Yellow Pad



That’s how I felt at my beautiful sister Mae’s bedside when she died in 1995, barely a year since arriving back home from her chemotherapy in Michigan. She had two daughters — Ynna Belen and Angela Jed, just as beautiful as her. She had beautiful dreams …


A broad coalition that includes doctors is advocating higher tobacco taxes. To drum up support for this campaign, everyone is encouraged to tell a personal story about the harmful effects of smoking.

I told friends that my story would not be about me. But as I started writing, I realized it is too. It’s about the me that I have become after cancer reared its ugly head yet again.


Because pain is personal. Because suffering is personal. Because cancer is personal. I did not know how I could fight for my sister anymore. She would scream in pain, while my survivor guilt was gnawing away at my very being. It still does.


Mae used to smoke occasionally, not heavily but I am certain she was exposed to tobacco smoke at work. The link between tobacco exposure and breast cancer may not be as clear as it is with lung cancer and other chronic lung diseases. But the link is there, as it is with 18 other cancers and even low birth weight.

What does recent evidence show?

Jones, ME and co-authors in 2017 reported their 2013 findings from following-up 102,927 women recruited back in 2003. In this prospective Generations Study cohort in the United Kingdom, they asked the women to answer serial questionnaires over that 10- year period with an average of 7.7 years of follow-up. Of the recruited women, 1,815 developed invasive breast cancer. They corrected for confounding factors like concomitant alcohol intake (an aggravating factor) and duration of breastfeeding (a mitigating or protective factor). After adjusting for these confounding factors, the evidence showed that women who reported “ever smoking” compared to those who reported that they “never smoked” were, on the average, 14% more likely to develop breast cancer (hazards ratio HR 1.14, 95% confidence interval CI 1.03 — 1.25).

Those who started smoking before the age of 17 were, on the average, 24% more likely to develop invasive breast cancer (HR 1.24 95% CI 1.08-1.43). If they started very early, i.e. 1-4 years after they first had their menses, they were, on the average 23% more likely to develop invasive breast cancer than if they had never smoked (HR 1.23 95% CI 1.07-1.41). Women with a family history of breast cancer had a significantly higher risk (ever smoker vs. never smoker HR 1.35; 95% CI 1.12 — 1.62) in relation to ever smokers than women without a family history (ever smoker vs. never smoker HR 1.07; 95% CI 0.96 — 1.20; not significant). (Reference: Jones ME, Schoemaker MJ, Wright LB et al. Smoking and risk of breast cancer in the Generations Study cohort. Breast Cancer Research. 19 (118). 2017).

The evidence is solid.

So I will continue to FIGHT, we will continue to FIGHT. And we will continue to fight that good fight, with means we know will work, that of raising taxes on tobacco products so that Filipinos, especially our youth, cannot afford to start this deadly addiction.

Dear legislators, do not deny our people this good fight! Increase tobacco taxes now!

Dear Senator Sonny Angara, I am glad that you will resume the hearings to have new legislation on the tobacco tax. My hope is that, ultimately, a law that will effectively deter smoking will be in place soon.


Dr. Maria Asuncion Silvestre was a practicing neonatologist and associate professor at the University of the Philippines College of Medicine before she shifted gears to development work. She now works in maternal and child health as founder of the nonstock, not-for-profit organization Kalusugan ng Mag-Ina (KMI; Health of Mother and Child) and as faculty member of the Asia Pacific Center for Evidence Based Healthcare. Both are member organizations of the Sin Tax Coalition. Dr Mianne survived her own two battles with invasive breast cancer, almost 20 years apart, because of early detection.