As a child, Caroline Joyce remembers her grandmother singing One Day At A Time by Irish country singer Gloria.

It’s a refrain she has repeated many times as a family support worker and life coach. And one she has held on to herself, since being diagnosed with breast cancer during COVID-19.

“And sometimes, it’s just one minute at a time,” reflects Caroline. “You have to pull yourself back and go, ‘Just one minute.’”

Caroline grew up on a dairy and sheep farm in Turlough, Co Mayo. A mother of two, she has worked in social care and family support throughout her career, but also runs Cara International, providing in-home childcare services to families; which saw her win Mayo businesswoman of the year in 2015.

Always on the go, it was only when she went to the GP about a pain in her hip in February that she happened to mention she’d felt “a bit of pressure” under her right arm.

“I couldn’t feel a lump, I couldn’t feel anything,” she explains. “The GP did a check and couldn’t find anything and basically he said, ‘Look the best thing to do is to put your name down on the HSE website for BreastCheck’.”

While Caroline was not overly concerned, because she was eligible for free screening having turned 50, she took his advice and received an appointment for Wednesday 4 March; even though by then, the pressure had seemed to dissipate.

“I got the letter on the Monday,” Caroline says of the follow-up appointment for further investigation. “At that point I suppose you get very worried. You think, ‘This is very quick’.”

Getting the diagnosis

An ultrasound was scheduled in Galway on Wednesday 11 March; the same day the first death due to COVID-19 in Ireland was announced.

This added an extra level of tension, though at that stage, Caroline was able to bring her partner Chris to the hospital, where the radiologist explained that there were three tiny dots around the nipple on her right breast, and that a biopsy was necessary.

Three small incisions were made, and after the procedure, Caroline and Chris met with consultant, Dr Karl Sweeney, who told them there was a possibility it could be lobular cancer.

“He described lobular as a sneaky cancer growing in lines and not necessarily as a lump and possibly why my GP or I did not find a lump. He also said it can be difficult to pick up on a mammogram,” says Caroline, who was told that while the results could be benign, if the “dots” were malignant, she would be looking at a partial lumpectomy, and if they were connected, a possible mastectomy.

“It was looking like I could lose my breast, this could be very serious,” says Caroline, though admits that the worst part was wondering how she would tell her family, and in particular, her sons. In the meantime, she had to focus on keeping her business going, especially after the first raft of COVID-19 restrictions came in to force the following day.

“Life goes on, that’s the problem,” reflects Caroline, who received the call from her consultant on Monday 16 March, having agreed to take her results over the phone. The bad news was it was cancer, and while it hadn’t spread, Dr Sweeney was recommending a full mastectomy of the right breast as soon as possible.

Cancer during COVID-19

Surgery was scheduled for Tuesday 31 March in Galway, though with the pandemic at its height, Chris could only go as far as the front door with Caroline, where she was met by staff in full PPE and had to undergo a COVID-19 symptom screening test (but no swab) before admission.

Despite the fear around the virus, however, she felt she was in safe hands and was back home within 24 hours. “The nurses were lovely, they were very caring and even with the way Dr Sweeney explained everything, I felt completely ‘held,’” says Caroline, who was supported in her recovery by the breast check nurses in Castlebar eg having her dressing changed once a week.

For Caroline, however, the masectomy paled in comparison to her concerns that the cancer might have spread, so she was relieved when Dr Sweeney called to confirm this was not the case.

But as the tumour was 7cm in length, he was recommending chemotherapy followed by radiation and hormone treatment, with her first session scheduled in Castlebar in mid-June.

Raising awareness

Caroline was expected to start losing her long, blonde hair within a few weeks; but she decided that if this was going to happen, it would be on her terms.

That’s why she did a live head-shave on Facebook on 24 June to raise funds for Mayo Pink Ribbon under the umbrella of the National Breast Cancer Research Institute, which is working on a number of initiatives, including a cause close to Caroline’s heart: a microwave imaging system for early detection of breast cancers such as lobular.

“To me, it was a no-brainer,” says Caroline, who called on Chris to do the honours, as due to COVID-19, they could not get a hairdresser. She has raised €11,500 to date; as well as awareness around lobular breast cancer.

“I thought, ‘If only one other person watches this video and gets a diagnosis, it will save a life,’” she says.

I have loads of nieces and nephews and you’d love to give them a big hug... but you can’t

At the time of interview, Caroline was mid-way through chemotherapy, with eight cycles scheduled over 16 weeks. Fatigue is what she struggles with most.

“You go to sweep a floor in your house and you feel like you’ve climbed a mountain,” says Caroline.

Staying safe during COVID19 is also a concern. Caroline is still living in virtual lockdown; she can’t go to the supermarket, will only walk in very quiet places and if she meets a friend every now and then, does so outdoors.

“I have loads of nieces and nephews and you’d love to give them a big hug... but you can’t,” says Caroline, who would like to remind people that there are many in Irish society who are still at risk.

“And it’s not just putting me at risk,” she adds, “it’s the nurses that are minding you and their families, and patients that are in the bed next door to me.”

All going to plan, she hopes to finish chemo by September and radiation either by her 51st birthday in November or Christmas. Then there will be hormone treatment, but while there is a long road ahead, she focuses on the positives.

If I had cancelled, this would be in my lymph nodes now, this would be a bigger fight, it would have spread

“Dr Sweeney said, ‘Your cancer is in the bin in the hospital, this is the topping and tailing of it.’ I thought it was brilliantly worded,” she says.

And she hopes her story will encourage any person who may be concerned about a change in their body not to put off going to the GP because of COVID-19.

“If I had cancelled, this would be in my lymph nodes now, this would be a bigger fight, it would have spread, especially considering the size the tumour was. So to me, I was blessed in so many ways,” she says.

“I went into this at the height of COVID-19. I had the surgery at the height of COVID-19. I was given excellent care.”

Follow Caroline’s journey on Facebook and here on our website, where she will be sharing a monthly diary. To support the National Breast Cancer Research Institute, donate at www.breastcancerresearch.ie

He is grateful to people like Caroline for raising funds to support vital research in these challenging times.

One such project- which is close to Caroline’s heart- is the early-stage development of a microwave breast imaging system that will hopefully help identify lobular cancer, which can be “mammographically occult” in about 50% of cases ie not show up on mammogram.

“I’ve been the principal investigator looking at an early-stage microwave breast imaging system that is being developed by MVG – who are a very large French company – and they have decided to do their initial pilot studies in humans here in the breast unit in NUI Galway,” says Professor Kerin.

“It does seem able to pick up breast cancer on imaging. It has potential advantages over mammography in that there’s no compression for example and it does seem to be able to pick up lobular breast cancer,” he continues; but qualifies that this is still at early prototype stage and larger studies are planned.

It’s one of many ongoing projects, which range from maintaining a “biobank” of tissue and bloods from breast cancer patients to studies looking at the genes that cause breast cancer. Professor Kerin believes maintaining these projects are vital to the delivery of care, “as the best outcomes for people are in research-rich environments”.

On the ground, COVID-19 has impacted “at an enormous level”.

“In the hospital, it takes twice as long to do half as much,” says Professor Kerin, who says that while the stalling of screening programmes like BreastCheck means they will be “playing catch-up for the foreseeable future”, it’s still important not to delay seeing the GP if people have concerns.

“The main cardinal symptoms are a lump, bloody discharge from the nipple or tethering or dimpling in the breast,” he says. “Those things mean that you should see your GP and get them to refer you to the breast unit; and we’re still seeing people with those urgent symptoms within two weeks.”

Broadcaster Mícheál Ó Muircheartaigh is just one of the people lending support to the All Ireland Cycle Challenge to raise funds for breast cancer research.

The initiative is part of the annual Pink Ribbon Tour cycle in support of the National Breast Cancer Research Institute. Sadly, due to COVID-19, it is not possible to stage the event this year, so organisers have created the “All Ireland Cycle” which gives everyone a chance to take part and cycle for their county.

Participants are encouraged to cycle 200km in 10 days between 28 August and 6 September; with the county with the most kilometres cycled collectively winning the All-Ireland title.

Registration is €25 and each participant will receive a commemorative neck snood. Register at www.allirelandcycle.ie