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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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00:12:42,320 --> 00:12:47,360
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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00:13:08,200 --> 00:13:10,160
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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00:13:25,320 --> 00:13:27,280
So we have a range
of people in clinic,
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00:13:27,280 --> 00:13:29,920
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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00:13:52,960 --> 00:13:56,200
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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00:14:01,200 --> 00:14:03,360
we would say that what we're looking
at is what is,
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00:14:03,360 --> 00:14:06,600
"What is the chance of you being
cancer-free ten years from now?"
240
00:14:06,600 --> 00:14:09,040
And if chemotherapy improves
your chance
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00:14:09,040 --> 00:14:11,640
of being alive by about 5% or more,
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00:14:11,640 --> 00:14:14,200
then chemotherapy is something that
we would usually discuss
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00:14:14,200 --> 00:14:17,800
with a patient. Let me make sure I
understand that, though,
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00:14:17,800 --> 00:14:20,320
because another way to say the same
thing is that,
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if you've got 100 women,
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00:14:22,520 --> 00:14:26,160
all of them have chemo,
247
00:14:26,160 --> 00:14:29,240
and chemo will save
the lives of five of them,
248
00:14:29,240 --> 00:14:32,400
that's the threshold?
249
00:14:32,400 --> 00:14:36,040
Yes, so... In a... This would be
a relatively low-risk case.
250
00:14:36,040 --> 00:14:38,600
Let's say you have 100 women.
80 of them,
251
00:14:38,600 --> 00:14:41,840
if they do nothing at this point,
252
00:14:41,840 --> 00:14:43,440
would live ten years very happily
253
00:14:43,440 --> 00:14:45,880
with their cancer not coming back.
254
00:14:45,880 --> 00:14:49,160
And maybe 15 of them,
the cancer comes back.
255
00:14:49,160 --> 00:14:51,800
Chemotherapy will be
the thing that means
256
00:14:51,800 --> 00:14:54,600
the cancer doesn't come back
for five out of the 15.
257
00:14:54,600 --> 00:14:57,800
So you have treated 100 women,
258
00:14:57,800 --> 00:15:00,120
and five women have been benefited.
259
00:15:00,120 --> 00:15:03,840
That point is worth repeating.
In 100 women,
260
00:15:03,840 --> 00:15:06,000
five of them are
going to die of other causes -
261
00:15:06,000 --> 00:15:08,280
perhaps heart attacks or
car crashes,
262
00:15:08,280 --> 00:15:10,080
that kind of thing.
263
00:15:10,080 --> 00:15:12,560
Of all of the women that are left,
264
00:15:12,560 --> 00:15:15,360
80 of them, the cancer is not
going to come back.
265
00:15:15,360 --> 00:15:18,240
It doesn't matter whether they have
chemotherapy or not,
266
00:15:18,240 --> 00:15:20,160
they are already cured.
267
00:15:20,160 --> 00:15:24,400
That leaves 15 women where
the cancer is going to return.
268
00:15:24,400 --> 00:15:27,080
However, for five of these women,
269
00:15:27,080 --> 00:15:29,280
if they have chemotherapy now,
270
00:15:29,280 --> 00:15:32,840
they can prevent
the cancer from coming back.
271
00:15:32,840 --> 00:15:34,440
But when you start off,
272
00:15:34,440 --> 00:15:37,320
you have no idea who these five
women are,
273
00:15:37,320 --> 00:15:41,320
and so every single one
of these women
274
00:15:41,320 --> 00:15:44,960
has to go through chemotherapy
just to save five lives.
275
00:15:44,960 --> 00:15:47,440
And for everybody else,
276
00:15:47,440 --> 00:15:52,240
chemotherapy made no
difference whatsoever.
277
00:15:52,240 --> 00:15:55,720
They had all of
the side-effects - hair loss,
278
00:15:55,720 --> 00:15:57,600
vomiting, giving up work,
279
00:15:57,600 --> 00:15:59,840
not being able to see people -
280
00:15:59,840 --> 00:16:02,040
all of that for 95 women,
and actually,
281
00:16:02,040 --> 00:16:04,480
it made no difference?
282
00:16:04,480 --> 00:16:07,000
So, yes, that would be the case,
283
00:16:07,000 --> 00:16:09,080
and these are the difficult
conversations because
284
00:16:09,080 --> 00:16:11,200
a patient, they could also
be thinking, you know,
285
00:16:11,200 --> 00:16:12,720
"Is it really worth it?"
286
00:16:12,720 --> 00:16:15,280
But then I guess on
the flip side of that,
287
00:16:15,280 --> 00:16:18,800
you don't know whether you're in
the 95 or you're in the five.
288
00:16:18,800 --> 00:16:20,480
And maybe, actually, chemo will be
289
00:16:20,480 --> 00:16:22,560
the thing that saves your life.
Exactly.
290
00:16:22,560 --> 00:16:23,880
When all is said and done,
291
00:16:23,880 --> 00:16:27,440
the majority of people would put
quite a lot of value
292
00:16:27,440 --> 00:16:30,520
on the concept of, "I don't want
this cancer to come back." Mm.
293
00:16:30,520 --> 00:16:34,560
Just because the alternative is
so horrible to imagine.
294
00:16:42,760 --> 00:16:45,760
Judy has invited me
to observe one of her appointments.
295
00:16:45,760 --> 00:16:48,560
Anne, do you want to come down?
Thank you.
296
00:16:48,560 --> 00:16:50,600
Anne is a 67-year-old swimming coach
from Barnet.
297
00:16:50,600 --> 00:16:53,440
Hello, come in, my name is Judy
King. I am one of the consultants.
298
00:16:53,440 --> 00:16:54,680
She had surgery to remove
299
00:16:54,680 --> 00:16:57,720
a two-centimetre breast tumour,
three weeks ago.
300
00:16:57,720 --> 00:16:59,960
..which is going to wreak havoc
with scheduling...
301
00:16:59,960 --> 00:17:01,760
I'm going to talk about what
the chemo is,
302
00:17:01,760 --> 00:17:03,440
and why we would recommend it.
303
00:17:03,440 --> 00:17:06,680
And then you can have a think about
whether that's something that you
304
00:17:06,680 --> 00:17:08,880
want to do or not. OK.
So if we take,
305
00:17:08,880 --> 00:17:11,320
sort of, women in your situation
306
00:17:11,320 --> 00:17:13,400
with this kind of cancer,
we're looking at,
307
00:17:13,400 --> 00:17:15,600
"What is the chance
of people being alive and well,
308
00:17:15,600 --> 00:17:17,680
"cancer-free ten years down the
line?"
309
00:17:17,680 --> 00:17:22,520
Yes. So, this is the chance that
everything is fine.
310
00:17:22,520 --> 00:17:28,000
There's a pretty good chance, cancer
has been cut out, job done. Mm-hm.
311
00:17:28,000 --> 00:17:32,680
This, here, is the risk of
the cancer coming back.
312
00:17:32,680 --> 00:17:36,080
Yeah? So,
my job is to reduce that risk.
313
00:17:36,080 --> 00:17:40,240
Right. In terms of absolute numbers,
314
00:17:40,240 --> 00:17:43,640
we reduce the chance of it coming
back again by about 4%.
315
00:17:43,640 --> 00:17:46,760
So, the thing is that
I don't know if you're one
316
00:17:46,760 --> 00:17:48,880
of these people over here...
317
00:17:48,880 --> 00:17:52,160
No. ..who the surgery is enough,
318
00:17:52,160 --> 00:17:55,360
and I don't know if you're one
of these people over here.
319
00:17:55,360 --> 00:17:58,520
So, what I have to say is that I
recommend that everybody
320
00:17:58,520 --> 00:18:01,760
has the tablets
and the chemo just to reduce
321
00:18:01,760 --> 00:18:04,320
the risk as much as possible.
Just to get to that, yeah. So, I'm
322
00:18:04,320 --> 00:18:06,400
going to talk a little bit about
how the chemo works
323
00:18:06,400 --> 00:18:09,040
and the side-effects,
and then I think we should have
324
00:18:09,040 --> 00:18:12,280
a talk about whether that's
something that you want to do. OK.
325
00:18:12,280 --> 00:18:13,720
Is that all right? Yeah.
326
00:18:13,720 --> 00:18:17,360
So, side-effects,
common things - feeling tired,
327
00:18:17,360 --> 00:18:20,920
people do feel pretty washed out
for a couple of days. Mm-hm.
328
00:18:20,920 --> 00:18:23,040
Chemotherapy can drop your
immune system.
329
00:18:23,040 --> 00:18:25,280
That means that, if you get
a fever or if you get
330
00:18:25,280 --> 00:18:26,480
an infection, you can't...
331
00:18:26,480 --> 00:18:28,880
Your body can't fight it properly.
If you get a fever,
332
00:18:28,880 --> 00:18:31,560
you must phone the emergency
numbers. If you can't get through,
333
00:18:31,560 --> 00:18:34,200
you have to go to A&E. All right.
334
00:18:34,200 --> 00:18:36,200
It does affect your hair.
335
00:18:36,200 --> 00:18:38,080
All right? That's probably my...
336
00:18:38,080 --> 00:18:40,720
Out of everything, it's the hair
loss that's going to be...
337
00:18:40,720 --> 00:18:42,640
It's actually the thing that
most people...
338
00:18:42,640 --> 00:18:45,000
Because I've got such fine
hair anyway, so...
339
00:18:45,000 --> 00:18:48,800
Always worth having a scarf or
a wig or what have you. Yeah.
340
00:18:48,800 --> 00:18:50,480
Other things,
feeling sick or being sick,
341
00:18:50,480 --> 00:18:53,480
acidy, bowels can go either way -
can be diarrhoea,
342
00:18:53,480 --> 00:18:54,840
can be constipation.
343
00:18:54,840 --> 00:18:57,720
Aches and pains,
those kinds of things.
344
00:18:57,720 --> 00:18:59,640
What are you thinking?
345
00:18:59,640 --> 00:19:01,240
I'm going for it.
You're going for it.
346
00:19:01,240 --> 00:19:03,160
Yeah. All right, we're going for it.
347
00:19:03,160 --> 00:19:05,480
Do you want to sign consent now,
or do you want some time
348
00:19:05,480 --> 00:19:07,200
to think it over? No, no, I've
349
00:19:07,200 --> 00:19:10,240
made up my mind, that's what
I'm going to do. Okey-doke.
350
00:19:27,600 --> 00:19:29,960
How are you feeling?
351
00:19:29,960 --> 00:19:32,920
OK, OK. It's a lot to take in
352
00:19:32,920 --> 00:19:36,160
in one, sort of,
short space of time.
353
00:19:36,160 --> 00:19:37,760
Was there a point where you thought,
354
00:19:37,760 --> 00:19:39,800
"Oh, maybe I won't?"
355
00:19:39,800 --> 00:19:42,680
It's always been the case of,
356
00:19:42,680 --> 00:19:45,720
"There's a possibility you might
have to have chemo."
357
00:19:45,720 --> 00:19:48,600
So, I think that's been
a lead into it, with it.
358
00:19:48,600 --> 00:19:51,440
It's not come as
a big shock to say,
359
00:19:51,440 --> 00:19:52,800
"Yeah, you've got to do it."
360
00:19:52,800 --> 00:19:57,240
I think if I don't go along
those lines, you know, my...
361
00:19:57,240 --> 00:19:59,280
The chances are it's going
to return,
362
00:19:59,280 --> 00:20:01,760
and I don't want that.
363
00:20:01,760 --> 00:20:05,000
I don't know, it's just all so much.
It's a lot, isn't it?
364
00:20:05,000 --> 00:20:08,440
It is a lot. It's one of those
things, isn't it?
365
00:20:08,440 --> 00:20:10,840
I know. It still sucks, though.
366
00:20:10,840 --> 00:20:13,080
Yeah. It still sucks.
ANNE LAUGHS
367
00:20:15,760 --> 00:20:17,400
When I was talking to her outside,
368
00:20:17,400 --> 00:20:19,840
she was sort of saying,
"If I don't have the chemo,
369
00:20:19,840 --> 00:20:23,080
"it's overwhelmingly likely that
the cancer will come back."
370
00:20:23,080 --> 00:20:25,520
And I didn't, sort of, correct her.
371
00:20:28,880 --> 00:20:32,160
But I think that, like,
the difference that the chemo makes,
372
00:20:32,160 --> 00:20:35,560
even if it's not exactly 4%...
It's not as big as she thinks.
373
00:20:35,560 --> 00:20:37,080
No, exactly.
374
00:20:37,080 --> 00:20:38,920
It sort of sits slightly
more uncomfortably
375
00:20:38,920 --> 00:20:40,960
with you than it does with me.
376
00:20:40,960 --> 00:20:42,400
I'll tell you why.
377
00:20:42,400 --> 00:20:45,520
I've seen the cancers come back.
Of course.
378
00:20:45,520 --> 00:20:47,720
And I know that this is
a relatively gentle chemo
379
00:20:47,720 --> 00:20:49,080
and I can get her through it.
380
00:20:49,080 --> 00:20:51,680
And I know if that was somebody
that I cared about,
381
00:20:51,680 --> 00:20:54,160
I would 100% tell them to have it.
382
00:20:54,160 --> 00:20:55,400
I spend all my life trying
383
00:20:55,400 --> 00:20:57,760
to explain mathematical concepts
to people.
384
00:20:57,760 --> 00:20:59,440
And I know how hard it is, right?
385
00:20:59,440 --> 00:21:02,840
And I know how difficult this
concept is.
386
00:21:02,840 --> 00:21:05,160
And I'm not saying, even for
387
00:21:05,160 --> 00:21:07,960
a moment, that it would change
the path that she's on,
388
00:21:07,960 --> 00:21:10,440
change the decision that she's made.
389
00:21:10,440 --> 00:21:13,400
But I'm just thinking about
the patients who are taking chemo
390
00:21:13,400 --> 00:21:15,920
because they think it's their
only chance of survival
391
00:21:15,920 --> 00:21:19,160
without realising, actually,
it's making a very small difference.
392
00:21:19,160 --> 00:21:20,880
So, the thing is,
393
00:21:20,880 --> 00:21:23,960
I don't think philosophically
people can really deal
394
00:21:23,960 --> 00:21:28,320
with that level of complex thinking
and decision-making.
395
00:21:28,320 --> 00:21:32,200
I think people need confidence
in their decisions,
396
00:21:32,200 --> 00:21:35,240
and sometimes that requires
a more simplistic answer.
397
00:21:40,480 --> 00:21:42,520
I'm feeling conflicted.
398
00:21:42,520 --> 00:21:46,440
I'm uneasy that patients might not
see how small the benefits are,
399
00:21:46,440 --> 00:21:48,880
but I know what it's like
to be frightened,
400
00:21:48,880 --> 00:21:51,480
and just want a doctor
to take charge.
401
00:21:52,880 --> 00:21:55,120
Despite my swollen lymph nodes,
402
00:21:55,120 --> 00:21:57,760
I'm still hoping
to avoid chemotherapy,
403
00:21:57,760 --> 00:22:01,080
but my mum is urging
a more realistic approach.
404
00:22:01,080 --> 00:22:03,760
Mum had cancer when I was in school.
405
00:22:05,040 --> 00:22:07,240
This is why she doesn't give a shit.
406
00:22:07,240 --> 00:22:08,920
SHE LAUGHS
407
00:22:08,920 --> 00:22:12,080
Our family, though, so Mum's got
nine brothers and sisters -
408
00:22:12,080 --> 00:22:14,360
how many of them have not had
cancer?
409
00:22:14,360 --> 00:22:17,640
THEY LAUGH
410
00:22:17,640 --> 00:22:20,680
You know like how some
families play rugby?
411
00:22:20,680 --> 00:22:21,920
Ours gets cancer.
412
00:22:23,120 --> 00:22:25,960
I was very worried about her when
I first heard the news.
413
00:22:25,960 --> 00:22:28,480
Yeah. When I first told you, though,
414
00:22:28,480 --> 00:22:31,560
I told it to you in
a very positive way. Yes, yeah.
415
00:22:31,560 --> 00:22:33,400
What, and you were still worried
about it?
416
00:22:33,400 --> 00:22:37,800
Well, I looked it up online. What
did you see when you looked it up?
417
00:22:37,800 --> 00:22:41,440
Well, if it's a hysterectomy
and if it's cancer,
418
00:22:41,440 --> 00:22:44,840
then it's chemo. In this country,
in the western world,
419
00:22:44,840 --> 00:22:47,120
they decide to do it.
420
00:22:47,120 --> 00:22:49,960
I don't know of anyone who's got
away without the chemo
421
00:22:49,960 --> 00:22:53,240
or the radio.
You just do your best to fight it.
422
00:22:53,240 --> 00:22:56,160
I've got a chance
of it not being, though. Yeah.
423
00:22:57,880 --> 00:22:59,480
So, just wait and see.
424
00:23:04,360 --> 00:23:06,000
Yeah, well done.
425
00:23:06,000 --> 00:23:09,480
They're full of lots of chemicals,
you see. What are chemicals?
426
00:23:09,480 --> 00:23:11,720
"What are chemicals?"
That's an excellent question,
427
00:23:11,720 --> 00:23:15,320
and probably one for your mum to
answer, I'd say, rather than me.
428
00:23:15,320 --> 00:23:16,760
If Hannah has chemotherapy,
429
00:23:16,760 --> 00:23:18,640
that's going to have, you know,
430
00:23:18,640 --> 00:23:21,920
dramatic implications on
a number of levels,
431
00:23:21,920 --> 00:23:23,880
from pragmatic levels
to emotional levels.
432
00:23:23,880 --> 00:23:27,640
I mean, the kids seeing her going
through that's
433
00:23:27,640 --> 00:23:30,920
going to be tough. Me seeing her go
through that is going to be tough.
434
00:23:30,920 --> 00:23:34,200
Hannah going through that is going
to be tough. What shall we play?
435
00:23:34,200 --> 00:23:37,480
All that really matters is
the emotional stability,
436
00:23:37,480 --> 00:23:39,440
which is the most important thing.
437
00:23:42,760 --> 00:23:45,440
I think the thing about cancer,
there's this point,
438
00:23:45,440 --> 00:23:48,320
there's this fork in the road,
439
00:23:48,320 --> 00:23:50,960
and it does come down
to something as simple
440
00:23:50,960 --> 00:23:53,560
as a few cancer cells in
the wrong place.
441
00:23:53,560 --> 00:23:55,760
Where, on one path, we have
442
00:23:55,760 --> 00:24:00,120
a very sick person at home,
potentially dying,
443
00:24:00,120 --> 00:24:03,800
and everything changes.
444
00:24:03,800 --> 00:24:06,320
And then the other fork,
which is...
445
00:24:07,960 --> 00:24:12,000
I get better, and we get to go
on with our lives.
446
00:24:17,880 --> 00:24:21,760
I'm still thinking about my
conversations with Judy and Anne,
447
00:24:21,760 --> 00:24:25,440
and how the numbers change as
cancer progresses.
448
00:24:25,440 --> 00:24:29,080
I want to understand why patients
decide to keep going with treatment,
449
00:24:29,080 --> 00:24:31,520
when the odds are stacked
against them.
450
00:24:35,320 --> 00:24:37,600
Online, I came across Nina,
451
00:24:37,600 --> 00:24:40,240
a 39-year-old fashion designer
452
00:24:40,240 --> 00:24:42,320
and mum from South London.
453
00:24:42,320 --> 00:24:46,520
I can't wait to go into
chemo tomorrow,
454
00:24:46,520 --> 00:24:48,760
having one more session,
455
00:24:48,760 --> 00:24:50,360
one more cycle.
456
00:24:53,040 --> 00:24:57,080
She's got a particularly
aggressive form of breast cancer
457
00:24:57,080 --> 00:24:58,920
that's now considered terminal.
458
00:25:00,960 --> 00:25:03,480
Women with her type
and stage of cancer
459
00:25:03,480 --> 00:25:08,160
have only a 12% chance
of living five years.
460
00:25:09,560 --> 00:25:11,320
Hi, how are you doing?
461
00:25:11,320 --> 00:25:14,520
Nice to meet you.
Lovely to meet you, thank you.
462
00:25:14,520 --> 00:25:15,760
Yeah, well, let's hug!
463
00:25:15,760 --> 00:25:18,080
Her chemo is often exhausting,
464
00:25:18,080 --> 00:25:21,440
and her life's been taken over
by medications.
465
00:25:23,520 --> 00:25:26,160
Wow, you weren't joking. Ha, no,
466
00:25:26,160 --> 00:25:29,760
there's... There's quite a lot.
467
00:25:29,760 --> 00:25:32,120
This is for...? This is every day?
468
00:25:32,120 --> 00:25:34,560
So much medication, isn't it?
469
00:25:34,560 --> 00:25:35,960
After chemo,
470
00:25:35,960 --> 00:25:40,120
I take these that help me
with anti-sickness. Yep.
471
00:25:40,120 --> 00:25:42,400
Now that I'm on my third cycle,
472
00:25:42,400 --> 00:25:45,000
I'm having to take
the pills more often
473
00:25:45,000 --> 00:25:48,040
because I just feel so bad.
474
00:25:48,040 --> 00:25:51,000
Yeah, so blood thinners,
475
00:25:51,000 --> 00:25:53,480
I have to take these.
That's an injection?
476
00:25:53,480 --> 00:25:57,200
Yeah, and I have to inject myself
every day,
477
00:25:57,200 --> 00:26:01,520
and every day it gets harder.
478
00:26:01,520 --> 00:26:04,160
Do you have to psyche
yourself up?
479
00:26:04,160 --> 00:26:07,080
Yeah. Yeah. I feel like my stomach
is getting more sensitive
480
00:26:07,080 --> 00:26:10,040
because I've had
so many months of it.
481
00:26:10,040 --> 00:26:12,040
And some days I just
want to push it in,
482
00:26:12,040 --> 00:26:13,880
but it hurts me. Yeah.
483
00:26:15,440 --> 00:26:17,120
Oh, gosh.
484
00:26:17,120 --> 00:26:23,240
And it's a big reminder that
I have cancer.
485
00:26:23,240 --> 00:26:27,320
It's a big reminder,
on my good days, that
486
00:26:27,320 --> 00:26:30,760
things are not normal.
487
00:26:30,760 --> 00:26:34,840
I mean, all of this is just such
a heavy price that you have to pay.
488
00:26:34,840 --> 00:26:38,480
Yeah, it feels like it.
It's the vomiting,
489
00:26:38,480 --> 00:26:40,360
it's the infections,
490
00:26:40,360 --> 00:26:43,760
it's the bleeding gums,
it's the nose bleeds.
491
00:26:43,760 --> 00:26:49,040
I've made a choice to have chemo,
and, you know,
492
00:26:49,040 --> 00:26:52,360
you can keep throwing anything
at me.
493
00:26:52,360 --> 00:26:56,600
As long as I know that I have
a percentage in there
494
00:26:56,600 --> 00:27:00,200
of it working, I will do it.
You know,
495
00:27:00,200 --> 00:27:02,000
I've committed myself to it.
496
00:27:02,000 --> 00:27:03,840
Do you sort of feel in a way like
497
00:27:03,840 --> 00:27:08,120
you're paying with this three
months now and in return,
498
00:27:08,120 --> 00:27:09,840
hopefully, you get a couple of
years?
499
00:27:09,840 --> 00:27:13,160
Yeah. It's like a price, a trade.
500
00:27:13,160 --> 00:27:15,040
Yes, it feels like a trade.
501
00:27:15,040 --> 00:27:18,040
Yes, there's just no guarantee.
502
00:27:18,040 --> 00:27:20,480
You have to have the treatment
503
00:27:20,480 --> 00:27:22,360
and hope for the best.
504
00:27:22,360 --> 00:27:25,280
A lot of it is hope,
and I'm hopeful.
505
00:27:25,280 --> 00:27:32,280
Do those stories of real miracles
where people had stage four cancer,
506
00:27:32,280 --> 00:27:33,720
things look really bad,
507
00:27:33,720 --> 00:27:37,200
and then, somehow or other,
their tumours shrank
508
00:27:37,200 --> 00:27:40,880
and they managed to go on
and live these very long,
509
00:27:40,880 --> 00:27:43,360
healthy lives, do they play on your
mind, those stories?
510
00:27:43,360 --> 00:27:45,480
All the time. Do they?
511
00:27:45,480 --> 00:27:47,680
Yeah, I think I'm
going to be one of those stories.
512
00:27:47,680 --> 00:27:49,560
I really believe.
513
00:27:49,560 --> 00:27:55,680
And how do you feel about...
thinking about the end? Are you...
514
00:27:55,680 --> 00:27:58,880
Do you think that you've accepted
what's going on?
515
00:28:00,680 --> 00:28:03,840
Yes, and no.
SHE CHUCKLES
516
00:28:03,840 --> 00:28:05,600
But, yeah, right now,
517
00:28:05,600 --> 00:28:09,040
my heart does not see death.
518
00:28:09,040 --> 00:28:11,280
My heart does not see the end.
519
00:28:11,280 --> 00:28:12,720
Your heart sees those stories.
520
00:28:12,720 --> 00:28:15,480
My heart sees those stories of hope
521
00:28:15,480 --> 00:28:17,560
and I know I'm going to live,
522
00:28:17,560 --> 00:28:20,640
and I'm not going to die.
523
00:28:20,640 --> 00:28:23,920
There's no reason why I can't be
one of those people.
524
00:28:23,920 --> 00:28:25,120
So...
525
00:28:28,480 --> 00:28:31,960
Good luck. Thank you.
526
00:28:34,080 --> 00:28:36,520
One thing she said really stood out
to me,
527
00:28:36,520 --> 00:28:40,880
where she said that she would
have chemo even if it was 1%,
528
00:28:40,880 --> 00:28:44,800
even if there was a 1% chance that
chemo would buy her more time,
529
00:28:44,800 --> 00:28:46,040
she would take it.
530
00:28:48,880 --> 00:28:52,120
And that seems pretty incredible
to me.
531
00:28:52,120 --> 00:28:57,360
Are you risking, sacrificing,
really more than you should?
532
00:28:57,360 --> 00:29:01,120
Rather than just enjoying what
you have left?
533
00:29:02,640 --> 00:29:04,320
I think that's what the danger is.
534
00:29:04,320 --> 00:29:07,360
And I don't think she's there yet
but I think that there is...
535
00:29:07,360 --> 00:29:11,000
I don't always think that hope
is a good thing.
536
00:29:11,000 --> 00:29:14,400
I think there are some times where
it can be a bit counterproductive.
537
00:29:15,440 --> 00:29:17,880
Because it's unrealistic? Yeah.
538
00:29:19,960 --> 00:29:22,120
Yeah, or because... Because...
539
00:29:22,120 --> 00:29:23,640
Because you're so focused on
540
00:29:23,640 --> 00:29:26,480
the best possible thing that
could happen
541
00:29:26,480 --> 00:29:29,720
that you fail to prepare
for what really is happening.
542
00:29:42,520 --> 00:29:45,360
In fact, patients will often go
through treatment with
543
00:29:45,360 --> 00:29:48,080
a very low chance of success.
544
00:29:48,080 --> 00:29:52,080
One study showed that over
a third of terminal cancer patients
545
00:29:52,080 --> 00:29:54,480
would undergo treatment even if
there was only
546
00:29:54,480 --> 00:29:58,760
a 0.1% chance it
would prolong their life.
547
00:29:58,760 --> 00:30:00,760
But the doctors who treat them,
if they were
548
00:30:00,760 --> 00:30:02,480
to have cancer themselves,
549
00:30:02,480 --> 00:30:05,240
say they would refuse treatment
unless it had
550
00:30:05,240 --> 00:30:09,240
at least a 25% chance of working.
551
00:30:09,240 --> 00:30:12,960
Nina is clearly not alone in her
dedication to hope,
552
00:30:12,960 --> 00:30:14,600
but I can't help but wonder
553
00:30:14,600 --> 00:30:17,240
what kind of information gap
we've created,
554
00:30:17,240 --> 00:30:19,520
where the very people offering
a treatment
555
00:30:19,520 --> 00:30:21,880
wouldn't want it for themselves.
556
00:30:24,320 --> 00:30:25,560
Big day.
557
00:30:30,800 --> 00:30:32,440
Got about 20 minutes.
558
00:30:35,480 --> 00:30:36,720
SIGHS
559
00:30:36,720 --> 00:30:39,720
Then I'm getting in the car
to go to the hospital to find out...
560
00:30:43,280 --> 00:30:45,840
..what the situation is, basically,
561
00:30:45,840 --> 00:30:48,440
to find out what they found in
the lymph nodes,
562
00:30:48,440 --> 00:30:50,080
to find out...
563
00:30:53,680 --> 00:30:58,440
..whether I need to have chemo
or...
564
00:31:03,760 --> 00:31:08,400
..whether the surgery did
the job of getting everything out.
565
00:31:15,200 --> 00:31:17,760
You just don't have any control
or any choice
566
00:31:17,760 --> 00:31:19,600
over what's going to happen.
567
00:31:46,200 --> 00:31:47,800
So how are you, Hannah?
568
00:31:47,800 --> 00:31:49,240
Yeah, all right. Good.
569
00:31:51,400 --> 00:31:54,360
So, you're obviously waiting to hear
what the results are.
570
00:31:54,360 --> 00:31:56,880
We're putting you through misery.
I know.
571
00:32:02,640 --> 00:32:04,040
I'll tell you in the car.
572
00:32:10,600 --> 00:32:11,880
SHE LAUGHS WITH RELIEF
573
00:32:11,880 --> 00:32:13,640
Yes?
574
00:32:13,640 --> 00:32:15,640
HE LAUGHS
Gone?
575
00:32:21,120 --> 00:32:23,760
Oh, my God, really?
576
00:32:23,760 --> 00:32:25,920
Oh, fucking brilliant!
577
00:32:28,440 --> 00:32:29,960
Oh, baby!
578
00:32:32,080 --> 00:32:33,760
Oh, my God.
579
00:32:33,760 --> 00:32:36,080
Oh, God.
580
00:32:38,120 --> 00:32:40,600
Oh, God. Oh, my God.
581
00:32:43,360 --> 00:32:46,240
That's amazing.
So go on. Tell me, tell me. Tell me.
582
00:32:46,240 --> 00:32:49,320
It's done. Absolutely done?
It's done.
583
00:32:49,320 --> 00:32:50,880
Oh, God.
584
00:32:52,640 --> 00:32:54,200
Jesus Christ.
585
00:32:55,240 --> 00:32:56,680
Oh, thank God.
586
00:32:57,920 --> 00:33:01,120
But they said that all
the lymph nodes came back negative.
587
00:33:04,560 --> 00:33:07,040
And he was like, "Can't guarantee."
588
00:33:07,040 --> 00:33:10,520
You know, "This isn't, like, 100%
like, you know, this isn't, like,
589
00:33:10,520 --> 00:33:13,920
"a guarantee that it's never come
back again, but, like..."
590
00:33:13,920 --> 00:33:15,560
Bloody hell.
591
00:33:15,560 --> 00:33:16,800
Great.
592
00:33:17,840 --> 00:33:20,000
Getting drunk tonight. Fuck, yeah.
593
00:33:22,480 --> 00:33:23,880
Woo!
594
00:33:33,040 --> 00:33:34,240
CHILDREN PLAYING
595
00:33:37,320 --> 00:33:38,680
Pleased with you.
596
00:33:41,160 --> 00:33:44,000
Well done, well done.
597
00:33:45,200 --> 00:33:47,440
It's the best possible news.
598
00:33:49,560 --> 00:33:52,960
But there's still a one in ten
chance that my cancer will come
back.
599
00:33:54,320 --> 00:33:55,480
Have you had dinner?
600
00:33:55,480 --> 00:33:57,680
Yeah, we did. What did you have?
601
00:33:57,680 --> 00:34:00,480
Daddy? Daddy?
602
00:34:04,480 --> 00:34:07,240
A few months later,
there's a problem.
603
00:34:08,600 --> 00:34:11,640
I've started to notice swelling
in my legs.
604
00:34:12,840 --> 00:34:14,280
If I'm not careful,
605
00:34:14,280 --> 00:34:17,960
my right leg swells up
606
00:34:17,960 --> 00:34:20,160
to be much bigger than
the left-hand side.
607
00:34:20,160 --> 00:34:24,440
It's caused by a side-effect of my
surgery called lymphedema,
608
00:34:24,440 --> 00:34:27,560
where excess fluid builds up
in your limbs.
609
00:34:27,560 --> 00:34:28,680
It's grim, innit?
610
00:34:30,120 --> 00:34:32,560
You have this system called your
lymphatic system,
611
00:34:32,560 --> 00:34:34,400
and it's like little tubes
612
00:34:34,400 --> 00:34:38,920
and channels that are drawing fluid
away from all parts of your body,
613
00:34:38,920 --> 00:34:41,600
and then bringing it upwards towards
your heart.
614
00:34:41,600 --> 00:34:44,600
Now, along those tubes,
615
00:34:44,600 --> 00:34:46,760
you have these little things
called nodes.
616
00:34:46,760 --> 00:34:50,640
When they were doing my surgery,
617
00:34:50,640 --> 00:34:53,040
because they were concerned about
cancer being in
618
00:34:53,040 --> 00:34:55,120
the lymph nodes,
they chopped them all out.
619
00:34:55,120 --> 00:34:57,760
And so now the fluid just,
essentially, leaks out
620
00:34:57,760 --> 00:34:59,760
and collects in my leg.
621
00:35:07,280 --> 00:35:10,160
My devilishly sexy tights!
622
00:35:10,160 --> 00:35:14,600
They're compression garments, so,
um,
623
00:35:14,600 --> 00:35:20,520
they just help stop all of
the fluid building up, basically.
624
00:35:20,520 --> 00:35:22,720
So, they're really tight down
the bottom,
625
00:35:22,720 --> 00:35:26,680
and then they're slightly less tight
as you go further up.
626
00:35:26,680 --> 00:35:30,480
But the idea is that they just
keep the swelling down.
627
00:35:30,480 --> 00:35:35,040
So, you have to wear them all day,
every day.
628
00:35:35,040 --> 00:35:37,760
You really do? Yeah,
even on the beach.
629
00:35:39,600 --> 00:35:42,600
It just feels very sensitive
to the touch.
630
00:35:42,600 --> 00:35:46,720
It just feels very full
and sort of tight.
631
00:35:46,720 --> 00:35:48,720
It's not painful.
632
00:35:51,320 --> 00:35:54,720
It's not, like, excruciating agony.
It's just really uncomfortable.
633
00:36:04,360 --> 00:36:06,440
The problem with lymphedema
634
00:36:06,440 --> 00:36:09,680
is that you have no idea how
quickly it's going to progress.
635
00:36:09,680 --> 00:36:12,920
It could be that it happens over
the course of a few weeks or months.
636
00:36:12,920 --> 00:36:14,720
I mean, it really can be that quick.
637
00:36:15,960 --> 00:36:17,400
Come on.
638
00:36:18,680 --> 00:36:21,800
I have got really upset about
it because, you know,
639
00:36:21,800 --> 00:36:25,560
you can't be upright
for sustained periods of time.
640
00:36:25,560 --> 00:36:27,960
There was one evening I was like,
"Right, I'm
641
00:36:27,960 --> 00:36:30,120
"going to do some baking
with my daughter,"
642
00:36:30,120 --> 00:36:32,800
and ended up standing up
for a while.
643
00:36:32,800 --> 00:36:35,880
And then finally, like,
644
00:36:35,880 --> 00:36:38,120
sat down and put my feet up
and like,
645
00:36:38,120 --> 00:36:40,600
literally, my leg,
it was like a balloon.
646
00:36:40,600 --> 00:36:42,800
It was, like, incredible.
This thing
647
00:36:42,800 --> 00:36:46,040
just, like, basically expanding,
like, under your hands.
648
00:36:47,600 --> 00:36:51,120
I just don't have that view of
myself in the future. You know?
649
00:36:51,120 --> 00:36:54,040
Like, I don't see myself as, like,
in my 50s
650
00:36:54,040 --> 00:36:57,560
with, like, one giant leg, like,
651
00:36:57,560 --> 00:37:01,160
unable to walk 100 metres or, like,
652
00:37:01,160 --> 00:37:03,480
unable to work, even.
653
00:37:09,640 --> 00:37:12,160
When we are facing something that
feels like it's
654
00:37:12,160 --> 00:37:15,280
a really terrible enemy,
like cancer,
655
00:37:15,280 --> 00:37:21,000
we have this bias towards just
trying to get rid of
656
00:37:21,000 --> 00:37:23,600
the overarching concern,
657
00:37:23,600 --> 00:37:25,240
and worry about side-effects later.
658
00:37:25,240 --> 00:37:27,280
Maybe we are too willing
659
00:37:27,280 --> 00:37:30,320
to just do treatment at any cost
just
660
00:37:30,320 --> 00:37:33,360
because it feels like we're
doing something.
661
00:37:36,440 --> 00:37:39,280
It's estimated up
to 400,000 people
662
00:37:39,280 --> 00:37:41,800
in the UK have lymphedema.
663
00:37:41,800 --> 00:37:43,640
After a radical hysterectomy,
664
00:37:43,640 --> 00:37:46,560
there's a one-in-four chance
of getting it.
665
00:37:49,640 --> 00:37:53,960
There's limited treatment for
lymphedema available on the NHS,
666
00:37:53,960 --> 00:37:58,120
so I'm going to see a private
lymphedema surgeon, Alex Ramsden.
667
00:37:58,120 --> 00:38:00,200
They did the radical hysterectomy.
668
00:38:00,200 --> 00:38:05,880
OK. And they took out everything,
and then a bit more.
669
00:38:05,880 --> 00:38:09,080
Right. When you say everything,
so there was a hysterectomy?
670
00:38:09,080 --> 00:38:12,760
Yeah, and the nodes. And it was...
The lymph nodes.
671
00:38:12,760 --> 00:38:14,400
So that's really important.
672
00:38:14,400 --> 00:38:16,440
So, they took out the common
lymph nodes,
673
00:38:16,440 --> 00:38:20,000
they took out the interior iliac.
674
00:38:20,000 --> 00:38:23,400
Yep. The exterior iliac. Right.
675
00:38:23,400 --> 00:38:26,600
And they also took out
the...obturator?
676
00:38:26,600 --> 00:38:29,400
Obturator, I was just going to
say obturator. Is that quite a lot?
677
00:38:33,080 --> 00:38:36,520
Yes. So I'm not a gynaecologist.
Of course. OK?
678
00:38:36,520 --> 00:38:38,760
But they are often very aggressive
679
00:38:38,760 --> 00:38:40,760
with this sort of tumour,
680
00:38:40,760 --> 00:38:43,200
and they often take out
a lot of nodes,
681
00:38:43,200 --> 00:38:45,320
and it's very difficult to know,
682
00:38:45,320 --> 00:38:49,520
before you start, whether they're
going to be positive or negative.
683
00:38:49,520 --> 00:38:52,360
One of the problems with lymphedema,
as you will come across,
684
00:38:52,360 --> 00:38:54,480
is not many people know much
about it.
685
00:38:54,480 --> 00:38:56,840
People mention the word cancer
and everybody hears,
686
00:38:56,840 --> 00:38:58,880
"Cancer, cancer, cancer, cancer,
cancer."
687
00:38:58,880 --> 00:39:01,000
Patients have this massive
treatment,
688
00:39:01,000 --> 00:39:03,240
and they have all this investment
of time and care
689
00:39:03,240 --> 00:39:04,560
and effort, and that's great.
690
00:39:04,560 --> 00:39:07,560
But then you're left with something
that is only going to get worse.
691
00:39:07,560 --> 00:39:09,720
You've got it for
the rest of your life.
692
00:39:09,720 --> 00:39:11,840
"Here's a stocking."
"Here's a stocking."
693
00:39:11,840 --> 00:39:14,120
And everyone goes,
"That's really rubbish,"
694
00:39:14,120 --> 00:39:17,760
so it's a very common thing that
people get very upset
695
00:39:17,760 --> 00:39:20,760
and more traumatised by
the lymphedema than they do
696
00:39:20,760 --> 00:39:22,400
by the cancer sometimes.
697
00:39:32,600 --> 00:39:34,000
SNIFFLES
698
00:39:34,000 --> 00:39:36,000
I'm really sorry.
699
00:39:41,400 --> 00:39:44,120
It's just quite hard
to hear someone articulate it.
700
00:39:47,800 --> 00:39:48,920
OK.
701
00:39:50,880 --> 00:39:55,200
So, we've kind of got to
the nub of it quite quickly.
702
00:39:55,200 --> 00:39:58,800
I don't really know if there
was a choice,
703
00:39:58,800 --> 00:40:00,800
and now there's this, like,
704
00:40:00,800 --> 00:40:04,640
lifelong sort of sentence,
as it were,
705
00:40:04,640 --> 00:40:09,760
of, like, what could be
a genuinely, like, debilitating,
706
00:40:09,760 --> 00:40:12,600
life-changing condition.
There might not have been options.
707
00:40:12,600 --> 00:40:15,040
You might have had to do it. Yep.
708
00:40:19,360 --> 00:40:21,400
It will be a little bit stingy,
709
00:40:21,400 --> 00:40:22,960
and I apologise in advance.
710
00:40:22,960 --> 00:40:27,040
Alex is injecting dye into my
lymph vessels
711
00:40:27,040 --> 00:40:29,400
and using an infra-red camera
to determine
712
00:40:29,400 --> 00:40:31,760
the extent of my lymphedema.
713
00:40:33,240 --> 00:40:35,520
This is the fluid that's trying
to get out of your leg.
714
00:40:35,520 --> 00:40:37,360
It can't go through your pelvis.
Yeah.
715
00:40:37,360 --> 00:40:39,440
So it's now going onto your
tummy wall.
716
00:40:39,440 --> 00:40:41,880
That's why you're getting
fullness of your tummy wall.
717
00:40:41,880 --> 00:40:45,800
So, this is the bit that gets
really, like, thick, basically.
Right.
718
00:40:48,880 --> 00:40:52,880
God, it's, like, a whole galaxy!
SHE CHUCKLES
719
00:40:56,840 --> 00:41:00,560
The right leg is really good,
720
00:41:00,560 --> 00:41:03,400
all the way up to where you
describe, which is the upper thigh,
721
00:41:03,400 --> 00:41:06,400
when you're starting to get those
dermal back flow patterns
722
00:41:06,400 --> 00:41:09,560
overflow onto your abdominal wall,
and that is lymphedema,
723
00:41:09,560 --> 00:41:14,120
but it's the very earliest stage
of lymphedema that you have. OK.
724
00:41:15,960 --> 00:41:17,360
Because you're really early,
725
00:41:17,360 --> 00:41:19,800
what you're trying to
do is stop it getting worse.
726
00:41:19,800 --> 00:41:22,880
If it stays like this forever,
that's fine. Right.
727
00:41:22,880 --> 00:41:25,120
It might stay the same
for the next 20 years.
728
00:41:25,120 --> 00:41:26,200
I don't know.
729
00:41:27,560 --> 00:41:29,400
Most likely,
it's going to get worse.
730
00:41:38,360 --> 00:41:40,320
Am I asking for a bit too much?
I don't know,
731
00:41:40,320 --> 00:41:41,960
maybe I am,
maybe I'm being a bit greedy.
732
00:41:41,960 --> 00:41:44,240
It's, like, I was in
a position where someone had
733
00:41:44,240 --> 00:41:47,680
to take stuff out
to save my life, right? I know that.
734
00:41:47,680 --> 00:41:50,080
I just... Maybe I am being
a bit greedy to be, like,
735
00:41:50,080 --> 00:41:51,840
"Is it too much to ask that
736
00:41:51,840 --> 00:41:55,560
"I wasn't left with
a lifelong chronic condition?"
737
00:41:57,840 --> 00:42:01,280
Only half of cancer patients feel
that long-term side-effects
738
00:42:01,280 --> 00:42:05,880
of treatment are fully explained
to them. At the moment,
739
00:42:05,880 --> 00:42:09,400
the way that these side-effects
and statistics are given,
740
00:42:09,400 --> 00:42:13,000
it's like...reeled off like
a list of numbers.
741
00:42:13,000 --> 00:42:15,280
I'm not saying for a second
that these treatments
742
00:42:15,280 --> 00:42:16,720
aren't a good thing,
743
00:42:16,720 --> 00:42:19,600
I just think that people should
be given...
744
00:42:21,480 --> 00:42:22,800
..the opportunity
745
00:42:22,800 --> 00:42:26,120
to understand what they're
really signing up for.
746
00:42:30,080 --> 00:42:32,000
Life-changing decisions are so hard
747
00:42:32,000 --> 00:42:34,600
to make when you're in
the middle of a crisis.
748
00:42:37,440 --> 00:42:41,360
But if you're not part of deciding
what risks are worth taking,
749
00:42:41,360 --> 00:42:44,800
cancer care can end up feeling like
something that's done TO you.
750
00:42:44,800 --> 00:42:46,160
Not with you.
751
00:42:49,880 --> 00:42:53,280
I keep thinking about how this
all started,
752
00:42:53,280 --> 00:42:55,480
the smear test that I put off,
753
00:42:55,480 --> 00:42:58,240
and the one that later found
my cancer.
754
00:43:01,640 --> 00:43:03,400
That's the smear test letter,
755
00:43:03,400 --> 00:43:05,240
the one that I missed.
756
00:43:07,920 --> 00:43:11,120
And then there's the one that they
sent as the follow-up.
757
00:43:19,640 --> 00:43:21,680
What happened...
758
00:43:23,360 --> 00:43:26,240
..in my body that I didn't know
about between then and then?
759
00:43:27,840 --> 00:43:30,520
And what would they have found
if I'd gone to that one?
760
00:43:35,120 --> 00:43:38,560
The cervical screening programme
is one of only three screening tests
761
00:43:38,560 --> 00:43:40,200
offered by the NHS,
762
00:43:40,200 --> 00:43:43,600
along with breast and bowel cancer
for those over 50.
763
00:43:53,360 --> 00:43:55,280
The NHS estimates that their
764
00:43:55,280 --> 00:44:01,040
cervical screening programme saves
around 5,000 lives every year.
765
00:44:01,040 --> 00:44:04,000
But even screening provokes debate.
766
00:44:06,000 --> 00:44:08,600
I'm in Glasgow to meet
Dr Margaret McCartney.
767
00:44:08,600 --> 00:44:10,880
She's a GP and an honorary fellow
768
00:44:10,880 --> 00:44:14,560
at the Centre for Evidence-Based
Medicine.
769
00:44:14,560 --> 00:44:17,000
She wants to tell me about some
research that turns
770
00:44:17,000 --> 00:44:21,200
the tables on what we think we
know about cancer.
771
00:44:21,200 --> 00:44:22,880
So, when I was at medical school,
772
00:44:22,880 --> 00:44:25,680
very much you were taught that
cancer is a bad thing,
773
00:44:25,680 --> 00:44:27,840
and certainly very often it is
a bad thing.
774
00:44:27,840 --> 00:44:30,200
It's something you would
want to know about and treat,
775
00:44:30,200 --> 00:44:32,200
but it's more complicated than
that as well.
776
00:44:32,200 --> 00:44:34,760
We know that there are many people
who've got
777
00:44:34,760 --> 00:44:37,840
a cancer in their bodies that they
would not have known about had they
778
00:44:37,840 --> 00:44:39,520
not gone to get tested for it,
779
00:44:39,520 --> 00:44:41,560
and they would never have known
about it
780
00:44:41,560 --> 00:44:43,800
because it wasn't
a cancer that was destined
781
00:44:43,800 --> 00:44:46,160
to spread or to kill them or
to cause problems.
782
00:44:46,160 --> 00:44:47,640
Is this quite a rare thing, though,
783
00:44:47,640 --> 00:44:51,120
that people have cancers that won't
go on to kill them?
784
00:44:51,120 --> 00:44:53,120
There's a background that's useful,
which is
785
00:44:53,120 --> 00:44:55,560
that there have been
a lot of autopsy studies done over
786
00:44:55,560 --> 00:44:58,480
the last few decades,
where people have examined
787
00:44:58,480 --> 00:45:03,600
the tissues of individuals who have
died suddenly and unexpectedly,
788
00:45:03,600 --> 00:45:06,320
usually road traffic accidents.
So, they've had a sudden death,
789
00:45:06,320 --> 00:45:08,680
and these people weren't being
treated for cancer.
790
00:45:08,680 --> 00:45:10,600
They weren't being investigated
for cancer.
791
00:45:10,600 --> 00:45:13,920
They didn't have symptoms that we
knew about that would suggest cancer
792
00:45:13,920 --> 00:45:15,480
and the tissues have been examined
793
00:45:15,480 --> 00:45:21,320
but have found cancer in around
about 7% of cases. 7%?
794
00:45:21,320 --> 00:45:22,560
Yeah, yeah.
795
00:45:22,560 --> 00:45:27,040
This does seem like quite
an astonishing thing to say.
796
00:45:27,040 --> 00:45:29,680
It's a really weird thing to try
and think about
797
00:45:29,680 --> 00:45:32,120
because it runs counter
to everything that we're taught
798
00:45:32,120 --> 00:45:34,440
and we're told.
If you go and look for cancer,
799
00:45:34,440 --> 00:45:36,760
you will find cancer.
There's no question about that,
800
00:45:36,760 --> 00:45:38,080
so if you go and put, you know,
801
00:45:38,080 --> 00:45:40,760
hundreds of people through
a CT scanner or an MRI scanner,
802
00:45:40,760 --> 00:45:43,800
you will find cancers that they
had no symptoms of,
803
00:45:43,800 --> 00:45:45,320
they didn't have any inkling about.
804
00:45:45,320 --> 00:45:47,120
The big question is whether that
cancer was
805
00:45:47,120 --> 00:45:50,240
going to go on and do that
person harm.
806
00:45:50,240 --> 00:45:53,840
Some of the studies using
MRIs put this number slightly lower,
807
00:45:53,840 --> 00:45:55,280
but we do know that there is
808
00:45:55,280 --> 00:45:58,720
a pool of undiagnosed tumours
out there.
809
00:45:59,800 --> 00:46:02,560
But to discover whether those
cancers will cause harm,
810
00:46:02,560 --> 00:46:05,160
Margaret wanted
to show me something extraordinary
811
00:46:05,160 --> 00:46:09,720
that reveals why hunting for cancer
cells isn't always a good thing.
812
00:46:09,720 --> 00:46:14,160
So, this is a graph of what happened
in South Korea when they decided
813
00:46:14,160 --> 00:46:18,240
to offer the population screening
for thyroid cancer,
814
00:46:18,240 --> 00:46:21,520
and they started
to screen people just in 1999.
815
00:46:21,520 --> 00:46:24,320
So, you'll see that, as they started
to screen for thyroid cancer,
816
00:46:24,320 --> 00:46:28,160
they found more and more
and more and more thyroid cancer.
817
00:46:28,160 --> 00:46:29,920
But what you really need to know is,
818
00:46:29,920 --> 00:46:31,960
does this make a difference
to death rates?
819
00:46:31,960 --> 00:46:34,080
Look at the orange line
down the bottom,
820
00:46:34,080 --> 00:46:36,720
and you'll see that
the mortality is a flatline.
821
00:46:36,720 --> 00:46:39,000
This is a classic graph
showing overdiagnosis,
822
00:46:39,000 --> 00:46:41,560
because what you're doing is
you're diagnosing more
823
00:46:41,560 --> 00:46:43,480
and more and more thyroid cancer,
824
00:46:43,480 --> 00:46:45,800
but you're not making any
difference to death rates.
825
00:46:45,800 --> 00:46:48,200
If you get diagnosed with thyroid
cancer, what happens?
826
00:46:48,200 --> 00:46:50,560
What is the treatment for it?
It's all in the neck, isn't it?
827
00:46:50,560 --> 00:46:52,960
Yeah, that's right. It's your
thyroid gland around here.
828
00:46:52,960 --> 00:46:56,040
You're going to be offered surgery,
you might be offered radiotherapy,
829
00:46:56,040 --> 00:46:58,240
you might have to go into long-term
treatment after that,
830
00:46:58,240 --> 00:46:59,480
so lots of interventions.
831
00:46:59,480 --> 00:47:02,520
So, there will be some people who've
had surgery on their necks
832
00:47:02,520 --> 00:47:04,680
that they didn't need?
Totally, absolutely.
833
00:47:04,680 --> 00:47:07,000
If you're not
going to benefit from a treatment,
834
00:47:07,000 --> 00:47:09,120
all it can possibly do is give
you side-effects.
835
00:47:09,120 --> 00:47:12,640
I guess, in the UK,
for something like thyroid cancer,
836
00:47:12,640 --> 00:47:14,000
we don't screen... Yeah.
837
00:47:14,000 --> 00:47:16,960
..but then there are other types
of cancer where we do.
838
00:47:16,960 --> 00:47:19,160
Like breast cancer, for example.
839
00:47:19,160 --> 00:47:21,840
So, in that case, then,
is the equation flipped?
840
00:47:21,840 --> 00:47:25,080
Is it very obvious that there's
a benefit to do it?
841
00:47:25,080 --> 00:47:28,120
Well, I'd love to say that
there was, but it is more complex.
842
00:47:28,120 --> 00:47:30,760
So the government have made
a decision that it's cost-effective
843
00:47:30,760 --> 00:47:32,600
to offer it to women.
So, the Marmot Review
844
00:47:32,600 --> 00:47:34,800
looked at the evidence around
this a few years ago
845
00:47:34,800 --> 00:47:36,040
and they concluded that,
846
00:47:36,040 --> 00:47:38,880
for every 200 women that had
breast cancer screening,
847
00:47:38,880 --> 00:47:40,920
you would delay
the death of one woman,
848
00:47:40,920 --> 00:47:44,080
but at the cost
of three women being over-treated
849
00:47:44,080 --> 00:47:47,840
for breast cancer.
And when you say overtreated,
850
00:47:47,840 --> 00:47:52,040
are those the type
of women who have cancer,
851
00:47:52,040 --> 00:47:53,520
but don't know about it,
852
00:47:53,520 --> 00:47:56,640
and it's not really
going to go on to cause a problem,
853
00:47:56,640 --> 00:47:59,400
and yet they're having things
like mastectomies
854
00:47:59,400 --> 00:48:01,920
and biopsies, and all of the
concerns around those?
855
00:48:01,920 --> 00:48:04,040
Yeah, that's exactly right.
So, these are people
856
00:48:04,040 --> 00:48:06,680
that would never have come to the
attention of a doctor
857
00:48:06,680 --> 00:48:09,360
had they not had the tests done.
So, what you're saying,
858
00:48:09,360 --> 00:48:11,560
it's good for this group
of women overall,
859
00:48:11,560 --> 00:48:13,200
but, sorry, you're the unlucky one,
860
00:48:13,200 --> 00:48:15,200
and you're the unlucky one,
and so are you.
861
00:48:15,200 --> 00:48:17,360
But the problem is that those women
will never know
862
00:48:17,360 --> 00:48:18,600
that they've been unlucky.
863
00:48:18,600 --> 00:48:21,120
And this is the really big problem
because the temptation is,
864
00:48:21,120 --> 00:48:23,760
for every single woman who's been
detected as having a problem,
865
00:48:23,760 --> 00:48:25,800
to think that she has been
diagnosed early
866
00:48:25,800 --> 00:48:28,320
and that her life has been made
better because of that.
867
00:48:28,320 --> 00:48:30,440
But you just don't know that -
you don't know which
868
00:48:30,440 --> 00:48:31,760
of those women that you are.
869
00:48:31,760 --> 00:48:34,440
Whether you're the woman that
actually did get a benefit,
870
00:48:34,440 --> 00:48:36,560
or whether you're the majority
of women that actually
871
00:48:36,560 --> 00:48:38,400
didn't get benefit from treatment.
872
00:48:38,400 --> 00:48:41,480
Do you think it is
a big problem that you have
873
00:48:41,480 --> 00:48:44,720
those three women in 200
being overtreated?
874
00:48:44,720 --> 00:48:48,160
Well, I suppose I wouldn't be
the person to judge that.
875
00:48:48,160 --> 00:48:50,160
It would be those individual women
to judge that.
876
00:48:50,160 --> 00:48:51,880
So, if you have breast
cancer screening,
877
00:48:51,880 --> 00:48:54,400
I think you should decide
for yourself whether you think
878
00:48:54,400 --> 00:48:56,280
that that risk is worth it
or not worth it.
879
00:48:56,280 --> 00:48:58,480
You know, are you happy with that
risk yourself?
880
00:49:01,760 --> 00:49:05,760
Cancer screening saves thousands
of lives every year,
881
00:49:05,760 --> 00:49:09,160
but it's important to acknowledge
that this is not without cost.
882
00:49:10,680 --> 00:49:15,280
There's like this fundamental
disconnect, really,
883
00:49:15,280 --> 00:49:17,400
between what the numbers say
884
00:49:17,400 --> 00:49:20,200
and what it actually feels like
when you're the number.
885
00:49:22,280 --> 00:49:25,080
Because, of course, you can look at
all those statistics and say,
886
00:49:25,080 --> 00:49:27,160
"Oh, that is pretty terrible
887
00:49:27,160 --> 00:49:29,800
"that people are having these
life-changing surgeries
888
00:49:29,800 --> 00:49:34,480
"that they don't need,
that they never had to go through."
889
00:49:34,480 --> 00:49:37,520
But then, at the same time,
890
00:49:37,520 --> 00:49:39,520
having been diagnosed
with cancer,
891
00:49:39,520 --> 00:49:41,240
I know in that moment...
892
00:49:44,600 --> 00:49:47,640
..I just wanted to get rid of it.
893
00:49:47,640 --> 00:49:49,720
I just wanted to get rid of it.
894
00:49:49,720 --> 00:49:52,320
It wouldn't really have mattered
what the numbers said.
895
00:50:01,040 --> 00:50:05,160
There are no easy choices
in any of this.
896
00:50:05,160 --> 00:50:08,600
Turning down treatment wasn't
right for me,
897
00:50:08,600 --> 00:50:11,200
but that's not the case
for everyone.
898
00:50:12,600 --> 00:50:13,640
I'm leaving...
899
00:50:15,760 --> 00:50:17,680
..St James's.
900
00:50:21,120 --> 00:50:23,320
Three surgeries,
901
00:50:23,320 --> 00:50:26,040
50 sessions of radiotherapy,
902
00:50:26,040 --> 00:50:29,360
six rounds of chemotherapy.
903
00:50:34,360 --> 00:50:36,440
And I've just told them
no more treatment.
904
00:50:42,800 --> 00:50:44,760
Rob is a climbing wall inspector
905
00:50:44,760 --> 00:50:46,720
and dad to four-year-old Caleb.
906
00:50:47,880 --> 00:50:52,080
He has a cancer of the soft tissue
called synovial sarcoma,
907
00:50:52,080 --> 00:50:54,440
and it's terminal.
908
00:50:54,440 --> 00:50:56,600
I went to Yorkshire to meet him.
909
00:50:58,240 --> 00:51:01,920
If it's OK, I want to take you back
to that decision that you made.
910
00:51:01,920 --> 00:51:06,080
Yeah. Tell me a bit about what you
were weighing up in your mind at
that
911
00:51:06,080 --> 00:51:09,320
point in time. What were the two
sides of that argument?
912
00:51:09,320 --> 00:51:13,160
It was quite simply quality
or quantity.
913
00:51:13,160 --> 00:51:16,520
I thought, if I had treatment, that
I would be spending
914
00:51:16,520 --> 00:51:18,040
a lot of time in hospital,
915
00:51:18,040 --> 00:51:21,920
and I did... That isn't going to be
916
00:51:21,920 --> 00:51:24,960
a very good quality of life.
I could have had the treatment,
917
00:51:24,960 --> 00:51:28,760
and it could have, say, given me
an extra four or five months.
918
00:51:28,760 --> 00:51:30,440
I could have had the treatment,
919
00:51:30,440 --> 00:51:33,480
and I could have passed away during
treatment or just after.
920
00:51:33,480 --> 00:51:36,320
And trying to calculate, work out,
921
00:51:36,320 --> 00:51:40,560
that decision was really,
really difficult, to be honest.
922
00:51:40,560 --> 00:51:43,440
But, then, very easy on
the flip side of it,
923
00:51:43,440 --> 00:51:47,600
of thinking, "If I want to go
to Scotland in my van with Caleb,
924
00:51:47,600 --> 00:51:51,600
"if that's something I
want to do before I pass away,
925
00:51:51,600 --> 00:51:54,160
"going through treatment isn't
going to get me there."
926
00:51:57,000 --> 00:52:01,720
Well, Caleb, this is Glencoe.
927
00:52:06,120 --> 00:52:07,160
It was only 24 hours,
928
00:52:07,160 --> 00:52:08,600
but I got him to Scotland,
929
00:52:08,600 --> 00:52:10,000
eight hour drive up there,
930
00:52:10,000 --> 00:52:12,040
but we also went to Loch Lomond,
931
00:52:12,040 --> 00:52:14,680
so we had a paddle around
Loch Lomond as well.
932
00:52:14,680 --> 00:52:18,120
So, we did
lots of things in that 24 hours.
933
00:52:19,920 --> 00:52:22,000
Some people might say
934
00:52:22,000 --> 00:52:24,520
that choosing not
to have treatment at
935
00:52:24,520 --> 00:52:27,440
the stage you were at was
a bit like giving up.
936
00:52:27,440 --> 00:52:29,440
I don't see it as giving up.
937
00:52:29,440 --> 00:52:35,000
I see it is accepting
the inevitable, to be honest.
938
00:52:35,000 --> 00:52:37,960
I know I'm deteriorating, I know
things are changing,
939
00:52:37,960 --> 00:52:42,040
but as long as I can come here,
ride my bike, I will do.
940
00:52:42,040 --> 00:52:44,480
I've made a lot of memories here,
941
00:52:44,480 --> 00:52:47,320
and that's definitely not what
I would have got
942
00:52:47,320 --> 00:52:48,800
had I been in a hospital bed.
943
00:52:57,720 --> 00:53:01,840
So, this, um, is just a memory box
for Caleb.
944
00:53:01,840 --> 00:53:04,640
It's got lots of things, all the
rocks from different walks
945
00:53:04,640 --> 00:53:06,680
we've been on and painted. Together.
946
00:53:06,680 --> 00:53:10,120
I think that's just so sweet, having
stuff like this ready for him.
947
00:53:10,120 --> 00:53:11,840
And then, of course,
948
00:53:11,840 --> 00:53:15,000
letters which... These were written
in 2019 when
949
00:53:15,000 --> 00:53:16,840
I was going through treatment.
950
00:53:16,840 --> 00:53:21,520
So, there's, like, one for his
18th birthday and 21st,
951
00:53:21,520 --> 00:53:25,640
wedding day, all these kinds of
stuff. Er, first car.
952
00:53:25,640 --> 00:53:28,400
When you realise you're gay,
953
00:53:28,400 --> 00:53:31,040
that's an important one.
954
00:53:31,040 --> 00:53:34,080
You never know! Exactly.
955
00:53:34,080 --> 00:53:36,320
So, first fight with your mum.
956
00:53:36,320 --> 00:53:37,360
SHE LAUGHS
957
00:53:37,360 --> 00:53:38,800
First day at school -
958
00:53:38,800 --> 00:53:41,640
that one can go in the bin, yes!
You made it.
959
00:53:41,640 --> 00:53:46,280
I made it, milestone.
And how does it feel to have
960
00:53:46,280 --> 00:53:49,760
already, some of them out of date,
almost? Well, that's...
961
00:53:49,760 --> 00:53:51,800
Yes, I've surpassed many of
the estimations
962
00:53:51,800 --> 00:53:54,560
because that's what it is at
the end of the day, isn't it?
963
00:53:54,560 --> 00:53:55,640
They're only estimates.
964
00:53:55,640 --> 00:53:57,600
It takes, I think, quite a lot
of strength
965
00:53:57,600 --> 00:53:59,640
to put something like this together.
966
00:53:59,640 --> 00:54:02,960
Yeah. Has it helped you too?
Oh, definitely.
967
00:54:02,960 --> 00:54:06,400
I think writing the letters made
it feel like I was,
968
00:54:06,400 --> 00:54:10,040
like it was the start of
the acceptance, to be honest,
969
00:54:10,040 --> 00:54:12,480
of that this is what's happening.
970
00:54:19,600 --> 00:54:23,240
So, what happens now? Wait, really.
971
00:54:23,240 --> 00:54:24,720
Keep taking my meds,
972
00:54:24,720 --> 00:54:27,080
keep riding my bike.
973
00:54:27,080 --> 00:54:29,360
Go on living, really.
974
00:54:29,360 --> 00:54:31,800
There's nothing else you can do.
975
00:54:36,680 --> 00:54:40,160
There's this incredible amount
of strength in what he's doing,
976
00:54:40,160 --> 00:54:46,240
and I think Rob is someone
who is just
977
00:54:46,240 --> 00:54:49,040
totally fine with his own mortality.
978
00:54:49,040 --> 00:54:50,920
Like, I know he doesn't want to die,
979
00:54:50,920 --> 00:54:54,560
of course not, but he's...
980
00:54:54,560 --> 00:54:59,320
He's got this calmness of mind.
981
00:54:59,320 --> 00:55:02,080
Like, he's worked out what is
important to him,
982
00:55:02,080 --> 00:55:06,520
he knows what his values are,
and therefore,
983
00:55:06,520 --> 00:55:08,760
everything else falls into place.
984
00:55:19,760 --> 00:55:22,360
I'll need regular follow-ups
for the next five years
985
00:55:22,360 --> 00:55:24,760
to see if the cancer has come back.
986
00:55:27,560 --> 00:55:31,920
Hi, Hannah. Hi, how are you doing?
Come through. Thank you.
987
00:55:31,920 --> 00:55:34,240
Come on in, have a seat. Thank you.
988
00:55:34,240 --> 00:55:35,760
How is it otherwise going?
989
00:55:35,760 --> 00:55:39,920
You're fine? Yeah, it's OK, yeah.
990
00:55:39,920 --> 00:55:44,480
I realise now that this is
going to be part of my life forever.
991
00:55:47,640 --> 00:55:50,560
It's an anniversary today.
992
00:55:50,560 --> 00:55:53,680
Not the sort of anniversary you
traditionally celebrate,
993
00:55:53,680 --> 00:55:56,480
but it was a year ago today that
I was in hospital
994
00:55:56,480 --> 00:55:58,520
with my surgery.
995
00:55:58,520 --> 00:56:00,720
I was thinking about it
this morning.
996
00:56:00,720 --> 00:56:02,800
It's only until very recently that
997
00:56:02,800 --> 00:56:05,800
I haven't just been completely
reeling from it.
998
00:56:05,800 --> 00:56:08,440
I mean, I think it's just impossible
to, like,
999
00:56:08,440 --> 00:56:10,920
get cancer in your mid-thirties
1000
00:56:10,920 --> 00:56:15,000
and not come out of it with
1001
00:56:15,000 --> 00:56:17,160
a really different view of life.
Yeah,
1002
00:56:17,160 --> 00:56:18,800
it's left an indelible mark,
hasn't it?
1003
00:56:18,800 --> 00:56:21,040
I mean, it's not a simple, you know,
1004
00:56:21,040 --> 00:56:23,520
"Heal, get over it, move on."
1005
00:56:23,520 --> 00:56:25,960
I mean, you do have to move on to a
degree, but it's not,
1006
00:56:25,960 --> 00:56:27,640
it's nowhere near that simple.
1007
00:56:29,840 --> 00:56:31,000
I think, for most of us,
1008
00:56:31,000 --> 00:56:32,920
for most of our lives,
1009
00:56:32,920 --> 00:56:36,840
we get to pretend that
we are immortal, really.
1010
00:56:36,840 --> 00:56:40,400
We don't have to live
with this shadow of death,
1011
00:56:40,400 --> 00:56:42,200
really, hanging over us
all the time.
1012
00:56:42,200 --> 00:56:44,520
We have this kind of luxury of that,
1013
00:56:44,520 --> 00:56:48,880
and so I think that whenever
you are confronted
1014
00:56:48,880 --> 00:56:50,960
with your own mortality,
1015
00:56:50,960 --> 00:56:53,760
as you are when you receive
a cancer diagnosis,
1016
00:56:53,760 --> 00:56:56,000
no matter how serious it is,
1017
00:56:56,000 --> 00:56:59,240
I think that we are so not used
to that idea,
1018
00:56:59,240 --> 00:57:02,080
we are so terrified of the idea
1019
00:57:02,080 --> 00:57:05,560
that we are unwilling
to tolerate any risk whatsoever.
1020
00:57:08,240 --> 00:57:10,880
I try not to think too hard about
the numbers of recurrence,
1021
00:57:10,880 --> 00:57:14,200
because that number of one in ten,
1022
00:57:14,200 --> 00:57:16,320
the chance of recurrence,
it is still there,
1023
00:57:16,320 --> 00:57:19,760
and it is still true
and it's still a fact.
1024
00:57:22,440 --> 00:57:24,640
I don't know, I just think,
over time,
1025
00:57:24,640 --> 00:57:28,200
you have to accept that life comes
with risks, and that
1026
00:57:28,200 --> 00:57:31,760
you can't sort of wander around
being terrified
1027
00:57:31,760 --> 00:57:34,440
of everything that might
happen. Otherwise,
1028
00:57:34,440 --> 00:57:37,360
you're never going to have
the chance to properly live it.
1029
00:57:43,800 --> 00:57:47,480
I think that somehow we've decided
that the chance of dying
1030
00:57:47,480 --> 00:57:50,080
is the only number that matters,
1031
00:57:50,080 --> 00:57:52,280
and so we've built
a one-size-fits-all approach
1032
00:57:52,280 --> 00:57:57,960
to cancer care that takes courage
and strength to deviate from.
1033
00:57:57,960 --> 00:58:01,240
Perhaps that's because we're not
having honest conversations
1034
00:58:01,240 --> 00:58:04,920
about the true benefits
and costs of treatment.
1035
00:58:04,920 --> 00:58:08,960
Only when we do can people work out
what they most care about,
1036
00:58:08,960 --> 00:58:11,360
and make the choice that's right
for them.
84656
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