Some pertinent facts and figures on common cancers of women in the Philippines. Read on.

CERVICAL CANCER

• Cervical cancer is the most common cancer in the female reproductive tract and is the second most common cancer in women next to breast cancer. It is however, a more deadly cancer since for every four Filipinas who survive breast cancer, only two or three will survive cervical cancer.

• Worldwide, one woman dies of cervical cancer every 2 minutes, and some 500 thousand new cases of this disease are seen every year.

• In Asia, there are 266,000 new cases of cervical cancer diagnosed each year. Of these, 7,225 new cases are from the Philippines according to the 2005 National Cancer Institute statistics. The sad thing is that two-thirds of these cases are diagnosed at a late stage when they are beyond the operative stage such that 32.3 percent of them die in first year and 73 percent will die within five years.
• In the Philippines, conservative estimates in 2000 placed the number of cervical cancer cases at between 35,000 and 70,000, to which almost 7,000 new cases are added every year, with 3,807 deaths occurring every year. 52% die within five years of diagnosis.
• The bad news about cervical cancer is that although it is only second to breast cancer as the most common malignancy that afflicts and kills women, in terms of virulence, however, cervical cancer is a more deadly disease: for every 4 Filipino women who survive cancer of the breast, only 2 or 3 will survive cancer of the cervix.
• The cost of preventing cervical cancer through early screening could only be as high as P800 for a Conventional Pap Smear test in private hospitals, and -through an inexpensive acetic acid-based visualization screening method that is being introduced in developing countries worldwide - it could be as low as P50 only.
• Cervical cancer generally takes as long as 10 years, and may even take 30 years, to develop into a full-fledged malignancy. It begins as an abnormality in cervical cells, and this abnormality is detectable through screening tests that are painless, quick, and affordable.
• Every woman may gauge her susceptibility to cervical cancer because this cancer is likely to afflict a woman who has warts of the high risk human papilloma virus in the anal and genetal areas; started having sex soon after she began her first menstruation; has or had several sexual partners; has or had sexually transmitted disease; is a previous or current smoker, or is regularly exposed to secondary smoke; used diethylstilbestrol (DES), a drug for preventing miscarriage of pregnancy, or her mother used it when pregnant with her; has five children or more; belongs in the low socio-economic class; or has compromised immune status or poor resistance to diseases.

• Pap smear, when conducted every three years, can reduce the incidence of cervical cancer up to 90.8 percent, and when done at an annual interval can reduce it further up to 93.5 percent (Sherries 1993). A study conducted by the UP-DOH Cervical Cancer Screening Research Group found out that the visual examination of the cervix aided by acetic acid wash is the most cost-effective screening method for cervical cancer. The DOH now recommends this method for early detection of cervical cancer (Cordero 2003).

• Society of Gynecologic Oncologists of the Philippines president Dr. Efren Domingo said that cervical cancer is the leading gynecologic cancer in the Philippines. In the year 2000, they diagnosed 5,000 new cases of cervical cancer, and in 2005 there were 7,500 new cases diagnosed. “Since cervical cancer is a cancer associated with sexually transmitted disease (STD) virus, prophylactic (preventive) vaccination is the ideal move for mass protection

• In 2002 the American Cancer Society came out with the following guidelines for early detection of cervical cancer:
• All women should start having pap smears three years from the time they start having vaginal intercourse, but not later than 21 years old. Screening should be done every year with the conventional pap test or every two years using the newer liquid-based Pap test.
• From age 30, women who have had three normal pap test results in a row may reduce going for pap smears every two to three years with either the conventional (regular) or liquid-based pap test. However, for women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or are immunocompromised due to, chemotherapy, chronic steroid use, or organ transplant should still continue to have annual pap smears.
• For women over 30 years old with access to a center where the human papillomavirus is tested like (Asian Hospital, Makati Medical Center, Medical City, St. Luke’s, among others), they may opt for HPV testing. If found to be negative, they may defer screening to every three years with either the conventional or liquid-based pap test, plus the HPV DNA test.
• Women 70 years of age or older who have had three or more normal pap tests in a row and no abnormal pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
• Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done for treatment for cervical cancer or for a precancerous lesion. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines.

• It is always helpful for women to see their gynecologist for an annual check-up on their birth month so they don’t ever forget that on their birthday, their gift to themselves is their health. Having a regular check up can help you catch cervical cancer before it catches you.

BREAST CANCER

• Breast Cancer is the leading killer of women ages 35 to 54 worldwide. More than a million develop the disease without knowing it, and almost 500,000 women die from it every year. The Philippines has the highest incidence of breast cancer In Asia and the 9th highest in the world today.

• Approximately 70 percent of breast cancers occur in women with none of the known risk factors. Only about five percent of breast cancers are inherited. In the 1940s, the risk for breast cancer was 1 in 22. Today, it is 1 in 8.
• 26 females out of 100 females and 1 male for every 105 males may be diagnosed with breast cancer in the Philippines. Since the 1980s, breast cancer ranks 1st among the top leading cancers afflicting women in the Philippines and ranks 2nd to lung cancer if both sexes are considered. Its incidence starts to peak at the age of 30 in women. (Source: Philippine Cancer Facts & Estimates, PCSI, 2005.) However, it was reported in 2004 that breast cancer cases in the Philippines exceeded lung cancer by 685 cases for both sexes. (Source: UP-DOH Report, Manila Bulletin, January 2004)
• Recently, more women are presenting with bilateral disease at an early age (30’s-40’s). Generally, the disease is still being diagnosed late in its course hence the survival rate of breast cancer in the Philippines is below 50%. Making the situation more difficult, an estimated seventy percent (70%) of breast cancer patients in the Philippines are indigents.
• Alarmingly, the Philippines has the highest prevalence of breast cancer in Asia. (Source: International Agency for Research on Cancer, 2004). In addition to the successful reduction in fertility and westernization of the Filipino lifestyle, the limited access to breast health contributes significantly to its recorded highest prevalence in Asia. Among the reasons for the limited access to breast health in the Philippines include: location of health facilities, limited income, high prices of diagnostic tests and hospital care, low levels of education, and the lack of breast cancer awareness.

• Women who work at night, like those employed in call centers, could be prone to breast cancer and menstrual problems, according to an Institute for Occupation Health and Safety Development official.
• Noting the increasing number of women working the graveyard shift — usually from 6 p.m. to 6 a.m. — in the ubiquitous call centers, the institute’s executive director, Noel Colina, said this type of working arrangement could pose health risks for women.
• A study by the US-based Fred Hutchinson Cancer Research Center which found that women who work the graveyard shift may face up to 60 percent higher risk of breast cancer compared to those who never work at night.
• The study showed that exposure to light at night may affect the production of melatonin, a hormone which is mainly produced by the pineal glands during the night, Colina said.
• “Nighttime sleep deprivation or exposure to light at night somehow interrupts melatonin production, which in turn stimulates the ovaries to kick out extra estrogen, a known hormonal promoter of breast cancer,” he said.
• Screening for breast cancer, which is the most common form of malignancy among Filipino women, is being promoted through self-breast examination campaign called “sariling salat sa suso,” and through clinical breast examination done by the physician. Forty-four percent and five percent of women in the Philippines practice these methods of breast cancer screening, respectively (BSNOH 2000). Mammography is also being recommended every five years among women more than 50 years old to detect nonpalpable breast masses.

OVARIAN CANCER

• Cancer of the ovary is the 10^th leading site for both sexes combined and the 5^th among women. In 2005, there is an estimated 3,283 new cases and 1,918 deaths. Incidence rises steeply starting at age 40.

• Evidence is lacking to pinpoint the specific cause or causes of cancer of the ovary. Some factors are suspected of increasing the risk: nulliparity, menstrual irregularities, history of breast cancer or endometrial cancer. There could also be a hereditary predisposition in some women. Pregnancy and oral contraceptives could be protective. The role of exogenous hormones as protective agents is being studied.

• Ovarian cancers are usually asymptomatic at the outset and many cases are detected late. It is usually detected as an abdominal mass, or a mass felt during a pelvic examination.

• Thorough annual pelvic examination may detect early cancer of the ovary starting at age 40.

• For early cancer of the ovary, surgery is curative. For clear cell carcinoma, appropriate surgery followed by adjuvant chemotherapy prolongs survival in all stages. Advanced cancer requires judicious and cost-effective palliative care.

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