“Natatakot ako.” I’ve been trying to convince my mom to get a mammogram for years but her reply is always along the lines of those two words, her go-to conversation ender and the barrier to my peace of mind.
In 2018, the Philippine Society of Medical Oncology reported that the Philippines has the top incidence of breast cancer among Asian countries. Breast cancer accounted for 15 percent of all new cancer cases for both sexes the same year. “Public awareness on cancer prevention is low,” the group added. “Most Filipino patients consult a doctor only when their cancer is already in its advanced stage.”
For Breast Cancer Awareness month, I sat down with Filipino breast cancer survivors 48-year-old plantita Rowena Cabangon, 52-year-old wellness and essential oil enthusiast Gina Torres-Evangelista and 56-year-old editor and writer Alya Honasan. We had a chat about the things they didn’t expect from their battle with cancer, the misconceptions that need to be put down and the local support groups that helped them along the way.
Mom, if you’re reading this, let’s schedule a check-up together soon.
Can you share with us how you found out that you had breast cancer? How did you discuss it with your family?
Gina: One day, after taking a shower, I was doing a self-breast exam when I felt a lump on my right breast and a few small lumps in my right armpit. I immediately called my OB-GYNE and scheduled an appointment. The minute my OB-GYNE felt the lumps, she scheduled me for a mammogram and a sonogram.
A few days after, she got the results and asked me to go see her. All throughout this, my husband was with me every step of the way. However, before telling the whole story to our families, I needed to get all the information I could get so that I would know what to tell them.
Alya: I found out through what was supposed to be a routine mammogram and ultrasound that were two years delayed. The doctor said she saw something that she “could not dismiss as benign”—and she was right. I worked fast after that—had a biopsy in two days, found out the results in a week, and had the operation days later on June 19, 2013.
I started 12 rounds of chemo in July and 33 rounds of radiation in February 2014. My family was not particularly involved, not because they didn’t care, but because they were more in shock than I was; I’m single and depended mainly on my friends.
Rowena: I was self-examining my breasts when I noticed a lump. I immediately went to my doctor to have it checked. My mammogram showed a suspicious mass and my doctor wasted no time to have it biopsied. Thus, the result confirmed that it is cancer. The feeling was overwhelming. I’m lucky that my husband was with me all throughout the ordeal.
What are the causes of breast cancer? Is it avoidable?
Alya: They really don’t know what causes it for sure—a combination of some genetics, an unhealthy lifestyle, toxins in our environment. I personally think it’s caused by stress, which I ate for breakfast for many years.
Rowena: I’m the first in the family to have breast cancer, but my father died from complications of lymphoma; maybe the cancer is in our genes. I can’t say that cancer is avoidable.
Gina: It is difficult to pinpoint what exactly is the cause of my breast cancer. It could be a number of things. I suppose the way to avoid getting any type of cancer is to make sure your house is clean, free from unwanted toxins.
Did you undergo a mastectomy or a lumpectomy? Can you share with us what you were feeling at the time and what made you feel that way?
Rowena: I had both a lumpectomy (a surgery that removes cancer or other abnormal tissue from the breast which is also called breast-conserving surgery) and a mastectomy (a surgery that removes all breast tissue in order to treat or prevent breast cancer). The mastectomy really got me in tears. It’s hard to accept the fact that you’re losing your breast. It felt like you’re going to lose a part of your womanhood. But, it only took me some time to accept it. And eventually, it gave me a sense of security knowing that a part of me that caused cancer is now taken out of my system.
Alya: I had stage 2a invasive ductal carcinoma and was deemed a candidate for a lumpectomy because of the size of my breasts, which are a D cup. Leaving some comfortable margins around the mass to be sure, my surgeon removed a ping-pong ball-sized lump of flesh under my left boob.
Now [my boobs aren’t] even, but I haven’t opted for any reconstruction. It isn’t noticeable at all, I think. I had no issues about it, but I admit I was unnerved by the idea of a mastectomy. Since the lumpectomy option was available, I opted for that.
Gina: I had a lumpectomy on my right breast and had 25 lymph nodes removed from my right armpit, 19 of which were malignant. Initially, I was mulling over getting a mastectomy but my breast surgeon said that I only needed a lumpectomy. It helps a lot if you have a sibling who is a doctor who can give you some medical advice. My sister is a practicing family medicine physician in the U.S.
I wasn’t really scared of the lumpectomy. That was not even an issue. It was more having cancer that just threw me off. Having a lumpectomy was not as devastating as hearing the words “you have cancer.”
What are some of the misconceptions about breast cancer that you were shocked to learn weren’t true?
Gina: [It’s a misconception that] it’s a death sentence. It definitely isn’t. Breast cancer is one of the most treatable cancers. Early detection is key.
[It’s not true that] you need to have a mastectomy. It depends on so many factors—size, location, type and grade of the tumor. Each person will have a different type of diagnosis. In my case, I just needed a lumpectomy. The survival rate of those who have mastectomy vs. lumpectomy is just the same.
[It’s also not true that] all breast cancers are the same. There are several types of breast cancers and there are factors like the hormone receptors and the HER2/neu tests that will determine your type of breast cancer.
Alya: That chemotherapy will leave you plastered—I was sleepy, but I kept working. That it ravages your body—I have remained relatively healthy, although some side effects are showing up just now, seven years later, like weaker bones and bad teeth. That you will be deliriously happy after beating it—I fell into a depression after, which I felt required harder work than beating cancer.
Who are the people who are part of your support system? Can you recommend groups or resources for other Filipinos who are battling breast cancer?
Gina: Of course, my husband, my parents, siblings, and in-laws have been with me from the beginning of my wellness journey. My friends have also been a huge part of my support system. I can never overemphasize the importance of telling your family and friends so it will be easier to talk to them about it.
The Carewell Community Foundation [where Gina volunteers at] and ICanServe Foundation, Inc. have been the groups that I have relied on so much for information. There is a sense of belonging, sisterhood and camaraderie among those who have cancer. Without even really being close to the members, there’s that feeling of comfort [with] knowing that you are all going through the same path even if your types of cancers are different.
My team of doctors has been very supportive. They answered all my questions about treatment plans. It really helps if you are constantly in touch with your team of doctors—oncologist, breast surgeon, onco-radiologist and OB-GYNE.
Rowena: All I have is my family and friends for support. I didn’t join any support group because the support I’m getting from the people surrounding me is more than enough to help me get through it.
Alya: My support system was composed primarily of my childhood friends, who went to every single chemo session with me. I am also a member of the support group ICanServe, founded by my good friend Kara Alikpala, and it provides invaluable assistance to patients, as well as promoting early detection.
What’s your message for people who are battling breast cancer and those who have noticed symptoms for it but are too afraid to get themselves checked?
Gina: Breast cancer is not as bad you think it is. Don’t be afraid to talk about it. It will help with your sanity! It could also help others who are going through the same situation as you.
It might be too much of a cliché, but you have to have a positive outlook. Always remember that being pessimistic when you are already sick will not make you feel better. I was diagnosed with Stage IIIC Triple Negative Invasive Ductal Carcinoma which is a difficult type of cancer to treat. I managed to overcome it because I claimed that I was going to be well. It has been 11 years since my diagnosis and I am OK!
Rowena: For those people who are battling breast cancer like me, stay positive, live healthy, be truly happy, have a peace of mind and find strength in God. Do regular follow-ups and get monitored on schedule.
For those who have noticed symptoms for breast cancer, conquer your fear. Remember that when breast cancer is detected early, a cure is attainable.
Alya: If you already have breast cancer, please remember that it is completely possible to beat this. Even if you are in an advanced stage, don’t give up fighting, because you never know how things will turn out. It’s a fight that is almost 80 percent won in your head.
If you are afraid to get checked, then you are being foolish. It is always better to find out earlier than later. You owe it to yourself to be vigilant. This is not something that will go away if you ignore it.
Art by Dana Calvo
Photos courtesy of Alya Honasan and Gina Torres-Evangelista