as well as through the examination of death certificates [18
]. This cancer registry has provided a valuable tool to evaluate the burden of cancer in Cuba. The information from the cancer registry contributed to future developments of the country's National Cancer Control Program which commenced in 1989 [19
The Netherlands Antilles, formerly a Dutch colony and now autonomous, consists of six small Caribbean islands (Curacao, Aruba, Bonaire, Saba, St. Eustatius and St. Maarten). A cancer registry was established in 1977 [20
]. The establishment of a cancer registry in this region was accomplished through a unique combination of conditions that favored a highly reliable registration of cancer cases. There was a centralized Pathology Laboratory, direct access to laboratory and hospital records for critical evaluation of each individual case prior to registration. There was also cooperation of hospitals and physicians.
The Dr Elizabeth Quamina National Cancer Registry of Trinidad and Tobago (Ms Veronica Roach, Registrar) is a resource established in 1994 by the late Dr. Elizabeth Quamina. The registry includes data through passive and active collection from all sources where cancer is diagnosed, and has the capabilities to measure the burden of cancer in Trinidad and Tobago; determines incidence and mortality rates for all cancers; identifies cancer clusters and trends; informs government policies; satisfies requests for information from medical and non medical personnel; and disseminates information and analysis of data to health professionals and the general public through the publication of reports. The Trinidad and Tobago Registry presentation was done by Dr. Alan Patrick, on behalf of Ms. Veronica Roach. From this registry, it is apparent that the top two incident cancers in Trinidad and Tobago are prostate and colon/rectum cancers for males, and cervical and breast cancers for females. This cancer registry is capable of providing data to support cancer research priorities; however the requests for information have been infrequent.
The cancer registry of Guyana was established in 2000 [21
] as an independent body, but is now a Department of the Ministry of Health (Dr. Wallis Plummer on behalf of Nurse Penelope Layne, Registrar). Significant effort has gone into enhancing the system of registration and reporting of cases, and both active and passive data collection is encouraged. The registry demonstrates both alarmingly high incidence and mortality rates of cervical, breast, and prostate cancers. Unfortunately, despite this important data, limited resources and a lack of expertise have prevented further work from being done to investigate the determinants of these rising cancer rates.
The Jamaican Cancer Registry was established in 1959 (Dr. Norma McFarlane-Anderson) and serves the eastern regions of Kingston and St. Andrew. There are discussions for the establishment of a cancer registry that will support the western region of the island. Barbados will soon have its own cancer registry (Dr. Anselm Hennis).
Dr. Robert Yearwood, the only urologist in Grenada, has established a prostate cancer registry since 1996 with 300 patients to date. There have been 28 new prostate cancer cases that have been registered since the beginning of this year (Dr. Robert Yearwood, personal communication). Based on a review of the pathology records, Dr. Robert Yearwood also reported that there have been 13 cases of breast cancer, and 10 cases of cervical and uterine cancers diagnosed this year.
Bahamas currently has a national cancer registry (Dr. Robin Roberts), and observations of high prostate cancer rates in this country were reported. The Bahamas National Cancer Registry is in its most embryonic stage, and documents only the cancers reported in the government's health care facilities and in the government's official health publications and reports. Very few health care providers are aware of its existence. Dr. Robin Roberts indicated that there is a great need to upgrade the cancer registry's function; expand its data base; and advance its utility, reliability, and relevance.
This information emphasizes the need for other Caribbean islands to have their own cancer registries. The participants of this meeting agreed that the development of cancer registries should be addressed at the next Consortium meeting. The Cancer Registry of Trinidad and Tobago should be used as a template in order to better understand the issues and requirements related to the establishment of a cancer registry, to standardize registries throughout the Caribbean, and to allow for pan-Caribbean comparisons to be made.