Nov. 18, 2001 – Superior levels of cancer care and treatment will soon become available in the Virgin Islands, as the Charlotte Kimelman Cancer Treatment Center moves closer to reality.
Having a local cancer center will greatly improve the quality of care and treatment, from the standpoint of both patient and physician, Dr. Bert M. Petersen Jr. said at the 8th annual Bio-Medical Ethics Workshop on Women's Health, held last week at Roy L. Schneider Hospital.
Petersen, a native Virgin Islander, is a New York City surgeon, cancer specialist and medical school professor.
Once the territory's cancer center is established, Petersen envisions a level of specialist care not available now. He said he is working to establish academic affiliations "that would result in specialists, residents and interns being based at the center."
Amos Carty, Schneider Hospital attorney, said bond issue procedures are "moving along," and the hospital's share of the proceeds — recently estimated at more than $6 million — should be available for use by the end of November.
In August. Gov. Charles W. Turnbull signed a bill into law providing for the creation of a Tobacco Settlement Financing Corp. empowered to borrow money though the issuance of bonds backed by anticipated annual payments to the territory from the nationwide class-action settlement with tobacco companies. "By law," Carty said Wednesday, "all proceeds will go to health and medical care," to be shared by the Health Department and the territory's two semi-autonomous hospitals.
Meanwhile, a planning group headed by Beverly Chongasing, president of the Schneider Hospital Board of Trustees, is proceeding with preliminary planning for the physical building that will house the cancer center. The ad hoc group "will hold meetings late this month with a consultant experienced in the building of cancer care units," she said Sunday. "We need to know what to do, what to ask, what to plan for, before we start to work with an architect."
Legislation some years ago mandated a Tumor Registry Board for the purpose of compiling statistics on cancers in Virgin Islands residents, Carty noted. Now, he said, implementation of the registry will at last become a reality.
The registry and the cancer center cannot come too soon for medical professionals in the Virgin Islands and the patients they serve. Improved diagnostic tools continue to move from research into mainstream use, but some of these are not routinely used for cancer care in the Virgin Islands — such as MRI (magnetic resonance imaging) and ultrasound, which, can pick up minute changes in breast tissue that are not evident on mammograms.
Special perspectives and needs
Petersen, focusing on breast and ovarian cancer at Wednesday's workshop session, presented some facts of particular importance to Virgin Islanders and African Americans.
He said extensive testing was done of Tamoxifen, a drug given post-breast cancer that is believed to be effective in preventing recurrence of the cancer. However, Petersen said, "only 3 percent of the total test pool of the major tests was composed of minority women. And that 3 percent included all minorities. This is far below the rate of breast cancer occurrences in minority populations."
A common problem with testing pools is that the patients at major research centers tend to be of higher economic levels, with a different history of preventive medical care, than poorer population groups. "Because of unfortunate historical events, African Americans in particular have been reluctant to take part in research," Petersen said. "It is vital to recruit them for test pools, if African Americans are to gain necessary data about their special risks."
With a local cancer center, he said, there will be opportunity for participation in large trials in proportions appropriate to the population mix.
The most immediate advantage of having such a center, of course, is that it will greatly reduce the economic — and often cultural — stress of obtaining treatment that only has been available off-island.
An important component of Petersen's post-mastectomy therapy is a pool program. "Here," he said, referring to St. Thomas, "we have the entire ocean and the beneficial salt-water," and this therapy is free to all.
Of concern to Petersen is the tendency of Virgin Islanders to refuse to identify themselves as cancer patients, "so they lose the benefit of support group help," which is an important factor in recovery, he said. He noted that studies have shown that women who have a close female friend have a longer life span on average.
A plus in the Virgin Islands, Petersen said, is the strong church community, for the spiritual component of healing needs to be represented. "Doctors cannot be seen as taking healing out of God's hands," he said. "Church groups can help tremendously with reassurance and education and urging women to be tested and treated."
So many cancer-related factors are unique to the Virgin Islands, to the Caribbean, to women and to African-American women in particular, he said. The local cancer center will be a place for collecting data and providing education about the needs of cancer patients in the entire Virgin Islands community, extending knowledge far beyond the statistics to be compiled for the tumor registry.
A web site targeted to reach women of Caribbean descent is being developed by the New York University School of Medicine, Petersen said. Researchers there are seeking up to 10 local volunteers with Internet access for a telephone interview. Interested women may contact Saraida Ortiz at (718) 429-6600, ext. 161, or Dr. Jyotsna Changrani at (212) 263-3074. Compensation of $40 will be given to chosen participants.
Genetic testing as another tool
Petersen, who was named outstanding chief surgical resident at George Washington University Medical Center in Washington, D.C., in 1994, was recruited to join the faculty of the Beth Israel Medical Center Cancer Center when it opened in New York City in 1996. He has become a voice for minority health-care issues, especially relating to cancer prevention, detection and treatment.
He was named senior investigator for the New York Cancer Project, a study designed to examine genetic, ethnic and environmental factors in cancer incidence and mortality among 300,000 New Yorkers. In addition, he directs the Family Risk Program at the Beth Israel Cancer Center, a clinical surveillance and genetic counseling service for healthy women at increased risk for breast and ovarian cancer due to their family history.
Scientists have long suspected a hereditary basis for some breast cancers. In 1994 and 1995, researchers discovered BRCA1, a breast cancer susceptibility gene on chromosome 17. Studies found that in families at high risk for cancer, women who carry mutations in BRCA1 have an 80 to 90 percent lifetime risk of breast cancer and a 40 to 50 percent risk of ovarian cancer.
"Because it is a dominant gene, family histories from both father and mother are important," Petersen said. That also means many more of the next generation are likely to inherit the tendency than if BRCA1 were a recessive gene.
BRCA2, another cancer-susceptibility gene, has been linked to men as well women, not only for breast cancer, but also for prostate cancer.
"These genes are believed to occur in 5 to 20 percent of breast cancers," Petersen said. "Genetic testing is available, and genetic counseling will be a feature of the cancer center."
