Women and Cancer: 'It's not okay to ignore something that is not normal about your body for a prolonged period...'
One-in-four women will get cancer - but the good news is the outcomes are now much better than ever
We all want to think someone else will get cancer, not us. That it's always someone older, someone more unhealthy, someone whose granny or mum had the disease that will get it before we do.
It's not that we're being cruel, wishing affliction on someone else, it's just the way most of us would like to think.
But the reality is that one-in-four women in Ireland today will develop cancer in their lifetime. And the only way we can start tackling that shocking statistic is if we stop burying our heads in the sand and get knowledgeable about the facts instead of just hoping it won't happen to us.
Of course cancer doesn't care if you're male or female but there are some uniquely female statistics to the disease. One in 10 women will be affected by breast cancer - compared to one in 100 men. One in 32 women will develop colorectal cancer, one in 35 will be diagnosed with lung cancer.
The most common cancers in women are non-melanoma skin cancer (cancers that develop in the upper layer of the skin and don't usually spread), breast cancer, bowel cancer, lung cancer and melanoma skin cancer followed by gynaecological cancers like cervical, ovarian and uterine.
The total number of invasive cancers in women is projected to increase by 84pc by 2040. In just a generation, the number of breast cancer detections alone has virtually doubled.
That's the scary bit, but here's the good news. The prognosis has never been better. Thanks to improved detection, screening programmes and treatment options, cancer survival rates are on the rise. But we could be holding back more progress.
"There's still a lot of fear around cancer and that can be very inhibiting," says Naomi Fitzgibbon, a specialist cancer nurse who heads up the support telephone service, Cancer Nurseline (tel: 1800 200 700) at the Irish Cancer Society (cancer.ie).
"Sometimes women can feel busy with family or career and put off going to the GP, or schedule an appointment only to forget all their questions once they get in because they're running late for something else or feel uncomfortable with a male GP."
She advises writing down issues before seeing someone, but most importantly, make that appointment.
"It's not okay to ignore something that's not normal about your body for a prolonged period. It can be hard, but be brave and get it checked out."
In 'women's cancers' like breast, cervical and ovarian cancer, there are certain symptoms to look out for. Changes in the breast's size and shape, changes in the nipple, the skin around the nipple or a lump as well as swelling in the armpit or collarbone are all possible indicators of breast cancer.
The survival rate for breast cancer has improved dramatically, standing at 82pc now and expected to rise to 90pc in the next decade, largely due to heightened awareness and high-profile initiatives, like the Cancer Society's Paint It Pink campaign (paintitpink.ie) encouraging the public to host a pink-themed event to raise vital funds for the organisation.
Cervical cancer is mainly caused by the human papilloma virus (HPV) and being vaccinated against this can reduce the risk. Smoking increases risk, so too does having multiple sexual partners from a young age. Symptoms include abnormal vaginal bleeding, discharge with a foul odour and pain during sex. Since the cervix is always changing, regular screening is advised (see cervicalcheck.ie).
Ovarian cancer is more subtle but sometimes manifests itself as period-type pains, bloating, indigestion, changes in bowel habits, tiredness and abnormal vaginal discharge. Those more at risk are over 55, have a family history of the faulty gene associated with breast cancer, have never been pregnant or have taken HRT for more than 10 years. There may also be a slight elevated risk associated with fertility treatment.
Ireland's survival rate for ovarian cancer is the lowest in Europe and it's often dubbed 'the silent killer'. But Naomi believes such terminology is unhelpful, "it's slower to diagnose," she says. "But it's also rarer and can be treated."
One of the additionally difficult things about these female cancers is the way in which they can be so intrinsically linked with a woman's sense of femininity. Angelina Jolie said it was an 'empowering' choice to have her breasts removed, but not all women get to make that choice or feel the same way.
"It can be very difficult," agrees Naomi. "Breasts are tied into how we're 'meant' to look as a woman, our ovaries produce eggs and drive our fertility, from an early age we're driven by our sex hormones and anything that alters that and makes us different to other women can have huge psychological ramifications."
There can also be knock-on effects on having children and relationships. Chemotherapy can affect fertility and sex hormones.
"Some women find the sexual side goes from their relationship and it's very distressing," says Naomi. "It can be a very delicate subject to broach but it's important to have the conversation because there's help out there, it's not taboo and it's not discussed enough."
The Irish Cancer Society offers women a wealth of help from survivor support - other women who have been through the same problems - to initiatives like the Look Good… Feel Better programme, offering hair and beauty workshops, particularly helpful for women who have lost hair going through treatment.
But it's also important women don't get lulled into the mentality that it's only 'women's cancers' they need to be mindful of.
The incidence of lung cancer in Irish women is on the rise, largely to do with the fact we have one of the highest levels of female smoking in Europe and women quitting the habit slower than men.
"Smoking has an unambiguous cause and effect with regard to cancer," says Professor Seamus O'Reilly, medical oncologist at Cork University Hospital and Fellow of the Royal College of Physicians of Ireland.
"Unfortunately there's still an image aspect to smoking and an association with being thin, particularly among young women, which is when the habit is formed - very few people take up smoking after the age of 18."
It's just one preventable factor.
"Smoking is a major problem and obesity is another," says Professor O'Reilly. "One-in-six cases of cancer I see is obesity related."
Currently 57pc of women in the country are overweight and 23pc are obese. But a WHO study expects the obesity epidemic to escalate faster in women than men, increasing to 85pc overweight and 57pc obese by 2030.
There's not always a clear-cut reason for why someone might be diagnosed with cancer, but lifestyle matters and simply eating healthily, exercising and maintaining a healthy BMI, lowering alcohol consumption and not smoking has been shown to lower the risk. Breastfeeding has also been shown to lower the risk of breast cancer, particularly if done for longer than one year.
"It's awful to see people in my clinic who, if something had been done differently in the years previously, would never have been there," says Professor O'Reilly. "It's hard to change people's behaviour, there are a lot of people who smoke or are overweight that think 'it won't happen to me'."
Interestingly, a positive mental attitude has been shown to have a huge impact on recovery. Hope matters. But in the battle against cancer, women need to know changes in their own bodies, know what to look for and act fast. It's not enough to just hope it won't happen to you.
‘At first, it’s in the back of your mind: – will it come back? But that fades’
Breast cancer survivor Gillian Colleran from Glenageary, Co Dublin now uses her experience to help others on the Irish Cancer Society’s Survivor Support Programme.
Gillian was just 31 and on honeymoon in the Caribbean when she felt a lump in her breast while putting on sunscreen. “Cancer never came into my mind,” she says. “I’d had cysts before and assumed it was another one of those, I never thought about it again the whole time we were away.”
But she’d also been feeling tired, something she’d put down to working and organising the wedding and, on returning home, her GP referred her to James’s Hospital Triple Assessment Clinic where she was diagnosed with breast cancer the same afternoon.
“I was flabbergasted,” she recalls. “As a young woman, cancer had been the last thing on my mind. I’d no experience of it in my friends or family, suddenly I was plunged into an unknown world.
“How people react to you can be the hardest thing,” she adds. “Most friends hadn’t been through anything similar and they all wanted to know what happened. Others couldn’t deal with it at all and didn’t know what to say to me.”
The Society’s support groups provided vital help. “Suddenly you’re in a group of people who know exactly what you’re going through,” explains Gillian.
She finds it cathartic now helping others, but it’s also made her stronger.
“I don’t sweat the small stuff now,” she says. “When you’ve been through something as horrific as a cancer diagnosis it makes a big difference in how you deal with minor things.”
And it strengthened her marriage, though she knows from experience that other women’s relationships can be destroyed by the stresses and strains of the disease.
The first year was taken up with treatment — a lumpectomy, radiotherapy and chemotherapy. The second year prompted a lot of existential questions, but the third year marked a return to normality.
“At first it’s always in the back of your mind: will it come back?” says Gillian, now 10 years clear of cancer. “But that fades over time. Now it feels like a lifetime ago.”
'The doctor told me I had cancer. He didn't realise it was my birthday'
Bernie Gallagher from Letterkenny, Co Donegal was diagnosed with ovarian cancer on her 49th birthday.
"'Happy Birthday Bernie!,' I said after the doctor told me," she says. "He hadn't realised it was my birthday and the poor man, I think he felt so bad. The next thing, four nurses landed in on me with a cake singing Happy Birthday!"
The fact she's able to laugh about the memory, or that she felt sorry for the doctor moments after being told she had cancer, is testimony to the mum-of-three's brilliant outlook which helped her deal with the diagnosis in the weeks and months that followed.
But it's also indicative of how women can sometimes approach their health. "I would have put everything else first," says Bernie, now 57. "I was running here and there for family and never bothered with myself. It was go, go, go all the time."
In the summer of 2007 she knew the persistent pain she'd been feeling wasn't going away and felt it wasn't IBS or gallstones, as had been suggested by her GP.
"I'd pain in my back and front, my appetite went and I felt tired all the time," she recalls. "I was also up four or five times a night needing to pee."
After being admitted to hospital, it was discovered she had an 11cm by 8cm tumour.
When doctors ran the CA125 ovarian cancer blood test, it was one of the highest readings they'd seen. "The doctor told me 'I can't understand how it's so high and you're still here'," she says.
She had her ovaries removed and went through three courses of chemotherapy before going on to get the all clear. Family and faith, she says, got her through, but she's never wondered 'why me?'. "I feel it was something I had to go through," she says.
She wrote a poem for Relay For Life, a fundraiser run in Donegal. "One of the lines is 'If feeling unwell, go see your doctor, he'll check all your cells'," she says.
"That's the message I want to get across to other women, don't leave it too long - if something doesn't feel right, get it checked out."