Angelina Jolie's Personal Choice

On May 15th, I was called by a major TV network inquiring if the PBCN had a similar case like Angelina Jollie. When I replied that we know of no cases of prophylactic mastectomy, the TV researcher then asked if we knew of any scheduled case of mastectomy who they could interview. I told her to best contact any major hospital because for sure, they would have mastectomy cases. Then on May 21st, I was invited and accepted a live early morning TV interview to publicly air the PBCN's view on the matter. The entire TV staff and crew listened intently as I spoke and even another guest of the Department of Health promoting one of their many health programs kept nodding. Because of the public interest generated, I was interviewed live the next day over a radio program. Following were my main points:

1. Breast removal for preventive purposes is not a guarantee or assurance that breast cancer will be prevented. In fact this option belongs to the age-old Halsted era when it was said by prominent surgeons that to prevent breast cancer, it would be best to simply remove the breasts of a female the moment she is born. "no breast - no breast cancer." The truth is that breast cancer can develop even without breasts because it is a hormonal disease that does not exempt flat-breasted women or lesbians.

2. In the Philippine setting, most if not all females value and treasure their breasts and in fact will not just agree to breast removals. Note that majority of women place their hands on their chest whenever they bend so as not to expose the cleavage of their breasts, wear shirts when swimming and do not wear clothes which easily expose their breasts. This cultural practice will withstand medical options for breast removals just for preventive purposes.

3. Regardless of hereditary risk factors or genetic dispositions to breast cancer, there are non-invasive options that are kinder that will not permanently damage a woman's self-esteem - avoiding and eliminating known environmental risk factors and causes of breast cancer!

4. Angelina Jollie does NOT represent the common woman NOR can she be made an example to follow. Personalities remain to be media materials and their individual choices or views can not and should not influence the general public as being even close to the truth. Her personal life does not even have to be discussed to see why she is very far from being like you, your daughter, your sister or your mother.

5. A woman with the stature of like Angelina can do anything with her body and still maintain her status and even increase her public image just as others have done - change the color of one's skin, tatoo one's entire body or even change gender. Definitely not the case with most women who live ordinary lives. And not every woman has a Brad Pitt by her side!

6. Lastly, my own wife was diagnosed with late stage breast cancer when our youngest daughter was only five years of age.  Because it takes 5 to 10 years before the first symptoms of breast cancer are manifested, our daughter was definitely conceived when her mother already had breast cancer! Our daughter is genetically predisposed - in vitro! So does that mean that our daughter, now aged 18 will have to loose both her breasts to prevent her from getting the disease that took away her mother at an early age? NO WAY! There are other ways of preventing a woman from getting breast cancer no matter the genetic predisposition!

Breast surgeon Shelley Hwang, MD, chief of breast surgery and professor of surgery at Duke University Medical Center and Duke Cancer Institute, who did not treat Jolie, when interviewed by WebMD stated the following salient points:

1. Only about 5% of all breast cancers are in women who have this genetic mutation.

2. Most breast cancer experts would agree that the choice is really the patient's to make, and I really want to emphasize, it is a choice.

3. The women who should absolutely consider genetic testing are those who themselves have had a triple-negative breast cancer, the kind associated with BRCA mutations, at an early age, under 45, people who have had both ovarian and breast cancer in family members, and people who have breast cancer in the family and are of Ashkenazi Jewish descent.

Breast cancer does not have to happen

March 3^rd would have marked my 40^th year with Rosa who passed away in 2000, a month after her 48^th birthday. Rosa died 4 years after she was medically diagnosed with breast cancer at age 44.

That morning, I received the journal of a woman who died 10 years after her diagnosis of breast cancer at age 50. In the afternoon, I received a call from a 41 year old woman whose breast tumor had already burst and was seeking assistance. In one day, I faced two cases which I have become most familiar with in my more that 15 years of breast cancer advocacy. Two different cases which mirror the unacceptable breast cancer epidemic situation in our country today where one of 13 will get the disease within their lifetime.

The 1st woman had submitted herself to all medical interventions at the Chinese General Hospital and total expenses reached a total of around P2 million pesos. The 2nd  woman was so poor that she could not even afford a P3,000 biopsy at the East Avenue Medical Center. Rosa however, did not submit to chemotherapy and radiation by choice.

The 1st woman wrote in her journal that her medical breast exam a year before her diagnosis was just fine. The 2nd woman first noticed a breast lump 10 years before medical diagnosis. This brings forth what I have long been saying that there really is no such thing as early detection because it takes 5 to 10 years before the first symptoms of breast cancer are manifested. Moreover, 80% of lumps are normal in the course of a woman’s reproductive life and not all of the remaining 20% are necessarily a malignancy. Furthermore, not all malignancies are of the aggressive type and this is will only be known after the fact.

During Rosa’s time, we had zero knowledge and understanding of the disease and neither was thermal imaging available then.  I am very sure that if the 1st woman had undergone thermal imaging a year before her diagnosis, a severe breast abnormality would already have been seen as against her being told that all was fine. She could have had the benefit of avoiding the harrowing experience of chemotherapy. In her journal, she wrote that, “Chemotherapy was the most painful treatment I experienced in my whole life”.

The 1st woman mentioned of how kind, gentle and approachable her doctors were, especially that her surgeon was considered the “king” among breast cancer surgeons.  All I have to say is that they have to be such because of how unkind and terrible their treatments would be. The ill effects and irreversible damages done by invasive and toxic procedures are known only afterwards. But because of the hope of extending life, patients will “bite the bullet.”  Unfortunately the often said “5-year survival rate” is in the USA and not in the Philippines where I have observed to be much, much lower.  As far as the doctors were concerned, she had already surpassed the 5-year period.

The 2nd woman went to the provincial hospital in Sta Cruz, Laguna more than 10 years after she her lump first surfaced. She was then referred to the East Avenue Medical Center but could not afford treatment, no matter how negligible the costs. Her breast has now worsened because she did not do anything at all – but, she is "staying alive" without medical intervention. Breast cancer is not a disease that our Lord God Almighty created and neither can its resolution be given to His hands. Neither is the supposed cure a question of money.  

These two women had no prior information, knowledge and understanding of breast cancer. The 1st one died 10 years after diagnosis and medical treatment while the 2nd one is still alive after 10 years of non-diagnosis and non-treatment. Unlike many others, Rosa and I had learned tremendously from attending five World Conferences of Breast Cancer which is how the Philippine Breast Cancer Network was founded in 1997.

Had I then the knowledge and experience that I possess now, Rosa would most possibly be with me today continuing the advocacy for the eradication of breast cancer.  But then, if not for her battle with breast cancer, I would not be able to do what I do now.

The Philippine Breast Cancer Network continues its most difficult task in honor of Rosa, the 1st woman, the 2nd woman and countless victims of this most dreaded woman’s disease. The PBCN strongly believes that breast cancer does not have to happen.  

Happy "would-be" 40th anniversary, dearest Rosa!

Mining, mercury and breast cancer

Former President Joseph Estrada totally banned mining during his term but his predecessors have since lifted the ban.. In fact, during President Nonoy Aquino's state visit to China two years ago, four Chinese mining companies agreed to invest US$14 billion in mining operations between 2011 and 2014.

Photo from beforeitsnews.com

China's rapid industrialization needs has led to thousands of small scale mining operations in more than 30 provinces. Being the 12th largest source of gold in the world, the Philippines has become the 3rd largest gold exporter to Hongkong, after Switzerland and China itself with total shipments averaging 80 tons annually since 2010 from a measly 11 kg in 2001. Mt. Diwalwal in Compostela Valley is considered to have the largest gold deposit in the world and alone has about 30,000 miners (60% of all the country's artisinal miners). Today, the Naboc and Agusan rivers are grossly contaminated with mercury and cyanide and these long-lasting elements have accumulated in the ground water and food chain.

The typhoon that hit Compostela in December 2012 released untold amounts of mercury in the lowlands.

Photo from geotayo.com

In Bulacan, enormous amounts of industrial waste and mercury is dumped into the Marilao-Meycauyan-Obando river system from small-scale lead recylers in Marilao and from leather tanneries and numerous gold jewelers in Meycauyan.

These effluents go directly into Manila Bay and find their way to Cavite, a clear symptom of which are the contaminated shellfish. Both Bulacan and Cavite are now experiencing an alarming rate of breast cancer cases.

Photo from aboutphilippines.ph

Years ago, I visited Guihulngan in Negros Oriental (100 kms north of Dumaguete City) where I learned that it had the highest incidence rate of breast cancer in the province. How could a small and sleepy town have an epidemic? What was common among the population was their ground water which I already suspected. When the weather was too rough to travel by sea from Dumaguete to Cebu City, one could travel by land to Guihulngan and take a small boat to Toledo and then take a land ride Cebu. What was in Toledo? Atlas Consolidated Mining and Development Corporation whose operations were stopped when fisher folk complained that its tailings had so contaminated the fishing grounds. Guess where all the mercury and cyanide had also gone? To the ground water of Guihulngan.

In the recent earthquake that hit Guihulngan in February 2012, a rapid increase of breast cancer cases can be expected when all the mercury and cyanide were abruptly released from the groundwater.

Photo from denverpost.com

And with the recent typhoon that hit Compostela Valley in December 2012, also expect an outbreak of breast cancer when all the mercury and cyanide from the mining areas widely spread.

Photo from HANDOUT/Reuters

Mercury exerts an estrogenic effect on breast cancer cells by binding to estrogen receptors mostly found in the breast area, causing increased abnormal cell growth. This heavy metal disrupts normal cellular repair and disrupts the natural detoxification mechanisms of the kidney and liver (the blood factory).

Do medical oncologists ever determine the presence of heavy metals such as mercury in their breast cancer patients? They never do! So how can they ever really treat breast cancer caused by mercury and cyanide. Breast cancer caused by environmental contamination and treated with toxic chemo drugs will only aggravate and result into further health complications.

One out of 13 women in the Philippines will get breast cancer during her lifetime and only a firm environmental solution can reverse this public health crisis.

October, breast cancer carnival month

When October ends, will the pink carnival also end? Nope, because breast cancer will continue to dominate the fear of every woman in the Philippines where 1 in 13 will get the disease. The show goes on.....

As aptly said by Rosa Francia Meneses during the 1999 World Conference on Breast Cancer in Ottawa, “The greatest risk of getting breast cancer tomorrow is being born today in a developing country. The greatest risk of not surviving breast cancer today is being a woman in the Philippines."

In the Philippines, the Department of Health has more than once embarked on major breast cancer programs since 20 years ago. None has made any major inroad as seen by the country’s registering the highest growth in incidence rate worldwide while having the 12^th highest mortality rate. Only recently, the government’s Philippine Health Insurance Corporation opened the doors to more over-diagnosis and over-treatments of breast cancer by providing treatment funds for its qualified members.

And at the legislative levels of government, no bill has been written for the prevention of this environmental disease. All bills proposed were on early detection thru mammography – clearly riding this public health issue from a medical point of view and NOT on a people’s point of view, which is “we do not want to get breast cancer!” 

Media has even made itself part of the carnival by featuring the latest treatments, even alternative ones. All the 3 major television networks more than once took contact with the PBCN for their respective features for breast cancer month. However, the PBCN saw no reason to be part of the "carnival" - the glamorization, commercialization and misinformation. Either they wanted personalities with breast cancer to attract viewers, prop up the medical-pharmaceutical industry or present early detection as a preventive measure. It was best and prudent for the PBCN no to be used as a decor or worse, to be misrepresented to the public. All were grossly lacking in research and journalism depth. I challenged them to make a powerful feature on the risks and dangers of annual chest x-rays and mammograms but I knew none would take me upon it. So don't think that all the talk on breast cancer seen on television is reliable - they will simply go through the motions with not much substance.

So who will benefit with the October breast cancer awareness month? The medical—pharmaceutical-supplement network industry! Even a supposedly conscientious company has allowed itself to be used which would likewise benefit themselves. The entire awareness blah-blah-blah will simply scare women to seek medical solutions without addressing how they got it in the first place. And why would it be important for every patient to understand her environmental exposures which led to her breast cancer? Because her daughters, sisters, relatives, neighbors and co-workers will one day also get breast cancer – not from the genes but because of environmental risk exposures!

The PBCN has been observing several patients from specific areas but not limited to Angeles City (Pampanga), Guihulngan (Negros Oriental) and Bacoor (Cavite). What is similar to all is their ground water supply which is most definitely contaminated with carcinogens from different sources.

Then as far as occupational hazards would be the high incidence rate among government female workers – specifically public school teachers. The required annual chest x-rays have only done harm by exposing their breasts to repeated radiation particularly during their periods of vulnerability.

There is no such thing as early detection. It takes 5 to 10 years before the first symptoms of breast cancer are manifested. So-called long term survivors either had no cancer in the very first place (over diagnosis) or had non-aggressive types such as DCIS (Ductal Carcinoma In Situ) which was never life-threatening even without treatment.

Mammography is a medical risk factor for eventually getting breast cancer. Women are being told year in and year out that they are clear from the disease, only waiting for the time to be told, “I’m sorry Ma’m but you now have breast cancer,”

The October carnival happens every year but the tragedy of breast cancer must stop.
NO to mammography!

Teachers - an occupational hazard for breast cancer

Today, the nation celebrate's Teacher's day - ironically in the month of breast cancer awareness. Just this morning, another teacher-victim of breast cancer passed away just 3 years after being diagnosed at age 34.

Ever since the PBCN was established, we have observed several patients from the teaching profession, mostly coming from the public school sector. Among the early PBCN members was Lenirose Espanol-Cuartero who was diagnosed at age 31 and died just 2 years later.

In 2004, a long-scheduled PBCN symposium on breast cancer for all the public school Principals of Lipa City was unceremoniously cancelled by the Department of Education's Division of Schools Superintendent - just a few days. No reason was given.

Prior to the incident, a PBCN symposium was held for the faculty of Mabini High School in Lipa City on September 2003. The danger of radiation from annual chest X-rays was discussed among other environmental causes of breast cancer. The teachers found the symposium very relevant and thought it best to have others to also know how to avoid breast cancer. It was through their initiative that a symposium for all principals and teachers in their division be scheduled. Most likely, the Division learned that the PBCN was questioning the annual chest X-rays done on all women, regardless of their health history or condition. He most probably did not want teachers questioning this.

When asked in international breast cancer conferences what would account for the epidemic in the Philippines, all are shocked to know of this annual chest X-ray required of all female teachers. Despite the fact that the Quezon Institute for Tuberculosis no longer exists, this practice is still being done ever since then President Manuel Quezon died of tuberculosis. Other than tuberculosis incidence now being minimal and curable, there are now other means to test through the skin, saliva and blood. But chest x-rays are still being done, no matter how old or non-calibrated the equipment is. By annually exposing the breasts of all women (most of whom have healthy lungs), they are being placed at great risk of getting breast cancer.

Read this link on a recent study on chest radiation done on women before age 30 as a risk for those with BRCA1/BRCA2 mutation:  http://www.nlm.nih.gov/medlineplus/news/fullstory_129037.html

The PBCN recently held a symposium in Donsol, Sorsogon and we were not at all surprised to have met teachers afflicted with breast cancer. Though a small community of only 50,000 inhabitants with a very rural and pollution-free environment, the only common risk factor of these teachers were the annual chest x-rays done by mobile units contracted by the Department of Health.


There is no question that radiation causes cancer! While mainstream media keeps reporting about early detection and advances in treatment (whether conventional or not), nothing at all is being mentioned about causes, risk factors and prevention such as the high risks of radiation - like the annual chest x-rays done on all female teachers. Media would never mention this for if they did, they would be opening the doors questioning mammography which is being pushed by the medical sector, as well as government authorities. For this, both the Department of Education and the Department of Health are equally to be blamed for the breast cancer epidemic in our country today.

The moment it is admitted that annual chest x-rays place women at risk of getting breast cancer, out of the window goes mammography!

Triple Negative Breast Cancer

With update below

Upon the request of Desiree Jimenez-Razo (36), we traveled to Donsol, Sorsogon to address her breast cancer as well as conduct a symposium for teachers in this far-flung tourist destination.

She had undergone breast surgery two months ago and had been diagnosed with invasive ductal carcinoma at the Bicol Reguional Training and Teaching Hospital in Legazpi City. Though the pathology report was negative for residual tumor, all surgical margins of resection and all ten axillary lymph nodes, the immunohistochemical report showed triple negative breast cancer: Estrogen receptor negative (ER-); Progesterone receptor negative (PR-) and HER2/neu negative (HER2-). 

It is said that from 10 to 20% of medically diagnosed breast cancer cases are triple negative, occurring more often in younger women and are considered often to be aggressive with a poorer prognosis than other types of breast cancer. At this time, however, there is no standard medical recommendation that women with triple-negative breast cancer should have more treatment than the usual.

Ongoing studies have been looking at whether giving chemotherapy before surgery is better than after surgery. However, doctors are still developing their understanding of triple-negative breast cancer and vary in their treatment recommendations because triple negative breast cancer does not respond to hormone drugs and becomes resistant to chemotherapy. To this very day, medical science does not yet know the cause of triple negative breast cancer or the factors that initiate the process.

In my opinion, triple breast cancer is medically considered aggressive precisely because there is no drug doctors can use to address it. As if all the surgery, chemotherapy and radiation aren't aggressive in themselves! 

A school teacher since after college, Desiree (a mother of two sons, 12 & 8) had none of the known medical risk factors. She has been residing since birth at a relatively clean environment as evidenced by the "butandings" (whale sharks) in Donsol, the main tourist attraction of their less than 50,000 inhabitant community. What could have most likely caused her breast cancer - a triple negative at that?

During the symposium we conducted for teachers the day before leaving Donsol, there was another teacher who had also just recently undergone breast surgery and undergoing chemotherapy despite not having any hormone assay. Another one had multiple lumps on both breasts upon our physical examination. Two others had thyroid problems while another was already sensing breast lumps. The only common risk exposure to these teachers was the annually required chest x-rays which were done by a mobile unit from Legazpi City.   

To my knowledge, the Philippine is the only country in the world that requires annual chest x-rays on all its public school teachers regardless of their health condition, no matter that majority have no history of lung illnesses. Worst of all, even young girls entering college are unnecessarily exposed to the dangers of radiation during their vulnerable period - at a time when their breasts are undergoing formation. History taking is foremost in medical screening but both government and medical authorities in the Philippines continue to expose women to the high risks of radiation especially in the rural areas where out-dated and terribly unsafe mobile machines are being used!

Prior to coming to Donsol, we had a 50 year old patient whose latest mammogram showed a BIRADS 4 (suspicions of malignancy). This particular woman had been submitting herself to annual mammography since age 38 in the hope of early detection only to get a suspicious malignancy from the continuous exposures to radiation from mammography. No, it was not early detection but eventual affliction from mammography!  In the case of Desiree, she had underwent chest x-ray more than once within a year in two occasions for use of a relative's work application. 

Instead of looking at possible receptors to find a drug (because tamoxifen and herceptin are not for triple negative breast cancer), looking into environmental factors such as radiation exposures would be more like it! Government and health authorities must stop the practice of requiring annual chest x-rays on all female employees as well as female students entering high school and college. As for mammography, women must not submit to this high risk exposure to radiation!

The PBCN re-affirms its position that whatever type of breast cancer (triple negative or not), a non-toxic and non-invasive approach will be safe and beneficial for the patient! 

Updated 28 September 2014

Exactly two years ago, we travelled all the way to Donsol, Sorsogon for a public school teacher who underwent a mastectomy with 0/10 lymph nodes negative and diagnosed with triple negative breast cancer. While we were there, we visited another co-teacher breast cancer patient but she and her policeman husband preferred to follow their doctor. She passed away six months later - most surely because of the toxic chemo she submitted to.

The PBCN is proud and happy because Desiree is a living testimony of how an empowered woman can live with breast cancer without chemotherapy. Last April, she gave normal birth to a heath baby boy and her seaman husband has jumped ship to be with her and their three sons in their simple but peaceful and beautiful town of Donsol. Keeping well and staying happy together!

15 years of breast cancer advocacy in the Philippines

It has now been 15 years since Rosa Francia-Meneses established the Philippine Breast Cancer Network as a direct result of the 1^st World Conference on Breast Cancer held in Kingston, Ontario in 1997.

The PBCN pays special tribute to Andrea Martin from the USA, who had devoted her life to the global movement for the eradication of breast cancer and who was a very special friend of the PBCN.  We likewise give special recognition to the following who have maintained the course and pursue in this quest: North America - Sharon Batt, Barbara Brenner, Judy Brady, Devra Davis, Samuel Epstein, Nancy Evans, Ann Fonfa, Jackie Manthorne, Karen Miller, Sandra Steingraber and Laura Weinberg; Europe - Laura Potts, Helen Lynn and Annie Sasco; and Japan - Akiko Domoto and Kimiko Goldberg

But as these persons have been trailblazers in their respective countries, our organizations all face a lacking of new faces of dynamism and resolve, of 2^nd liners who will continue what was started in that historical 1997 Kingston Conference. But without a doubt, there are already newly-diagnosed women out there who have already picked up the baton. 

The PBCN has only been able to persist because it is the only breast cancer organization with a completely patient’s perspective that is led by a man who will not yet die. The burden of advocacy on a patient, most especially in the Philippines is not only demanding of her time and health but breast cancer activism in itself has yet to be accepted and recognized by society and governance.

If not for personal donations from both patients and supporters, the PBCN would have already succumbed to the cancer industry with all the offers of partnerships and assistance from the medical-pharmaceutical sectors as well as grandstanding politicians. This is the reality of territory the PBCN has been in since 15 years ago – yet though it would be simply practical just to survive, the PBCN has always relied on divine intervention and to quote Goethe, “The moment one definitely commits oneself, the Providence also moves. All sorts of things occur to help which would not have otherwise have happened. A whole stream of events flow from that decision, bringing all kinds of unforeseen incidents, meetings and material assistance which no one could have foreseen. Whatever one can do or dream one can, do it. Boldness has genius, power and magic. Do it now.”

August 28^th was the 15^th year of the PBCN and also the 60^th birthday of its founding President. I was able to attend mass, but on television. It was for a simple yet great public servant who perished from a plane crash and captured the hearts and minds of the entire nation. He had dreams that did not fit into the political realities in the country but held steady since more than 20 years ago – he had no idea whether his efforts would go anywhere. Are there others like him?

Yes there are! Two days before, I accompanied my daughter and her classmates undertake a cultural research visit to a small and obscure town in Laguna province. They were all amazed at how the town has maintained its cultural heritage and how the entire community is starting to progress. Then they were shocked to see the month-long waist-deep flood waters that remain and of all places, where the town Mayor and his family reside. Yes, this unassuming mayor of Pila, Laguna is another Jesse Robredo in the making.

Why did I have to mention this?  Because just like these devoted public officials who kept on with their “impossible dream” ….. the PBCN after 15 years of breast cancer advocacy and all its accompanying personal sacrifices, I know deep inside that something’s got to give! 

The PBCN’s advocacy for the prevention and ultimate eradication of breast cancer did not end with the death of Rosa Francia-Meneses.  As silent as every woman copes and confronts with her life-threatening disease, so does the PBCN grapple to stay alive. Despite having lost its recovery center in Tiaong, Quezon aggravated with the unsolved cold-blooded murder of its caretaker, the PBCN continues to provide care and management for women afflicted or suspected to have breast cancer whenever, wherever and however possible.  

Breast cancer is today a national public health epidemic – this is the reality. But the truth is that breast cancer can be prevented! 

The reality is that the medical-pharmaceutical industry continues to mislead the public in believing that early detection prevents breast cancer. But the truth is that mammography causes breast cancer!

The reality is that the PBCN is in dire need of funds. But the truth is that firm resolve and not money has kept the PBCN alive and kicking the past 15 years.

To face reality, one can just opt to be practical. But to be real, one just has to be true.

“Freedom from Breast Cancer!”