Why each case of breast cancer is different

Dr. Daren Teoh

Breast cancer remains the leading cause of death among women in the Philippines, accounting for nearly 27.7% of deaths in 2014 alone. In the same year, more than 18,000 women were also diagnosed with breast cancer.

According to the Philippine Council for Health Research and Development, one in thirteen Filipina women is expected to develop breast cancer during her lifetime

. "The highest risk of having breast cancer is simply to be a woman," says Maria Luisa Abesamis Tiambeng, consultant in medical oncology at Cardinal Santos Medical Center.

Although some patients experience breast pain, breast cancer is usually painless. . Symptoms may include a change in breast size; dimple (when the chest is not completely rounded but that it sinks at some point); chipping or thickening of the breast skin; a newly inverted nipple; skin rash or discharge; swelling of the upper arm or armpit where the lymph nodes are located; and redness or tingling of the skin on the chest, such as that of an orange peel.

The best chance of surviving breast cancer is early detection, but unfortunately in the Philippines, many are diagnosed at stage 3 or 4 Tiambeng said, there is no national screening program. Screening is not subsidized and awareness is not widespread. Only 55% survive stage 3 breast cancer for more than five years and only 15% survive stage 4.

Not curable

The stage of breast cancer depends on the size of the tumor. and distant metastases. Stage 0 has no palpable mass and has no chance of spreading to other organs; Stage 1 involves a mass less than 2 cm and a cancer that has not spread to the underarms or lymph nodes; Step 2 measures more than 2 cm and can sometimes involve the lymph nodes; Stage 3 is greater than 5 cm, with lymph node involvement; and step 4 means that the cancer has spread from the breast to other organs such as the lungs, brain and bones.

Stage 4 is not curable, but there is treatment, says Tiambeng

the life and quality of life of the patient. Stage 4 no longer depends solely on chemotherapy. There are now other options, depending on the tumor class of breast cancer, "she said.

The tumor class does not depend on the stage, type of tumor or number of lymph nodes involved , but rather the biology of the disease., like the characteristics of the tumor.

About 75% of all mammary tumors are hormone receptor positive and require hormone therapy, 20 percent are HER2 positive, a tumor class very aggressive that requires targeted therapy or smart drugs, about 10-20 percent is triple negative breast cancer (TNBC), where chemotherapy is the only approved drug choice, and some have inherited mutations such as BRCA1 or BRCA2

"In advanced breast cancer, because you are not trying to cure them, you ask them what they want in life. Many are mothers who just want to see their children finish school or attend the wedding of their children with their hair still intact, "said Dr. Daren Teoh, a clinical oncologist at Rafflesia Medical Center and KPJ Sabah Specialist Hospital in Malaysia [19659004Teohwasinthecountrytodiscusstreatmentoptionsforpatientswithadvancedbreastcancer

For those who have hormone-positive cancer, he says, hormone therapy (endocrine) or tamoxifen inhibitors and aromatase (for menopausal women) endocrine therapies More recently, endocrine therapies have been combined with other agents such as palbociclib.

Like chewing gum [19659003] "Tamoxifen was developed in the 80's. It's like a chewing gum-it blocks the cancer cells so that they can no longer feed themselves, and they go into hiberna or die, "says Teoh.

HER2-targeted therapy uses trastuzumab or an aromatase inhibitor associated with chemotherapy; TNBC requires chemotherapy, or a combination of targeted therapy, usually with single agents, and inherited mutation therapy needs PARP inhibition, a class of systemic agents that prevents the mutated BRCA cancer cell from repairing the damage to DNA

for the common positive hormone-receptor cancer is fulvestrant for postmenopausal women. The fulvestrant blocks the cancer cells and destroys them, so that it can not continue to eat, targeting the estrogen receptor that inhibits the growth of tumor cells, "he said.

Dr.Maria Luisa Abesamis Tiambeng

Hormone therapy for advanced breast cancer that "slows tumor growth by binding and degrading the estrogen receptor, a key factor in the progression of breast cancer. Meaning that it can work against tumors that have become resistant to tamoxifen.

Tiambeng recommends that women begin mammography between 40 and 44 years of age, and an annual mammogram at 45-54. If the results have been normal over the last 10 years, 55 and over may have a mammogram every two years or continue annual screening if the woman is healthy and expected 10 years more.

Patients can contact Filipino Philanthropy Competition Bureau (PCSO) for financial assistance. Hospitals now have an office dedicated to the PCSO, so there's less waiting at its head office in Quezon City. They may also seek help through the Ministry of Health's Breast Cancer Access Program (BCMAP). PhilHealth subsidizes chemotherapy up to 7,000 pesos per cycle.

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