Cancer is largely considered a lifestyle-related disease. Many chemical, biological, radioactive, and other naturally occurring and synthetic substances, as well as predisposing factors and high-risk behaviors like smoking, diet, sexual activity, pollution and occupational exposure have been linked to cancer.

Many different types of cancers have been identified. In the Philippines, the most common sites of reported deaths from cancer are the trachea, bronchus and lung (8.4 deaths per 100,000 population), breast (4.4 per 100,000) and leukemia (2.9 per 100,000). Among males, the leading sites are the lungs, prostate, colorectal area and liver. Among females, the leading sites are the breast, uterus, cervix and lungs. Among children, the leading cancers are the leukemias and lymphomas.

There is a yawning gap in locally relevant scientific information on the relationship between the purported cancer agents and the predisposition of Filipinos for the disease. Despite this, the relationship of tobacco smoking to many forms of cancer has been firmly established. This is why tobacco control is one of the cornerstones of cancer prevention. Another well-established correlation is between infection with hepatitis B and the development of liver cancer in later life. For this reason, hepatitis B immunization at birth has been
included in the expanded program on immunization.

Another cornerstone of cancer prevention and control is early detection through the promotion of selfassessment techniques. Early detection of cancer can greatly affect the outcome of clinical management. When discovered early in their course and given appropriate treatment, a high percentage of malignancies can undergo remission.

Screening for breast cancer, which is the most common form of malignancy among Filipino women, is being promoted through self-breast examination campaign called “sariling salat sa suso,” and through clinical breast examination done by the physician. Forty-four percent and five percent of women in the Philippines practice these methods of breast cancer screening, respectively (BSNOH 2000). Mammography is also being recommended every five years among women more than 50 years old to detect nonpalpable breast masses.

Pap smear, when conducted every three years, can reduce the incidence of cervical cancer up to 90.8 percent, and when done at an annual interval can reduce it further up to 93.5 percent (Sherries 1993). A study conducted by the UP-DOH Cervical Cancer Screening Research Group found out that the visual examination of the cervix aided by acetic acid wash is the most cost-effective screening method for cervical cancer. The DOH now recommends this method for early detection of cervical cancer (Cordero 2003).

Digital rectal examination every five years is also used as a screening tool for prostatic and colorectal malignancy among males older than 50 years old. However, only about two percent of the target population submits to the procedure (BSNOH2000).

Economic factors, non-awareness of the gravity of cancer upon first presentation and fear of being diagnosed with cancer are usually the reasons for late diagnosis (Ngelangel 1993). Increasing the awareness and submission of the populace to the many screening procedures developed for the different kinds of malignancies can improve treatment outcome and lessen the mortality for the disease.

Cancer is known to produce unbearable pain to patients in the last stages of the disease. To improve the quality of life during this stage, patients need effective pain relief therapy. Since morphine is not readily available, the DOH has continued to ensure that even poor patients have access to this pain relief medication. Morphine sulfate tablets are distributed to hospitals and hospice care facilities for cancer patients through the CHDs and the Philippine Cancer Society following rules and regulations mandated by the law
for regulated substances.

A variety of treatment modalities continue to be developed for each specific form of cancer, but the cost of treatment can be staggering. This is why public health interventions are focused on health promotion, disease prevention and early detection. Malignant neoplasm or cancer has been among the top ten leading causes of death in the Philippines since the 1970s. Cancer incidence has been slowly but steadily increasing over the past years. Cancer is the third leading cause of death in the country, accounting for 9.9 percent of all deaths in 2000 (PHS).

The reported cases of malignant neoplasms has been increasing up to 1995 but an abrupt decrease in the number of cases was noted in 1996 due to a change in the system of reporting, malignancies were removed among the notifiable diseases in the Field Health Service Information System. The morbidity rates have remained underreported thereafter at 4.0 to 9.0 cases per 100,000 population. On the other hand, the trend in reported deaths from all kinds of malignant neoplasm is increasing over the years reaching 47.7 per 100,000 population in 2000.

In 2002, the region with the highest morbidity rate for cancer is SouthernTagalog at 89.9 cases per 100,000 population, followed by Western Mindanao at 15.4 per 100,000 and Western Visayas at 9.6 per 100,000. The large variation in the data may be due to underreporting in some regions.

The scale of lifestyle changes required in order to delay the onset and avert the course of degenerative diseases renders them difficult to control. Health sector managers would need more than the seasonal mass media campaigns or people to get rid of old habits and make correct choices for health. The healthy lifestyle campaign should be clear, consistent and competitive enough to overcome the effects of contradictory information and persuasions from the commercial sector.

The health management paradigm that shifts from directly fighting lifestyle-related diseases to fighting off the risk factors and risk behaviors acquired by the individual has proven to be a difficult challenge to health care providers. The means and control switches are with the patient, not with the health care provider. The prerequisite education and training of most health practitioners do not include the development of skills for behavior modification nor is their school training adequate for the challenging task of counseling patients.

The life long maintenance of the cost of medicines could drain resources of patients. Access to these drugs is crucial in ensuring reduction in co-morbidity, mortality and disability rates of these lifestyle-related diseases. There is a need to strengthen networking and collaboration among the various stakeholders to ensure sharing of technologies, resources and expertise to prevent and control lifestyle-related diseases. This has been shown time and time again during advocacy activities and development of guidelines and management protocols.

Source:

National Objective for Health, Philippines 2005-2010, DOH, Manila