"For each individual, their cancer is their cancer and how it's treated is dependent on them," says consultant radiologist Dr Deirdre Duke. "It may be dependent on their age, it may be dependent on what stage they're at, it may be dependent on what other medical problems they have."
Dr Duke, who has a special interest in breast imaging, carries out most of her work in the symptomatic clinic in Beaumont hospital. “I would have been training in radiology, I did my basic radiology training in Beaumont hospital, and when I completed my four years I went over to work in BreastCheck,” she says.
BreastCheck is the national breast cancer screening service. It is free and available to all women between the ages of 50 and 70. Once you sign up for the service, you are then called for a mammogram every two years.
However, for those of us unfamiliar with medical terminology, what does “symptomatic service” mean? “The symptomatic service is for the woman who is at home having a shower or sitting watching TV or whatever and she notices something with her breast,” Dr Duke explains.
“So either she feels a lump, she notices skin changes or nipple changes, or she has nipple discharge. She has become aware that there is a change in her breast, so she now has a symptom of breast problems. So she goes to her GP, her GP will assess her, decide whether or not she needs to be referred on, and if they decide yes, she is then referred to a symptomatic breast service.
"In general, the services available to patients in Ireland who have been diagnosed with cancer are excellent. In about 2008-2009 the national council control programme amalgamated all the cancer services into eight cancer centres," she says.
Duke explains that, because of the eight cancer centres, there are rules and regulations that govern how patients are dealt with. “For example, in our service we have certain key performance indicators, certain timelines, that we have to meet in relation to how we manage patients.”
She states that like with most areas of healthcare the movement of patients from the community into care is where difficulties can emerge. “The actual getting the patient in to be diagnosed is usually where the hold-up arises.”
Mammogram
Duke appears to feel that while Irish women are aware of the symptoms, it is important not to become complacent.
“In general women are quite breast aware, but sometimes people think, ‘Oh, I had a mammogram last year and I’m not due one again for another year. So, therefore, I’m fine until the next mammogram, whereas they need to start thinking of it like the NCT for their car. Yes, the NCT will pick up issues if they are there, but that doesn’t mean that nothing will happen your car till you come again.”
According to Dr Duke, there are two main points it is imperative women remain aware of.
The first is that breast symptoms often have nothing to do with breast cancer. “There are lots of things that can happen in the breast that probably have nothing to do with breast cancer. You know women will get a lot of cyclical breast pain, their breast may change in size or shape over the years – it may not have anything to do with breast cancer.
“On the flip side of it, I suppose that women are aware that it can actually happen any women in their lifetime. So, typically, we would get an older woman who will say but I’m not eligible for a breast check anymore so how could I get cancer. They’ve gone over 70, and they’re saying, but I’m too old to get cancer. And it is very rare in younger women, but it can happen.”
When educating the public on breast cancer it seems balance is key. “It’s all about getting the right message to women. Sometimes, just the wrong message is sent out. You can have a lot of people worrying who don’t need to worry and then you can have another group who kind of have themselves convinced, ‘Oh, well, this can never happen me’.”
Duke supports various cancer charities, but she has direct involvement with Breast Cancer Ireland. The charity's Avonmore Slimline Milk-backed Great Pink Run takes place on Saturday, October 13th, in the Phoenix Park, Dublin and on Sunday, October 14th, in Kilkenny Castle Park.
For those facing a breast cancer diagnosis, Dr Duke says it is important not to lump all breast cancers together. “I suppose breast cancer is one of the areas that the treatments are improving year on year and the survival rates are improving year on year, so most people now are actually surviving it. I’m not saying you’d wish it on anybody, but things have improved dramatically even since I started dealing with this disease.
“Everything is changing all the time. In my area I deal in radiology so therefore if you can imagine it is essentially technology based, the machines get better every time. Each time we upgrade an ultrasound machine the image that we get is sharper each time. No more than your phone it just keeps getting better.”
Though, it is the interpersonal aspect of her career which Dr Duke relishes. “I actually deal with people all day every day, and that is the bit I enjoy the most,” she says. “Medicine brings everybody down to the same level in that any person can get sick irrespective of their upbringing or their background.”
