Category: A Medical Perspective
Octobers and Genetic Testing
Ever since Pablo, my first child was born in October, it has become one of those extra special months on my calendar. I remember in 2007, the year he was born, when finally October arrived, how my heart used to skip a beat on seeing his forecasted date of arrival of the 8th as the sell-by date on the milk cartons. He kept us all in suspense until the 13th of that month though, one of the longest 5 days wait of my life. And we’ve been celebrating every year since with themed birthday cakes and fun parties.
Then there’s Halloween. I had it buried in my calendar as one of those festivals that I wasn’t keen on remembering with any special celebration, but alas it has been unearthed from my childhood and marked excitedly every year with masks and face paint, spooky tunes and hanging apple games, evening house callings and poem recitals, pumpkins (at a push), apple cake (Barm Brack hasn’t reached the Spanish shores) and lots of fresh tasty nuts.
This year Halloween will be made extra special by the presence of my sister and her youngest son Ronan. And we’ll be celebrating more than ghosts and goblins too! Spilling in to the 1st of November, I’ll be ditching chemotherapy sessions (hopefully forever) out of my life and burying that bitter spirit with a bottle of the bubbly stuff.
But October of 2016 has become more booked up than ever with four chemo sessions still to complete, the usual fortnightly collection of my sick certificates, the first of my biannual revision tests and on the last day of the month, I’ll be genetically tested for alterations to the “Brackey genes”, as I affectionately call them.
I first heard about these menacing genes, correctly named BRCA 1 and BRCA 2, from the lovely girl who supervised my fourth year biochemistry practicals eighteen years ago. These genes, when altered, were just around then being discovered to play a major role in many incidences of familial breast and ovarian cancer in women. I remember listening with interest at the time but since it was not a disease that had ever affected my family at the time, that information was very swiftly shelved at the back of the top most recess of my mind, where memories of passing interests fade into darker and darker haziness.
Until the day I was told I had breast cancer and the possible genetic implications of that were mentioned. The memory of that pretty girl, who my class mate asked out on a date, reluctantly were dug up, dust blown off it and the future date of the 31st of October 2016 assigned to bring to fruition the practical reality of what was once for me just a fleeting wonder.
If anyone is familiar with Dr. Seuss’ (rather surreal) tale of “The Cat in The Hat”, you’ll know the mysterious characters who appear midway through the story, Thing One and Thing Two, running out of a closed box and running amuck up and down the corridors with kites and dresses while “mother is out”. Well they’re like Brackey 1 and Brackey 2, in their mutated forms.
When functioning properly, BRCA 1 and BRCA 2, located on chromosomes 17 and 13 respectively act as tumour suppressor genes. So the genes create proteins to autocorrect damage to its own DNA in order to prevent the formation of cancerous tumour cells, normally in the breasts or ovaries at some relatively early stage in a young woman’s life.
But when they take on the characteristics of Thing One and Thing Two, and decide to run amuck in the body, it is almost always due to an inherited mutation (spontaneous mutations in these genes caused by environmental factors are extremely rare). There are different ways that the genes can be mutated or altered, and some are more harmful than others (changes in the BRCA 1 gene being more detrimental). But only 5-10% of breast cancer cases are attributed to these mutations. The rest of the cases are caused by…well whatever (see my post on “Why Me?”).
At the end of this month, October, I’m going to be taking the initial steps to find out into which category of breast cancer cause I fall, genetic or whatever. A history of a medical nature of my greater family will be taken and stored as a family tree, then blood samples taken to be sent off for rigorous genetic analysis and the results will be presented to me at some unknown time next year.
If I test positively for any mutation in either of the BRCA genes, the most immediate consequence for me will be the removal of my other breast and ovaries as soon as possible, the prophylactic surgery, which Angelina Jolie gave a public image to in 2013.
If I test negatively, I’ll go on my merry way, continue with my hormone treatment and biannual screening tests for five years and hopefully become a cancer-free survivor statistic for many years to come.
With my familiy’s medical history as it stands today, the indicator is pointing in the direction of a negative result. To really qualify for an analysis of your BRCA gene state, there would have to be many more incidences of breast cancer in the female branch of my family tree as there currently are (and I have my mother and sister, six aunts and twenty nine female cousins!). But my age and the type of tumour that I had (invasive lobular carcinoma) may indicate some sort of genetic involvement.
So what result am I hoping for?
Well, on the one hand, a positive result would provide an explanation for my breast cancer occurring at my age, which although I’ve accepted it, a reason for it would be conclusive for me. It would also justify the removal of my other breast, which although deemed healthy now, I view it as, my oncologist called it, a “disease time bomb” (hearing those words from a professional cancer doctor are more that disconcerting).
I think it would be safer to remove my left breast, a kind of insurance policy, but since the removal of a healthy breast from women who have had a unilateral mastectomy, has not demonstrated an increase in survival rate or decreased the reoccurrence of breast cancer, doctors are reluctant to perform the prophylactic surgery, unless there’s a genetic implication.
On the other hand, whereas a positive test result would be good news for me now, it could provide a possible future legacy for my two daughters in particular and somewhat for my son, an inheritance which is paved with medical tests and screenings and futuristic decisions of an ethical nature.
The laws in Europe concerning genetic testing and applying the results to embryos and even to the unfertilized egg are changing, the result of which is in the provision of more and more leniency to couples and doctors to choose in advance the genetic make-up of a child. Already 30 families have “benefitted” from this action in Spain. So it could mean that if either Ana Maeve or Ellen tested positively for the altered BRCA genes, they could have their own eggs tested and only the “unblemished” ones harvested.
To me it sounds like taking up the role of God here on earth. And if you asked me if I’d prefer to have had breast cancer or be unborn, my reply should be obvious. Having this disease is not pleasant but it is moulding me into a stronger person, at least emotionally and spiritually.
Testing negatively won’t exactly liberate my girls from future screening either. If your mother has had breast cancer, it is recommended to begin screening for this disease ten years younger than her age of diagnosis so my girls will inherit that legacy either way from the age of twenty nine.
The genetic testing will be an interesting end to October and the suspense of the results I will have to contain until next year. In the end, I have concluded that it doesn’t really matter whether I test negatively or positively. What will be will be. More and more I realise how little of life we can actually control.
Concerning health and illness, I think the best I can do is to educate my children from a young age to be mindful of their health and their obligations in looking after it and to allow them to see, through my actions and behavior, how having a major illness isn’t the end of the world. Life can still be looked on with a smile. We can continue to celebrate the passing of the years and seasons with joy and thanksgiving and accept the reminders and coming of the end with a hopeful peace.
To Reconstruct or Not To Reconstruct? That IS the Question.
A good bra has been a central part of my wardrobe ever since, well, I’ve needed one. And that necessity happened to coincide, more or less, with the opening of Dungarvan’s first specialized ladies lingerie shop, Helen’s Boutique. Her bras were more expensive than what had been found before in my hometown, as, in the confines of her little shop at the far end of O’ Connell street coming from Grattan Square, Helen stocked more variety of better brands.
I remember my first fitting and purchase of what seemed like a “granny bra” to me but as my mother couldn’t stress enough the importance of good support and an even better fit, in my young teenage years with my rather large dense breast, I had to sacrifice frills and lace for thick straps and underwires.
The return to Helen’s became an annual affair and gradually as my weekend and summer jobs became more lucrative, I was able to take over the funding of my own garments of breast support. It is a buying habit I continued up until the summer before last, because as I told Helen last year, I have never found another lingerie shop and proprietress to be as consistently helpful and supportive, pardon the pun! The vanilla colored bra for my wedding dress, all my maternity bras, black bras, skin-colored ones, under-wired, strapless, plain t-shirt ones to the feminine lacy kind, I’ve always gone back to buy them at Helen’s Boutique.
So now I’m in to a new bra era: the orthopedic mastectomy bra. It’s really no different from a normal bra except for the pocket it hides away in the cups to accommodate fake silicon breasts, which are easily popped in. I haven’t been able to travel back to Dungarvan yet since my mastectomy in May so I still don’t know if Helen can continue to be my “bra specialist”. In the meantime I’ve found another supplier, who is extremely friendly and accommodating and seems to stock a good selection of very stylish mastectomy bras.
So the not so humble bra remains the central all-important piece of my wardrobe.
The decision to address the “missing breast” issue with an external silicon breast, as opposed to an internal reconstructed one, has of course been entirely my own. It is a very personal decision and requires careful consideration.
When I first approached the centre, which is a separate dedicated cancer unit in the hospital where I’ve been receiving all my care and specializes in breast cancer, I became acutely aware of becoming part of a system of work. After the initial appointment with an oncologist, you are slotted in for all the staging tests. Then, you meet the gynecological surgeon, then the plastic surgeon, then the oncologist and finally the oncological radiotherapist. A whirlwind of information is presented to you in appointment slips and consultations. Once the best plan of action has been determined for your particular case of cancer, surgery first followed by chemotherapy and then radiotherapy, for example, the ball starts rolling into action very quickly.
The decision to have my breast reconstructed with an internally inserted prosthetic silicon breast under my skin was assumed to be accepted by me, I suppose by virtue of the high numbers of patients undergoing this kind of breast reconstruction regularly. And initially I didn’t give it any thought. Reconstruction, yeah, of course. Isn’t that all part of the breast cancer treatment package nowadays?
And then one morning, one of the doctors who I had to see, was delayed and I hadn’t brought anything to read. A quick root around in my bag and I found that grey sheet of paper that I had thoughtlessly crumpled up as reading to be done at some other time. It has turned out to be the paper that has determined my aesthetic fate for the foreseeable future. It was entitled, “Risk Factors of Silicon Breast Reconstruction”.
It listed amongst others, allergies, autoimmune response, muscle damage, infection, septicemia, silicon leakage and the necessity to operate every ten years to change the implant.
In retrospect, I realise these papers are informative and a legal requirement and not necessarily indicative of the reality. I assume statistically more women receive successful breast reconsctructive surgery than not. But at the time, whilst reading all the possible scenarios of how the surgery can go wrong, I became very doubtful about the reconstructive procedure as an option for me. I reached for my phone and began searching for the alternatives to breast reconstructive surgery with silicon implants. (Personally, I would have preferred if my plastic surgeon had presented these options to me himself so that a discussion could have opened up about the pros and cons of the options available. Finding out for oneself via the internet and weighing up the positives and negatives without the support of a professional seems too much like being left to your own devices.)
Well, one alternative is a different kind of reconstructive surgery, a manipulation in the body, which is more “natural” when it comes to acceptance or non-rejection of the implanted matter. This is because the reconstructed breast is “built” out of fat and muscle tissue from ones own body, either from the abdominal area or the back. There are varieties but it is generally called DIEP or TRAM flap surgery. It sounds wonderful, (especially if the fat is coming from the abdomen – hey a tummy tuck and breast augmentation all at once!!!) but the surgery time can take up to twelve hours. And it involves more than a transfer of fat and muscle. There’s blood vessels and circulation to consider too. Not such a simple procedure, I soon realized, and the down side is that the body doesn’t always accept the transferred tissue, despite coming from one’s own body.
The other alternative is not to reconstruct, to go breast free. I first read about this in the waiting room, waiting for the doctor who was delayed, in the throes of my panic about risk factors of silicon breast implants, on the website http://www.breastfree.org. This site contains information about and testimonials from women who have opted for exactly what the website name advertises, going breast free.
It didn’t take much convincing. It is the less popular choice, only 20% of women with breast cancer opt to go breast free. But there is no doubt that it is the safer option. Recovery from the mastectomy itself is easier, virtually pain-free I would testify to and shorter. And there is no question or doubt about whether the subsequent treatments for the actual cancer are compromised. They’re not.
So I chose cancer cure first, reconstruction maybe later. As it is, I’ve missed the boat on the silicon implant reconstructive surgery as that must be decided on before the mastectomy (this is because, a tissue expander has to be inserted during the surgery for removal of the breast and saline solution must be regularly injected in to the missing breast site to create an internal pocket into which the silicon implant can be inserted). I can decide on the flap surgery at a later date.
Going breast free is definitely the less pretty and more inconvenient choice. One is left with a big scar around which anything from fat to scar tissue is likely to form. The images of results of breast reconstructive surgery on the internet are quite impressive. The anxiety and conservative nature of my personality have come even more to the fore for me. And I have trust issues too, I suppose.
I’m the person who, when consulting the two gynecological surgeons for a first and then second opinion, while listening to all they had to say, I found myself examining their hands and nails! Those hands were the hands that were going to be cutting into my skin, touching my interior and sewing me back up. One surgeon had slender hands with long fingers and beautifully manicured nails. She had a presence and calmness about her that I admired. The other surgeon had short stubby hands with nails bitten down to the quick. She had a tired face and rarely smiled.
In the end it was the latter who operated on me because she was part of a system that I trusted more as an entire package. So on accepting the lady with the bitten fingernails, I found myself worrying about things like, why she had bitten nails; if she’s a nervous person, would she have had her coffee before operating on me; so, the time of my operation became an issue for me. As it turned out I was operated on mid-morning. When I was wheeled in to the operating theatre and she looked in to my eyes, smiled and asked, “everything alright?”, I felt like quizzing her on her night’s sleep, her breakfast, the number of coffees she’d had that morning, her partner, her children…
Instead I just replied with a faint half-smile, “yes, everything’s alright”. I thought, I place myself in your hands and I’ve prayed for you this morning. It’s all out of my control anyway so may God be with you.
That’s all the trust I placed in that surgeon. Now I’m not sure I could work up to that level of trust again for a twelve hour breast reconstructive surgery. I’m a fragile being with an even more fragile shell of a body.
For the time being, I prefer to focus my energy on my present image, disfigurement and all, and love it with good moisturizing and sun protection creams. Invest in the best silicon foobs on the market and a good stylish bras. Buy flattering clothes and pretty earrings. Exercise and feed my body with wholesome nourishing food.
And re-educate myself and my children about the importance of nurturing a beauty, the kind that shines from the inside out and transforms any face, any smile, any body type into a grace transcendental of any external image.
“Health is Wealth” as the saying goes…
A folder and a notebook were my first purchases following diagnosis. After only the fifth medical visit over a period of ten days, I quickly realized that I’d have to get organized. One doctor’s visit could lead on to two or three more tests, which would then lead onto more consultations. And each separate medical visit produced its own set of papers, from authorization slips to health risks or methods of preparation for any given test.
One week’s agenda looked something like this:
Monday morning: gynecologist public hospital/mammogram. Afternoon: medical certificate. Evening: MRI of breast and ultrasound.
Tuesday: Consult private gynecologist.
Wedeneday morning: Second opinion. Afternoon: Ultrasound of abdomen.
Thursday: Collect result of electrocardiograph.
Friday: Deep tissue biopsy with ultrasound and insertion of tag for surgery.
The following week was something similar with the inclusion of a PET scan, blood tests, chest x-ray, bone scan and another MRI.
God, is this what every person diagnosed with cancer has to do? I never realized there were so many different machines for so many different tests. Nuclear medicine, radio diagnostics and the new era of imaging tests. And all the doctors, nurses, ancillary staff and the space, a designated nuclear-insulated space for each huge scanning machine that requires a patient to be injected with radioactive tags.
Then there are the waiting rooms, always full to the brim with people. Are they all sick?
I’ve always had the good fortune to be well and healthy and even though I’ve imagined to a certain degree of empathy how it must be for those closest family members and good friends who have suffered through illnesses, I could never really fully comprehend the implications of being seriously ill.
Here I was with a folder and notebook organizing my bits of papers and appointments. While in the whole of Spain, the Spanish government, or the Spanish civil servants or whoever is responsible for the Spanish Health System are organizing their agendas and folders for the millions of receiving sick people of a premium health care.
The immensity of co-ordinating 40 million people through births, vaccines, minor sicknesses, major diseases, medical emergencies, senior citizen care, recovery or palliative care to death was unfolding before my eyes on a daily basis. The hour long or more delays in the waiting room suddenly became less and less significant (and I fill the time with incessant writing or reading!)
And I have never put my hand in my pocket. No money has ever been exchanged between me and a nurse or a doctor or a secretary. I know receiving healthcare is not like going out to buy a fridge but it certainly costs a lot more. Scratching the surface just a little I have compiled a short shopping list with my findings:
- Ireland’s first state of the art PET scanner installed in a private clinic in Dublin in 2002: €3.8 million. (The first one to appear in Spain was in 2003 in La Paz public hospital, where I am being seen to by my oncologist here in Madrid).
- MRI scanner: From as little as $175,000 up to $3 million, obviously depending very much on quality and performance.
- Gamma camera: (and I copy and paste from a kind of buy and sell of medical equipment website)
Gamma camera system: $350,000
Total Capital Costs: $350,000
Operating and Ownership Costs
Service contract for years 2 through 5 = $32,500/year
Salary and expenses for 2 full-time technologists in years 1 through 5 = $90,000/year
Cost of Nuclear Regulatory Commission licensing = $20,000/year
Cost for accessories, such as syringes, film, and optical disks, at $15/procedure
= $30,000/year in years 1 and 2: $33,000/year in years 3 through 6
Cost for radiopharmaceuticals at $250/dose = $500,000/year
Total Operating Costs = $640,000 in year 1;
= $672,500/year in years 2 through 5
Present Value = $3,306,311
So who is paying for all my treatment? Well I am of course (although I haven’t contributed enough yet to foot the bill so many more working Spanish citizens are digging deep on my behalf) as I benefit from both private and public healthcare. Living and working in Spain, I pay 4.7% of my contractual salary for social insurance, which covers not only health but pensions and unemployment benefits also. My employer, The British Council pay the other 23.6%, which is generally passed on to the employee as a lower salary compared to Ireland, for example. (I get paid a lot less here as a teacher in Spain than I would in Ireland). But now I know I can rely on a premium healthcare; I get my deduction’s worth.
Having a major illness has opened my eyes to the truth of the saying “health is your wealth”. But the wealth of a country should also be measured by the organization and efficiency of its Health System. In my opinion, health and education are the fundamental cornerstones of any democratic society.
Elena, my home helper, from Romania tells me about her cousin who is receiving chemotherapy in her home country for stage 4 breast cancer. If she doesn’t pay out something to each person who deals with her along the way, the nurse who draws her blood, the surgeon who performs the operation, the oncologist who organizes her treatment, they’re not interested in her. Their salaries are so low that the sick people themselves have to subsidise them. A “pay or you’ll die” kind of system.
And in Venezuela nowadays if you want chemotherapy, the oncologist gives you a shopping list to browse on the black market: http://www.nytimes.com/2016/05/16/world/americas/dying-infants-and-no-medicine-inside-venezuelas-failing-hospitals.html?smid=fb-share&_r=0.
I don’t like that I have breast cancer but I do feel fortunate and blessed that it’s 2016, when the prognosis has never been so good. And I feel privileged that I live in a country where the choices for cancer treatment are amongst a multitude of centres of excellence. I would like to say it’s a right but since not every sick person around the world has the same choice as me, now in 2016, I feel the healthcare I am receiving is still a privilege. And referring back to a previous post on the fairness of this situation, I think now this is where the real unfairness and inequity lies.
Sickness is a harsh reality but caring for the sick should be a fair right for everyone.
Of all the 28 risk factors for getting breast cancer, as listed on this website: http://www.breastcancer.org/risk/factors, realistically four apply to me.
1. Being a woman but since, and I quote from the internet, “changing your sex to reduce your risk of breast cancer is not a realistic or reasonable possibility”, there’s nothing to be done or said about that.
2. First period before the age of 12.
I remember the evening I got my first period. I’ll save any reader the gory details of that episode but when my mother announced,
“Oh love you’ve got your period!”,
I sobbed into her shoulder for a long time. Today I name my childish feelings “disbelief” and “disgust” at the very idea that firstly, this bleeding had a name and secondly, that it seemed to be normal. I was ten years old, (and a half judging by the darkness outside and the lit fire that I sat beside all that evening.)
2. Dense breasts
That very same evening of the first period episode and after my mother teaching me the mechanics of hygienic care, I received a crash course from my father on “the facts of life”. I sat down at the kitchen table and on the back of an envelope, he proceeded to draw two small circles with pipes coming out of them, which both lead down to a bigger oval further down. It was a diagram of the female reproductive system apparently. It looked like a rams head with horns to me! There was a mention of eggs and ovaries and babies and male and female mice. I HAD NO IDEA WHAT MY FATHER WAS ON ABOUT! I wanted to go back to my Lego house designs.
But sure enough, everything my father talked about that night, slowly started to unfold, the monthly periods and all that. My interest in Lego houses declined, and I paid more attention to my growing breasts and boys.
The genes for adolescent hormones were well and truly switched on at that stage and they were expressing the familiar changes in a growing girl’s body. Amongst them were the developing breasts, which kept growing and growing and then growing some more. When were they going to cease taking on their fullness? I stopped athletic running with the pain caused by their annoying jiggling. And what’s more, they swelled even more every month before the period.
Dense breasts I was blessed with and dense breasts have been my on-off friends for thirty years. So dense, they hid the growing cancer from my regular palpating fingers. So dense, they hid the cancer even from the first imaging (ultrasound) test I did and from the mammogram and even the fine needle biopsy. I and Carlos and even the gynecologist were beginning to wonder if the confirmed cancer in the lump under my arm could be coming from elsewhere in my body. I never thought it possible to be hoping for breast cancer and that it would be good news at that.
4. Age of giving birth to first child greater than 30 years.
Pablo, my first-born, arrived on the 13 th of October 2007 and I was was aged 31 years and 5 months. I remember well my exact age because not long afterwards my father read out the statistic about the average age Irish women gave birth for the first time: 31 years and 5 months.
An average statistic for an average girl I say. There’s nothing wrong with being average. It’s safe to belong to the masses of normality. Discovering breast cancer at 39 is against the odds, which depending on the website you read and the year published, the chances are 1 in quite a high number. So all of a sudden, I have deviated from being healthily normal and joined the thousands of young and younger women around the world who are diagnosed annually with breast cancer into a different kind of reality.
Amidst my frenzied panic at the beginning, to the forefront, literally, of my mind was the question,
It’s almost as if with the pang of each strained headache, the words came pelting across my forehead, why me, why me?
Each woman I saw on the street, more overweight than me, why not her? For each cigarette I saw perched on a passerby’s lips, why not them? Why not the drug addicts or the winos, the hormone pushers or someone older? I’m young, I’m healthy, I’ve always done all the “right” things so why the hell me? Who’s out there to answer me that? Who will explain in plain English why I got breast cancer at age 39? I have a young family to rear, I need all my strength and energy for them. This is not fair. Life is not fair.
Unlike many people in such circumstances, who prefer to deal with their journey with an illness in private, I have felt a compelling need to tell people, to connect, to reach out. People have unknowingly offered their interpretations of this illness, which I have listened to in an attempt to build up some kind of sense.
Nieves maintains the whole earth is contaminated, from the soil which nourishes our fruit and vegetables and grains, to the water we drink, to the air we breathe. According to her it’s impossible to avoid. It made me wonder why we all didn’t have cancer.
Someone very dear to my heart mentioned that it could be a manifestation of my unhappiness at being in a foreign city. I didn’t think I was that unhappy, permanently exhausted yes, but unhappy enough to warrant breast cancer?
Then my sister-in-law Esther said something, which rattled me at first, but it stayed with me and it has persisted with me ever since. “This had to come,” she said, “and only good things can come from it.”
I’ve given up asking, “why me?” and I’ve taken to asking “why not me?”.
This has shaken up my life, my mind (and hence the blogging), my memories and my reality. Esther was referring to grace from God. I don’t really, deeply, comprehend it but somehow I don’t think it’s for me to get my mind around. I will lay back and rest my muscles with the thought and let its meaning slowly be absorbed.
Oncology and a Return to My University Days
Hearing the words “my oncologist” uttered side by side and what’s more by my own voice has been the most shocking phrase of my lexicon over the past month.
At age 39 turning 40, in what I believed to be, the prime of my health, I never could have imagined in my wildest dreams that I would be using these words in what has become my daily conversation with family and friends.
On the day I received the piece of paper from that first gynecologist who saw me, where the words “confirmation of carcinoma” appeared, her parting advice to me was:
“Don’t look at the internet.”
Talk about falling on deaf ears!
I have a bachelor’s degree in biochemistry! The treatments of today were research projects of my university days 20 years ago. How could I not look at the internet and revisit my molecular biology textbooks?
I remember my classmates and I had been placed in topic-related groups. Some had to research allergies, for example. I was put with Rachel H and Stephen R and our topic was “Programmed Cell Death and Cancer”. Hah!
At that time, the study of cancer, oncology, was not included in the secondary school biology programme. I was a complete novice when it came to knowledge about cancer. So I was approaching my studies about programmed cell death with completely fresh eyes and holding no pre-conceived notions about the disease.
I read with great fascination the details about how at microscopic level, even a healthy cell goes through a cycle of birth, division and then death, all beautifully turned on and switched off by our own genes.
That is until, disease sets in, and most inevitably over time, mechanisms go awry upsetting that exquisitely tailored control of the cell cycle, and they stop dying. The cells continue to grow uncontrollably and if they take on other characteristics such as the ability to infiltrate other healthy cells, for example, then it becomes cancer.
Twenty years ago, the research of the previous half century, into how cancer cells behave when compared to healthy cells, was being elucidated in the textbooks I was reading at university.
The logical next step in research on cancer was, equipped with a greater understanding of how cancer cells operate at a molecular level, to target their peculiar behaviors and to stop them in their tracks. Chemotherapy has been doing that for a long time. Everybody knows about the obvious side effects of that treatment, so synonymous with cancer; the hair loss, the nausea and vomiting, the fatigue, all caused because while, targeting the annihilation of fast-growing cancerous cells, other healthy fast growing cells also take a hit. Not very clever, not very specific and a most unfortunate accompaniment of cancer treatment, the part which gives the disease such infamy. (And the part which Pablo says he’s going to fix in the future – his latest career choice being medical scientist. Bless little souls.)
In my eyes, the really wonderful advancement in breast cancer treatment, at least, is knowing with breathtaking precision that the tumour expressed in my right breast is somewhat different to the tumour expressed in my cousin’s breast, which is different in turn to that of Belcha’s, a family friend. Therefore I’ll have one cocktail of drugs and accompanying radiotherapy and they’ll have another. There will be aspects of the treatment schedule in common but there are differences too.
Belcha’s tumour profile ten years ago gave a very pessimistic prognosis and three years later, when she was struck by breast cancer, the monoclonal antibodies that I was reading about 20 years ago have probably saved her life!
And these medical scientific breakthroughs represent today’s miracles among others. The capacity to comprehend the world we live in is inexhaustible but the will to improve it based on what we know at the moment is miraculous and a gift from God, in my opinion. We are all touched in different ways.
Finally I can make tiny sense of the biochemistry course that chose me to study it. Because after 2 years I had had enough of it. I was fed up of so much technicality by then. I had wanted to give up those studies and go elsewhere but my father and others around persisted with the idea of finishing. And finish I did, graduated and went on to become a secondary biology teacher.
Oncology has now become integrated into the secondary biology curriculum, at least in Ireland. Year after year, I bullet point the characteristics of a cancer cell and my students and I inevitably enter into discussions on statistics and personal anecdotes. Because, after all, we all know someone who has had cancer and unfortunately many of us also know people who have died from the disease. Hopefully in those short-lived classes, some young mind will be inspired to find out more and fuel the advancements of the future.