The best method to make a true comparison of all parishes is to use the crude incidence rate
(CIR). Table 1 displays the crude incidence rates for all parishes. A pictorial representation of
the crude incidence rates for all parishes is illustrated using a bar chart in Fig. 4. Kingston and
St. Andrew are treated as one because of how they are interwoven. When the parishes are
analysed based upon the crude incidence rate it can be observed that top four crude incidence
rates were Kingston and St. Andrew, St. Ann, St. Elizabeth and St. Catherine. Their crude
incidence rates were 9.8, 8.7, 8.7 and 8.1 respectively. Kingston and St. Andrew has no bauxite
in the soil and their concentration of uranium in the soil is less than 4 mg/kg. This is illustrated
in Figs. 1 and 2. Kingston and St. Andrew are however the most industrialized parishes in
Jamaica. St. Ann, St. Elizabeth and St. Catherine contain bauxite and concentration of uranium
in the soil is greater than 4 mg/kg. An anomalous occurrence was Manchester which had a low
CIR of 3.2 but however has bauxite and the concentration of uranium in the soil is in general
greater than 6 mg/kg. Trelawny also has bauxite however no mining occurred in this parish in
2008. Its CIR was 2.7 and the concentration of uranium in the soil varied from 0 mg/kg to above
14 mg/kg. Most of the bauxite found in Trelawny and St. James falls under the Cockpit Country
Protected Area (CCPA).[3] In 2008 the mining of bauxite occurred primarily in St. Ann, St.
Elizabeth, St. Catherine and Manchester. Uranium has a natural decay series therefore other
radioactive elements will be present in the soil such as thorium and radon gas. Mining can cause
these particles to enter into the lungs of individuals. Al-Zoughool and Krewski (2009) confirmed
in their study that radon gas is a human lung carcinogen.[10] They found it was the second highest
cause of death due to lung cancer among miners after cigarette smoking.
Table 2 displays the age distribution of persons diagnosed with lung cancer in 2008. A total of
190 persons were diagnosed with lung (bronchus) cancer in 2008. The 190 persons consisted of
155 males and 35 females. In 2008 the CIR for males across all parishes was 11.6 and in the case
of females the CIR was 2.6. Gibson et al. (2010) studied cancer of the lung but also included the
trachea.[2] This study focused on Kingston and St. Andrew from 2003 to 2007. They obtained
that a total of 242 males were diagnosed with lung cancer and the CIR for this gender was 15.6.
In the case of females they obtained that a total of 67 were diagnosed with lung cancer and the
CIR was 3.9. This present study and theirs show that men are predominantly affected by lung
cancer. Some discrepancies may be due to the fact that this present study included all parishes
and it was for a shorter period of time. In this present study of the 190 persons diagnosed with
lung cancer, 62 were smokers. Table 2 also shows that the highest frequencies of persons
diagnosed with lung cancer occurred in the age group 55 years to 79 years. Figure 4 shows the
age distribution of lung cancer in Jamaica 2008 presented in the form of a histogram. The mean
age (µ) at which diagnosis occurred was 65.4 years. The standard deviation ( σ) was 12.1 years.
Their ages ranged from 34 years to 96 years and the skewness was 0.088.
Four parishes in Jamaica 2008 cancer of the lung was the leading cancer. These parishes were
St. Ann, St. Elizabeth, St. James and Westmoreland. The distribution of the various forms of
cancer in St. Ann and St. Elizabeth can be seen in Tables 3 and 4 respectively. In St. Ann of the
15 persons diagnosed with lung cancer 7 were smokers. In St. Elizabeth of the 13 persons that
were diagnosed with lung cancer 4 were smokers. In Kingston and St. Andrew of the 65 persons
that were diagnosed with lung cancer 18 were smokers. 42 persons were diagnosed with lung
cancer in St. Catherine and 15 were smokers. In St. James in 2008 11 persons were diagnosed
with lung cancer but only 1 was a smoker. In Westmoreland 5 persons were diagnosed with lung
cancer in 2008 and 2 were smokers.
Limitations
In 2008 and earlier there were two major cancer treatment centres in Jamaica for the public.
These were Kingston Public hospital in Kingston and Cornwall Regional hospital in St. James.
The machines they had at that time were cobalt machines. Hence many cases would be referred
to Kingston Public hospital from other parishes or to Cornwall Regional hospital. This would
depend on the proximity and the accessibility, meaning the length of the waiting list. Staff at the
Jamaica Cancer Registry only get data from hospitals and private sources in Kingston and St.
Andrew Jamaica. Hence some patients from the western end of the island such as the parishes of
St. James, Westmoreland, Trelawny and Hanover would not be recorded based upon the present
practise. Hence these would contribute to errors in the data from parishes in those regions of the
island. In Kingston in that period there was the Radiation Oncology Centre of Jamaica which
was established in 2001. This is a private centre for the treatment of cancer. Hence the limitation
here, would be your socioeconomic status. There would also be persons who would seek
alternative ways to treat their cancer.