Breast cancer survivor

At her home in Lancaster, 70 miles north of Los Angeles, Margaret Afable has a morning ritual: She checks her email around 9’oclock in the morning and at the same time runs her left hand to her breasts for a daily self test. That April morning in 2008 something was different. She didn’t get that much email and she felt a lump on her right breast. She looked at herself in the bathroom mirror and thought: 'Not me.' She just turned 60 and most Filipinas, she looks much younger with her natural light brown hair with caramel highlights, a feature she acquired from her Caucasian roots, blends pretty well with her gray hair.

Breast cancer is a devastating condition that every woman can experience in her lifetime. One of the most indiscriminating illnesses, it can affect women from every social status, culture and ethnicity. For most Asian women -- Filipina Americans included -- the silent approach to breast cancer may have contributed to its prevalence. For some, talking about their experiences can make a difference.

The latest nation-wide data from the American Cancer Society “Cancer Facts and Figures,” says that breast cancer is the leading cancer among Chinese (55 per 100,000), Filipino (73.1 per 100,000), Japanese (82.3 per 100,000) and Korean (28.5 per 100,000) and the most frequent cause of cancer death among Filipina women (11.9 per 100,000) is breast cancer.”

Filipinas, like most Asian women, are reluctant to talk about how they feel when the topic is about the sensitive parts of their body, particularly the breasts. For the last decade, fewer Asian American women -- including Filipina Americans -- went for a mammography and Pap smear testing.

Afable’s father hailed from West Virginia and her mother was from the province of Samar, eastern Visayan region of the Philippines Islands. She was born in Manila and immigrated to America in 1983, joined her brothers in Los Angeles and lived there for 14 years. In 1997, Afable moved to Lancaster with her then 13 years old daughter, Melissa. The following year, she started the home-based daycare center she was considering of building years ago.

On normal days, the children at the center wait for her to set up the play table. She gives them pencils, paper and crayons as always. That night collected her thoughts again: “I canceled my health insurance two months ago,” she told herself.

Other than minor food allergy, she saw little use of the insurance, which cost her $259 monthly. It took a lot out of her income. Because of financial concern, it took her two weeks to finally see a doctor.

At the Antelope Valley Hospital, Afable was directed to the clinical evaluation center for potential breast cancer patients. The first step is to have a biopsy, a test that can predict if cancer cells are present. A small amount of tissue would be taken out and examined under a microscope to provide information about the malignancy of her lump, a procedure that can predict what type of surgery might be needed. She paid the bill to have the biopsy done.

After less than a week, the phone call came. For some reasons, the dreaded message bore no fear. She had to move on. Without delay, she was scheduled for a mammogram, but hesitated. The x-ray of her breast will cost her $300. The attendant advised her to apply for Medi-Cal. As a single mother with a serious medical condition, she was approved immediately. Unlike Afable, most Filipina-American women are retired with pensions and affordable health insurance and thus unaware of the state and federal assistance.

As expected, the mammogram shows positive.

Antelope Valley Hospital oncologist, Dr. Mukund Shah, delivered the information and choices -- mastectomy or lumpectomy, terms that do not mean anything to Afable until Shah explained them to her in detail. Mastectomy is a surgery to remove the whole infected breast and an artificial breast can be implanted later. A lumpectomy is a procedure in which only the tumor or lump and the surrounding tissues are removed.

There is not much to decide. The thought of losing one of her breasts was unimaginable, so she opted out for lumpectomy. The medical crew of Dr. Joseph Kim at City of Hope didn’t waste any time.

The following week, Afable showed up for the procedure. After the surgery, the doctor told her that a large amount of tissue surrounding the tumor was removed. Also, small portion of tissues were taken out of her right arm pit to determine the spread of cancer. After the operation, a schedule was handed to her for the first of four chemotherapy sessions. “She was in her early stage,” said Kim. “I have to be sure that the cancer has not spread to the lymph nodes so I have to take some tissue out of her armpit and do some analysis. We did not find the cancer spreading.”

Toxatere was intravenously administered on her first chemotherapy visit. Instantaneously, the chemo drug took over Afable’s body. The next morning, she woke up with a heavy head, thinking: Where is the pain coming from?’

The mothers and their children are coming any second for her to begin her day care. However, she managed to walk to the bathroom and into the shower. As she ran her hands through her scalp, clumps of her natural light brown flowed down the drain.

She called her brother’s wife, Lolita, and asked her to pick up a headband at the hospital gift shop. Wearing it to cover her balding head, despite the discomfort, she went to her next dose of the chemo the next week at the local Antelope Valley cancer center. The nurse made her lie down in bed and induced the drug onto her lifeless skin. Five minutes later, dizzy and nauseated, she cut short her telephone conversation with Lolita and hollered, ‘Why is everything spinning.’

Immediately, the nurse pulled the needle out of her skin, called 911 and instructed the paramedic to take her to the emergency room at the hospital nearby. This time, her body rejected the drug. She was given an intravenous to flash out Toxatere. It was a success. Again Afable looked at her self in the mirror the next morning, “What now?” she asked.

The next week, she was back at the hospital for another decision to make. Shah, the oncologist, offered her an alternative – to change Toxatere into a more potent and higher dosage of chemo. The nurse read her the side effects: hair loose, nails black, more fatigue and more muscle pain. Again, Afable opted out. She took the next option: RADIATION.

For seven weeks, five days straight, Afable underwent treatment and recently finished her last session. Her fair skin has a pinkish tone and she is more energetic, although the band is still wrapped around her head. She is back in her usual routine, getting the play table ready for the children. This time, she only has two regulars and her grand-daughter, Lailani.

Medical professionals, scientists and researchers are continuously examining ways to handle life-threatening diseases such as the one Afable faced with City of Hope in Duarte, Los Angeles, being the leading institution for biomedical research, treatment and education in the fight to conquer cancer, diabetes, HIV/AIDS and other diseases. Researchers from different departments areindependently working on alternative approaches.

It was here that Jason Wang and colleagues developed Big Blue transgenic mouse model, a new way of detecting cancer cell.

Traditionally, ways to detect breast cancer, such as mammogram, will take a long time to diagnose. In Wang’s procedure, the genetic material of the mutation or cancer clusters in the body can be detected quickly. If the damaged cell taken turned blue, the cancer can be dealt with sooner. Wang emphasized that while environmental change, stresses and poor nutrition can contribute the rapid multiplication of a bad cell, its production does take a long time.

“Repair cell or housekeeper cell … safeguard against this damage,” he pointed out. “It can repair, if the damage is not severe. If the cell is overloaded, the repair gene cannot play their normal role and the cell will go bad and grow out of control,” Wang said, while explaining that the addition of antioxidants such as certain fruits and vegetables to one’s diet can eliminate the multiplication of free radicals. COH scientists, Melanie Palomares and Shiuan Chen, are also researching an alternative medicine to lower estrogen levels and thereby decrease breast cancer risk.

Filipino-American Pedro Ramirez, cancer awareness project manager at St. Vincent Medical Center in Filipinotown, Los Angeles, strongly urges Filipina women to undergo early breast screening.

“In 2002, most Filipina Americans who see their doctor were mostly on their advanced stage of breast cancer,” said Ramirez. “We started the program to investigate why. The fear of the word ‘cancer’ is most common among the group. Religion or ‘leave it to God’s hand” is another,” he said.

Today, the center has built awareness among the group’s ideology about breast cancer and the program has spread to other Asian American communities.

The radiation therapy worked with Afable. The rest of the year passed without much discomfort while the high-spirited woman remained under the doctor’s supervision, taking medication to block estrogen for the next five years, until in full remission.

On February 23, she turned 61, a time for reflection and contemplation.

‘This will be a good year,’ she told herself.