“In the U.S., one out of 8 women develop breast cancer in their lifetime. All of them get treated and very few of them die. In the Philippines, it’s twice that number. One out of 4 Filipinas develop breast cancer, half of them die. Seventy percent of those who die, die without treatment,” says Dr. Norman San Agustin, founder and president of the Asian Breast Center (ABC), about the sorry state of breast cancer care in the Philippines.
It is for this reason that Dr. San Agustin decided to give up his 50 years of residency in the U.S. and come back home to the Philippines to set up ABC in October 2017. “It’s my way of giving back, especially to marginalized Filipino women,” he says.
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Back for good
Dr. San Agustin spent most of his adult life in the United States, but he considers himself homegrown in the Philippines as his education started at the De La Salle University and he completed his degree in Medicine at the University of Santo Tomas. Shortly after graduation, he went to the United States to get the best surgical training. He trained at various teaching institutions affiliated with Yale Medical University and Columbia Presbyterian Medical University, and also at the Memorial Sloan Kettering Cancer Center.
Unable to return to the Philippines after finishing his training because of Martial Law, he started his surgical practice in Morristown Medical Center, rated as one of the top 50 hospitals in the United States and among the top five hospitals in the New York metropolitan area.
Part of a generation of Filipinos whose love for country was fired up in their younger years, San Agustin came to a point when the calling to serve his country can no longer be ignored. He saw ABC as an opportunity to propagate, in the Philippines, the advancements on breast cancer and its detection and treatment, as well as a chance to reach out to more women. ABC is one of the few ambulatory centers in the world that is free-standing (meaning, it’s dedicated only to one disease, breast cancer), affiliated with an American hospital (Morristown Medical Center), and profit for charity. “We see patients who can pay and the profit we get goes to charity,” he says, explaining the concept behind ABC as a project.
Breakthroughs on breast care
Classifying breast density is considered crucial to breast care as it affects one’s prognosis. Unfortunately, it remains uncommon, if not totally unheard of among lot of Filipino women. “Measuring a woman’s breast density is known to help determine one’s chances of developing cancer in her lifetime and the outcome of the treatments,” notes Dr. San Agustin.
Hence, he stresses the importance of molecular breast imaging (MBI), a new nuclear medicine technique that makes tumor cells visible with a special camera, specifically designed to better detect breast cancer in women with dense breasts—which are common among Filipino women. MRI, which hospitals commonly offer, he says, is “more expensive and potentially nephrotoxic—it could compromise your kidneys.”
Dr. San Agustin also vouches for ambulatory surgery, which has been around for 30 years and is practiced in many parts of the world. “Many people die from breast cancer not because of cancer but because of hospital acquired infection. The treatment for the disease is affordable but the patient incurs unnecessary cost for the hospital stay,” he observes. “I’m not saying hospitals are bad, they definitely are very important. But there are many cases where patients don’t need to be hospitalized—one of them is breast surgery.”
Dr. San Agustin also points out that breast cancer is often detected late here in the Philippines, so mastectomy (removal of breasts) has become the standard of care. But he stresses that this should not be the case if the cancer is detected early. “Many go to clinics to get mammograms and ultrasound. My advice is: go to a breast surgeon,” he says. “Unless you do that, you’re doing a disservice to yourself. A breast surgeon can talk to you not only about the present status of your breast but also about your chances of developing breast cancer or the breast cancer risk assessment, and can recommend the needed tests.”
Likewise, in selected early breast cancers, the advent of IORT (Intraoperative Radiation Therapy) eliminates the need for a tedious, lengthy whole breast radiation, which is given a few weeks after surgery every day for 6 ½ weeks or 33 treatments. IORT provides single dose of radiation for 25 to 30 minutes immediately after a lumpectomy while the patient is asleep. “IORT minimizes the risk for lung complications, which happens when you radiate the whole breast,” he stresses.
One-stop specialty clinic
ABC at the 8th Floor Centuria Medical Makati is a far cry from the usual hospital setting. You’ll easily get a sense of calm as you’re welcomed in a relaxing lounge punctuated by a stunning painting depicting the beauty of a woman’s breast.
Dr. San Agustin is at the clinic every day, and personally sees his patients. ABC is equipped with all the basic and advanced facilities for detection and treatment of breast cancer—e.g., mammogram, ultrasound, MRI, MBI, IORT. The tests and the surgeries are done in the same clinic.
For patients who opt to stay for another day in the clinic after their surgery, the clinic also has comfortable suites designed with the comforts of a hotel room.
It is Dr. San Agustin’s fervent hope that ABC will be able to provide healing to women challenged by this disease.
Asian Breast Center is located at 8th Floor Centuria Medical Makati, Kalayaan Ave., cor. Salamanca St., Brgy. Poblacion, Makati City.
Photographs by Mia Kimberly Villareal