Sunday, February 16, 2014

Philippine Media black out on the 25 Year Canadian Study on Mammography

There seems to be a total media silence in the Philippines on significant studies on breast cancer published by two internationally reputable medical journals. Considering that our country has a breast cancer epidemic and loud pronouncements by the Department of Health, medical organizations and various hospital based breast cancer support groups, a search on mammography in the websites of major news networks showed disheartening results.

This validates the high degree of influence of the medical-pharmaceutical industry on local media which does not only misinform but even keeps the general public ignorant on the most dreaded disease of all women.

The Lancet published in 22 October 2011 an article entitled, “Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis.” According to the article, global breast cancer incidence increased from 641,000 cases in 1980 to 1,643,000 cases in 2010, at an annual rate of increase of 3.1% and killed 425,000 women in 2010, of whom 68,000 were aged 15-49 years in developing countries. In the Philippines, 1 in 13 women will get breast cancer in her lifetime with our country registering the highest increase worldwide of 589% in a 30 year period.

Twenty eight months later, the British Medical Journal published just last 11 February 2014 a research entitled, “Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomized screening trial.” The research involved 89,835 participants aged 40 -59 and concluded that annual mammography in women aged 40-59 does not reduce mortality from breast cancer 22% of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial. 

Following are the most recent search results on mammography from 8 selected media (online, Television and print) where the country's leading newspaper's latest was even 4 years ago written by a doctor based in Cebu. Another doctor's article on his hospital's mammography was the latest item of a TV network. The country's leading television network was about a company's upgrade of its mammogram units while another newspaper showed in its business page the acquisition of hospital while another news daily was abut a hospital's modern mammography. Only an internet based news network mentioned the Canadian Study but only in reference to having both breasts removed as having better survival. The remaining two simply had items from Reuters on how important mammography is. Note the dates of each article.

Rappler 12 February 2014 : Women diagnosed with breast cancer caused by a notorious gene have a much better survival chance if they have both breasts removed instead of one, a study said. Another study in the same journal, meanwhile, cast doubt on the value of annual mammogram screening of women aged 40 to 59. It is the latest evidence in a long-running debate about the usefulness of a costly procedure that sometimes results in over-diagnosis – the discovery (and treatment) of cancers that would never have caused symptoms or death during a woman's lifetime. 
Manila Bulletin 31 December 2013 : Women should have a mammogram – an X-ray of the breast tissue scanning for early signs of cancer -every two years between ages 50 and 74, according to the U.S. Centers for Disease Control. 
ABS-CBN News 16 December 2013 : Last year, Philips agreed a partnership with Abu Dhabi's new, 196-bed Burjeel Hospital to supply, install, maintain and upgrade medical equipment including MRI and CT scanners, digital mammography units and ultrasound machines.

Manila Standard Today 25 October 2013 : The latest acquisition increased Metro Pacific’s total hospital bed capacity to 2,137 beds. The hospital will construct a new four-story building, which would be completed by early 2015. The building will house the most advanced diagnostic imaging center in the province, with initially a 64-slice CT scan and digital x-ray machines, and eventually a 1.5 Tesla MRI and a digital mammography machine. 

TV5 InterAksyon News 02 October 2013 : Manila Doctors Hospital (MDH) offers the latest digital mammography services should your surgeon requests you to have one. With the digital mammography, images and results are readily available. Brightness, darkness, or contrast of photos can be adjusted and sections of an image can be magnified after the mammogram is completed, making it easier to see subtle differences between tissues. 

GMA News 19 March 2013 : In the latest installment in the mammogram debate, a new study finds that getting a mammogram every other year instead of annually did not increase the risk of advanced breast cancer in women aged 50 to 74, even in women who use hormone therapy or have dense breasts, factors that increase a woman's cancer risk. 

Philippine Star  12 May 2012 : Doctors encourage women to undergo annual mammography tests because the Philippine Cancer Society reports that breast cancer is now the leading cause of death among women.

Philippine Daily Inquirer 18 January 2010 : If the new guidelines are officially adopted, women who are younger than 50 opting to have a screening mammogram will not be covered by their health insurance.  They advocate the return to the former guidelines: annual screening starting at age 40, and starting at age 30 (or earlier) for higher risk women.

Correlating the 30 year incidence study and the 25 year research on mammography with media's indifference on the breast cancer epidemic in the Philippines, places a gigantic burden on the PBCN in its advocacy. Only by massive public awareness can this silence end. The PBCN continues to seek a staunch and fearless ally in the national government to seriously address this pressing situation.

Sunday, February 9, 2014

2014 World Cancer Marketing Day

"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." - Rosa Francia Meneses, 1999 World Conference on Breast Cancer

The primary goal of the World Cancer Day on February 4th is the significant reduction of death and illness caused by cancer by the year 2025. Previously set to 2020, the organizers led by the Union for International Cancer Control (UICC) will always extend the deadline because cancer is an incurable disease.

Considering that UICC was founded 80 years ago when cancer was not yet a prevalent disease, it would be interesting to know how such an organization can possibly exist for such a long period and now come up with a most overarching goal. In the world cancer day's website, one is even asked to sign up for a “cancer free world!” 

During the 2002 World Conference on Breast Cancer in Victoria, B.C., I was accosted by a Berkeley Professor for the PBCN handouts which stated “Stop Breast Cancer!” Short of saying that I was out of my mind, he categorically stated it will never happen. The global movement for the eradication of breast cancer, of which the Philippine Breast Cancer Network is a part of, carries a patient's perspective as opposed to the medical point of view. In this regard, our advocacy is much, much bolder than that of the UICC.

The UICC will never have in its Board of Directors, well respected doctors and scientists who will not tow the line of the pharmaceutical industry. Supporters of the UICC include AMGEN, Roche, Boehringer Ingelheim, GlaxoSmithKline, Pfizer, Bayer, Novartis, Sanofi and MSD. Would anyone ever think that the UICC would ever bite the hand that feeds it? Rather, it would serve themselves to nurture a lucrative cancer market! 

Early 2012, a cancer stake-holders consultative meeting was held under the wings of the UICC. Just like the World Cancer Day which sounds and looks good, it didn't smell nice. They will forever push lifestyle and pharma but never touch on the environment.Cancer meetings that look good but smell bad!

Even the Department of Health has no standing program on cancer which is not even listed in its disease surveillance because for the DOH, cancer not a disease that needs to be seriously addressed. Looking back, all their past programs on breast cancer have failed miserably from the time it embarked 20 years ago to reduce the incidence rate of breast cancer in the country. 

All it can offer is the Medicines Access Program of DOH-NCPAM which caters to the medicinal needs of patients who cannot afford treatment for Breast Cancer Stage I-IIIA Patients through the Philippine Cancer Society. Try availing of this. Another breast cancer program to surely fail.

Then, under its Z Benefit Package, PhilHealth announced in 2012 that it would provide to its members P100,000.00 for the treatment of breast cancer (stage 0 to IIIA). In reaction to this, I warned PhilHealth of the over diagnosis and over treatment of breast cancer.  Yet now, the Pre-Authorization checklist for breast cancer is no where to be found in the website of PhilHealth! Was it scrapped just a few years after it was offered to its members? If so, why?

Patients are the major stakeholder and they must be at the center of all decision making. Women do not want to have breast cancer yet they are being led to believe that with early detection, there is a cure. So are women being made to have annual cancer causing mammograms? Prevention is knowing and avoiding identified environmental carcinogens.

The World Cancer Declaration's Target # 3 states: "To reduce exposure to cancer risk factors." If they really mean on having a world free of cancer, you do not reduce but eliminate known environmental causes of breast cancer! The incidence rate of breast cancer worldwide has nearly tripled since 1980 and will certainly be a "run away train" in the years to come. In our country, 1 in 13 Filipino women will get breast cancer.

One of the Global Advocacy Messages states, “That the success of early detection programs can be measured by a reduction in the stage of the cancer at diagnosis with earlier diagnosis associated with a reduction in the risk of dying from cancer."

It takes 5 to 10 years before the first symptoms of breast cancer are manifested. How then can there ever be early detection? So all women must undergo annual mammograms year in and year out until one day they are told that they already have breast cancer? Will all women starting at age of puberty be periodically screened for breast cancer? Will women with early diagnosis, even of the non-invasive type be made to lose their breasts and later submit to chemotherapy just to supposedly make sure she is said to be cancer-free and cured? How I wish it were as simple as that!

And now, the Philippine Medical Association (PMA) is calling for the return of local public hospitals and health centers to the control of the Department of Health (DOH) because local government units (LGUs) have failed to adequately provide quality health services to the people. The shortage of 930,000 doctors was even cited. Unfortunately, as I had earlier shown, the DOH can not or will not truly act on the cancer epidemic, except to banner pink ribbons and support pharmaceutical initiatives. The solution lies not in having so many doctors but in having lesser patients!

Yes, the World Cancer Day is one huge marketing event of the cancer industry – just like the breast cancer month every October. I would like to refer to a parable about saving babies from drowning in a river. All heroic efforts were focused downstream until one asked "who’s throwing all of these babies into the river in the first place!" To truly end breast cancer, we must look upstream and stop the cause.