Living a good life is about having choices. But Filipino women with breast cancer often believe they are left with no choice at all.
At the soon-to-open Asia Breast Center—the country’s first freestanding ambulatory cancer care unit for profit-for-charity, dedicated to the comprehensive treatment and management of breast diseases—the doctors, many of them established names working for top hospitals in the United States, believe in giving more options to women suffering from the illness.
(Fifty percent will be donated to foundations/institutions that aim to help breast cancer patients who can’t afford treatment)
Dr. Norman San Agustin, president and CEO of Asia Breast Center, is a fellow of the American College of Surgeons, and founder and president of Morristown Surgical Associates at the Morristown Medical Center in New Jersey.
The Asia Breast Center at the 8/F Centuria Medical Makati in Century City, Kalayaan Ave., Makati, is affiliated with the Cancer Program of Morristown Medical Center. Morristown is among the top five hospitals in the greater New York Metropolitan area, and also among the top 50 hospitals in the United States.
The center will introduce a multidisciplinary approach in the management of breast cancer.
“With the beautiful reconstruction we’ve been doing now, the oncoplastic surgeon has evolved, where the concern is not only preserving the life of the patient, but preserving her integrity as a woman,” San Agustin said.
San Agustin is determined to break what he calls the cycle of fear among Filipino women—misconceptions, he said, that plague the educated and uneducated alike: that breast cancer means losing your life, your breast, and your identity as a woman.
Filipino women, he said, wrongly believe that they get better results if they opt to remove the entire breast. That’s why mastectomy is widely practiced in the country—not because women prefer to have their breasts removed, but because they feel they are left with no choice at all.
“That kind of mind-set is like arguing that wheels should be square instead of round,” he pointed out.
With one of every five women in the Philippines developing breast cancer in their lifetime, that means more women opting to give up their “girls” believe it’s the only way to stay alive. The psychological damage can be so huge that some women cannot even stand to look at themselves in the mirror anymore.
There has been tremendous research over the years involving thousands of women. With all things equal—age, cancer stage, tumor size, tumor type, receptor type—the outcomes for a mastectomy and a lumpectomy are exactly the same, San Agustin said.
“I heard from contacts here that 90 percent of Filipino women go for mastectomy. That’s the complete opposite of treatments in the United States, where many choose lumpectomy. I have highly educated Filipinos asking me how cancer returned when the entire breast has been removed,” he noted.
During a mastectomy, no doctor can possibly remove all the glands in the body, since they are located under the skin. If doctors shave off everything, the skin becomes gangrenous, and necrosis (death of the skin tissue) occurs.
“All you need is one dot, one nodule for cancer to return. The little fat left in the skin is critical because that contains the vascular elements that will supply oxygen to the skin. Without that, the skin would die,” he said.
But what about a lumpectomy that leaves the breast alone? That’s the reason patients need radiation, to destroy the remaining cancer cells, San Agustin explained.
Radiation therapy could also be the reason women shy away from lumpectomy. This normally entails daily radiation, Monday to Friday, for six-and-a-half weeks. That means hours of going through traffic and waiting in line at the hospital.
“So they say, tanggalin mo na lang, without fully understanding the devastating implications of mastectomy. They take the cosmetic part of the surgery for granted,” he said.
The Asia Breast Center will offer accelerated partial breast irradiation (APBI). It is a localized form of radiation treatment (brachytherapy) where a radioactive “seed” is inserted to kill breast cancer cells that may still be around after a lumpectomy.
This is a highly effective dose of radiation, San Agustin said, which enormously reduces treatment time.
A caveat, though: the specialized catheter is expensive (costing up to $3,000 or about P140,000). APBI can only be performed on women with stages 0-1 cancer.
“It is more critical that, before deciding on the modality of treatment, patients should discuss it with three specialists who speak to each other—a diagnostic radiologist, a radiation oncologist and a surgical oncologist,” he said.
This way, the patient and the doctors will know which treatment comes first. The traditional surgery-chemo-radiation sequence of treatment, for example, will not work on someone with inflammatory carcinoma, and could even cause death.
Someone with inflammatory carcinoma, he said, will have a better survival rate doing chemo, surgery, radiation, and then chemo again.
“We are not retrospective in our management; we are prospective. Before we treat you, three of us, plus the patient, will talk to each other. The difficult cases will be presented to the board at Morristown,” he said.
The center’s partnership with Morristown means they are held to a higher standard. A team of doctors, including Dr. Sammy Ang, Dr. Ed Santos, Dr. George Bocobo and Dr. Max Basco, will be coming in to share their expertise.
BREVAGen, a test for sporadic genes (sans family history of cancer), can determine your risk of developing breast cancer in the next five years. After all, more than 80 percent of women who develop breast cancer have little or no family history of the disease, San Agustin said.
Specimens, however, will need to be sent abroad for testing.
“You may be free of cancer from a clinical point of view, but you are never, ever cancer-free. Once you develop cancer, you are susceptible to recurrence or new cancers several times more than the average population,” he said.
But breast cancer is a different beast altogether. It can recur even decades after diagnosis, so post-treatment is very critical.
A consultation relevant to the mammography findings should include recommendations on how to reduce chances of developing.
Unlike pancreatic or lung cancer, in which patients die after a few months, those with advanced or aggressive breast cancer could live for a few more years, he said.
Cancer will slowly affect the flesh. Then it can metastasize to the chest, ribs, lungs and brain before it kills the patient.
“It’s a hard and painful way to go. So it’s disconcerting that people take it very lightly. It’s a huge issue,” San Agustin said.
The clinic will also put in a mobile unit so that testing, such as mammography, can now be done outside the center.
“We will bring the equipment to them. No more excuses,” he added.