This study, based on data from the Martinique General Cancer Registry, 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 method 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 region and provide essential information to support local health 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, on the website of the Martinique Regional Health Agency, and on the website of the Martinique Regional Oncology Platform.

Significant survival disparities1 among the 10 cancer sites studied

For this first edition of survival data for people aged 15 and older with cancer in Martinique, 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 plasmacytomas.” For certain sites, due to insufficient sample sizes, survival estimates are sometimes presented for men and women combined.

These initial results show that survival rates vary 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 cancer site, some of these departments may have survival rates identical to, or even lower than, those of the overseas territories.

For example, prostate cancer in Martinique has a very favorable prognosis with a 5-year standardized net survival (SNS) rate of 95%, higher than the average for men diagnosed in mainland France (93%).

For cancers of the cervix, the lip-mouth-pharynx region, the stomach, and the lung, the 5-year standardized net survival (SNS) rates are 59%, 40%, 31%, and 16%, respectively. These are equivalent to the estimated average for mainland France2.

For cancers of the uterine body, esophagus, colon-rectum, breast, and for the “multiple myeloma and plasmacytoma” group, the 5-year SRS are 50%, 3%, 53%, 83%, and 55%, which are lower than the estimated averages for mainland France² by 24, 14, 10, 5, and 5 percentage points, respectively.

As in mainland France, survival decreases with age at diagnosis for many sites such as the stomach, the lip-mouth-pharynx group, the colon-rectum group, the cervix and body of the uterus, and for multiple myeloma. Thus, for cervical cancer, the 5-year net survival rate is 62% for those diagnosed at age 50. This survival rate drops to 52% when diagnosed at age 70.

In contrast, for esophageal, lung, prostate, and breast cancer, 5-year net survival rates appear less closely linked to age at diagnosis. For breast cancer, for example, net survival remains fairly stable whether the cancer was diagnosed at age 40 (85%) or at age 80 (82%).

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

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, more difficult access to care, a higher prevalence of certain chronic diseases, a disadvantaged socioeconomic status, and identity, societal, and cultural issues—particularly the use of self-medication and herbal remedies before, during, and after diagnosis—are all factors that could potentially make early diagnosis and management of certain cancers more difficult.

Improving participation in organized screening programs and achieving earlier diagnoses

When focusing more specifically on sites where 5-year survival rates are lower than the average for mainland France³, several hypotheses may explain these differences.

For breast cancer, where the 5-year survival rate is slightly lower than the mainland France average4 (-5 percentage points), the different histological characteristics of the disease could partly explain this difference.
Furthermore, in Martinique as in mainland France, fewer than one in two women participate in organized breast cancer screening, which enables earlier diagnosis (49.5% over the 2013–2014 period5 vs. 51.3% for all of France over the same period).

For colon and rectal cancers, which affect both women and men, participation in organized screening is lower than for breast cancer screening. Over the 2013–2014 period, only 25.7% of eligible individuals in Martinique participated (vs. 32.1% for all of France over the same period).

However, early detection of these cancers through regular screening offers better chances of cure with generally less intensive treatments. The intensity of treatment is a very important factor for patients with comorbidities.

While data show that the 5-year survival rate for cervical cancer in Martinique is equivalent to the estimated average in mainland France,⁷ vaccination of children as young as 11 against the HPV viruses that cause these cancers and screening for women aged 25 to 65 remain insufficient. Thus, in 2022, 12.1% of 16-year-old girls and 1.2% of boys of the same age were vaccinated in Martinique⁸ and 44.1% of women underwent screening during the 2019–2021 period⁹. An increase in these rates, coupled with easier access to specialists, would, on the one hand, promote earlier detection of cervical cancer and, on the other hand, reduce the number of these cancers (more than 3,100 cases of cervical cancer per year in France).

Regarding endometrial cancer, the more advanced stage at diagnosis, less frequent gynecological follow-up, and poorer general health are all prognostic factors that may explain the significant and early excess mortality among older women compared to the rest of France.

For esophageal cancer, diagnoses at an advanced stage, the intensity of certain treatments, the burden of comorbidities—including those linked to alcohol and ^tobacco use10—and the lack of specialists in this field in the region may explain this difference.

Finally, the region will very soon have state-of-the-art nuclear medicine facilities for the majority of cancer diagnoses and treatments; wait times for care should improve.

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 Martinique, the prevalence of known (self-reported) diabetes was 11.5% in the adult population in 2021,¹¹ which is twice as high as the estimated rate in mainland France (Esteban study, 2016).

The population there is also, due to their lifestyle habits and behaviors (sedentary lifestyle, unbalanced diets leading to overweight and obesity—1 in 4 young people and more than 1 in 2 adults are overweight or obese—more at risk of end-stage chronic kidney disease, which affects more than 1,000 people per million inhabitants (compared to 500 per million nationally). The prevalence of reported hypertension was 31.5% in Martinique in 2021 versus 20% in mainland France12.

Demographic and Socioeconomic Indicators

Martinique, with 368,783 inhabitants as of January 1, 2018, is among the oldest territories in France, with a population in sharp decline. In 2023, 34% of residents were over the age of 60. The aging of the population has accelerated sharply over the past three decades. In 1990, 72% of Martinicans were under the age of 44. Today, that figure stands at just 48%.

Furthermore, the unemployment rate there stood at 12% in 2022, compared to 7% in mainland France. According to INSEE, 44,300 households in Martinique live below the poverty line, representing 27% of the regional population and 32% of children. This poverty rate is nearly twice that observed in mainland France (14.4%).

However, it has been observed that survival rates for people with cancer tend to be lower among those living in the most socioeconomically disadvantaged environments14. Many factors may explain this, such as difficulties in accessing the healthcare system (screenings, early diagnosis, wait times, and certain treatment access procedures), or patient characteristics (comorbidities, risk behaviors, psychosocial factors).

National and regional mobilization in cancer control policies

Isolated regions, including overseas territories, must be able to provide their residents with appropriate, high-quality healthcare. The ten-year cancer control strategy, in its fourth pillar—“Ensuring that progress benefits everyone”—includes a specific measure targeting these regions. This involves adapting cancer control initiatives, ensuring coordination among all stakeholders—particularly through digital technologies—supporting cooperation in overseas territories across prevention, care, and research, ensuring equitable access to care throughout the patient journey, and enhancing the attractiveness of these regions for both patients and healthcare professionals.
In this context, the National Cancer Institute, the Martinique Cancer Registry, and Santé publique France are working closely with the Martinique Regional Health Agency.

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 regional roadmap reflects its strong commitment to the fight against cancer.
Led and implemented by the ARS, in collaboration with cancer care stakeholders and coordinated by the Martinique Regional Oncology Platform, it is structured around four strategic priorities:

• Axis 1: improved prevention and screening;

• Axis 2: Coordinating stakeholders to ensure better follow-up and an improved quality of life for patients;

• Axis 3: Reduce wait times for care and provide support to ensure equal opportunities;

• Priority 4: Addressing inequalities.

Each priority area is then broken down into operational objectives.

In addition, the Director General of the ARS, Ms. Anne Bruant-Bisson, sought the support of the National Cancer Institute to develop, in collaboration with local healthcare stakeholders, recommendations for the fight against cancer. Thus, the support mission, which took place from November 13 to 17, provided an opportunity to meet with key stakeholders and observe the already strong commitment of all local actors to improving the cancer care landscape in the region. The mission was thus able to formulate context-specific findings and recommendations, drawing on existing resources and constraints, to ensure the coordination of care pathways, optimize the use of home hospitalization, develop a strategy for health education and literacy improvement, and promote the implementation of interventions or pilot projects addressing specific challenges in Martinique. The conclusions of this report will be submitted to the ARS in the coming days.
Following this mission, the ARS’s general management has already established a steering committee that has met twice in the presence of national and territorial elected officials, user associations, and stakeholders from the health, social, medico-social, and primary care sectors, as well as partner institutions. The ARS and the GIP PROM are participating in the work of the CIOM to actively contribute to the implementation of the action plan. A revised version of the territorial roadmap is expected in June 2024. A schedule will be communicated to all stakeholders.

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, rapid access to care is a major challenge that justifies 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.”