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 11^th 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

      President

      Philippine Breast Cancer Network

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

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!