As if the Covid-19 crisis wasn’t bad enough, a recent study involving Queen’s University Belfast with University College London and DATA-CAN (the UK’s Health Data Research Hub for Cancer), suggests that it could result in at least 20pc more deaths over the next 12 months in people who have been newly-diagnosed with cancer.
The study, drawing on global experience, looks at the challenges facing cancer patients in the midst of the pandemic, and suggests that it could soon ignite a further cancer pandemic, if not addressed now.
There are many factors at play, including changes to diagnosis and treatment protocols, social-distancing measures, changes in people’s behaviour in seeking medical attention and the economic impact of Covid-19, as well as deaths due to Covid-19 infection.
However, the most significant are, as Professor Mark Lawler, professor of digital health at Queen’s University Belfast and scientific lead for DATA-CAN, and a co-author on the study, explains “both urgent referral rates [our early warning system or ‘red flag’ for catching cancer at its earliest stage] and patient attendances for chemotherapy delivery [an appropriate proxy measure of a cancer service’s activity] have dropped significantly.”
At the time of writing, there is no clear indication of when BreastCheck will reopen. Breast Cancer Ireland is concerned that people with symptoms of cancer are delaying seeking medical advice and has encouraged people with symptoms to contact their GP.
Some of this is entirely out of the public’s hands, but not all of it, and Fianna Fail county councillor for South Dublin and breast cancer survivor Teresa Costello is very keen to emphasise that we stay on top of those parts that are within our control – chiefly, presenting with worries or possible symptoms. “I run my own online support group for women affected by breast cancer,” Teresa says, “and I had been wondering, if I felt another lump now, what would I do? Would I go to the doctor? I realised I had so many questions I didn’t know the answer to. So I wondered, did the other women feel the same? I ran a poll and over 100 people took part; 60pc said they would be afraid to go to their doctor in case they contracted Covid, and they also felt they would be wasting the medical professionals’ time.
“I know that’s not a scientific study, but that scared me. At the best of times, people were putting off checking themselves and taking action, so now this; it’s really frightening.”
Teresa was 36, with a five-year-old son, when she was diagnosed in 2013. “I found a lump by chance when I was in the shower. I never checked my breasts. I didn’t ever think about it, and I didn’t know much about breast cancer. There was no history of cancer in my family, and I had only heard of older women getting it. It just wasn’t on my radar.”
She knew enough, however, to go to her doctor. “He checked and he felt the lump, and said, ‘it’s probably nothing; I’m going to refer you to St James, but try not to worry.’ So I went to James, and by then, there was an indentation so deep that it was like a missing part of my breast. If I had known what the warnings signs of breast cancer were, if I had regularly checked my breasts, I would have seen the changes happening, and I would have caught the cancer much earlier. Everyone’s breasts are different. But if you are checking regularly, and you notice something different, something changed, you’re ahead of the game.”
As it was, Teresa says, “my breast was deformed by the time I was in St James. I had three tumours, although I had only felt one, and they were quite aggressive. Within a few weeks, I was on chemotherapy, for 16 weeks, then a mastectomy with reconstruction, then radiotherapy, and further reconstruction. Everything happened so fast. It was surreal. I know a lot of women who have post-traumatic stress after a cancer diagnosis, because it’s such a shocker. It takes a while to sink in.”
It was, Teresa says, “really shocking, but you go into fight mode. You’re afraid of upsetting everybody in your circle, you want to be strong. I felt really guilty telling people. And I found being in hospital very hard. My son was so young, and he was all I had. My mum and dad were great, with him and with me, but I’m a really independent person. At one point, I had a chat with myself. I said ‘right, cancer is trying to take stuff from me. It can take my sense of invulnerability, my sense of security, but it’s not going to take my sense of humour, and I’m not going to give in.'”
Once her treatment was finished, “the fact that I had had breast cancer caught up with me mentally, and that was a bit traumatic. But life moved on. Because it does. I met my boyfriend, and we got engaged last November. It was funny the way we met. I knew him to see, he was friends with other friends of mine for years but I never really spoke to him. Then I met him in the hospital one day when he was bringing his father to an appointment. He came over and said hi….” As she says, “good things came too. I made amazing friendships, and cancer gave me perspective on life. It stopped me in my tracks and made me realise that life can really change, so fast.”
“I think the whole world has realised that now,” she adds. “There are similarities here, between cancer and Covid-19. We all take everything for granted, until something terrible happens. But, when it does, you also learn that life does eventually go back to normal, even after a trauma. The world is going to bounce back, because that’s what people do. This will be a story to tell in 20 years from now. But in the meantime, I’m very passionate about people not ignoring possible symptoms.
“Covid-19 is horrendous and we’re in a worldwide pandemic and the blanket of fear has been thrown over us all, but that doesn’t stop cancer. Cancer doesn’t discriminate. Cancer doesn’t take time off, it’s still going to be hitting people. I would hate anyone to ignore a sign or a symptom and be afraid to visit their doctor. GPs will still refer you.
“Clinics are still going ahead. So don’t wait. We don’t know how long this will go on. But the same rules apply: if you find something different, something unusual, don’t decide to ignore it until the restrictions are lifted. Don’t think you’re a burden on the medical system. The doctors would rather you went to them and got it checked out. For cancer, its business is as usual. We need to make sure the health of our country doesn’t suffer an even worse blow because no one wants to near a doctor or a hospital.”
Getting yourself checked is, Teresa says, “something I’m so passionate about, because of not taking ownership of my breast health. I let myself down. If me explaining this helps other people take responsibility, then I’ll be happy. Breast Cancer Ireland have an app you can download that shows you how to check your breasts, and has details of the eight warning signs to look for. It’ll even give you a discreet reminder once a month to check your breasts. The earlier breast cancer is caught, the easier it is to deal with it. So don’t wait. No one should wait.”
Teresa says that she feels “so grateful that I survived breast cancer. I know I’m exceptionally lucky as I have met many girls along the way that were not. Having breast cancer changed me forever. I don’t take the little things for granted anymore, I am just grateful to be around to enjoy them, especially the milestones that I get to see my son, who is now 12, reach.
“My whole life changed after breast cancer, I moved house, I changed career, leaving a company where I had worked for 14 years. I went from being single to now being engaged. I have travelled much more. And last year I got elected in our local elections. I have learned first-hand you are never too old to start over and I live my life to the fullest. Breast cancer will always be a part of my life. I always carry with me an anxiety of re-occurrence, however, I take each day as it comes to me and live in the now.”
It is important that we do not ignore the signs of breast cancer. If you are worried you might have one of the signs or symptoms, Breast Cancer Ireland encourages you to contact your GP. You will have a consultation either in person or over the phone and if your doctor thinks you need to be referred on, you will be. Hospital diagnostic cancer services are continuing to operate. Precautionary measures are being taken to ensure surgeries and hospitals are safe for patients. To learn more about the eight signs to look out for, download Breast Cancer Ireland’s free BreastAware App, or go to BreastCancerIreland.com