Beyond breast detection
Know thy breasts. When women examine their breasts manually every month, they are the first to notice any abnormality, such as a lump. A lump may be an early symptom of breast cancer.
Early detection and treatment saves lives that could have been lost to breast cancer. The Philippines leads in the number of breast cancer cases monitored in Asia.
This message was emphasized by Dr. Felicidad Claudia Ordonez, head of the The Medical City Clark Breast Centre during the “Post Graduate Course in Breast Surgical Oncology” held recently by The Medical City (TMC) Clark Breast Cancer Center, reported SunStar Pampanga’s Reynaldo G. Navales last Oct. 8.
A major factor in the country leading in breast cancer occurrence may be the significant lag between the time a person detects a breast abnormality and the period when the person seeks treatment of the condition.
Denial, anxiety over possible medical expenses, and fear of mortality may be reasons hindering a person from seeking medical assistance for breast cancer.
These were highlighted in the paper on “Challenges in the early diagnosis and treatment of breast cancer in developing countries,” which was written by Karla Unger-Saldaña and published online on August 10, 2014 in the “World Journal of Clinical Oncology.”
Citing “available data on breast cancer clinical stage,” Unger-Saldaña compared that “while more than 70 percent of breast cancer patients in most high-income countries (HICs) are diagnosed in stages I and II, only 20 percent-50 percent patients in the majority of low- and middle-income countries (LMICs) are diagnosed in these earlier stages.”
In HICs, the media time-lag between “symptom discovery and treatment start” is 30-48 days. In LMICs, the delays are longest, ranging from three to eight months.
Unger-Saldaña attributed the delay between diagnosis and treatment to “access barriers and quality deficiencies in cancer care” in LMICs.
This may explain why the “majority of countries with the top incidence rates are high-income countries (HICs), while the majority of those with the highest mortality rates are low- and middle-income countries (LMICs).”
The same study shows that “delays greater than three months are associated with reduced survival.”
For men and women belonging to low- and middle-income families, breast cancer seems to be more “deadly” because of the expenses involved with medical diagnosis and treatment.
Two of the commonly used tests to screen breast cancer are the mammogram and clinical breast exam, which entail costs for the patient.
Aside from screening breast cancer, the mammogram test is needed for follow-up evaluations of people with breast cancer. Medical professionals recommend the 3D mammogram over the 2D mammogram because of the clearer images that can detect more cancers and less painful procedures dues to minimal breast compression.
The Philippine Cancer Society also recommends a multidisciplinary team approach to benefit patients with breast cancer. This involves the surgeon, medical oncologist and radio oncologist, as well as pathologist, counsellor, nutritionist, and rehabilitation specialist.
Unger-Saldaña wrote that “access to health care” refers to the “degree of fit” between a “patient’s socioeconomic characteristics, the health system, and health services organization”.
In LMICs, the “more cost-effective strategy” is early detection or “downstaging,” as recommended by the World Health Organization and the Breast Health Global Initiative.
Yet, early detection is only effective if there is access to health services that will follow up on the findings. For low- and middle-income persons with breast cancer, this means “affordable, accessible, acceptable, and available” primary care, breast imaging procedures, and “referral pathways to cancer care.”
“Screening is useless if access to adequate diagnosis and treatment cannot be assured,” wrote Unger-Saldaña, citing the Breast Health Global Initiative.