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!”

  

Floods and breast cancer

Update: Exactly a year after the floods of August 2012, flood waters have again hit the country, and the Department of Health still maintains that the prevention of non-communicable diseases such as breast cancer is in tobacco and alcohol intakes? 
http://www.telegraph.co.uk/news/picturegalleries/worldnews/9462526/Aerial-photographs-of-the-flooding-around-Manila-the-Philippines.html


The Philippine Breast Cancer Network takes serious concern over the massive floods in our country the past four years: Tropical Storm “Ondoy” in September 2009,  Typhoon “Sendong” in December 2011 and the monsoon rains in early August 2012.

Acid water levels have most likely risen quickly because of the rains and the acid water has now affected wide areas in Luzon, Visayas and Mindanao spreading into ground water that people in rural areas drink water from. The downpours diluted the concentration of heavy metals in mining, industrial and farming areas but they were not dissolved and have certainly contaminated water systems.

Residential, commercial and industrial wastewater contain hormone-disrupting chemicals such as natural estrogen and alkylphenols, insecticides, pesticides, herbicides, pharmaceuticals, chlorinated solvents, industrial chemical waste, petroleum products and heavy metals. The floods have spread huge undetermined volumes of these toxic pollutants and contaminants including those known to cause cancer and birth defects especially mercury and dioxin from power plants, fuel depots, paper mills and many other industrial factories along Pasig River and Manila Bay.

Unique to the Philippines is the numerous junk shops where it would not be surprising to have significant amounts of PCB’s (polychlorinated biphenyl) from drained fluids of used transformers and electric motors. Then there are the garbage landfills, notably Payatas and San Mateo whose tailings go straight down to the Marikina river system, and Smoky Mountain whose toxic solid waste have been permanently buried beneath former President Ramos’ flagship project, the 79 hectare Manila Harbour Centre.

In the highly urbanized industrial City of Iligan is where the National Power Corporation operates six hydro-electric power plants and where several heavy industries (steel, cement, chemical, refractory and food) have been operating since the 1970’s. There has already been an alarming number of breast cancer, leukemia and lung cancer in a city with a small density of less than 400 persons per square kilometer. Just like Manila Bay, Iligan Bay is as polluted. When the floods of "Sendong” struck in December 2011, the waterways have definitely become a serious environmental health hazard.

While “Ondoy” flooded Marikina City within 12 hours, the recent floods submerged the city for 3 days just three years later.  And what industries are in Marikina City aside from the shoe industry?  For starters - Fortune Tobacco, Armscor, Purefoods and Nestle. Despite their waste disposal systems – the floods had certainly overflowed their holding wastewater  ponds! Furthermore, all persistent organic pollutants in Payatas, San Mateo and Antipolo went down to this valley!

Our country will continue to experience calamities due to a multitude of socio-political-economic factors and it can only be hoped that present and future governance can act to limit if not contain the degree of damage to life and property. The Philippines has become very vulnerable to catastrophes. In fact, our country registered the highest increase in the incidence rate of breast cancer over the past 30 years worldwide. The recent flooding has again unleashed and exposed thousands of women to environmental toxins and carcinogens and this will be validated with the surge of breast cancer cases in the flood-stricken areas of the country at least five years from today.

Population and breast cancer

Several books have drawn attention to the severe economic and social problems linked to having too few children.

Philip Longman, in his book "The Empty Cradle," concentrates on the economic disadvantages of a rapidly falling birth rate. Fears of a "population bomb" aside, modern economics have depended on ever-growing populations. New businesses flock to areas where population is growing, and social security systems depend on growing numbers of taxpayers to finance welfare for each retiring generation. He notes that it may seem counter intuitive to worry about too few children at a time when the world population is still growing by around 75 million a year. Fertility rates, however, have plummeted in recent years and no industrialized nation has enough children being born to sustain its population. U.N.data show that currently 59 countries, accounting for 44% of world population, are not producing enough children to avoid population decline.


Another book, "The Coming Generational Storm," by Laurence Kotikoff and Scott Burns focuses on the fiscal crunch facing the United States due to the costs of an aging population, accusing politicians of deliberately ignoring the long-term financial burdens in favor of short-term political interests. According to the authors, the difference between the US government;s future receipts and expenditures will be in the order of $45 trillion.


In their book, "Bare Branches: The Security Implications of Asia's Surplus Male Population. " Valerie Hudson and Andrea den Boer observe that China and India, with 38% of the world's population, have surpluses of young males far beyond what any natural forces could produce. Noting that female infanticide was practiced in many cultures and epochs, Asian culture has had a particularly marked preference for male offspring and modern technology has allowed this preference to be applied more radically than in the past. The book puts the number of women eliminated in seven Asian countries at just over 90 million with India and China respectively accounting for 43% and 45% of this total.


And even if the future isn't as bleak as these authors describe, mainstream economics opinion is in agreement that the dramatic fall in fertility will pose severe problems for the world's economy. Peter Heller, in his book, "Who Will Pay?" points out that society may well rue the day it embraces the logic of the family planning movement.


The Women's Global Network for Reproductive Rights (WGNRR)  stands firm against population control policies but is also against hazardous contraceptives while advocating for abortion rights and the reduction of maternal mortality & morbidity.  


In her presentation on "Breast cancer and the Environment" years ago, Professor Devra Lee Davis pointed out that the proportion of male births in Canada and the USA have been in steady decline since the 1970's. According to her study, had the sex ration not dropped, at least 38,000 more baby boys would have been born in the USA and 8,600 more in Canada. This observation was part of the human evidences pointing to the proliferation of environmental xenoestrogens that has resulted in the feminization of nature and consequently the rapid rise of breast cancer, especially in areas of toxic waste dumping (California, New York and Florida). Today, 1 in every 8 women in the USA will get breast cancer.

In arriving at our own country's population program, health concerns (particularly breast cancer) must be at equal footing with economic matters. Whatever population size may best serve our country's specific needs, the PBCN is totally against the use of hormonal contraceptives in any form because it places women at high risk of getting breast cancer. Instead, the use of condom is highly recommended. A woman's health and safety (whether with or without child) is foremost as her reproductive system is so complex and intricate that makes her most vulnerable to the environmental factors causing breast cancer.


The Philippine government has unknowingly been implementing an effective population control program by distributing breast cancer causing hormonal contraceptives nationwide and thereby causing the death of thousands of women annually from the breast cancer epidemic. The country today has the highest incidence rate of breast cancer in Asia and the 10th highest worldwide. Today, 1 in every 13 women will get breast cancer in the Philippines!
 

Ang Hinaharap (Upfront)

Breast cancer is the leading cause of death of women in the entire world today. More than a million women are afflicted every year with North America having the highest incidence rate with one out of eight women getting the disease. Next comes the northeastern European countries followed by Australia and New Zealand. Our country should be proud because we are in the Top Ten Breast Cancer Hotspots of the world! In fact, we have the highest incidence rate in Asia - much, much higher than China or Japan.

Yet we are not a highly industrialized as the USA, nor are we agriculturally productive as Australia, nor do we have a huge wide area of land with a population as that of China. In fact our country is even an archipelago surrounded by the China Sea and Pacific Ocean. 

The Hereditary Factor is Misleading

If we are to believe medical science, Filipinos must then have a genetic predisposition for breast cancer. Despite our different dialects, we must somehow be related to one another to have a high degree of hereditary factor because breast cancer is afflicting all women from as far north as Batanes to as far south as Tawi-Tawi.  In fact, breast cancer today tops all cancers for both men and women. Because of this epidemic situation, our Department of Health has had a Breast Cancer Desk for more than 15 years – unfortunately just that - a desk.

So, does it have something to do with urbanization? Nope! The Cordillera Autonomous Region and the National Capitol Region both have cancer as the 3^rd leading cause of mortality. Population density? Nope! CAR has the lowest in the country with less than a hundred per square km., while the NCR has almost 15,000/ sq.km. Poverty? Nope! In the NCR, cities with the high concentrations of urban poor have similar incidence rates of cancer as cities with the low concentrations of urban poor.  Education? Nope! We have as much affliction among well-educated women as uneducated women. Being childless? Not at all! Having children does not prevent breast cancer, as several cases have been diagnosed shortly after having given birth..

What about Religion? Maybe so, but it isn’t because of spirituality. Muslims don’t eat pork while Christians do and this could probably be a reason why the former are less afflicted. So maybe cancer comes with what we eat? Actually, mounting evidences in the past decade of breast cancer advocacy in North America have clearly established the environmental link to breast cancer with as much as 80% of breast cancer cases having been due to the environmental – meaning what we eat, what we drink and what we breath.

  

Breast cancer is a hormonal disease, particularly involving estrogen. There have been identified specific chemical groups that are estrogen copycats. Since most of the estrogen receptor sites are located in the breast area, the lifetime exposure of a woman to foreign environmental estrogens increases her chances of getting breast cancer. It takes 5-10 years before the first symptoms appear. The longer a woman lives in a toxic environment, the greater the risk of getting breast cancer. So do we chop off the breasts once a woman is born? Do we just remove all her reproductive organs as a preventive measure? Do we just find ways for her glands to stop the production of estrogen? To what extent will we interfere with a woman’s body?

Medicine and science has never been challenged as it is today.  The advent of breast cancer advocacy, which puts forward a patient’s perspective as opposed to a non-patient’s point of view has resulted in a shifting paradigm.

Breast Cancer is Unacceptable

What is causing breast cancer in the Philippines? Enough evidence exists to raise serious concern on the environmental link to breast cancer to make this a priority for investigation and evidence-based regulatory action.

Why is cancer the leading cause of death in Central Luzon? Why does Pampanga, particularly Angeles City have the highest incidence rate of breast cancer in the entire country? The undetermined volume of “Agent Orange”, a chemical used in the Vietnam War by the United States were stocked and flown from the US Air Base. The legacy of Agent Orange has affected the reproductive health of the people of Pampanga, particularly women and children resulting in numerous cases of leukemia, child birth defects and breast cancer. Dioxin is one of the most toxic substance ever created by humans.

What about the Cordillera Autonomous Region? Despite being in the highlands, the soil, water and air supply have been severely affected by many years of mercury and cyanide from gold mining and the continuing practice of pesticides in the vegetable growing areas. At least 10 tons of mercury are released by the entire mining industry annually into the environment. Guihulngan, a very small and sleepy town 100 kms north of Dumaguete has a very high rate of breast cancer. Just across this sleepy town is Atlas Mining, now shut down due to environmental damages. The 6.9 MG earthquake that hit Guihulngan on February 2012 have most likely released and further caused the spread of mercury and cyanide that had accumulated over the years in the water table of this town. Expect an increase of breast cancer in Guihulngan and nearby areas in the coming years!

And the National Capitol Region? Surrounded by the one of the most polluted and contaminated bodies of waters in the entire world – Manila Bay, Pasig River and Laguna Lake – it wouldn’t be difficult to understand why breast cancer has become an epidemic. San Francisco and New York have the highest rates of breast cancer in the world and numerous studies have shown the toxicity of their bodies of water, primarily caused by toxic dump sites five decades ago. The typhoon on August 2012 brought back to the tourist boulevard of Manila Bay all the trash for the world to see.   

What is even most particular to the Philippines is the government’s population control program of oral and inject able contraceptives.  Thousands upon thousands of women have been put to great risk with the early and prolonged use of the pill, undeniably a risk factor for breast cancer. Furthermore, numerous women are required chest x-rays for pre-employment, pre-enrollment and annual check-up’s as against selective screening. The supposed minimal amount of radiation cannot be discounted because it is never dose-related but a matter of timing of exposure. These periodic amounts radiation of women’s breasts have put so many at great risk.   

Population, Poverty and Pollution

As our country grapples with a sinking economy that has impoverished the vast majority of our people, health safety has become a class privilege in the pursuit of work. Thousands of migrants to urban settlers have had to live in subhuman conditions, eat unhealthy foods, drink contaminated water and toil in unsafe working environments. Thousands of the rural population have had to allow the devastation of their bays, rivers and mountains by various industries.

From being an environmentally sound archipelago just a century ago with natural resources so vast and plenty, the Philippines is fast becoming an ecological disaster whose signs are now clearly seen in it’s people health, with breast cancer as the tip of the iceberg.

Wherever and whenever in the country the PBCN has conducted symposiums, the matter of health and the environment has not only clarified misconceptions but has also empowered women in taking strong actions to prevent their daughters from getting breast cancer.

“Ang Hinaharap ay Ipaglalaban!” 

With the establishment in 1997 of the Philippine Breast Cancer Network, which advocates a preventive approach towards the eradication of breast cancer, the landscape of breast cancer in the Philippines has significantly changed. Identifying and eliminating the causes of breast cancer has now become more urgent than seeking the cure.

Corollary to this, government and industry will sooner or later adhere to the Precautionary Principle – that of acting upon evidence rather than waiting for absolute proof. The medical profession will also sooner or later adhere to the patient’s Right to Informed Consent – that of full disclosure of all information and options, and most importantly, total respect for her decision.

Numerous scientific studies showing the environmental have already been presented in more than five World Conferences on Breast Cancer held in North America since 1997. Just a few days ago, the US Senate has passed the Safe Chemicals Act which shifts the burden of proof from government agencies to producers and manufacturers to prove their products are safe for public use and consumption.

In the Philippines? The current President would rather lift the ban on mining and simply provide funds for women who will get breast cancer!

Is this having more fun in the Philippines or is it just being funny in the Philippines?

Breast Cancer is no fun at all !!!

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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Cancer stakeholders' meetings that look good but smell bad

The Cancer Stakeholders' Consultative Meeting with the theme "Moving as One" held on May 25th 2012 at the 5-star Diamond Hotel was organized by the Cancer Institute Foundation headed by Cecilia L. Llave, MD, PhD. in collaboration with UP Manila's National Institute of Health (UPM-NIH) and the Philippine Council for Health Research Development (PCHRD). The activity was in pursuit and support of the World Cancer Day of the Union for International Cancer Control (UICC).

http://www.uicc.org/%E2%80%9Cmoving-one%E2%80%9D-cancer-stakeholders-meeting-action-plan-cancer-prevention-and-control

Sounds and looks good but it doesn't smell nice!

1. Founded in 1933, the Switzerland-based UICC is run by a Board composed mostly of medical doctors and professors - notably the immediate past Chair of the American Cancer Society. For an international organization to last nearly 80 years without controlling the epidemic increase of cancer worldwide, they must be well funded! Well, just see who their partners are:

http://www.uicc.org/about-uicc/partners-description

2. For more than a decade now, nothing that really matters has really come out of the PCHRD's "Five Year Health Research Priorities" as far as cancer control is concerned. Today, 1 in every 13 women in the Philippines will get breast cancer and this supposed scientific institution can not even declare the environmental links to breast cancer. They would rather focus on research and development of medicinal plants to be offered to the pharmaceutical industry to market. With a low state budget, the PCHRD relies on the cancer industry for its research programs. Guess there simply is no money in prevention!

http://www.pchrd.dost.gov.ph/index.php/news/494-pchrd-gruppo-medica-recognizes-outstanding-undergraduate-thesis-in-herbal-medicine

3.Unlike the USA's National Institutes of Health which has more than 50,000 search results about breast cancer, the Philippine's version of NIH has only one: that taking garlic supplements by mouth may improve symptoms of benign breast disease. So what about malignancies? And their vision is to be the country's recognized authority in health research and development and the key source of critical health information for national development in the Philippines and Southeast Asia??? No wonder the Philippines today has the highest incidence rate of breast cancer in Asia and the 10th highest worldwide!!!

http://search2.google.cit.nih.gov/search?site=NIH_Master&client=NIHNEW_frontend&proxystylesheet=NIHNEW_frontend&output=xml_no_dtd&filter=0&getfields=*&q=breast+cancer&btnG.x=27&btnG.y=4&btnG=search&ie=UTF-8&ip=127.0.0.1&access=p&sort=date:D:L:d1&entqr=3&oe=UTF-8&ud=1&start=0

http://nih.upm.edu.ph/index.php?searchword=breast+cancer&ordering=&searchphrase=all&option=com_search

4. How in the world can breast cancer be prevented by early detection??? This shows the mindset of the Cancer Institute Foundation. Despite the fact of 26,000 breast cancer cases in 2010 and only 7,000 of cervical cancer, the CIF's major focus is on cervical cancer. Why? Simply because of its partnership with GlaxoSmithKline, the makers of the cervical cancer vaccine.

http://www.cifphil.org/

5. In May 2008,  I attended a Senate hearing on cancer where Dr. Llave lengthily presented her program for cervical cancer simply lobbying for more budget allocations. (I will be commenting on the cervical cancer program later on). Her thinking on prevention revolves around exercise (like running in polluted streets?), healthy diet (like eating vegetables grown with pesticides?), regular visits to a doctor (like waiting to be told you have breast cancer?), early diagnosis (like radiation exposure to mammograms?) and accessible treatment (like chemotherapy via health insurance?) to bring down mortality rates. This well meaning doctor still does not understand that breast cancer is an environmental disease and thus preventable by identifying these factors and eliminating as many as possible. By doing so, there wouldn't be a critical need for the deployment of primary and secondary caregivers, low-cost screening and treatment technologies as Dr. Llave pointed out.

http://opinion.inquirer.net/21831/cancer-is-not-just-a-%E2%80%98sickness-of-the-rich%E2%80%99

On the month of Mother's Day again, four years later during that "Moving as One" meeting, it was stated that health education n played almost no role in decreasing the incidence of cancer. Well, that's if it's coming from the UP Manila's National Institute of Health (UPM-NIH), the Philippine Council for Health and Research Development (PCHRD) and most of all from the Union for International Cancer Control (UICC).  

A gamble, a test or a sign?

The scenarios of newly diagnosed women with breast cancer are almost always very similar. With shock and fear dominating the woman and her entire family, there is a rush for quick answers and solutions to a crisis never thought to come their way.

A visit to the hospital and a cancer specialist becomes the first step in the confusing web of breast cancer. Decisions are hurriedly done, assured by the most recent advances in science and medicine. The patient mainly relies on her attending physician.  But as the days and weeks go by, more questions arise and doubts of cure start trickling in. Entering the hospital for a sure cure has become like entering a casino to win a quick fortune. Having sufficient funds, whether savings or insurance is likened to having enough capital to gamble....and what first appeared to be low risk turns out to be high risk!  As they say, the casino never loses.....it's the gambler who will lose his shirt! A woman and her family bet all their money on perceived odds that surgery, chemotherapy and radiation would work.

For other patients though, they would rather not "gamble" but opt to try various options and alternatives that have been said to be of real benefit. This places much of the burden on the patient and her family. It will be a continuing search for positive experiences in curing breast cancer. With so much information from so many resources, the patient will test one after another for as long as her resources can manage to. From one experience to another, she will hope to conquer breast cancer with whatever may come her way and for as long as she does not turn for the worse. At the very least, testing non-toxic and non-invasive methods will not complicate or compromise her. "No harm - No foul!"

Yet in either scenario, it is only what is clear and visible to one's heart which will spell her journey in the unknown depths of breast cancer. There will always be events that will happen - good and bad - and most often it will be the sudden and unexpected ones beyond her control which will become crossroads for her. To resign from a job or not. To relocate residence or not. To let go of a troubled marriage or not. To continue chemo or not. To continue alternative treatment or not. To fight or to surrender. To live or to die.

There always will be signs.

A woman with breast cancer will have to reach out in the deepest bottom of her heart and soul for the very purpose of her life, that she may find strength and courage to confront the disease with full honor and dignity. Breast cancer is an environmental disease which is preventable. Like so many other victims today, she has become the one in thirteen women in the Philippines to get breast cancer. It was never her fault.

                       Breast Cancer is a sign of the times!