The Philippines has a breast cancer epidemic

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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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!

One's character and personality will ultimately determine how she confronts breast cancer.

I have always kept in my mind what a very close friend of mine told me that not all women can be as brave and daring as my late wife in her face-off with breast cancer in 2000. In fact, when she set up the Philippine Breast Cancer Network in 1997, not a few were curious in knowing what made her do it despite so many patients before her. Only when her activist background in her younger years became known would it then be understood how such a simple and soft-spoken mother of four be able to have done all she did in a very brief period before she claimed her right to be in the eternal kingdom of our Lord God Almighty.

Breast cancer chooses no one (rich or poor, young or old, learned or not, with or without child, colored or not, Muslim or Christian) - you just have to be a woman because this dreaded disease has already become a global epidemic. The cancer industry continues to make enormous profits from all medical aspects of the disease -from detection to treatment - yet until this very day, no cure can be guaranteed no matter how much money one has wherever in the entire world.

This reality places a huge burden on every woman diagnosed or suspected to have breast cancer. Hounded by the fear of death, she becomes desperate in seeking for a cure. Thinking that doctors would know what to do, she is not aware that most if not all doctors have limited if not archaic understandings of the disease. In fact, an OB-GYN with whom a woman goes to would automatically refer her breast concerns to a surgeon who would most often than not require a mammogram and/or biopsy. Upon diagnosis, the surgeon would naturally operate, an oncologist would expectantly go for chemo and a radiologist would perform radiation.

With minimal understanding of the disease and absence of other treatment options, she submits to all of the above without real participation in decision making. For others, medical insurance coverage and/or family pressure led her to the cut-poison-burn cycle. For those who have opted for natural or alternative options either from the very start or after conventional treatment, decision making could also have been influenced by family and/or friends. But for whatever path and from whoever the patient's choice came from, it will remain the patient's burden to heal her own self.

Here lies the crucial factor in confronting breast cancer. One's character and personality!

In any sport, it is one's fighting heart that gives that added finish towards victory. So it is in the arena of breast cancer. Family and friends though fully supportive will remain to be mere spectators. True victory comes when the patient carves her own path and surmounts her personal limitations, regardless of the outcome.

Yes, not all women can be like Rosa .... and this is why no woman should ever get breast cancer!

1 in 13 Filipino women will get breast cancer in her lifetime

The Philippines experienced the world’s highest increase of breast cancer incidence from the year 1980 to 2010 and today, the chances women of getting breast cancer is 1 in every 13.

In a recent study of 187 countries, global breast cancer incidence increased from 641,000 cases in 1980 to 1,643,000 cases in 2010 for an annual rate of increase of 3.1%. More than two-thirds of cases of breast cancer in 2010 were women aged 50 years and above - though most of whom were in developed countries with an increase of 104%, developing countries in this age range increased by 274%. For women between the ages of 15 and 49, there were twice as many breast cancer cases in developing countries with a 266% increase than in developed countries with only 63%.  A total of 425,000 women died from breast cancer - 68,000 of whom were between the ages of 15 and 49 in developing countries.

Among countries with not less than 10,000 cases in 2010, the Philippines ranked 11^th among the top 20 countries with the highest incidence rate of breast cancer and is now among the 6^th grouping of countries where 1 in every 13 women will get breast cancer. The Philippine risk of mortality is one in 49 cases.

The most alarming finding is that the Philippines registered the highest increase of 589% from 1980 to 2010. Compare this with the global increase of 256% with a risk incidence of 1 in 18, developing countries increase of 270% with 1 in 26 and that of Southeast Asia’s 479% increase with 1 in 20. North America continues to have the highest incidence rate of 1 in 8 followed by Western Europe and Australasia with 1 in 10.

On October 1^st will be held the 2^nd Annual Symposium of the newly formed Philippine Breast Cancer Society (PBCS) at the St. Luke’s Medical Center - Global City.  A society exclusively composed of medical doctors led by surgeons, oncologists and radiologists regarded as experts in the field of breast cancer, it must be asked of them why they continue to peddle expensive, unsuccessful and potentially carcinogenic technologies/treatments to the their patients. The breast cancer risk of mortality in the USA is 1 in 46 while that of Southeast Asia is 1 in 78 and yet they continue to ignore the healing benefits of non-toxic and non-invasive interventions. Shouldn’t they be looking at prevention along with safe methods of detection? Why has there been such an outrageous increase of breast cancer incidence despite of all recent trends in the medical science and all the programs of the Department of Heath and the Philippine Cancer Society? Why won’t they look at environmental and occupational exposures? Why do they consistently address the wrong questions?

The Philippine Breast Cancer Network (PBCN) fully supports the call to the UN and the WHO by over 100 scientists, health professionals, civil society representatives and other stakeholders, led by Dr Annie J Sasco and André Cicolella from France, to tackle the challenge of non-communicable diseases (particularly breast cancer) by global action, especially in low-and-medium income countries, including environmental health factors and occupational disease prevention.

Source of data: Study report of the Institute for Health Metrics and Evaluation (IHME) as published in the September 2011 issue of The Lancet medical journal. IHME was launched in 2007 with funding from Bill & Melinda Gates foundation and the State of Washington and is based in Seattle, Washington, USA. 
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61351-2/fulltext

Another breast cancer program to surely fail.

It has now been more than14 years since the PBCN significantly changed the landscape of breast cancer advocacy in the Philippines. Since then, almost all hospitals have organized support groups and have launched various activities every October. A year ago, the Department of Health (DOH) and the Philippine Cancer Society, Inc. (PCSI) launched a program for medicine access for indigent patients with early stage breast cancer in a bid to improve survival rates in our country. But just like many programs in the past, it will surely fail.

                             

In her own words, the PCSI Executive Director said that cancer is an expensive disease and only when early detection is linked to cost-effective treatment can they stop women from dying. The Patient Navigation Program is meant to show that breast cancer is curable and shall be implemented in the East Avenue Medical Center (EAMC) in Quezon City, the Jose Reyes Memorial Medical Center (JRMMC) and Philippine General Hospital (PGH) both in Manila and in the Rizal Medical Center (RMC) in Pasig City.

Though survival is of great concern, the matter of a cure has been the subject of decades of efforts, funding, research since the 1970's worldwide. To this very day, there is no known cure no matter how much money one has, anywhere in the world. Thus, it is not only a matter of providing care and treatment for indigents but for all women - rich or poor. So what assurance can the DOH and PCSI give that their program can increase survival rates when all their past breast cancer programs have been failures?

In a Senate Hearing last year on pending breast cancer bills all focused on early detection, the head of the PGH Cancer Institute said that women die of cancer because of poverty. Does this make any sense at all? Then, the representative of the Philippine College of Surgeons said that breast cancer can be prevented if women have early pregnancy or multiple pregnancies. He even went further saying that even prophylactic mastectomies could be considered. Is this guy serious???  The PBCN was firm in putting forward placing priority in the prevention of the disease. The Philippines has the 10th highest incidence of breast cancer in the world and the highest in Asia. Rather than focusing our country's meager resources and limited capabilities in futile programs such as the above, it would be far more beneficial to embark on efforts on how breast cancer can be avoided by our women!

Breast cancer is an environmental disease and only by identifying and eliminating environmental causes can there be a declining incidence of breast cancer in our country. The first and immediately doable are for the Department of Health to:

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.

Only when government and society finally understands and recognizes that the state of our environment is directly linked to public health can our mothers, sisters, wives, daughters, relatives and friends be spared from breast cancer.