Dr. Brylle Dala, an oncologist and chief of the Chemotherapy Unit at Eastern Visayas Medical Center, said the problem with breast cancer cases in the region is that they are usually detected in the late stage due to the inaccessibility of health facilities and personnel to diagnose the illness early on.

"What should be done is once a patient has a palpable or suspicious mass on her breast, the first step is to undergo a confirmatory test, if it is benign or malignant. So, it is mammography or breast ultrasound for those less than 40 years old," Dala said.

But in a poor region like Eastern Visayas, such facilities are not readily available in the provinces. Except for Leyte, where Tacloban City is located, none of the five other provinces have the facilities.

Patients suspected of having breast cancer who seek treatment in the different provincial hospitals are usually referred to EVMC, the apex hospital in the region. EVMC is also part of the National Cancer Center Network of the Department of Health. Two other private hospitals in the city offer treatment for breast cancer.

The absence of specialists and testing facilities for breast cancer that is accessible to them has discouraged many women with suspected mass from seeking medical attention until it is too late.

In September this year, out of 171 breast cancer patients seeking treatment at the EVMC Chemotherapy Unit, 76 of them were already in Stage IV, where the survival rate is greatly diminished.

Data from the DoH regional office in Eastern Visayas shows that from 2018 to 2022, a total of 428 patients have died due to breast cancer in the region, 419 of them were women.

DoH-8 has no data on the prevalence of breast cancer in the region since its cancer prevention program started only in 2018.

Dala said that as an apex hospital, those who should be referred to EVMC are patients for definitive treatment, including those who are confirmed and diagnosed with breast cancer, while prevention should be done at the lower level, such as rural health units.

"But this is not what happens. They come here to get checked and sadly, what we see are cases that are in advanced stage because they have no access to early detection," he said.

Dala said provincial local government units should make the initial move to bring early detection and treatment nearer to the people.

"Local governments should create partnerships with apex hospitals to have satellite clinics. In satellite clinics, they can schedule maybe a once or twice a month consultations where we can bring a team of specialists from the apex hospital so that coordination is easier," he said.

Unlike other illnesses, cancer care and treatment involves a multidisciplinary team that a specialist cannot work without the others.

"We cannot treat cancer alone without the CT scan, a pathologist that will read the biopsy, and medical oncologist. That is the reason why provincial hospitals do not have breast cancer treatment; it is not only the machine that is needed but also experts of various disciplines. In Eastern Visayas, we can only find them in Tacloban," Dala said.

For a region like Eastern Visayas, with a population of 4.5 million in 2020, there are only four medical oncologists at present and two mammography specialists who can read and interpret results — all of them are based in Tacloban.

Dala admitted that even if the provincial LGUs will establish satellite clinics for early detection and treatment of breast cancer, forming a team of specialists that will conduct consultations on a regular basis in the provinces can be difficult to manage due to a lack of available experts in the region.

"It is difficult but it can be done," he said.

In Tacloban, the city government launched a program in August this year that proactively looks for women who may have breast cancer and gets them treated for free.

The initiative, dubbed as Mission Leapfrog Program, is a pilot project that aims to increase awareness on breast and cervical cancer, conduct medical screening for early detection of cancer and create a complete navigation guide that can be replicated in other LGUs.

The program, jointly being undertaken by the city government and DoH regional office with funding from a pharmaceutical company, involves multi-stakeholders like PhilHealth, EVMC through Dr. Dala, the Department of Education, Tingog Party List and the Office of House Speaker Martin Romualdez.

Dr. Danilo Ecarma, Tacloban City health officer, said the program targets to conduct clinical breast cancer screening to at least 29,000 women who are 40 years and above in the community level.

The program rolled out with breast cancer screening on public school teachers.

(This story is published with the support of the Philippine Press Institute, Novartis and ICanServe Foundation. The World Health Organization has declared October 19 as International Day against breast cancer to raise awareness and promote women's access to timely and effective controls, diagnoses and treatments.)