Fact or Myth: Men Don’t Have Breast Cancer!

I spoke with several Filipino men whose family members died of breast cancer. They openly shared their experiences of how difficult it was for the whole family, however it was clear there was underlying message of how much pain and suffering their loved-one went through. Knowing a little bit about the culture, I had a gut feeling they want to talk to me about it but it was just too hard to talk about it. Why bring back the painful past! Out of respect and from prior experience I did not press the topic, believing this conversation was down a dead-end road. But I was caught off guard when they asked me; “Do men get breast cancer?” From their facial expression, I sensed a different emotion than talking about their relative’s end-of-life experiences. They seemed worried about “What if I will get cancer too” or perhaps thinking about their own mortality. Many questions ran through my mind on how to answer the question. Were they asking me because they really wanted to know? Or they just want some reassurance, “It isn’t going to happen to me”. The truth is I can give all the facts and statistic about men with breast cancer. But I thought about “What is my answer going to do to their feelings? What should I say? What would I say?

Fact 1: All women are at risk. Approximately 70% of breast cancers occur in women with none of the known risk factors. For men, the lifetime risk of getting breast cancer is about 1 in 1,000.

Fact 2: Only about 5% of breast cancers are inherited. About 80% of women diagnosed with breast cancer will be the first to be victims in their families. Breast cancer risk is increased if other members of the family (blood relatives) have had breast cancer. About 1 out of 5 men with breast cancer have a close relative with some type of cancer.

Fact 3: Early detection does NOT prevent breast cancer. Avoiding and eliminating known causes will prevent breast cancer!

Fact 4: Mammography fails to detect as much as 20% of all breast cancer and as much as 40% in women under the age of 50. Because breast cancer is so uncommon in men, so they tend to not be concerned about breast cancer and its possible warning signs. Some men even ignore the symptoms and delay medical treatment until the cancer has reached an advanced stage. This is why male breast cancers are likely to be stage III or stage IV when diagnosed.

Fact 5: 1 out of 4 who are diagnosed with breast cancer die within the first five years. No less than 40% die within 10 years.

Fact 6: Risk factors are not necessarily causes of breast cancer. Enough evidence exists linking environmental pollution and contamination to cause breast cancer. The risk factors in men are alcohol, obesity, Estrogen treatment, or radiation exposure.

Fact 7: The global incidence of breast cancer has tremendously risen by 256% in the past 30 years with Southeast Asia increasing by 479%! And the ‘authorities’ and ‘experts’ that should know; don't know why. 

Fact 8: Breast cancer is the leading killer of women ages 35 to 54 worldwide. More than a million women develop breast cancer without knowing it and almost 500,000 die from it every year.

Fact 9: 1 out of 13 Filipino women will develop breast cancer in her lifetime. The province of Pampanga has the highest incidence rate in the entire country.

Fact 10: The Philippines has the highest incidence rate of breast cancer in Asia and registered the highest increase of 589% among 187 countries over a 30 year period from 1980 to 2010.

Everyone is at Risk!

Philippine Breast Cancer Network

Long Road Ahead for Palliative Care: the U.S. and the Philippines

Everyone has the right to palliative care, is a basic human right. No one should have to suffer from avoidable pain or manageable symptoms. However, only 20 out of 234 countries have effectively integrated palliative care into their healthcare system, the other 42% have no delivery system for palliative care services, and 32% service delivery reaches only a small percentage of the population. Some 80% of the world’s population lack adequate access to medication needed for palliative care. In the U.S., hospitals or nursing home facilities are most common to receive palliative care services; however, approximately 63% of hospitals report a palliative care program.

Meanwhile, palliative care can be defined differently between developed and developing countries. In the U.S., palliative care is a specialized medical consist of physicians, nurses, social workers, and other healthcare professional working together with primary physicians providing care for patient with cancer, Alzheimer, CHF, COPD, kidney disease, Parkinson, ALS, HIV/AIDS, and many more. The goal is relief of symptoms such as pain, constipation, nausea, short of breath, loss of appetite, insomnia, and depression resulting from disease process or medical treatments. When patients are able to function at their best possible level; resulting in improved quality of life and well-being of patients and their family. Palliative care can and should be delivered at the beginning of diagnosis along with curative treatment. Why don’t all terminal ill patients receive palliative care?

In the Philippines, palliative care provides mostly pain control for cancer patients whereas hospice has a strong association with dying and support for the bereaved. The term “hospice” does not mean end-of life care rather “a home, building or institution for the terminally ill to receive specialized palliative care regardless of capacity to cure the disease. Contrary to the U.S. hospice is based on the timeline of 6 months or less to live rather than the functionality, disability and severity of illness of dying patients; hospice programs historically were more likely to be an effective method in relief of suffering during a cancer death but not so for Alzheimer, dementia or CHF. The challenge of selecting U.S. hospice benefit is giving up curative medical treatment; therefore, some patients sign on with hospice when they have exhausted curative treatment or at the end of their rope.

The challenge is that palliative care and hospice are currently not part of the government medical insurance program in the Philippines. In 2013, the country had nearly 106 million in population with a life expectancy of 72 years. PhilHealth, a government-owned insurance agency provides universal health coverage, however struggles with coverage with high unemployment and underemployment and access as more than half of healthcare facilities are privately-owned. According to The Philippine Department of Health (DOH), by 2010, 62% of population covered by National Health Insurance Program (NHIP) but only 73% had access to affordable essential drugs in 2009 and 54.3% out of pocket expenditure for healthcare in 2007. The reality is that more than 80% of Filipinos cannot afford out of pocket expenses needed for basic medical care.

Cancer is the third leading cause of Death in the Philippines. Philippine Cancer Society (2010) survey indicates that 13% males and 12% female would have some types of cancer if they live beyond age 75. Breast cancer is most common cancer followed by cancer of the lung, liver, cervix, colon, thyroid, rectum, ovary, prostate and non-Hodgkin lymphoma. Since majority of Philippine families cannot afford out-of-pocket medical expense for early screening and prevention, the majority of cancer cases were not diagnosed and treated at an early curable stage.  Only 30% of patients who have been diagnosed with cancer received medical treatments while the 70% did not return for treatment due to “they are afraid of the diagnosis, financial problem and a matter of attitude and perception” said Dr. Saleshe Tracy Anne Fernandex of Breast Cancer Clinic at the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu City.  As a result, breast cancer survival rate was the lowest among 15 Asia countries while 10% male and 7% female of cancer patients would have died before age 75. 

There are 34 organizations, 108 hospice and palliative care services providing a range of inpatient, outpatient and home care in urban cities. Philippines consists of 7,107 islands each has their own unique cultural identity and dialects making logistically difficult to provide services. Most hospice organizations are providing fee for service and free services in order to serve the indigent. During the end-of-life care, Filipino family members are primary caregivers for patients. Senator Marcos Jr. has introduced Senate Bill 3342, “the Palliative and End of Life Care Act” to provide benefit of 60 days a year leave with full pay for immediate family members or relatives who care for a critically ill. If the bill is passed; all government and private hospitals and health centers is required to provide palliative care and end of life services to all patients with life-threatening illness. 

There is work to be done in both countries on how to promote awareness and access to palliative care. Let's start with education first!