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MANILA, Philippines – Breast cancer is currently the most common cancer among women in the Philippines.1 and all over the world2. According to the CI5 database, breast cancer incidence and mortality have risen steadily in many Asian countries, especially among Filipino women, as we now have the highest incidence of breast cancer in Southeast Asia.3. Breast cancer is also second only to lung cancer in terms of death rate, making it a major public health problem.1.
According to foreign data, approximately 62% of women with breast cancer are diagnosed at an early stage when the cancer is still confined to the breast, for which the 5-year survival rate is 99%. Only 6% are diagnosed at stage 4, for which the 5-year survival rate drops significantly to 27%4. Locally, it is estimated that the 10-year survival rate among Filipino women with breast cancer is only 57%, which is much lower compared to that of developed countries.5. This lower survival rate is mainly due to lack of awareness and low detection rates, resulting in a higher proportion of late-stage cases. Inadequate access and the high cost of treatment also contribute significantly to the higher morbidity and mortality rates observed among Filipino breast cancer patients.6.
Breast cancer is best treated with a multidisciplinary team approach (MDT)7. This means that doctors who specialize in different areas of cancer diagnosis and treatment, along with other related health professionals, work together to formulate a patient’s overall treatment plan that involves different treatment modalities. This treatment plan generally includes surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy depending on the stage of the patient, the characteristics of the tumor, and other important factors that are considered on a case-by-case basis.
For patients with early stage breast cancer, the primary treatment consists of surgery to remove the tumor, followed by chemotherapy to eradicate any remaining microscopic cancer cells. Treatment that is given after surgery is called adjuvant therapy and is aimed at lowering the risk that the cancer will come back.
For larger or fast-growing tumors that have not yet spread outside of the breast and to the lymph nodes under the arm, systemic drug therapy is recommended to kill cancer cells before surgery, and this approach is called therapy. neoadjuvant. This aims to reduce the size of the tumor to facilitate surgery and can also eliminate any distant microscopic disease that has not yet been detected by routine diagnosis.
Adjuvant radiation therapy involving the use of high-energy X-rays to target cancer cells is also added in certain cases, such as in large tumors, lymph node involvement, compromised surgical margins, and after breast-conserving surgery .8.
Certain special tests are done to better characterize tumors and identify additional treatment options. For patients whose tumors are positive for hormone receptors (i.e., estrogen and / or progesterone receptors), hormone therapy is added as a maintenance treatment after chemotherapy, most commonly in the form of aromatase inhibitors and tamoxifen. In HER2-positive cases, the addition of targeted therapy in the form of trastuzumab and pertuzumab is recommended in addition to chemotherapy.8.
Breast cancer most often spreads to the bones, lungs, brain, and liver. For patients with stage 4 or metastatic disease, surgery is rarely performed and systemic therapy becomes the main mode of treatment. Chemotherapy can be administered orally or intravenously, especially for patients with threatened organ function or rapid disease progression accompanied by severe symptoms. Otherwise, hormone therapy is the preferred systemic treatment for hormone receptor-positive metastatic disease. Radiation therapy can also be performed as a supportive treatment for certain sites of disease spread, such as painful bone metastases.8.
In recent years, many novel systemic therapies have emerged that target critical signaling pathways involved in the development of breast cancer, and most of them are currently approved for advanced or metastatic breast cancer. Some locally available targeted therapies include CDK4 / 6 inhibitors that interfere with the cell cycle and are approved for women with advanced or metastatic ER positive, HER2 negative, or metastatic breast cancer; and PARP inhibitors that prevent repair of damaged DNA and are approved for patients with HER2-negative metastatic breast cancer and a BRCA1 or BRCA2 gene mutation after prior chemotherapy.
Immunotherapy, which harnesses the body’s immune system to kill cancer cells, is another novel treatment option that has emerged in this environment.8. It is not yet clear why not all cancer patients respond to certain specific treatments, but much research is being done to develop better ways to predict which individuals are most likely to respond. More clinical trials are also underway to investigate how to better achieve sustained remissions and overcome resistance to treatment.
Cancer treatment is individualized and does not follow a one-size-fits-all approach8. If you or someone you know has cancer, talk to a cancer specialist to develop the most appropriate personalized treatment plan. It is important to discuss all of your possible treatment options with your cancer care team so that you can make the best decision for your situation.
Educate yourself, be aware, and remember that early detection and treatment are the best ways to overcome cancer.
For more information, you can visit the Philippine Society of Medical Oncology on its website and Facebook page.
Dr. Meredith García-Trinidad is a cancer expert and patient advocate.
Pfizer Philippines joins the country in celebrating Breast Cancer Awareness Month in October.
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REFERENCES:
1International Agency for Research on Cancer. World Health Organization. Globocan 2018 – Philippines. https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf. Retrieved October 20, 2020.
2International Agency for Research on Cancer. World Health Organization. Globocan 2018 – Worldwide. https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf. Retrieved October 20, 2020.
3International Agency for Research on Cancer. World Health Organization. Cancer incidence in five continents Temporal trends. https://ci5.iarc.fr/CI5plus/Default.aspx Accessed October 20, 2020.
4Cancer.net Editorial Board. Breast cancer statistics. https://www.cancer.net/cancer-types/breast-cancer/statistics#:~:text=Sixty%2Dtwo%20percent%20(62%25),older%20than%2065%20(68%25) . Retrieved October 20, 2020.
5Laudico, AV et al. 2010 Philippine Cancer Facts and Estimates. Philippine Cancer Society. Manila 2010. Page 20.
6Urrutia JD, Balmaceda CN and Baccay E. Estimation of probabilities and probabilities for breast cancer survival
Stage 2 and Stage 3 Cancer Patients. MATEC Web of Conferences 60. DOI: 10.1051 / matecconf / 20166003007. https://www.matec-conferences.org/articles/matecconf/pdf/2016/23/matecconf_iccbs2016_03007.pdf. Retrieved October 21, 2020.
7Rajan, S et al. Multidisciplinary decisions in breast cancer: does the patient receive what the team has recommended? British Journal of Cancer. British Journal of Cancer (2013) 108, 2442–2447.
8NCCN Clinical Practice Guidelines in Oncology. Breast cancer Version 6.2020 – September 8, 2020.
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