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Monday 23 October 2017

'Cancer care is improving day by day and now we are winning the battle'

Four years after being diagnosed with Breast Cancer Marie Carberry feels healthy and anxiety-free again.

Marie Carberry
Marie Carberry
a consultant analyzing a mammogram

Radiotherapy after breast cancer chemotherapy will be a breeze," they said. "All you have to do is lie there with no needles and no chemicals," they said. "You won't feel a thing," they said. "It's the icing on the cake," they said.

And they were right - mostly.

After eight gruelling sessions of chemotherapy which was administered over 16 weeks then radiotherapy really was going to be a walk in the park.

Radiotherapy is a carefully planned process so as to give maximum attention to the area where the breast tumour is and as little as possible to the surrounding normal cells. My radiation oncologist recommended 25 sessions, which took place Monday to Friday over five weeks. I was allowed the weekends off for good behaviour.

Step one of this process for me involved a Computed Tomography scan (CT) which scanned the treatment area. To this end I had to lie on the plinth, put my hands behind my head and wrap them around a small pole. The radiotherapist then permanently tattooed my skin under each arm and in the centre of my chest so they could reproduce the treatment position every day during the actual radiotherapy.

Tremble

The mapping process usually takes about 45 minutes during which time you must stay perfectly still. My right side managed to do this but the left side, where all my lymph nodes were removed, was very stiff and, after about ten minutes, I started to tremble ever so slightly. The tremor started at my neck and soon worked its way down my left side, ending up at my ankle.

The more I tried to keep still the more I trembled and it wasn't long before I felt like I was vibrating. The radiologist assured me I was doing okay but that it could be more difficult during the actual radiotherapy.

She was right. The trembling happened many times during the actual radiotherapy and some days I ended up in tears as the whole process would have to be restarted from scratch when I just couldn't keep still. Then I would feel guilty for making the radiologist's day even longer than it should have been. The process should take about twenty minutes. Some days it could take an hour.

Lying on that plinth on my own, in a semi-darkened room with large radiation machines whirring around me, I would use every swear word I could think of and then, feeling mightily sorry for myself, curse the fact that I had been struck by breast cancer in the first place. I wasn't the only one of course.

According to the Irish Cancer Society there are more than 2,600 new cases of breast cancer diagnosed in Ireland each year, with Irish women having a 1-in-10 chance of developing breast cancer in their lifetime.

The risk of developing breast cancer increases with age with about 80pc of breast cancers occurring in women over 50 years. Breast cancer can also occur in men but it is rare.

Breast Cancer Ireland advises women to examine their breasts on a monthly basis and report any changes to their GP. These changes include:

Q A lump or thickening which is different to the rest of the breast tissue

Q Continuous pain in one part of the breast or armpit

Q One breast becomes larger or lower

Q A nipple becomes inverted or changes shape or position

Q Skin changes including puckering or dimpling

Q Swelling under the armpit or around the collarbone

Q A rash on or around the nipple

Q Discharge from one or both nipples

Some 74pc of Irish women with breast cancer who have been diagnosed discovered the lump themselves and I was one of them. A swelling under my left arm alerted me that something was wrong and I took myself off to my GP which led to a referral to a breast specialist. Within two weeks, I'd had a biopsy, ultrasound and a mastectomy.

It all happened so fast I had no time to come to terms with it. One minute I was walking around healthy as a goat, and the next I was standing in front of a mirror looking at a scar where my breast used to be.

It was a shocking and terrifying time in my life and I will always be eternally grateful to both my GP and consultant breast specialist for looking after me so quickly and with great care.

I completed my chemo and radiation treatment within six months and the following year I had a breast reconstruction.

The good news for all us women who had or have breast cancer is that survival rates are improving all the time. This is because of early diagnosis, the national mammogram screening programme and the ongoing research into better treatment.

Treatment

Last July the National Institute for Health and Care Excellence (NICE) in the UK gave initial approval for a new radiotherapy treatment that can be given to the patient as they are undergoing surgery.

Intraoperative Radiotherapy is administered for just 20 minutes directly into the breast tissue and will obviate the need for any further radiotherapy treatment. Imagine... no more daily round trips to the hospital! No more permanent tattooing. No more desperate attempts to keep from fidgeting as you try and fail to lie still. No more tears and no more liberal use of the 'F' word. All your radiotherapy treatment can be done and dusted before you even wake up. For me this would have been like manna from heaven.

The improvements in treatment don't stop at radiotherapy.

While I was grateful for all my medication during my treatment, it is fair to say that chemotherapy is a one size fits all treatment. The idea is to throw everything available at the cancer and blast it to kingdom come in the hope it won't come back. Chemotherapy by its nature is a debilitating treatment with a daunting list of side effects, but make no mistake about it, I would have done it ten times over if that was what was required.

Thankfully it wasn't, and the great news is that researchers are now looking at bespoke treatments for cancer patients.

Oncotyping is a test that doctors can use to discover the risk of the cancer occurring in other parts of the body. If the risk is low then the chemotherapy can be reduced or, in some cases, not applied at all.

Another example of an improvement in care is in sentinel node biopsying. The biopsy identifies the lymph nodes most likely to contain cancer cells and removes the need to strip the underarm of all of the lymph nodes which, in turn, reduces the risk of lymphedema - a painful and permanent swelling of the arm.

During the summer I was thrilled to hear that UCD scientist Dr Madeline Murphy was given the green light from Breast Cancer Campaign to carry out research into my own form of breast cancer known as triple negative.

Triple negative occurs in about 15pc of breast cancers and is an aggressive form of the disease with low survival rates.

It can also become resistant to therapies such as chemotherapy. Unlike oestrogen or herceptin-based breast cancers, triple negative cannot be treated with drugs. Dr Murphy's grant will be used to investigate how two proteins in tumours might be causing the resistance to chemotherapy.

Chances

Katherine Woods, research communications manager at Breast Cancer Campaign explains: "Dr Murphy's research could help to prevent this resistance, improving the chances of survival for thousands of people and bring us one step closer to our goal that by 2050 breast cancer could be overcome and outlived."

In July this same organisation awarded Dr Maria Morgan at the Royal College of Surgeons €126,000 to explore whether calcium deposits in the breast encourage the growth of tumours.

It's nearly five years since I was diagnosed with breast cancer and a couple of those early years were filled with fear and dread. As time passed those fears started to dissipate, and now there are some days when I feel as if the whole experience happened to someone else.

Cancer is a frightening disease that can cause untold pain and misery, but the money put into research and development and ongoing improvements in treatment means there are many, many more survivors out there and their number is rising all the time.

I am delighted to be one of those survivors.

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