Montserratian oncologist Dr Perrie Ryan has warned that cancer outcomes in the Caribbean remain significantly worse than in developed countries, as he urged residents to prioritise screening, early detection and informed decision-making.
Speaking on Tuesday, March 10, at a town hall meeting at the Day Community Centre on the management of breast and prostate cancers, Ryan delivered a comprehensive, data-driven presentation that combined regional statistics, treatment pathways and practical guidance for patients.
The session, chaired by Ann Thomas, brought together residents, health officials and members of the diaspora for what organisers described as a critical public education effort.
“Cancer in its various form touches many lives in our community and in our island of Montserrat,” Thomas said. “These lives are not just statistics. They are our friends, our neighbours, our family.”
Deputy Premier Veronica Dorsette-Hector welcomed Ryan home, describing his return as both meaningful and necessary.
“You are a son of the soil, and we are extremely proud of your accomplishments and the selfless service you are providing to us,” she said. “This is your second visit, and this speaks volume.”
Ryan said his motivation was rooted in service.
“You give back what God has given you. You do all you can to help when you can,” he told the audience.
Caribbean cancer burden still high
Ryan pointed to data from regional and international agencies showing that cancer death rates in the Caribbean are two to nine times higher than in the United States for several major cancers, including breast and prostate.
Among women, breast cancer accounts for roughly 30 percent of cancer deaths in the region, followed by cervical cancer at 18 percent. For men, prostate cancer is the leading cause of cancer death, responsible for about 47 percent of cases.
He said these disparities persist, particularly among people of African descent.
For prostate cancer, Ryan noted that Black men face significantly higher risks, including earlier onset and higher mortality rates. In the United States, the lifetime risk is about 12.9 percent, but death rates for Black men are nearly double those of the general population.
In the United Kingdom, he added, one in four Black men will develop prostate cancer, compared to one in eight among white men.
Breast cancer trends show similar disparities. While it is one of the most common cancers globally, Black women have the highest mortality rates, partly due to more aggressive subtypes such as triple negative breast cancer.
Survival depends on stage
Ryan stressed that outcomes are closely tied to how early the disease is detected.
For prostate cancer, men diagnosed with localised or regional disease have a five-year survival rate of about 99 percent. However, survival drops sharply to around 34 percent once the cancer has spread.
Breast cancer follows a similar pattern. Localised disease carries a five-year survival rate of about 99 percent, but this falls to roughly 32 percent for metastatic disease. For triple negative breast cancer, survival in advanced stages can be as low as 15 percent.
“The survival decrease based on the stage,” Ryan said. “If a patient has early stage disease, that person can live a long, productive life.”
The cost of care
The financial burden of cancer treatment was another major concern raised during the session.
Ryan outlined typical costs based on international data. For prostate cancer, initial treatment in the first year can reach around US$28,000, while advanced metastatic disease can cost hundreds of thousands of dollars over time.
Breast cancer treatment costs can range from about US$71,000 for early-stage disease to more than US$180,000 for advanced cases over a two-year period.
“For folks who have cancer here in Montserrat, I know that cost is an issue, and we need to find ways to decrease the cost burden,” he said.
Understanding prostate cancer care
Ryan walked the audience through the full pathway of prostate cancer diagnosis and treatment, emphasising that management depends heavily on stage and risk level.
He explained that screening begins with prostate-specific antigen testing, but warned against relying on it alone.
“The PSA by itself is insufficient,” he said, noting that inflammation or benign enlargement can also elevate results.
Follow-up steps may include digital examination, MRI imaging and biopsy. Once diagnosed, the cancer is staged based on tumour size, lymph node involvement and spread to other organs.
Treatment options vary:
- Low-risk disease may be managed through active surveillance, with regular PSA monitoring.
- Intermediate-risk disease may require surgery or radiation therapy.
- High-risk disease typically involves a combination of radiation therapy and hormone treatment.
Ryan explained that prostate cancer is driven by testosterone, and many treatments aim to reduce or block its effects. This includes androgen deprivation therapy, oral medications and, in some cases, surgery.
For advanced or metastatic disease, additional options include chemotherapy, targeted therapies, immunotherapy and newer approaches such as nuclear medicine treatments.
“These are all ways in which we can fight this cancer,” he said, adding that patients should understand that multiple lines of treatment are available.
Breast cancer treatment pathways
Turning to breast cancer, Ryan outlined the different types, including invasive ductal carcinoma, invasive lobular carcinoma and inflammatory breast cancer.
He paid particular attention to triple negative breast cancer, which lacks key hormone receptors and is often more aggressive.
“Women with triple negative disease should undergo genetic testing. If that’s not done, that’s a violation from standard of care,” he said.
Diagnosis typically involves mammography, ultrasound and biopsy, followed by staging and testing for hormone receptors and other biomarkers.
Treatment has evolved significantly, Ryan said. Instead of immediate surgery, many patients now receive chemotherapy before surgery to shrink tumours and improve outcomes.
Treatment pathways include:
- Early-stage disease: surgery followed by radiation and hormone therapy where appropriate
- Hormone receptor-positive cancers: long-term hormonal therapy, often for five to ten years
- HER2-positive cancers: targeted therapies combined with chemotherapy
- Triple negative cancers: chemotherapy and immunotherapy, often before surgery
- For metastatic breast cancer, treatment depends on whether the disease is causing organ failure or remains stable. Options include hormone therapy, targeted drugs, chemotherapy and immunotherapy.
Ryan emphasised that cancer can change over time, meaning repeat biopsies and updated testing are often necessary to guide treatment.
Prevention, screening and lifestyle
In response to questions, Ryan urged residents to take proactive steps to reduce risk and improve outcomes.
For prostate cancer, he recommended that Black men begin screening in their early 40s, or earlier if there is a strong family history.
For breast cancer, he highlighted the importance of routine screening and awareness of changes in the body.
He also pointed to lifestyle factors that can reduce risk.
“Smoking cessation, healthy living and exercise, avoidance of alcohol, early stage diagnosis and surveillance,” he said, are key.
Gaps in access to care
A major focus of the discussion was the lack of comprehensive cancer care on island.
Ryan said effective cancer treatment requires three core components: medical oncology, radiation oncology and specialised surgery.
“For a cancer programme, you need medical oncology like me. You need a radiation oncologist, and you need to know who the surgeons are,” he said.
He acknowledged that establishing such a system in Montserrat would be challenging and costly, but said discussions are needed on how to improve access, whether through regional partnerships, visiting specialists or expanded support for overseas treatment.
“I’m trying not to tell people where they are not, but maybe where it could be,” he said.
Empowering patients through knowledge
Despite the challenges, the oncologist said education remains one of the most powerful tools available.
He encouraged patients to ask questions, understand their diagnosis and take an active role in their care.
“Is this the best available therapy? And are there alternatives? What is step one, step two, step three?” he said.
The session ended with a call for continued dialogue and community engagement, as Montserrat looks to strengthen its response to one of the leading health challenges facing the region.
Listen to the full presentation here: https://montserratradioecho.wordpress.com/2026/03/10/tuesday-march-10-2026-davy-hill-town-hall-meeting-on-the-topic-of-the-management-of-breast-and-prostate-cancers/
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