Cancer or Malignant Neoplasms

Cancer is largely considered a lifestyle-related disease. Many chemical, biological, radioactive,

and other naturally occurring and synthetic substances, as well as predisposing factors and high-
risk behaviors like smoking, diet, sexual activity, pollution and occupational exposure have been
linked to cancer.
Many different types of cancers have been identified. In the Philippines, the most common sites
of reported deaths from cancer are the trachea, bronchus and lung (8.4 deaths per 100,000
population), breast (4.4 per 100,000) and leukemia (2.9 per 100,000). Among males, the leading
sites are the lungs, prostate, colorectal area and liver. Among females, the leading sites are the
breast, uterus, cervix and lungs. Among children, the leading cancers are the leukemias and
lymphomas.
There is a yawning gap in locally relevant scientific information on the relationship between the
purported cancer agents and the predisposition of Filipinos for the disease. Despite this, the
relationship of tobacco smoking to many forms of cancer has been firmly established. This is
why tobacco control is one of the cornerstones of cancer prevention. Another well-established
correlation is between infection with hepatitis B and the development of liver cancer in later life.
For this reason, hepatitis B immunization at birth has been
included in the expanded program on immunization.
Another cornerstone of cancer prevention and control is early detection through the promotion of
selfassessment techniques. Early detection of cancer can greatly affect the outcome of clinical
management. When discovered early in their course and given appropriate treatment, a high
percentage of malignancies can undergo remission.
Screening for breast cancer, which is the most common form of malignancy among Filipino
women, is being promoted through self-breast examination campaign called “sariling salat sa
suso,” and through clinical breast examination done by the physician. Forty-four percent and five
percent of women in the Philippines practice these methods of breast cancer screening,
respectively (BSNOH 2000). Mammography is also being recommended every five years among
women more than 50 years old to detect nonpalpable breast masses.
Pap smear, when conducted every three years, can reduce the incidence of cervical cancer up to
90.8 percent, and when done at an annual interval can reduce it further up to 93.5 percent
(Sherries 1993). A study conducted by the UP-DOH Cervical Cancer Screening Research Group
found out that the visual examination of the cervix aided by acetic acid wash is the most cost-
effective screening method for cervical cancer. The DOH now recommends this method for early
detection of cervical cancer (Cordero 2003).
Digital rectal examination every five years is also used as a screening tool for prostatic and
colorectal malignancy among males older than 50 years old. However, only about two percent of
the target population submits to the procedure (BSNOH2000).
Economic factors, non-awareness of the gravity of cancer upon first presentation and fear of
being diagnosed with cancer are usually the reasons for late diagnosis (Ngelangel 1993).
Increasing the awareness and submission of the populace to the many screening procedures
developed for the different kinds of malignancies can improve treatment outcome and lessen the
mortality for the disease.
Cancer is known to produce unbearable pain to patients in the last stages of the disease. To
improve the quality of life during this stage, patients need effective pain relief therapy. Since
morphine is not readily available, the DOH has continued to ensure that even poor patients have
access to this pain relief medication. Morphine sulfate tablets are distributed to hospitals and
hospice care facilities for cancer patients through the CHDs and the Philippine Cancer Society
following rules and regulations mandated by the law
for regulated substances.
A variety of treatment modalities continue to be developed for each specific form of cancer, but
the cost of treatment can be staggering. This is why public health interventions are focused on
health promotion, disease prevention and early detection. Malignant neoplasm or cancer has been
among the top ten leading causes of death in the Philippines since the 1970s. Cancer incidence
has been slowly but steadily increasing over the past years. Cancer is the third leading cause of
death in the country, accounting for 9.9 percent of all deaths in 2000 (PHS).
The reported cases of malignant neoplasms has been increasing up to 1995 but an abrupt
decrease in the number of cases was noted in 1996 due to a change in the system of reporting,
malignancies were removed among the notifiable diseases in the Field Health Service
Information System. The morbidity rates have remained underreported thereafter at 4.0 to 9.0
cases per 100,000 population. On the other hand, the trend in reported deaths from all kinds of
malignant neoplasm is increasing over the years reaching 47.7 per 100,000 population in 2000.
In 2002, the region with the highest morbidity rate for cancer is SouthernTagalog at 89.9 cases
per 100,000 population, followed by Western Mindanao at 15.4 per 100,000 and Western
Visayas at 9.6 per 100,000. The large variation in the data may be due to underreporting in some
regions.
The scale of lifestyle changes required in order to delay the onset and avert the course of
degenerative diseases renders them difficult to control. Health sector managers would need more
than the seasonal mass media campaigns or people to get rid of old habits and make correct
choices for health. The healthy lifestyle campaign should be clear, consistent and competitive
enough to overcome the effects of contradictory information and persuasions from the
commercial sector.
The health management paradigm that shifts from directly fighting lifestyle-related diseases to
fighting off the risk factors and risk behaviors acquired by the individual has proven to be a
difficult challenge to health care providers. The means and control switches are with the patient,
not with the health care provider. The prerequisite education and training of most health
practitioners do not include the development of skills for behavior modification nor is their
school training adequate for the challenging task of counseling patients.
The life long maintenance of the cost of medicines could drain resources of patients. Access to
these drugs is crucial in ensuring reduction in co-morbidity, mortality and disability rates of
these lifestyle-related diseases. There is a need to strengthen networking and collaboration
among the various stakeholders to ensure sharing of technologies, resources and expertise to
prevent and control lifestyle-related diseases. This has been shown time and time again during
advocacy activities and development of guidelines and management protocols.

Diabetes
Do you suspect you have diabetes?
Do you have to urinate three to four times at bedtime?
Do you feel unusual thirst?
Do you get tired easily?
Did you have a rapid loss of weight?
If you do, you may be suffering from Diabetes. Don’t waste time. Consult your doctor
immediately.
What is diabetes?
Diabetes is a serious chronic metabolic disease characterized by an increase in blood sugar levels
associated with long term damage and failure or organ functions, especially the eyes, the
kidneys, the nerves, the heart and blood vessels.
How does one become a diabetic?
Diabetes occurs when insulin is not adequately produced by the pancreas. It also happens when
the body cannot properly use insulin.
Insulin is a hormone necessary for the proper utilization of sugar by muscles, fat and liver.
What are the complications of diabetes?
In diabetics, blood sugar reaches a dangerously high level which leads to complications.
• Blindness
• Kidney failure
• Stroke
• Heart Attack
• Wounds that would not heal
• Impotence
What are the types of diabetes?
Type 1 – Insulin dependent diabetes
Develops during childhood or adolescence and affects about 10% of all diabetic patients.
Sufferers require a lifetime of insulin injection for survival since their pancreas cannot produce
insulin.
Type 2 – Non-insulin dependent diabetes
How will you know if you are a diabetic?
If you urinate frequently, experience excessive thirst and unexplained weight loss.
If your casual blood sugar (plasma glucose) level is higher than 200mg/dl.
If you have fasting plasma glucose level of not more than 126mg/dl.
If you have any these symptoms, especially if you are overweight or hypertensive, you should
see your doctor right away for proper guidance and treatment.
Who are at risk of diabetes?
children of diabetics
obese people
people with hypertension
people with high cholesterol levels
people with sedentary lifestyles
What can you do to control your blood sugar?
1. Diet Therapy
Avoid simple sugars like cakes and chocolates. Instead have complex carbohydrated like rice,
pasta, cereals and fresh fruits.
Do not skip or delay meals. It causes fluctuations in blood sugar levels.
Eat more fiber-rich foods like vegetables.
Cut down on salt.
Avoid alcohol. Dietary guidelines recommend no more than two drinks for men and no more
than one drink per day for women.
2. Exercise
Regular exercise is an important part of diabetes control.
Daily exercise . . .
Improves cardiovascular fitness
Helps insulin to work better and lower blood sugar
Lowers blood pressure and cholesterol levels
Reduces body fat and controls body weight Exercise at least 3 time a week for ate least 30
minutes each session. Always carry quick sugar sources like candy or softdrink to avoid
hypoglycemia (low blood sugar) during and after exercise.
3. Control your weight
If you are overweight or obese, start weight reduction by diet and exercise. This improves your
cardiovascular risk profile.
It lowers your blood sugar
It improves your lipid profile
It improves your blood pressure control
4. Quit smoking.
Smoking is harmful to your health. 5. Maintain a normal blood pressure.
Since having hypertension puts a person at high risk of cardiovascular disease, especially if it is
associated with diabetes, reliable BP monitoring and control is recommended. See your doctor
for advice and management.
If there is no improvement in blood sugar what advice can I expect my doctor to give?
There are drug therapies using oral hypoglycemic agents. Your doctor can prescribe one or two
agent, depending on which is appropriate for you.
1. Sulfonylurea – Glibenclamide, Gliclazide, Glipizide, Glimepiride, Repaglinide
2. Biguanide – Metformin
3. Alpha-glucosidase Inhibitors – Acarbose
4. Thiazolidindione – Troglitazone, Rosiglitazone, Proglitazone. Remember
If you have the classic symptoms of diabetes:
See your doctor for blood sugar testing
Start dieting
• eat plenty of vegetables
• avoid sweets such as chocolates and cakes
• cut down on fatty foods
Exercise regularly
If you are obese, try to lose some weight
Avoid alcohol drinking and stop smoking
If you are hypertensive, consult your doctor for advice and management

Environmental Health
Environmental Health is concerned with preventing illness through managing the environment
and by changing people's behavior to reduce exposure to biological and non-biological agents of
disease and injury. It is concerned primarily with effects of the environment to the health of the
people.
Program strategies and activities are focused on environmental sanitation, environmental health
impact assessment and occupational health through inter-agency collaboration. An Inter-Agency
COmmittee on Environmental Health was created by virute of E.O. 489 to facilitate and improve
coordination among concerned agencies. It provides the venue for technical collaboration,
effective monitoring and communication, resource mobilization, policy review and
development. The Committee has five sectoral task forces on water, solid waste, air, toxic and
chemical substances and occupational health.
Vision:
Health Settings for All Filipinos
Mission:
Provide leadership in ensuring health settings
Goals:
Reduction of environmental and occupational related diseases, disabilities and deaths through
health promotion and mitigation of hazards and risks in the environment and worksplaces.
Strategic Objectives:
1. Development of evidence-based policies, guidelines, standards, programs and parameters for
specific healthy settings.
2. Provision of technical assistance to implementers and other relevant partners
3. Strengthening inter-sectoral collaboration and broad based mass participation for the
promotion and attainment of healthy settings
Key Result Areas:
• Appropriate development and regular evaluation of relevant programs, projects, policies
and plans on environmental and occupational health
• Timely provision of technical assistance to Centers for Health Development (CHDs) and
other partners
• Development of responsive/relevant legislative and research agenda on DPC
• Timely provision of technical inputs to curriculum development and conduct of human
resource development
• Timely provision of technically sound advice to the Secretary and other stakeholders
• Timely and adequate provision of strategic logistics
Components:
• Inter- agency Committee on Environmental Health
• IACEH Task Force on Water
• IACEH Task Force on Solid Waste
• IACEH Task Force on Toxic Chemicals
• IACEH Task Force on Occupational Health
• Environmental Sanitation
• Environmental Health Impact Assessment
• Occupational Health

Leprosy
LEPROSY PROFILE
Cause
Mycobacterium leprae or leprosy bacili
Mode of Transmission
Airborne: inhalation of droplet/spray from coughing and sneezing of untreated leprosy patient
Signs and Symptoms
*long standing skin lesions that do not disappear with ordinary treatment
* loss of feeling/numbness on the skin
* loss of sweating and hair growth over the skin lesions
* thickened and/or painful nerves in the neck, forearm, near elbow joint and the back of knees
Immediate Treatment
Multi-Drug Therapy (MDT)
* Go to the nearest health center for immediate treatment
Prevention and Control
* treat all leprosy cases to prevent spread of infection
* young children should avoid direct contact with untreated patients
* practice personal hygiene
* maintain body resistance by healthful living
o good nutrition
o enough rest and exercises
o clean environment

Pandemic (H1N1) 2009 - update 101

Weekly update
21 May 2010 -- As of 16 May, worldwide more than 214 countries and overseas territories or
communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009,
including over 18097 deaths.
WHO is actively monitoring the progress of the pandemic through frequent consultations with
the WHO Regional Offices and Member States and through monitoring of multiple sources of
information.
Situation update:
The current situation is largely unchanged since the last update. The most active areas of
pandemic influenza virus transmission currently are in parts of the Caribbean and Southeast
Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza
activity remains low to sporadic. In central Africa, there has been increased transmission of
seasonal influenza type B viruses, accounting for 85% of all influenza isolates in the region.
Influenza B also continues to be detected at low levels across parts of Asia and Europe, and has
now been reported in Central America.
In the tropical region of the Americas, the most active areas of pandemic influenza virus
transmission continue to be in parts of the Caribbean. In Cuba, a second period of active
community transmission of pandemic influenza virus began during late February 2010, peaked
during late April 2010, and has been declining since; this second period of transmission,
although associated with severe and fatal cases, appears to be less intense overall than the first
period of transmission which occurred during late September to late November 2009. In contrast,
in the Dominican Republic, low to moderate intensity of respiratory diseases activity has been
primarily associated with co-circulation of respiratory viruses other than influenza; only sporadic
detections of seasonal influenza viruses have been reported. Low levels of pandemic influenza
viruses have been circulating across parts of Central America and tropical areas of South
America, for example, in Mexico since December 2009, in Colombia and Brazil since early
2010, and in Guatemala since early April 2010. Nicaragua and Honduras have also been recently
reporting geographically regional spread of influenza viruses, however, the relative proportions
of seasonal influenza, pandemic influenza, and other respiratory virus detections are not known.
In contrast, in Panama, low levels of respiratory disease over the past three months have been
primarily associated with circulating respiratory viruses other than influenza. Of note, Bolivia
experienced a recent period of low but sustained transmission of seasonal influenza type B
viruses between late February and early May 2010. There continues to be evidence from several
countries in this region that there is ongoing co-circulation of influenza with other respiratory
viruses (including respiratory syncytial virus (RSV), and adenovirus).
In Asia, the most active areas of pandemic influenza virus transmission are in parts of South and
Southeast Asia, particularly in Bangladesh, Malaysia, and Singapore. In Malaysia, limited data
suggests that a second period of active pandemic influenza virus transmission has been occurring
since early April 2010, but overall activity may have recently stabilized and does not appear to
exceed pandemic influenza activity seen during an earlier period of transmission lasting from
July until early September 2009. In Singapore, levels of ARI have remained elevated since mid
April 2010; during the most recent reporting week, levels of ARI exceeded the epidemic
threshold and the proportion of patients with ILI testing positive for pandemic influenza virus
infection was 39%. In Bangladesh increased co-circulation of pandemic influenza and seasonal
influenza type B viruses has been detected since mid April 2010 but now appears to have
stabilized. Low level circulation of pandemic influenza continues to persist in Thailand and in
the western and southern parts of India; sporadic detection of pandemic influenza continue to be
reported in Cambodia and in the Philippines. In East Asia, only sporadic detections of pandemic
influenza virus are being reported; seasonal influenza type B viruses have been predominant in
this region, however circulation appears to be declining in China and the Republic of Korea.
In the temperate regions of the northern and southern hemisphere, overall pandemic influenza
activity remains low to sporadic. In Australia and New Zealand, slight increases in ILI activity
were reported; however, in Australia, these increases have been attributed primarily to
circulating respiratory viruses other than influenza. In the southern temperate regions of the
Americas, only sporadic detections of influenza viruses have been reported, except in Chile,
which continues to report localized areas of increased ILI activity (in the Los Lagos area)
associated with co-circulation of pandemic influenza and other respiratory viruses. In Europe,
very low to sporadic levels of pandemic and seasonal influenza type B viruses continue to be
detected. Seasonal influenza type B virus persists mainly in parts of eastern and northern Europe.
Georgia reported an increase in the number of respiratory disease consultations due to influenza-
like-illness (ILI), mainly in children (under age 5) and school-age children (5-14 years old age
group); whether this increase is associated with pandemic influenza A (H1N1) virus is not yet
known.
In Sub-Saharan Africa, limited data from several countries suggest that active transmission of
pandemic influenza virus in West Africa has now largely subsided. In Ghana, 6% of respiratory
samples tested positive for pandemic influenza virus during the most recent reporting week.
Across the rest of region, the pandemic influenza virus continues to be detected sporadically or at
low levels, most recently in Angola and Rwanda. Sporadic detections of seasonal influenza
H3N2 and influenza B viruses have been reported in western, central Africa and to a lesser
extent southern Africa.
The Global Influenza Surveillance Network (GISN) continues monitoring the global circulation
of influenza viruses, including pandemic, seasonal and other influenza viruses infecting, or with
the potential to infect, humans including seasonal influenza. For more information on virological
surveillance and antiviral resistance please see the weekly virology update (Virological
surveillance data, below).
Weekly update (Virological surveillance data)
As of May 12 May 2010, 4 additional cases of oseltamivir resistant pandemic
influenza A (H1N1) 2009 viruses have been reported. It brings the cumulative total
to 289 so far. All but one of these have the H275Y substitution and are assumed to
remain sensitive to zanamivir.

NEW) Weekly update on oseltamivir resistance to pandemic influenza A (H1N1)

2009 viruses [pdf 17kb]

*Countries in temperate regions are defined as those north of the Tropic of Cancer or south of
the Tropic of Capricorn, while countries in tropical regions are defined as those between these
two latitudes.

**Abbreviations: influenza-like-illness (ILI), acute respiratory infection (ARI), and severe acute
respiratory infection (SARI)
WHO Clinical Management Guidelines for Human infection with Pandemic (H1N1),
2009:

WHO Guidelines for Pharmacological Management of Pandemic (H1N1) 2009

Influenza and other Influenza Viruses:
MAP OF INFLUENZA ACTIVITY AND VIRUS SUBTYPES (WEEK 18: 25 APRIL -
8 MAY 2010)
Map of influenza activity and virus subtypes [png 230kb]
Description: Displayed data reflect the most recent data reported to Flunet
(www.who.int/FluNet), WHO regional offices or on Ministry of health websites in the
last 2 weeks. The percent of specimens tested positive for influenza includes all
specimens tested positive for seasonal or pandemic influenza. The pie charts show
the distribution of virus subtypes among all specimens that were tested positive for
influenza. The available country data were joined in larger geographical areas with
similar influenza transmission patterns to be able to give an overview
(http://www.who.int/csr/disease/swineflu/transmission_zones/en)

Qualitative indicators (Week 29 to Week 18: 13 July 2009 - 8 May 2010)

The qualitative indicators monitor: the global geographic spread of influenza, trends in acute
respiratory diseases, the intensity of respiratory disease activity, and the impact of the pandemic
on health-care services.
Human infection with pandemic (H1N1) 2009 virus: updated interim WHO guidance
on global surveillance

The maps below display information on the qualitative indicators reported. Information is
available for approximately 60 countries each week. Implementation of this monitoring system is
ongoing and completeness of reporting is expected to increase over time.
List of definitions of qualitative indicators

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially

reported to WHO by States Parties to the IHR (2005) as of 16 May 2010
Map of affected countries and deaths

The countries and overseas territories/communities that have newly reported their first pandemic
(H1N1) 2009 confirmed cases since the last web update (No. 100): none.
The countries and overseas territories/communities that have newly reported their first deaths
among pandemic (H1N1) 2009 confirmed cases since the last web update (No. 100): none.

Region Deaths*
 WHO Regional Office for Africa (AFRO) 168

WHO Regional Office for the Americas (AMRO) At least 8396

WHO Regional Office for the Eastern Mediterranean

(EMRO) ** 1019

WHO Regional Office for Europe (EURO) At least 4874

WHO Regional Office for South-East Asia (SEARO) 1808

WHO Regional Office for the Western Pacific (WPRO) 1832

Total* At least 18097

*The reported number of fatal cases is an under representation of the actual numbers as many
deaths are never tested or recognized as influenza related.