Every September Toronto's breast-cancer survivors take to the streets, rallying together and swapping stories about their harrowing ordeals. But this past weekend, no one was prepared for the question that came from the four-year-old girl who greeted them at a pit stop during their 60-kilometre trek.
"Do you have the same cut as me?"
Aleisha Hunter, a Cambridge, Ont. girl, who stands knee-high and knows all the words to the songs from the musical Cats, is Canada's youngest known breast-cancer survivor – and one of a handful of children around the world to suffer from a malignant tumour in their breast before reaching puberty. Aleisha, who had a full mastectomy only three months ago, was one of the volunteers helping the more than 4,600 walkers in the annual Weekend to End Women's Cancers, a fundraiser for the Princess Margaret Hospital's cancer-research unit.
The youngster's wide smile and bouncy steps belie the year-and-a-half saga that she has endured – one of sleepless nights, unexplained pain and a mysterious lump in her chest. Her mother, Melanie Hunter, has repeatedly told her how special she is, and Aleisha's doctors concur.
"Rare, rare – really rare" said Nancy Down, one-third of the surgery team that removed Aleisha's tumour, when asked about the young girl's condition. "I would describe it as a handful of cases in the literature that have been reported."
When Aleisha's mother first noticed a small lump on the left side of her daughter's chest and sought treatment in Hamilton, the diagnosis was lymphatic inflammation, a bacterial infection of the lymph nodes. But as Aleisha's appetite dropped dramatically and the lump expanded, an unsatisfied Ms. Hunter took her daughter to the emergency room at Toronto's Sick Kids Hospital in May. Doctors promptly ordered an MRI and biopsy, which showed that the lump – by this time turning purple, and spreading out like a web – was in fact a case of juvenile secretory breast carcinoma.
There is little research on the condition. The tumours, which secrete fluid, can be found in the breasts of adult women but are not as common as other types of tumours. A team of South Korean doctors published a paper in 2000 about a three-year, one-month-old girl that they successfully operated on: "To our knowledge ... this seems to be the youngest case of secretory carcinoma of the breast which [has] been reported in English literature," they wrote in the Journal of the Korean Breast Cancer Society.
In the days leading up to Aleisha's June surgery, Ms. Hunter repeatedly reassured her daughter that the doctors, who consulted with pediatric experts in Western Canada, as well as Texas and Illinois, were going to "fix her ouchy." The little girl oscillated between joy and suspicion. After overhearing her mother describe the procedure on the phone to a relative, she announced, "They aren't cutting my booby out."
But the two-hour operation was a success and there is nothing to suggest the cancer will return, Dr. Down said. The team removed her nipple, areola, breast tissue, as well as the lymph nodes under her arm. Her love of the musical Cats came from watching the movie version over and over again on DVD in the hospital during her recovery.
The medical team ruled out chemotherapy after they determined that the cancer had not spread, but will be watching her closely. Sick Kids' surgeon Sharifa Himidan, the primary doctor on the case, will author a report on the procedure, cementing Aleisha's place in international medical history, Dr. Down said.
And while Aleisha's age may be startling, there is nothing to suggest that this is part of some greater trend in young girls, the doctor said. "Certainly the cases are not, to my knowledge, increasing in frequency. I don't think it's something that parents as a rule have to have any particular concern about."
Ms. Hunter's only concern now, she said, is how Aleisha is going to cope with her self-image as she gets older. For the first few days after the surgery, she pulled up her shirt for anyone who expressed interest. But shortly after, she told her mother that she was tired of people looking at her.
On the weekend, the four-year-old met and quickly befriended Cindy Phillips, a 48-year-old mother from Guelph, Ont., who underwent similar surgery eight years ago. As the first walkers started crossing the finish line, Ms. Phillips, dressed in a cat costume, and Aleisha walked hand-in-hand toward them. Ms. Hunter looked at her daughter and said: "She's a pretty confident kid.""I think her being involved in these walks and events and being around all of the other survivors, she's going to have a concept of why and what happened, and not go 'Oh wait, there's something different about me.' I think that really helps."