Hospital incidence of cancer among Filipinos

1. During the fiver-year period of this survey (1941-1945), 3,531 tumors were examined and studied at the Cancer Institute of the Philippine General Hospital and the Pathological Laboratory of St. Lukes Hospital, one of the 117,546 admissions. Of these tumors, 2,163 (1.84%) were malignant or cancers, and 1,368 (1.16%) were benign tumors2. Malignant epithelial tumors or carcinomas comprise 1,653 (76.4%), 325 (15%) were sarcomas and 185 (8.6%) were special cancers3. Two out of every 100 persons admitted to the Philippine General Hospital and St. Lukes Hospital suffered from cancer. Following the computation in New York City, 1 out of every 200 deaths in Manila ought to be from cancer4. The distribution of the malignant growths in the different systems and organs of the body is instructive. It gives the different specialists in our country a basis for noting the organs that are more prone to cancer5. The high incidence of cancer of the breast, cervix, ovary and uterus is in accord with the findings in temperate countries; but the high frequency of cancer of the cheek, lymph nodes (sarcoma), nasopharynx, chorioepitheliomas, and primary cancer of the liver (hepatomas) is quite at variance with the findings in temperate countries6. The peak of cancer incidence among the Filipinos is between 40 and 50 years. This peak comes earlier than in temperate countries, when it is from 55 to 647. This first sudden increase in cancer among Filipinos begins at 26 years and shows an abrupt diminution at 70 years8. Of all malignant tumors in this series 1,366 (63.2%) were in females, 797 (36.8%) in males-or a ratio of 3 women to 2 men9. At the ealier age period, 26 to 60, the cancer incidence is higher among women than among men; but from 61 to 90, the reverse is true-the incidence is higher among men than among women10. This series shows a definitely high incidence of carcinoma of the inner cheek, hepatomas, and chorioepitheliomas-higher than in American Hospitals11. This paper aims to start a reliable and systematic body of cancer statistics in the Philippines from the records of hospital patients. Its goal is the organization of cancer clinics in city and provincial hospitals, from which more accurate data on cancer in the Philippines could be complied12. The establishment of cancer control under a Cancer Institute, as the one organized in the Philippine General Hospital in 1941, is imperative. With the cooperation of our Public Health Service, now supervising the provincial hospitals, and with the aid of a Tumor Registry, a standardized and well classified nomeclature of cancer incidence in the Philippines could be formulated13. As cancer statistics depends much upon biopsies and autopsies, these two phases of medical education should be encouraged in hospitals and medical schools14. The induction in our medical practice of modern scopes such as the cystoscope, the peritonescope, the proctoscope, the gastroscope, and the bronchoscope for objective diagnosis and biopsies would improve our means of diagnosis, not only for cancer, but also for parasitic or bacterial diseases that are more common in our tropical country15. The organization of cancer clinics in our general hospitals consisting of a surgeon, a radiologist, and a pathologist, to deliberate on all cancer cases irrespective of the departments concerned, should be affected to bring about a closer coordination in the diagnosis and treatment of the cancer patients. (Summary)

The reactions and complications of blood bank transfusions

1. The Army blood bank during the early period of the Liberation in 1945 used by the PCAU hospitals showed a high percentage of reactions (24%), due partly to insufficient refrigeration, to trauma which it had been subjected in its transportation and mainly due to the use of blood during or after its expiration dates2. By eliminating the above factors and by constant improving the different phases of its operation the St. Lukes Hospital Blood Bank has gradually and effectively diminished the reactions - 19% in the first year of operation; then 13%, and finally 8% (August, 1946 to March, 1947). The reaction of 8% in the last 3 months compares favorably with the Mayo Clinic Blood Bank3. The preservation technic of blood including the preservative solution, variations in temperature, trauma, and long period of storage of the blood is just as important as the hemolytic incompatibilities. All the factors in blood preservation technic work together and should be controlled together, in order to insure successful blood banking4. The majority of the reactions observed by us were primarily due to pyrogen and contaminated bottles and tubings; and they are allergic or anaphylactic in origin. The Rh factor frequent among Americans is not an important cause of transfusion reaction among Filipinos, because 97.3% of Filipinos are Rh positive5. The transmission of syphilis and malaria by blood bank transfusion has not been observed by us until now, due to the rigid routine Kahn control of all our donors, and to the use of the Field Stain of the concentrated blood smear for malaria in suspected cases6. Although the cardiovascular accidents are very rate and were not observed by us, physicians should always exercise caution when giving transfusion to patients with myocardial damage, hypertension, or blood dyscrasias. (Summary)

Cancer control in the Philippines: The role of the private practitioners and surgeons

1. In this paper I have presented the cancer-control plan in America, together with a list of successful treatments by American surgeons and radiologists, for the purpose of achieving as many cases of five-year cures as possible. The cancerologists of America are convinced that cure in cancer by surgeons and radiologists can not be attained without a well organized control plan, in towns and countries consisting of early diagnosis and prevention, so that the slogan in cancer control should be: "Cancer is curable, provided it is diagnosed and treated early."2. I have pointed out to you that cancer control in the Philippines consists only of cancer cure and that we do not have the most important implement - namely, the systematic organization for cancer diagnosis and prevention in the provinces. Although the agencies of provincial hospitals and laboratories could be used, there is lack of cancer clinics from which cancer-consciousness among private practitioners and among the people could be disseminated3. As there are many advanced cancers not detected in the early stage, the surgeons of our country are not given the opportunity to achieve a large number of five-year cures through operation and irradiation; and the majority of the advanced cases operated on and irradiated recur, metastasize, and die within five years4. There is a large number of advanced cancers that are over-crowding the general hospitals of the provinces and cities, especially Manila. This is a problem in accommodation. It is also the cancer control problem of the medical profession of the Philippines in general and of the College of Surgeons in particular, because the surgeons of our country are adversely affected by the successful results of their operations in cancer. (Summary)