Cancer is a catastrophic disease and is one of the leading causes of death in the Philippines. More than 153,000 patients were estimated to have cancer in 2020. Breast cancer ranks first in incidence with 17.7 percent of the cases, followed by lung (12.5 percent), and colorectal (11.3 percent).
Colorectal (or simply Colon) Cancer Awareness Month spotlights on this malignancy because it is the third most common cancer in the world. Furthermore, it is the second cancer killer internationally, despite it being a treatable cancer. The advocacy is annually celebrated in March, as it encourages people at risk to undergo screening, as colorectal cancer (CRC) is a preventable disease.
Over the last decade, there has been an increasing incidence of CRC in persons younger than 50 years of age (called as “early onset colorectal cancer”) in the United States. This disease was recently in the spotlight in 2020 after “Black Panther” star Chadwick Boseman died from the disease at the age of 43. Last week, the Philippine sports community was shocked when Ginebra player Lewis Alfred (LA) Tenorio announced that he had been diagnosed with Stage 3 colon cancer at the young age of 38.
CANCER screening is looking for cancer before the person develops any symptoms. The best way to prevent CRC is through screening. Almost all of these cancers start as benign growths called polyps and may take as long as 10 years to become malignant. The removal of these polyps through a procedure called colonoscopy prevents CRC, reducing the risk by as high as 70 percent. When the test finds cancer at an early stage, treatment is most effective and can result in cure.
CRC screening is recommended for average-risk asymptomatic persons starting the age of 50 years in the Philippines. Earlier screening is advocated in patients with additional risk factors, like family history of colorectal cancer.
THE National Integrated Cancer Control Act (NICCA) Republic Act 11215 was signed into law on February 14, 2019, to ensure high quality health services for patients diagnosed with cancer, and to provide financial assistance to the Filipino patient as a cancer diagnosis burdens the family with a financial catastrophe.
In preparation for the full implementation of Universal Health Care, the Department of Health (DOH) will be starting the integration of primary care guidance and standard of care to encompass health promotion, primary prevention, screening, early diagnosis, and referral. In the health care system of developed countries, as exemplified by Kaiser Permanente in the United States, the success of holistic management of patient’s health is achieved under the efficient coordination of primary care physicians.
The DOH realizes that prevention and screening of malignancy will be cost-effective in cancer management economics, given the country’s limited financial, infrastructure, and manpower resources. It aims to make cancer care more equitable, affordable and accessible to all, especially to the underprivileged, poor and marginalized Filipinos.
March against Colon Cancer
THE Medical City organized an online forum entitled “March against Colon Cancer: Towards a Universal Cancer Care Beyond the Pandemic” on March 3, 2023, in collaboration with the DOH. The speakers were DOH Assistant Secretary Dr. Beverly Lorraine Ho, Professor Jose D. Sollano, medical oncologist Dr. Necy Juat, and this writer.
Dr. Ho gave updates on the NICCA, and shared the many wonderful benefits for cancer patients, like expansion of coverage of services and a more sizable budget for medicine assistance and other diagnostic examinations. Cancer patients are already considered “persons with disabilities,” and can thus avail of discounts in medicines and hospital services.
Cancer patients now have improved access to free medicine, as the budget of the Cancer and Supportive-Palliative Medicine Access Program (CSPMAP) has been increased to P1 billion this year. The CSPMAP has now been expanded to eight focus cancers, including CRC. The Cancer Assistance Fund (CAF) is a separate program that funds cancer control services such as diagnostics, therapeutic procedures, and additional medicines.
She added that “the department recognizes that its programs may need assistance from the private sector, and that is why we celebrate partnerships, like what we have with the Medical City.”
Start of screening age for CRC maintained at 50
Prof. Sollano discussed the Third Asia-Pacific Consensus Recommendations on CRC screening (2022) and emphasized that the start of the screening age for average-risk is maintained at 50 years, as the cost-effectivity of lowering this age to 45 has not yet been demonstrated in Asia. Risk stratification and sequential offering of tests are reasonable approaches to CRC screening in Asia.
Despite the numerous benefits from NICCA for cancer patients, the fight against CRC has been an uphill battle. In spite of the numerous educational activities by the DOH and the medical community in the last five years, a majority of the population is still reluctant to undergo testing due to lack of medical awareness (health literacy). The absence of a national population-based CRC screening program and the big financial burden of screening on the individual patient (as discussed by Dr. Juat) are additional barriers to this campaign. Local health maintenance organizations still refuse to pay for CRC screening strategies.
When the DOH has a national CRC screening program in the future, this can result in diagnosing cancers in the earlier stages when these can be effectively treated and lead to an eventual decrease in mortality. At that future time, screening measures to prevent CRC can be finally realized as envisioned by NICCA.
About the Author: Dr. Jun R. Ruiz is a Philippine and American board-certified gastroenterologist. He is the Lead for Colon Cancer Awareness Advocacy of The Medical City, and the Programs and Advocacy Officer of TMC’s Cancer Institute.