First part: Breast cancer: Unveiling the enemy
Third part: Breast Cancer: Fighting misinformation saves lives
NOTICED a lump? Keep calm, don’t panic. Be prepared.
But don’t ignore it. Seek the help of a medical doctor, inform a family member, prepare a list of questions to ask the doctor, identify organizations and agencies that can provide financial assistance, and try to be organized.
Dr. Wilfredo Liangco, medical oncologist at the Medical Center Manila, said on the day a patient is diagnosed with breast cancer, he or she is already considered a survivor.
Liangco, in a talk during the seminar on Think Pink Health Reporting on Breast Cancer in the Philippines, pointed out that “googling” one’s condition was not one of the steps, as this tends to catastrophize and result in the patient’s despair.
Dr. Frederick Ivan Ting of the Riverside Medical Center in Bacolod City, who was in the same seminar, pointed out the importance of breast cancer screening, which can start with breast self-examination, a breast examination by a physician, and later procedures like mammograms, breast ultrasounds, breast MRI, and biopsy.
“The only sure way to determine whether a lump is cancer is to do a biopsy,” Ting said.
The American Cancer Society recommended that women starting at age 40 to 45 should have mammograms yearly, and women 55 to 74 years old can have it one to two years.
Ting said the goal of breast cancer screening is early detection, as breast cancer increases with age.
“The earlier we detect breast cancer, the higher chances of survival, the lower the stage of cancer, the higher chances of survival. That is why early detection is very important,” Ting added.
In the tests and procedures, the breast cancer stage will be determined. The stage determines how the cancer will be treated as well as the chances of survival over a certain number of years. It will be classified into zero to five stages.
The pathology result will also show if the cancer cells have receptors for the hormones estrogen and progesterone, as well as the human epidermal growth factor receptor, or HER2, which is the protein involved in cell growth.
Treatment of cancer
Ting said the treatment of cancer today is an effort by multi-disciplinary teams, which is essential for optimal management of breast cancer patients and is now the standard of care in the management of patients with cancer.
The team is composed of a medical oncologist, surgeon, pathologist, radiation oncologist, and nurses/paramedical staff. The team discusses with the patient the goal of treatment and treatment plan for systemic therapy or surgery and guides the patient on what treatment to choose.
On the other hand, Liangco explained the different treatment procedures for patients with breast cancer, as well as palliative care.
Surgery is one of the treatment options, where breast surgeons will determine which form of surgery is best: either lumpectomy, where only the cancerous lump is removed, or mastectomy, where the whole breast is removed.
There are also systemic treatments. Systemic therapy is an essential component of cancer treatment, especially when the cancer has advanced to a stage where localized treatments like surgery or radiation may not be sufficient. The choice of systemic therapy depends on the type of cancer, its stage, and the individual patient’s specific circumstances. It is often used in conjunction with other treatment modalities to provide the best possible outcome for cancer patients.
Systemic treatment includes chemotherapy, hormone therapy, immunotherapy, targeted drug therapy, and radiation.
Liangco said the type of chemotherapy will depend on the type of breast cancer, the grade of the tumor, and the state of cancer, among others. It can be administered either intravenously or orally.
Hormone therapy is given to breast cancer patients whose tumors are affected by estrogen and progesterone, while immunotherapy uses medicines to improve the patient’s immunity to help the body fight the cancer.
Hormone therapy, Liangco said, is determined by a test done after surgery to determine if the type of breast cancer has receptors for the naturally occurring hormones estrogen and progesterone.
Another systemic treatment is targeted drug therapy, which could be given to patients to slow the growth of or destroy cancer cells.
Liangco said that because of their targeted action, these drugs have an effect on cancer cells and mostly leave normal, healthy cells alone. It often has less severe side effects than standard chemotherapy drugs, improving the survival rate, compliance, and quality of life of patients.
Radiation, meanwhile, is a type of treatment that uses high-energy beams from a machine to destroy the cancer cells in the targeted areas. Liangco said radiation decreases the risk of cancer coming back. It is also used for improving symptoms such as pain or bleeding in patients in the advanced stage.
Diagnosis and treatments are part of the cancer journey; another part is access to care such as hospitals, doctors and surgeons.
According to Dr. Ting’s paper, “Geographic distribution of cancer care providers in the Philippines,” for every 100,000 Filipinos, there is less than one medical oncologist, surgical oncologist, radiation oncologist, gynecologic oncologist and palliative doctor.
“There are only 340+ medical oncologists in a population of more than 109 million, and they are mostly concentrated in Metro Manila, while other areas do not even have one,” Ting said.
Where to go for help
In 2019, then President Rodrigo Duterte signed Republic Act 11215, or the National Integrated Cancer Control Act (NICCA), a piece of legislation that aims to increase the rate of cancer survival and reduce the burden on patients and their caregivers.
“The law assures that every cancer patient shall be served regardless of age, race, kind of cancer, cancer stage, gender, or ethnicity. No one is left behind,” said Kara Magsanoc-Alikpala, founding president of the ICanServe Foundation — an advocacy group that promotes and conducts breast cancer control programs.
NICCA law provides a Cancer Assistance Fund on top of the Cancer Supportive and Palliative Medical Assess Program. It also expands the PhilHealth benefits under the Z package.
Dr. Herdee Luna of the Philippine Cancer Society said navigating the health care systems for breast cancer patients is moving, with gaps slowly being addressed.
She said various government and nongovernment agencies are providing financial packages to cancer patients, like the Philippine Charity Sweepstakes Office Medical Assistance Program, the Department of Social Welfare and Development, the DOH (Department of Health) Cancer Supportive and Palliative Medical Assess Program, the Office of the President, the Office of the Vice President, and the Public Assistance Center through the Senate of the Philippines.
Malasakit Centers nationwide, with 16 field offices, provide medical assistance through affiliated hospitals.
In Region 7, the Malasakit office served a total of 21,071 beneficiaries and disbursed a total amount of P43,240,852 in assistance.
The assistance covers hospitalization expenses, the cost of medicines, and other medical treatment or procedures such as implants, common laboratory tests, and diagnostic imaging procedures for any illness or ailment.
Dr. Jerra Armendarez, medical officer IV, Non-Communicable Disease Section of DOH 7, said resources are available for cancer patients in the region.
At the moment, only the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu City is accredited to accommodate and provide care to cancer patients in the region.
Armendarez urged the public to visit their municipal health officers if they notice signs and symptoms of cancer, so an immediate referral will be made to VSMMC. At the VSMMC, the social services department will facilitate the patient’s availment of the free services, provided all the requirements are complete.
She also highlights the need for cancer literacy, especially for women in the countryside. There is a need to do a massive education campaign in order to bring down mortality rates as well as the late detection of cancer.
To be continued...
(The story is published with the support of the Philippine Press Institute, Philippine Cancer Society, ICanServe Foundation and Novartis in collaboration with the Swiss Chamber of Commerce of the Philippines and the Pharmaceutical & Healthcare Association of the Philippines.))