Tuesday 16 January 2018

Author Cathy Kelly on skin cancer: 'It's benign': the wonderful words you long to hear

All-clear: But Cathy Kelly believes government problems have caused delays in treatment
All-clear: But Cathy Kelly believes government problems have caused delays in treatment

Woody Allen has a point when he says that the most beautiful words in the world are: 'It's benign'.

Yes, if you are 16, you think it's 'I will love you forever', and if you are trying for a baby, you will sink to the floor with relief and joy to hear 'you are pregnant'.

But 'it's benign' is certainly up there.

On Monday, the person glorying in those words was me.

Less than a week after a dermatologist took a needle biopsy from my face after determining that something needed to be checked, I got the news that it was clear.

Now, I have form with skin cancer.

Malignant melanoma, to be precise - the most dangerous and, if untreated, fatal version of the three forms of skin cancer.

Years ago, I had a malignant melanoma removed from my hip. It was thin and therefore, all removed surgically. At the time, surgery was the only option - but now, there are incredible new drugs which have turned this once fatal cancer into a curable one.

I diagnosed my melanoma myself and have made myself the bane of all doctors' lives since with my conviction that I know lots of stuff. Plus, I watched every episode of ER in the '90s.

I have always downplayed the melanoma because I didn't want people with what I saw as real cancers - people living with fear, who were throwing up with chemo, suffering with hair loss or radiation burns, who had endured radical surgery, and those who were living with cancer - to see me with my scar on my hip and hear my 'story'.

I had a tiny surgical procedure.

Nothing to see here, folks.

My motto is: move on, get checked, and use factor 50 sunblock and factor 90 when visiting hot places.

Years later, as a former skin cancer sufferer, you end up having dermatology appointments where bits of you are looked at in the cold light of day.

You hear that a mark on your face looks dodgy (not exact medical terminology).

It needs to come off.

I can catastrophise, people, and I can do it fast.

"Don't worry", says the wonderful dermatologist with kindness.

Worry? It is my specialist Mastermind subject, one of many things I cannot delegate.

Luckily, my sister works at Cancer Research UK and we discussed coolly - I am very scientific and cool, despite the catastrophic thinking - the success rates with skin cancer.

There's a 90pc cure rate with early diagnosis, we figure out. Most melanomas are diagnosed early, hence the good figures.

I think of all the new drugs, like the fascinating immunotherapy ones - one of the many new approaches to cancer treatment, including melanoma treatment, where drugs trigger the immune system to fight cancer cells.

In 10 years, US reports suggest that immunotherapy could be the most valuable class of drugs in history. These drugs are more efficient and less toxic than any previous drugs.

Not so bad, I decide.

I think of years ago, working with wonderful oncologist Dr Cathy Kelly (yes, really - she is obviously the talented one, the one who routinely and, with huge compassion, saves lives in the Mater Hospital) on a plan to educate people about cancer trials.

I think of my dear friend and fellow author Emma Hannigan's radiation burns in her mouth on her eighth round of cancer treatment.

With the right drugs, I will be alive - benign or not.

Which is the point when you have beloved twin sons, not quite 13. As the American Express advert says: priceless.

Then, on Tuesday, I heard Professor John Crown on radio highlighting the plight of a group of patients with advanced melanoma who were not getting the big immunotherapy cancer drugs.

September has been mentioned as when they might get them - and September may be too late for them. Some will not survive 'til then and others will be too sick to take the drugs - only Professor Crown, who has to look these people in the eye, can say this with such ferocity.

The European Medical Agency has approved these drugs, says Professor Crown. Ireland will be getting them. Just not yet.

Why? Because no big decisions have been made during the non-Governmental months.

So amazing people, with families and loved ones, hopes and dreams, will die.

"I have been very harshly critical of medical economics in the past and I understand the need for it," says Professor Crown, "but this time, they are getting it wrong. I have got one young man who is really desperate to get these drugs. He says 'who will I call? Will I call the minister?'"

The drugs they need are Pembrolizumab (which put President Jimmy Carter's melanoma, which had spread to his brain, into remission) and Nivolumab.

The patients are being treated with an older drug, Ipilimumab, commonly known as 'Ippi'. Great drug, but not the 'we will fix you' one required in these cases.

The thing is, folks, we are at a tipping point in the curing cancer stage. Cancer trials are where it's at.

Professor Crown adds: "I would say most of the improvements over the past 15 years in the area of breast cancer have been down to drug trials."

Thanks to ICORG, The All-Ireland Co-Operative Oncology Research Group which he set up 15 years ago, Ireland has more than carried its weight in drug trials.

But trials in hospital cost money - US figures say it costs three to five times as much money per person undergoing treatment. There's more monitoring, more inputting.

The scientists in the wonderful Breast Cancer Ireland Research Centre are at the forefront of breast cancer research in Ireland.

Associate Professor Dr Leonie Young, who is vital and passionate about helping women, and talks about the loneliness of women who have breast cancer, explains the fascinating work she is involved in.

"It's sometimes called 'Precision Medicine'," she explains brilliantly, knowing how complex it is but understanding that non-scientists need simple words we can cling to.

"We are looking for biomarkers so clinicians (oncologists) can figure out the correct treatment to use. Sometimes, a treatment stops working midway - and we need to find out why."

This is very targeted and, indeed, precision medicine. She explains it's about constant analysis and re-analysis to find out why some drugs fail in some women, and to analyse - using serum biomarkers - which ones do work. This work, Leonie says, means oncologists will be able to target the correct drug for each person, rather than subject them to a drug they do not need.

Herceptin is a breast cancer 'wonder drug'. Professor Arnold Hill of Breast Cancer Ireland, who helped fund the Breast Cancer Ireland Research Centre, has described it as "a game changer", and it has been trialed in Beaumont Hospital.

You see? From research in Irish hospitals to saving women's lives.

I feel humbled by these stories and these brilliant scientists. My heart breaks for the people waiting for the vital immunotherapy drugs.

Our government, and groups like Science Foundation Ireland and the Health Research Board, are there with funds to help research.

But massive private fundraising is still needed to help charity organisations like Breast Cancer Ireland, set up to fund research and increase breast cancer education.

And when amazing drugs are discovered, we need to use them.

Or people die.

Lovely Minister Harris, I know you have thousands of deserving and ill people begging you for help right now, but if you were still in your constituency office in Bray, about a mile from me right now, I'd nip down and beg you myself.

For the people who sadly never heard 'it's benign' the way I did on Monday.

Sunday Independent

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