Reducing cancer in the Philippines

Cancer cases and deaths in the Philippines are on the rise. It has climbed as the number 3 cause of death. Experts estimate that cancer cases will soon overtake heart disease as the number one cause of death worldwide. This is an alarming statistic since one-third of all cancer cases can be prevented through a healthy lifestyle.

Current statistics

In the spirit of sharing relevant local data with the public, I’ve listed the top 7 causes of cancer cases for males and females, and also the top 7 causes of cancer deaths (mortality figures) for both sexes.

The data were taken from the Philippine Cancer Society and Department of Health publication entitled 2010 Philippine Cancer Facts and Estimates, authored by A.V. Laudico, V. Medina, M.R.M. Lumague, C.A. Mapua, M.T.M. Redaniel, F.G. Valenzuela and E. Pukkala.

Take note, however, that these figures are not actual counts nationwide (which we don’t have) but rather “best estimates” computed by extrapolating data gathered in Metro Manila and Rizal province.

Targeting preventable cancers

The difficulty with most cancers is that treatment can be expensive and difficult. Obviously, the government cannot shoulder all the chemotherapy expenses of poor patients, sometimes amounting to half a million pesos for a six-month session for one patient alone. Given the limited health budget, how then can the Philippine government address the growing burden of cancer in a realistic and doable way?

The solution lies in maximizing government’s resources by targeting the kinds of cancer that are 1) prevalent in the country and 2) preventable using affordable techniques.

Using this simple template, the government can first address the top four major cancers:

• Lung cancer — mainly caused by cigarette smoking and exposure to cigarette smoke (passive smoking). Smoking prevalence in the country is very high, which is at around 56 percent in men and 12 percent in women. Sad to say, smoking prevalence is highest in poor Filipino males at 64.1 percent. To avoid getting lung cancer, the individual should simply quit smoking and avoid secondhand smoke. Effective public health strategies to reduce smoking prevalence in the country include 1) increasing taxes on cigarettes, 2) prohibiting smoking in public places, 3) placing graphic warnings on cigarette labels, and 4) educating the public. However, studies show that telling the public not to smoke (health education) is not as effective as increasing the cost of cigarettes. Smokers are addicted to cigarettes and may not follow the doctor’s advice.

Liver cancer — Hepatitis B infection is a major cause of liver cancer. In the Philippines, an estimated 16 percent or roughly 16 million Filipinos are infected with the Hepatitis B virus. Hence, if we reduce the number of Filipinos that are Hepatitis B carriers, then we can reduce the incidence of liver cancer. Strategies to reduce liver cancer should entail vaccination of children and some adults (those with no immunity) with Hepatitis B vaccine. Mothers who are positive for Hepatitis B should also inform their doctor so their babies will be vaccinated right after birth. A policy of giving free Hepatitis B vaccination to all children may be costly, but it is much cheaper considering the lost wages and treatment costs incurred by the public. In Taiwan, a near universal vaccination of their children has already slashed liver cancer cases in young adults within two decades. We can replicate Taiwan’s success here in the Philippines.

• Breast cancer — the leading cause of cancer deaths in women. The exact etiology of breast cancer is unclear, but it is associated with bad genes and a high fat diet. Although breast cancer prevention can be difficult, one positive aspect of the disease is that it can be detected early using 1) regular breast examinations, and 2) affordable screening test such as a mammogram. If detected in the early stages, surgery for breast cancer cures the disease and the surgery costs only around P15,000 in our government hospitals (as charity cases). PhilHealth can pay for the operation expenses. Hence, early detection and surgical treatment are doable strategies in order to reduce breast cancer deaths.

• Cervical cancer — its two main risk factors are unsafe sex and exposure to human papilloma virus (HPV). Like breast cancer, there are affordable methods to detect cervical cancer. Doctors conduct a Pap smear test to detect cancer cells. In the community setting, a cheaper acetic acid (vinegar) wash is a viable alternative. The good news is that early detection and prompt surgery is curative for cervical cancer. A procedure involving the removal of the uterus (hysterectomy) will save the patient. The cost of the surgery is around P20,000 in government hospitals (as charity cases) and can be shouldered by PhilHealth. In addition, there is a vaccine to prevent HPV infection that may help prevent cervical cancer. However, at the present time, the cost of vaccinating all young women against HPV may be beyond the government’s resources.

The other top cancers in the country include cancers of the colon, stomach, and esophagus. However, these diseases are more expensive to screen and treat. Hence, I will leave their discussion for another day.

In summary, the general public should follow these cancer prevention tips: Stop smoking (lung), reduce alcohol intake (liver), get vaccinated (liver), engage in safe sex (cervical), eat a healthy diet (various cancers), and see your doctor regularly for your checkups.

For the government, crafting the necessary policies to target the four major cancers listed above is a good starting point to reduce the burden of cancer in the country. It is well within our resources to control these diseases. Let’s DOH it! –Willie T. Ong, MD (The Philippine Star)