This study, based on data from the General Cancer Registry of Guadeloupe, focuses on 10 of the most common cancer sites of regional interest. It provides estimates of 1-year and 5-year survival rates after diagnosis, broken down by age and sex, using the same methodology as that applied to data from mainland France. These initial results reveal significant disparities among these sites and differ from the estimated survival rates in mainland France.

These data serve as a benchmark for survival in this department and provide essential information to support local healthcare stakeholders in adapting regional versions of the Ten-Year Strategy for the Fight Against Cancer.

This report, along with a methodological note and supplementary materials, is available on the websites of the National Cancer Institute and Santé publique France.

Survival disparities1 among the 10 cancer sites studied

For this first edition of survival data on individuals aged 15 and older with cancer in Guadeloupe, the analysis focused on 10 of the most common cancer sites of regional interest. It covers individuals diagnosed with cancer between 2008 and 2015 and followed through June 30, 2018.

The cancer sites studied are: the “lip-mouth-pharynx” group, the esophagus, the stomach, the “colon, rectum, and anus” group, the lung, the prostate, the breast, the body and cervix of the uterus, and “multiple myeloma and plasmacytoma.” For certain sites, due to insufficient sample sizes, survival estimates are sometimes presented for men and women combined or for one gender only.

These initial results show that survival varies significantly depending on the site studied and may, in some cases, differ from national estimates for mainland France. A comparison with mainland France, using a single value, does not reflect the disparities that exist between departments. Depending on the site of the cancer, some departments may have survival rates identical to, or even lower than, those of the overseas territories.

Survival differences, 5 years after diagnosis, range from -20 percentage points for endometrial cancer to +1 percentage point for prostate cancer.

Thus, the differences in 5-year age-standardized survival (ASS) compared to the mainland average² are significant for 7 of the cancer sites studied and are unfavorable to Guadeloupe. These include cancers of the uterine body (55% in Guadeloupe vs. 77% in mainland France), the esophagus (5% vs. 17%), the lip-mouth-pharynx complex (35% vs. 45%), breast cancer (79% vs. 88%), “multiple myeloma and plasmacytomas” (51% vs. 60%), colon, rectum, and anus cancers (57% vs. 63%), and lung cancer (14% vs. 20%).

However, there is no significant difference for three types of cancer. The 5-year net survival rate is therefore comparable for cervical cancer (57% vs. 63%), stomach cancer (30%), and slightly more favorable for Guadeloupe in the case of prostate cancer (94% vs. 93%).

As in mainland France, survival decreases with age at diagnosis. In Guadeloupe, the 5-year net survival rate decreases as age at diagnosis increases for nearly all of the cancer sites studied.

For example, for uterine body cancer, a woman diagnosed at age 50 has a 5-year net survival rate of 72%; this drops to 41% for a woman diagnosed at age 80. The 5-year net survival rate for cancers of the lip, mouth, and pharynx decreases from 43% at age 50 to 33% at age 70.

Health determinants and prevalence of chronic diseases: factors to consider in the fight against cancer in Guadeloupe

Certain characteristics, specific to the territory and its residents, may partly shed light on these results and the differences observed compared to mainland France, without fully explaining them. Lower participation in organized cancer screening programs, delays in seeking or accessing care, a higher prevalence of certain chronic diseases, and a disadvantaged socioeconomic status are all factors that can negatively impact population health.

Screening to enable earlier diagnoses and improved participation in organized screening programs

When focusing more specifically on cancer sites where the 5-year standardized net survival rates are lower than the French mainland average³, several hypotheses can be proposed to explain these differences.

For endometrial cancer, there is a 20-point gap in the 5-year standardized net survival rate compared to the French mainland, with Guadeloupe at 55%. It is only after age 75 that the net survival gaps narrow. These gaps are explained by higher mortality rates for all ages up to 3 years after diagnosis. For this
cancer, it is important to consider the heterogeneity of tumors, which exhibit distinct histopathological characteristics and have different prognoses. Thus, survival gaps can be explained by a different distribution of histological subtypes, diagnoses at more advanced stages, and the presence of comorbidities.

For esophageal cancer, the 5-year NSS gap is 12 percentage points lower than the French average⁴ (5% vs. 17%). This can be explained by diagnoses at a more advanced stage of the disease, longer delays in treatment initiation, and the intensity of certain treatments in the context of already frail patients.

For cancers of the “lip-mouth-pharynx” complex, the 5-year OS in Guadeloupe (35%) is 10 percentage points lower for both sexes compared to the observed French mainland average5 (45%). The main risk factors for these cancers—alcohol and tobacco use⁶—are lower in Guadeloupe than in mainland France and cannot explain this gap. This could be due to diagnoses at a more advanced stage, which are more frequently observed in a population facing greater economic hardship than in mainland France.

For breast cancer and “multiple myeloma and plasmacytoma,” the 5-year survival rate is 9 percentage points lower than the mainland France average7:

• for the former, the largest gaps are observed among women aged 60 (82% in Guadeloupe vs. 92% in mainland France) and those aged 70 (76% vs. 87%). Lower participation in organized breast cancer screening (during the study period) among these age groups could partly explain these differences. In Guadeloupe, organized screening rates among women aged 60 and 70 were 3 and 7 percentage points lower, respectively, than those in mainland France. The latest data indicate a participation rate closer to the national rate; it stands at 45.1% in 2021/2022 vs. 47.7% nationally;

• for the latter, the 5-year net survival rate is lower across all age groups except for those aged 80. This difference observed among younger patients could be linked to reduced access to innovative drugs, a delay in their use, or lower inclusion in clinical trials. The development of the oncohematology network is being strengthened through the Guadeloupe University Hospital in Pointe-à-Pitre.

For lung cancer, “colon, rectum, and anus” cancers, and cervical cancer, the 5-year survival rate is 6 percentage points lower than the French mainland average. In Guadeloupe, it stands at 14% for lung cancer and 57% for the combined “colon, rectum, and anus” and cervical cancer. These discrepancies can be explained:

• for lung cancer, by the distribution of histological types, which shows a higher proportion of adenocarcinomas than in mainland France, and other prognostic factors for survival linked to occupational activities and environmental factors¹¹;

• for cancers of the colon, rectum, and anus, largely by a higher excess mortality rate immediately after diagnosis, reflecting the difficulty of early management of this cancer, and primarily among the oldest age groups. However, the screening rate¹² has been higher in Guadeloupe than in mainland France since 2012; therefore, it cannot explain these survival disparities (during the 2016–2017 period, the participation rate was 36.5% in Guadeloupe versus 33.1% in mainland France);

• for cervical cancer, due to the absence of organized screening during the study period. The 5-year net survival rate is significantly lower than that of mainland France for patients diagnosed before age 60, and higher for those diagnosed after age 80.

Finally, two cancer sites have a standardized net survival (SNS) similar to or equal to the mainland France average13. These are prostate cancer, for which the 5-year standardized net survival is 94% in Guadeloupe (vs. 93%). Excess mortality is observed among men aged 50 in the first year after diagnosis and at all time points after diagnosis for those aged 80. The rate for stomach cancer (30%) is equal to the mainland France average, despite a higher incidence across the Caribbean.

Furthermore, the territory suffers from a shortage of medical specialists in oncology and an MRI equipment rate lower than that of mainland France. These shortages negatively impact the time it takes for cancer patients to receive care. For example, pending authorization for thoracic oncology surgery as outlined in the 2023–2028 Regional Health Plan (SRS) and the establishment of the care pathway, surgical treatment for lung cancer is primarily performed outside the territory.

A high prevalence of certain chronic diseases

The prevalence of certain chronic diseases increases the risk of comorbidities that may reduce survival among people with cancer.

In Guadeloupe, the prevalence of known (self-reported) diabetes was 12% in the adult population in 2021,¹⁵ which is twice as high as the estimated rate in mainland France (Esteban study, 2016). Furthermore, the prevalence of reported hypertension was 29.9% in Guadeloupe in 2021 versus 20% in mainland France16. Finally, premature mortality from cardiovascular diseases ranks Guadeloupe second (after Réunion) among the most affected departments: this type of mortality is significantly higher in Guadeloupe than the national average (and more pronounced among women).

This issue of premature mortality from cardiovascular diseases is linked to the significant prevalence of overweight (57% of Guadeloupeans are affected, 63% of women and 49% of men, of whom 23% are obese). This is more pronounced in Saint Martin, where 26.3% of children (12.6% in Guadeloupe) are overweight¹⁷.

Demographic and Socioeconomic Overview

Guadeloupe, an archipelago consisting of 5 groups of islands, had a population of 387,629 as of January 1, 2018. Since 2013, the population has declined by an average of 0.7% annually, primarily due to the outflow of 18- to 25-year-olds, which has not been offset by natural increase, which has been declining for some thirty years.

According to INSEE, in 2020, 34.5% of Guadeloupe’s population lived below the national poverty line. Poverty particularly affects the unemployed, single-parent families, and young households. For the poorest, social benefits are the main source of income.
In 2022, on average, the unemployment rate in Guadeloupe stood at 18.6% of the labor force (employed or unemployed) aged 15 or older. It is up 1.5 percentage points compared to 2021 and remains more than twice the national unemployment rate (7.3%).

However, it has been observed that survival rates for people with cancer tend to be lower among those living in the most socioeconomically disadvantaged environments.¹⁹ Many factors may explain this, such as difficulties accessing the healthcare system (screenings, early diagnosis, wait times, and certain treatment access procedures), or patient characteristics (comorbidities, risk behaviors, psychosocial factors).

Furthermore, according to the 2019 Santé DOM survey published in September 2021 by INSEE, three out of 10 Guadeloupeans have delayed or foregone medical care for the following reasons: excessively long wait times, prohibitively high costs, transportation issues, or simply a lack of specialists. Thus, one in six Guadeloupeans (17%) had to forego care in the past 12 months for financial reasons (medical, dental, medication, psychological, vision, and hearing care): this is three percentage points higher than in metropolitan France (excluding forgoing vision or hearing care).

A national and regional mobilization in cancer control policies

Due to their geographical location, the overseas territories must be able to provide their residents with appropriate, high-quality healthcare. The ten-year strategy to combat cancer, in its fourth pillar “Ensuring that progress benefits everyone,” includes a specific measure aimed at these territories. This involves adapting cancer control initiatives, ensuring coordination among all stakeholders—particularly through digital technologies—supporting cooperation in overseas territories in collaboration with mainland France across prevention, care, and research, ensuring equitable access to care throughout the patient journey, and enhancing the attractiveness of these territories for healthcare professionals.
In this context, the National Cancer Institute, the Guadeloupe Cancer Registry, and Santé publique France are working closely with the Health Agency of Guadeloupe, Saint Martin, and Saint Barthélemy (ARS).

The ARS has implemented a regional adaptation of the ten-year strategy to tailor measures and actions to local specificities in order to better address the regional context. The 2021–2025 regional roadmap reflects its strong commitment to the fight against cancer. Led and implemented by the ARS, in collaboration with cancer care stakeholders, it aims to reduce the impact of cancer on the health and lives of Guadeloupeans by addressing several challenges.

This involves improving prevention regarding addictions (tobacco, alcohol, cannabis), promoting a balanced diet and physical activity, and combating infectious risks (including HPV viruses), particularly in schools. Key priorities include strengthening prevention and raising awareness about work- and environment-related cancer risks, increasing public participation in organized screening programs for breast, colorectal, and cervical cancers, and enhancing the region’s appeal to reduce areas with insufficient medical coverage. With the support of civil society organizations, improving the quality of life for people with cancer (and their caregivers) is a major focus of regional policy. This involves, in particular, providing better information, making supportive care available to help patients cope better with the disease and treatments, and improving care conditions, regardless of where the patient lives.

Furthermore, the 2023–2028 Regional Health Strategy (SRS) has planned changes to healthcare services, particularly in the fields of “nuclear medicine” and “cancer treatment.” By the end of the SRS, Guadeloupe is expected to gain an additional PET scan and gamma camera, as well as brachytherapy and chemotherapy services on the island of Marie-Galante. Furthermore, the number of cross-sectional imaging devices (CT scanners and MRI machines) installed or planned has increased significantly over the past two to three years. Over the course of the SRS, projections for medical imaging equipment in the archipelago include 12 CT scanners and 6 MRI machines. Authorization holders will also be able to expand their fleet to up to 3 devices per facility location.

Finally, during the Interministerial Committee on Overseas Territories meeting held on July 18, 2023, at Matignon, the Prime Minister announced a measure dedicated to oncology (Measure 25). This measure aims to:

“Reducing wait times for cancer care. The four most prevalent types of cancer in the overseas territories are colorectal, breast, cervical, and prostate cancers. For these four conditions, resources for prevention and early detection will be doubled in the overseas territories. For cancer patients, timely access to care is a major challenge, justifying the implementation of cooperation between healthcare facilities to strengthen the existing healthcare infrastructure. An action plan will be finalized in early 2024 to significantly reduce wait times for cancer treatment.”