Breast cancer is the most prevalent cancer in women.

How ever in recent years regional

differences in breast cancer risk factors have not been identified “Review of the Epidemiology of

Breast Cancer in Asia: Focus on Risk Factors Hyun Jo Youn , Wonshik Han”, however as 776

abstracts were taken 562 were excluded whist the remaining 214 published between 2013 and

2015 elucidate that members of the elder range , those share a family history with breast cancer ,

individuals with early menarche, late menopause are associated with a higher risk for said

cancer. Further more individuals who are known to smoke and intake fatty food are also at risk

conversely those who opt to take dietary rich food such as fruits vegetables, and plant/soy-based

products were associated with a lower risk for breast cancer. The risk factors cold then be

modifiable such as diet or habits or non-modifiable age ang family history.

As breast cancer risk increases in late menopause there is particularly around the range of

menopause Breast cancer has distinct causes, prognoses, and outcomes and effects in patients at

premenopausal and postmenopausal ages this would incur a global burden “Global burden and

trends in premenopausal and postmenopausal breast cancer: a population-based study 2020” a

Population-based study to assess the global burden of breast cancer incidence and mortality in

2018 and to investigate incidence trends over a 15-year period. Through statistical analysis the

understanding said index provides information on the directly proportional relation to increase

Countries with a very high HDI (human development index) had the highest premenopausal and

postmenopausal breast cancer incidence.

While breast cancer can be a global burden further Risk factors can also be bases on ones

socioeconomic status since those well off can generally afford better treatment than the middle

class and the lower class where poverty is defined by the percentage of residents living below the

federal poverty line within a census trac. Race is also a key factor It is well documented that
African-American women are more likely than white women to have late-stage breast cancer at

diagnosis and, consequently, to have less favorable outcomes Race, “Socioeconomic Status, and

Breast Cancer Treatment and Survival Cathy J. Bradley, Charles W. Given, Caralee Roberts

2002” In addition Racial differences could also warrant a dissimilarity between treatment

considerable evidence to suggest that these differences include Breast cancer diagnosis,

treatment, and survival may be more attributable to economic disparities or disparities in

insurance coverage than to race. In addition, it is difficult to determine if true progress has been

made in lessening this gap without knowing the appropriate population (i.e., racial groups, low-

income groups, uninsured groups, or publicly insured groups) toward which intervention efforts

should be directed. The study also showed that racial disparity remains even if socio economic

status is controlled However, the overall effect of race on stage at diagnosis and survival is

greatly reduced when analytic models include income as a variable, in this health insurance also

play a role in association to income since higher income would suggest better company health

insurance options for its employees thus white women can get insurances such Medicare and

Medicaid which would lead to another disparity where African-American women are less likely

to undergo breast-conserving surgery than are white women

After Assessing the aforementioned risk factors the COVID-19 pandemic continues to be

at large which has caused disruptions in cancer care around the world due to logistical and

psychosocial reasons “Treatment of cancer patients during the COVID-19 pandemic in the

Philippines by Frederic Ivan Ting, Danielle Benedict Sacdalan, Honey Sarita Abarquez, and

Arnold John Uso 2020”, upon treatment recommended prioritization of cancer care, ensuring a

safe work environment, organizing the transition of cancer care, and maintaining cohesion in a

time of isolation
 In prioritization of cancer care Oncologists are advised to prioritize cancer patients to be

seen in the clinic or cancer center based on the patients’ current underlying cancer status and

their risk for COVID-19 infection. Several factors are to be considered, such as the patients’

cancer stage and tumor grade, tumor characteristics and tumor burden. The management of cases

should be individualized with consideration to the tumor biology in terms of its growth

characteristics, benefit of treatment, institutional resources (availability of treatment options in

the facility), logistical concerns and regional differences (COVID-19 infection rate per locality

or region) and the risks of infection. The option to treat or delay treatment is best discussed with

the patient within the context of multidisciplinary care. Shared decision making where the

advantages of proceeding with treatment are weighed against the risks of delaying it and

constraints imposed by the prevalence of COVID-19 infections. The final decision should be

made after a thorough discussion with the patient and informed consent.

When ensuring a safe work environment Oncology clinics and cancer institutions in the

Philippines should remain COVID-19-free sanctuaries and clinic staffs should be provided with

the proper protective equipment. Several precautions have to be in place to ensure the safety of

both patients and healthcare providers Patients can be screened remotely (e.g., over the phone for

symptoms of COVID-19 infection prior to their scheduled visit) and promptly advised to seek

appropriate care if symptoms are present in accordance with national health department

guidelines. A triage/screening area manned by personnel with appropriate personal protective

equipment (PPE) should be in place in all cancer institutions to ensure the safety of both the

patients and the healthcare worker.

 Patients who are suspected of having signs or symptoms of COVID-19 need to be

properly isolated from the rest of the patients, quarantined and referred to the appropriate

specialist for proper management. Limiting the number of companions each patient can bring

with them into the treatment facility is another important intervention to reduce the risk of

COVID-19 in the oncology clinic.

To mitigate traffic certain changes should be made in the clinic protocols to better suit the

situation. This will include limiting entry/exit to designated points. The areas where people

naturally congregate, such as waiting and dining areas, may need to be actively monitored by

clinic staff in order to strictly enforce physical distancing measures and Proper handwashing

must always be strictly observed.

In the Philippines, cancer treatment centers are concentrated in highly urbanized areas,

such as Metro Manila, Metro Cebu, Iloilo City and Davao City, but due Enhanced community

quarantines and the natural archipelagic of the country itself made it difficult to access said

centers due to the unavailability of public transportation and limitation of drug availability in the

provinces. It is, therefore, of utmost importance that oncologists maintain communication with

their cancer patients, whether through SMS or online communication platforms, such as email or

social media, to discuss their medical concerns and treatment options. Even before the pandemic

Cancer was already an increasing problem in Developing Countries “Cancer control in

developing countries: using health data and health services research to measure and improve

access, quality and efficiency by Timothy P Hanna & Alfred CT Kangolle 2010” there

continuous efforts to understand sch treats and advance cancer control programs. Consider the

four principal approaches of cancer control to be cancer prevention, early detection,

diagnosis/treatment and palliation, now on Donabedian terms the researchers describe it as

quality of oncology services for cancer control in developing countries Donabedian describes

quality assessment in terms of structure, process and outcome. Structure refers to the attributes of

the setting where care is delivered. This includes material resources, human resources and

organizational structure. To assess structure, one must consider how well the health care system

interfaces with society and individuals in society Process refers to what is actually done while

care is provided and received. This includes patient's health care seeking activities, the diagnostic

process, treatment recommendation and treatment delivery. Outcome refers to the effects of care

on the health status of patients and populations. Outcomes may be medical parameters (e.g.

survival after cancer treatment), quality of life, patient satisfaction, equity or economic efficiency

Outcomes also include measures such as changes in patient knowledge and individual's behavior.

As fo how said structure is on developing countries such as the Philippines There is a limited but

growing body of literature describing the current status of cancer treatment resources,

particularly for radiation therapy, in developing countries. The emerging picture demonstrates

extreme limitation of human resources, physical resources and equipment. Taking into account

the annual incidence of cancer in developing countries, there is an urgent need to improve health

services for cancer control in developing countries; Capacity building in oncology health

services research, policy and planning relevant to developing countries. Development of high-

quality health data sources. More oncology-related economic evaluations in developing

countries. Exploration of high-quality models of cancer control in developing countries.

During certain time the factor of human error or fortuitous events may occur these events

may deviate from the set of guidelines already present withing the facility in question Several

professional organizations and consensus groups exist to translate evidence-based medicine into
recommendations for best patient care which pointed out Guideline-based treatment has been

shown to improve overall survival in breast cancer patient, For example, breast cancer patients

who underwent recommended radiotherapy were up to four times less likely to die from the

disease than patients who did not follow the recommended treatment Despite the established

survival benefit, some patients decline evidence-based treatment recommendations offered by

their physicians, Attitudes towards health is known to vary between cultures, which may have a

strong impact on the uptake of recommended treatment and survival outcome. “Impact of

deviation from guideline recommended treatment on breast cancer survival in Asia Peh Joo Ho,

Samuel Guan Wei Ow, Yirong Sim, Jenny Liu, Swee Ho Lim, Ern Yu Tan, Su-Ming Tan, Soo

Chin Lee, Veronique Kiak-Mien Tan, Yoon-Sim Yap, Wen Yee Chay, Benita Kiat Tee Tan, Fuh

Yong Wong, Jingmei Li & Mikael Hartman 2020”. thus, Non-compliance with recommended

treatment was associated with worse survival, Notably, patients who did not follow

recommended chemotherapy, radiotherapy or endocrine therapy were ~2 to 3 times more likely

to die from breast cancer than patients who do.non compliance I usually due to An ethnic

disparity in recommended treatment uptake has also been observed by others; recommended

treatment uptake is frequently lower in minority populations. Although higher noncompliance

with chemotherapy and radiotherapy were observed in Indian patients as compared with Chinese

patients, the observed worse survival was not significant. To the contrary, we observed no

disparate treatment uptake among Malay and Chinese ethnic groups where worse survival was

observed in Malay patients