CALAPAN CITY, Mindoro Oriental—Dr. Patty Caballero-Cabral had been undergoing mammography and ultrasound examinations yearly since 2013, and all results turned out normal. In 2020, however, when the Covid-19 pandemic upended life all over the world, her checkup routine was disrupted and she found herself spending most of her time attending to patients in the public hospital in this province.

In September 2021, the 50-year-old physician noticed an asymmetry in her breast size. “At first I thought it was just part of menopause,” she said. After three months, on Dec. 30, she took the tests that confirmed her strong suspicion that she has cancer.

Caballero-Cabral, also called Doc Patty, has been undergoing treatment for Stage 3 breast cancer since her diagnosis. Last Sept. 23, a week before the start of the Breast Cancer Awareness Month of October, she shared her experiences in a radio program, “Living with Hopes and Realities” on Media Spirit Care on dzSB 104.1 Spirit FM after a retreat, “Ilang – A Sanctuary of Prayer” in Victoria town managed by a priest-friend of hers, The program was simulcast on Calapan cable TV Channel 64 and livestreamed on Facebook.

Doc Patty’s family has a history of the ailment. She said her father died of liver cancer, lung and colon cancer, and her mother of breast cancer. “Relatives who are also doctors had breast cancer,” she said.

Prevalence

According to data from the Philippine Obstetrical and Gynecological Society (POGS), the Philippines had the highest prevalence of breast cancer among 197 countries in 2017. It was most common among women, with the highest incidence rate of 17.62%, or 15% of new cancer cases, and 8% of cancer deaths in the country. Men, too, can be afflicted by breast cancer, and die from it.

In Mimaropa (or the provinces Mindoro Oriental, Mindoro Occidental, Marinduque, Romblon and Palawan), breast cancer deaths numbered 190 in 2020 and 225 in 2021, per Philippine Statistics Agency records. Fifty-four and 70 of the cases were in Oriental Mindoro, respectively; three involved men.

More than half (53%) of those with breast cancer were diagnosed in Stages 3 (locally advanced) and 4 (metastatic), the POGS said, citing its 2017 study.

While only 2-3% were in Stage 1, up to one-third of the patients had early-stage breast cancer that could later be metastatic, or capable of spreading to other body parts such as the brain, bones or liver.

Survival rates for women with advanced breast cancer are lower than those in the early stages. For Stage 3 cases, the 5-year relative survival rate is about 72% compared to around 22% for those in Stage 4.

“Friends and medical colleagues did not fall short of [health] reminders,” Doc Patty said. “But I realized that everything happens for a reason, and what is important is the present.” She is mother to three children, whom she regards as her biggest reason to fight the disease, and like herself all engaged in medicine—Ian, a graduate of medicine; Sofia, a medical technology graduate going to med school; and Erika, a medical student.

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‘Instruments of God’

In their breast awareness campaigns, doctors in Oriental Mindoro strongly recommend early detection and treatment, especially for those with a family history of cancer and in “high risk” situations like obesity, history of smoking and alcohol consumption, unhealthy eating, sedentary life, and constant stress.

“Don’t fear us doctors. Please help us so we can help you. We are instruments of God,” said Dr. Michael dela Paz, head of the surgery department at Oriental Mindoro Provincial Hospital.

According to Dr. Mervin Tan, a surgeon, not all body lumps are cancerous. And for women who are concerned about preserving their breasts, “there are surgical options, like breast conservation surgery, use of implants, and plastic reconstruction,” he said.

Doc Patty’s antidote to fear of cancer is prayer. But she is also taking advantage of what science offers, as well as innovative treatments that can give women a greater chance than before to live healthy, fulfilling lives following a cancer diagnosis.

Doctors like surgeon Minda Zarah Perez, radiation oncologist Jon Arcillas, medical oncologist Abigail Garcia-Barrientos, and Agnes Gorospe suggest chemotherapy sessions using innovator drugs and radiation treatment.

With advances in breast cancer treatment, survival rates have improved, and there has been more focus on quality of life for survivors, the doctors said. By reducing side effects and other complications, innovative treatments (such as targeted therapy) have given women the opportunity to reclaim their lives, returning to work, family and other activities with greater confidence and energy.

Doc Patty thinks that despite the improvements in breast cancer care, many patients still lack treatment options outside of chemotherapy and hormonal therapy because of poverty, lack of knowledge of and access to the best doctors and treatments, fear of learning the facts about cancer, and huge expenses.

No longer a death sentence

There is a cure to breast cancer and it is no longer a death sentence, Dr. Arthur Sebastian, a surgeon, emphasized.

He added: “Most of the success stories had their surgery done at an early stage, but I have one in Stage 3a (large mass, no skin or lymph node involvement) diabetic lady that I operated on way back 2005. She still follows up once a year, although she’s based in another province, in Laguna. She was 46 when she underwent surgery and post-op adjuvant treatment.”

Sebastian agreed that priorities in the healthcare framework should be shifted to early detection and comprehensive patient care. Many patients are apparently keeping the disease to themselves until the symptoms become unbearable and are noticed by others, which usually happens in the late stage, he said.

Breast cancer survivor Maila Saab shares her “experiences and learnings” with other people all over the country. “I feel more for the poor living in areas where information, doctors, facilities and financial assistance are least accessible,” she said.

Even Doc Patty said she had had to ask for help, and shared where patients could seek assistance both from government agencies and nongovernment organizations.

Dela Paz and Barrientos said they hoped that with the passage of the National Integrated Cancer Control Act, the Oriental Mindoro provincial hospital would finally be converted into a regional hospital under the Department of Health. As a regional hospital, it would be able to provide better services for cancer patients in the province, and islanders would not need to travel to Batangas and elsewhere for treatment such as radiation therapy.

“We lose the patients if there are no facilities because travel means additional expenses,” said Barrientos.

With the barangay elections scheduled on Oct. 30, healthcare advocates say voters should examine the candidates’ agenda on health.

Manual for patients

“If a local government is interested in addressing breast cancer, it can get in touch with I CanServe (ICS) Foundation,” said Dr. Cecille Montales, a breast cancer survivor and a native of Victoria, Oriental Mindoro.

ICS is an NGO that pioneered “Ating Dibdibin,” a community-based breast cancer program in Taguig City in 2012. Last Sept. 14, it launched “You Can Do This—A Breast Cancer Patient’s Manual,” which can be downloaded online for free, to support patients, survivors and their caregivers.

The advocacy group of breast cancer survivors and volunteers promotes early detection, access to accurate diagnosis and timely treatment, survivorship and palliative care, patient navigation, and hospice care.

Breast cancer “warrior” Saab expressed thanks to God for her life, and that she is able to live out God’s purpose.

“The purpose, I believe, is to encourage those facing this battle and help prevent others from going through this painful, but very colorful, journey. Our learning experience and unforgettable encounters will make us a better person, and not miss each day to be thankful to the Lord for this miracle of life and use for His glory!” she said, adding:

The journey is “from breast cancer patient to warrior, to not just a survivor but an overcomer.”

This story is published with the support of the Philippine Press Institute, Novartis and ICanServe Foundation. —Ed.