Dr George Laquis: Some cancers don’t need treatment

By Yvonne Baboolal
Many women who are diagnosed with breast cancer and made to undergo surgery, radiotherapy and chemotherapy do not need treatment at all. In such cases, they can actually live with the disease, says Dr George Laquis, former head of the T&T Cancer Society, who has been at the forefront of the cancer battle in T&T for more than four decades.

Giving an example, Dr Laquis said women diagnosed with breast carcinoma in situ (BCIS) will die with the cancer but not from it.

“I am not sure we should be treating those kinds of cancer. We can leave it alone,” he said, also making the point in reference to the shortage of cancer drugs and the high cost of treatment.

Speaking on the topic of cancer misdiagnoses, Dr Laquis said from the time a type of cancer is detected, the usual reaction is to start a process of surgery, radiotherapy and chemotherapy. He said such a misdiagnosis creates physical and psychological distress.

Then, there’s the case of making a diagnosis when you don’t need to. For instance, if a 75-year-old man is diagnosed with prostate cancer, it may be best not to tell him, Laquis said.

“In all probability, he is going to die anyway in ten years or less.”

Laquis said if an elderly patient comes to him saying he wants to see if he has cancer, he tells him: “I don’t want to see if you have cancer. Physicians are trained to interfere. There comes a time when it’s best to put your hands behind your back.”

He said 30 per cent of all geriatric hospital admissions in the United States are because of doctor and medical error, which is the third leading cause of death.

Cervical cancer
In its series on cancer for Cancer Awareness Month, the T&T Guardian spoke to Marina Hilaire-Bartlett, executive director of the public health agency, Population Services International (PSI) Caribbean, on the rise in cervical cancer in T&T. Hilaire-Bartlett preferred not to describe it as an increase.

“I would say the prevalence is higher than it should be,” she said,

Washington-based PSI, according to its website, has been for four decades a game changer in contraceptive product marketing and distribution. In 2013, the agency distributed more than a billion condoms worldwide and more than 100 million tubes of lubricant.

Hilaire-Bartlett said PSI Caribbean, is also involved in an HIV programme. She said 210 new cases of cervical cancer are diagnosed every year in T&T and there is a strong link between cervical cancer and the sexually transmitted disease, Human papillomavirus (HPV), as 99 per cent of the causes of cervical cancer is HPV.

HPV is one of the most prevalent sexually transmitted diseases and, in T&T, cervical cancer is the second most common form of cancer among women.

“It’s a preventable cancer,” Hilaire-Bartlett said.

She said there is a need for a greater investment in women’s health by the State and other health agencies. Noting that PSI Caribbean works with the Health Ministry and the Family Planning Association, Hilaire-Bartlett said they focus on prevention of cervical cancer by prevention and early treatment of HPV.

She said the HPV vaccine, one of the main ways to prevent cervical cancer, is administered freely at public health institutions. The best way to administer the vaccine is to give it to boys and girls over 11 and 12 years of age before they are sexually active. However, this has been met with resistance from parents, she said.

“Parents feel this would encourage them to become sexually active.”

State of cancer treatment centres
Medical personnel at the cancer treatment centre at the St James Infirmary and at the cancer clinic at the San Fernando General Hospital (SFGH) are devoted and are doing a remarkable job under the circumstances, the T&T Guardian was told.

Dr Anand Chatoorgoon, former SFGH medical director, said patients get chemotherapy treatment at the hospital but no radiotherapy. The hospital also does cancer surgeries and provides cancer drugs free of charge.

The Southern Medical Clinic, a private facility, has an arrangement with the Government to administer radiotherapy to cancer patients there.

“The Government picks up the tab. All the processes are quite expensive. At San Fernando, patients have to go on a six-week course with the drugs and sometimes more than one course.”

Asked about the condition of facilities at the SFGH, Chatoorgoon said: “Yes, it’s good. It’s okay.”

Conditions at the St James Infirmary are also the “best they can be,” Laquis said.

“Staff work hard. The facilities are not perfect but they try their best with what they have. They are a very devoted group doing very good work. Considering the circumstances, they are doing a remarkable job.”

Last week, in a T&T Guardian interview, Laquis suggested that the Couva Children’s Hospital, built under the former Kamla Persad-Bissessar administration for sick children, should be converted into a centre for a national cancer programme. He said the Government should set up a committee to look for a suitable academic partner to come up with the programme.

The building was completed just before the end of the last administration’s term in September last year but to date remains unopened and unused by the new government.(Trinidad Guardian)

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