It was summer 2024 and Lydia Whelan was tired. She wasn’t feeling like herself but put that down to the stresses and busy nature of modern living. When she discovered an indentation on her breast, however, she realised she needed to see a doctor.
Her doctor referred her for a biopsy, after which the then 32-year-old was diagnosed with stage 2 breast cancer.
“When I heard that, sure the waterworks started. My whole world felt like it was crashing around me. I was just like how? My partner was beside me and he was sobbing his heart out,” she said.
“I took that day to digest the news, I was very emotional. The next day when I got up out of bed, I thought ‘OK, what do I have to do today about this’?”
RM Block
Whelan’s breast cancer is what’s known as HER2+, which is very aggressive, but doctors said very treatable.
This, according to William Gallagher, professor of cancer biology at University College Dublin (UCD), is one of the biggest changes that has happened in recent years in terms of cancer treatment and research.
“HER2+ used to be very difficult to treat. About 15 per cent of breast cancers have high levels of this protein called HER2 and it’s like a switch, it turns on the cancer and makes it very aggressive,” he says.
However, in recent years, various drugs have been developed to “turn off that switch” and target the protein “in different ways and in a more sophisticated manner”.
[ Irish Cancer Society says budget funding vital to prevent death rate increasingOpens in new window ]
Consequently, he says the “whole landscape has changed” and so what used to be one of the most challenging types of breast cancer “is probably the most treatable form now in terms of survival rate”.
It’s not just this form of breast cancer that has seen a positive shift. Some 50 years ago, the go-to methods of treatment for cancer were surgery, radiation therapy and the beginnings of chemotherapy.
But as research and innovation has been carried out to tackle this deadly disease, treatment options have improved significantly - and so have patient outcomes and experiences.
Gallagher says there is widespread acknowledgment of the negative side effects of chemotherapy, such as hair loss and nausea, due to its aggressive nature.
As a result, researchers have started looking at the genes in tumour tissue to try to predict the outcome for these patients.
“You can predict whether that will be an aggressive tumour or not. If you don’t have an aggressive tumour, you could potentially avoid chemotherapy. That was a big thing that happened. And interestingly, Ireland was one of the leading countries in that approach,” he says.
It is largely due to advances in treatment that there are now more than 220,000 people in Ireland living with or after cancer, a 50 per cent increase from a decade ago.
Claire Kilty, head of research at the Irish Cancer Society, says it is a “really exciting time for cancer research”.
“Thirty years ago, three in 10 survived. Now, it’s six in 10. And nine in 10 for breast cancer. All these cutting-edge breakthroughs are going to push that number even higher again,” she says.
Kilty says immunotherapy drugs, in particular, have been “revolutionary” in the outcomes for cancer patients.
Pembrolizumab, often referred to as Pembro for short, is one of the most well-known immunotherapy drugs.
It came to public attention in Ireland when the late Vicky Phelan used it to treat her cervical cancer, and later campaigned to make it accessible to other women affected by the CervicalCheck scandal.
Speaking in 2020 about the drug, Phelan said: “It has given me almost three years of a quality of life I could never have hoped for on chemotherapy.”
Kilty says the use of immunotherapy is “one of the top areas” that has seen a growth in research and products in recent years.
“It’s using our immune system to kill cancer cells. These drugs turn off that cloaking system that cancer has and make it easier for our immune system to find and destroy them,” she says.
[ Good news for breast cancer survivors who live in fear of recurrenceOpens in new window ]
According to Kilty, since the Covid-19 pandemic, there has been progress in relation to cancer vaccines.
“We’re seeing a lot of research in the area of mRNA vaccine which was used to protect us all against Covid,” she says.
“Now, they’re using that same technology to use these molecules to actually treat cancer. This year, there was a clinical trial that was launched to try and develop those cancer vaccines as treatment.”
Liquid biopsies are another recent revelation, and they are being used “more and more” in Ireland particularly in relation to lung cancer, according to Jarushka Naidoo, professor of medical oncology and consultant medical oncologist at Beaumont RCSI Cancer Centre.
These are basically “blood tests”, Prof Naidoo says which test the DNA the tumour has shed - making it a less-invasive and more convenient diagnostic tool than more traditional tissue biopsies.
Prof Naidoo is leading the Irish Cancer Society funded pilot lung health check project, which brings low-dose CT scanning and breathing tests to communities in north Dublin in a bid to diagnose lung cancer earlier among those who are high-risk.
Historically, the five-year survival rate for stage four lung cancer was between 5 and 8 per cent, Prof Naidoo says, but now it is between 20 and 25 per cent.
“Treatment has completely changed. It bears no resemblance from when I started. There has been major progress in lung cancer in the last 10 to 20 years. And that’s due to all of those pieces playing a part,” she adds.
But researchers remain aware of the areas in which further research and innovation is required. Kate Duffy, a second-year PhD student at UCD, is currently researching prostate cancer and how it spreads across the body in a bid to improve survival rates for these patients.
The five-year survival rate for prostate cancer is 95 per cent and there are excellent treatments available, Duffy says, but problems arise when the cancer comes back and spreads to other areas of the body, particularly the bone.
When this happens and the cancer becomes metastatic, survival rate drops to 35 per cent, she says.
“It’s like a weed in your garden. When you’re pulling the initial weed, small spores can travel. We’re looking at extracellular vesicles (EVs) which are kind of like those little spores; they help cancer cells talk to each other and send signals,” she says.
“Targeting EVs would be a way to stop cancer spreading, preventing prostate cancer moving from the primary site to the bone.”
One of the other main changes in this area, Duffy says, is the focus on more individualised treatment plans.
This is one area in which researchers believe artificial intelligence (AI) could be of particular assistance. There is a growing number of studies being carried out into the use of digital tools, particularly in the area of diagnostics, screening and early detection.
There is potential, researchers say, that AI could be used to assist radiologists in picking up patterns that may not be visible to the naked eye.
This would also help in the area of personalised medicine, which Duffy says is one of the “main differences” in recent decades.
“We’ve moved from a one-size-fits-all treatment landscape to acknowledging cancer is super personal. There are so many different subtypes and they’re all very individualistic,” she says. “We want the least amount of side effects and the least amount of burden on the patient body.”
The unbearable impact of treatment is something to which Lydia Whelan can attest. When she underwent six rounds of chemotherapy, she experienced painful side effects, she says.
“I got really really sick that I was in and out of hospital and I had to stay in hospital. That was really, really hard because it was coming up to Christmas and I love Christmas,” she says.
In February, she underwent surgery, followed by 15 rounds of radiation. She laughs: “I’ve had the kitchen sink thrown at me.”
The recovery from these treatments, she says, was intense; she went from being an independent, fit woman before cancer to someone who was reliant on her friends and family for everything.
“It really was debilitating. I wasn’t prepared to even look at myself in the mirror. It was really hard, the recovery from that,” she adds.
[ Diagnosed with cancer at 18: ‘It was like, okay, the fun part of life is over’Opens in new window ]
Now she believes it was all worth it. Last week, she received a phone call to say she had finished treatment, which she says came as a complete surprise.
“Going through treatment was very emotional. I remember being around my nephews one day and thinking ‘I don’t want to miss an inch of their lives’,” she says.
“I’m unbelieveably grateful that treatment and treatment plans have come on so much. I don’t know how I would have coped if they hadn’t. I’m very mindful there are people who are diagnosed and it’s gone too far for them and they’ve subsequently passed. I am so grateful that I am one of the lucky ones.”
