Breast Cancer and me
On October 20, 2015, the Economist will host an event in London "that will bring together the most influential health care leaders from Europe to explore and shape the dialogue on cancer." The title: "War on Cancer: Enemy of the State. Healthcare in Asia 2015."
"The WHO projects that in the next 20 years, cancer cases worldwide will surge 75% from 2008 figures, to 25 million per year. The economic cost staggers at over $1 trillion, and the social cost will devastate communities. The coming cancer crisis will strain rich countries and damage poor ones. But prevention can reverse the rise in cancer cases, while innovative approaches can reduce cancer's impact.
"According to the World Health Organization, 20% of all deaths in Europe are caused by cancer, and their 2014 'World Cancer Report' forecasts a swell in incidental cases to 27 million worldwide by 2030. As populations and life expectancies around the world continue to rise, so, too, will instances of the disease.
"The experience in high-income countries has shown that cancer control cannot succeed without well-functioning and flexible health systems. Against this backdrop, innovations are cropping up in health systems around the world—in policy and organizational structure, and in treatments and technology."
March 13 was my first chemo treatment. In preparation for this, I had all the lab tests done the week before, and on March 10, the nurse called me with the news: "You have been cleared!" For a split-second, I was elated (I took it as cleared no chemo), but what she really meant was that I have been cleared by the doctors to proceed. It appeared that all my lab tests showed I was in great condition; even my 2D Echo and ECG came back with, "You have a heart of 30-year-old," my liver was in great shape, all tests confirmed I was in excellent health. Except, I have breast cancer.
"Cleared to proceed" meant that my almost perfectly healthy body will be now be injected with toxins to ensure that whatever may have been left from the mastectomy would be eliminated. Even when my cancer marker test came back with a result showing that there were no traces of cancer cells in my blood, there was a possibility that some might have gotten away before the surgery. My surgeon, Dr. Orlando Diomampo, one of the best in the Philippines, did a great job of harvesting 27 lymph nodes (14 of which were malignant), but to be absolutely sure, chemo was necessary. That I suffered no infections after the surgery, I was working out two weeks later, and that I was ready for chemo treatments after four weeks, were testament both to the exceptional skill of my surgeon and my healthy body.
A few months ago, I noticed a small lump in my left armpit which I had thought was fatty tissue. A month later, it grew to the size of a small egg, and on January 23, I went to a doctor for consultation. A biopsy was immediately ordered. I could tell that something was wrong. The following day, Craig and I went to St. Luke's Medical Center (a JCI-certified hospital in the Philippines) to further consult with one of the best gynecologists in the country, Dr. Rebecca Singson. She gave me a general checkup and detected no lumps in the breasts. When I showed her my armpit, she was shocked, did another physical test in case she missed something, and found nothing suspicious. She then consulted with her colleague, and a series of tests were immediately ordered, changing my life forever.
The results of both the digital mammogram and 3D sonogram were e-mailed to me the following day; they were also uploaded to St Luke's eHealth website, and with my login and password, I reviewed the test results. Both results were negative; there were no indications of breast cancer. My doctors were confused, and I remained cautiously hopeful. Two days later, the biopsy results confirmed breast cancer. A PET scan was scheduled the following day to determine the extent of the spread of cancer. The results showed the concentration area of the cancer cells.
In a meeting that followed, we decided that a radical mastectomy was unavoidable, my left breast must be removed. Breast conservation, our first choice, was not possible. I was scheduled for mastectomy on February 13. The hardest feeling to cope with was not being sick. The hardest conversation was having to tell my children. I felt saddest for our oldest grandchild, Jackson (5½), to feel for the first time, a loved one with a seemingly serious illness. When Graham (4) and I had a private moment, he agreed to lend me his hammer (from his Thor Halloween costume last year) to crush the bad cells. Eleanor (1½), is the sweetest, most beautiful girl. I have a lot to live for, and I am determined to do so.
Craig checked me into the hospital for a radical mastectomy. The past two weeks moved so fast that there was no time to feel. That night, for the first time, we broke down and cried as the emotions held at bay for the past two weeks came crashing down. They harvested 27 lymph nodes, 14 of which were malignant. The cancer started at the back of my left breast, ductal, but decided to migrate away from the breast and formed their community in the axilla.
How did this happen? I never smoked, an occasional glass of wine every now and then, we eat healthily most of the time (we have an organic farm!), I have been practicing yoga on and off since the 1970s. Except for the occasional flu, I have never been sick in my entire life. I take multivitamins every day. On the treadmill, I would walk an average of 10 kilometers four times a week. What did I miss? I had this overwhelming guilt, not only at the pain I was causing my family, but the enormous expense of time and money that we would have to go through!
In the end, the answer was very simple: my gender and age. Many women who develop breast cancer have no risk factors other than age and gender. Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed in 2012 (second most common cancer overall). This represents about 12% of all new cancer cases and 25% of all cancers in women. A 60-year-old woman has a 1-in-30 chance of developing breast cancer in the next ten years.
My gender, my age.
They biopsied the tumors, and the results were estrogen-plus, progesterone-plus, HER2-neu-plus. The last one calls for an aggressive treatment. My chemo therapy and maintenance will continue for many years until a cure is found. As strange as it might sound, I am grateful that it happened, when it happened. I am 62 years old and, at the moment, on sabbatical in the Philippines. At 62, I am not too young to miss a lot in life and not too frail to handle chemo. In the Philippines, I have access to world-class JCI-certified hospitals, excellent doctors, and nurses for a fraction of what it would cost in the US. My oncologist, Dr. Gerardo Cornelio, is one of the best in his profession. With a support structure at home, I am very mobile and would not have to depend on someone to take off from work to drive me to a doctor's appointment. Like most children, mine would be glad to do so, but like most mothers, I would hate to be a burden.
A firm handshake and a warm embrace. That is what they used to say about me. Now, things are a little different. My lifestyle started to change. I now have to be conscious of my surroundings, avoid public places such as open markets (which I love!), and wear a face mask when going out. Avoid a lot of hugging. A litany of little things. But what I miss most of all is the freedom of movement that I so enjoyed, the social interaction and lively debates. I miss not being able to uncaringly greet anyone with a warm embrace.
My doctors consulted among themselves and agreed that my case was "reportable." Earlier in the process, Craig and I discussed that something good must come out of this. Maybe this is one of them. I was raised a Catholic, and my Christian faith remains strong. I find comfort when my friends say "God has a plan for you." The challenge was to know what it could be. How do I turn this bad thing into a good thing?
The Philippines now has the highest incidence of reported breast cancer among its Asian neighbors. Whatever the number is, I imagine it easily doubles, as the cases in the provinces do not get reported nor properly diagnosed. Born and raised in the Philippines, I also lived in the US and have enjoyed, for many years, the best of worlds. My background is in both technology and health care. I now have a full understanding of what I ought to do for the remainder of my life.
Technology. Healthcare. Breast cancer patient. I have joined the war on cancer.
My entrepreneurial mind is now focused on establishing a foundation in the Philippines that will create a tissue bank for breast cancer research purposes, exchanging valuable data with other research facilities in the world. The Philippines is uniquely placed to create this contribution to research, having a largely homogenous genetic pool, and an administration willing to support biotechnology research. And, yes, a DNA lab to make DNA testing in the Philippines available and affordable. I am convinced that DNA testing is the way forward. Knowing will lead to prevention.
Both of these facilities do not exist in the Philippines, and this is where I can contribute. I have found a new calling. And so, I have decided that, in between my chemotherapies, I will develop a plan for these two projects and, when I am ready, will seek help from my extensive network of friends and business associates.
This will be my legacy. God bless you!
