In the Philippines, breast and cervical cancers remain significant health concerns affecting women of all ages and socio-economic backgrounds.

Despite advancements in medical science and increased awareness campaigns, these cancers continue to pose a threat to the health and well-being of women.

During the celebration of National Cancer Month in February, experts emphasized the importance of understanding the prevalence, risk factors, and available resources for prevention and treatment, all crucial in the fight against these diseases.

Led by the Department of Health (DOH), the month-long celebration aimed to raise awareness about cancer and its early detection.

The DOH noted that cancer is a major public health concern in the Philippines, with an estimated 153,751 cases recorded in 2020. The most common cancers include lung, breast, colorectal, liver, cervical, and prostate cancer.

Aside from raising awareness of cancer detection and its risk factors, the DOH stressed the importance of encouraging the public to take proactive steps toward prevention and early intervention.

Incidence and mortality rates

Dr. Mae Concepcion Dolendo of the National Integrated Cancer Control Act (NICCA) Council and Head of Southern Philippines Medical Center Cancer Institute explained the incidence of breast cancer per 100,000 population based on the 2020 data.

"Incidence is much higher compared to other Asian countries and even worldwide," she said. "It’s 52.7 percent compared to Asia's 36.8 percent and the global rate of 47.8 percent."

Dolendo also highlighted the high mortality rate "because our patients come in the last stages of the disease." The Philippines has a mortality rate of 19.3 percent, compared to Asia's 11.9 percent and the global rate of 13.6 percent.

The cumulative risk of breast cancer below 74 years old is also slightly higher in the Philippines compared to global statistics, Dolendo explained. “It is 5.66 percent in the Philippines, 3.98 in Asia, and 5.2 worldwide.”

“In terms of cervical cancer, we also see that the Philippines has a higher incidence compared to Asia and the world,” Dolendo said, noting that the country is at 15.2 percent compared to 12.7 percent in Asia and 13.3 percent worldwide.

There is also a slightly higher mortality rate of 7.9 percent compared to 7.1 percent in Asia and 7.3 percent worldwide.

For the cumulative risk for ages 0-74, the Philippines has 1.61 percent compared to 1.35 in Asia and 1.39 worldwide.

Dr. Lilli May Teodoro-Cole, Head of the Department of Obstetrics and Gynecology at the UERMMCI, shared that about 7,897 new cervical cancer cases are diagnosed annually in the Philippines.

“Cervical cancer ranks as the 2nd leading cause of female cancer in the country,” Cole explained. “It is also the 2nd most common female cancer in women aged 15 to 44 years old in the Philippines,” she added.

When it comes to mortality, Cole noted that about 4,052 cervical cancer deaths occur annually in the Philippines.

“Cervical cancer ranks as the 4th leading cause of cancer deaths in the Philippines and the 4th leading cause of cancer deaths in women aged 15 to 44 years in the country,” she added.

Understanding the risk factors

The experts shared that several factors contribute to the development of breast and cervical cancers in the Filipino population.

For breast cancer, risk factors include infections, age, family history, reproductive factors, obesity, alcohol consumption, and lack of physical activity.

Meanwhile, Cole explained cervical cancer is primarily caused by persistent infection with high-risk types of human papillomavirus (HPV).

This is often exacerbated by factors such as early age at first sexual intercourse, multiple sexual partners, having many children, smoking, sexually transmitted infections, and long-term intake of pills.

“Most of these factors have something to do with lifestyle,” she said. “There is really no reason why we cannot prevent cervical cancer because the cause has been identified,” Cole added.

Challenges for cancer patients

One of the major challenges in combating breast and cervical cancers in the Philippines is the limited access to early detection and screening services, particularly in rural areas.

“There are many challenges for cancer in the Philippines; we know that,” Dolendo said. “Treating cancer is very expensive and very difficult,” she added.

However, Dolendo noted that the major challenges are late diagnosis and high financial costs.

In the Philippines, 53 percent of breast cancer cases are diagnosed with Stage 3 or 4, the late stage. Dolendo also noted the low screening outcomes for breast cancer (2.22 percent) and cervical cancer (0.39 percent).

At baseline, only 16 out of designated cancer centers are fully functional. Currently, there are 35 access sites nationwide.

“Cancer, no matter where in the world, is really difficult because the disease itself is challenging, the treatment is expensive in the long-term, and there are indeed many challenges,” Dolendo said in a mix of English and Filipino.

Among the strategies suggested by the World Health Organization (WHO) is how to set priorities and invest wisely by providing care for all. “It’s not just achieving Universal Healthcare for every Filipino but also Filipinos with cancer,” she added.

Cole, meanwhile, noted that many women lack awareness of the importance of regular screenings, and cultural barriers may prevent them from seeking medical assistance until the disease has progressed to an advanced stage.

“Health-seeking behavior is a problem in our country. I have seen patients seeking consults when the cancer is already in the advanced stage,” Cole said. “The reality is that there is poor awareness in our country with regards to cancer,” she added.

Cole pointed out that if there is no awareness, there is also no knowledge about how the disease is contracted or what the symptoms are.

“There is low cancer prevention consciousness; most cancer patients seek consultation in the advanced stages,” she explained. “If there is poor uptake on screening modalities, there’s delay in seeking help for cancer-like symptoms,” she added.

Currently, Cole noted that screening modalities especially for cervical cancer are very much available.

Treatment options and services available

Cancer in adults in terms of location and type varies, and they are commonly slow-growing, Dolendo explained. She noted that the presenting features are very different because the types of cancers experts see are also different.

These symptoms, she said, do not necessarily mean they are cancer. “What it means is just basically, we have to seek consult,” she Dolendo said.

Cole explained that the treatment strategies for cervical cancer include extrafascial / radical hysterectomy; concurrent chemoradiation like pelvic external beam radiotherapy, weekly chemotherapy, and brachytherapy.

Dolendo explained that cancer treatment services in the Philippines have been classified according to functions, and there are also designated specialty care centers across the country.

“The Philippine Cancer Center is the national specialty cancer center and we have advanced comprehensive centers that are being developed by the DOH,” Dolendo said. These facilities, she added, are being enhanced to be able to deliver the kinds of services that are necessary.

“We also have the basic comprehensive cancer centers and we added more from the baseline of 25 to now we have 35 access sites across the country,” Dolendo said.

Initiatives and efforts to combat cancer

To address these challenges, the experts noted that the Philippine government has implemented various initiatives aimed at promoting cancer awareness, prevention, and early detection.

DOH, for instance, conducts regular cancer screening programs, including mammography and Pap smear tests, in partnership with local government units and non-governmental organizations.

Moreover, many advocacy groups and community-based organizations also play a crucial role in raising awareness, providing support services, and advocating for improved access to cancer care.

Dolendo noted that there are various efforts to improve services for cancer patients in the country. “We have to prevent cancer because we don’t want it to happen,” she said.

The Philippines’ strategic focus includes better health promotion and cancer awareness, early detection of treatable cancers, timely diagnosis and prompt treatment of cancer patients, increased treatment completion and improved survivorship care, and reduced financial burden across the continuum of care.

While the Philippines is “doing quite well” in terms of prevention and screening, Dolendo noted there are plenty of opportunities for improvement particularly in diagnosis and resource capacity.

“We’re doing very well in terms of prevention and screening and awareness and education, but there is still a huge gap or a huge opportunity for improvement to policy and planning, for diagnosis and treatment capacity as well as treatment and access,” she said.

The battle against cancer

Dolendo noted that the Philippines, through the NICCA, global collaborations, and multi-stakeholder participation, has made significant strides in the battle against cancer.

“This cancer fight is not very simple because it spans across various fronts: from prevention, to early recognition, early cancer recognition, timely care access, treatment completion, survivorship, and end-of-life for both adults and children,” Dolendo said.

She also enjoined the public to seek and have a deeper understanding of cancer while exploring what resources are available.

“There are many resources available for cancer and actively, not only to partake, but also to actively contribute to the ongoing fight for a cure and improved quality of life for cancer patients in the country,” Dolendo said.

Meanwhile, Dolendo urged cancer patients to “never lose hope” because “cancer research is the most active and dynamic area of research.”

“Cancer is curable, and there are resources that the government provides for cancer patients,” she added.

Cole, for her part, underscored the importance of health-seeking behavior.

“Cancer doesn’t wait, neither should you,” she said. She also stressed the need for Filipinos, especially women, to take care of themselves by doing regular cancer screening.

“If you love yourself, find time. Just because we don't feel anything doesn't mean we're healthy,” she added.

Cole noted that in government hospitals, most services are offered free. “This is the time for screening but just be patient because there are so many patients,” she said.