What to do after you find a lump in your breast, and more: The Breast Cancer Map

Breast cancer is the most common type of cancer among women in the Philippines, with more than 27,000 new cases in 2020 alone.^[1]

Through awareness and substantial support, breast cancer survival rates have increased globally. With advances in early detection, diagnosis, and treatment options, breast cancer-related deaths are steadily declining.^[2]

This highlights the importance of awareness and early detection to fight this disease and improve the quality of life of women with breast cancer.

What is breast cancer?

Breast cancer is a disease in which cells in the breast deviate from their normal cell growth pattern. It may begin in different parts of the breast. Most breast cancer cells form in the glands that produce milk and its ducts.^[2]

In some cases, breast cancer can spread outside the breast area to other parts of the body via blood vessels and lymph vessels.

It primarily affects women aged 50 years old and above. However, there are breast cancer subtypes, like triple negative breast cancer, that can still affect younger women below 40. Men can also be diagnosed with breast cancer, comprising 1% of the total number of patients.^[3]

What are the signs and symptoms of breast cancer?^[4] 

It is essential to be aware of any changes in the physical appearance of your breast. Each person may have different symptoms of breast cancer. Some do not have any notable signs and symptoms until the later stage of cancer.

Here are the signs and symptoms you should look out for:

• Unusual thickness in parts of your breast compared to the surrounding area. 
• Lump in the breast or underarm
• Dimpling or irritation of breast skin
• Notable change in breast size, shape, or appearance
• Red or flaky skin in the nipple area
• Pain in the nipple and breast area
• Discharge of blood and other fluid other than breast milk

It is best to consult your doctor for further assessment if you have these symptoms. 

What are the causes of breast cancer?^[5]

Breast cancer grows when a cell’s DNA is damaged. It could be genetic or environmental, or in most cases, a combination of the two. 

If your mother, sister, father or child has been diagnosed with breast or ovarian cancer, you have a higher risk of being diagnosed with breast cancer in the future. Your risk increases if your relative was diagnosed before the age of 50.

Types of Breast Cancer^[6]

There are several different types of breast cancer, including:. 

Ductal Carcinoma In Situ (DCIS) 

Also called Stage 0 breast cancer, ductal carcinoma in situ is considered by some to be precancerous because the cells haven’t spread beyond your milk ducts. This condition is very treatable. However, prompt care is necessary to prevent the cancer from becoming invasive and spreading to other tissues.

Invasive Ductal Carcinoma (IDC)

Starting in your milk ducts of your breast, this cancer breaks through the wall of your duct and spreads to surrounding breast tissue. Making up about 80% of all cases, this is the most common type of breast cancer.

Lobular Carcinoma In Situ (LCIS)

It is a precancerous condition in which there are abnormal cells in the lobules of your breast. It isn’t a true cancer, but this marker can indicate the potential for breast cancer later on. 

So, it’s important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.

Invasive Lobular Cancer (ILC)

This cancer forms in the lobules of your breast (where breast milk production takes place) and has spread to surrounding breast tissue. It accounts for 10% to 15% of breast cancers.

Inflammatory Breast Cancer (IBC)

Rare and aggressive, this type of cancer resembles an infection. People with inflammatory breast cancer usually notice redness, swelling, pitting and dimpling of their breast skin. It’s caused by obstructive cancer cells in their skin’s lymph vessels.

Triple-Negative Breast Cancer (TNBC)

Making up about 15% of all cases, triple negative breast cancer is one of the most challenging breast cancers to treat. It’s called triple negative because it doesn’t have three of the markers associated with other types of breast cancer. This makes prognosis and treatment difficult.

What are the risk factors for breast cancer?^[5]

These are the factors that may increase one’s risk of developing breast cancer: 

• Gender: Breast cancer occurs nearly 100 times more often in women than in men.
• Age: Two out of three women with invasive cancer are diagnosed after age 55.
• Race: Breast cancer is diagnosed more often in Caucasian women than women of other races.
• Obesity: Obesity is a risk factor for both men and women.
• Menstrual and Reproductive History: Early menstruation (before age 12), late menopause (after 55), having your first child at an older age, or never having given birth can also increase your risk for breast cancer.
• Lack of Physical Activity: A sedentary lifestyle with little physical activity can increase your risk for breast cancer.
• Poor Diet: A diet high in saturated fat and lacking fruits and vegetables can increase your risk for breast cancer.
• Being Overweight or Obese: Being overweight or obese can increase your risk for breast cancer. Your risk is increased if you have already gone through menopause.

• Drinking Alcohol: Frequent consumption of alcohol can increase your risk for breast cancer. The more alcohol you consume, the greater the risk.
• Radiation to the Chest: Having radiation therapy to the chest before the age of 30 can increase your risk for breast cancer.
• Combined Hormone Replacement Therapy (HRT): Taking combined hormone replacement therapy, as prescribed for menopause, can increase your risk for breast cancer and increases the risk that the cancer will be detected at a more advanced stage.

Experts suggest women between 25 – 39 years old undergo clinical breast examination every 1 – 3 years.^[7] Annual clinical breast examination with mammogram is recommended for women with higher risk factors and aged 40 years and older.^[7,8]

Diagnosing Breast Cancer

An early and accurate breast cancer diagnosis may lead to better treatment outcomes and lesser medical spending in the long run.^[9,10,11] Through proper examinations, you’ll be able to identify appropriate treatment options for your condition and optimize your healthcare cost.

Here are the most common test and procedures used to diagnose breast cancer^[12]:

• Mammogram: A mammogram can help in detecting breast cancer cells early. A mammogram uses an X-ray to take images of the structures in the breast and screen for abnormality. 

• Ultrasound: breast ultrasound uses soundwaves to check deep structures within the breast and examine any lump or mass in the breast tissues.

• Biopsy: To confirm if a suspected mass or lump is cancerous or not, these tissue samples will be sent to the lab for further examination to confirm a cancer diagnosis.

• Breast magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.

Cost of breast cancer screening in the Philippines

The cost of cancer screening and diagnosis varies depending on the hospitals and medical centers. Contact your physician for further details. You can also ask queries to cancer centers near you.

According to BICOL Medical center, DOH, Republic of Philippines, the cost of breast cancer screening and treatment, can range between 500 to 10,000 pesos¹³.  

HMOs may not cover your breast cancer biopsy and other screening procedures. Be sure to ask your insurance provider so you can save money on these tests. You can also ask the hospital or clinic for available packages and discounts.

Breast cancer staging^[14]

After your doctor confirms and diagnoses your breast cancer, he will identify the extent of cancer in your body. This will help you and your medical team determine the appropriate treatment options.

Further tests may be done to know the current stage of your cancer. This may include the following procedures:

• Blood test, such as a complete blood count
• Mammogram of the other breast to look for signs of cancer
• Breast MRI
• Bone Scan
• Positron emission tomography (PET) Scan
• Computerized Tomography (CT) Scan

Breast cancer staging is based on its severity and malignancy. It ranges from Stage 0 to Stage IV, with 0 being non-invasive and Stage IV indicating that cancer has spread to other body areas.

What are the treatments for breast cancer?^[15]

Due to advancements in cancer treatment, women now have access to better options in combating breast cancer. Your doctor will guide you and determine the appropriate treatment options based on the type and stage of your breast cancer.

In the Philippines, numerous hospitals around the country are equipped with facilities capable of treating cancers and are ready to answer your queries even during the pandemic.

Most women will undergo surgery to remove cancerous tissues in the breast and may receive follow-up treatments such as chemotherapy, hormone therapy, or radiation treatments to destroy and prevent the cancer cells from returning.

Here are some of the common treatment options for breast cancer:

1. Breast-conserving surgery (Lumpectomy)

Breast-conserving surgery (BCS) is a viable option for most women with early-stage cancer. During this procedure, your surgeon will remove the cancer tissues from your breast and leave healthy breast tissues intact as much as possible.

This treatment may be recommended for women with smaller tumors. In some cases, women may undergo chemotherapy to shrink the size of cancer before removing them. Follow-up radiation therapy and other treatments are usually done after BCS.

This treatment will allow you to keep most of your breasts. Talk to your doctor to find out if BCS is a feasible treatment for you. Also, discuss with your doctor if you are planning to have breast reconstruction in the future.

2. Mastectomy

Unlike BCS, mastectomy involves removing the entire breast to eliminate cancer tissues. This procedure is done when breast-conserving surgery is not an option. 

Newer surgical techniques may be available for some cases to improve the appearance of the breast after mastectomy.

3. Lymph node surgery

Breast cancer usually spreads first to the nearby lymph nodes of the armpit and to surrounding areas of the breast. 

Lymph node surgery is done if your doctor suspects metastasis to your lymph nodes. They will remove one or two lymph nodes from your armpit and determine if cancer cells are present. 

Lymph nodes may be removed as part of the surgery to remove the breast cancer or as a separate operation.   

4. Radiation therapy

Your doctor may recommend radiation therapy after breast cancer surgery to lower the chance of recurrence of cancer cells in the breast. This procedure involves the use of high-energy waves directed at your body. 

The standard schedule for getting whole breast radiation is 5 days a week (Monday through Friday) for about 6 to 7 weeks. 

Another option is hypofractionated radiation therapy where the radiation is also given to the whole breast, but in larger daily doses (Monday through Friday) using fewer treatments (typically for only 3 to 4 weeks).

You may notice minor side effects of radiation therapy, such as fatigue and sunburn-like rash on the area where the radiation is aimed. Swelling of the breast may also occur. Fortunately, complications from radiation therapy rarely happen.

5. Chemotherapy^[16]

Chemotherapy is an example of systemic therapy, which involves the use of specific drugs that destroy fast-growing cells like cancer. 

Not all women with breast cancer will need chemotherapy. However, there are specific cases in which the procedure can significantly benefit the patients.

Before Surgery (Neoadjuvant Chemotherapy)

Your doctor may recommend chemotherapy before surgery if you have a larger tumor. Chemo can help shrink the tumor and limit the spread of cancer cells, making them easier to remove during surgery and enabling the surgeons to save the breast and lymph nodes.

Doctors can also observe how cancer will respond to chemo before they remove the tumor. This will allow them to identify specific drugs suited to treat your cancer. 

After Surgery (Adjuvant Chemotherapy)

Your doctor may recommend adjuvant chemotherapy, or chemotherapy after surgery, to kill cancer cells that might have been left after the surgery. Some cancer cells can be so tiny that imaging tests cannot detect them and, if left unchecked, can form new tumors.

Adjuvant chemo can be used to decrease the risk of breast cancer returning or spreading to other parts of your body.

Common side effects of chemotherapy include hair loss, nausea, vomiting, fatigue, and a decrease in the immune response. 

6. Hormone therapy

Hormone therapy, another example of systemic therapy, is recommended for the treatment of hormone-sensitive breast cancers. These types of cancer cells become more active when hormones such as estrogen and progesterone bind to them.

This treatment stops the growth of hormone-sensitive tumors by blocking your body’s ability to produce hormones and interfering with the effects of hormones on breast cancer cells. 

Some of the most common side effects of hormone therapy are hot flashes, night sweats and vaginal dryness. More severe complications such as bone thinning and blood clots may also develop.

7. Immunotherapy

Another systemic treatment approach for breast cancer is Immunotherapy. This treatment interferes with cancer cells’ ability to bind with your immune cells, allowing your immune system to fight off cancer more effectively.

8. Supportive care 

Supportive or palliative care is a specialized treatment that focuses on providing relief from serious illnesses. It is used to support ongoing aggressive treatments, such as surgery, chemotherapy, or radiation therapy, to reduce the burden on the patients and their support system.^[17]

Together with a team of doctors, nurses, and other medical professionals, palliative care improves the quality of life and survival chances of people suffering from cancer.

How much is the cost of breast cancer treatment in the Philippines?

The cost of cancer treatment in the Philippines may range from P100,000 to a million pesos. However, this may vary widely for each cancer patient, depending on their hospital and treatment.^[18]

This could be discouraging for the average Filipino. One study by the University of the Philippines concluded that cancer can be significant economic burden for Filipinos, leading to decreased household income and poverty.

Fortunately, government entities can provide financial support to cancer patients. Click this quick guide on how to find financial assistance for cancer patients in the Philippines.

Prognosis 

The prognosis for breast cancer depends on your cancer type and its severity. As soon as you detect breast cancer and have treatment, the better the chance of survival. 

Stage 0 to Stage III breast cancers have a high survival rate of at least 70-100% in 5 years after discovery.^[19] 

Advancements in medicine in recent years have improved the survival rates of women with cancer.

Cancer is not a death sentence, and it can be treated. Maintain a positive outlook in life and know that you are not alone in your journey. You can have a lot of options, and you can be in control of your health and life.

The Breast Cancer Map Step-By-Step Walkthrough

Although the Philippines rank highest for the most cases of breast cancer in Asia, breast cancer awareness among the Filipino people is still lacking¹⁹ and needs to go deeper if we want lasting change. 

Detecting cancer cells in their earlier stages can dramatically increase the survival chance of women with breast cancer.²⁰ Filipina women need to be aware of breast cancer symptoms, screening options, and other treatment options to make informed decisions and take control of their health. 

Hope From Within has come up with the Breast Cancer Map: Your Step-By-Step Patient Journey Guide, to help women with their fight against breast cancer.

1. Start with a breast self exam

Routine breast self-examination is an essential part of women’s health. Frequent breast self-exam allows you to improve your body awareness and understand the look and feel of your breast. 

Finding a lump or something unusual in your breast may be stressful. Don’t panic. Take note of your observations and consult them with your doctor as soon as possible. 

2. Don’t be afraid to ask

If you find a lump in your breast or notice an unusual change in the appearance of your breast, find medical experts who can help you. 

Breast cancer treatment requires a multidisciplinary approach. That’s why you need a team of the best breast cancer doctors in the Philippines on your side, guiding you every step of the way.  

3. Ask about complete panel testing and other tests

Now that you know who to talk to, it is essential to know and ask for complete panel testing or biomarker testing. 

Biomarker testing is used to look for specific tumor markers in your body that can provide information about your cancer. Knowing your biomarker helps you and your doctor identify the type of breast cancer you have and choose appropriate treatment options.

Some breast cancer types are more aggressive and need your immediate attention, such as cancer cells with Hormone Receptor (HR) and Human Epidermal Growth Factor Receptor -2 (HER2).

• HR+ and HER2+, comprise 10% of all breast cancer cases.²¹
• HR+ and HER2-, account for 68% of breast cancer incidences²¹
• HR- and HER2+, also known as Inflammatory Breast Cancer
• HR- and HER2-, also known as Triple Negative Breast Cancer, which is harder to treat

4. Understand your result and find out more about your disease

If you’ve been diagnosed with breast cancer, your cancer care team will discuss your treatment options with you. It’s important that you think carefully about each of your choices and weigh the benefits of each treatment option against the possible risks and side effects²²

You need to be aware of Triple Negative Breast Cancer (TNBC). It affects 20% of breast cancer patients with similar symptoms to other breast cancer subtypes but is more aggressive and leads to a poorer prognosis.

Although this cancer subtype doesn’t respond well to conventional treatment, discuss with your doctor other treatment options available to fight off this cancer. 

5. Know all your treatment options

Screening for breast cancer and knowing your type are vital for proper diagnosis and treatment. After having a confirmed breast cancer diagnosis, you may research or ask your doctor about the best hospitals for breast cancer treatment in the Philippines. Likewise, ask if neoadjuvant treatment is suitable for your condition. 

Neoadjuvant treatment uses cancer treatments such as chemotherapy, radiation therapy, and hormone therapy to downstage breast cancer progression and shrinks existing tumors before removing them. Successful neoadjuvant treatment may allow women to be eligible for breast-conserving surgery.

Discuss with your doctor all possible treatment options and clarify the details of your condition so you can physically and mentally prepare for your treatment journey. Remember, do not be afraid to ask. Your medical team are your partners in overcoming cancer.

6. Undergoing treatment

Once you and your doctor decide the best treatment for you, be sure to ask about how you can apply for cancer medical assistance. The cost of chemotherapy and other therapies for breast cancer in the Philippines can be daunting, but Hope From Within stands in unity with cancer patients in making these treatment options more accessible.

7. New lease on life

Enjoy living life and embrace your new normal with positivity and happiness. With innovative treatment options, effective testing and screening, and better breast cancer awareness in the Philippines, more and more women will be able to gain more years to live out their best lives with the ones they love. 

8. Better access to cancer care

The battle against breast cancer can be overwhelming and financially catastrophic for anyone. The cost of medical procedures and much-needed medications can negatively affect the lives of cancer patients and their loved ones. 

If you are a cancer patient, you can seek medical and financial assistance for cancer treatment through various government programs available in the Philippines.

Through the enactment of the National Integrated Cancer Control Act (NICCA), thousands of Filipina women will have better access to cheaper and quality breast cancer care all over the country. This law aims to improve the quality of life of Filipinos fighting cancer and provide dedicated support throughout their journey.

Although NICCA has already been passed, various provisions are not yet implemented and experienced by many cancer patients. The fight for better cancer care and access is just starting. Support the fight against cancer by signing the petition to fully implement the NICCA now.

References: 

1. Global Cancer Observatory. (2021, March). 608-philippines-fact-sheets.pdf. International Agency for Research on Cancer https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf 
2. Mayo Clinic Staff. (2022, April 27). “Breast cancer”. mayoclinic.org

https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470

3. Khattab, A., et al. (2021).  Male Breast Cancer. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK526036/ 
4. Centers For Disease Control and Prevention. (2021). “Breast Cancer”

https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm

5. National Breast Cancer Foundation,INC. (2020, April). “Risk Factors”. https://www.nationalbreastcancer.org/breast-cancer-risk-factors 
6. Cleveland clinic. “Breast Cancer

https://my.clevelandclinic.org/health/diseases/3986-breast-cancer

7. The American College of Obstetricians and Gynecologists. (2021). “Breast Cancer Risk Management and Screening in Average-Risk Women”. Acog.org https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women#:~:text=If%20performed%20for%20screening%2C%20intervals,women%20and%20women%20with%20symptoms 
8. American Cancer Society. (2022). “American Cancer Society Recommendations for the Early Detection of Breast Cancer”. Cancer.org. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html#:~:text=Women%20who%20are%20at%20high,typically%20starting%20at%20age%2030. 
9. Lao, C., et al. (2022). Differences in Breast Cancer Cost by Cancer Stage and Biomarker Subtype in New Zealand. PharmacoEconomics – open, 10.1007/s41669-022-00327-5. Advance online publication. https://doi.org/10.1007/s41669-022-00327-5 
10. Alghamdi, A., et al. (2021). The Economic Burden Associated with the Management of Different Stages of Breast Cancer: A Retrospective Cost of Illness Analysis in Saudi Arabia. Healthcare (Basel, Switzerland), 9(7), 907. https://doi.org/10.3390/healthcare9070907 
11. Brandão, M., et al. (2020). Healthcare use and cost in early breast cancer: a patient-level data analysis according to stage and breast cancer subtype. ESMO open, 5(6), e000984. https://doi.org/10.1136/esmoopen-2020-000984 
12. Centers For Disease Control and Prevention. (2021). “How Is Breast Cancer Diagnosed?”. https://www.cdc.gov/cancer/breast/basic_info/diagnosis.htm 
13. Breast and soft tissue. Bicol Medical center. 

https://bmc.doh.gov.ph/rates-and-fees/surgery/breast-and-soft-tissue

14. Mayo Clinic Staff. (2022, April 27). “Staging breast cancer”. Mayoclinic.org https://www.mayoclinic.org/diseases-conditions/breast-cancer/diagnosis-treatment/drc-20352475 
15. American Cancer Society. (2021). “Treating Breast Cancer”. Cancer.org https://www.cancer.org/cancer/breast-cancer/treatment.html 
16. American Cancer Society. (2021). “Chemotherapy for Breast Cancer”. Cancer.org https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html 
17. Berman, R., et al (2020). Supportive Care: Indispensable Component of Modern Oncology. Royal College of Radiologist Clinical Oncology Information Network, 32(11), 781-788. doi: 10.1016/j.clon.2020.07.020
18. Ngelangel, C., et al. (2018). Philippine Cost in Oncology (PESO): Describing the Economic Impact of Cancer on Filipino Cancer Patients Using the Asean Cost in Oncology Study Dataset. Acta Medica Philippina, 52(2). https://doi.org/10.47895/amp.v52i2.418 
19. Alkabban, F., & Ferguson, T. (2021). Breast Cancer. https://www.ncbi.nlm.nih.gov/books/NBK482286/ 
20. Wu TY, Lee J. Promoting Breast Cancer Awareness and Screening Practices for Early Detection in Low-Resource Settings. Eur J Breast Health. 2018 Nov 21;15(1):18-25. doi: 10.5152/ejbh.2018.4305.
21. Cancer Stat Facts: Female Breast Cancer Subtypes. National Cancer Institute. https://seer.cancer.gov/statfacts/html/breast-subtypes.html 
22. Treating Breast Cancer

https://www.cancer.org/cancer/breast-cancer/treatment.html

PH-OBR-00024 03/10/2022 09/08/2023