While the coronavirus threat remains globally pervasive, there are also other important health problems that seek immediate and continuous attention in terms of awareness, prevention, and treatment.
In the Philippines, cervical cancer ranks second as the leading prevalent type of cancer among women.
Human papillomavirus (HPV) causes most cases of cervical cancers and pre-cancerous cervical lesions. Genital HPV is a common virus spread mainly by skin-to-skin contact during sexual activity which may have no visible signs or symptoms. At least 14 types of HPV have been found to be cancer-causing. These HPV-related cancers and diseases are cervical cancer, vaginal and vulvar cancers, penile cancer, anal cancer, oropharyngeal cancer, and genital warts.
The pandemic proves toxic to household care for members who are stricken with health conditions such as cancer. Issues in financial turmoil, delays or discontinuity of care, and other problems arise.
Last November 4, the third virtual session of the 9th HPV Summit discussed how the country’s health care policies cover aspects of the continuum of care for cervical cancer and HPV— from screening to prevention, to treatment and access. The theme of the of virtual event was “Advancing health care policy towards HPV-free Philippines” with live public broadcast via the Philippine Obstetrical and Gynecological Society’s (POGS) Facebook page.
Effective primary (vaccination) and secondary prevention approaches (screening and treatment for precancerous lesions) will prevent most cervical cancer cases. When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.
Currently, there are some laws and legislations being worked on by policymakers that play a vital role in the implementation of the holistic model of cancer care.
First is the Universal Health Care (UHC) Act, which states that every Filipino shall be granted eligibility and access to preventive, promotive, curative, rehabilitative, and palliative care for medical, dental, mental, and emergency health services. Another law is the National Integrated Cancer Control Act (NICCA) which provides for the prevention and control of cancer by improving survivorship through scaling up programs like primary prevention, early detection or screening, prompt and accurate diagnosis, treatment, surveillance, survivorship care, rehabilitation, and hospice care.
Lastly, health champions are also pushing for the expansion of the current list of vaccines in the National Immunization Program. The bill filed this 18th Congress, principally authored by Representatives Helen Tan, Strike Revilla, Cristal Bagatsing, Len Alonte, and Manuel Cabochan, provides for a system in determining other types of vaccine-preventable diseases, amending for the purpose Republic Act No. 10152 also known as the Mandatory Infants and Children Health Immunization Act of 2011. Section 3 of R.A. No. 10152 is being proposed for amendment so that Human Papillomavirus (HPV) shall be included in the list of vaccine-preventable diseases, as may be determined by the Department of Health (DOH).
In the 3rd session of the HPV virtual summit, Dr. Clarito Cairo, Jr., DOH Program Manager for Philippine Cancer Prevention and Control, correlates the importance of bridging healthcare legislation to implementation of HPV-related and cervical cancer-related programs.
“The key to bridge [health care] legislations to their successful implementation is the shared sense of purpose among the stakeholders and working together,” Dr. Cairo said.
An example of an effective immunization system backed by multi-stakeholder collaboration is the DOH’s HPV vaccination for young girls aged 9 to 14 years old in the School-Based Immunization (SBI) program. This program is currently being shifted to Community-based Immunization Program due to the COVID-19 pandemic.
Dr. Cairo also discussed cancer prevention and care in the context of the cancer law. “NICCA ideally covers all stages of prevention and care of cancer. The global commitment is to include everyone who can be vaccinated against HPV,” he said.
“In pursuit of cervical cancer elimination, we ought to follow the 90-70-90 targets, that is, 90% of girls should be fully vaccinated with HPV vaccine by age 15; 70% of women should be screened with a high performance test by 35-45 years of age; and 90% of women with pre-cancer should be treated and 90% of women with invasive cancer should be managed. By 2023, the screen-and-treat approach for cervical cancer screening will be rolled out and scaled up and gender-neutral HPV vaccination will be launched,” explained Dr. Cairo.
On a local government unit (LGU) level, the DOH observes doing catch-up immunization of those who failed to get the first dose of the HPV vaccination due to pandemic-related school closures. Screening methods for cervical cancer includes pap smear and visual inspection with acetic acid (VIA) programs which are covered by the government’s free cervical cancer screening program.
Meanwhile, the Responsible Parenthood and Reproductive Health Act of 2012 is also seen essential in combating HPV as it mandates gender equality in addressing reproductive healthcare as human rights concern and social responsibility.
Landmark health laws were created through the contributions of patients and patient advocacy groups. With the integration of key legislations and the cooperation of all stakeholders, it guarantees that the cancer care continuum model can be seen through.
According to Carmen Auste, Vice Chair of the Cancer Coalition of the Philippines, “NICCA was drafted by the patients themselves, based on the ideas, suggestions, and lived experiences of actual patients. The law is also a product of collaboration of stakeholders across all sectors, and I’m glad that we’re still together right now.”
Auste also noted the power of the patient voice in transforming the future of cancer care and that cure is imperative: “Ang sakit na cancer ay hindi lamang sakit ng pasyente… Kapag mayroong nagkaroon ng cancer sa pamilya, the whole lifestyle, the whole future of the family is affected.” [Cancer is not just a disease of the patient… If one member of the family has cancer, the whole lifestyle, the whole future of the family is affected.]
NICCA’s key aspects such as the National Cancer Control Council (NCCC) is yet to be launched. With the COVID-wrought society we are now in, it would take a great deal of unity, funding, and priority to jumpstart NICCA’s engine. Auste called on all advocates and patient groups to raise their voices and continually reach out to legislators and political leaders to prioritize bringing NICCA to life, activate the NCCC, fund the cancer program and assistance fund, and designated COVID-safe facilities for cancer patients, people living with cancer, and survivors.