Screening for cervical cancer at the family counselling centre with the papnicolau smear technique - abstract

The communication is made to highlight the importance of screening for cancer of the cervix among women in the reproductive age group. Women attending family planning clinics form a high risk, and should be screened for cervical cancer. The study was conducted at the Family Counselling Centre (F.C.C.) located in a densely populated are in Kingston. The Centre holds daily ten-hour sessions. An extension of this Centre in down town Kingston meets once a week. The period under review was from May, 1967 - December, 1970. While at some clinics all cases did not have Papanicolau (pap) smears done, at the F.C.C. every women had the benefit of this examination. At this clinic, 3,585 women were examined and 5,320 pap smears done, i.e. 1,735 were repeated smears. All women with "positive" smears had cone biopsy done for tissue confirmation. Treatment of the cervical cancer was mainly by radiotherapy. Of the 3,585 women screened, 96 women had "atypical" smears of which 35 or 1 percent were thought to be "positive: for cancer. 80 percent of the women with " positive" smears had tissue confirmation of the cervical cancer. 30 percent of the women proven to have cervical cancer showed histological evidence of invasion. Cervical cancer screening augments the cost of the family planning service, but this must be weighed against the fact that cancer of the cervix ranks first among cancers in Jamaican women and causes a high morbidity and mortality when diagnosed in the invasive stage. By this screening method treatment of the cancer in the early stage is possible, so that ultimately the cost of the programme will be fully warranted (AU)

Report on 151 childhood malignancies observed in Jamaica

During a 10-year period 1958-67, 151 tumors were noted in children under 15 years of age in Jamaica. This comprised 2.9 percent of all malignant tumors observed. Leukemia was the most common form of cancer. The incidence of retinoblastomas was high and surpassed incidences of neuroblastomas and of Wilms' tumors. Kaposi's sarcoma was not observed, and hepatocellular carcinoma was extremely rare. The tumor incidence pattern in Jamaica therefore largely resembles that in the United States and in Western Europe. It contrasts significantly with that in Uganda and in Western Nigeria. This merits attention, since over 90 percent of the Jamaican population is either pure Negro or of predominantly Negro descent as a result of importation from West Africa in former days. (Summary)

Aspects of cancer of the gastro-intestinal tract in Jamaica

Some of the cancers of the Gastro-intestinal tract take on a special significance in Jamaica. This is particularly evidenced by the incidence figures of Cancer of the Oesophagus and Cancer of the Stomach in males. A recent publication from the International Union against Cancer, compared data from 32 Cancer Registries in 24 Countries. Among these Jamaica was found to have the highest incidence of Cancer of the oesophagus Cancer exceeding the Jamaican rates, but as no Cancer Registry figures were available from those countries, a comparison could not be made. Jamaica's high incidence figures are shared by at least 2 other Caribbean islands, Puerto Rico and Curacao. Cancer of the Stomach is the most common single type of Cancer in Jamaican male. The incidence figures for all types of Gastro-intestinal Cancer will be briefly discussed in relation to rates in other parts of the world and the suspected aetiological factors wil be briefly reviewed (AU)

The five most frequent cancers in Jamaica

The pattern of cancer in Jamaica is in several respects remarkably different from that in Africa, yet also quite different from that in temperate zones (Fig. 6 Table 2). It is unlikely that genetic differences could account for this. A search for possible environmental aetiological factors is clearly indicated for such neoplasms as oesophageal cancer, where Jamaica shows the highest figures of 25 countries compared and where the Caribbean seems to be especially afflicted (Table 2). Carcinoma of the cervix, the highest ranking cancer in females, shows an incidence second to Cali, Columbia. Our present knowledge of the environmental aetiology of this disease, justifies the recommendation that circumcision of newborn boys should be widely offered in Jamaica. This practice would also offer virtually complete protection against penile cancer, a relatively frequent cancer in males. In any event, the knowledge that reasonable cleanliness would go a long way in preventing both cervical and penile cancers should be widely disseminated throughout the Jamaican population. Our breast cancer incidences are remarkably high and indicate that a careful epidemiological study should be dine of the practice of breast-feeding in patients with breast cancer as compared with controls. Gastric cancer, the highest ranking cancer in males, is not frequent in absolute terms when compared with other countries (AU)

Problems in the hematological diagnosis of unusual coagulation disorders

Thirteen cases of severe coagulation disorders occuring during the past 5 years and investigated at the Government Pathological Laboratory, Jamaica are discussed. Nine of these were hemophilias, one had Christmas disease and three further cases which presented complicated aberrations are discussed in detail. Of this latter group one had multiple congenital deficiency of prothrombin complex (i.e. prothrombin factor VII and factor X) and the other two, who were siblings, had multiple anomalies (anti-hemophilic globulin deficiency, a circulating anti-coagulant acting as a thrombo-plastin inhibitor as well as a plasma thromboplastin antecedent deficiency) (AU)

Cancer of the cervix in Jamaica (abstract only)

Figures from the Cancer Registry at the University College Hospital of the West Indies show that carcinoma of the cervix in Jamaica is responsible for over 30 percent of all malignancies in females. This compares with 26.8 percent in U.S. Negroes, 41.7 percent in Bantus and 5 percent in South West England. Some statistical and morphological aspects of this carcinoma are presented (AU)

Cirrhosis of the liver in Jamaica

The incidence of cirrhosis of the liver in a necropsy series in Jamaica is analysed. There were 77 cases (4.9 percent of necropsies), which could be classified morphologically as follows: post-necrotic, 30 percent; portal, 28.5 percent; post-veno-occlusive disease (VOD), 30 percent; biliary, 1.3 percent. The morphogenesis of cirrhosis following VOD is discussed.(AU)

Cor triventriculare: infundibular stenosis with subdivision of the right vertricle

Two unusual cases of triventricular hearts are described in which the right ventricle is partitioned into two chambers, the smaller of which is placed antero-superiorly and gives off the pulmonary trunk. Other anomalies present are high interventricular septal defect, overiding aorta and biscuspid pulmonary valves. Only a few cases of this anomaly appear to have been described. The possible pathogenesis is discussed and its relationship to Fallot's tetralogy is considered.(AU)

Analysis of 136 consecutive cases of malignant neoplasms of the stomach

One hundred and thirty-six consecutive cases of malignant neoplasms of the stomach are analysed. These cases were taken from the files of the Jamaica Cancer Registry but were not otherwise selected. The incidence of this tumor in Jamaica is compared with similiar studies in standard populations in Denmark, England and Africa and the general pathology and natural history reviewed. Cases of carcinomas of the stomach in Jamaica first present themselves at a late stage, and results of surgical treatment are correspondingly poor. The role of gastric cytology in the early diagnosis of carcinoma of the stomach is discussed (AU)

Congenital heart disease in Jamaica: observations on post mortem incidence, with a report of an unusual case of cor triloculare biatriatum

A study of the autopsy records in the University College Hospital of the West Indies shows congenital cardiac disease to comprise 2.2 percent of all cases autopsied. The incidence and pattern of the disease appears to show no great differences to that observed in other countries. An unusual case of cor triloculare biatriatum is recorded, and the pathogenesis discussed (AU)

Cirrhosis and liver cancer in Jamaica (abstract only)

The overall incidence of liver cirrhosis in 1560 autopsies (still-births excluded) at University College Hospital is 4.9 percent. Morphological study reveals approximately one-third each of portal, post-necrotic and post-V.O.D. types. Various aetiological factors are presented and the morphogenesis, particularly of post-V.O.D. cirrhosis, is discussed. Primary carcinoma of the liver in Jamaica occurs more frequently than is reported in Europeans, but much less than in Africans. Hepatocellular carcinoma is more common than cholangiocarcinoma and there is predilection for the young adult male (AU)

The incidence of malignant neoplasms in Jamaica

Data obtained so far from a comprehensive survey of cancer in Kingston and St. Andrew are given. The findings revealed an overall incidence of cancer comparable with Denmark but with certain remarkable site differences. In Jamaica, cancer of the upper alimentary and and respiratory tract, oesaphagus, cervix and penis ocurred more frequently while gastro-intestinal malignancies were less common. Cancer of liver and lung occupied an intermediate position between European and African incidences; the incidence for liver cancer is much lower than in Africa. Data on cancer obtained from the autopsy records of the University College Hospital for the year 1952-1958 were compared with similar autopsy studies in American whites and negroes. (AU)

Leukaemia in Jamaica: a statistical survey of seventy cases

Information from all parts of the world indicates that the incidence of leukaemia has been increasing in recent years. In a survey of leukaemia in Jamaica for the years 1953-1957, evidence is brought forward to suggest that a similar increase is occurring here and the figures for 1957 show an incidence of leukaemia comparable to that of most European countries. An analysis of 70 cases of leukaemia show chronic myeloid leukaemia to be the commonest variety. The frequency of the acute leukaemias is similar to British figures, and the overall picture of age and sex distribution is also almost identical. The possible reasons for this general increase in leukaemia are discussed. (AU)

Haemophilia in Jamaica

Comment is made of the few cases of haemophilia reported among mixed and coloured populations, and the literature relevant to this is briefly surveyed. A brief account is given of the history of haemophilia and its recent separation from other coagulation defects. The main theories of blood coagulation are briefly presented. Three cases of haemophilia occurring in Jamaicans of predominantly Negro ancestry are presented with clinical and haematological data. Investigations with the thromboblastin generation test leave no doubt that these are bona fide haemophiliacs. Certain points in connection with the diagnosis, prognosis and treatment of haemophilia are discussed. Despite the few case4s of haemophilia described in coloured populations, it is felt that the incidence of the disease in these racial groups is much higher than had been thought. Once medical facilities become more widely available in underdeveloped territories the incidence of haemophilia will probably be found to be equal or nearly equal to that found among the Teutonic races of Europe and America. (AU)

Further observations on the morphology of veno-occlusive disease of the liver in Jamaica

Extended pathological-anatomical data gleaned from 19 autopsies on patients with veno-occlusive disease of the liver are presented. The condition is frequently observed in Jamaican infants and children and less frequently in adults. Repeated attacks lead to a diffuse non-portal type of cirrhosis. Grossly the cirrhosis is indistinguishable from the portal type of Laennec's cirrhosis but the condition should not be regarded as a result of protein-malnutrition alone, nor as an after effect of kwashiorkor earlier in life. The pivotal lesion is obstruction of the smaller and medium sized branches of the hepatic vein. In the acute phase this mostly presents the picture described by earlier investigators as endophlebitis hepatica obliterans. Thrombosis is notably rare. The possibility is advanced that Duguid's concept of organizing arterial mural thrombi could explain the picture of "endophlebitis" in this condition, but so far this cannot be substantiated as it has not been demonstrated histologically that the endophlebitic thickening are either thrombi or mural despositions of constituents from the blood which have become organised. Available data suggest a toxic substance in "bush-teas" as a possible aetiologic factor. Concurrent substance of fatty change in the liver and of pancreatic pathology, both identical to the lesions observed in protein-under-nutrition, suggest that the latter may be an important co-factor. The result of dietary studies done Rhodes (1955) are also in conformity with this concept. (AU)

A case of liver cirrhosis in a child

The clinical history and pathological findings are described in a case of hepatic cirrhosis dying at the age of 3 1/2 years. The onset of symptoms began soon after the cessation of breast feeding with the development of ascites and hepatomegaly, later followed by jaundice and a haemorrhagic diathesis. At autopsy a well developed cirrhosis of the liver was present, the microscopic appearance of which revealed a thickening of the intima of the branches of the hepatic veins and a marked fibrosis showing a predilection for non-portal areas. It is suggested that this picture fits into the group described by Bras, Jelliffe and Stuart, as chronic veno-occlusive disease or chronic V.O.D. Kwashiorkor and the infantile hepatic cirrhosis of the Indian workers are briefly compared with this condition (AU)