GENETIC TESTING

Dr. Diana Cua

September 21, 2006
Astoria Plaza
Ortigas Center, Pasig City

(Dr. Diana Cua is a breast surgeon at Medical Plaza Makati and at the Makati Medical Center. She also is co-founder of Bosom buddies, a breast cancer support group.)

This coming year, we’ll be proud to inform you that we will be having a joint project with Stanford. Basically, it’s about genetic testing. We don’t really have that much of a genetic counselor here is the country, and most of the time, we still have to go abroad to find out if your breast cancer is an inherited, or sporadic, by random type of breast cancer. I think the level of awareness in our country, with regards to breast cancer, has been much improved throughout all the past five years. And just to emphasize the breast cancer, majority of breast cancers are not inherited.

So, this test will actually apply to very minority of the group of we know with breast cancer. Generally we say that you know, about less than 10% of the women with breast cancer are inherited. So, for that small minority of women who might also want to do it as a favor their families and I think a lot of women, or their families, rather, are worried or concerned that they might have inherited the breast cancer gene.

Well, this test will be available. As I have said earlier, this test actually is in a way, prohibitive also, because of the cost, so I’m just announcing it. It may for now, be beneficial to the people who can afford it, because the idea there is basically take a blood test here in the Philippines and send it abroad, and then we’ll be using technology to help us have an actual meeting or consultation with the Stanford genetic doctors. And there, they will be giving the patient the option of whether she needs or need not undergo the test, because the test will cost a bit, since everything is in US dollars.

Right now, I think the plan is having it done in the States, which a standard is like US$3,00.00 and if it’s in Hong Kong, it’s like a US$1,500.00, and I think there is going to be an offer from India for US$1,000.00. So, as I’ve said, this is not for everyone because a minority of women do have inherited breast cancer, and also in this country, it’s not really everyone who could throw away, or not throw away, but you know, spend this much amount of money for breast cancer genetic testing.

It is also actually available for other cancers, like you know, for colon cancer, but we’re starting off just with breast cancer genetic testing.

Then another announcement that I would want is for those who are you know, less fortu…no, not naman less fortunate, but who wants to cut on the costs of their medications, we are, for October, we do have a limited number of medications up for grabs. They’re much, much cheaper than most of the current prices. Arimidex will be like PhP6,830.00 per box, Femara for PhP7,000.00, and Aromasin, we’re still negotiating. Right now, it is looking like around PhP7,000.00 per box. As I’ve said, it’s limited, and we’ll start it by October.

I’ll just mention like two things, about, just to add up with Francis mentioned. I noticed a lot of people here usually say, “Oh, I had stage III, it became stage IV.” When you say the word stage IV, it actually means you were initially diagnosed as stage IV. Meaning, upon the first you went to a doctor, and after a series of tests, they found out that your cancer has spread, then that’s actually a stage IV. But if you were like a stage II before, and then your cancer has gone to the other parts of your body, you just metastasized. I mean, in essence, yes, both stage IV and a metastasized woman have the same implication. The treatment that she will be receiving will not be for cure, but for palliation. And as I have always said to everyone, this is a medical opinion. There are doctors who have seen miracles; we call them miracle patients, because they do get out of the box. But these are just a handful of patients wherein they have liver mets, and they’ve lived for 20 years. But those are just the extreme minority.

Another thing is maybe a lot of women think if you’re a stage IIA, and I’m a stage IIA, we’re about the same case. Actually, in one of my seminars abroad, I actually saw, in Sweden, there is a group there by Laslous Tabaris (?). He was the one who is actually responsible for establishing that mammogram should start at 40. Basically, he was the one who made a study showing that it benefits women to have mammogram at 40.

Anyway, this doctor basically practices in a place wherein their slides, their specimen slides are this big. And they can see a good slice of the cancer as whole, rather than just the way we do it, which is like, everything is just chopped into several pieces. So, anyway, in one of those slides that he showed us, the pathology showed us, they actually saw like 11 types of breast cancer in one patient.

It’s actually quite known now already that breast cancer is not homogeneous, which means a lot of us think, if you have invasive ductal, it’s purely invasive ductal. I think a lot of you have noticed some of your diagnoses these days are more detailed. They have certain things like. You know, invasive ductal with DCIS or something, or lobular carcinoma. So, it’s combined. But for pathologists who are looking into breast cancer alone, it’s quite common, or it’s more actually of a standard to see a mix group of breast cancers in a particular patient’s breast cancer. And that’s the reason why a stage IIA person may not do the same way as another stage IIA person; because the combination, the amount of invasive ductal, of grade III versus grade I, may not be the same. So, that’s it. Thank you.