Breast Cancer in the Philippines

Many of you might already know that cancer ranks third among the leading causes of mortality and morbidity in the Philippines. Infectious and cardiovascular diseases are the top two. Cancer prevention attitude here sucks, and a researcher has lamented that if this continues, "it is estimated that for every 1,800 Filipinos, one will develop cancer annually."

Seventy-five percent (75%) of all cancers here occur after age 50 years, and only about three percent (3%) occur at age 14 years and below. Most Filipino cancer patients wait until the last hour before consulting (see Filipino Patient Type #1) and at this point, the cancer is most often at an advanced stage.

From the Japanese Journal of Clinical Oncology, Vol.32, Sup.1, 2002

The grim fact is this: "for every two new cancer cases diagnosed annually, one will die within the year."

For this post, I will limit the discussion on breast cancer in the Philippine setting, risk factors involved, and conclusions reached in some studies.

• In Asia, the Philippines has the highest reported incidence rate of breast cancer. From 43.2 in 1993-1995, the age-standardized incidence rate (ASR) is now 47.7 per 100,000 females, and this figure exceeds the rate reported for several Western countries, including Spain, Italy, and most Eastern European countries.



• Liede and colleagues have estimated that at least five percent (5%) of breast cancers in the Philippines may be attributed to mutations in the breast cancer susceptibility genes BRCA1 and BRCA2.



• Many breast cancers are diagnosed among 35 to 50-year-old Filipino women.



• In terms of breast cancer detection, a local study revealed that the use of breast self-examination (BSE) and aspiration biopsy/open biopsy are the most cost-effective strategies in the Philippine setting, incurring savings for the government by almost 3 million Philippine Pesos or US $60,000 (1989 value) per year per 100,000 women. Mammography is not readily available nor affordable especially in the rural areas.
  
  
• How many Filipinas do a regular breast self-examination (BSE)? Another local study reveals that only 54 percent had ever done a BSE, of whom only 27 percent are still practicing it at an average of 9.2 times a year. Reasons given for not doing the BSE included no symptoms, busy, don’t know how, don’t like, don’t think important, always forget, afraid and not aware.



• Why do Filipinas with breast problems always consult when it is too late? A 1993 local study on the determinants of late-stage diagnosis of breast cancer among Filipino patients indicated that economic factors, non-awareness of the gravity of breast cancer and fear of being diagnosed with cancer may be reasons for late diagnosis.



• Unreasonably stubborn breast cancer patients - a 1997 DOH-WHO breast cancer screening field survey in Metro Manila revealed that there was a large non-compliance rate (79.1 percent!) among women found to have breast masses (2.8 percent positivity rate) in terms of consulting hospitals and specialized clinics for re-evaluation and possible treatment. Now, you know why many breast cancer patients die here.



• Women who are currently on combined oral contraceptives or who have used them in the last 10 years are at a slightly increased risk of having breast cancer diagnosed. There is no evidence of an increased risk 10 or more years after stopping use.



• Post-menopausal women are at an increased risk of having breast cancer diagnosed while on hormone replacement therapy (HRT). There is no evidence of an increased risk of breast cancer 5 or more years after stopping HRT.



• Significant risk factors identified for breast cancer in the Philippines from a local study include: longest residence in rural areas, lower than high school education, history of benign breast disease, infertility, and greater than 35 years age at first pregnancy.



• Protective factors identified: severe dysmenorrhea (don't hate those cramps anymore!), number of livebirths (the more children, the better!), and breastfeeding (best for baby, best for mommy!).



• Cooking methods like boiling food in coconut milk have recently been associated with a significantly increased risk of breast cancer here in the Philippines.



• Another study suggests that high intake of deep-fried, well-done red meat may be associated with an increased risk of breast cancer, and the positive association may be modified by body weight. The same study also said that nonhydrogenated soybean oil, if not used in high-temperature cooking, may be associated with a reduced risk of breast cancer.

Breast cancer is easy to beat if you catch it early. Ladies, please learn how to do a breast self-examination, and do not fear going to your doctor for a consultation.

Here's an excellent website on How To Do Breast Self-Exams (be sure to turn on your speakers; it will teach you step-by-step procedures).