Tuesday, May 20, 2014

PBCN Position on Senate Bills on Breast Cancer

Philippine Senate Committee on Health
Public Hearing on SBN 1873
10am, Tuesday, 20 May 2014

I am registering my strongest objection to Senate Bill No. 1873 authored by Sen. Trillanes, as well as SBN 2114 authored by Sen. Santiago and SBN 354 authored by Sen. Legarda.

Our country has had the highest increase in breast cancer incidence rate worldwide for the past 30 years, where today, is the highest in Asia and 11th highest worldwide. One in every 13 women will get breast cancer which is a serious and urgent public health epidemic that has never been fully addressed by government. To even aggravate matters, SBN 1873 and SBN 354 will further worsen the situation by opening the floodgates, leading thousands of innocent victims to the medical-pharmaceutical slaughterhouse of slash, poison and burn.  

According to the US Department of Defense Breast Cancer Research Program, an estimated 30% of all breast cancer cases (both invasive and DCIS) are considered to be over diagnosed and over treated. Over diagnosis is diagnosis of cancers that would not have presented within the life of the patient. Overtreatment can occur in two ways—either in over diagnosis, where any treatment is unnecessary, or with the administration of more aggressive therapies than is necessary. It has recently been estimated that one to three deaths from overtreatment occur for every one breast cancer death avoided.

Despite the PBCN’s concerns submitted during Public Hearings to both Houses of Congress since 2010, government has not taken any concrete action to curtail the most common form of cancer that has caused tremendous misery, sufferings and untimely deaths to thousands of women –young or old, rich or poor, learned or unlearned, with or without child, Christian or Muslim, urban or rural. Instead, the Department of Health and PhilHealth have even embarked on programs that have even worsened the breast cancer crisis.

In May 2011, the Department of Health (DOH) and the Philippine Cancer Society launched a medicine access program through a patient navigation scheme targeting indigent women diagnosed with early stage breast cancer. Health Secretary Ona said that cancer is a costly disease, with the cost of medicines and treatment way out of reach for many of our people. The scheme would provide medicine entitlements to poor and vulnerable sectors for priority disease such as cancer. Has the Senate ever looked into the progress or failure of this program?

In July 2012, Philhealth launched the Z Benefit Package, providing for P100,000 for the entire treatment for early breast cancer. But in reality, PhilHealth members prefer going to private hospitals rather than any government hospital. Majority of  patients in government hospitals seek free medical treatment but are not PhilHealth members. Has the Senate ever reviewed the progress or failure of this program?
Participating in above-mentioned breast cancer treatment programs were the East Avenue Medical Center (EAMC), the Jose Reyes Memorial Medical Center (JRMMC), the Philippine General Hospital (PGH) and the Rizal Medical Center. PhilHealth also includes contracted government hospitals in each region. Has the Senate ever made an investigation on the success or failure rates of all these hospitals in their respective treatment of breast cancer?

Without knowing and validating diagnostic and treatment success or failure rates, this August Body is now intending to fund another “white elephant” in supposedly addressing a known environmental disease? Despite the fact that Philhealth has a gigantic reserve fund of Php117 Billion to fund the Z Benefit Package, why does SBN 1873 want to allocate additional funds?  Is this another Napoles scam in the making in the guise of addressing a public health crisis by exploiting breast cancer? Or is this another diversion of funds for the coming presidential elections, similar to when PhilHealth spent a large amount for TV Ads for the former PGMA in the 2004 elections?

Going back to PhilHealth’s Z Benefit Package for breast cancer:

1.      How are patients diagnosed with breast cancer? By mammograms? Is the Senate Committee on Health aware that mammography is now under extreme doubt as to whether it is truly reliable and whether mammography has significantly saved lives? Very recent studies, most notable of which was the 25 Year Canadian Study which concluded that annual mammography in women aged 40-59 does not reduce mortality from breast cancer and 22% of screen detected invasive breast cancers were over-diagnosed. In a 10 year German study, it showed that mammography did more harm and had negligible benefits.  The Swiss Medical Board acknowledged that there was no evidence to suggest that overall mortality was affected while emphasizing the harm of mammography  — in particular, false positive test results and the risk of over diagnosis.

2.      What is PhilHealth’s definition of Early Stage Breast Cancer because in its selection criteria were stated Stage 0 up to– Stage 3A?  It seems PhilHealth does not even know what early stage breast cancer is.

3.      What are the safeguards against over diagnosis and over treatment?  Many cases are of the DCIS type (Ductal Carcinoma In Situ) which is non-invasive and when left untreated, will in many cases not develop into a  life-threatening disease.

4.      Why are only specific chemo drugs included in the list? Is it because they are the most effective, the cheapest or the only ones available? Worst of all is if these particular drugs are in need of human experiment or about to be phased out!  For example, Avastin was approved by the USFDA for metastatic breast cancer in 2004 only to be revoked in 2011because there was no evidence that it extended life or improved quality of life while causing severe adverse reactions. 

5.      What would be the standard treatment since medical institutions vary in their  respective approaches to breast cancer? For the same breast cancer patient, opinions vary between surgeons and oncologists and between surgeons themselves and oncologists themselves.  
So why then will all the above mentioned Senate Bills be enacted and funded when it is very clear that more harm than good will happen? It is imperative that our Senators conduct a deeper inquiry on WHY our country has a breast cancer epidemic and what must be legislated to truly address this public health crisis – not by seeking a cure but focusing on the environmental causes of breast cancer.       

Presently severely tarnished by the pork barrel, the Senate can possibly redeem  itself by enacting laws to protect all women from the scourge of breast cancer, a few of which are the following which will not cost a centavo:
1.      STOP mandatory annual chest x-rays for all government employees and make it optional for companies and schools during pre-employment and pre-enrollment. This alone will drastically reduce breast cancer because all women regardless of health status are being unnecessary exposed regularly to at least 1,000 millirads of radiation.

2.      STOP the use of hormonal contraceptives in its population control program because breast cancer is a hormonal disease. Women will not be placed at risk of breast cancer when the use of other methods such as condoms and rhythm method are encouraged instead.  

3.      STOP operations of air-water-soil contaminating industries regardless of environmental clearances - specially identified mining operations that continue to spill cyanide and mercury in the waterways of our country.

4.       STOP the use of triclosan and parabens in all productions of various cosmetics and bath soaps/shampoos among other common consumer products. A Safety Chemical Act needs to be legislated to keep our people healthy and not be at risk of developing cancer from these identified carcinogenic substances.

      Danny Meneses
      Philippine Breast Cancer Network

SIGN THE ONLINE PETITION  now to junk all pending Senate Bills on Breast Cancer. We can no longer be silent!

Monday, May 12, 2014

Breast Cancer and the Philippine Senate

In several occasions in the past years, the PBCN had attended Congressional and Senate public hearings on proposed legislative bills on breast cancer. In all of them, focus was on early detection by annual mammograms. The PBCN always submitted its position against mammography and instead proposed efforts to address this public health epidemic with prevention actions.

As can be seen in the 13th, 14th, 15th and 16th Congress, all proposed Senate Bills carried a medical perspective and upon further study, were actually lifted from similar bills proposed in the US Senate.

SBN 2019 of Sen. Santiago was on the hospitalization of women medically with breast cancer but who have health plans.

In the 14th Congress, SBN's 2017 of Sen. Santiago, SBN 1815 of Sen. Villar and SBN 78 of Sen. Legarda were all focused on mammography and early detection.

SBN 3071 of Sen. Trillanes was about breast cancer benefits in Philhealth's coverage of its members.

SBN 1784 was for the enactment of Breast Cancer Patient Protection Act of 2007 in continuation of her SBN 2019.

For the 15th Congress, SBN 1399, SBN 1110 and SBN 189 were for the enactments of previous bills proposed by Senators Legarda, Villar and Trillanes.

It was during this period that the PBCN attended a public hearing and submitted its position while voicing out its strong view on the matter of early detection and vehemently questioned the medical perspective on breast cancer, while urging government to look into and act on the environmental causes of the disease.

In the current 16th Congress, the Senate is about to enact the Breast Cancer Patient Education Act by Sen. Santiago, the Breast and Cervical Cancer Potection Act by Sen. Trillanes and the Breast Cancer Detection Act of 2013 by Sen. Legarda.

All these acts will not only result into the furtherance of a public health epidemic beause of overdiagnosis and overtreatment but worse, will not stop our women from getting breast cancer. The Philippines has had the highest increase of breast cancer incidence worldwide for the past 30 years and yet nothing is being done to identify and eliminate the environmental causes of breast cancer.

The most recent studies in North America and Europe have already confirmed what the PBCN has long been saying about mammography and early detection. Yet our "well-meaning" Senators have either refused or have been coerced by the multi-billion medical-pharmaceutical industry not to act in favor of our people.

The Senate Committee on Health chaired by Sen. Guingona has scheduled another public hearing on breast cancer this May 20th 2014 and the method by which the PBCN was being invited was very much insulting. Without any previous communication, they called to simply ask if the PBCN would be interested to attend. Attend what? Another circus of totally uniformed Senators on the true issues on breast cancer?

The PBCN still hopes for a courageous Senator who will truly champion the welfare and interests of our people! That of eliminating the environmental causes of this public health epidemic that chooses no one regardless of economic or social status. Breast Cancer does NOT have to happen!