Cancer Causes & Control

, Volume 28, Issue 11, pp 1251–1263 | Cite as

Gynecologic cancer mortality in Trinidad and Tobago and comparisons of mortality-to-incidence rate ratios across global regions

  • Adana A. M. Llanos
  • Wayne A. Warner
  • Silvana Luciani
  • Tammy Y. Lee
  • Smriti Bajracharya
  • Simeon Slovacek
  • Veronica Roach
  • Marjorie Lamont-Greene
Original paper



To examine the factors associated with gynecologic cancer mortality risks, to estimate the mortality-to-incidence rate ratios (MIR) in Trinidad and Tobago (TT), and to compare the MIRs to those of select countries.


Data on 3,915 incident gynecologic cancers reported to the National Cancer Registry of TT from 1 January 1995 to 31 December 2009 were analyzed using proportional hazards models to determine factors associated with mortality. MIRs for cervical, endometrial, and ovarian cancers were calculated using cancer registry data (TT), GLOBOCAN 2012 incidence data, and WHO Mortality Database 2012 data (WHO regions and select countries).


Among the 3,915 incident gynecologic cancers diagnosed in TT during the study period, 1,795 (45.8%) were cervical, 1,259 (32.2%) were endometrial, and 861 (22.0%) were ovarian cancers. Older age, African ancestry, geographic residence, tumor stage, and treatment non-receipt were associated with increased gynecologic cancer mortality in TT. Compared to GLOBOCAN 2012 data, TT MIR estimates for cervical (0.49 vs. 0.53), endometrial (0.61 vs. 0.65), and ovarian cancers (0.32 vs. 0.48) were elevated. While the Caribbean region had intermediate gynecologic cancer MIRs, MIRs in TT were among the highest of the countries examined in the Caribbean region.


Given its status as a high-income economy, the relatively high gynecologic cancer MIRs observed in TT are striking. These findings highlight the urgent need for improved cancer surveillance, screening, and treatment for these (and other) cancers in this Caribbean nation.


Caribbean Trinidad and Tobago Cervical cancer Ovarian cancer Endometrial cancer Mortality Mortality-to-incidence rate ratio 



Support was provided by Washington University School of Medicine (GSAS/CGFP Fund 94028C) (WAW), and by the Cancer Center Support Grant Number P30CA072720 from the National Cancer Institute (through a New Investigator Award awarded to AAML). We acknowledge the assistance of Stephan Samuell, Central Statistical Office in Trinidad & Tobago. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the affiliating organizations.

Compliance with Ethical Standards

Conflict of interest

Authors have no conflicts of interest to disclose.


  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in globocan 2012. Journal International du Cancer (Int J Cancer) 136:E359–E386CrossRefGoogle Scholar
  2. 2.
    Weiderpass E, Labreche F (2012) Malignant tumors of the female reproductive system. Saf Health Work 3:166–180CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Razzaghi H, Quesnel-Crooks S, Sherman R et al (2016) Leading causes of cancer mortality—Caribbean region, 2003–2013. MMWR Morb Mortal Wkly Rep 65:1395–1400CrossRefPubMedGoogle Scholar
  4. 4.
    Melan K, Janky E, Macni J et al (2017) Epidemiology and survival of cervical cancer in the French west-indies: data from the martinique cancer registry (2002–2011). Glob Health Action 10:1337341CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Blake G, Hanchard B, Gibson T et al (2003) Gynaecologic cancer incidence, Kingston and St Andrew, Jamaica, 1973–1997, and gynaecologic cancer mortality, Jamaica, 1999. West Indian Med J 52:273–277PubMedGoogle Scholar
  6. 6.
    Gelband H, Sankaranarayanan R, Gauvreau CL et al. (2016) Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from disease control priorities, 3rd edn. Lancet 387:2133–2144CrossRefPubMedGoogle Scholar
  7. 7.
    Pinheiro PS, Callahan KE, Ragin C, Hage RW, Hytlon T, Kobetz EN (2016) Black heterogeneity in cancer mortality: Us-blacks, Haitians, and Jamaicans. Cancer Control 23:347–358CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Lewis-Bell K, Luciani S, Unger ER et al (2013) Genital human papillomaviruses among women of reproductive age in Jamaica. Revista Panamericana de Salud Publica (Pan Am J Publ Health) 33:159–165CrossRefGoogle Scholar
  9. 9.
    Bahadoor-Yetman A, Riley L, Gibbons A et al (2016) Prevalence of cervical cancer and associated mortality in grenada, 2000–2010. Revista Panamericana de Salud Publica (Pan Am J Publ Health) 39:194–199Google Scholar
  10. 10.
    (PAHO) PAHO (2013) Cancer in the Americas, country profiles 2013. PAHO, Washington, D.C.Google Scholar
  11. 11.
    Ortiz AP, Perez J, Otero-Dominguez Y et al (2010) Endometrial cancer in puerto rico: incidence, mortality and survival (1992–2003). BMC Cancer 10:31CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Warner WA, Morrison RL, Lee TY et al (2015) Associations among ancestry, geography and breast cancer incidence, mortality, and survival in Trinidad and Tobago. Cancer Med 4(11):1742–1753CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Boyle P, Parkin D (1991) Cancer registration: principles and methods. Statistical methods for registries. IARC Sci Publ 95:126–158Google Scholar
  14. 14.
    Jensen O, McLeannan R, Muir C, Skeet G (1991) Cancer registration: principles and methods. IARC Sci Publ 95Google Scholar
  15. 15.
    Fritz A, Percy C, Jack A et al (2000) International classification of diseases for oncology, 3rd edn. World Health Organization, GenevaGoogle Scholar
  16. 16.
    Segi M (1960) Cancer mortality for selected sites in 24 countries (1950–1957). Sendai Department of Public Health, Tohoku University of Medicine, SendaiGoogle Scholar
  17. 17.
    World Health Organization (2016) World health organization, health statistics and information systems, mortality database. GenevaGoogle Scholar
  18. 18.
    Ferlay J, Soerjomataram I, Ervik M et al (2013) Globocan 2012 v1.0, cancer incidence and mortality worldwide: Iarc cancerbase no. 11. International Agency for Research on Cancer, LyonGoogle Scholar
  19. 19.
    Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD (2005) Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ 83:171–177PubMedPubMedCentralGoogle Scholar
  20. 20.
    Bruni L, Barrionuevo-Rosas L, Albero G et al. (2016) Human papillomavirus and related diseases in Trinidad & Tobago. Summary report 15Google Scholar
  21. 21.
    Lewis MJ (2004) A situational analysis of cervical cancer in latin america and the caribbean. Pan American Health Organization, Washington DCGoogle Scholar
  22. 22.
    Andall-Brereton GM, Hosein F, Salas RA et al (2011) Human papillomavirus genotypes and their prevalence in a cohort of women in Trinidad. Revista Panamericana de Salud Publica (Pan Am J Publ Health) 29:220–226Google Scholar
  23. 23.
    Ragin CC, Wheeler VW, Wilson JB et al. (2007) Distinct distribution of hpv types among cancer-free afro-caribbean women from tobago. Biomarkers 12:510–522CrossRefPubMedGoogle Scholar
  24. 24.
    Hosein F, Mohammed W, Zubach V, Legall G, Severini A (2013) Human papillomavirus genotypes in invasive cervical squamous cell carcinoma in Trinidad. Revista Panamericana de Salud Publica (Pan Am J Publ Health) 33:267–270CrossRefGoogle Scholar
  25. 25.
    Walboomers JM, Jacobs MV, Manos MM et al (1999) Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 189:12–19CrossRefPubMedGoogle Scholar
  26. 26.
    Bosch FX, Lorincz A, Munoz N, Meijer CJ, Shah KV (2002) The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 55:244–265CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Islami F, Torre LA, Drope JM, Ward EM, Jemal A (2017) Global cancer in women: cancer control priorities. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive OncologyGoogle Scholar
  28. 28.
    Lu KH, Dinh M, Kohlmann W et al (2005) Gynecologic cancer as a sentinel cancer for women with hereditary nonpolyposis colorectal cancer syndrome. Obstet Gynecol 105:569–574CrossRefPubMedGoogle Scholar
  29. 29.
    Obermair A, Youlden DR, Young JP et al (2010) Risk of endometrial cancer for women diagnosed with hnpcc-related colorectal carcinoma. Int J Cancer 127:2678–2684CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Gayther SA, Pharoah PD (2010) The inherited genetics of ovarian and endometrial cancer. Curr Opin Genet Dev 20:231–238CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Rauh-Hain JA, Krivak TC, Del Carmen MG, Olawaiye AB (2011) Ovarian cancer screening and early detection in the general population. Rev Obstet Gynecol 4:15–21PubMedPubMedCentralGoogle Scholar
  32. 32.
    Kirchhoff T, Gaudet MM, Antoniou AC et al (2012) Breast cancer risk and 6q22.33: combined results from breast cancer association consortium and consortium of investigators on modifiers of brca1/2. PLoS ONE 7:e35706CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Machado PM, Brandao RD, Cavaco BM et al (2007) Screening for a brca2 rearrangement in high-risk breast/ovarian cancer families: evidence for a founder effect and analysis of the associated phenotypes. J Clin Oncol 25:2027–2034CrossRefPubMedGoogle Scholar
  34. 34.
    Meijers-Heijboer H, van den Ouweland A, Klijn J et al (2002) Low-penetrance susceptibility to breast cancer due to chek2(*)1100delc in noncarriers of brca1 or brca2 mutations. Nat Genet 31:55–59CrossRefPubMedGoogle Scholar
  35. 35.
    Michailidou K, Hall P, Gonzalez-Neira A et al (2013) Large-scale genotyping identifies 41 new loci associated with breast cancer risk. Nat Genet 45:353–361CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Struewing JP, Hartge P, Wacholder S et al (1997) The risk of cancer associated with specific mutations of brca1 and brca2 among ashkenazi jews. New Engl J Med 336:1401–1408CrossRefPubMedGoogle Scholar
  37. 37.
    Thorlacius S, Olafsdottir G, Tryggvadottir L et al (1996) A single brca2 mutation in male and female breast cancer families from iceland with varied cancer phenotypes. Nat Genet 13:117–119CrossRefPubMedGoogle Scholar
  38. 38.
    Thorlacius S, Struewing JP, Hartge P et al (1998) Population-based study of risk of breast cancer in carriers of brca2 mutation. Lancet 352:1337–1339CrossRefPubMedGoogle Scholar
  39. 39.
    NCCN (2016) Nccn guidelines version1.2016 NCCNGoogle Scholar
  40. 40.
    SGO (2014) Sgo clinical practice statement: genetic testing for ovarian cancer. SGO, ChicagoGoogle Scholar
  41. 41.
    Pal T, Permuth-Wey J, Betts JA et al (2005) Brca1 and brca2 mutations account for a large proportion of ovarian carcinoma cases. Cancer 104:2807–2816CrossRefPubMedGoogle Scholar
  42. 42.
    Schrader KA, Hurlburt J, Kalloger SE et al (2012) Germline brca1 and brca2 mutations in ovarian cancer: utility of a histology-based referral strategy. Obstet Gynecol 120:235–240CrossRefPubMedGoogle Scholar
  43. 43.
    Walsh T, Casadei S, Lee MK et al (2011) Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing. Proc Natl Acad Sci USA 108:18032–18037CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Kaye SB, Lubinski J, Matulonis U et al (2012) Phase ii, open-label, randomized, multicenter study comparing the efficacy and safety of olaparib, a poly (adp-ribose) polymerase inhibitor, and pegylated liposomal doxorubicin in patients with brca1 or brca2 mutations and recurrent ovarian cancer. J Clin Oncol 30:372–379CrossRefPubMedGoogle Scholar
  45. 45.
    Donenberg T, Ahmed H, Royer R et al (2016) A survey of brca1, brca2, and palb2 mutations in women with breast cancer in Trinidad and Tobago. Breast Cancer Res Treat 159:131–138CrossRefPubMedGoogle Scholar
  46. 46.
    Roach A, Warner WA, Llanos AA (2015) Building capacity for human genetics and genomics research in Trinidad and Tobago. Revista Panamericana de Salud Publica (Pan Am J Publ Health) 38:425–430Google Scholar
  47. 47.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA: A Cancer J Clin 65:87–108Google Scholar
  48. 48.
    Bray F, Jemal A, Grey N, Ferlay J, Forman D (2012) Global cancer transitions according to the human development index (2008–2030): a population-based study. Lancet Oncol 13:790–801CrossRefPubMedGoogle Scholar
  49. 49.
    Globocan (2012) Estimated cancer incidence, mortality and prevalence worldwide in 2012. Online analysis > prediction. International Agency for the Research on Cancer, LyonGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Adana A. M. Llanos
    • 1
    • 7
  • Wayne A. Warner
    • 2
  • Silvana Luciani
    • 3
  • Tammy Y. Lee
    • 4
  • Smriti Bajracharya
    • 5
  • Simeon Slovacek
    • 4
  • Veronica Roach
    • 6
  • Marjorie Lamont-Greene
    • 6
  1. 1.Department of Epidemiology, Rutgers School of Public Health and Division of Population Science, Rutgers Cancer Institute of New JerseyRutgers UniversityNew BrunswickUSA
  2. 2.Oncology Division, Department of Cell Biology and Physiology, Siteman Cancer CenterWashington University School of MedicineSt. LouisUSA
  3. 3.Cancer Prevention and ControlPan American Health OrganizationWashington, DCUSA
  4. 4.Division of Applied and Advanced Studies in EducationCalifornia State UniversityLos AngelesUSA
  5. 5.Center for Public Health Systems Science, George Warren Brown School of Social WorkWashington UniversitySt. LouisUSA
  6. 6.Dr. Elizabeth Quamina Cancer RegistryMt. HopeTrinidad and Tobago
  7. 7.Department of EpidemiologyRutgers School of Public HealthPiscatawayUSA

Personalised recommendations