The Cayman Islands can say how many of its people die of cancer. It cannot say how many are diagnosed each year, which cancers are most common, at what stage they are found, or whether patients here survive as long as patients in Barbados, Bermuda or the UK. Cayman has had a registry since 2010 and can answer none of them.

Cancer, recorded on death certificates as “malignant neoplasms”, was the second most common cause of death in the latest Economics and Statistics Office figures, at 20.7% of deaths, or one in five, according to the Minister for Health, Environment and Sustainability, Katherine Ebanks-Wilks MP, who put the figure to Parliament on 5 October. “The Cayman Islands does not have reliable population-based cancer data,” the Minister told the House. “Instead, we are guided by regional and international data.” Government has now published a White Paper proposing a mandatory registry, open for comment until 15 November, with a Bill promised for January.

A registry that counts volunteers

The Cayman Islands Cancer Registry was set up in 2010 by the Health Services Authority (HSA) and the Cayman Islands Cancer Society. Nothing obliges anyone to report to it: patients register themselves, or a physician does so with their written permission.

As at 30 September the registry held “just under 900 reported cases”, the HSA told The Caymanian Journal (TCJ) by email on 9 October. It added 52 cases in 2024, after duplicates were removed, and 47 in 2025. The Ministry separately described the database as holding “just under 1000 cases recorded over approximately 12 years”. The HSA said: “The HSA does not currently have an estimate of the total number of cancers diagnosed in the Cayman Islands each year. However, it recognises that the number of cases voluntarily reported to the cancer registry is lower than the actual number of cancer diagnoses.”

How much lower is visible in one charity’s books: “In 2024, the Cancer Registry recorded 12 breast cancer cases in Cayman, while the Foundation assisted 49 cases,” the Breast Cancer Foundation told TCJ, adding that the two datasets must be checked for comparability. Approximately 65% of registrants are female and breast cancer “has consistently been the most reported cancer”, the HSA said, marks of who registers rather than who is diagnosed: “As it is a voluntary registry, we can’t be 100% certain that the data accurately reflects cancer trends in Cayman.”

The Cancer Society, which co-founded and funds the registry, agrees. “Without comprehensive reporting, we cannot reliably distinguish between genuine trends in cancer incidence and changes in the number of people contributing data,” its Head of Operations, Dave O’Driscoll, told TCJ on 8 October.

What the numbers would show

The Caribbean Public Health Agency published its first regional incidence report this year from seven registries; Cayman was not among them. The Minister told Parliament the regional figures show lower bowel and breast cancer rates than the UK and U.S., and higher cervical rates. Whether Cayman follows that pattern is unknown.

Stage at diagnosis is the second. The National Cancer Policy, published in August, set screening intervals for bowel, cervical and breast cancer; without a registry it has no way to measure whether screening is moving diagnoses from late stage to early. “Historically, our records suggest that approximately 70% of our clients were diagnosed at Stage IV. In more recent years, our records indicate that approximately 70% are being diagnosed at Stage 0 or Stage I,” the Breast Cancer Foundation said, while stressing the figures are “indicative of a change observed within our client group, rather than conclusive evidence of a national trend”.

Age at diagnosis is the third. The average age of the Foundation’s breast cancer patients over the past two years is “48 years and 10 months”, against a reported global median of about 62 to 63. The Foundation cautioned that “younger patients may be more likely to access the Foundation’s services” and that it “cannot conclusively answer that question from our own records”.

Survival is the fourth. Cayman has never published a survival rate for any cancer.

What mandatory reporting would mean

The White Paper’s draft Act would require every doctor and dentist to report a confirmed cancer diagnosis within 14 days, with a CI$5,000 fine for failure without reasonable excuse. The registry would hold a unique ID number rather than names, addresses or dates of birth; the Freedom of Information Act would not apply to it; and unauthorised disclosure by registry staff would carry up to three years’ imprisonment. A Cancer Registry Bill was drafted in 2015 “but did not progress to the legislative stage”, the Ministry of Health, Environment and Sustainability told TCJ on 15 October, and the Minister’s reference to bringing a Bill “back” meant when she is back at Parliament in January.

Access to registry data “will be restricted to the Ministry of Health, Environment and Sustainability”, it said, no other body will see identifiable data, and “will not be used in a manner that affects an individual’s insurance or immigration status”. Non-residents treated in Cayman will be excluded. The registrar function is expected to transfer from the HSA with its existing funding, with “no overall financial impact”.

Both charities support the duty, subject to “appropriate legal, governance and confidentiality safeguards” in the Foundation’s words. Its Medical Director, Dr Virginia Hobday, was blunter: “The current system of voluntary collection of information gives misleading information,” she said. “The Cancer Registry is long overdue and has been supported by the medical community for over 20 years.”

The Opposition has not decided. The Office of the Leader of the Opposition, Joseph Hew MP, told TCJ on 13 October that it “recognizes the importance of having reliable national data” but is “still considering the proposed scope of the registry, particularly the extent of mandatory reporting” and the privacy safeguards. It will review the proposals “before determining our position on the proposed legislation”. The Ministry said consultation feedback so far has been “overwhelmingly positive”, with stakeholders calling a registry “long overdue”; it will summarise the themes rather than release individual responses.

For 16 years the Cayman Islands has had the software, the registrar and the form, and has lacked only the duty to use them. It knows how many people cancer kills and almost nothing about the people it does not.