Health system barriers worsen cancer diagnosis delay, low screening rates

(Last of two parts)

MANILA, Philippines—In Asia, where breast cancer remains a significant public health problem, delayed diagnosis and low screening persist due to several health system barriers—aside from personal and socio-cultural factors.

Breast cancer strikes women in Asia earlier than women in Western countries. The risk of getting breast cancer among Asian women peaks between the ages of 40 and 50, while in Western countries, it is between 60 and 70 years.

Still, despite recommendations promoting early screening, late-stage breast cancers were found to be common in many Asian countries. Several studies found that delayed diagnosis and screening can be attributed to several factors.

GRAPHIC Ed Lustan

Some Asian women cited the lack of knowledge about breast screening programs in their country, while others noted some misconceptions they have had, which pushed them away from undergoing screening due to worry, anxiety, and fear.

Several Asian cultures were likewise linked to low breast screening uptake. Studies have stressed that cultural factors—fear of stigma, fear of being ostracized, language barriers, and a preference for traditional healers—were behind the reluctance of many Asian women to undergo screening.

READ: Low screening rates worsen risk of breast cancer among Asian women

However, the burden of low screening uptake and late-stage breast cancer diagnosis in the region was not mostly due to the hesitancy and attitude of women toward the disease.

A study published last year found that health system factors serve as “major barriers to early breast cancer diagnosis and treatment among Asian women,” especially those who are living in low-and-middle-income countries.

Inadequate health service delivery

According to a study by Agani Afaya et al., among the barriers to timely breast cancer diagnosis and treatment among Asian women were issues in the delivery of health services.

The study, which reviewed earlier studies on delayed breast cancer diagnosis and treatment among women in Asian countries, found that low care quality and service delivery within health facilities contributed to the significant delays in Asian women seeking breast cancer treatments.

“The low quality of medical services decreases timely visits. … some women, who visited a physician on time, underwent mastectomy or passed away, or had a low survival chance due to errors in medical practices. This reduces the patients’ trust in the medical sector” a separate study conducted among Iranian women noted.

The 2022 study also stressed that long-distance and lack of access to hospitals, limited cancer screening centers, and hospitals not having screening facilities were among the predominant factors which influence the delays in seeking diagnosis and treatment among women in Asian countries.

A separate study published last January in The Lancet detailed the lack of genomic and molecular biomarkers—which aid in clinical diagnosis and prognostication of many cancers—in several health facilities in the Philippines.

“In the Philippines, biomarker testing for breast, colorectal, and lung cancer is available in only six centers – all of which are located in the capital of Manila. These centers serve a population of more than 110 million,” the study explained.

“Consequently, 60% of medical oncologists in the Philippines have reported that the unavailability of these tests in their area of practice hindered testing. Substantial investment in Asean’s health infrastructure and diagnostic capacity is necessary to overcome common barriers to timely cancer diagnosis,” it added.

Issues in health workforce

Among the biggest issues in the health workforce identified by Afaya and his co-researchers based on previously published studies was the unavailability of doctors—especially oncologists and cancer specialists in low-and-middle-income Asian countries.

“A low physician-patient ratio was also identified as a barrier to early diagnosis and treatment of breast cancer. Delay in diagnosis and misdiagnosis resulted in one of the most common health workforce factors that served as a barrier to the early detection of breast cancer,” the researchers wrote.

In the Philippines, cancer treatment and other support mechanisms that help with cancer prevention, detection, diagnosis, and care have already been made available in the past years.

However, a lawmaker and cancer prevention advocate emphasized that such progress would still require the skills and expertise of medical specialists—specifically oncologists—which, unfortunately, the Philippines lacks.

“We need more trained oncologists. Technology can only go so much without the right professional medical personnel. Even if we have so much funding, so many treatment centers, without the right oncologist and a sufficient number of trained professionals [we will continue to face problems],” said Rep. Jude Acidre.

There are currently 348 oncologists in the Philippines—a figure which Dr. Jorge Ignacio, oncologist and chair of the Cancer Institute of UP-Philippine General Hospital (UP-PGH), verified as close to accurate.

According to Dr. Ignacio, there are at least 10 oncologists in the UP-PGH alone. However, he clarified that there are several doctors with different specializations who accept consultations for patients who are diagnosed with cancer.

READ: More needs to be done: Better breast cancer treatment, care pushed

More health system barriers

Afaya and his co-researchers identified health financing (including the cost of treatment and lack of health insurance) as well as flaws in the health information system (such as lack of information on health facilities and contradictory information) as some of the perceived barriers among Asian women.

“[S]tudies indicated that the advancement of the stage of cancer at diagnosis is associated with an increased cost,” the researchers noted.

“Therefore, in order to improve early diagnosis and treatment and to reduce the burden of breast cancer, interventions targeting subsidizing the high cost of treatment and policies aimed at early detection to reduce both health and economic impacts of breast cancer are imperative,” they added.

In the Philippines, the cost of cancer treatment can range from ₱120,000 to as much as over ₱1 million. The estimated price of chemotherapy cost per session, depending on the cancer type, meanwhile starts at ₱20,000 up to over ₱120,000.

While efforts have been made to make cancer treatment—including chemotherapy, targeted therapy, and chemotherapy drugs—available and accessible to more Filipino cancer patients, many still rely on their own hard-earned money to pay for the medical services they needed.

A study published in 2018 in Acta Medica Philippina—a peer-reviewed general medical and health science journal published by the University of the Philippines (UP)—highlighted the economic impact of cancer diagnosis in families.

The study, which analyzed 909 cancer patients in the Philippines, found that 40.6 percent of cancer patients’ families experienced financial toxicity—or financial problems—due to the high cost of medical care.

The researchers also found that the mean combined out-of-pocket expenses of respondents at 3 and 12 months after diagnosis amounted to ₱181,789.00.

Previously published statistics also showed that at least 7 in 10 cancer patients in the country “drop out of treatment regimen” due to lack of funds.

READ: PH cancer patients lack access to preventive screening, costly treatment

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