Zero Peso Bill: Making Breast Cancer Treatment Affordable Through Early Action
This week we will know how to prevent the massive expenses in dealing with breast cancer. But first we will review the basic about breast cancer. To diagnose breast cancer, our diagnostic approach generally follows three main steps: clinical examination, breast imaging, and biopsy. The process begins with a thorough clinical examination, which involves taking a detailed patient history and performing a physical exam. A complete history is vital as it reveals key risk factors. For instance, if a patient has one first-degree female relative with breast cancer, her risk nearly doubles. That risk increases significantly with two first-degree relatives, and even a second-degree relative can raise a person’s risk by about 40% compared to the general population. Other critical information we gather includes early menarche (before age 12), late menopause (after 55), and having a first child after age 30, as all these factors can increase lifetime risk.
Following the history, we proceed to the physical examination, which consists of inspection and palpation. During inspection, the patient is asked to change positions, raising her arms, pressing her hands on her hips so we can carefully assess the breasts’ size, shape, and contour. We look for any changes in coloration, skin dimpling, peau d’orange (orange-peel skin), nipple inversion, or signs of inflammation. After inspection, we perform palpation. The patient lies on her back, and we use the pads of our index, middle and ring fingers to systematically feel the entire breast tissue in a pattern, such as circular or wedge-shaped, to ensure we do not miss any abnormalities.
If the clinical examination raises any concerns, the next step is breast imaging. The most common imaging tools are the sonomammogram and the mammogram. A sonomammogram involves applying gel to the breast and using an ultrasound transducer to capture images. A mammogram, which is used for patients over 30, compresses each breast between two plates to take X-ray images; this technique has been proven to reduce cancer deaths by 20-25%. If a suspicious mass is found, a biopsy is required. We have three main types: Fine Needle Aspiration Cytology (FNAC), core needle biopsy, and open biopsy. Of these, the core needle biopsy is the recommended standard because it provides a more definitive tissue sample. FNAC, while quick and inexpensive, is less specific and cannot determine critical receptor statuses like ER/PR and HER2/neu. An open biopsy is reserved for when less invasive methods are inconclusive.
Once a diagnosis of breast cancer is confirmed, the patient will undergo a combination of management strategies, including systemic, surgical, and radiation therapy. Systemic management includes several modalities. Chemotherapy uses cytotoxic drugs to destroy rapidly dividing cells. For cancers fueled by hormones, such as ER+/PR+ tumors, hormone therapy blocks this growth signal. Targeted therapy attacks specific cancer cell markers, like the HER2 protein, with precision. Lastly, immunotherapy empowers the body’s own immune system to recognize and combat cancer cells effectively. Surgical management includes Breast Conserving Surgery (BCS), also known as a lumpectomy, which removes the tumor with a margin of healthy tissue to preserve the breast’s appearance. For locally advanced cancer, a Modified Radical Mastectomy (MRM) is performed, which involves removing the entire breast tissue, leaving a flat chest wall. A third option is oncoplastic breast surgery, which can be performed at various stages, it involves removing the cancerous tissue and immediately reconstructing the breast using tissues from another part of the body. Finally, radiation therapy is a critical adjunct, typically administered daily (excluding weekends) for five to six weeks.
And now, for one of the most common and pressing questions we encounter in the clinic, “How much will this cost?” Realistically, comprehensive treatment for breast cancer can range from 2 million to 4 million pesos or more, depending on the tumor’s aggressiveness and the required therapies. But what if I told you that the bill could potentially be zero? Yes, it is possible. Here’s how, First, through early detection. If the cancer is found at a very early stage when the tumor is small and has not spread to the lymph nodes, treatment can be much less aggressive. In such fortunate cases, chemotherapy and radiation can often be omitted, and the patient may only require surgery. A less complex surgical procedure can be performed in a government hospital under programs where “No Balance Billing” is practiced. This means the patient can receive the necessary care without worrying about a catastrophic hospital bill. Second, and just as importantly, is through robust public health funding. It is our fervent hope and a collective call to action that our leaders will channel billions in funds directly into cancer treatment programs. When public money is invested wisely and transparently into healthcare, rather than being lost to corruption, it transforms lives. It makes zero billing treatment a widespread reality, not just a rare exception.