AS Jamaica’s birth rate continues to decline, with more women opting not to have children or doing so at an older age, breast surgical oncologist Dr Jason Copeland says the country is likely to see an increase in breast cancer incidents.

“One of the things we have found is that women who have never had a child or women who delay pregnancy until later in life, between the ages of 30 and 35, statistically there is an increased risk of developing breast cancer in these women, and women who have had less than three children,” the clinical director of breast oncology service at Kingston Public Hospital (KPH) told the Jamaica Observer.

The surgeon explained that this is because breast cancer, in large part, is hormonally driven.

According to the National Cancer Institute in the Unites States, studies have shown that a woman’s risk of breast cancer is related to the oestrogen and progesterone made by her ovaries, and being exposed to these hormones for a long time at high levels is linked to an increased risk of breast cancer.

The institute stated that these increased hormonal levels are caused by a woman starting menstruation early, going through menopause late, being older at first pregnancy, and never having given birth. Consequently, the studies found that giving birth is a protective factor for breast cancer.

Recently, there has been much conversation about the alarming drop in Jamaica’s birth rate and how this will impact the country’s development.

Jamaica’s Population Health Status Report 2000–2022, tabled in Parliament in May, showed that the country continues to face a low birth rate problem, with the total number of live births in the country declining sharply over the last 20 years.

Overall, it said Jamaica’s crude birth rate, which is the number of annual live births per 1,000 population, declined by 10.2 percentage points from 21.7 per 1,000 population in 2000 to 11.4 per 1,000 population in 2022.

The country has also fallen below the replacement-level fertility rate of 2.1 for the first time and is currently at 1.9.

Dr Copeland, pointing to the correlation between reproduction and breast cancer, said that the incidents of breast cancer in Jamaica have already “been increasing, and the projections are that it will continue to increase”.

“There is actual data from the Global Cancer Observatory that says, between 2018 and 2022, there was about a 36 per cent increase in incidents of breast cancer in Jamaica,” said Dr Copeland, who was contacted by the Sunday Observer as part of the newspaper’s focus on the disease in keeping with Jamaica’s observance of Breast Cancer Awareness Month.

He added that the World Health Organization (WHO) has also warned that developing countries should expect a 40 per cent increase in incidence of breast cancer over the next two decades as more women choose to not have children or have them at an older age.

He, however, sought to clarify that not having kids does not automatically mean that a woman will have breast cancer.

“There is only a slight chance of an increase on an individual level, but when you take that on a population level you can see that the increase is more significant,” he explained.

Dr Copeland said that his research published by the National Library of Medicine — which examined breast cancer in Jamaica, the stage, grade, and molecular subtype distributions across age blocks, the implications for screening and treatment for the average Jamaican woman — shows that the risk of breast cancer is approximately one in every 15, with the typical age of diagnosis being between 52 and 54.

However, he said that this is particularly concerning because Jamaica is seeing patients diagnosed with breast cancer at a younger age compared to other countries like the United States, which has an average age for diagnosis at 62 years old.

“When we talk about breast cancer in young women, 36 per cent of the cancers that are diagnosed in our women, these women are below the age of 50 at the time of diagnosis,” he told the Sunday Observer.

“We understand that there are some differences we see in breast cancer here. For example, the types that we see tend to be more biologically aggressive, so they have a higher grade. We have twice the rate of the triple-negative breast cancer type, which is an aggressive breast cancer type,” said Dr Copeland.

He said, too, that the situation is particularly alarming because his study found that 40 per cent of patients in Jamaica tend to present with breast cancer at stage three when diagnosed.

“This is because we still don’t have, I think, the level of awareness in the population that we should have about breast cancer screening. We are seeing a lot of patients who will have a lump in the breast and will not go to have it checked, and when they present, they are presenting late,” he explained.

“When you combine the fact that we are seeing more aggressive breast cancer subtypes and we’re also seeing the cancers presenting much later, you can understand that our breast cancer mortality is much higher,” said Dr Copeland, who stressed that this is a big problem.

According to the Population Health Status Report for 2000–2022, breast cancer is the leading cause of death for women in Jamaica.

The report further noted that the mortality rate for breast cancer increased from 20.1 deaths per 100,000 in 2000 to 28.2 deaths per 100,000 in 2021. A total of 439 women are said to have died due to breast cancer in 2021.

Dr Copeland is urging women to become familiar with the shape and feel of their breasts, perform monthly breast examinations, and seek a doctor’s opinion if they notice something abnormal.

“Every woman should really get a breast cancer risk assessment done once you are over the age of 30. It’s an individual assessment looking at your personal history, your family history, and it will determine your level of risk,” he said.

“If you have a high risk of developing breast cancer, then your mammogram screening should start at age 40 and that is done every year. In some women, you may add a breast ultrasound in particular if the breast is dense. Examine your breast,” Dr Copeland urged women.