Our fight against cancer—in the lungs and in civil society

Anno Domini MMXXII. Year 2022 is upon us. New year, new hope, as they say. The Philippine Republic, still reeling from the COVID-19 pandemic, is set to choose its new leaders once again. Those who will emerge triumphant in the race would have their hands full. A lot is at stake in this year’s election—grueling inequality, looming inflation, hulking debt, Chinese hegemony, to name a few. Amid crises, two leaders stood out in history for their unapologetic passion and brilliance.

One by the name of José “Ka Pepe” Diokno fought vigorously for patriotic legislation against the economic and military interests of American imperialism and the Marcos dictatorship. The other by the name of Miriam Defensor Santiago pounced fiercely on corruption and illegal operations catalyzed by political dynasties. Tragically, these firebrand lawmakers each succumbed to lung cancer at ages 65 and 71: one having smoked very often, the other having never smoked at all.

Lung cancer is the leading form of cancer worldwide with over 2.2 M new cases and nearly 2 M deaths in 2020. It is second only to breast cancer with 19,180 or 12.5% of the new cancer cases nationwide, yet it is the most fatal of all types with 17,063 or 18.4% of cancer-related deaths. Its incidence, according to a study by the Lung Center of the Philippines (LCP) from 2000 to 2008, tripled among females hospitalized from 52 to 164 and doubled among males from 193 to 390.

Tobacco smoking is the cause of about 80% of lung cancer cases in females and about 90% of cases in males. In 2015, there were 16.6 M Filipino adults who kept feeding their smoking habit for PHP 678.40 every month, plus 3.6 M more exposed to secondhand smoke in the workplace. Apart from one’s family history, even more risks include exposure to radioactive gas, industrial chemicals like asbestos and heavy metals, plus air pollutants such as coal and exhaust fumes.

Horrid symptoms abound for those unfortunate to develop lung cancer—from fatigue, sudden weight loss, and shortness of breath to chest pain and bloody cough. Its severity climbs up to Stage 2 when the cancer in the lung moves to the lymph nodes, Stage 3 when it reaches the mid-chest area, and Stage 4 when it spreads to other organs. As almost half of the diagnoses are already in late-Stage 4A, successful treatment and survival are hardly afforded to patients.

Curing lung cancer is by no means budget-friendly with around PHP 900,000 in total cost—too punishing for PHP 29,200 in PhilHealth case rates to cover. Yet as the health budget increased to PHP 268.4 B this year, so too may the LCP’s capability for early screening, transplants, and information management via PHP 75 M in added funding. Resources are sorely needed, as the LCP hit 200% overcapacity in its emergency rooms and 100% in its COVID-19 wards last year.

Hope would not be lacking this time with the approval of the Universal Health Care Act and the National Integrated Cancer Control Act in 2019—which promise expanded PhilHealth packages, a national cancer center and control council, plus a free medicine assistance fund for all Filipino citizens diagnosed with cancer. These are all in line with the country’s target, as per the United Nations’ Sustainable Development Goal, of reducing premature cancer deaths by 30% in 2030.

Lung cancer—whether or not by the same poison inhaled for oneself and exhaled unto others—already robbed the Philippines of arguably two of the best presidents the country has never had; yet still, it has kept preying on the next generation’s brightest hopes. “Ignorance can be treated,” the “Iron Lady” did say, and this is where communication would be most critical—so that Filipino children, in the dream that we share with “Ka Pepe,” “may have a better life than we have had.”

Sharing her knowledge and insights on lung cancer is Dr. Corazon A. Ngelangel, the President of the Philippine Cancer Society Inc. (PCSI)—a non-profit organization working towards cancer prevention and mitigation through information, education, advocacy, and services. As a cancer specialist, Dr. Ngelangel is a Professor Emeritus at the University of the Philippines College of Medicine and the Director of the Asian Cancer Institute at the Asian Hospital & Medical Center.

  • Kindly explain what lung cancer is and how it arises within the human body.

Lung cancer begins when normal cells in the lung change—initiated by a carcinogen—breaking oftentimes the DNA, creeping pathologically to the molecular level then towards the whole cell, mutating uncontrollably and fast, becoming a crazy-looking lesion, irking its surroundings, and making the patient feel symptoms eventually.

Carcinogens, or cancer-producing substances, promote lung cancer development by causing genomic alterations brought about by smoking and tobacco, excessive exposure to asbestos, radon, and air pollution. Unfortunately, some people have a genetic predisposition to develop lung cancer—alterations in the EGFR, KRAS, and ALK genes constitute the primary changes detected in lung adenocarcinoma. At the molecular level, science reveals that alterations in the EGFR, ALK, ROS1, BRAF, and PD-L1 can now be inhibited by medicines that halt the signals driving cancer progression.

  • How similar or different are the various types of lung cancer from each other?

Under the microscope, there are at least two major types of lung cancer—non-small cell lung carcinoma (around 85% of cases) and small cell lung carcinoma (around 15%). Non-small cell lung carcinoma includes different subtypes such as adenocarcinoma, squamous cell carcinoma, large cell carcinoma, etc. Structurally, molecularly, and pathologically, these lung cancer types are different from one another. No two cancers are the same.

  • Which societal groups in our population are the most prone to lung cancer?

There is no societal group that is most prone to lung cancer. That is, whoever you are—if you are exposed to occupational hazards, tobacco, and unhealthy vices or lifestyle and diet, willingly or not—you are placed at a high risk of developing lung cancer. If you do not engage in good health practices, avoid these risk factors, go for cancer screening, and—if detected positive—get treated very early on.

It might, however, be also true that those who are underprivileged are more likely to be exposed to occupational hazards, tobacco, and unhealthy vices or lifestyle and diet, which could increase the risk for cancer development. In addition—due to lack of financial support—they have less access to screening that detects cancer early on, which offers a greater chance for cure when cancer is treated early; they also exhibit scant health-seeking behaviors and are even prone to receiving health-related misinformation, causing further fears and delay in seeking treatment. These all lead to worse patient outcomes. And so, our government and society must intervene towards lifting these people from their underprivileged conditions.

  • In which approaches and resources are there gaps in combating lung cancer?

The lack of programs for information dissemination and education on preventing cancer, such as a continued “no smoking” campaign, in schools and in the community is apparent, as well as the lack of funds for an organized nationwide lung cancer screening program. There is so much health-related misinformation on the Internet, which causes a delay in seeking proper care. In a publication, the delay in seeking standard-of-care treatment causes 2.5 times higher mortality compared to when treatment was sought early. Also, most of the screening, diagnostics, and treatment procedures are out-of-pocket procedures.

  • Can you comment on our newly passed laws on cancer and universal healthcare?

The National Integrated Cancer Control Act or NICCA has provisions across the cancer care continuum involving whole-of-government, whole-of-society, whole-of-system, and life-course approaches. Furthermore, the NICCA program covers the processes of care across the cancer control continuum—risk assessment, primary prevention, early detection, diagnosis, treatment, survivorship, rehabilitation and reintegration, and end-of-life care—noting the transitions in care from one type of care to the other and reflecting life-course approach. We hope that the plans judi bola for this will be implemented fully and wholly soon.

Accordingly, NICCA will complement and supplement the Universal Health Care Act to achieve in reducing premature mortality from non-communicable diseases—including cancer—by 30% between 2010 and 2030.

  • Are there outcomes that, in a few years, you hope to witness in our country?

With good primary and secondary cancer control programs in our community, we could soon be finding less and less far-advanced lung cancers plus more and more early cases having a good prognosis. The LCP launched its screening program for early detection of lung cancer; we hope that this gains country-wide coverage. With good science and medicine, we are hoping to make this so-called “terminal” disease a chronic one—which gives hope to those who come down with this ailment. Lung cancer can be converted to a chronic disease that may be without symptoms. And with a multidisciplinary team approach to lung care management, we hope to share best practices for the benefit of our patients.

But it takes the village, so to speak, to make this happen—our government must make NICCA happen; our people and our community must work with our government to make this happen.

  • Do you have a message to share with those who are actively fighting lung cancer?

Let’s keep on fighting! Advocate for the prevention, early diagnosis, and early treatment of lung cancer—on behalf of the Filipino people or for someone afflicted with cancer. Prove cancer can be conquered. Lung cancer treatment has gone a long way, with tremendous improvements in multidisciplinary therapies aiming for long survival and cure. But always start with no to cigarette smoking, yes to early cancer screen, yes to early prompt treatment, and yes—we are here for you and each other.

Lung cancer—whether or not by the same poison inhaled for oneself and exhaled unto others—already robbed the Philippines of arguably two of the best presidents the country has never had.

“Nagbabágang simbuyó” (“burning passion”). Former Senators José “Ka Pepe” Diokno (1922–1987) and Miriam Defensor Santiago (1945–2016) each succumbed to lung cancer at ages 65 and 71.
Corazon A. Ngelangel, M.D., M.S., Ph.D. (image from Asian Hospital Charities Inc. via PCSI).
Horrid symptoms abound for those unfortunate to develop lung cancer—from fatigue, sudden weight loss, and shortness of breath to chest pain and bloody cough (infographic from the Department of Health).