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This programme
contains some strong language
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and some scenes which
some viewers may find upsetting.
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Fuck.
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That means I might be
stage three. Cancer.
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SHE EXHALES
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My name is Hannah Fry.
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This equation encapsulates all of
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the fundamental properties of
the subatomic world.
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I'm a professor of mathematics,
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and I've spent my life using
numbers to try
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and understand the world around me.
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An airport city,
and building it and running it
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has tested us to our
absolute limits.
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In January last year,
I was diagnosed with cervical cancer.
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I started filming myself as a way
to cope with what's happening to me.
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Oh, God, oh, my God, it feels like
my guts are going to come out.
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Again, this is around your knee.
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With my doctors, I've had to make
some hard decisions about my care,
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and I'm not sure we've always
got them right.
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They are often very aggressive
with this sort of tumour,
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and they often take out
a lot of nodes.
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Welcome to my cancer research cave.
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I've become obsessed with
the statistics behind cancer...
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My books.
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..and it's made me question all my
assumptions about this disease.
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Now I want to find out how doctors
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and patients feel about
their treatments.
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Are we making the right choices
in how we deal with cancer?
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For 95 of those women,
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chemotherapy made no difference
to what happened to their cancer?
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Yep.
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Is searching for cancer
always a good idea?
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This is a classic graph
showing overdiagnosis,
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because what you're doing is
you're diagnosing more
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and more and more thyroid cancer,
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but you're not making any
difference to death rates.
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Have we become so afraid of this
disease that we'll do anything
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to fight it, no matter the cost?
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As long as there's a percentage,
there's hope.
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It means I might be that 1%
that it works for.
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And what will I do when faced
with my own odds?
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I think, whatever happens now,
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this has fundamentally
changed me, like.
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Five! OK, do you want to give
that to...
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I live in South London
with my husband, Phil,
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and our two daughters.
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Come on, sausage.
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They are two and four.
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They are absolutely brilliant,
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and ridiculously hard work
in equal measure.
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Phil, my husband,
he's a stay-at-home dad.
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He takes care of the kids,
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he's their primary carer. I like
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to describe it that we've got a very
traditional 1950s relationship,
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just everything's switched
around the other way.
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There's no way that I would be able
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to do my job unless I had that
home support.
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This particular algorithm,
it works a lot like
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predictive text does on your phone.
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I think the thing about looking at
things through numbers is that it
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gives you a chance to see yourself
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and to see the world from
a completely different perspective.
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If you imagine you have a corridor
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with lots of people moving in
opposite directions,
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people naturally form these lanes
in pedestrian traffic.
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I like to imagine it as though
you've got these two worlds that are
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running in parallel
to one another.
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So, on the one hand, you've got kind
of like the real world,
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and then running alongside it,
I think it's almost like you have
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a mathematical version
of that same world.
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So, this is the one where you have
all of the numbers
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and all of the data
and all of the equations.
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It's a way that you can zoom out
and see things as they really are,
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rather than how you
perceive them to be.
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In January 2021, my life changed.
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I had a call from my GP telling me
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they detected abnormalities
on my smear test,
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an appointment I'd put off
for six months.
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So, this one that we're doing here
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is for your blood group and type.
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I had a number of follow-up
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investigations before they could
give me the full picture.
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He just told me the facts,
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which were that they'd found
a tumour
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and it was about the size of
a gobstopper,
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and it was all contained within
the cervix.
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In the moment, you don't really
realise what's happening,
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and then it's only after that you're
reeling from everything.
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"What the hell just happened?"
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Your hair's really clean.
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Did you wash it?
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Yeah, all by myself.
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I did it myself.
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There's no guarantee that
this is all going to be OK.
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And I've had a pretty good life.
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Like, it's one thing for yourself
to be like,
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"OK, if I only live to 36 or
37, OK, you know, whatever."
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Like...
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Look at all of the experiences
I had,
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and that look at all of
the brilliant things that I got
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to do, and look at all
the friends I got to make.
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I can't quite deal with the idea
of my daughters not having me.
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That's the really hard bit,
I think.
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Hannah's human, so she worries,
but at the same time,
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she thrives on information.
You know,
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she's a mathematician and scientist
and she,
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you know, data is her is, you know,
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the thing she lives by.
That's who she is.
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So, when something like
this happens,
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she's like,
"I need to know everything.
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"I don't want to leave any
stone unturned."
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Like an instinctive reaction,
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to just want to read about it.
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In the last 40 years,
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cancer survival rates have
doubled in the UK.
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50% of people diagnosed now
survive at least ten years,
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and that's due to an ever more
sophisticated raft
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of surgeries and treatments.
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The first intervention recommended
for me is surgery,
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what they call a
radical hysterectomy.
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They don't just take out the uterus,
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they don't just take out the cervix.
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They take out the top section
of the vagina,
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they take out the fallopian tubes,
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they take out all
the tissue that surrounds it,
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so that, in the end, there's nothing
between my bladder
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and my bowels. It's completely
empty.
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And all of the pelvic lymph nodes.
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I wanted to talk to someone who's
been in this position before.
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The first person I thought of was my
friend David Spiegelhalter.
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He's had prostate cancer,
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and he's spent a lifetime working
in medical statistics.
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I'm just like, I don't know,
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trying to tackle it in the same way
that I do with everything.
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I've got, like, this massive stack
of books next
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to me of things that I'm trying
to get through.
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Do you think... I don't know.
Did the numbers help you?
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I think, like everyone else,
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it came as a huge emotional hit.
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You know, I'm not immune
to any of those kind of feelings,
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but I suppose I did try to take
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a kind of mathematical view to it
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and start doing some research
on what
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the options might be
and what the outcomes might be.
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And, you know, one aspect of it,
of course,
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is the feeling that, um,
"Oh, you know, I've got cancer,
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"let's get it out, you know,
just cut it out."
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Now I would say to people to
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try to keep that under control,
just keep calm,
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keep calm.
That may not be the best policy.
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You have to think that these
treatments have harms attached
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to them, both short-term
and long-term,
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and the benefits just may not
be worth it.
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Sometimes you should, what? Fight the
urge to want to get rid of it?
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I'm talking about
the mild case of the disease.
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Many more people will be living
with cancer in the future.
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Is that what happened in your
case, then?
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Was not having surgery an option?
No,
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I was quite strongly recommended
to have surgery due to
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the particular severity
of my prostate cancer.
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And, so far, I'm clear
five years out,
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so we'll see, you know...
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I... In that sense,
I'm not going to complain.
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Like David's, my doctors have made
it clear that
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surgery is the only
option for me.
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The hysterectomy will mean
I can't have another baby,
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which is something I'd hoped for,
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but I decided it was
a price I was willing to pay.
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I'm, like, only at
the beginning. Hopefully,
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this is just a little blip,
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a moment of reset
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and, kind of, a moment of pause.
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The cancer unit or normal?
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Yes, please, the cancer unit,
yeah, thank you.
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My home for the next...week.
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What procedure are you
having today?
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A radical hysterectomy.
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Well, this, is quite the thing.
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The surgeons are going to remove my
pelvic lymph nodes.
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They're worried there might be
cancer in them,
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but they're not sure.
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The biggest question
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and the most difficult uncertainty
is whether or not
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the cancer had got into
the lymph nodes.
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If the cancer hadn't got into
the lymph nodes,
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then it was stage one cancer.
Basically,
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your chances of survival are
really good.
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About 95%. The surgery works.
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You're in a really,
really good position.
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But if it had got into just
one lymph node,
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you jump from stage one cancer
straight to stage three cancer.
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It becomes very, very serious.
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Hmm.
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So the consultant just came in.
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And I asked him if he saw anything
in the lymph nodes.
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And he said that there was four
on one side
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that were a bit enlarged.
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And one on the other side.
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Not great news, though, is it?
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Four or five of them were enlarged,
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and that could be just
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your body's fighting infection,
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or they could be enlarged
because they're cancerous.
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I'd read all of this literature
before going in
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and I knew that if it was in
one lymph node,
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it was 60% chance of survival,
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two lymph nodes it dropped
below 50%.
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And here he was saying four or five
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could potentially be cancerous.
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I mean...
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Well, then, you're a goner,
aren't you, really?
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Mummy! Aw!
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After six days, I'm home,
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but I have to wait for
a follow-up appointment
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to find out if there's cancer
in my lymph nodes.
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In the UK, doctors often recommend
further treatment after surgery,
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called adjuvant therapy.
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It's often
chemotherapy or radiotherapy.
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It's a bit like an insurance policy.
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Although the cancer
has been removed,
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there's a chance it might come back.
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The treatment aims
to reduce that risk.
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I want to understand how doctors
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decide which patients should have
these extra treatments,
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especially as they come
with side-effects.
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Judy King is a medical oncologist
in North London.
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So we have a range
of people in clinic,
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but the number of the people that
we'll be seeing are having
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what's called adjuvant chemotherapy.
So they've had their surgery,
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they may have had scans.
And, as far as we can see,
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there is no cancer.
However, we know that, untreated,
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a number of those patients will have
what we call
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micro-metastatic disease,
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so there will be tiny cells that
will have floated off
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and ended up in the wrong
place, which,
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if left unchecked, could come back
and cause a cancer recurrence.
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And so those are the things that
we're trying to treat.
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Where do you set that boundary
of, "It's worth it for you,
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"and it's not worth it for you"?
So, in breast cancer,
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we would say that what we're looking
at is what is,
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00:14:02,400 --> 00:14:05,680
"What is the chance of you being
cancer-free ten years from now?"
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00:14:05,680 --> 00:14:08,120
And if chemotherapy improves
your chance
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00:14:08,120 --> 00:14:10,720
of being alive by about 5% or more,
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00:14:10,720 --> 00:14:13,320
then chemotherapy is something that
we would usually discuss
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00:14:13,320 --> 00:14:16,840
with a patient. Let me make sure I
understand that, though,
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00:14:16,840 --> 00:14:19,400
because another way to say the same
thing is that,
247
00:14:19,400 --> 00:14:21,680
if you've got 100 women,
248
00:14:21,680 --> 00:14:25,160
all of them have chemo,
249
00:14:25,160 --> 00:14:28,280
and chemo will save
the lives of five of them,
250
00:14:28,280 --> 00:14:31,440
that's the threshold?
251
00:14:31,440 --> 00:14:35,040
Yes, so... In a... This would be
a relatively low-risk case.
252
00:14:35,040 --> 00:14:37,760
Let's say you have 100 women.
80 of them,
253
00:14:37,760 --> 00:14:40,840
if they do nothing at this point,
254
00:14:40,840 --> 00:14:42,560
would live ten years very happily
255
00:14:42,560 --> 00:14:44,960
with their cancer not coming back.
256
00:14:44,960 --> 00:14:48,160
And maybe 15 of them,
the cancer comes back.
257
00:14:48,160 --> 00:14:50,840
Chemotherapy will be
the thing that means
258
00:14:50,840 --> 00:14:53,680
the cancer doesn't come back
for five out of the 15.
259
00:14:53,680 --> 00:14:56,840
So you have treated 100 women,
260
00:14:56,840 --> 00:14:59,160
and five women have been benefited.
261
00:14:59,160 --> 00:15:02,920
That point is worth repeating.
In 100 women,
262
00:15:02,920 --> 00:15:05,000
five of them are
going to die of other causes -
263
00:15:05,000 --> 00:15:07,440
perhaps heart attacks or
car crashes,
264
00:15:07,440 --> 00:15:09,120
that kind of thing.
265
00:15:09,120 --> 00:15:11,640
Of all of the women that are left,
266
00:15:11,640 --> 00:15:14,400
80 of them, the cancer is not
going to come back.
267
00:15:14,400 --> 00:15:17,360
It doesn't matter whether they have
chemotherapy or not,
268
00:15:17,360 --> 00:15:19,200
they are already cured.
269
00:15:19,200 --> 00:15:23,520
That leaves 15 women where
the cancer is going to return.
270
00:15:23,520 --> 00:15:26,240
However, for five of these women,
271
00:15:26,240 --> 00:15:28,320
if they have chemotherapy now,
272
00:15:28,320 --> 00:15:32,000
they can prevent
the cancer from coming back.
273
00:15:32,000 --> 00:15:33,520
But when you start off,
274
00:15:33,520 --> 00:15:36,400
you have no idea who these five
women are,
275
00:15:36,400 --> 00:15:40,360
and so every single one
of these women
276
00:15:40,360 --> 00:15:44,080
has to go through chemotherapy
just to save five lives.
277
00:15:44,080 --> 00:15:46,520
And for everybody else,
278
00:15:46,520 --> 00:15:51,280
chemotherapy made no
difference whatsoever.
279
00:15:51,280 --> 00:15:54,800
They had all of
the side-effects - hair loss,
280
00:15:54,800 --> 00:15:56,720
vomiting, giving up work,
281
00:15:56,720 --> 00:15:58,880
not being able to see people -
282
00:15:58,880 --> 00:16:01,240
all of that for 95 women,
and actually,
283
00:16:01,240 --> 00:16:03,600
it made no difference?
284
00:16:03,600 --> 00:16:06,040
So, yes, that would be the case,
285
00:16:06,040 --> 00:16:08,160
and these are the difficult
conversations because
286
00:16:08,160 --> 00:16:10,280
a patient, they could also
be thinking, you know,
287
00:16:10,280 --> 00:16:11,800
"Is it really worth it?"
288
00:16:11,800 --> 00:16:14,320
But then I guess on
the flip side of that,
289
00:16:14,320 --> 00:16:17,920
you don't know whether you're in
the 95 or you're in the five.
290
00:16:17,920 --> 00:16:19,520
And maybe, actually, chemo will be
291
00:16:19,520 --> 00:16:21,600
the thing that saves your life.
Exactly.
292
00:16:21,600 --> 00:16:22,960
When all is said and done,
293
00:16:22,960 --> 00:16:26,560
the majority of people would put
quite a lot of value
294
00:16:26,560 --> 00:16:29,720
on the concept of, "I don't want
this cancer to come back." Mm.
295
00:16:29,720 --> 00:16:33,760
Just because the alternative is
so horrible to imagine.
296
00:16:41,800 --> 00:16:44,880
Judy has invited me
to observe one of her appointments.
297
00:16:44,880 --> 00:16:47,560
Anne, do you want to come down?
Thank you.
298
00:16:47,560 --> 00:16:49,680
Anne is a 67-year-old swimming coach
from Barnet.
299
00:16:49,680 --> 00:16:52,480
Hello, come in, my name is Judy
King. I am one of the consultants.
300
00:16:52,480 --> 00:16:53,720
She had surgery to remove
301
00:16:53,720 --> 00:16:56,760
a two-centimetre breast tumour,
three weeks ago.
302
00:16:56,760 --> 00:16:59,040
..which is going to wreak havoc
with scheduling...
303
00:16:59,040 --> 00:17:00,880
I'm going to talk about what
the chemo is,
304
00:17:00,880 --> 00:17:02,440
and why we would recommend it.
305
00:17:02,440 --> 00:17:05,680
And then you can have a think about
whether that's something that you
306
00:17:05,680 --> 00:17:08,040
want to do or not. OK.
So if we take,
307
00:17:08,040 --> 00:17:10,440
sort of, women in your situation
308
00:17:10,440 --> 00:17:12,480
with this kind of cancer,
we're looking at,
309
00:17:12,480 --> 00:17:14,680
"What is the chance
of people being alive and well,
310
00:17:14,680 --> 00:17:16,760
"cancer-free ten years down the
line?"
311
00:17:16,760 --> 00:17:21,560
Yes. So, this is the chance that
everything is fine.
312
00:17:21,560 --> 00:17:26,960
There's a pretty good chance, cancer
has been cut out, job done. Mm-hm.
313
00:17:26,960 --> 00:17:31,680
This, here, is the risk of
the cancer coming back.
314
00:17:31,680 --> 00:17:35,160
Yeah? So,
my job is to reduce that risk.
315
00:17:35,160 --> 00:17:39,280
Right. In terms of absolute numbers,
316
00:17:39,280 --> 00:17:42,640
we reduce the chance of it coming
back again by about 4%.
317
00:17:42,640 --> 00:17:45,880
So, the thing is that
I don't know if you're one
318
00:17:45,880 --> 00:17:48,000
of these people over here...
319
00:17:48,000 --> 00:17:51,280
No. ..who the surgery is enough,
320
00:17:51,280 --> 00:17:54,400
and I don't know if you're one
of these people over here.
321
00:17:54,400 --> 00:17:57,600
So, what I have to say is that I
recommend that everybody
322
00:17:57,600 --> 00:18:00,840
has the tablets
and the chemo just to reduce
323
00:18:00,840 --> 00:18:03,360
the risk as much as possible.
Just to get to that, yeah. So, I'm
324
00:18:03,360 --> 00:18:05,440
going to talk a little bit about
how the chemo works
325
00:18:05,440 --> 00:18:08,160
and the side-effects,
and then I think we should have
326
00:18:08,160 --> 00:18:11,440
a talk about whether that's
something that you want to do. OK.
327
00:18:11,440 --> 00:18:12,800
Is that all right? Yeah.
328
00:18:12,800 --> 00:18:16,400
So, side-effects,
common things - feeling tired,
329
00:18:16,400 --> 00:18:20,000
people do feel pretty washed out
for a couple of days. Mm-hm.
330
00:18:20,000 --> 00:18:22,120
Chemotherapy can drop your
immune system.
331
00:18:22,120 --> 00:18:24,360
That means that, if you get
a fever or if you get
332
00:18:24,360 --> 00:18:25,520
an infection, you can't...
333
00:18:25,520 --> 00:18:27,920
Your body can't fight it properly.
If you get a fever,
334
00:18:27,920 --> 00:18:30,680
you must phone the emergency
numbers. If you can't get through,
335
00:18:30,680 --> 00:18:33,320
you have to go to A&E. All right.
336
00:18:33,320 --> 00:18:35,360
It does affect your hair.
337
00:18:35,360 --> 00:18:37,160
All right? That's probably my...
338
00:18:37,160 --> 00:18:39,800
Out of everything, it's the hair
loss that's going to be...
339
00:18:39,800 --> 00:18:41,680
It's actually the thing that
most people...
340
00:18:41,680 --> 00:18:44,080
Because I've got such fine
hair anyway, so...
341
00:18:44,080 --> 00:18:47,840
Always worth having a scarf or
a wig or what have you. Yeah.
342
00:18:47,840 --> 00:18:49,560
Other things,
feeling sick or being sick,
343
00:18:49,560 --> 00:18:52,560
acidy, bowels can go either way -
can be diarrhoea,
344
00:18:52,560 --> 00:18:53,880
can be constipation.
345
00:18:53,880 --> 00:18:56,800
Aches and pains,
those kinds of things.
346
00:18:56,800 --> 00:18:58,640
What are you thinking?
347
00:18:58,640 --> 00:19:00,400
I'm going for it.
You're going for it.
348
00:19:00,400 --> 00:19:02,240
Yeah. All right, we're going for it.
349
00:19:02,240 --> 00:19:04,600
Do you want to sign consent now,
or do you want some time
350
00:19:04,600 --> 00:19:06,280
to think it over? No, no, I've
351
00:19:06,280 --> 00:19:09,360
made up my mind, that's what
I'm going to do. Okey-doke.
352
00:19:26,800 --> 00:19:29,040
How are you feeling?
353
00:19:29,040 --> 00:19:31,960
OK, OK. It's a lot to take in
354
00:19:31,960 --> 00:19:35,280
in one, sort of,
short space of time.
355
00:19:35,280 --> 00:19:36,840
Was there a point where you thought,
356
00:19:36,840 --> 00:19:38,880
"Oh, maybe I won't?"
357
00:19:38,880 --> 00:19:41,760
It's always been the case of,
358
00:19:41,760 --> 00:19:44,840
"There's a possibility you might
have to have chemo."
359
00:19:44,840 --> 00:19:47,640
So, I think that's been
a lead into it, with it.
360
00:19:47,640 --> 00:19:50,520
It's not come as
a big shock to say,
361
00:19:50,520 --> 00:19:51,840
"Yeah, you've got to do it."
362
00:19:51,840 --> 00:19:56,280
I think if I don't go along
those lines, you know, my...
363
00:19:56,280 --> 00:19:58,480
The chances are it's going
to return,
364
00:19:58,480 --> 00:20:00,840
and I don't want that.
365
00:20:00,840 --> 00:20:04,080
I don't know, it's just all so much.
It's a lot, isn't it?
366
00:20:04,080 --> 00:20:07,520
It is a lot. It's one of those
things, isn't it?
367
00:20:07,520 --> 00:20:09,840
I know. It still sucks, though.
368
00:20:09,840 --> 00:20:12,200
Yeah. It still sucks.
369
00:20:09,840 --> 00:20:12,200
ANNE LAUGHS
370
00:20:14,880 --> 00:20:16,520
When I was talking to her outside,
371
00:20:16,520 --> 00:20:18,920
she was sort of saying,
"If I don't have the chemo,
372
00:20:18,920 --> 00:20:22,120
"it's overwhelmingly likely that
the cancer will come back."
373
00:20:22,120 --> 00:20:24,720
And I didn't, sort of, correct her.
374
00:20:27,920 --> 00:20:31,200
But I think that, like,
the difference that the chemo makes,
375
00:20:31,200 --> 00:20:34,640
even if it's not exactly 4%...
It's not as big as she thinks.
376
00:20:34,640 --> 00:20:36,120
No, exactly.
377
00:20:36,120 --> 00:20:38,120
It sort of sits slightly
more uncomfortably
378
00:20:38,120 --> 00:20:40,120
with you than it does with me.
379
00:20:40,120 --> 00:20:41,440
I'll tell you why.
380
00:20:41,440 --> 00:20:44,600
I've seen the cancers come back.
Of course.
381
00:20:44,600 --> 00:20:46,800
And I know that this is
a relatively gentle chemo
382
00:20:46,800 --> 00:20:48,120
and I can get her through it.
383
00:20:48,120 --> 00:20:50,840
And I know if that was somebody
that I cared about,
384
00:20:50,840 --> 00:20:53,320
I would 100% tell them to have it.
385
00:20:53,320 --> 00:20:54,520
I spend all my life trying
386
00:20:54,520 --> 00:20:56,880
to explain mathematical concepts
to people.
387
00:20:56,880 --> 00:20:58,520
And I know how hard it is, right?
388
00:20:58,520 --> 00:21:01,920
And I know how difficult this
concept is.
389
00:21:01,920 --> 00:21:04,240
And I'm not saying, even for
390
00:21:04,240 --> 00:21:07,120
a moment, that it would change
the path that she's on,
391
00:21:07,120 --> 00:21:09,480
change the decision that she's made.
392
00:21:09,480 --> 00:21:12,400
But I'm just thinking about
the patients who are taking chemo
393
00:21:12,400 --> 00:21:14,880
because they think it's their
only chance of survival
394
00:21:14,880 --> 00:21:18,320
without realising, actually,
it's making a very small difference.
395
00:21:18,320 --> 00:21:19,960
So, the thing is,
396
00:21:19,960 --> 00:21:23,000
I don't think philosophically
people can really deal
397
00:21:23,000 --> 00:21:27,360
with that level of complex thinking
and decision-making.
398
00:21:27,360 --> 00:21:31,280
I think people need confidence
in their decisions,
399
00:21:31,280 --> 00:21:34,400
and sometimes that requires
a more simplistic answer.
400
00:21:39,600 --> 00:21:41,600
I'm feeling conflicted.
401
00:21:41,600 --> 00:21:45,520
I'm uneasy that patients might not
see how small the benefits are,
402
00:21:45,520 --> 00:21:47,960
but I know what it's like
to be frightened,
403
00:21:47,960 --> 00:21:50,640
and just want a doctor
to take charge.
404
00:21:52,000 --> 00:21:54,120
Despite my swollen lymph nodes,
405
00:21:54,120 --> 00:21:56,720
I'm still hoping
to avoid chemotherapy,
406
00:21:56,720 --> 00:22:00,200
but my mum is urging
a more realistic approach.
407
00:22:00,200 --> 00:22:02,800
Mum had cancer when I was in school.
408
00:22:04,200 --> 00:22:06,360
This is why she doesn't give a shit.
409
00:22:06,360 --> 00:22:08,000
SHE LAUGHS
410
00:22:08,000 --> 00:22:11,120
Our family, though, so Mum's got
nine brothers and sisters -
411
00:22:11,120 --> 00:22:13,520
how many of them have not had cancer?
412
00:22:13,520 --> 00:22:16,760
THEY LAUGH
413
00:22:16,760 --> 00:22:19,760
You know like how some
families play rugby?
414
00:22:19,760 --> 00:22:21,040
Ours gets cancer.
415
00:22:22,160 --> 00:22:25,120
I was very worried about her when
I first heard the news.
416
00:22:25,120 --> 00:22:27,560
Yeah. When I first told you, though,
417
00:22:27,560 --> 00:22:30,600
I told it to you in
a very positive way. Yes, yeah.
418
00:22:30,600 --> 00:22:32,480
What, and you were still worried
about it?
419
00:22:32,480 --> 00:22:36,840
Well, I looked it up online. What
did you see when you looked it up?
420
00:22:36,840 --> 00:22:40,480
Well, if it's a hysterectomy
and if it's cancer,
421
00:22:40,480 --> 00:22:43,960
then it's chemo. In this country,
in the western world,
422
00:22:43,960 --> 00:22:46,200
they decide to do it.
423
00:22:46,200 --> 00:22:49,040
I don't know of anyone who's got
away without the chemo
424
00:22:49,040 --> 00:22:52,320
or the radio.
You just do your best to fight it.
425
00:22:52,320 --> 00:22:55,280
I've got a chance
of it not being, though. Yeah.
426
00:22:56,960 --> 00:22:58,640
So, just wait and see.
427
00:23:03,440 --> 00:23:05,000
Yeah, well done.
428
00:23:05,000 --> 00:23:08,520
They're full of lots of chemicals,
you see. What are chemicals?
429
00:23:08,520 --> 00:23:10,840
"What are chemicals?"
That's an excellent question,
430
00:23:10,840 --> 00:23:14,440
and probably one for your mum to
answer, I'd say, rather than me.
431
00:23:14,440 --> 00:23:15,840
If Hannah has chemotherapy,
432
00:23:15,840 --> 00:23:17,720
that's going to have, you know,
433
00:23:17,720 --> 00:23:20,960
dramatic implications on
a number of levels,
434
00:23:20,960 --> 00:23:22,920
from pragmatic levels
to emotional levels.
435
00:23:22,920 --> 00:23:26,680
I mean, the kids seeing her going
through that's
436
00:23:26,680 --> 00:23:29,920
going to be tough. Me seeing her go
through that is going to be tough.
437
00:23:29,920 --> 00:23:33,240
Hannah going through that is going
to be tough. What shall we play?
438
00:23:33,240 --> 00:23:36,560
All that really matters is
the emotional stability,
439
00:23:36,560 --> 00:23:38,520
which is the most important thing.
440
00:23:41,880 --> 00:23:44,600
I think the thing about cancer,
there's this point,
441
00:23:44,600 --> 00:23:47,400
there's this fork in the road,
442
00:23:47,400 --> 00:23:50,040
and it does come down
to something as simple
443
00:23:50,040 --> 00:23:52,680
as a few cancer cells in
the wrong place.
444
00:23:52,680 --> 00:23:54,840
Where, on one path, we have
445
00:23:54,840 --> 00:23:59,240
a very sick person at home,
potentially dying,
446
00:23:59,240 --> 00:24:02,800
and everything changes.
447
00:24:02,800 --> 00:24:05,400
And then the other fork,
which is...
448
00:24:07,040 --> 00:24:11,120
I get better, and we get to go
on with our lives.
449
00:24:16,920 --> 00:24:20,800
I'm still thinking about my
conversations with Judy and Anne,
450
00:24:20,800 --> 00:24:24,480
and how the numbers change as
cancer progresses.
451
00:24:24,480 --> 00:24:28,160
I want to understand why patients
decide to keep going with treatment,
452
00:24:28,160 --> 00:24:30,640
when the odds are stacked
against them.
453
00:24:34,400 --> 00:24:36,760
Online, I came across Nina,
454
00:24:36,760 --> 00:24:39,280
a 39-year-old fashion designer
455
00:24:39,280 --> 00:24:41,360
and mum from South London.
456
00:24:41,360 --> 00:24:45,600
I can't wait to go into
chemo tomorrow,
457
00:24:45,600 --> 00:24:47,880
having one more session,
458
00:24:47,880 --> 00:24:49,480
one more cycle.
459
00:24:52,160 --> 00:24:56,240
She's got a particularly
aggressive form of breast cancer
460
00:24:56,240 --> 00:24:58,160
that's now considered terminal.
461
00:25:00,000 --> 00:25:02,520
Women with her type
and stage of cancer
462
00:25:02,520 --> 00:25:07,240
have only a 12% chance
of living five years.
463
00:25:08,680 --> 00:25:10,440
Hi, how are you doing?
464
00:25:10,440 --> 00:25:13,600
Nice to meet you.
Lovely to meet you, thank you.
465
00:25:13,600 --> 00:25:14,920
Yeah, well, let's hug!
466
00:25:14,920 --> 00:25:17,120
Her chemo is often exhausting,
467
00:25:17,120 --> 00:25:20,560
and her life's been taken over
by medications.
468
00:25:22,600 --> 00:25:25,280
Wow, you weren't joking. Ha, no,
469
00:25:25,280 --> 00:25:28,840
there's... There's quite a lot.
470
00:25:28,840 --> 00:25:31,280
This is for...? This is every day?
471
00:25:31,280 --> 00:25:33,680
So much medication, isn't it?
472
00:25:33,680 --> 00:25:35,040
After chemo,
473
00:25:35,040 --> 00:25:39,320
I take these that help me
with anti-sickness. Yep.
474
00:25:39,320 --> 00:25:41,480
Now that I'm on my third cycle,
475
00:25:41,480 --> 00:25:44,160
I'm having to take
the pills more often
476
00:25:44,160 --> 00:25:47,160
because I just feel so bad.
477
00:25:47,160 --> 00:25:50,040
Yeah, so blood thinners,
478
00:25:50,040 --> 00:25:52,560
I have to take these.
That's an injection?
479
00:25:52,560 --> 00:25:56,320
Yeah, and I have to inject myself
every day,
480
00:25:56,320 --> 00:26:00,520
and every day it gets harder.
481
00:26:00,520 --> 00:26:03,200
Do you have to psyche
yourself up?
482
00:26:03,200 --> 00:26:06,160
Yeah. Yeah. I feel like my stomach
is getting more sensitive
483
00:26:06,160 --> 00:26:09,120
because I've had
so many months of it.
484
00:26:09,120 --> 00:26:11,160
And some days I just
want to push it in,
485
00:26:11,160 --> 00:26:13,000
but it hurts me. Yeah.
486
00:26:14,520 --> 00:26:16,080
Oh, gosh.
487
00:26:16,080 --> 00:26:22,200
And it's a big reminder that
I have cancer.
488
00:26:22,200 --> 00:26:26,480
It's a big reminder,
on my good days, that
489
00:26:26,480 --> 00:26:29,800
things are not normal.
490
00:26:29,800 --> 00:26:33,920
I mean, all of this is just such
a heavy price that you have to pay.
491
00:26:33,920 --> 00:26:37,600
Yeah, it feels like it.
It's the vomiting,
492
00:26:37,600 --> 00:26:39,440
it's the infections,
493
00:26:39,440 --> 00:26:42,800
it's the bleeding gums,
it's the nose bleeds.
494
00:26:42,800 --> 00:26:48,040
I've made a choice to have chemo,
and, you know,
495
00:26:48,040 --> 00:26:51,400
you can keep throwing anything
at me.
496
00:26:51,400 --> 00:26:55,680
As long as I know that I have
a percentage in there
497
00:26:55,680 --> 00:26:59,280
of it working, I will do it.
You know,
498
00:26:59,280 --> 00:27:01,080
I've committed myself to it.
499
00:27:01,080 --> 00:27:02,960
Do you sort of feel in a way like
500
00:27:02,960 --> 00:27:07,200
you're paying with this three
months now and in return,
501
00:27:07,200 --> 00:27:08,960
hopefully, you get a couple of
years?
502
00:27:08,960 --> 00:27:12,240
Yeah. It's like a price, a trade.
503
00:27:12,240 --> 00:27:14,120
Yes, it feels like a trade.
504
00:27:14,120 --> 00:27:17,120
Yes, there's just no guarantee.
505
00:27:17,120 --> 00:27:19,640
You have to have the treatment
506
00:27:19,640 --> 00:27:21,360
and hope for the best.
507
00:27:21,360 --> 00:27:24,320
A lot of it is hope,
and I'm hopeful.
508
00:27:24,320 --> 00:27:31,400
Do those stories of real miracles
where people had stage four cancer,
509
00:27:31,400 --> 00:27:32,760
things look really bad,
510
00:27:32,760 --> 00:27:36,240
and then, somehow or other,
their tumours shrank
511
00:27:36,240 --> 00:27:39,920
and they managed to go on
and live these very long,
512
00:27:39,920 --> 00:27:42,440
healthy lives, do they play on your
mind, those stories?
513
00:27:42,440 --> 00:27:44,480
All the time. Do they?
514
00:27:44,480 --> 00:27:46,880
Yeah, I think I'm
going to be one of those stories.
515
00:27:46,880 --> 00:27:48,600
I really believe.
516
00:27:48,600 --> 00:27:54,760
And how do you feel about...
thinking about the end? Are you...
517
00:27:54,760 --> 00:27:58,000
Do you think that you've accepted
what's going on?
518
00:27:59,720 --> 00:28:02,960
Yes, and no.
519
00:27:59,720 --> 00:28:02,960
SHE CHUCKLES
520
00:28:02,960 --> 00:28:04,640
But, yeah, right now,
521
00:28:04,640 --> 00:28:08,120
my heart does not see death.
522
00:28:08,120 --> 00:28:10,440
My heart does not see the end.
523
00:28:10,440 --> 00:28:11,840
Your heart sees those stories.
524
00:28:11,840 --> 00:28:14,560
My heart sees those stories of hope
525
00:28:14,560 --> 00:28:16,720
and I know I'm going to live,
526
00:28:16,720 --> 00:28:19,680
and I'm not going to die.
527
00:28:19,680 --> 00:28:23,000
There's no reason why I can't be
one of those people.
528
00:28:23,000 --> 00:28:24,240
So...
529
00:28:27,560 --> 00:28:31,080
Good luck. Thank you.
530
00:28:33,160 --> 00:28:35,560
One thing she said really stood out
to me,
531
00:28:35,560 --> 00:28:39,920
where she said that she would
have chemo even if it was 1%,
532
00:28:39,920 --> 00:28:43,880
even if there was a 1% chance that
chemo would buy her more time,
533
00:28:43,880 --> 00:28:45,120
she would take it.
534
00:28:47,920 --> 00:28:51,240
And that seems pretty incredible
to me.
535
00:28:51,240 --> 00:28:56,360
Are you risking, sacrificing,
really more than you should?
536
00:28:56,360 --> 00:29:00,200
Rather than just enjoying what
you have left?
537
00:29:01,760 --> 00:29:03,400
I think that's what the danger is.
538
00:29:03,400 --> 00:29:06,480
And I don't think she's there yet
but I think that there is...
539
00:29:06,480 --> 00:29:10,040
I don't always think that hope
is a good thing.
540
00:29:10,040 --> 00:29:13,480
I think there are some times where
it can be a bit counterproductive.
541
00:29:14,560 --> 00:29:17,000
Because it's unrealistic? Yeah.
542
00:29:19,000 --> 00:29:21,200
Yeah, or because... Because...
543
00:29:21,200 --> 00:29:22,720
Because you're so focused on
544
00:29:22,720 --> 00:29:25,560
the best possible thing that
could happen
545
00:29:25,560 --> 00:29:28,880
that you fail to prepare
for what really is happening.
546
00:29:41,600 --> 00:29:44,480
In fact, patients will often go
through treatment with
547
00:29:44,480 --> 00:29:47,160
a very low chance of success.
548
00:29:47,160 --> 00:29:51,160
One study showed that over
a third of terminal cancer patients
549
00:29:51,160 --> 00:29:53,480
would undergo treatment even if
there was only
550
00:29:53,480 --> 00:29:57,760
a 0.1% chance it
would prolong their life.
551
00:29:57,760 --> 00:29:59,920
But the doctors who treat them,
if they were
552
00:29:59,920 --> 00:30:01,560
to have cancer themselves,
553
00:30:01,560 --> 00:30:04,320
say they would refuse treatment
unless it had
554
00:30:04,320 --> 00:30:08,280
at least a 25% chance of working.
555
00:30:08,280 --> 00:30:12,120
Nina is clearly not alone in her
dedication to hope,
556
00:30:12,120 --> 00:30:13,680
but I can't help but wonder
557
00:30:13,680 --> 00:30:16,320
what kind of information gap
we've created,
558
00:30:16,320 --> 00:30:18,680
where the very people offering
a treatment
559
00:30:18,680 --> 00:30:21,000
wouldn't want it for themselves.
560
00:30:23,400 --> 00:30:24,680
Big day.
561
00:30:29,960 --> 00:30:31,560
Got about 20 minutes.
562
00:30:34,680 --> 00:30:35,720
SIGHS
563
00:30:35,720 --> 00:30:38,800
Then I'm getting in the car
to go to the hospital to find out...
564
00:30:42,400 --> 00:30:44,880
..what the situation is, basically,
565
00:30:44,880 --> 00:30:47,520
to find out what they found in
the lymph nodes,
566
00:30:47,520 --> 00:30:49,160
to find out...
567
00:30:52,720 --> 00:30:57,560
..whether I need to have chemo
or...
568
00:31:02,800 --> 00:31:07,440
..whether the surgery did
the job of getting everything out.
569
00:31:14,280 --> 00:31:16,960
You just don't have any control
or any choice
570
00:31:16,960 --> 00:31:18,760
over what's going to happen.
571
00:31:45,400 --> 00:31:46,960
So how are you, Hannah?
572
00:31:46,960 --> 00:31:48,400
Yeah, all right. Good.
573
00:31:50,480 --> 00:31:53,360
So, you're obviously waiting to hear
what the results are.
574
00:31:53,360 --> 00:31:56,000
We're putting you through misery.
I know.
575
00:32:01,720 --> 00:32:03,120
I'll tell you in the car.
576
00:32:09,720 --> 00:32:11,000
SHE LAUGHS WITH RELIEF
577
00:32:11,000 --> 00:32:12,720
Yes?
578
00:32:12,720 --> 00:32:14,800
HE LAUGHS
579
00:32:12,720 --> 00:32:14,800
Gone?
580
00:32:20,160 --> 00:32:22,880
Oh, my God, really?
581
00:32:22,880 --> 00:32:25,000
Oh, fucking brilliant!
582
00:32:27,600 --> 00:32:29,080
Oh, baby!
583
00:32:31,240 --> 00:32:32,920
Oh, my God.
584
00:32:32,920 --> 00:32:35,200
Oh, God.
585
00:32:37,200 --> 00:32:39,720
Oh, God. Oh, my God.
586
00:32:42,440 --> 00:32:45,280
That's amazing.
So go on. Tell me, tell me. Tell me.
587
00:32:45,280 --> 00:32:48,400
It's done. Absolutely done?
It's done.
588
00:32:48,400 --> 00:32:50,000
Oh, God.
589
00:32:51,800 --> 00:32:53,280
Jesus Christ.
590
00:32:54,400 --> 00:32:55,760
Oh, thank God.
591
00:32:57,000 --> 00:33:00,160
But they said that all
the lymph nodes came back negative.
592
00:33:03,640 --> 00:33:06,040
And he was like, "Can't guarantee."
593
00:33:06,040 --> 00:33:09,600
You know, "This isn't, like, 100%
like, you know, this isn't, like,
594
00:33:09,600 --> 00:33:12,960
"a guarantee that it's never come
back again, but, like..."
595
00:33:12,960 --> 00:33:14,600
Bloody hell.
596
00:33:14,600 --> 00:33:15,880
Great.
597
00:33:16,960 --> 00:33:19,120
Getting drunk tonight. Fuck, yeah.
598
00:33:21,600 --> 00:33:23,040
Woo!
599
00:33:32,160 --> 00:33:33,400
CHILDREN PLAYING
600
00:33:36,360 --> 00:33:37,800
Pleased with you.
601
00:33:40,320 --> 00:33:43,080
Well done, well done.
602
00:33:44,360 --> 00:33:46,600
It's the best possible news.
603
00:33:48,600 --> 00:33:52,080
But there's still a one in ten
chance that my cancer will come back.
604
00:33:53,400 --> 00:33:54,600
Have you had dinner?
605
00:33:54,600 --> 00:33:56,840
Yeah, we did. What did you have?
606
00:33:56,840 --> 00:33:59,560
Daddy? Daddy?
607
00:34:03,520 --> 00:34:06,320
A few months later,
there's a problem.
608
00:34:07,720 --> 00:34:10,760
I've started to notice swelling
in my legs.
609
00:34:11,920 --> 00:34:13,360
If I'm not careful,
610
00:34:13,360 --> 00:34:17,000
my right leg swells up
611
00:34:17,000 --> 00:34:19,280
to be much bigger than
the left-hand side.
612
00:34:19,280 --> 00:34:23,560
It's caused by a side-effect of my
surgery called lymphedema,
613
00:34:23,560 --> 00:34:26,720
where excess fluid builds up
in your limbs.
614
00:34:26,720 --> 00:34:27,800
It's grim, innit?
615
00:34:29,240 --> 00:34:31,640
You have this system called your
lymphatic system,
616
00:34:31,640 --> 00:34:33,480
and it's like little tubes
617
00:34:33,480 --> 00:34:37,960
and channels that are drawing fluid
away from all parts of your body,
618
00:34:37,960 --> 00:34:40,720
and then bringing it upwards towards
your heart.
619
00:34:40,720 --> 00:34:43,720
Now, along those tubes,
620
00:34:43,720 --> 00:34:45,840
you have these little things
called nodes.
621
00:34:45,840 --> 00:34:49,720
When they were doing my surgery,
622
00:34:49,720 --> 00:34:52,080
because they were concerned about
cancer being in
623
00:34:52,080 --> 00:34:54,120
the lymph nodes,
they chopped them all out.
624
00:34:54,120 --> 00:34:56,880
And so now the fluid just,
essentially, leaks out
625
00:34:56,880 --> 00:34:58,960
and collects in my leg.
626
00:35:06,400 --> 00:35:09,200
My devilishly sexy tights!
627
00:35:09,200 --> 00:35:13,640
They're compression garments, so, um,
628
00:35:13,640 --> 00:35:19,560
they just help stop all of
the fluid building up, basically.
629
00:35:19,560 --> 00:35:21,760
So, they're really tight down
the bottom,
630
00:35:21,760 --> 00:35:25,720
and then they're slightly less tight
as you go further up.
631
00:35:25,720 --> 00:35:29,560
But the idea is that they just
keep the swelling down.
632
00:35:29,560 --> 00:35:34,120
So, you have to wear them all day,
every day.
633
00:35:34,120 --> 00:35:36,920
You really do? Yeah,
even on the beach.
634
00:35:38,640 --> 00:35:41,640
It just feels very sensitive
to the touch.
635
00:35:41,640 --> 00:35:45,800
It just feels very full
and sort of tight.
636
00:35:45,800 --> 00:35:47,800
It's not painful.
637
00:35:50,360 --> 00:35:53,800
It's not, like, excruciating agony.
It's just really uncomfortable.
638
00:36:03,440 --> 00:36:05,520
The problem with lymphedema
639
00:36:05,520 --> 00:36:08,760
is that you have no idea how
quickly it's going to progress.
640
00:36:08,760 --> 00:36:12,000
It could be that it happens over
the course of a few weeks or months.
641
00:36:12,000 --> 00:36:13,800
I mean, it really can be that quick.
642
00:36:15,040 --> 00:36:16,440
Come on.
643
00:36:17,760 --> 00:36:20,840
I have got really upset about
it because, you know,
644
00:36:20,840 --> 00:36:24,640
you can't be upright
for sustained periods of time.
645
00:36:24,640 --> 00:36:27,040
There was one evening I was like,
"Right, I'm
646
00:36:27,040 --> 00:36:29,120
"going to do some baking
with my daughter,"
647
00:36:29,120 --> 00:36:31,920
and ended up standing up
for a while.
648
00:36:31,920 --> 00:36:35,000
And then finally, like,
649
00:36:35,000 --> 00:36:37,120
sat down and put my feet up
and like,
650
00:36:37,120 --> 00:36:39,640
literally, my leg,
it was like a balloon.
651
00:36:39,640 --> 00:36:41,800
It was, like, incredible.
This thing
652
00:36:41,800 --> 00:36:45,200
just, like, basically expanding,
like, under your hands.
653
00:36:46,600 --> 00:36:50,160
I just don't have that view of
myself in the future. You know?
654
00:36:50,160 --> 00:36:53,160
Like, I don't see myself as, like,
in my 50s
655
00:36:53,160 --> 00:36:56,600
with, like, one giant leg, like,
656
00:36:56,600 --> 00:37:00,280
unable to walk 100 metres or, like,
657
00:37:00,280 --> 00:37:02,600
unable to work, even.
658
00:37:08,680 --> 00:37:11,160
When we are facing something that
feels like it's
659
00:37:11,160 --> 00:37:14,320
a really terrible enemy,
like cancer,
660
00:37:14,320 --> 00:37:20,120
we have this bias towards just
trying to get rid of
661
00:37:20,120 --> 00:37:22,720
the overarching concern,
662
00:37:22,720 --> 00:37:24,400
and worry about side-effects later.
663
00:37:24,400 --> 00:37:26,320
Maybe we are too willing
664
00:37:26,320 --> 00:37:29,360
to just do treatment at any cost just
665
00:37:29,360 --> 00:37:32,520
because it feels like we're
doing something.
666
00:37:35,520 --> 00:37:38,400
It's estimated up
to 400,000 people
667
00:37:38,400 --> 00:37:40,920
in the UK have lymphedema.
668
00:37:40,920 --> 00:37:42,720
After a radical hysterectomy,
669
00:37:42,720 --> 00:37:45,760
there's a one-in-four chance
of getting it.
670
00:37:48,640 --> 00:37:53,040
There's limited treatment for
lymphedema available on the NHS,
671
00:37:53,040 --> 00:37:57,160
so I'm going to see a private
lymphedema surgeon, Alex Ramsden.
672
00:37:57,160 --> 00:37:59,280
They did the radical hysterectomy.
673
00:37:59,280 --> 00:38:04,880
OK. And they took out everything,
and then a bit more.
674
00:38:04,880 --> 00:38:08,120
Right. When you say everything,
so there was a hysterectomy?
675
00:38:08,120 --> 00:38:11,880
Yeah, and the nodes. And it was...
The lymph nodes.
676
00:38:11,880 --> 00:38:13,400
So that's really important.
677
00:38:13,400 --> 00:38:15,640
So, they took out the common
lymph nodes,
678
00:38:15,640 --> 00:38:19,120
they took out the interior iliac.
679
00:38:19,120 --> 00:38:22,440
Yep. The exterior iliac. Right.
680
00:38:22,440 --> 00:38:25,640
And they also took out
the...obturator?
681
00:38:25,640 --> 00:38:28,560
Obturator, I was just going to
say obturator. Is that quite a lot?
682
00:38:32,080 --> 00:38:35,600
Yes. So I'm not a gynaecologist.
Of course. OK?
683
00:38:35,600 --> 00:38:37,880
But they are often very aggressive
684
00:38:37,880 --> 00:38:39,800
with this sort of tumour,
685
00:38:39,800 --> 00:38:42,320
and they often take out
a lot of nodes,
686
00:38:42,320 --> 00:38:44,360
and it's very difficult to know,
687
00:38:44,360 --> 00:38:48,520
before you start, whether they're
going to be positive or negative.
688
00:38:48,520 --> 00:38:51,400
One of the problems with lymphedema,
as you will come across,
689
00:38:51,400 --> 00:38:53,560
is not many people know much
about it.
690
00:38:53,560 --> 00:38:55,880
People mention the word cancer
and everybody hears,
691
00:38:55,880 --> 00:38:57,920
"Cancer, cancer, cancer, cancer,
cancer."
692
00:38:57,920 --> 00:39:00,080
Patients have this massive
treatment,
693
00:39:00,080 --> 00:39:02,360
and they have all this investment
of time and care
694
00:39:02,360 --> 00:39:03,640
and effort, and that's great.
695
00:39:03,640 --> 00:39:06,600
But then you're left with something
that is only going to get worse.
696
00:39:06,600 --> 00:39:08,760
You've got it for
the rest of your life.
697
00:39:08,760 --> 00:39:10,840
"Here's a stocking."
"Here's a stocking."
698
00:39:10,840 --> 00:39:13,120
And everyone goes,
"That's really rubbish,"
699
00:39:13,120 --> 00:39:16,760
so it's a very common thing that
people get very upset
700
00:39:16,760 --> 00:39:19,920
and more traumatised by
the lymphedema than they do
701
00:39:19,920 --> 00:39:21,560
by the cancer sometimes.
702
00:39:31,680 --> 00:39:33,200
SNIFFLES
703
00:39:33,200 --> 00:39:35,120
I'm really sorry.
704
00:39:40,480 --> 00:39:43,200
It's just quite hard
to hear someone articulate it.
705
00:39:46,840 --> 00:39:48,040
OK.
706
00:39:49,960 --> 00:39:54,280
So, we've kind of got to
the nub of it quite quickly.
707
00:39:54,280 --> 00:39:57,880
I don't really know if there
was a choice,
708
00:39:57,880 --> 00:39:59,800
and now there's this, like,
709
00:39:59,800 --> 00:40:03,680
lifelong sort of sentence,
as it were,
710
00:40:03,680 --> 00:40:08,760
of, like, what could be
a genuinely, like, debilitating,
711
00:40:08,760 --> 00:40:11,760
life-changing condition.
There might not have been options.
712
00:40:11,760 --> 00:40:14,200
You might have had to do it. Yep.
713
00:40:18,520 --> 00:40:20,480
It will be a little bit stingy,
714
00:40:20,480 --> 00:40:22,080
and I apologise in advance.
715
00:40:22,080 --> 00:40:26,120
Alex is injecting dye into my
lymph vessels
716
00:40:26,120 --> 00:40:28,480
and using an infra-red camera
to determine
717
00:40:28,480 --> 00:40:30,880
the extent of my lymphedema.
718
00:40:32,280 --> 00:40:34,520
This is the fluid that's trying
to get out of your leg.
719
00:40:34,520 --> 00:40:36,400
It can't go through your pelvis.
Yeah.
720
00:40:36,400 --> 00:40:38,560
So it's now going onto your
tummy wall.
721
00:40:38,560 --> 00:40:40,880
That's why you're getting
fullness of your tummy wall.
722
00:40:40,880 --> 00:40:44,920
So, this is the bit that gets really,
like, thick, basically. Right.
723
00:40:47,960 --> 00:40:52,000
God, it's, like, a whole galaxy!
724
00:40:47,960 --> 00:40:52,000
SHE CHUCKLES
725
00:40:55,920 --> 00:40:59,560
The right leg is really good,
726
00:40:59,560 --> 00:41:02,440
all the way up to where you
describe, which is the upper thigh,
727
00:41:02,440 --> 00:41:05,400
when you're starting to get those
dermal back flow patterns
728
00:41:05,400 --> 00:41:08,640
overflow onto your abdominal wall,
and that is lymphedema,
729
00:41:08,640 --> 00:41:13,320
but it's the very earliest stage
of lymphedema that you have. OK.
730
00:41:15,040 --> 00:41:16,360
Because you're really early,
731
00:41:16,360 --> 00:41:18,840
what you're trying to
do is stop it getting worse.
732
00:41:18,840 --> 00:41:21,960
If it stays like this forever,
that's fine. Right.
733
00:41:21,960 --> 00:41:24,200
It might stay the same
for the next 20 years.
734
00:41:24,200 --> 00:41:25,320
I don't know.
735
00:41:26,600 --> 00:41:28,480
Most likely,
it's going to get worse.
736
00:41:37,480 --> 00:41:39,360
Am I asking for a bit too much?
I don't know,
737
00:41:39,360 --> 00:41:41,080
maybe I am,
maybe I'm being a bit greedy.
738
00:41:41,080 --> 00:41:43,320
It's, like, I was in
a position where someone had
739
00:41:43,320 --> 00:41:46,800
to take stuff out
to save my life, right? I know that.
740
00:41:46,800 --> 00:41:49,200
I just... Maybe I am being
a bit greedy to be, like,
741
00:41:49,200 --> 00:41:50,920
"Is it too much to ask that
742
00:41:50,920 --> 00:41:54,680
"I wasn't left with
a lifelong chronic condition?"
743
00:41:56,880 --> 00:42:00,360
Only half of cancer patients feel
that long-term side-effects
744
00:42:00,360 --> 00:42:04,920
of treatment are fully explained
to them. At the moment,
745
00:42:04,920 --> 00:42:08,440
the way that these side-effects
and statistics are given,
746
00:42:08,440 --> 00:42:12,000
it's like...reeled off like
a list of numbers.
747
00:42:12,000 --> 00:42:14,400
I'm not saying for a second
that these treatments
748
00:42:14,400 --> 00:42:15,760
aren't a good thing,
749
00:42:15,760 --> 00:42:18,760
I just think that people should
be given...
750
00:42:20,640 --> 00:42:21,880
..the opportunity
751
00:42:21,880 --> 00:42:25,200
to understand what they're
really signing up for.
752
00:42:29,240 --> 00:42:31,040
Life-changing decisions are so hard
753
00:42:31,040 --> 00:42:33,680
to make when you're in
the middle of a crisis.
754
00:42:36,520 --> 00:42:40,440
But if you're not part of deciding
what risks are worth taking,
755
00:42:40,440 --> 00:42:43,960
cancer care can end up feeling like
something that's done TO you.
756
00:42:43,960 --> 00:42:45,320
Not with you.
757
00:42:48,920 --> 00:42:52,440
I keep thinking about how this
all started,
758
00:42:52,440 --> 00:42:54,520
the smear test that I put off,
759
00:42:54,520 --> 00:42:57,320
and the one that later found
my cancer.
760
00:43:00,840 --> 00:43:02,560
That's the smear test letter,
761
00:43:02,560 --> 00:43:04,320
the one that I missed.
762
00:43:06,920 --> 00:43:10,240
And then there's the one that they
sent as the follow-up.
763
00:43:18,800 --> 00:43:20,760
What happened...
764
00:43:22,400 --> 00:43:25,360
..in my body that I didn't know
about between then and then?
765
00:43:26,920 --> 00:43:29,600
And what would they have found
if I'd gone to that one?
766
00:43:34,160 --> 00:43:37,640
The cervical screening programme
is one of only three screening tests
767
00:43:37,640 --> 00:43:39,240
offered by the NHS,
768
00:43:39,240 --> 00:43:42,720
along with breast and bowel cancer
for those over 50.
769
00:43:52,520 --> 00:43:54,400
The NHS estimates that their
770
00:43:54,400 --> 00:44:00,120
cervical screening programme saves
around 5,000 lives every year.
771
00:44:00,120 --> 00:44:03,160
But even screening provokes debate.
772
00:44:05,000 --> 00:44:07,800
I'm in Glasgow to meet
Dr Margaret McCartney.
773
00:44:07,800 --> 00:44:09,880
She's a GP and an honorary fellow
774
00:44:09,880 --> 00:44:13,680
at the Centre for Evidence-Based
Medicine.
775
00:44:13,680 --> 00:44:15,960
She wants to tell me about some
research that turns
776
00:44:15,960 --> 00:44:20,360
the tables on what we think we
know about cancer.
777
00:44:20,360 --> 00:44:21,960
So, when I was at medical school,
778
00:44:21,960 --> 00:44:24,760
very much you were taught that
cancer is a bad thing,
779
00:44:24,760 --> 00:44:26,880
and certainly very often it is
a bad thing.
780
00:44:26,880 --> 00:44:29,240
It's something you would
want to know about and treat,
781
00:44:29,240 --> 00:44:31,200
but it's more complicated than
that as well.
782
00:44:31,200 --> 00:44:33,840
We know that there are many people
who've got
783
00:44:33,840 --> 00:44:37,040
a cancer in their bodies that they
would not have known about had they
784
00:44:37,040 --> 00:44:38,520
not gone to get tested for it,
785
00:44:38,520 --> 00:44:40,600
and they would never have known
about it
786
00:44:40,600 --> 00:44:42,880
because it wasn't
a cancer that was destined
787
00:44:42,880 --> 00:44:45,240
to spread or to kill them or
to cause problems.
788
00:44:45,240 --> 00:44:46,720
Is this quite a rare thing, though,
789
00:44:46,720 --> 00:44:50,200
that people have cancers that won't
go on to kill them?
790
00:44:50,200 --> 00:44:52,160
There's a background that's useful,
which is
791
00:44:52,160 --> 00:44:54,640
that there have been
a lot of autopsy studies done over
792
00:44:54,640 --> 00:44:57,560
the last few decades,
where people have examined
793
00:44:57,560 --> 00:45:02,640
the tissues of individuals who have
died suddenly and unexpectedly,
794
00:45:02,640 --> 00:45:05,480
usually road traffic accidents.
So, they've had a sudden death,
795
00:45:05,480 --> 00:45:07,760
and these people weren't being
treated for cancer.
796
00:45:07,760 --> 00:45:09,640
They weren't being investigated
for cancer.
797
00:45:09,640 --> 00:45:13,040
They didn't have symptoms that we
knew about that would suggest cancer
798
00:45:13,040 --> 00:45:14,560
and the tissues have been examined
799
00:45:14,560 --> 00:45:20,400
but have found cancer in around
about 7% of cases. 7%?
800
00:45:20,400 --> 00:45:21,560
Yeah, yeah.
801
00:45:21,560 --> 00:45:26,120
This does seem like quite
an astonishing thing to say.
802
00:45:26,120 --> 00:45:28,680
It's a really weird thing to try
and think about
803
00:45:28,680 --> 00:45:31,240
because it runs counter
to everything that we're taught
804
00:45:31,240 --> 00:45:33,520
and we're told.
If you go and look for cancer,
805
00:45:33,520 --> 00:45:35,880
you will find cancer.
There's no question about that,
806
00:45:35,880 --> 00:45:37,200
so if you go and put, you know,
807
00:45:37,200 --> 00:45:39,840
hundreds of people through
a CT scanner or an MRI scanner,
808
00:45:39,840 --> 00:45:42,880
you will find cancers that they
had no symptoms of,
809
00:45:42,880 --> 00:45:44,360
they didn't have any inkling about.
810
00:45:44,360 --> 00:45:46,160
The big question is whether that
cancer was
811
00:45:46,160 --> 00:45:49,240
going to go on and do that
person harm.
812
00:45:49,240 --> 00:45:52,960
Some of the studies using
MRIs put this number slightly lower,
813
00:45:52,960 --> 00:45:54,320
but we do know that there is
814
00:45:54,320 --> 00:45:57,880
a pool of undiagnosed tumours
out there.
815
00:45:58,880 --> 00:46:01,600
But to discover whether those
cancers will cause harm,
816
00:46:01,600 --> 00:46:04,240
Margaret wanted
to show me something extraordinary
817
00:46:04,240 --> 00:46:08,720
that reveals why hunting for cancer
cells isn't always a good thing.
818
00:46:08,720 --> 00:46:13,200
So, this is a graph of what happened
in South Korea when they decided
819
00:46:13,200 --> 00:46:17,240
to offer the population screening
for thyroid cancer,
820
00:46:17,240 --> 00:46:20,480
and they started
to screen people just in 1999.
821
00:46:20,480 --> 00:46:23,400
So, you'll see that, as they started
to screen for thyroid cancer,
822
00:46:23,400 --> 00:46:27,320
they found more and more
and more and more thyroid cancer.
823
00:46:27,320 --> 00:46:28,960
But what you really need to know is,
824
00:46:28,960 --> 00:46:31,040
does this make a difference
to death rates?
825
00:46:31,040 --> 00:46:33,160
Look at the orange line
down the bottom,
826
00:46:33,160 --> 00:46:35,840
and you'll see that
the mortality is a flatline.
827
00:46:35,840 --> 00:46:38,120
This is a classic graph
showing overdiagnosis,
828
00:46:38,120 --> 00:46:40,680
because what you're doing is
you're diagnosing more
829
00:46:40,680 --> 00:46:42,600
and more and more thyroid cancer,
830
00:46:42,600 --> 00:46:44,840
but you're not making any
difference to death rates.
831
00:46:44,840 --> 00:46:47,240
If you get diagnosed with thyroid
cancer, what happens?
832
00:46:47,240 --> 00:46:49,680
What is the treatment for it?
It's all in the neck, isn't it?
833
00:46:49,680 --> 00:46:52,040
Yeah, that's right. It's your
thyroid gland around here.
834
00:46:52,040 --> 00:46:55,000
You're going to be offered surgery,
you might be offered radiotherapy,
835
00:46:55,000 --> 00:46:57,360
you might have to go into long-term
treatment after that,
836
00:46:57,360 --> 00:46:58,600
so lots of interventions.
837
00:46:58,600 --> 00:47:01,560
So, there will be some people who've
had surgery on their necks
838
00:47:01,560 --> 00:47:03,720
that they didn't need?
Totally, absolutely.
839
00:47:03,720 --> 00:47:06,040
If you're not
going to benefit from a treatment,
840
00:47:06,040 --> 00:47:08,160
all it can possibly do is give
you side-effects.
841
00:47:08,160 --> 00:47:11,680
I guess, in the UK,
for something like thyroid cancer,
842
00:47:11,680 --> 00:47:13,000
we don't screen... Yeah.
843
00:47:13,000 --> 00:47:16,120
..but then there are other types
of cancer where we do.
844
00:47:16,120 --> 00:47:18,160
Like breast cancer, for example.
845
00:47:18,160 --> 00:47:20,920
So, in that case, then,
is the equation flipped?
846
00:47:20,920 --> 00:47:24,160
Is it very obvious that there's
a benefit to do it?
847
00:47:24,160 --> 00:47:27,160
Well, I'd love to say that
there was, but it is more complex.
848
00:47:27,160 --> 00:47:29,840
So the government have made
a decision that it's cost-effective
849
00:47:29,840 --> 00:47:31,680
to offer it to women.
So, the Marmot Review
850
00:47:31,680 --> 00:47:33,880
looked at the evidence around
this a few years ago
851
00:47:33,880 --> 00:47:35,040
and they concluded that,
852
00:47:35,040 --> 00:47:37,960
for every 200 women that had
breast cancer screening,
853
00:47:37,960 --> 00:47:40,000
you would delay
the death of one woman,
854
00:47:40,000 --> 00:47:43,080
but at the cost
of three women being over-treated
855
00:47:43,080 --> 00:47:46,880
for breast cancer.
And when you say overtreated,
856
00:47:46,880 --> 00:47:51,160
are those the type
of women who have cancer,
857
00:47:51,160 --> 00:47:52,600
but don't know about it,
858
00:47:52,600 --> 00:47:55,720
and it's not really
going to go on to cause a problem,
859
00:47:55,720 --> 00:47:58,440
and yet they're having things
like mastectomies
860
00:47:58,440 --> 00:48:00,960
and biopsies, and all of the
concerns around those?
861
00:48:00,960 --> 00:48:03,040
Yeah, that's exactly right.
So, these are people
862
00:48:03,040 --> 00:48:05,640
that would never have come to the
attention of a doctor
863
00:48:05,640 --> 00:48:08,360
had they not had the tests done.
So, what you're saying,
864
00:48:08,360 --> 00:48:10,720
it's good for this group
of women overall,
865
00:48:10,720 --> 00:48:12,320
but, sorry, you're the unlucky one,
866
00:48:12,320 --> 00:48:14,200
and you're the unlucky one,
and so are you.
867
00:48:14,200 --> 00:48:16,480
But the problem is that those women
will never know
868
00:48:16,480 --> 00:48:17,640
that they've been unlucky.
869
00:48:17,640 --> 00:48:20,160
And this is the really big problem
because the temptation is,
870
00:48:20,160 --> 00:48:22,840
for every single woman who's been
detected as having a problem,
871
00:48:22,840 --> 00:48:24,840
to think that she has been
diagnosed early
872
00:48:24,840 --> 00:48:27,360
and that her life has been made
better because of that.
873
00:48:27,360 --> 00:48:29,520
But you just don't know that -
you don't know which
874
00:48:29,520 --> 00:48:30,800
of those women that you are.
875
00:48:30,800 --> 00:48:33,520
Whether you're the woman that
actually did get a benefit,
876
00:48:33,520 --> 00:48:35,800
or whether you're the majority
of women that actually
877
00:48:35,800 --> 00:48:37,440
didn't get benefit from treatment.
878
00:48:37,440 --> 00:48:40,520
Do you think it is
a big problem that you have
879
00:48:40,520 --> 00:48:43,800
those three women in 200
being overtreated?
880
00:48:43,800 --> 00:48:47,160
Well, I suppose I wouldn't be
the person to judge that.
881
00:48:47,160 --> 00:48:49,200
It would be those individual women
to judge that.
882
00:48:49,200 --> 00:48:50,960
So, if you have breast
cancer screening,
883
00:48:50,960 --> 00:48:53,400
I think you should decide
for yourself whether you think
884
00:48:53,400 --> 00:48:55,360
that that risk is worth it
or not worth it.
885
00:48:55,360 --> 00:48:57,600
You know, are you happy with that
risk yourself?
886
00:49:00,920 --> 00:49:04,800
Cancer screening saves thousands
of lives every year,
887
00:49:04,800 --> 00:49:08,280
but it's important to acknowledge
that this is not without cost.
888
00:49:09,800 --> 00:49:14,400
There's like this fundamental
disconnect, really,
889
00:49:14,400 --> 00:49:16,480
between what the numbers say
890
00:49:16,480 --> 00:49:19,280
and what it actually feels like
when you're the number.
891
00:49:21,320 --> 00:49:24,120
Because, of course, you can look at
all those statistics and say,
892
00:49:24,120 --> 00:49:26,280
"Oh, that is pretty terrible
893
00:49:26,280 --> 00:49:28,880
"that people are having these
life-changing surgeries
894
00:49:28,880 --> 00:49:33,640
"that they don't need,
that they never had to go through."
895
00:49:33,640 --> 00:49:36,600
But then, at the same time,
896
00:49:36,600 --> 00:49:38,560
having been diagnosed
with cancer,
897
00:49:38,560 --> 00:49:40,360
I know in that moment...
898
00:49:43,800 --> 00:49:46,720
..I just wanted to get rid of it.
899
00:49:46,720 --> 00:49:48,760
I just wanted to get rid of it.
900
00:49:48,760 --> 00:49:51,440
It wouldn't really have mattered
what the numbers said.
901
00:50:00,040 --> 00:50:04,160
There are no easy choices
in any of this.
902
00:50:04,160 --> 00:50:07,680
Turning down treatment wasn't
right for me,
903
00:50:07,680 --> 00:50:10,360
but that's not the case
for everyone.
904
00:50:11,680 --> 00:50:12,720
I'm leaving...
905
00:50:14,880 --> 00:50:16,840
..St James's.
906
00:50:20,240 --> 00:50:22,440
Three surgeries,
907
00:50:22,440 --> 00:50:25,160
50 sessions of radiotherapy,
908
00:50:25,160 --> 00:50:28,480
six rounds of chemotherapy.
909
00:50:33,440 --> 00:50:35,600
And I've just told them
no more treatment.
910
00:50:41,880 --> 00:50:43,920
Rob is a climbing wall inspector
911
00:50:43,920 --> 00:50:45,880
and dad to four-year-old Caleb.
912
00:50:46,960 --> 00:50:51,240
He has a cancer of the soft tissue
called synovial sarcoma,
913
00:50:51,240 --> 00:50:53,480
and it's terminal.
914
00:50:53,480 --> 00:50:55,760
I went to Yorkshire to meet him.
915
00:50:57,280 --> 00:51:00,960
If it's OK, I want to take you back
to that decision that you made.
916
00:51:00,960 --> 00:51:05,160
Yeah. Tell me a bit about what you
were weighing up in your mind at that
917
00:51:05,160 --> 00:51:08,400
point in time. What were the two
sides of that argument?
918
00:51:08,400 --> 00:51:12,240
It was quite simply quality
or quantity.
919
00:51:12,240 --> 00:51:15,640
I thought, if I had treatment, that
I would be spending
920
00:51:15,640 --> 00:51:17,200
a lot of time in hospital,
921
00:51:17,200 --> 00:51:20,920
and I did... That isn't going to be
922
00:51:20,920 --> 00:51:23,960
a very good quality of life.
I could have had the treatment,
923
00:51:23,960 --> 00:51:27,960
and it could have, say, given me
an extra four or five months.
924
00:51:27,960 --> 00:51:29,560
I could have had the treatment,
925
00:51:29,560 --> 00:51:32,600
and I could have passed away during
treatment or just after.
926
00:51:32,600 --> 00:51:35,480
And trying to calculate, work out,
927
00:51:35,480 --> 00:51:39,560
that decision was really,
really difficult, to be honest.
928
00:51:39,560 --> 00:51:42,480
But, then, very easy on
the flip side of it,
929
00:51:42,480 --> 00:51:46,680
of thinking, "If I want to go
to Scotland in my van with Caleb,
930
00:51:46,680 --> 00:51:50,600
"if that's something I
want to do before I pass away,
931
00:51:50,600 --> 00:51:53,320
"going through treatment isn't
going to get me there."
932
00:51:56,120 --> 00:52:00,880
Well, Caleb, this is Glencoe.
933
00:52:05,240 --> 00:52:06,400
It was only 24 hours,
934
00:52:06,400 --> 00:52:07,720
but I got him to Scotland,
935
00:52:07,720 --> 00:52:09,120
eight hour drive up there,
936
00:52:09,120 --> 00:52:11,160
but we also went to Loch Lomond,
937
00:52:11,160 --> 00:52:13,840
so we had a paddle around
Loch Lomond as well.
938
00:52:13,840 --> 00:52:17,240
So, we did
lots of things in that 24 hours.
939
00:52:19,040 --> 00:52:21,040
Some people might say
940
00:52:21,040 --> 00:52:23,640
that choosing not
to have treatment at
941
00:52:23,640 --> 00:52:26,640
the stage you were at was
a bit like giving up.
942
00:52:26,640 --> 00:52:28,520
I don't see it as giving up.
943
00:52:28,520 --> 00:52:34,080
I see it is accepting
the inevitable, to be honest.
944
00:52:34,080 --> 00:52:37,080
I know I'm deteriorating, I know
things are changing,
945
00:52:37,080 --> 00:52:41,160
but as long as I can come here,
ride my bike, I will do.
946
00:52:41,160 --> 00:52:43,520
I've made a lot of memories here,
947
00:52:43,520 --> 00:52:46,440
and that's definitely not what
I would have got
948
00:52:46,440 --> 00:52:47,920
had I been in a hospital bed.
949
00:52:56,800 --> 00:53:00,880
So, this, um, is just a memory box
for Caleb.
950
00:53:00,880 --> 00:53:03,800
It's got lots of things, all the
rocks from different walks
951
00:53:03,800 --> 00:53:05,720
we've been on and painted. Together.
952
00:53:05,720 --> 00:53:09,320
I think that's just so sweet, having
stuff like this ready for him.
953
00:53:09,320 --> 00:53:10,960
And then, of course,
954
00:53:10,960 --> 00:53:14,200
letters which... These were written
in 2019 when
955
00:53:14,200 --> 00:53:15,880
I was going through treatment.
956
00:53:15,880 --> 00:53:20,600
So, there's, like, one for his
18th birthday and 21st,
957
00:53:20,600 --> 00:53:24,840
wedding day, all these kinds of
stuff. Er, first car.
958
00:53:24,840 --> 00:53:27,480
When you realise you're gay,
959
00:53:27,480 --> 00:53:30,160
that's an important one.
960
00:53:30,160 --> 00:53:33,240
You never know! Exactly.
961
00:53:33,240 --> 00:53:35,440
So, first fight with your mum.
962
00:53:35,440 --> 00:53:36,480
SHE LAUGHS
963
00:53:36,480 --> 00:53:37,840
First day at school -
964
00:53:37,840 --> 00:53:40,800
that one can go in the bin, yes!
You made it.
965
00:53:40,800 --> 00:53:45,360
I made it, milestone.
And how does it feel to have
966
00:53:45,360 --> 00:53:48,800
already, some of them out of date,
almost? Well, that's...
967
00:53:48,800 --> 00:53:50,960
Yes, I've surpassed many of
the estimations
968
00:53:50,960 --> 00:53:53,640
because that's what it is at
the end of the day, isn't it?
969
00:53:53,640 --> 00:53:54,720
They're only estimates.
970
00:53:54,720 --> 00:53:56,760
It takes, I think, quite a lot
of strength
971
00:53:56,760 --> 00:53:58,680
to put something like this together.
972
00:53:58,680 --> 00:54:02,000
Yeah. Has it helped you too?
Oh, definitely.
973
00:54:02,000 --> 00:54:05,480
I think writing the letters made
it feel like I was,
974
00:54:05,480 --> 00:54:09,160
like it was the start of
the acceptance, to be honest,
975
00:54:09,160 --> 00:54:11,680
of that this is what's happening.
976
00:54:18,720 --> 00:54:22,440
So, what happens now? Wait, really.
977
00:54:22,440 --> 00:54:23,920
Keep taking my meds,
978
00:54:23,920 --> 00:54:26,240
keep riding my bike.
979
00:54:26,240 --> 00:54:28,560
Go on living, really.
980
00:54:28,560 --> 00:54:30,880
There's nothing else you can do.
981
00:54:35,800 --> 00:54:39,320
There's this incredible amount
of strength in what he's doing,
982
00:54:39,320 --> 00:54:45,440
and I think Rob is someone
who is just
983
00:54:45,440 --> 00:54:48,240
totally fine with his own mortality.
984
00:54:48,240 --> 00:54:50,120
Like, I know he doesn't want to die,
985
00:54:50,120 --> 00:54:53,720
of course not, but he's...
986
00:54:53,720 --> 00:54:58,440
He's got this calmness of mind.
987
00:54:58,440 --> 00:55:01,200
Like, he's worked out what is
important to him,
988
00:55:01,200 --> 00:55:05,640
he knows what his values are,
and therefore,
989
00:55:05,640 --> 00:55:07,920
everything else falls into place.
990
00:55:18,840 --> 00:55:21,520
I'll need regular follow-ups
for the next five years
991
00:55:21,520 --> 00:55:23,880
to see if the cancer has come back.
992
00:55:26,680 --> 00:55:31,120
Hi, Hannah. Hi, how are you doing?
Come through. Thank you.
993
00:55:31,120 --> 00:55:33,400
Come on in, have a seat. Thank you.
994
00:55:33,400 --> 00:55:34,960
How is it otherwise going?
995
00:55:34,960 --> 00:55:39,000
You're fine? Yeah, it's OK, yeah.
996
00:55:39,000 --> 00:55:43,600
I realise now that this is
going to be part of my life forever.
997
00:55:46,800 --> 00:55:49,640
It's an anniversary today.
998
00:55:49,640 --> 00:55:52,840
Not the sort of anniversary you
traditionally celebrate,
999
00:55:52,840 --> 00:55:55,640
but it was a year ago today that
I was in hospital
1000
00:55:55,640 --> 00:55:57,680
with my surgery.
1001
00:55:57,680 --> 00:55:59,800
I was thinking about it
this morning.
1002
00:55:59,800 --> 00:56:01,880
It's only until very recently that
1003
00:56:01,880 --> 00:56:04,880
I haven't just been completely
reeling from it.
1004
00:56:04,880 --> 00:56:07,680
I mean, I think it's just impossible
to, like,
1005
00:56:07,680 --> 00:56:10,080
get cancer in your mid-thirties
1006
00:56:10,080 --> 00:56:14,080
and not come out of it with
1007
00:56:14,080 --> 00:56:16,200
a really different view of life.
Yeah,
1008
00:56:16,200 --> 00:56:17,880
it's left an indelible mark,
hasn't it?
1009
00:56:17,880 --> 00:56:20,240
I mean, it's not a simple, you know,
1010
00:56:20,240 --> 00:56:22,560
"Heal, get over it, move on."
1011
00:56:22,560 --> 00:56:25,200
I mean, you do have to move on to a
degree, but it's not,
1012
00:56:25,200 --> 00:56:26,840
it's nowhere near that simple.
1013
00:56:28,960 --> 00:56:30,160
I think, for most of us,
1014
00:56:30,160 --> 00:56:32,040
for most of our lives,
1015
00:56:32,040 --> 00:56:35,960
we get to pretend that
we are immortal, really.
1016
00:56:35,960 --> 00:56:39,520
We don't have to live
with this shadow of death,
1017
00:56:39,520 --> 00:56:41,400
really, hanging over us
all the time.
1018
00:56:41,400 --> 00:56:43,600
We have this kind of luxury of that,
1019
00:56:43,600 --> 00:56:48,040
and so I think that whenever
you are confronted
1020
00:56:48,040 --> 00:56:50,120
with your own mortality,
1021
00:56:50,120 --> 00:56:52,920
as you are when you receive
a cancer diagnosis,
1022
00:56:52,920 --> 00:56:55,160
no matter how serious it is,
1023
00:56:55,160 --> 00:56:58,400
I think that we are so not used
to that idea,
1024
00:56:58,400 --> 00:57:01,160
we are so terrified of the idea
1025
00:57:01,160 --> 00:57:04,720
that we are unwilling
to tolerate any risk whatsoever.
1026
00:57:07,320 --> 00:57:10,080
I try not to think too hard about
the numbers of recurrence,
1027
00:57:10,080 --> 00:57:13,280
because that number of one in ten,
1028
00:57:13,280 --> 00:57:15,440
the chance of recurrence,
it is still there,
1029
00:57:15,440 --> 00:57:19,000
and it is still true
and it's still a fact.
1030
00:57:21,520 --> 00:57:23,680
I don't know, I just think,
over time,
1031
00:57:23,680 --> 00:57:27,320
you have to accept that life comes
with risks, and that
1032
00:57:27,320 --> 00:57:30,920
you can't sort of wander around
being terrified
1033
00:57:30,920 --> 00:57:33,520
of everything that might
happen. Otherwise,
1034
00:57:33,520 --> 00:57:36,440
you're never going to have
the chance to properly live it.
1035
00:57:42,920 --> 00:57:46,680
I think that somehow we've decided
that the chance of dying
1036
00:57:46,680 --> 00:57:49,080
is the only number that matters,
1037
00:57:49,080 --> 00:57:51,360
and so we've built
a one-size-fits-all approach
1038
00:57:51,360 --> 00:57:57,040
to cancer care that takes courage
and strength to deviate from.
1039
00:57:57,040 --> 00:58:00,360
Perhaps that's because we're not
having honest conversations
1040
00:58:00,360 --> 00:58:03,960
about the true benefits
and costs of treatment.
1041
00:58:03,960 --> 00:58:08,000
Only when we do can people work out
what they most care about,
1042
00:58:08,000 --> 00:58:10,480
and make the choice that's right
for them.
135563
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