-------------------------------------------------------------------------------------------------------

I'm a survivor! Living with cancer in Guyana
By Angela Osborne
Stabroek News
June 20, 2004

Last Sunday Cancer Survivors' Day was celebrated around the world. In Guyana, a group of cancer survivors and their families got together at the Guyana Cancer Society and spoke about their lives, treatment, what is available, how they deal with their illnesses and what they would like to see happen in Guyana. Today Sunday Stabroek features six survivors:

Annette Kendall- two years a survivor
Annette Kendall has cervical cancer and has been fortunate to receive treatment and benefits. She is a mother of seven children and receives 80% reimbursement of her medical bills from the National Insurance Scheme (NIS). She said she has received tremendous support from her family and feels that something should be done to help the many people who are suffering from the same condition as her, especially Amerindian women.

"The government is not doing enough for them, and many cannot afford the treatment. It costs US$4,700.
Cancer survivors and supporters participate in a walk.

"It [being diagnosed] has taught me a great lesson; women need to take care of themselves, and their partners need to be aware of what they are doing." Kendall has undertaken to advise younger women to get pap smears regularly and most of all, to be careful.

Kemo Tanner- three years a survivor
Kemo Tanner was diagnosed at the age of eight months with cancer of the kidney. He is now three years old and has already had one year of chemotherapy. He is now undergoing a process of seven treatments, which he is receiving at the Georgetown Public Hospital every three weeks. Speaking on his behalf, his grandmother said he recently had an ultra sound done which revealed that the tumour is still there. She said his doctor had recommended that he seek further treatment in Barbados.

Savitri Warnauth- five years a survivor
Savitri Warnauth was diagnosed with cervical cancer in 1999. She underwent surgery for it and said she suffered tremendously afterwards. Warnauth said the doctors never believed she would recover. She then had a relapse in 2000 and began treatment again.

She said she has had every treatment available for this kind of cancer, including 12 chemotherapy treatments.

But Warnauth said she has received a lot of support from the Cancer Society, her family and a family in Trinidad. She too believes that young women should be careful and have regular pap smears.

Selena Ramnarine- nine years a survivor
Selena Ramnarine, 50, has Hodgkins lymphoma. She was able to receive the much-needed treatment last year in Trinidad, when the Cancer Society helped to raise part of the funds and the government through the Ministry of Health provided the remainder. She also received treatment at the Georgetown Hospital.

In all she has had six months of chemotherapy and six weeks of radiology. Ramnarine was supposed to go back for more treatment last month but she cannot afford the air fare and so she's stuck here. She said before she received any treatment the pain was too much, she was on liquids only, but now she's able to eat. She said she is eternally thankful to the general public for their help and support.

Esme Chung- five years a survivor
Esme Chung has breast cancer and feels that people should not be afraid to talk about their illness with their friends and family. She said that once a person had been diagnosed with cancer they should join the Guyana Cancer Society, because it was the link to the Ministry of Health and the help they may need. She went on to say, "The treatment in Guyana is a big joke and the government is doing nothing to help."

Kristy Ann Woon-A-Tai- five years a survivor
Kristy Ann Woon-A-Tai is 12 years old and was diagnosed with medulla blastoma (cancer of the back of the brain) in March 1999. Woon-A-Tai began to get headaches when she was seven; after one of those headaches got severe her parents took her to the hospital where a Computerised Axial Tomography Scan (CAT Scan) was done.

She had surgery soon after in the United States and radiation for six weeks. Since then, every year she does a magnetic resonance imaging (MRI) to see whether the cancer is coming back or spreading to other areas. For now, she is alright.

There are at least 32 different types of cancer known to researchers. The Guyana Cancer Society has on record 1,085 people diagnosed with cancer within the period January 2000 to June 2003. The highest in terms of numbers is breast cancer, which sees the most fatalities in women. The second highest is prostate cancer.

Survivors noted that from the moment you are diagnosed until you die you are a survivor. One parent of a cancer survivor indicated that persons living with cancer need not die, all they need is the treatment and in order to get the treatment they need contacts. She went on to say that there are organisations and hospitals which are willing to help the Cancer Society but in order to do so, they need the government's intervention to pave the way.

People who need treatment overseas must go through the Ministry of Health and the women lamented that the process at the ministry is too slow. Because of the lack of cooperation extended to the Cancer Society, the members said they are now feeling frustrated and are not as active as they would like to be.

The women also said they are still awaiting the arrival of the promised oncologist in Guyana as they hope this will allow for more treatments to be undertaken here.

Contacted on the claims made by the cancer patients that nothing is being done, Chief Medical Officer, Dr Rudolph Cummings said the ministry is now working with a broker in Trinidad to ensure that cancer patients get treatment expeditiously. "When patients provide the documentation from their doctor, within a matter of days a treatment is outlined and the opportunity for travel is arranged."

Dr Cummings said that cabinet is required to approve treatments over a certain cost and in these cases it would take a little over a week as cabinet only meets once a week. He said that once diagnosed with cancer, patients expect to be treated almost immediately. He added that the ministry is doing its best to ensure they receive treatment in a timely manner. He said prior to two years ago, patients might have been given dates six months after they were first diagnosed to get treatment overseas, but this has now changed.

With regard to the promised oncologist, Dr Cummings said approaches were made to friendly governments and they were awaiting responses.

The survivors said treatments and tests are far too expensive in the United States. They gave as an example the cost of an MRI, which is US$4,000 in that country. But they said that because of a discount given in Trinidad one can get this test done for US$1,600.

Dr Cummings confirmed this and also noted that treatment in Trinidad takes less than two weeks for a response, while in the United States it would take at least six weeks.

-------------------------------------------------------------------------------
Younger women in Guyana being diagnosed with breast cancer
By Michelle Nurse
Guyana Chronicle
October 12, 2003

Younger women in Guyana are being diagnosed with cancer of the breast, among them at least two teenagers. One of those young women has already undergone a mastectomy at a City hospital raising concerns that the irreversible surgery has been performed on one so young.

Though it is extremely rare worldwide for breast cancer to manifest itself in females of that age group, Guyana has recorded a slight increase in women in their 20s, 30s, and early 40s with cancer, Chairman of the Guyana Cancer Board, Dr. Walter Chin has said.

Breast cancer is usually diagnosed in women in their 50s, but the trend here of younger women having breast cancer diagnoses was observed years ago, Dr. Chin said.

The Guyana Cancer Registry has been recording more cases of younger women being diagnosed with cancer of the breast, and President of the Guyana Cancer Board, Dr. Walter Chin, said that evidence of this trend emerged years ago.

Of the 206 patients on the Breast Cancer Register for the period January 2000 to December 2002, there are 57 in the 41-50 age group, a similar number in the 51-60 bracket and 35 in the 61-70 age group. There are 21 patients in 71-80 bracket and seven in the 81-90 age group.

There are five recorded cases of females with breast cancer between the ages of 21 and 30 and 24 between the ages of 31 and 40, according to the Cancer Registry. There are no females under 20 with breast cancer on the registry.

"We are tending to see a number of women with breast cancer at an earlier age than what obtains in the developed countries," he said.

Dr. Chin pointed out that the process of cleaning up the data is now underway but nevertheless indicated that there is some evidence that "a little over three per cent of girls under 20 are getting cancer of the breast."

Asked about specific areas in the country where breast cancer in young girls may generally manifest itself, Dr Chin said: "We're looking at that right now... it doesn't seem as if it is (manifesting) itself in a particular area...; it's spread out all over Guyana, but we have to look further into that. We're in a sense trying to clean up the data to see if anything comes out of the information we have."

Despite the unusual manifestation, The Cancer Board has not been in contact with regional epidemiological facilities. Dr Chin explained that "we are looking at the figures; we're trying to be absolutely certain that these figures are accurate."

At present, the Board is working along with an epidemiologist to ensure that the figures are reliable and can be trusted.

"If that is so, we can then, probably in the near future, have these figures published and then start to compare our figures with figures from the rest of the Caribbean, ... and the developed countries.

"It is extremely unusual in the developed countries for girls under 20 to have cancer of the breast. So we have to be quite certain that what we are seeing is absolutely true before we can begin talking about cancer of the breast in that age group - three per cent is a significant percentage in that age group.

"I think we noticed, this trend, I would say many years... ago I began to see women in their mid-20s; now we're seeing it before (age) 20. But I think it first struck me 20 years ago when someone in their 20's had cancer of the breast, and unfortunately, it was not diagnosed early. The reason being because at that time, we really didn't think that breast cancer should be occurring in women in their mid-20's. So although there was a lump then, it was probably though then that it was a benign lump and not cancer," Dr. Chin said.

According to the doctor, if a patient complains of a lump in the breast, it may be clinically possible to make a diagnosis of cancer of the breast without a histological examination. The next step is the histological examination (microscopic examination) of either the lump itself, or tissue from the lump to determine whether it is cancer or not. If it is cancer, depending on the size and whether it has spread, surgical intervention may be necessary.

A biopsy should always be done, Dr. Chin stressed.

But Dr Chin has also pointed to the unreliability of some of the local diagnoses.

"We are not in a position where we can rely absolutely on the histological diagnosis in Guyana, because there are times when we have had the histological diagnosis where it said that there is no cancer and then (the tissue) is re-examined overseas and found to be cancerous. And on the other hand, we've had occasions where a diagnosis of cancer has been made and when the specimen has been looked at overseas... there's no diagnosis of cancer made! So we've had both sides ... the end result of which is that there has been a mistaken diagnosis," he said.

It is his recommendation that there should be in place a system where the labs can send a certain percentage of specimens overseas to recognised labs for confirmation of the diagnoses. In other words, a quality control system must be put in place, he said.

"We haven't reached that point as yet in Guyana," Dr Chin said.

Laboratories in Guyana fall under the purview of the Guyana National Bureau of Standards which issues licences, but there is need for "another independent way" of ensuring there is quality control in the lab. He pointed out that the Bureau of Standards does not have the kind of expertise to confirm whether or not the diagnoses from the laboratories are correct.

A mastectomy is performed when the physician has determined that the cancer has spread. The size of the cancer of the breast is also a determining factor.

"If it's just a small lump, the surgeon might perform a lumpectomy - taking out the lump without taking off the breast. If, unfortunately, the cancer is quite large that it necessitates the removal of the breast, (the surgery is done), he said."

Where the cancer almost takes over the entire breast - Cancer society has been trying to alert women that if there is a hard lump in the breast for over six weeks that they should consult a doctor to see if it is a benign lump or whether it is cancer.

"Unfortunately, we still see women who have had lumps for months and because it isn't paining she doesn't think it is cancer. We've been trying to get across the message that a breast lump is not painful is a lump that needs to be looked at. When a breast lump gets painful it's probably that ... it is at an advanced stage.

"It is unusual for young women to get breast cancer, but we have seen it in Guyana. We have to accept that fact. And if the breast was removed it would suggest that it was quite a big lump that necessitated the removal of the breast," Dr. Chin said.

"We know that breast cancer can be found in families and there are families that I know of in Guyana where breast cancer has been found. About five per cent of breast cancer is hereditary," he added.

According to Dr. Chin, the Cancer Society has also been "seeing cancer of the cervix in women in their 20's" and the Board is "looking at carrying out surveys in certain regions of Guyana to see whether the rate of cancer of the cervix among young women holds true and then following up on that to also ascertain the epidemiological risk factors that may be involved...".

He cautioned, however, that that process will be long-term. "It will take a few years actually, before we begin to look at the epidemiological factors involved in cancer of the cervix and cancer of the breast."

Meanwhile, a woman who was diagnosed with breast cancer and recently underwent a mastectomy has brought a case before the Guyana Medical Council, citing the possibility that her breast may have been wrongfully removed.

Head of the Guyana Medical Council, Dr. M.Y. Bacchus, told the Sunday Chronicle earlier this month that the woman has also charged that the doctor who performed the operation at the Georgetown Hospital refused to offer her a medical report.

The Council has ruled that the doctor must produce a medical report. It has also indicated that it will re-examine the woman's tissue specimen to ascertain if she, indeed, had cancer. The services of a third pathologist are also to be sought, Dr Bacchus said.

Editor's note,  Dr. Walter Chin died shortly after the article above was written, our heart felt sympathies goes out to his family and friends. Dr. Chin was one of the most respected medical professionals in Guyana, he will be missed greatly by all who knew him. RIP Doc.
----------------------------------
Guyana Cancer Society Radiotherapy Dept - Public Hospital Georgetown - 225-2398
gcs-gy@yahoo.com