An interview with Breast Cancer awareness advocate, Prof. Josephine Ceria, was aired this February through the DWFB Radyo Pilipinas-Laoag and DWNI Radyo Karruba-Burgos for the radio program, MMSU Rimat ti Ilocandia.                                         

Prof. Ceria is an Associate Professor 1 of the MMSU-College of Health Sciences (CHS) and is serving as a clinical instructor. She is also the Vice President for Finance of the Philippines Nurses Association, Ilocos Norte and Laoag City Chapter and a member, Volunteer Nurse of the Breast Cancer Imperative in Ilocos Norte.

From the discussion, Prof. Ceria shared valuable information on what breast cancer is, how is acquired or developed and who are the usual victims of this illness, the myths or beliefs about breast cancer, how can this be prevented, the early detection strategies, and the care and coping mechanisms when one has been afflicted with this illness.

Breast cancer trend

As shared by Prof. Ceria, breast cancer is the most common form of cancer worldwide. And since the 1980s, breast cancer ranks Number 1 among the top leading cancers among women in the Philippines. In a report of an official of the Philippine Society of Medical Oncology, it was said that among Asia countries, the Philippines has the No. 1 incidence of breast cancer: three out of 100 Filipino women will get breast cancer before the age of 75 and at least one out of 100 will die before reaching 75. Similarly, in a report material published by the International Agency for Research on Women of the World Health Organization, data shows that breast cancer accounts for 31.4 %, or a translated 27, 163 new cases of females of all ages for the year 2020 in the country.

Breast cancer is a tumor, as mass or a lump of malignant growth resulting from the division of abnormal cells in the breast. It may develop from the milk-producing gland or the milk duct. This malignant growth refers to the rapid cell division of abnormally growing cells compared to the healthy ones, resulting to the accumulation and formation of lump or mass.

From Prof. Ceria, breast cancer is often inherited. Doctors estimate that about 5-10% of breast cancers are linked to gene mutations passed through generations of a family. Ninety percent is not genetic but grows because of changes while one ages or other ways as triggered by considered risk factors. This genetic factor of breast cancer means that if the mother has breast cancer, the child does not necessarily automatically have it. Many who have this kind of risk usually do not develop breast cancer.

Risk Factors in Breast Cancer Development 

Breast cancer, or other type of cancers, are diet-related. This means that the way we take care and manage our body poses a big influence and difference if one could, or not, develop or acquire breast cancer. Diet-related risk factors for breast cancer include the following.

• Over-consumption of processed food products. As shared by Prof. Ceria, according to the World Health organization (WHO), there is a convincing evidence that processed meat such as hotdog, sausage, corned beef, and any other type of canned goods increases the risk of breast cancer as these are contributory factors in its development.
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• High alcohol intake also increases the risk of breast cancer because it damages the DNA in the cells. Also, high alcohol intake increases the level of estrogen in the body. Hence, high consumption means higher risk and moderate consumption means lower risk.
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• Frequent eating of salted fish like daing increases the risk in having breast cancer
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• Sugary drinks and any colored drinks increases the risk of developing breast cancer.
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• High consumption of grilled food especially barbecue since Heterocyclic amines are formed in  foods cooked at high temperatures.
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• Frequency in fast-food chains since products from these establishments thrive on fats. Frequent consumption of food with high fat content means higher risk of breast cancer.
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• Being a female is also a risk because of the high level of estrogen in the body. According to studies, 26 out of 100 female can be affected with breast cancer and 1 out of 105 males in the Philippines.
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• Exposure to radiation in the chest also increases the risk of breast cancer due to ionizing radiation.
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• Obesity coupled with no exercise increases risk because more fat cells  produce more  estrogen that will trigger the formation of cancer cells.
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• Late pregnancy also poses a risk as studies show that females aged 35 and above has more accumulated cells carrying cancer are develop which increases the development of breast cancer. Late menopause for those aged 55 and above also has higher risk in the development of breast cancer ,more estrogen triggers the formation of cancer cells.
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• Cigarette smoking. Chemicals such as nicotine, butadiene, and levels of benzene contribute to increasing the risk factor of breast cancer which include the second-hand smokers and third-hand smokers.
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• Other risk factors include those women who never got pregnant, asbestos workers, uranium miners, and workers in the nuclear industry are more at risk   in developing cancer. 

As these risks, as shared by Prof. Ceria, are diet-related, the more vulnerable individuals include women aged 40 and above and the obese because of the cells in fats that produce estrogen that triggers the formation of cancer cells.

Facts and Fallacies on Breast Cancer 

            Misconceptions and beliefs also surround knowledge on breast cancer. For this, Prof. Ceria also shared and clarified some misconceptions circulating around this disease.

• Use of deodorant or anti-perspirant causes cancer. According to Prof. Ceria, aluminum in these products may increase the risk but there is no evidence yet between breast cancer and the deodorant for its ingredients.
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• Wearing of underwire brachiere causes cancer. There is no evidence yet, however, it is to be noted that wire in the brachiere restricts the flow of lymph fluid in the breasts causing toxins to build up in the breast  but no evidence yet to support this as a cause of cancer. For this, Prof. Ceria noted that the breast must be relaxed during sleep.
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• Bumping the breast or being Hit causes cancer. There is no evidence yet as to this belief. However, if the breast is accidentally bumped, swelling in the breast may lead into tenderness, pain, hardening, and/or scarred tissue but not breast cancer.
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• Stress. According to Prof. Ceria, there is no conclusive evidence yet between breast cancer and stress, however, this can be linked to increase lifestyle behaviors such as drinking alcohol which increases the risk of breast cancer.
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• Nipple piercings. Area pierced is at risk for infection. Jewelry used may cause allergy  which then lead to infection   but not breast cancer.
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• Radiation from cellular phones and other gadgets causes cancer.. For this, Prof. Ceria shared that No evidence yet that radiowaves/ radiation from mobile phones  have direct effect on the development of breast cancer.
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• No-male disease of breast cancer. A common misconception is only the female can have breast cancer, but in reality, as shared by Prof. Ceria, the male can also develop breast cancer, but in rare cases as in 1 out of 105 males.
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• Breast cancer Cannot be healed. Breast cancer is not a terminal disease. With early detection and treatment, breast cancer can be treated such as those with early stages of development, from Stage 0-3.
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• Other misconception on what may potentially cause breast cancer such as artificial insemination, abortion, and similar conduct, overuse of perfumes, and graveyard shift or the night-duty have no evidence yet.

For the prevention of this disease, Prof. Ceria some ways to prevent the development of this disease. This includes the following preventive measures.

• Avoid/STOP  smoking. It is advised to STOP smoking and not to smoke inside the house and nearby areas to eliminate and/or minimize second- and third-hand smoking.
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• Eating healthy diet. Maintaining a balanced diet is integral in keeping the body healthy and stronger against breast cancer. It is advisable to eat plenty of fruits and vegetables, legumes, nuts, beans, and others. Fish is also recommended for their phytochemicals with antioxidant properties, increases anti-estrogen component, and contains chemo-preventive properties. Leafy and green vegetables contain carotenoid, antioxidants, including beta-carotene, lutein which reduce the risk of breast cancer. Fruits with high citrus are also recommended as they reduce the development of breast cancer for about 10 %. Fatty fish such as salmon, sardines, and mackerel contains omega-3 fats and antioxidants and have cancer-protective properties. Berries such as strawberries  prevent cellular damage due to its components.. Fermented foods such as yoghurt also contains probiotics that safeguards the body against breast cancer. Apples also contain antioxidants and has properties that inhibit the growth of cancer cells. Vegetable flowers such as cauliflowers, broccoli, and cabbage also reduce the development of breast cancer because of their anti-cancer potentials. Beans are loaded with high fiber content which aids in reducing the risk of the disease. An egg a day is also recommended as they can reduce the risk of cancer of about 18%. It is also advisable to choose meat from animals with lesser legs. Meat from animals with four legs often contain higher levels of fat, hence, chicken ( 2 legs ) would be a better alternative, and fish is the best ( no leg).
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• Limit consumption of processed foods such as red meat, grilled foods, barbecue, sugary drinks, any colored drinks, going to fast-food chains, avoiding fried foods frequently and refined carbohydrates if they can be replaced with  white bread.
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• Prevent obesity by exercising and maintaining healthy weight. It is advisable to know one’s ideal body weight, be physically active and sustained exercise. Walking is advised and avoiding heavy meal at night.
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• Breastfeeding is also encouraged to mothers as the longer one breastfeeds the baby, the greater is its protective effect from breast cancer as well.
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• Limiting exposure to radiation, hence, the use of complete personal protective equipment is advisable for healthcare workers.

 Early Detection Strategies 

Early detection strategies can also be administered and conducted to prevent breast cancer from reaching its terminal stage. This includes breast self-examination, clinical breast exam, mammogram for those aged 35 and above, and ultrasound to detect abnormality for those aged 35 and below.

Prof. Ceria also shared how to conduct breast examination including tips and pointers to remember in doing this breast cancer early detection strategy.

Breast self-examination is usually conducted to check for changes in the breast. It is best conducted to check if there is a breast lump or thickening that feels different from the surrounding tissue; change in the size, shape or appearance of a breast; changes to the skin over the breast such as dimpling; a newly inverted nipple; peeling/ scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin; or redness of the skin over your breast or  like the skin of an orange. It is advisable to do this examination monthly, 5^th to the 10^th day of menstrual cycle.

Breast exam, or palpation, can be done as follows.

In the shower or while taking a bath: Examine your breasts. Your hands will glide easily over wet skin. Middle 3 Finger pads of one hand , move gently over every part of each breast. Use your right hand ( three mid finger pads )to examine the left breast, the left hand to examine the right. Check for any lump, hard knot, or thickening.

Standing in front of  a mirror: Inspect your breast with arms at your sides. Next, raise your arms high overhead. Look for any changes in contour of each breast—a swelling, dimpling of the skin, or changes in the nipple. Then, rest palms on hips and press down firmly to flex your chest muscles. Left and right breast will not exactly match—few women’s breasts do. Regular inspection shows what is normal for you and will give you confidence in your examination.

Lying down: To examine your right breast, put a pillow or folded towel under your  shoulder, at the back of the breast. Place right hand behind your head—the left hand if the right breast will be examined, and right hand if left breast will be examined—this stretches/distributes breast tissue more evenly on the chest. Use three fingerpads  in palpating the breast. Use the three mid-fingers of the right hand in palpating the left breast, and the three mid-fingers of the left hand for the right breast. From the outermost top of the breast, make small circular motions all the way around the outer edge of the breast until you reach the top again, pressing gently all the while, or from the nipple to outside and outward to inward. Note the location of lump, if any. Continue palpating the axilla to check for swelling lymph nodes affected by the lump in the breast.

When suspicious lumps are noticed, it is recommended to check with the doctor.

In Ilocos Norte, the MMSU, including its healthcare professionals, and professional organizations have joined hands in combatting breast cancer. Awareness campaigns and services have been set in place to facilitate dissemination of information and building awareness and to assist those afflicted with breast cancer. In as much as there is no definite way to eliminate this disease, there are activities designed and implemented to cater to the needs of other people.

Philippines Nurses Association, Ilocos Norte & Laoag City Chapter and the Breast Cancer Imperative in Ilocos Norte, the following programs are being conducted.

• Mobile Mammogram. This project brings mammography services in response to requests of around 25 women in a single area.
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• Breast exam. To detect and prevent early development of breast cancer, this project is rendered clinically for women who wish for second and more professional opinion.
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• Breast cancer seminar. Awareness campaigns and seminars are also conducted to spread awareness and share detection strategies for more informed women in different areas.
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• Free mammogram for Certified 4 P’s women aged 40 and above, especially during Laoag  City Fiesta. Mammogram is also required  to women aged 40 y.o  and above every 1-2  years.
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• Patient referral and assistance. The organization also gives free referral for chemotherapy, mastectomy, and other related operations and assist them in finding and seeking the help of benevolent donors  for chemotherapy.

While breast cancer may affect all ages and regardless of sex,  this is  only to emphasize the kind of good diet and lifestyle everyone must observe to avoid this disease. Increasing awareness through radio broadcast and printed information materials are all essential in spreading essential knowledge to women.

More information are being aired by the Extension Directorate through our local radio partners, the DWFB Radyo Pilipinas-Laoag and DWNI Radyo Karruba-Burgos. And with the School-on-the-Air dubbed as Tarabay iti Pagtaengan, Pagbiagan, Salun-at (TIPPS), ken Dadduma Pay aired through the two aforementioned stations including the DWCI Radyo Adjo-Piddig, we hope to bring more relevant and timely information and technologies.

Additional reference:

2020. The Global Cancer Observatory. World Health Organization-International Agency for Research on Cancer retrieved at https://gco.iarc.fr/today/data/factsheets/populations/608-philippines-fact-sheets.pdf

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