A Clinical Profile of Male A Clinical Profile of Male Health in the Bahamas Health in the Bahamas “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
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A Clinical Profile of Male Health in the Bahamas “Real Men Die from Prostate Cancer” A Clinical Profile of Male Health in the Bahamas “Real Men Die from.
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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
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
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
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!