Dr. Patricia Caballero-Cabral, comes out in the open with her Stage 3 breast cancer journey in a radio program on Sept. 23, 2023.
MANILA, Philippines—Dr. Patty Caballero Cabral recalled going through tests for breast cancer yearly since 2013 and getting results that said there was nothing wrong.
But during pandemic in 2020, she was unable to undergo mammography and ultrasound because most of her time was spent inside the public hospital caring for patients.
The following year in September, she noticed asymmetry in her breast size.
“At first, I thought it was just part of menopause,” Cabral said.
She had mammography and ultrasound on Dec. 30, 2022. “I knew right away that I have high index of suspicion that I have cancer,” said the 50-year-old.
After a year of treatment, she was deeply involved in breast cancer awareness.
So as the world celebrated Cancer Awareness Month in October, she was in the program Media Spirit Care aired on dzSB 104.1 Spirit FM.
There, she told her story.
Also called Doc Patty, Cabral said she had expected to be stricken with cancer because of her family’s history with the disease.
“My father died from cancer of liver, lung and colon, my mom and relatives who are also doctors got breast cancer,” she said.
“Friends and medical colleagues did not fall short of reminders. But I realized everything happened for a reason, and what is important is the present,” said the mother of three—Ian, a graduate of medicine; Sofia, a graduate of medical technology and going to the college of medicine; and Erika, a medical student.
Breast cancer strikes anyone, but mostly women
The Philippines had the highest prevalence of breast cancer among 197 countries in 2017, according to the Philippine Obstetrical and Gynecological Society.
Breast cancer is the most common type of cancer in women in the Philippines, with the highest incidence rate of 17.6%, accounting for 15% of all new cancer cases and 8% of all cancer deaths in the country.
More than half (53%) of breast cancers in the country is Stage 3 and 4 while only 2% to 3% is Stage 1.
Up to one-third of patients with early-stage breast cancer will subsequently develop metastatic cancer, which is the most serious form of the disease and occurs when the cancer has spread to other parts of the body, such as the brain, bones or liver.
Advanced breast cancer comprises metastatic breast cancer (stage 4) and locally advanced breast cancer (stage 3).
Survival rates for women living with advanced breast cancer are lower than those for women with earlier-stage disease.
The 5-year relative survival rate for stage 3 breast cancer is approximately 72% compared to around 22% for stage 4 breast cancer.
Men are not spared from breast cancer, and deaths from it, according to records from the Philippine Statistics Agency.
Support system
About three years ago, when Maila Saab was undergoing chemotherapy for Stage 4 cancer, she and her husband agreed to have her hair shaved ahead of the procedure which they knew would eventually lead to hair loss. Her husband shaved his hair, too, in a gesture of sympathy.
“So, he shaved my hair (me) not knowing he was crying while doing it and immediately he finished mine, then he shaved his hair too,” said Maila.
“Days after, we found the male members of our church, both young and old, shaved their hair, too,” she said.
“My only daughter with long and curly hair like jokingly said she can try too and we said oh no, please no need. Some kids broke their piggy banks just to contribute for my surgery,” said Maila, whose first mammography results on January 25,2020 showed she had stage 4 cancer.
“Support system is very important for a breast cancer patient – emotionally, physically, financially and most importantly, the spiritual,” said Maila.
“First is God, then one’s natural and spiritual family, and the doctors who are not only doctors to me but special friends,” she said.
“All these are interlinked to overcome the battle. As I call mine as a ‘health project’ which has definitely an end in the way God will be glorified!” said Maila.
She said her health project was on course to the hoped result—remission—as her latest PET scan in September showed no growth and no new tumor.
Jessamine Evangelista-Magcamit, 33, says her mother Bella, who has Stage 2 breast cancer, had been promoting healthy living in the family through proper food and exercises.
“Why my good mother,” Jessamine recalled asking God.
“But I realized it’s God’s way to give all the love she deserved because even when she was still a student, she was already working for her siblings, then us her children,” she said.
Public school teacher Roderick Jose Calivara says it’s really difficult to be the husband of a breast cancer patient but the journey is the ultimate test of what love really is—blind to the wife’s physical degeneration and a commitment to “walking with her every step of the journey”.
This means being an “emotional and financial provider with God as the Ultimate Provider,” he says.
With wife Doreen, also a public school teacher, they say the available assistance they get from the government is not enough.
Among these are Philippine Health Insurance Corporation, the city government’s health card, social welfare and development office of the region, province and city, Philippine Charity Sweepstakes Office, Alliance of Concerned Teachers and discounts for PWDs.
“After all, I am overwhelmed and grateful to all who support in any way, including messaging how I am doing,” said Doreen who initially brushed aside the lump she felt on her left breast until friends insisted she get a laboratory test.
She was afraid to know if she is sick because her 68-year-old mother who has heart problems may not be able to bear it.
But she managed the information well, one day, came home and told her mother she had surgery.
The Calivara-Despues family is doing volunteer work in Church and communities and considered members of Anak ng Teatro, a Church-supported theater group, as their children.
The group organized a dinner concert, dubbed “Susong Matapang, Susong DSusuKo!”
The letter “D” stands for Doreen and “Ko” is for the initiative and commitment in the fight against cancer.
They also sold t-shirts and ballpens with advocacy texts for breast cancer awareness, and did other fundraising activities, aided by their Facebook page “DSusuko”.
Oncologist Dr. Abigail Garcia-Barrientos says patients are included in her “medical team” because their stories are powerful for others to learn from.
She says “cancer is never a walk in the park” and has to be a “shared journey and decision with family members, thus reducing anxieties and helps in the acceptance process.”
In Mindoro island’s only oncology unit at Maria Estrella Hospital there are no walls, curtains or barriers so patients get a “feeling of community” where they call each other “classmates or batchmates”. This is patterned after Veterans Hospital.
“We always give words of encouragement and ask the patient what she or he wants,” said Barrientos.
“At times, I’d ask some patients to talk with the others. When patients leave the unit for home, others would tell them to come back if they have no one to talk with,” she said.
“At the unit, patients get to appreciate their blessing if their situation is better than another, and also to get inspired by the others. I encourage patients to go back to work so they don’t dwell on self-pity then depression,” said Barrientos.
No longer a death sentence
Doc Patty says the antidote to fear is prayer. But she is also taking advantage of what science offers and innovative treatments offering women a greater chance than ever before to live healthy, fulfilling lives following their diagnosis.
With her Mindoreña doctor Minda Zarah Perez, a surgeon, radiation oncologist Dr Jon Arcillas and medical oncologist Barrientos, and Dr. Agnes Grospe, they went for the highest level of chemotherapy using innovator drugs, 33 shots of Tomo-Radiation treatment.
Currently she is on hormonal oral anhydrase inhibitor treatment.
With advances in breast cancer treatment, survival rates are improved, and there is an increased focus on quality of life for survivors, Doc Patty said.
By reducing side effects and other complications, innovative treatments (such as targeted therapy) have given women the opportunity to reclaim their lives after treatment, returning to work, family, and other activities with greater confidence and energy.
But Doc Patty thinks that despite improvements in breast cancer care, many patients still lack targeted therapeutic options outside of the standard chemotherapy and hormonal therapy to reduce the risk of recurrence because of poverty, lack of information to access the best doctors and treatments, fear of knowing the truth about cancer and huge expenses.
Dr. Arthur Sebastian, a surgeon, emphasizes there is cure to breast cancer, that it is no longer a death sentence, and survivorship has come a long way in recent years.
“Most of the success stories had their surgery done at an early stage, but I have one on stage 3a (large mass, no skin or lymph node involvement) diabetic lady that I operated on way back 2005,” said Sebastian.
“She still follows up once a year, although based in another province in Laguna. She was 46 when she underwent surgery and postop adjuvant treatment,” he said.
He agrees that the health care framework should shift to prioritize early detection and comprehensive patient care.
Finance and fears
Since breast cancer is hormonal, it strikes mostly women who are confronted with several stresses and fears – of stigma associated with it like a death sentence, being a burden to the family, appearing ugly, the pains from treatment, false information like it is incurable, and most of all, the expenses it would entail.
So many of the patients are keeping the disease to themselves until unbearable symptoms are noticed by others, and usually in the late stage.
In their breast awareness campaigns, doctors in Oriental Mindoro province appeal for early detection and treatment especially those with high risk factors like genetics, obesity, history of smoking and alcohol consumption, unhealthy eating, sedentary life and stressful living.
“Don’t fear us, doctors. Please help us to help you, we are instruments of God,” says Dr. Michael dela Paz, head of the surgery department at Oriental Mindoro Provincial Hospital, in a radio conversation on Sept. 30.
Dr. Mervin Tan, a surgeon, tells people not to be afraid of a lump because not all are cancer. And for women who mind keeping their breasts preserved, “there are surgical options like breast conservation surgery, use of implants and plastic reconstruction.”
Breast cancer warrior Maila Saab says as she “shares her experiences and learnings in other places in the country, she feels more for the poor living in areas where information, doctors, facilities and financial assistance are least accessible”.
Even Doc Patty has to ask for help and shares where to ask for assistance, both government and non-government.
Doctors Dela Paz and Barrientos wish that with the National Integrated Cancer Control Act (NICCA), the Oriental Mindoro provincial hospital will soon finally be converted into a regional hospital under the Department of Health for better and complete services for cancer patients so islanders do not need to travel to Batangas and elsewhere, like for radiation therapy.
“We lose the patients if there are no facilities because travel means additional expenses,” said Barrientos.
First district congressman Arnan Panaligan in August 2022 refiled the bill for the conversion. “Hopefully by November, the House will pass the bill. It will then go to the Senate. Hopefully it will also pass the Senate,” he said when asked for updates.
In Mimaropa (Mindoro Oriental and occidental, Marinduque, Romblon and Palawan) region, the Philippine Statistics Authority recorded deaths due to malignant neoplasm of breast at 190 in year 2020 and 225 in 2021. Fifty-four and 70 are from Oriental Mindoro.
Three of these deaths from the region were those of men.
As the barangay elections approach on October 30, health care advocates say the candidates’ agenda on health should be considered by voters.
Dr. Cecille Montales, also a breast cancer survivor, who hails from Victoria, Oriental Mindoro, said “if a local government is interested to address breast cancer, it can get in touch with I CanServe (ICS) Foundation.”
ICS is a non-government organization that pioneered ‘Ating Dibdibin’, a community-based breast cancer program, which they did for the city of Taguig in 2012, where Montales was executive assistant for health.
On Sept. 14, the foundation, in its 24th year, launched “You Can Do This – A Breast Cancer Patient’s Manual”, downloadable online to support breast cancer patients, survivors and their caregiver, for free, written in Filipino and English.
ICS is an advocacy group of breast cancer survivors and volunteers, that promotes early breast cancer detection, access to accurate diagnosis and timely treatment, to survivorship and palliative care, to patient navigation, and to hospice care.
Tan says early detection will also spare a patient from huge treatment expenses, and better chances for cure, than when cancer is already in late stage.
Patients Maila, Doreen and Doc Patty agree with their oncologist Barrientos that what is important is to face the present with positivity and treat each day as if it is the last.
Maila is still very thankful to God that she is still alive and able to live out God’s purpose in her life.
“One of this I believe is to encourage those facing this kind of battle and help prevent others from going through this painful but very colorful journey with a lot of learning experience and unforgettable encounters which will make us a better person and not miss each day to be thankful to the Lord for this miracle of life and use for His glory!” says Maila.
“From breast cancer patient to warrior to not just a survivor but an overcomer,” she says.
And for Doc Patty: “When I sought refuge to God in silence in a retreat center called “Ilang—A Sanctuary of Prayer” managed by a priest-friend in Victoria town, that’s when I was able to listen better to myself and to Him, and decide with a time-framed concrete and powerful plan in my journey – soul care and hope on top of the realities of living as a breast cancer patient. But one truth holds for everyone – anyone can die anytime, there are other causes, not just breast cancer.”
(This story is published with the support of the Philippine Press Institute, Novartis and ICanServe Foundation.)