Cancer in Cuba: The “Collateral Damage” Hypothesis

Erasmo Calzadilla

HAVANA TIMES — Since 2012 and following a consistent rise in incidence, cancer has been the chief cause of death in Cuba.

The public officials responsible for divulging this news through the press have assured us this doesn’t have to do with the spread of the condition but with a decrease in the incidence of the former main cause of death: heart conditions.

Official statistical reports make it possible for us to confirm that this claim is false. Heart conditions are becoming more common every year, and cancer has caught up and gotten ahead of these because it is advancing at breakneck speed.

Proving the bureaucrats wrong is easy. Some commentators, however, defend a more sophisticated hypothesis, one that I call the “collateral damage” hypothesis. The idea is more or less as follows: “medicine and sanitary conditions have improved so much over recent decades that many diseases that were previously terminal are no longer so (or take much longer to become so). As a result of this, a growing number of people meet their end in the arms of that condition that is least responsive to treatment – cancer.”

This hypothesis is based on a historical fact. Medicine did in fact improve ostensibly in the second half of the 20^th century and the Cuban revolution placed its breakthroughs at the service of the people. The results of this were quickly verified.

Though this is true, the current rise in the incidence of cancer cannot be totally accounted for by this hypothesis. This is what I intend to demonstrate in this post.

If the number of deaths caused by cancer were increasing because others were decreasing, the mortality rate for one or several of these different causes should be decreasing proportionately. Is this what we’re seeing?

Graph 1 shows the evolution of the main causes of death in Cuba. As we can see, none has decreased or decelerated in the past decades. Graph 2 shows that all have been on the rise since 1970.

We can confidently conclude that the current rise in cancer cases isn’t owed to improvements in terms of the prevention of other causes of death. What, then, is it owed to?

The bureaucrats and champions of the “collateral damage” hypothesis emphasize Cuba’s aging population. Since there are more and more elderly people in the country and cancer is a condition that affects this age group particularly, it is logical to expect a larger “batch” of cases because of this. This is true, but it doesn’t explain everything.

How much of the current rise in cancer cases can be chalked up to aging and how much to other “causes”? Below, we will attempt to find out.

Since 1970, Cuba’s population has experienced a number of changes that could be associated to the rise in the incidence of the condition. These are:

• Population growth
• Aging
• Rise in number of deaths due to cancer in some age groups (see Graph 3)

Since the final result is the sum total of all these factors, it is difficult to determine to what extent the current rates can be associated to each. Officials within the State apparatus take advantage of this situation to lay the blame primarily on aging. This way, they kill two birds with one stone: they remind us how good the State is while washing their hands on the matter.

This way, they sweep the rise in death rates within certain age groups below the rug of population aging. I want to pay close attention to this point.

Every age group has specific characteristics that set it apart from other groups. One of these is the death rate associated to cancer (among children, it is low, among adults, high).

This rate varies over time under the influence of different factors, but it does not change if the number of individuals that make up the group increases or decreases. That is to say, neither a rise in population, nor the aging of this population, modify these rates. This invariability allows us to determine to what extent the increase in cancer cases can be chalked up to other causes, to an increase in the number of carcinogens in the environment, for instance.

On the basis of the data supplied by Cuba’s annual statistical health report and using a spreadsheet, we can determine the impact had by each factor. Setting one of the three factors at its 1970 value, we can calculate how mortality rates would have evolved without the influence of the said factor. I won’t bore you with the details, I will go straight to the results.

Graph 4 is divided into two levels. The upper level shows the evolution of the mortality rate associated to cancer, from 1970 to the present.

The black line indicates the real value, sum of the three factors. The green line represents what the trend would have been if the mortality rates for the different age groups had remained unchanged. The blue (horizontal) line confirms that a rise in population in and of itself does not result in any change to any of the rates.

Put in simpler terms: from the blue to the green line, we see the influence of population aging, and from the green to the black line we see influence of the rise in mortality rates reported in a number of age groups.

The lower level shows the same thing but, instead of rates, registers the number of deaths taken place over the period. The red line is the most important one, as it reflects how many of the deaths caused by cancer since 1970 cannot be chalked up to aging or population growth and must be explained through other causes, quite likely an increase in environmental carcinogens. The curve reveals a clear upward trend.

Graph 5 summarizes what took place in 2013. During that year, there were 14,422 more deaths due to the cancer than there were in 1970. Of these, 2,600 (18 %) can be attributed to population growth, an additional 8,900 (62 %) to aging and a slightly larger number (2,900, or 20 %) to an increase in death rate in several age groups.

To conclude, there is growing number of deaths caused by cancer that cannot be explained as “collateral damage”. Other factors are having a significant influence over these trends. If we address them directly (instead of sweeping them under the rug or hiding them behind less controversial factors), we could well nip them at the bud.

When health authorities mention these other factors, they generally refer to factors that involve individual responsibility (smoking, alcoholism, unprotected sex and others) and never those they are responsible for (the spilling of carcinogens by industry and automobiles, the burning of garbage out in the open and others).

Without those additional 2,900 souls that perish because of cancer that cannot be chalked up to population growth or aging, cancer would not be the leading cause of death in Cuba. This number is larger than that caused every year by diabetes mellitus, suicide and cirrhosis, to mention only the most notorious causes of death in the country.

In my next post, I will explore why addictions and bad habits do not account for the current spread of cancer. If I still have Internet access and the editor allows me to continue expounding on this issue, that is.