Compelling case for increased colon screening

Most Barbadians know that October is Breast Cancer Awareness Month. This is due to the high level of public awareness, advocacy and corporate support of preventative care and screening directed towards this disease that affects mostly women.

However, lurking in the shadows with very few early symptoms but inflicting untold damage and death for a growing number of Barbadian men and women, is colorectal cancer.

Cancer of the colon is a wholly preventable cancer. When detected early through screening, patients can be successfully treated and go on to live normal, long, healthy lives.

If one could describe it as a “positive side”, colon cancer tumours often take many years to grow and spread. And so, in the intervening period, there are several opportunities to identify and eliminate the cancer before it metastasises to vital organs.

Why is colon cancer such a major talking point? The incidence of the disease is growing at an alarming rate in Barbados, and the cancer is now ranked as one of the leading causes of death.

Dr Sahle Griffith, Head of the Department of Surgery at the Queen Elizabeth Hospital (QEH), has seen more late-stage colon cancer cases than he would care to recall. In fact, the specialist is extremely concerned about the number of people under 50-years-old being diagnosed with Stages 3 and 4 colon cancer that has spread to organs like the liver.

Those stages of the disease are problematic for successful treatment and frequently, death follows soon after such a delayed diagnosis.
Movie-goers will not easily forget Chadwick Boseman, who played T’Challa in the hugely popular Marvel movie, Black Panther. Boseman, 43, died last year of colon cancer, in the prime of his life and acting career.

Here at home, entertainer, and emcee Antoine “Brudda Daddy” Williams, went public in 2017 when he was given the grim news that he too, had Stage 4 colon cancer.

Unlike Boseman, who kept his illness from the public until the very end, Williams’ decision to speak openly to Barbadians about his battle with colon cancer, brought a familiar face and attention to the disease.

Fortunately, Williams underwent successful but costly surgery to remove the tumour that was spreading. Today, Williams remains active, going about his day-to-day life, while still receiving follow-up treatment at the QEH.

On June 8, Dr Griffith, participated in a highly specialised surgery, led by Barbadian Hepatobiliary and Pancreatic Surgeon, Dr Greg Padmore, to remove a large tumour from a 46-year-old woman’s liver.

Dr Padmore, the 2012 QEH Intern of the Year, and a Senior Registrar in the QEH’s Department of Surgery, is on the verge of completing his sub-specialty training in liver and pancreatic surgery.

The historic operation on the young patient, will likely prolong her life by many years. Without the procedure, the alternative would have been palliative care.

Citing a Pan American Health Organisation (PAHO) paper on colon cancer in Latin America and the Caribbean, Dr Griffith stated that the current incidence rate for colon cancer of around 30 per 100, 000 persons in Barbados, is expected to jump by a staggering 60 per cent over the next 10 years.

“We recently published some data and about 70 per cent of those persons in that group were presenting with Stage 3 or Stage 4 disease, and a significant number of those persons were under 50 -years,” said Griffith, a Laparoscopic and Bariatric Surgeon.

“The issue that we have is screening . . . . What we do know is that the Barbados National Registry has suggested from their data, that around 65 per cent of the persons diagnosed with colon cancer in Barbados are dead within three years of their diagnosis.”

“And that is really in large part, due to the prevalence of advanced disease and the lack of expertise with regard to resection (surgically removing part or all of a tissue, structure, or organ) of liver metastases.”

A big advocate for continuous screening for cancers, the QEH surgical consultant said Barbadians should not be discouraged by the initial cost of colonoscopies, which are highly effective in detecting precancerous polyps or the presence of cancer in the bowels.

Offering his assessment of the economic costs of early screening versus treatment of late-stage cancers, Griffith said the answer is quite clear.

“If you find someone with Stage 3 or 4 disease, the total cost of treatment from beginning to end, inclusive of all the chemotherapy is about $300, 000. You cannot compare that with a test that costs $3, 000.”

Given the increasing evidence in support of disease presentation at earlier ages amongst Afro-American and Afro- Caribbean populations, the surgeon endorses colon screening from as early as age 45.

Moreover, Dr Griffith said a strong case can also be made for more consultant posts in the public health system for surgeons with sub-specialist skills such as Dr Padmore’s.

This, he noted, is required if the island is to adequately respond to the demand for high-quality care for those with various forms of the disease.

Colon Cancer Awareness Month is commemorated in March each year. (PR/QEH)