Sexual Health

• Cancer is now the third leading cause of death nationwide, with lung cancer ranking number one in mortality
• There are 184 cases diagnosed in 100,000 patients and that 96 deaths related to cancer are reported daily
• Republic Act No. 1121 or the National Integrated Cancer Control Act (NICCA) Act


  Aims to boost cancer control efforts, improve cancer survivorship and reduce the burden among cancer patients
• Members of patient support organizations belonging to Cancer Coalition Philippines helped craft the law, with inputs from medical societies, professional organizations, and the civil society
• Breast cancer

  • There were 86,484 total cancer cases in the Philippines, of which 27,163 breast cancer cases are reported every year
  • Breast cancer also claimed the lives of 9,926 Filipino women, making it the third most fatal type of cancer afflicting Filipinos
  • The Philippines had the highest rate of breast cancer in Asia and the ninth highest in the world in 2019, with the disease often diagnosed only in advanced stages

  
• An estimated 70 percent of breast cancer cases affect indigent women, making it more difficult for them to fight off the dreaded disease

  
• Early detection programs


  The best way for affordable care and to fight off breast cancer

  
• Causes of breast cancer

  • Genetic factors (10% of cases)
  • Particular virus (inconclusive)
  • Diet high in fat
  • Stress
  • Cigarette smoking in women with certain genetic backgrounds
  • Parabens in anti-perspirant deodorant and shaving (inconclusive)

  
• BRCA1 and BRCA2 genes


  • Mutations of these genes seem to cause breast cancer
  • BRCA1 and BRCA2 mutations also seem to increase susceptibility to ovarian cancer
  • In one study, 56% of women with BRCA1 and BRCA2 mutations eventually developed breast cancer and 16% developed ovarian cancer
  • Among men carrying mutations of these genes, 16% developed prostate cancer

  
• Genetic screening tests


  May be necessary to detect BRCA mutations in women who have a family history of breast cancer

  
• Gene therapy


  1. Genetically engineered cells containing normal BRCA1 genes are injected into the woman

  2. Studies in mice indicate this treatment is successful in shrinking tumors
• Breast self-exam


  • Done once a month, but not during the menstrual period, where there tend to be natural lumps in the breast
  • Early detection is important with higher chances of recovery with proper treatment
• Cultural factors, fear, over-reliance on doctors, lack of priority, and psychological factors prevent women from doing breast self-exams
• Kinds of breast lumps

  • Cysts (fluid-filled sacs, also called fibrocystic or cystic mastitis)
  • Fibroadenomas
  • Malignant tumors

  
• What to do if you discover a breast lump

  1. See a doctor immediately

  2. Doctor will perform needle aspiration

  3. If not a cyst, doctor will perform a biopsy to determine if it is benign or malignant

  
• Mammography


  • X-ray of the breast that can detect even small tumors and cancer in very early stages
  • Experts have ascertained that benefits outweigh the risks
  • Women are encouraged to have their baseline mammogram at around age 35, and two year intervals from age 40 to 49

  
• Treatment for malignant breast tumor

  • Radiation therapy
  • Chemotherapy
  • Hormone therapy
  • Mastectomy

  
• Types of mastectomy


  • Radical mastectomy (removal of entire breast and underlying muscle and lymph nodes)
  • Modified radical mastectomy (breast and lymph nodes but not muscles removed)
  • Simple mastectomy (only breast and possibly few lymph nodes removed)
  • Lumpectomy (only the lump and a small bit of surrounding tissues removed)
• Psychological aspects of mastectomy

  • Two sources of trauma: finding out one has cancer and amputation of the breast
  • Typical emotional response is depression, often associated with anxiety and anger
  • Marital and sexual problems may increase
  • Adjustments needed: less revealing clothes, different positions for sleeping and lovemaking
• Studies have shown that emotional responses usually last for about a year after which women gradually adapt to the stresses and return to their pre-cancer level of psychological functioning
• Breast self-exam procedure


  • Best time is about a week after your period ends
  • Lie down with a pillow under your shoulder, use finger pads to feel for lumps
  • Move around the breast in a circular, up and down line, or wedge pattern
  • Repeat on the other breast
  • Repeat while standing with one arm behind your head
• Warning signs to check for during breast self-exam

  • Any dimpling of the skin
  • Changes in nipple
  • Redness or swelling

  
• Cervical cancer

  • The most common cancer in the female reproductive tract and the second most common cancer in women next to breast cancer in the Philippines
  • Worldwide, one woman dies of cervical cancer every 2 minutes and some 500,000 new cases of disease are seen every year
  • Cervical cancer is the fourth most common cancer in women globally with an estimated 604,000 new cases and 342,000 deaths in 2020
  • Cervical cancer is deadlier than breast cancer: for every 4 Filipino women who survive breast cancer, only 2 or 3 will survive cervical cancer
  • Cervical cancer generally takes as long as 10 years and may even take 30 years, to develop into a full-fledged malignancy
  • Begins as an abnormality in cervical cells (detectable through screening tests)

  
• The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries, reflecting major inequities driven by lack of access to national HPV vaccination, cervical screening and treatment services and social and economic determinants
• Cervical cancer causes and prevention

  • Caused by persistent infection with the human papillomavirus (HPV)
  • Women living with HIV are 6 times more likely to develop cervical cancer compared to women without HIV
  • Prophylactic vaccination against HPV and screening and treatment of pre-cancer lesions are effective ways to prevent cervical cancer and are very cost-effective
  • Cervical cancer can be cured if diagnosed at an early stage and treated promptly

  
• Factors that increase susceptibility to cervical cancer

  • Women with HPV (human papilloma virus or warts) in the anal and genital areas
  • Teenagers who start having intercourse very early
  • Multiple sexual partners
  • Has had sexually transmitted diseases (STD)
  • Used diethylstilbestrol (DES), a drug for preventing miscarriage of pregnancy, or her mother used it when pregnant with her
  • Has five children or more
  • Compromised immune system or poor resistance to diseases

  
• Pap smear


  • Can reduce incidence of cervical cancer up to 90.8% when done annually
  • Women should start having pap smears three years from the time they became sexually active (vaginal intercourse) but not later than 21 years old
  • From age 30, women who have had three normal pap test results in a row may reduce going for pap smears every 2 to 3 years except for women at high risk
  • Visual examination of the cervix aided by acetic acid wash was found out to be the most cost-effective screening method

  
• Female sexual-reproductive cancers


  • Uterine (endometrial) cancer
  • Ovarian cancer
  • Cancer of the vulva
  • Cancer of the vagina
  • Cancer of the fallopian tubes

  
• Pelvic exam


  • Health care provider inspects the vulva and performs internal checks
  • Speculum exam - speculum is inserted into the vagina to hold vaginal walls apart to permit examination
• The cost of HPV vaccine in the Philippines ranges from P2,200 to P4,500
• HPV vaccine


  Can prevent cervical cancer

  
• Cost of HPV vaccine in the Philippines = P2,200 to P4,500
• Female sexual-reproductive cancers


  • Uterine (endometrial) cancer
  • Ovarian cancer
  • Cancer of the vulva
  • Cancer of the vagina
  • Cancer of the fallopian tubes

  
• Female sexual-reproductive cancers are rare in comparison to cervical cancer

  
• Pelvic exam


  1. Health care provider inspects the vulva

  2. Internal check for cystoceles and rectoceles, pus in the Skene glands, cysts in the Bartholin glands and strength of the pelvic floor muscles and abdominal muscles

  3. Speculum exam to look for unusual signs such as lesions, inflammation or unusual discharge from the vaginal walls and for any signs of infection or damage to the cervix

  4. Health care provider uses a small metal spatula to scrape a tiny bit of tissue from the cervix for the pap test for cervical cancer

  5. Bimanual vaginal exam where doctor slides the index and middle fingers of one hand into the vagina , with the other hand presses down from the outside on the abdominal wall to feel for the position of the uterus, tubes and ovaries and for any signs of growth, pain or inflammation
• Prostate cancer


  • Generally affects older men
  • Tumors are small and spread (metastasize) very slowly
  • A certain percentage of prostate tumors do spread and are lethal with 40,000 deaths a year
  • A prostate cancer gene (HPC1 for Hereditary Prostate Cancer) has been discovered but accounts for only 3 percent of all cases
• Early symptoms of prostate cancer


  • Frequent urination (especially at night)
  • Difficulty in urination and difficulty emptying the bladder
  • Frequent erections and increase in sex drive (in early stages)
  • Problems with sexual functioning (as disease progresses)
• Causes of prostate cancer

  • Age
  • Genetics
  • Diet (high meat and low vegetable intake)
  • Low vitamin D
  • Medication – anti-inflammatory drugs
  • Obesity
  • STDs
  • Agent orange (chemical used during the Vietnam War)
  • Enzyme PRSS3 linked to aggressive prostate cancer
• Diagnosis of prostate cancer

  1. Preliminary diagnosis by rectal examination

  2. Further tests advised after discovery of tumor from rectal exam
• Cancer of the penis


  • More common among uncircumcised men, suggesting that the accumulation of smegma under the foreskin may be related to its cause
  • Treatment may consist of surgery or radiation therapy
  • Rare form of cancer which tends to afflict young men between the ages of 29 and 35
  • Rate for white men is about double that for black men, with rates for Hispanics, Native Americans, and Asian Americans falling in between