When we were all going into the first lockdown in March 2020, Ger Dunphy (39) had been looking forward to coming out of social isolation due to breast cancer treatment.
“Mentally I went back to my chemo days,” she says of the pandemic requirements of social distancing and stringent hygiene measures. Her return to work as a project manager with ESB in April 2020 wasn’t going to bring the welcome mingling with colleagues that she had anticipated after all.
On the positive side, she was glad she didn’t have to commute from her home in Lucan, Co Dublin, “as my fatigue levels were still unbelievable”. But just two months later, in June, she found another lump in the same area of her breast as before.
The first time around, in 2018, the possibility of cancer “wasn’t really on my radar. It was a shock.” She is still not sure what prompted her to check her breasts while undressing after a night out that August, but she found a lump.
Dunphy went to her general practitioner the next day, was referred for a mammogram, an ultrasound and then a biopsy. While waiting for the biopsy, she was preparing herself mentally for the “worst-case scenario”, such as losing her breast, her hair, her fertility.
Only at the moment of her diagnosis with breast cancer, when the consultant started going through mortality rates, did she think, What? I could die from this?
However, only at the moment of her diagnosis with HER2-positive breast cancer, when the consultant started going through mortality rates, did she think, “What? I could die from this?”
“Maybe it’s the optimist in me. That never came into my mind as the worst-case scenario,” she says now, recalling how she went back home where she lives with her sister and cried. “It was quite an aggressive cancer. But obviously because I had found it early, it was a good prognosis.”
She had a lumpectomy, followed by 16 rounds of chemotherapy over five months and 20 sessions of radiotherapy over a month. She also had to take the drug herceptin intravenously every three weeks over a year. In addition, an anti-oestrogen drug was prescribed for 10 years “to prevent reoccurrence, hopefully”.
But, on discovering the new lump last June, Dunphy was immediately back to worst-case scenarios. The cancer could be back, but at least she knew she had managed the treatment last time. The only thing she hadn’t lost last time was her breast, but she resolved she could cope with that if necessary.
Contacting the GP, she was told they were doing online consultations, but when she explained that she needed to be seen in person by the doctor, it was arranged immediately. She then got a mammogram a week after finding the lump.
The pandemic did not delay any of that, she says, acknowledging that may be because she went privately. And thankfully, the outcome of the tests was good. “It was nothing to worry about.”
Dunphy is one of the survivors featuring in the "Still Here" campaign run by the Irish Cancer Society (ICS) in the lead-up to its annual Daffodil Day on March 26th. She got involved because she knows how much she depended on the ICS website for "the truth" when looking to inform herself about cancer. She also visited the daffodil centres in the hospitals, run by nurses and volunteers.
“It’s really good because they’re people who get it. You can go in and talk to them.” When your own family are so upset, Dunphy says, “you’re trying to protect them and you don’t really open up about everything.”
A group from the ARC Cancer Support Centre that she attended on Dublin’s South Circular Road has continued to meet by Zoom through the pandemic, which she finds helpful.
Despite prioritisation of cancer care within the health system, the pandemic's impact on services has been huge, says ICS director of advocacy and external affairs, Rachel Morrogh.
“Medical oncology and radiation oncology have coped somewhat better than cancer surgery, which has been severely hit. We appreciate that funding has been made available to cancer services in Budget 2021, but reduced capacity, deficiencies in healthcare infrastructure and interruptions to cancer services over the last 12 months mean that we continue to be very concerned about timely access to care for the people who need it.”
The ICS is particularly concerned about the impact that delays, both for people with symptoms going to GPs and for diagnostic tests, may have on the stage at which cancers are diagnosed. This affects the chances of successful treatment, long-term survival and a good quality of life.
“For instance, attendance at lung cancer rapid-access clinics dropped by 55 per cent in January 2021 compared to January 2020,” Morrogh says. “Even in a normal year, six in 10 lung cancers are diagnosed at a late stage and we are worried that the impact of Covid may increase this figure further.”
Colorectal cancers are also a cause of specific concern. Endoscopy procedures all but stopped in the first lockdown and the impact of this was seen well into the end of 2020 in the form of waiting lists for colonoscopies.
The third wave of the pandemic also had a severe impact on endoscopy units around the country, although they are scaling back up now, Murrogh says. At the end of February, almost 3,500 people had been waiting more than a year for a colonoscopy. “Of the total figure of 18,700 people who are waiting for a colonoscopy, over three in five are waiting over three months. In Ireland, more than five in 10 people with colorectal cancer are diagnosed at a late stage so delays in accessing colonoscopies, added to people putting off presenting to their doctor with symptoms, could lead to more advanced disease and a lower survival rate.”
After an incredibly challenging year for cancer patients and their families, the Still Here campaign is a reminder that the supports and services offered by ICS are available “every step of the way”, says Morrogh. It has also “continued being the voice of the cancer community, to ensure cancer didn’t become ‘the forgotten C’ during Covid-19”.
Prostate cancer survivor Vip Patel (59), who also features in the campaign, is always happy to help raise awareness of the disease. “Men won’t talk about this and I think that’s the big barrier,” he says. And, “let’s face it, you don’t get many Asians out there” discussing such issues.
Taboos build up because people are saying things about examinations and videos are going around, and you have the Monty Python sketch and that kind of stuff, and it doesn't really help. You just don't want to know.
“It took me over a year to get myself to go for a biopsy,” he says. Patel was in his early 50s when he was referred to a consultant who advised a biopsy should be done, but he kept putting it off.
“I was kind of looking for excuses,” he says. Needing to care for his wife after a hip replacement seemed a pretty good one.
I even went to see my consultant after the biopsies, thinking I would be fine
Anyway, he wasn’t worried. It was only through having annual blood tests for type 2 diabetes and high blood pressure that his rising prostate-specific antigen (PSA) level was flagged. “I even went to see my consultant after the biopsies, thinking I would be fine.”
It never occurred to him to bring anybody with him to that appointment. “I walked in there, singing away and then this . . .” he says, trailing off. He was presented immediately with a matter-of-fact diagnosis of cancer.
“Your mind goes into this fog. I am fairly compos mentis most of the time but your mind just goes.” All the detail about what he needed to do next was being recounted and “you don’t hear it. If there was somebody else [with me], they may have heard it.”
When he went home his wife, a Wexford woman who had lost her mother and two of her sisters in their 50s to cancer, she “just looked at me and said ‘no not you as well’ kind of thing. It is almost that she is used to that news.”
However, she was also “very positive”. Patel, an environmental scientist, weighed up the figures, such as a Gleason score of 7 (medium-grade cancer), researched the treatment options presented and chose brachytherapy, the implantation of radioactive seeds, in 2016.
“That worked very well for me.” Coming up to year five now, his PSA level has dropped to 0.35, compared to 6.5 just before his biopsy.
Unlike most radiation therapy, the seeds work from the inside out and, initially, he felt nothing. But tiredness began to hit after three or four weeks “and it kind of peaks after three or four months”. Eventually the seeds lose their radioactivity and just remain in there.
Running his own business, Patel took some weeks off work and then worked reduced time. “Bladder issues” were the main lasting effect to be managed, with access to toilets while out and about becoming a bigger consideration.
With active surveillance, prostate cancer can be caught early and you can live a normal life afterwards, he says. “I had no symptoms, that’s the worst thing about this.” That is why Patel recommends all men get their PSA level checked regularly, especially from the age of 50 onwards.
Other advice he would offer anybody going for a prostate biopsy is “take the sedation”. He learned that the hard way, although he can joke about it now. “I walked into the Mater and they said to me, ‘Do you want to be sedated?’ It’s funny, I just heard, ‘most men don’t get sedated, you know’.” So, he decided he would be like “most men”. He wouldn’t do that again.
Read: ‘Cancer was once a death sentence but thankfully not any more’