Cattin Lindsay M, Pinheiro Paulo S, Callahan Karen E, Hage Robert
St. George's University School of Medicine, PO Box 7, True Blue, West Indies, St. George's, Grenada.
University of Nevada Las Vegas, School of Community Health Sciences, 4505 S. Maryland Pkwy, Las Vegas, NV, 89154, USA.
Cancer Causes Control. 2017 Nov;28(11):1241-1249. doi: 10.1007/s10552-017-0960-5. Epub 2017 Sep 20.
Grenada is a small island nation of 105,000 in the Caribbean with one single general hospital and pathology laboratory. This study assesses cancer incidence on the island based on existing pathology reports, and compares the cancer mortality burden between Grenada and other Caribbean nations.
Age-adjusted overall and site-specific cancer "incidence" rates (based on pathology reports) and mortality rates were calculated and compared for 2000-2009. Next, mortality rates for a more recent period, 2007-2013, were calculated for Grenada and a pool of English-speaking, majority African-ancestry Caribbean island nations. Lastly, for direct mortality comparisons by cancer site, mortality rate ratios were computed using negative binomial regression modeling.
The pathology reports alone do not suffice to calculate national incidence rates but cancer mortality rates are rapidly increasing in Grenada. The leading causes of cancer mortality were prostate and lung cancers among men, and breast and cervical cancers among women. Overall cancer mortality is significantly higher for both male and female Grenadians than their Caribbean counterparts: RR 1.43 (95% CI 1.32-1.55) and RR 1.26 (95% CI 1.15-1.38), respectively. High prostate and non-Hodgkin's lymphoma rates are concerning.
Given the small existing cancer infrastructure, excessive mortality in Grenada compared to its neighbors may be disproportionately more attributable to low survival than a high cancer risk. Global solutions will be required to meet the cancer control needs of geographically isolated small nations such as Grenada.
格林纳达是加勒比地区一个拥有10.5万人口的小岛国，仅有一家综合医院和病理实验室。本研究基于现有的病理报告评估该岛的癌症发病率，并比较格林纳达与其他加勒比国家之间的癌症死亡负担。
计算并比较了2000 - 2009年年龄调整后的总体及特定部位癌症“发病率”（基于病理报告）和死亡率。接下来，计算了格林纳达以及一组以英语为母语、多数为非洲裔血统的加勒比岛国在2007 - 2013年这一更近时期的死亡率。最后，为按癌症部位进行直接死亡率比较，使用负二项回归模型计算死亡率比值。
仅病理报告不足以计算全国发病率，但格林纳达的癌症死亡率正在迅速上升。男性癌症死亡的主要原因是前列腺癌和肺癌，女性是乳腺癌和宫颈癌。格林纳达男性和女性的总体癌症死亡率均显著高于其加勒比地区的 counterparts：相对危险度分别为1.43（95%置信区间1.32 - 1.55）和1.26（95%置信区间1.15 - 1.38）。前列腺癌和非霍奇金淋巴瘤的高发病率令人担忧。
鉴于现有的癌症基础设施薄弱，与邻国相比，格林纳达过高的死亡率可能更多地是由于生存率低而非癌症风险高所致。需要全球性的解决方案来满足像格林纳达这样地理上孤立的小国的癌症控制需求。
