When the Asian Breast Center (ABC) reopened last June, oncologist Dr. Norman San Agustin was deluged with appointments. Some patients were in an advanced stage of breast cancer.

An advocate of early cancer detection, he said the cancer could have been controlled had these patients undergone health screening months before the new coronavirus disease (COVID-19) crisis.

San Agustin observed that women, who are at high at risk for breast cancer, have been in a challenging situation since the pandemic. Some are concerned about the safety of in-person medical consultations, while others have postponed screening or treatment due to the shutdown.

“These women felt a small bump in their breast over a year ago. It hadn’t grown into a lump yet. Unknowingly, they’ve had cancer for over a year, and thought the lump would decrease in size over time. Now they blame the lockdown for the delay in screening and diagnosis,” he explained.

San Agustin said breast cancer is a pandemic—a disease that spreads across many nations—just like COVID-19. However, he said, the Philippine COVID-19 fatality rate is 1.8 percent. Meanwhile, women with stage 3 and 4 breast cancer who do not undergo any treatment will most likely die.

Low survival rate

“With intense treatment, the survival rate is 22 percent,” noted San Agustin.

Studies have shown that the Philippines has the highest incidence of breast cancer and lowest survival rate in Asia. The major factors in mortality rate are late-stage diagnosis and low compliance with regular breast screening, particularly mammography.

The oncologist said one of the common excuses for avoiding mammography is that many women think that it is painful. “The old analog mammogram had no control over the pressure. The new digital mammogram is not painful,” he said. A few seconds of the inconvenience of breast screening are nothing compared to the suffering and expenses in the advanced stage.

San Agustin underscored that cancer in its early stages is curable. A lumpectomy, which costs some P100,000, can be covered by PhilHealth.

“The fear is that if people can afford to pay. If you are in stages 0-1, it costs nothing when covered by PhilHealth. In the advanced stage, medications will cost P2.6 million. This doesn’t include surgery and radiation. Early detection and treatment are the keys to survival and affordable care. Women over 35 should have their first baseline mammogram,” he said.

ABC is designed to deliver outpatient surgery procedures or same-day surgeries, which are more efficient and less costly compared with in-patient surgery. “Since the 1940s, there has been a trend to move patient care away from hospitals toward ambulatory centers. People think getting admitted into a hospital is safer. They have not heard of hospital-acquired bacterial infections. These bacteria are resistant to antibiotics. People can get unnecessarily sicker in the hospital. Some have died from pneumonia acquired there,” he said.

Adapting to the times

In this pandemic, ABC has adopted measures to minimize the exposure of the staff and the patients to the virus.

“As a matter of policy, we treat everyone as potential COVID-positive patient. Our concerns are not only our patients but also our staff and ourselves. We need to be vigilant,” said San Agustin.

Aside from the standard health protocols, ABC sanitizes the rooms with anolyte, a solution which kills microorganisms and pathogens. “We schedule and limit the number of patients and procedures per day, making sure there is ample time to clean up the rooms, furniture and equipment after each patient’s use,” he said.

Two days before the breast surgery, patients undergo the latest COVID-19 antigen swab test.

ABC’s location in Centuria Medical Makati, an ambulatory center at Century City, is an advantage, since it does not treat COVID-19 cases. “It’s COVID-safe because of the screening, temperature checks, foot baths, masks and frequent sanitation of the building,” said San Agustin.For women in quarantine, consultations are conducted through telemedicine, by online video. Mammo on Air was originally designed for women in the provinces.

“In the past, the only way to access a second opinion was for the patient to come to Makati or go abroad. Now, they don’t have to wait for a month to get a flight to Manila. For a fraction of the cost, they can book with Asian Breast Center and get an online appointment with a board-certified surgeon,” said San Agustin. He added that ABC has taken precautions to maintain patients’ privacy in cyberspace.

San Agustin has been batting for bullish breast cancer awareness campaigns through the media and organizations. ABC has been raising funds to help indigent women. Mammo on Wheels is envisioned as a mobile clinic that visits communities where breast screening and diagnosis are unavailable.

Ultimately, San Agustin urged women not to postpone consultation and treatment because of the anxiety of contacting the virus. He maintained that the advantage of seeking breast care offsets the risks.—CONTRIBUTED INQ

Asian Breast Center is at Centuria Medical Building, Century City, Makati; tel. 0917-1273271; visit asianbreastcenter.com