Friday, June 22, 2012

Over-diagnosis and over-treatment of breast cancer

The PBCN is deeply concerned with the absence of precautionary measures in the government’s Philippine Health Insurance Corporation’s Type Z Benefit Package, particularly in the over-diagnosis and over-treatment of breast cancer.

It has long been a reality in our country that poor or uninsured breast cancer patients receive little or minimal medical attention. This is the reason why the Department of Health launched in May 2011, the Patient Navigation Program to promote early breast cancer screening particularly among poor women and providing assured access to chemotherapy. The program is meant to show that breast cancer is a curable disease when detected, treated and managed early.

With the launching of the Type Z Benefit Package in the presence of President Noynoy Aquino in Malacanang Palace on July 2nd, members of PhilHealth will now be entitled to a package rate of P100,000 for the entire treatment course for early breast cancer. Coming from PhilHealth’s huge reserve fund of Php 30 billion, just 10% could easily cover 30,000 cases (more than double of government estimated cases in 2010). The opposite could then be the scenario for insured breast cancer patients who may likely be over-treated (receive drugs and procedures that can cause real harm) and even misdiagnosed.

Numerous studies have shown that early detection of breast cancer does not necessarily translate to saving more lives. Finding ever smaller cancerous lesions, even down to small clusters of cells can lead to over-diagnosis for if left alone but managed and observed over a period of time, would never have grown to endanger a woman’s life. Of the most common type of breast cancer, at least 50% of ductal carcinoma are non-invasive and can be safely managed without surgery or chemotherapy. Over-diagnosis leads to over-treatment.

For more than 15 years, the PBCN has seen all forms of misdiagnosis and mistreatments – unnecessary surgeries, chemotherapy and radiation. As a matter of fact, even among the ranks of medical practitioners there are varied, even opposing opinions in the diagnosis and treatment of breast cancer. To address this, the leading breast cancer practitioners have just recently formed their own society to educate doctors and hopefully arrive at standardized protocols and treatments among themselves precisely to avoid misdiagnosis and mistreatment of breast cancer cases.

Today, one out of 13 women will develop breast cancer in her lifetime and not three out of 100 as stated by the Department of Health. In fact, one out of 49 is likely to die and not one out of every 100 as stated again by the DoH. This is why the Philippines is not only among the countries with the highest incidence rate of breast cancer in Asia but the highest!

According to the Department of Health, the breast cancer survival rate in the Philippines is below 40 percent but according to PhilHealth’s Robert So, MD – one of the reasons for selecting Jose Reyes Memorial Medical Center as its Reference Hospital is its experience of an 80% cure rate. This will be the lead hospital and along with the UP-PGH and the Philippine College of Surgeons will provide the standards and guidelines in the treatment of breast cancer.

Though standard treatment protocols/clinical guidelines shall be adopted from the current state of the art- internationally accepted treatment guidelines (such as the NCCN Cancer Treatment Guidelines updated each year) based on scientifically-sound body of evidence depicting the lowest recurrence rates, survival rates must be over a 5-year period and not only two years as stated - especially that early stages are mostly to be addressed. 

The Type Z Benefit Package will be implemented nationwide by contracted government hospitals in each region - all of which are training hospitals largely lacking in funds and personnel. The world's 3rd leading pharmaceutical, Paris-based Sanofi-Adventis agreed to extend an 83% discount for their chemo drug Docetaxel (from P40,000 to P6,930). With the advent of PhilHealth members availing of the P100,000 breast cancer package, these government hospitals can now expect a significant market share previously dominated by private hospitals. No longer hindered by costs, their doctors will not think twice in performing mastectomy, chemotherapy and radiation.

Precautionary measures must be instituted in the Type Z Benefit Package, particular to cases of breast cancer. These must include among others:

   1. How is a woman said to have breast    
       cancer?  Invasive or non-invasive? 
       Aggressive or not?
  
   2. How is a woman’s case said to require 
       surgery, chemotherapy and radiation? 
       
    3. When surgery is necessary, will it be a lumpectomy? 
    Modified or radical mastectomy? 

4. When chemo is considered necessary, how is a drug chosen? (by availability?) Will it be single or multiple chemo drugs? Will it be done before or after surgery? Will there be an oral maintenance chemo drug to be prescribed or not?

5. When radiation is considered necessary, will it be by linear    acceleration or cobalt?

6. And most important of all, has the total course of treatment been thoroughly explained to the patient (including limitations, risks and adverse reactions), not simply having her sign a lengthy form of consent without being fully informed?

These precautionary concerns are meant to prevent the over-diagnosis and over-treatment of breast cancer cases from the expected surge of patients resulting from the P100,000 package of PhilHealth’s Type Z Benefit Package launched on July 2nd, 2012. Only by the end of President Noynoy Aquino’s term in 2016, will it then be known whether or not PhilHealth’s well-meaning intervention in an economically and medically “catastrophic” disease like breast cancer will have realized better health outcomes or resulted in shorter survival rates and higher mortality rates.

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29 comments:

  1. I'm interested to know where you got these statististics and how current they are: //Today, one out of 13 women will develop breast cancer in her lifetime and not three out of 100 as stated by the Department of Health. In fact, one out of 49 is likely to die and not one out of every 100 as stated again by the DoH.//

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  2. Kindly read my earlier blog: 1 in 13

    http://pbcn.blogspot.com/2011/09/1-in-13-filipino-women-will-get-breast.html

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  3. Hi..Your post was very informative and helped to understand breast cancer treatment .

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    1. Thanks Tahera, have you visited our website. www.pbcn.org? And if you're on facebook, do join the Philippine Breast Cancer Network group.

      Danny Meneses

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  4. Replies
    1. Thanks Pani! do visit our website www.pbcn.org and join us in Facebook. regards, Danny Meneses

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  5. sana tulungan nyo po rin yung girlfriend ko
    di ko po alam kung canser o hinde pero meron po syang buka sa suso at paminsan minsan sumasakit daw po

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    Replies
    1. paki bisita www.pbcn.org at dun sa contact page isulat mo mga detalye ng kaibigan mo para maka reply ang PBCN.

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  6. Hi... my mom has gone to mastectomy, chemotherapy and now been asked to have radiation. she is found with and early stage of stage2 and her2 positive, is there any way that we can asked assistant on our financial, how can we avail of that Type Z benefit package of the Philhealth or can we? please enlightened me with this pls...

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    1. From what we know, PhilHealth's Type Z Benefit Package applies only to newly diagnosed cases which your mother is not. Why not contact them directly to find out. Also, from what we also know, the package does not include Her2 chemo which costs something like half a million pesos. Send an email to so you will further be enlightened on your mother's options for managing her breast cancer.

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  7. Hello,nagpa breast mass biopsy Ako last July sa CGH ang result ay ductile carsinoma grade11. Tapos nag pa mastectomy Ako last week ang result( no residual malignant tumor, previous biopsy site left breast l. Negative for metastatic tumor,28 axillary lymph nodes) ang sabi nung surgeon kailangan ko daw pagpachemo at pumunta sa oncologist. Pwede kaya Ako sa Z package ng philhealth? Thanks po

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  8. Tin, ano itong CGH? Di advisable na magpa chemo ka, maski pwede sa PhilHealth. Pero sa totoo din, kailangan sa PhilHealth ay newly diagnosed at di pa nagagalaw. Nakapag surgery ka na kaya di na pwede sa Z package kaso mo. Mainam na din at di nga kami sang ayon na magpa chemo ka. Pagusapan natin kaso mo para ka maliwanagan at magkaroon ka ng batayan makapagpasiya. (0920)909-9212 or (0922)881-1010.

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  9. Hi po,I will be doing my first chemo this monday.
    And I am Er\Pr+ Her2+.
    My chemo meds includes Herceptin and Docetacel.
    I would like to know if these medicines are covered for a 20% discount for Pwd.
    I will be purchasing these medicines sa Oncologist not in the pharmacy kasi i was told cheaper daw sa Ongco.

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    1. Hi Maria, nakapagpurchase po ba kayo ng Herceptin sa oncologist nyo? Magkano nyo po nakuha?

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    2. Maria and Anonymous, Aside from Herceptin being exhorbitantly expensive, it is often misused because onco's nowadays readily prescribe it just because of a Her2+ assay.If you were to read the prescribing information of Herceptin, it is primarily indicated for metastatic breast cancer after previous chemo has failed. Furthermore, the number of cases that have responded positively after Herceptin has been very dismal, worldwide. Herceptin is really a deceptive drug of desperation which has more often than not, resulted into complications,aggravations and early death. No matter how expensive or not Herceptin is, the risks are far more than the benefits desired.

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  10. Hello po saan po kaya ako makakabili ng murang Docetaxel drug? Please advise po for my mom. Or any institution where we can get a free chemo drug.

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    1. Hi po may alam po akong mas murang docetaxel and herceptin po baka po makatulong 09228141629

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  11. Good Day! My mother had been diagnosed with breast cancer just this year. I'm a bit frustrated because I'm the only one who will take the full responsibility of her condition. May I know from you guys what are the things that I should be prepared of? Medyo natatakot po kasi ako sa mga pwedeng mangyari.

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    1. Hi Rose Anne, best we discuss the matter for your Mom to make a fully informed decision and know her options. Take contact at (0920)909-9212, (0922)881-1010 or (0926)744-1538.

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  12. Good afternoon! Yesterday 25Apr nalaman namin ang result ng breast ultrasound ng nanay ko at category 4. Doctor advised na kailangan magpa frozen biopsy sya if it is cancerous masectomy ang last result. Pinaghahanda kami ng 80-150 thousand only for the operation sa UST. Dahil wala kami ganun kahalaga saan kami pwede makahanap ng hospital na mura pero magagaling ang doctor?

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  13. Hwag magmadaling magpa frozen section. Tumawag kayo sa (0920)909-9212, (0922)881-1010 o (0926)744-1538 para mapag usapan kaso ng nanay mo at kung paano kayo matutulungan ng PBCN.

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  14. Gud pm po,meron po akong bukol s right side ng breast maliit n lng po..before po ngpa-breast scan ako and benign lymphatic nodes ang findings...Like ko pong ptanggalin, panu nu po ako matutulangan .

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    1. Ano ang mobile number mo para makausap ka. Mas maigi kung puntahan mo contact page sa website na ito at ipadala sa amin.

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  15. good day sir, i just want to ask if you know where is the highest number of cancer patients here in the philippines. and what's your opinion about building cancer treatment centers, where do you want it to built is it outside Metro Manila? and why? thanks for your time !

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    1. Highest number of breast cancer patients is in Central Luzon. C enters need to be outside Metro Manila because breast cancer is an environmental disease and as such, Metro Manila is not ideal.

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  16. Gandang araw po sir ask ko lang po kung San ko pwede I pacheck up ang misis ko may nkapa po kc sya n bukol as gilid ng kanan breast nya this last Dec. 8 lang po pasig city po kmi at magkanu po kya aabutin ng checkup nya... Tnx po

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    Replies
    1. send an email to pbcn@iname.com or a text to (0920)909-9212 para magabayan kayo. Wag agad pupunta sa doctor bago makausap mo ako.

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