Cover Women across the Philippines unite in the fight against breast cancer, embodying resilience and solidarity (Illustration: iStock)
Women across the Philippines unite in the fight against breast cancer, embodying resilience and solidarity (Illustration: iStock)
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The World Health Organization has identified breast cancer as the most prevalent form of cancer in women, impacting millions of individuals worldwide. This has prompted the healthcare industry to intensify its efforts to develop groundbreaking solutions to combat this life-threatening illness, with the Philippines being no exception
On May 14, 2013, Hollywood actor Angelina Jolie penned an op-ed in the New York Times, revealing a significant health decision she made: undergoing preventive mastectomy. The then 37-year-old actor learnt through genetic testing that she is at high risk for developing breast and ovarian cancer, just like her mum, whom she lost to the same kind of disease. It was a tough choice for her, she admits, but one that she hopes to inspire many women in the same situation. Her decision moved readers worldwide, so impactful that it caused a spike in genetic testing everywhere–a phenomenon aptly called The Angelina Jolie Effect.
Fast forward to today, genetic testing remains one of the most valuable tests for managing cancer. According to Dr Frances Victoria Que, a medical oncologist specialising in cancer genetics and genomics, this is a procedure where one’s DNA sequence is checked to see a person’s predisposition to certain types of cancers. Que cites that among the most common breast cancer syndromes is the Hereditary Breast and Ovarian Cancer Syndrome (HBOC), caused by germline mutations in the BRCA1 and BRCA2 genes. This can be detected using genetic testing. “Patients who are known to carry high-risk breast cancer predisposition genes may be advised to do enhanced screening such as doing annual mammograms alternating with breast MRI, starting at a younger age of 25 years old [instead of the usual recommendation, which is at 40 years old], or the option to undergo bilateral mastectomy to help reduce the risk of getting breast cancer,” Que says. “Bilateral mastectomy helps reduce the risk of breast cancer by about 90 per cent. This is what Angelina Jolie decided to do.” She adds that we now can shift the current medicine practice from reactive–which most of the time is too late for the patient–to proactive, where “we’re able to do molecular preemption, screening and early detection, which can catch cancers at an early stage where our goal is for a cure”.
Above Breast cancer survivors and advocates stress the importance of support groups, psychological care, and community in facing cancer’s challenges (Photo: Getty Images)
Breast cancer survivors and advocates stress the importance of support groups, psychological care, and community in facing cancer’s challenges (Photo: Getty Images)
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While genetic testing is available at a cost in private health institutions, the government offers this through the University of the Philippines’ Philippine Genome Center and the Philippine General Hospital (PGH). According to Dr Gerardo Legaspi, director of the PGH, indigent patients can take these tests. This is aligned with the government’s Cancer and Supportive, Palliative Medicine Access programme, a mechanism that minimises out-of-pocket expenditures of patients for medicines and procedures not yet covered by Philhealth.
Another innovation available to breast cancer patients is the intraoperative radiotherapy. In the Philippines, this kind of radiotherapy is only available at the PGH as of writing. “When you take out the tumour, while the wound is still open, you put in a probe that will emit radiation into the field and hopefully kill tumour cells left there,” says Legaspi. Unlike traditional radiotherapy, it shortens the waiting time for a patient to undergo radiotherapy administered externally.
Above Breast cancer (Photo: Getty Images)
Above Radiation Therapy (Photo: Getty Images)
Breast cancer (Photo: Getty Images)
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Moreover, Legaspi also shares details of the ongoing UP-PGH Manila Cancer Center project, which is the first private-public partnership of the current administration. “It’s envisioned to be a globally competitive cancer centre to complement the already existing UP-PGH Cancer Institute,” he says. “We have 60,000 consults a year and 11,000 new cancer patients annually. Of the 60,000 consults, 25,000 are breast cancer consults. We get around 3,500 to 4,000 new cancer patients a year. That’s quite big, so the decision was made to have a standalone cancer centre with 300 beds. We have dedicated 3,000sqm for this,” Legaspi expounds. Of the 300 beds, 150 are dedicated to charity patients and 150 to private patients–both are in the same building, which means that charity and private patients can use the same facilities and technologies.
For any cancer, early detection is crucial. According to Dr Diana Cua, the country’s first breast surgeon, there are several ways to detect breast cancer. The most common is regular self-examination. There are also three standard diagnostic tests for breast cancer such as breast ultrasound, mammogram and breast MRI. The first two are generally preferred for their affordability. While it gives better visibility, the latter requires the use of gadolinium dye, which may not be advisable for everyone.
Above The pink ribbon symbolises unity and hope for women worldwide fighting breast cancer, as advocacy and medical advances transform care in the Philippines (Illustration: iStock)
The pink ribbon symbolises unity and hope for women worldwide fighting breast cancer, as advocacy and medical advances transform care in the Philippines (Illustration: iStock)
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Nowadays, some hospitals in the Philippines offer digital breast tomosynthesis that provides 3D breast imaging for more precise and detailed results. “For patients who cannot afford a breast MRI, we now have the contrast-enhanced mammogram. They do a mammogram, inject a dye [to the patient], and then add those two pictures. It adds up to the accuracy, but it’s not as expensive as an MRI,” Cua says. In addition, scintimammography uses small amounts of radioactive material, a special camera and a computer to help investigate breast abnormalities. “PET scan, or positron emission tomography, can also be used as part of metastatic workup for locally advanced breast cancer,” says Dr Michael Martin Malabanan, a radiation oncologist from Asian Hospital & Medical Center. Big hospitals offer this type of scan and select independent health service providers.
Above Support groups can improve anxiety, depression, and overall quality of life for people affected by breast cancer (Photo: Getty Images)
Support groups can improve anxiety, depression, and overall quality of life for people affected by breast cancer (Photo: Getty Images)
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When it comes to treatment, Cua shares that there have been a lot of changes since she started decades ago. “It used to be all mastectomy; now we’re seeing more women going for lumpectomy, which is like a breast conservation type of operation. Then there is oncoplastic surgery where you remove the cancer, and then you mobilise the tissue so that it doesn’t form a defect,” Cua explains. There is also a trend towards using less chemotherapy. The way drugs are delivered has also evolved, gearing towards using nanoparticles, which, according to Cua, means “it will only target the cancer. Not the normal tissue so that the patient will have fewer side effects”.
Que adds, “When we see an early breast cancer that was surgically removed, we give adjuvant chemotherapy and hormonal therapy maintenance to help decrease chances of recurrences. For locally advanced breast cancers, we can give neoadjuvant systemic treatments.” She is referring to chemotherapy, anti-Her2 targeted therapy or immunotherapy, depending on the type of breast cancer. These will help shrink the tumours before a patient goes for surgery, making it easier for the surgeon to operate.
Above Breast cancer cells are highly mobile cells that rapidly spread and form tumors, underscoring the urgency of early detection and innovative treatments (Photo: Getty Images)
Breast cancer cells are highly mobile cells that rapidly spread and form tumors, underscoring the urgency of early detection and innovative treatments (Photo: Getty Images)
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In terms of radiotherapy, Malabanan explains that using Image Guided Radiation Therapy (IGRT) is at the forefront of treatment for patients who will need additional treatment for the breast or chest wall after definitive surgery and chemotherapy. “The machine does pre-treatment low-dose imaging before every radiation treatment, thereby ensuring a precise therapy. IGRT allows us to further spare the normal organs such as the heart, lungs, spinal cord and contralateral breast tissue. This can yield a better dose to the area while ensuring lower toxicities and side effects,” Malabanan says, describing what the Tomotherapy IGRT Machine at Asian Hospital & Medical Center can do.
While these treatments and approaches are currently available in the Philippines, our local doctors and health service providers continuously seek more ways to treat not only breast cancer but cancer in general. Besides the state-of-the-art facilities that the UP-PGH Manila Cancer Center envisions to complete by 2028, more advancements are coming in. In 2025, Asian Hospital & Medical Center is bringing the first Cyberknife (CK) to the Philippines. “CK is an IGRT machine that can treat small, hard to target lesions with utmost precision because it can track the tumour movement in real time,” says Malabanan.
Above Through collaborative innovations, Filipino health professionals continue to push boundaries, bringing hope to cancer patients nationwide (Photo: Getty Images)
Through collaborative innovations, Filipino health professionals continue to push boundaries, bringing hope to cancer patients nationwide (Photo: Getty Images)
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Cua, on the other hand, expects that AI or artificial intelligence will also have an impact on breast cancer diagnosis and treatment.
Legaspi hopes that on top of these innovations, there will be more efforts to focus on survivorship. He emphasises the need for experts who can guide the patients to handle their psychological issues once diagnosed with cancer, while they are undergoing treatment, or even until they are declared cancer-free. Breast cancer survivor and co-founder of ICanServe Foundation Crisann Olives-Celdran concurs, saying, “We must ensure that counselling services, support groups, and mental health professionals are integral to the standard cancer care package.” Olives-Celdran adds that survivorship in the Philippines is “wrought with health inequities”. This is because, despite signing the Philippine National Cancer Control Act (NICCA) into law, an urgent need remains to implement it properly.
Above Detail shot of four multi-ethnic women wearing pink shirts, holding breast cancer awareness ribbons. The focus is on one of the hands.
Detail shot of four multi-ethnic women wearing pink shirts, holding breast cancer awareness ribbons. The focus is on one of the hands.
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On the other hand, filmmaker and cancer patient advocate Kara Magsanoc-Alikpala has this to say to those dealing with the illness: “Never lose hope. Cancer is not a walk in the park but a gift and a gateway to many other blessings. So grab all opportunities to love and serve because that’s all that life is about. The real fear of cancer is not death but leading a life without meaning.”
It turns out that the Big C might not be as daunting as many envision it to be. There are options, support and hope.
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Whether on assignment or not, Maritess is always on the lookout for off-the-beaten-path destinations as well as the yummiest finds in the Philippines and abroad. In 2020, she plunged into the black hole of Korean la la land. Follow her escapades at @matetreyes.
