编者按：2023年中国整合肿瘤学大会（CCHIO）于11月16～19号在天津举行，在国际专场三-Unit2上，菲律宾癌症协会的Corazon Ngelangel教授带来了“Challenges&Perspectives of Global Cancer Control:Focus on Breast Cancer Control”的报告，介绍了乳腺癌当前的挑战及诊疗现状。报告结束后，Corazon Ngelangel教授接受了肿瘤瞭望的采访，分享了此次参会的体验及当前菲律宾在控制乳腺癌这一疾病方面所做的努力。

 

Corazon Ngelangel教授：CCHIO为我们提供了一个很好的交流机会，如你所了解的，我们缺乏面对面地与亚洲和世界上所有同道分享诊疗经验和最新诊疗进展的机会。过去几年，因为一些不可抗因素的影响我们只能在国内参加会议，今年我已经在几个国家参与了多场国际性会议，这让我在第一时间了解到其他国家的最新进展，比如前阵子我在会上了解了多发性骨髓瘤和未定潜能克隆造血（CHIP）的相关知识。

 

我是一名肿瘤内科医生，对血液学不是特别熟悉。但我很乐于了解超出我专业领域的事物，尤其是参加像我们现在在中国举办的CCHIO这样的综合性会议。

 

Oncology Frontier:Could you share your feelings about attending this CCHIO congress?

 

Actually，it’s a great opportunity since we had this pandemic thing and we have not really come face to face with all your colleagues in the world to share experiences and updates.This year has been quite eventful for me，with multiple meetings in various locations.For the past year，two years or so，there was nothing.Most of the time，you would stay within the country，and any meetings that did occur were limited in scope.And now this is very nice because you can see firsthand latest developments.For example，a while ago，I learned about the new developments in multiple myeloma and the CHIP thing.

 

I am a medical oncologist，but I’m not really into hematology.So，things beyond my expertise is kind of a welcome，particularly in joining such a conference as what we have now in China.

 

Corazon Ngelangel教授：我认为乳腺癌领域取得的成就是菲律宾整个癌症控制项目的一部分，但目前取得的相关成就不仅局限在乳腺癌领域，而是囊括了所有癌症项目。2019年，《全国癌症综合控制法案》签署成为法律。实施细则和条例（IRR）于2020年完成，但直到2022年，我们才开始着手制定一个真正切实可行的未来10年战略计划。

 

尽管在2019年法案签署之后，我们尚未真正取得成果，但在改善菲律宾癌症控制方面已经做出了一些初步的尝试。癌症药物获取计划是卫生部的一个项目，旨在为一些癌症患者提供免费药物，最初是为乳腺癌患者建立的。癌症药物获取计划最初是从2012年开始的一项乳腺癌药物获取计划演变而来。就在去年，我们扩大了该计划的范围以涵盖更多癌症。根据国家综合癌症控制法，涵盖范围内的癌症患者可以从卫生部免费获得药物。

 

另一方面，政府对菲律宾境内的几家癌症中心进行了改造升级。菲律宾是由众多岛屿组成的国家，无成片的大陆。为了解决不同岛屿之间患者的交通问题，菲律宾卫生部计划在主要岛屿上的三级医院建立癌症中心，其中也包括建设癌症中心的基础设施，特别是针对局部治疗的设施。在以前，放疗设施主要集中在马尼拉（位于吕宋岛）等地区。现在，放疗设施的安置范围正在逐渐扩大，覆盖从吕宋岛到米沙鄢群岛再到棉兰老岛这三个菲律宾的主要岛屿。这是治疗方面的情况。

 

我在本届CCHIO大会上主要讲的是癌症预防。特别关注的是缺乏有组织、以社区为基础、全民参与的乳腺癌早期检测计划。菲律宾癌症协会作为一个国家非政府组织，主动发起了一项乳腺癌早期检测计划，因为卫生部在这方面一直都没有相关计划。因此，我们在巴朗盖（barangay）地区提出了一项试点计划。巴朗盖是一个明确定义的地理区域和政治区域。我们这样做是为了有一个确定的基数人群及确定的癌症患者数量，方便我们对患者进行检查和统计学描述，然后可以把相关的数据递交给卫生部，向卫生部证明该计划的可行性和成功性。

 

该计划成功的关键在于其可负担性、可行性和患者教育的可实施性。出于经济原因我们不考虑昂贵的乳腺X线摄影，而是进行临床乳腺检查。另外，我们也在努力解决女性宫颈癌方面的问题。目前在菲律宾有一个在世界卫生组织（WHO）大力支持的宫颈癌筛查计划，而宫颈癌筛查在菲律宾卫生部（DOH）方面也得到了大量资金的支持，也是我们所关注的，目前正在大力推进的事情（也是卫生部在主动建立乳腺癌早期检测计划上态度不积极的原因）。在菲律宾，无论是在发病率还是在死亡率上，乳腺癌都居前位，但在关注度上却相对较低。其中宫颈癌在女性中居第二位，在两性癌症中居第四位，但乳腺癌却居于首位，这也是我们为什么要进行早期乳腺癌检测计划的原因。

 

Oncology Frontier:The Philippine Cancer Control Program began in 1988.So what do you think has been achieved over the last 30 years in the field of breast cancer and what are the challenges?

 

It’s not really in the field of breast cancer alone.It’s in the whole cancer control program in the Philippines.In 2019，the National Integrated Cancer Control Act was signed into law.It was signed in 2019 and the problem at the time was it was pandemic time.So the implementation kind of lagged because we had to focus our attention on the COVID problem before we went on to implement the law.

 

The IRR(implementing rules and regulations)was done in 2020，but it’s actually now，in 2022，that we are coming up with an honest-to-goodness strategic plan for the next 10 years or so.But even though we have not really，even beyond the 2019 signing of the law，there have been already some baby steps towards the improvement of cancer control in the Philippines.The Cancer Medicine Access Program，which is a Department of Health program to provide free drugs for some types of cancers，has been there initially started for breast cancer patients.

 

So that the cancer medicine access program began as a breast cancer medicine access program since 2012.And just last year we included several other cancers that the Department of Health can give free drugs to implementing the NICCA law.

 

And the other thing is that the government also is upgrading several cancer centers across the Philippines.The Philippines is made of islands.It’s not really a main big island.To address the challenge of transporting patients across different locations，the plan is to establish cancer centers in the major islands of the Philippines，specifically within the tertiary hospitals affiliated with the Department of Health.Also included in the cancer centers is infrastructure，particularly for radiotherapy.Because previously，radiotherapy facilities were primarily concentrated in Metro Manila.Now they are slowly scaling up with radiotherapy facilities from Luzon to Visayas and Mindanao.Those are the big three islands of the Philippines.So that’s treatment.

 

Now the thing I’ll be addressing prevention in my talk this afternoon at the convention event，particularly focusing on the lack of an organized，community-based，population-wide breast cancer early detection program.The Philippine Cancer Society，as a country-related NGO，took the initiative to jumpstart a breast cancer early detection program，since the DOH has not been starting it.So we came up with a pilot program in one barangay.Barangay is a locality，a defined geographic area，political area.We wanted to do that so that we would have a defined population，a defined number of patients that we can examine and come up with outcomes，that we could outline and then most probably prove the feasibility and success of the program to the Department of Health.

 

The key to the success of the program lies in its affordability and feasibility through education.We’re doing clinical breast examinations other than mammography because that’s very expensive.It’s important to note that cervical cancer in women is another aspect we’re addressing.There is a heavily funded cervical cancer screening program under WHO，and cervical cancer screening is very heavily funded by DOH.So that’s actually what they’re focusing themselves on.

 

And breast cancer，which is the main cancer in the Philippines，both in incidence and mortality，is left behind.Cervical cancer is second in women，maybe fourth in both sexes，but breast cancer is on the top.

 

Corazon Ngelangel教授：除前边已经提到的点，目前，我们的目标是实现癌症诊断和治疗的“分期改善”。目前菲律宾有60%到70%的女性被诊断为晚期乳腺癌即第Ⅲ、Ⅳ期。大约有30%到40%的患者处于第Ⅰ、Ⅱ期。我们开展早期检测计划的目的就是更早发处于晚期阶段的患者。

 

所以在接下来的10年左右，希望我们看到的是75%的患者诊断时疾病分期在第Ⅰ、Ⅱ期，25%的患者诊断时疾病分期在第Ⅲ、Ⅳ期。因为与处于第Ⅲ、Ⅳ期的患者相比，处于疾病第Ⅰ、Ⅱ期的患者生存率会更高，尤其是她们在得到及时治疗的情况下。

 

Oncology Frontier:Could you introduce the prevalence and practice of breast cancer in the Philippines?What are your perspectives for breast cancer control?

 

Apart from what I have said before，as of now，we are aiming to achieve a“stage shift”in cancer diagnosis and treatment.Currently，we have like 60 to 70%of women are diagnosed with breast cancer at stage 3 and 4，and about 30%to 40%are in the stage 1 and 2.So if we do this early detection program，we aim to stage shift.

 

In the next 10 years or so，hopefully，what we are looking at now would be 75%stage 1 and 2 and 25%stage 3 and 4 during diagnosis.It’s really easier to treat stage 1 and 2 breast cancer patients because they would have higher survival rates，particularly if they get treated promptly compared to stage 3 and 4.

 

Corazon Ngelangel教授

Philippine Cancer Society