‘In both these photos I had cancer. I just didn’t know it yet’

Breast Cancer Awareness: One in nine women will develop breast cancer

At age 29, she believed she was way too young for cancer. The Cork woman was in the middle of "living my best life", she says, having gone on a career break to embrace an opportunity to make money and travel by taking a teaching job in Abu Dhabi. Carefree and single, it's easy to make friends out there, she explains, because everybody in the expat community is in a similar position.

It wasn't paining me, or worrying me or anything

When she felt a lump on her breast, shortly after getting her Pfizer vaccine against Covid-19, she thought the two were connected. She had heard about temporary after-effects such as swollen lymph nodes, so she left it for a few weeks before seeking medical advice.

“It wasn’t paining me, or worrying me or anything. I felt so perfect, even when I was getting the lump checked, I thought, ‘this is mad, I feel healthy, I look healthy – I was in the gym for two hours today and I was fine, how could I be sick’?”

Niamh's GP in Abu Dhabi was also reassuring, saying it was unlikely to be something to worry about, since it wasn't painful and it was "moveable", but she referred her for testing just in case. "Thank God she did send me for an ultra sound," says Niamh now, as that indicated it needed further investigation. She went for a mammogram, another ultra sound and a biopsy all on the same day, a week before she returned to Ireland for her summer holidays on July 9th last.


The call

Three days later she got a call on her mobile at home in Togher to be told it was cancer. "It was a shock. I wasn't initially emotional – it was a lot to take in." Advised that whether she wanted to return to Abu Dhabi for treatment or have it at home in Cork, she needed it as soon as possible. The eldest of three, she decided it was better to stay home and be around family.

She knew the news was difficult for them as well. “For me, there’s guilt in that – everybody asks how I am, but people forget that family and friends are suffering too.”

Her Cork GP saw her straight away the next day and referred her to a consultant. By July 22nd, she was having surgery in the Bons Secours private hospital in Cork, to remove the lump. It was stage two breast cancer, but a grade three tumour, which is considered aggressive, and the medical staff recommended chemotherapy and radiation.

“It hadn’t spread to my lymph nodes; the surgery removed it all and there were healthy tissues around it. The chemotherapy and radiation for me is more just to make sure absolutely every bit of it is gone and that it won’t come back, hopefully.”

When you’re sitting there, “almost certainly cancer free and feeling fine”, it can seem a bit counterproductive to be agreeing to further treatment that will make you feel worse, she says, but “it is for the long run”.

After recovering from the surgery, Niamh's first round of eight, fortnightly chemotherapy sessions was scheduled for September 6th. That turned out to be the day after the high-profile death, at age 39, of English singer and actor Sarah Harding from secondary breast cancer. Also known as metastatic breast cancer, this is when cancer cells that started in the breast have spread to other parts of the body.

The former Girls Aloud singer had said in a newspaper interview a year before her death that, due to the Covid-19 pandemic, she had put off going to the doctor when she first started having symptoms. "Sarah's passing ignited a wide-reaching media discussion about the importance of making women of all ages, most notably younger women, more breast aware," says the CEO of Breast Cancer Ireland (BCI), Aisling Hurley. Knowing what is normal as a base line is key, so that if an abnormality arises, it will be detected early.

“Sadly, Sarah did notice an abnormality, but between the Covid pandemic and fear of going to her GP/hospital, coupled with her consideration that she was too young to get this type of disease, meant that her diagnosis was delayed.”

The fear is that other women here have similarly delayed seeking medical advice because, as Hurley reports, numbers attending breast clinics in the past 18 months are down in comparison to a similar time period pre-Covid, “yet breast cancer has not gone away nor subsided”.

According to leading breast surgeon and BCI chairman Prof Arnold Hill, “in recent months there has been a clinical impression of more women presenting with locally advanced breast cancer. We are currently studying this in greater detail and hope to have specific answers by the end of the year.”

People don't realise you do get it at such a young age

Harding’s death “really made me want to speak about it”, says Niamh, at this time of Breast Cancer Awareness Month. “She was so young and people don’t realise you do get it at such a young age.” Once it has developed into secondary breast cancer there is generally no curing it, she points out. The only option is treatment to prolong your life.

“It doesn’t matter your age; it doesn’t matter your health; it doesn’t matter how good you feel; it can be you,” stresses Niamh. One in nine women will develop breast cancer, “and I’m that one”.

Of the approximately 3,700 new cases diagnosed in this country annually, almost a third will be women aged between 20 and 50 years. Men can develop breast cancer too but the incidence is much lower, being about one in 1,000.

A lump

Like Niamh, Claire Butler-Jones was just 29 when she noticed a lump while taking a shower during a holiday in Portugal, with her husband Stephen and their then 18-month-old son Noah, in May 2019. She also believed she was too young for breast cancer and "I pushed it aside a bit in my head". Until, later that summer, she had a dream in which a former colleague, who had had breast cancer, seemed to be walking her through a hospital, and that prompted her to contact her GP the following morning.

As she was 16 weeks pregnant when her cancer was diagnosed in August 2019, “there were two lives in the balance”, she says simply. Medical staff wanted her to reach 20 weeks before performing a mastectomy and after that a course of chemotherapy and radiation was recommended.

Despite all the treatment she has been through, Claire still considers waiting for the results of her biopsy the worst part of the whole experience. “I think those five days will haunt me for ever. Even though I think I knew what was coming, I didn’t know at what level it would be, whether it would be doable or not. I would never wish that fear on anyone.” As it turned out “there was a sense of relief in knowing there was something they could do for it”.

She was terrified initially about what it might mean for the baby, Sonny, she was carrying but never really considered refusing treatment as there was so much reassurance.  Staff at the Coombe maternity hospital told Claire her to let the cancer unit in St Vincent’s Hospital look after her and they at the Coombe would look after her baby and that the two would work together. “They were incredible.”

The surgery was probably more of a concern for the baby than the chemotherapy she says and that’s why they did a mastectomy only on her right side rather than a double procedure, to lessen the time under general anaesthetic.

“I remember waking up from the surgery and there was a lady at my stomach and I could hear Sonny’s heartbeat through a doppler.” It was a huge relief and Sonny was safely delivered three weeks early by Caesarean section in January 2020, weighing seven pounds, before Claire went on to have further chemotherapy, surgery for lymph node removal and then radiation.

At 29 I knew how precious life could be and to be thankful for small things

Claire continues now to be on a daily anti-oestrogen tablet and has a monthly injection to keep her ovaries in menopause. “It is shutting down the possibilities of anything floating.” But she regards the symptoms of menopause as a small price for enjoying life with her family. “I am incredibly grateful. I have learned so much from it. At 29 I knew how precious life could be and to be thankful for small things.”

As for coping with the constant fear of cancer returning, she says she has trained her brain to compartmentalise things. “Some days I will have to say ‘I choose not to worry about that today’. I also take the doctors’ word as gospel and they have said the medication I am on is preventive.”

The week we talk, Claire is also waiting on the results of genetic testing to see if she has inherited mutations to the BRCA gene that would make her more susceptible to breast and ovarian cancer. “I guess I just have to take each day as it comes and deal with what I have in front of me now.”

She would say to other women that we’re lucky that checking for cancer in the breast is something we can do ourselves. “There are lots of parts of our bodies that we can’t see in to or access and thankfully the breasts, we can, we can feel them ourselves. It takes nothing to keep on top of checking yourself, no matter what age you are.”

A cancer diagnosis has been a big test for Niamh O’Donoghue’s naturally upbeat personality. She doesn’t personally know anybody else of her own age who has gone through a similar experience.

She had eggs harvested and frozen before the start of chemotherapy, just in case her fertility is affected in the long term. Currently, she too is receiving monthly injections to induce temporary menopause to protect her ovaries during treatment, and has also been to Dublin for genetic testing.

I am not a big party person but I am definitely going to be celebrating that one

She is due to finish her eight cycles of fortnightly chemotherapy sessions by the end of December and is wearing a cold cap during treatment, “hoping that will save some bit of my hair”. There will be a break of a few weeks before 20 sessions of radiotherapy in a four-week block next February.

Niamh will turn 30 in March and “that is my big cut off point”, she says. “I am not a big party person but I am definitely going to be celebrating that one.”

Hoping to return to the UAE next April, she knows she is not going to be the same person, physically or mentally, after this. “I was very happy in Abu Dhabi and don’t feel I needed something to shock me into reassessing my life,” she stresses. However, “although I’m fine now, I am going to be monitored for life. There is the big scare that it could come back and that is something that is always going to be in my head now – any little pain, any little lump, might be something more serious.”

When she first told friends about her diagnosis many of them said they hadn’t been checking and it made them think twice. “That was important,” she adds. “I was getting something positive out of this, if I could get my word across to just a few people and make them think.”

This year's Great Pink Run will take place virtually on October 16th and 17th, to raise funds for Breast Cancer Ireland research and awareness programmes across Ireland. Registrations for the national, family-focused event, run with Glanbia and supported by the Joe Duffy Group, are open on greatpinkrun.ie.

The factors

Age does not seem to be a major determinant of survival of breast cancer, says surgeon Prof Arnold Hill. The main factors in determining the outcome from breast cancer include the size of the tumour at presentation and the nodal status, the presence of lymph nodes involved. Specific biological factors, such as the presence or absence of various receptors on the cancer cell, also influence outcome because of improving targeted treatments in this area, says Hill, who is chairman of Breast Cancer Ireland.

One in nine women will develop breast cancer in their lifetime and lifestyle factors do have an effect on the rate of development of the disease, he explains. “The key solution is for moderation in all lifestyle aspects, such as alcohol consumption for example, and the maintenance of a healthy weight where possible.

It’s hugely important, he adds, that every woman is familiar with what is normal for her about her breasts. “If they notice a change, they should see their family doctor without delay to have this evaluated further.”

Eight signs of breast cancer to look out for
Puckering of the skin of the breast.
2 A lump in the breast or armpit.
3 A change in the skin around the nipple, or nipple discharge.
4 Dimpling or inversion of the nipple.
5 Unusual increase in the size of one breast.
6 One breast unusually lower than the other – nipples at different levels.
7 Enlargement of the glands.
8 Unusual swelling in the armpit.

A list of these signs, along with a video guide to how to perform a proper breast self-examination, are included in a free app, Breast Aware, that also sends monthly reminders to be “breast aware”.

Breast cancer in Ireland by numbers
1 in 9 women will develop breast cancer
1 in 1,000 is the incidence rate of male breast cancer
3,700 new cases diagnosed annually
690 deaths every year
30 per cent of women are diagnosed between 20-50 years
34 per cet of women diagnosed between 50-69 years
36 per cent of women diagnosed 70 years and above
85 per cent is now the survival rate, due to increased awareness and breast screening
2 per cent drop annually in mortality rates
5-10 per cent of breast cancer is hereditary
Source: Breast Cancer Ireland

Sheila Wayman

Sheila Wayman

Sheila Wayman, a contributor to The Irish Times, writes about health, family and parenting