1 00:00:03,115 --> 00:00:07,115 This programme contains some strong language from the start and scenes which some viewers may find upsetting 2 00:00:11,675 --> 00:00:12,235 Fuck. 3 00:00:14,395 --> 00:00:18,475 That means I might be stage three. Cancer. 4 00:00:20,515 --> 00:00:21,755 SHE EXHALES 5 00:00:25,075 --> 00:00:27,635 My name is Hannah Fry. 6 00:00:27,635 --> 00:00:30,675 This equation encapsulates all of 7 00:00:30,675 --> 00:00:34,715 the fundamental properties of the subatomic world. 8 00:00:36,075 --> 00:00:38,795 I'm a professor of mathematics, 9 00:00:38,795 --> 00:00:40,635 and I've spent my life using numbers to try 10 00:00:40,635 --> 00:00:42,875 and understand the world around me. 11 00:00:42,875 --> 00:00:47,955 An airport city, and building it and running it 12 00:00:47,955 --> 00:00:51,995 has tested us to our absolute limits. 13 00:00:51,995 --> 00:00:56,275 In January last year, I was diagnosed with cervical cancer. 14 00:00:57,475 --> 00:01:01,955 I started filming myself as a way to cope with what's happening to me. 15 00:01:01,955 --> 00:01:05,635 Oh, God, oh, my God, it feels like my guts are going to come out. 16 00:01:05,635 --> 00:01:07,875 Again, this is around your knee. 17 00:01:07,875 --> 00:01:11,315 With my doctors, I've had to make some hard decisions about my care, 18 00:01:11,315 --> 00:01:14,235 and I'm not sure we've always got them right. 19 00:01:14,235 --> 00:01:17,795 They are often very aggressive with this sort of tumour, 20 00:01:17,795 --> 00:01:20,235 and they often take out a lot of nodes. 21 00:01:23,635 --> 00:01:25,755 Welcome to my cancer research cave. 22 00:01:25,755 --> 00:01:29,355 I've become obsessed with the statistics behind cancer... 23 00:01:29,355 --> 00:01:30,995 My books. 24 00:01:30,995 --> 00:01:34,155 ..and it's made me question all my assumptions about this disease. 25 00:01:35,475 --> 00:01:37,355 Now I want to find out how doctors 26 00:01:37,355 --> 00:01:39,955 and patients feel about their treatments. 27 00:01:39,955 --> 00:01:44,235 Are we making the right choices in how we deal with cancer? 28 00:01:44,235 --> 00:01:47,275 For 95 of those women, 29 00:01:47,275 --> 00:01:52,235 chemotherapy made no difference to what happened to their cancer? 30 00:01:52,235 --> 00:01:53,555 Yep. 31 00:01:53,555 --> 00:01:55,955 Is searching for cancer always a good idea? 32 00:01:55,955 --> 00:01:58,715 This is a classic graph showing overdiagnosis, 33 00:01:58,715 --> 00:02:00,875 because what you're doing is you're diagnosing more 34 00:02:00,875 --> 00:02:02,955 and more and more thyroid cancer, 35 00:02:02,955 --> 00:02:05,755 but you're not making any difference to death rates. 36 00:02:07,235 --> 00:02:10,435 Have we become so afraid of this disease that we'll do anything 37 00:02:10,435 --> 00:02:13,075 to fight it, no matter the cost? 38 00:02:13,075 --> 00:02:17,475 As long as there's a percentage, there's hope. 39 00:02:17,475 --> 00:02:21,435 It means I might be that 1% that it works for. 40 00:02:21,435 --> 00:02:26,675 And what will I do when faced with my own odds? 41 00:02:26,675 --> 00:02:28,915 I think, whatever happens now, 42 00:02:28,915 --> 00:02:33,315 this has fundamentally changed me, like. 43 00:02:49,555 --> 00:02:52,675 Five! OK, do you want to give that to... 44 00:02:52,675 --> 00:02:55,515 I live in South London with my husband, Phil, 45 00:02:55,515 --> 00:02:57,315 and our two daughters. 46 00:02:57,315 --> 00:02:59,395 Come on, sausage. 47 00:02:59,395 --> 00:03:02,035 They are two and four. 48 00:03:02,035 --> 00:03:05,195 They are absolutely brilliant, 49 00:03:05,195 --> 00:03:10,355 and ridiculously hard work in equal measure. 50 00:03:16,355 --> 00:03:18,435 Phil, my husband, he's a stay-at-home dad. 51 00:03:18,435 --> 00:03:20,435 He takes care of the kids, 52 00:03:20,435 --> 00:03:22,955 he's their primary carer. I like 53 00:03:22,955 --> 00:03:26,195 to describe it that we've got a very traditional 1950s relationship, 54 00:03:26,195 --> 00:03:29,635 just everything's switched around the other way. 55 00:03:29,635 --> 00:03:31,075 There's no way that I would be able 56 00:03:31,075 --> 00:03:33,715 to do my job unless I had that home support. 57 00:03:36,035 --> 00:03:38,395 This particular algorithm, it works a lot like 58 00:03:38,395 --> 00:03:40,235 predictive text does on your phone. 59 00:03:40,235 --> 00:03:43,435 I think the thing about looking at things through numbers is that it 60 00:03:43,435 --> 00:03:46,795 gives you a chance to see yourself 61 00:03:46,795 --> 00:03:50,315 and to see the world from a completely different perspective. 62 00:03:50,315 --> 00:03:52,395 If you imagine you have a corridor 63 00:03:52,395 --> 00:03:55,075 with lots of people moving in opposite directions, 64 00:03:55,075 --> 00:03:59,475 people naturally form these lanes in pedestrian traffic. 65 00:04:00,915 --> 00:04:03,955 I like to imagine it as though you've got these two worlds that are 66 00:04:03,955 --> 00:04:06,075 running in parallel to one another. 67 00:04:06,075 --> 00:04:09,235 So, on the one hand, you've got kind of like the real world, 68 00:04:09,235 --> 00:04:12,515 and then running alongside it, I think it's almost like you have 69 00:04:12,515 --> 00:04:14,915 a mathematical version of that same world. 70 00:04:14,915 --> 00:04:17,195 So, this is the one where you have all of the numbers 71 00:04:17,195 --> 00:04:20,635 and all of the data and all of the equations. 72 00:04:20,635 --> 00:04:24,875 It's a way that you can zoom out and see things as they really are, 73 00:04:24,875 --> 00:04:27,115 rather than how you perceive them to be. 74 00:04:36,915 --> 00:04:41,155 In January 2021, my life changed. 75 00:04:41,155 --> 00:04:43,275 I had a call from my GP telling me 76 00:04:43,275 --> 00:04:46,235 they detected abnormalities on my smear test, 77 00:04:46,235 --> 00:04:49,275 an appointment I'd put off for six months. 78 00:04:51,915 --> 00:04:54,355 So, this one that we're doing here 79 00:04:54,355 --> 00:04:56,435 is for your blood group and type. 80 00:04:56,435 --> 00:04:57,715 I had a number of follow-up 81 00:04:57,715 --> 00:05:01,835 investigations before they could give me the full picture. 82 00:05:01,835 --> 00:05:04,035 He just told me the facts, 83 00:05:04,035 --> 00:05:06,755 which were that they'd found a tumour 84 00:05:06,755 --> 00:05:10,475 and it was about the size of a gobstopper, 85 00:05:10,475 --> 00:05:14,235 and it was all contained within the cervix. 86 00:05:14,235 --> 00:05:17,715 In the moment, you don't really realise what's happening, 87 00:05:17,715 --> 00:05:23,195 and then it's only after that you're reeling from everything. 88 00:05:23,195 --> 00:05:24,915 "What the hell just happened?" 89 00:05:28,275 --> 00:05:29,955 Your hair's really clean. 90 00:05:31,155 --> 00:05:32,915 Did you wash it? 91 00:05:32,915 --> 00:05:34,915 Yeah, all by myself. 92 00:05:34,915 --> 00:05:36,395 I did it myself. 93 00:05:41,155 --> 00:05:44,555 There's no guarantee that this is all going to be OK. 94 00:05:44,555 --> 00:05:47,555 And I've had a pretty good life. 95 00:05:47,555 --> 00:05:50,195 Like, it's one thing for yourself to be like, 96 00:05:50,195 --> 00:05:56,475 "OK, if I only live to 36 or 37, OK, you know, whatever." 97 00:05:56,475 --> 00:05:57,755 Like... 98 00:05:59,555 --> 00:06:01,195 Look at all of the experiences I had, 99 00:06:01,195 --> 00:06:03,755 and that look at all of the brilliant things that I got 100 00:06:03,755 --> 00:06:06,555 to do, and look at all the friends I got to make. 101 00:06:06,555 --> 00:06:10,195 I can't quite deal with the idea of my daughters not having me. 102 00:06:11,835 --> 00:06:13,515 That's the really hard bit, I think. 103 00:06:18,475 --> 00:06:21,195 Hannah's human, so she worries, but at the same time, 104 00:06:21,195 --> 00:06:23,115 she thrives on information. You know, 105 00:06:23,115 --> 00:06:25,595 she's a mathematician and scientist and she, 106 00:06:25,595 --> 00:06:28,115 you know, data is her is, you know, 107 00:06:28,115 --> 00:06:30,515 the thing she lives by. That's who she is. 108 00:06:30,515 --> 00:06:32,155 So, when something like this happens, 109 00:06:32,155 --> 00:06:33,995 she's like, "I need to know everything. 110 00:06:33,995 --> 00:06:36,475 "I don't want to leave any stone unturned." 111 00:06:36,475 --> 00:06:39,075 Like an instinctive reaction, 112 00:06:39,075 --> 00:06:40,715 to just want to read about it. 113 00:06:43,435 --> 00:06:44,755 In the last 40 years, 114 00:06:44,755 --> 00:06:48,275 cancer survival rates have doubled in the UK. 115 00:06:48,275 --> 00:06:52,555 50% of people diagnosed now survive at least ten years, 116 00:06:52,555 --> 00:06:55,475 and that's due to an ever more sophisticated raft 117 00:06:55,475 --> 00:06:57,795 of surgeries and treatments. 118 00:06:59,235 --> 00:07:02,715 The first intervention recommended for me is surgery, 119 00:07:02,715 --> 00:07:05,955 what they call a radical hysterectomy. 120 00:07:07,795 --> 00:07:10,835 They don't just take out the uterus, 121 00:07:10,835 --> 00:07:13,075 they don't just take out the cervix. 122 00:07:13,075 --> 00:07:15,195 They take out the top section of the vagina, 123 00:07:15,195 --> 00:07:16,755 they take out the fallopian tubes, 124 00:07:16,755 --> 00:07:18,795 they take out all the tissue that surrounds it, 125 00:07:18,795 --> 00:07:21,395 so that, in the end, there's nothing between my bladder 126 00:07:21,395 --> 00:07:23,755 and my bowels. It's completely empty. 127 00:07:23,755 --> 00:07:26,635 And all of the pelvic lymph nodes. 128 00:07:29,915 --> 00:07:32,875 I wanted to talk to someone who's been in this position before. 129 00:07:32,875 --> 00:07:37,475 The first person I thought of was my friend David Spiegelhalter. 130 00:07:37,475 --> 00:07:39,075 He's had prostate cancer, 131 00:07:39,075 --> 00:07:42,715 and he's spent a lifetime working in medical statistics. 132 00:07:42,715 --> 00:07:45,475 I'm just like, I don't know, 133 00:07:45,475 --> 00:07:48,035 trying to tackle it in the same way that I do with everything. 134 00:07:48,035 --> 00:07:50,035 I've got, like, this massive stack of books next 135 00:07:50,035 --> 00:07:52,515 to me of things that I'm trying to get through. 136 00:07:52,515 --> 00:07:56,315 Do you think... I don't know. Did the numbers help you? 137 00:07:56,315 --> 00:07:57,955 I think, like everyone else, 138 00:07:57,955 --> 00:08:00,115 it came as a huge emotional hit. 139 00:08:00,115 --> 00:08:03,955 You know, I'm not immune to any of those kind of feelings, 140 00:08:03,955 --> 00:08:06,835 but I suppose I did try to take 141 00:08:06,835 --> 00:08:10,555 a kind of mathematical view to it 142 00:08:10,555 --> 00:08:13,715 and start doing some research on what 143 00:08:13,715 --> 00:08:15,835 the options might be and what the outcomes might be. 144 00:08:15,835 --> 00:08:18,075 And, you know, one aspect of it, of course, 145 00:08:18,075 --> 00:08:21,235 is the feeling that, um, "Oh, you know, I've got cancer, 146 00:08:21,235 --> 00:08:23,155 "let's get it out, you know, just cut it out." 147 00:08:23,155 --> 00:08:24,555 Now I would say to people to 148 00:08:24,555 --> 00:08:26,795 try to keep that under control, just keep calm, 149 00:08:26,795 --> 00:08:29,475 keep calm. That may not be the best policy. 150 00:08:29,475 --> 00:08:32,515 You have to think that these treatments have harms attached 151 00:08:32,515 --> 00:08:34,955 to them, both short-term and long-term, 152 00:08:34,955 --> 00:08:37,915 and the benefits just may not be worth it. 153 00:08:37,915 --> 00:08:42,075 Sometimes you should, what? Fight the urge to want to get rid of it? 154 00:08:42,075 --> 00:08:45,115 I'm talking about the mild case of the disease. 155 00:08:45,115 --> 00:08:49,155 Many more people will be living with cancer in the future. 156 00:08:49,155 --> 00:08:51,395 Is that what happened in your case, then? 157 00:08:51,395 --> 00:08:54,055 Was not having surgery an option? No, 158 00:08:54,055 --> 00:08:56,895 I was quite strongly recommended to have surgery due to 159 00:08:56,895 --> 00:09:01,555 the particular severity of my prostate cancer. 160 00:09:01,555 --> 00:09:03,835 And, so far, I'm clear five years out, 161 00:09:03,835 --> 00:09:05,395 so we'll see, you know... 162 00:09:05,395 --> 00:09:08,515 I... In that sense, I'm not going to complain. 163 00:09:10,355 --> 00:09:13,155 Like David's, my doctors have made it clear that 164 00:09:13,155 --> 00:09:16,235 surgery is the only option for me. 165 00:09:16,235 --> 00:09:19,955 The hysterectomy will mean I can't have another baby, 166 00:09:19,955 --> 00:09:22,275 which is something I'd hoped for, 167 00:09:22,275 --> 00:09:25,275 but I decided it was a price I was willing to pay. 168 00:09:31,035 --> 00:09:35,755 I'm, like, only at the beginning. Hopefully, 169 00:09:35,755 --> 00:09:38,595 this is just a little blip, 170 00:09:38,595 --> 00:09:40,395 a moment of reset 171 00:09:40,395 --> 00:09:42,075 and, kind of, a moment of pause. 172 00:09:44,035 --> 00:09:45,275 The cancer unit or normal? 173 00:09:45,275 --> 00:09:47,475 Yes, please, the cancer unit, yeah, thank you. 174 00:09:50,955 --> 00:09:54,595 My home for the next...week. 175 00:10:00,275 --> 00:10:02,315 What procedure are you having today? 176 00:10:02,315 --> 00:10:04,035 A radical hysterectomy. 177 00:10:07,035 --> 00:10:10,035 Well, this, is quite the thing. 178 00:10:15,315 --> 00:10:18,795 The surgeons are going to remove my pelvic lymph nodes. 179 00:10:18,795 --> 00:10:20,995 They're worried there might be cancer in them, 180 00:10:20,995 --> 00:10:22,955 but they're not sure. 181 00:10:22,955 --> 00:10:24,395 The biggest question 182 00:10:24,395 --> 00:10:28,995 and the most difficult uncertainty is whether or not 183 00:10:28,995 --> 00:10:31,435 the cancer had got into the lymph nodes. 184 00:10:31,435 --> 00:10:34,395 If the cancer hadn't got into the lymph nodes, 185 00:10:34,395 --> 00:10:37,075 then it was stage one cancer. Basically, 186 00:10:37,075 --> 00:10:38,875 your chances of survival are really good. 187 00:10:38,875 --> 00:10:41,715 About 95%. The surgery works. 188 00:10:41,715 --> 00:10:44,275 You're in a really, really good position. 189 00:10:44,275 --> 00:10:48,035 But if it had got into just one lymph node, 190 00:10:48,035 --> 00:10:52,915 you jump from stage one cancer straight to stage three cancer. 191 00:10:52,915 --> 00:10:55,435 It becomes very, very serious. 192 00:11:09,395 --> 00:11:10,515 Hmm. 193 00:11:11,675 --> 00:11:13,475 So the consultant just came in. 194 00:11:15,635 --> 00:11:20,115 And I asked him if he saw anything in the lymph nodes. 195 00:11:22,635 --> 00:11:25,795 And he said that there was four on one side 196 00:11:25,795 --> 00:11:28,475 that were a bit enlarged. 197 00:11:29,875 --> 00:11:32,275 And one on the other side. 198 00:11:34,595 --> 00:11:36,355 Not great news, though, is it? 199 00:11:38,835 --> 00:11:41,075 Four or five of them were enlarged, 200 00:11:41,075 --> 00:11:44,635 and that could be just 201 00:11:44,635 --> 00:11:46,315 your body's fighting infection, 202 00:11:46,315 --> 00:11:49,715 or they could be enlarged because they're cancerous. 203 00:11:49,715 --> 00:11:52,235 I'd read all of this literature before going in 204 00:11:52,235 --> 00:11:54,515 and I knew that if it was in one lymph node, 205 00:11:54,515 --> 00:11:56,715 it was 60% chance of survival, 206 00:11:56,715 --> 00:11:59,235 two lymph nodes it dropped below 50%. 207 00:11:59,235 --> 00:12:02,155 And here he was saying four or five 208 00:12:02,155 --> 00:12:05,395 could potentially be cancerous. 209 00:12:05,395 --> 00:12:07,235 I mean... 210 00:12:07,235 --> 00:12:10,115 Well, then, you're a goner, aren't you, really? 211 00:12:20,035 --> 00:12:23,315 Mummy! Aw! 212 00:12:31,795 --> 00:12:33,955 After six days, I'm home, 213 00:12:33,955 --> 00:12:35,875 but I have to wait for a follow-up appointment 214 00:12:35,875 --> 00:12:39,355 to find out if there's cancer in my lymph nodes. 215 00:12:42,715 --> 00:12:47,755 In the UK, doctors often recommend further treatment after surgery, 216 00:12:47,755 --> 00:12:49,955 called adjuvant therapy. 217 00:12:49,955 --> 00:12:53,795 It's often chemotherapy or radiotherapy. 218 00:12:53,795 --> 00:12:56,195 It's a bit like an insurance policy. 219 00:12:56,195 --> 00:12:58,035 Although the cancer has been removed, 220 00:12:58,035 --> 00:13:00,755 there's a chance it might come back. 221 00:13:00,755 --> 00:13:03,115 The treatment aims to reduce that risk. 222 00:13:08,595 --> 00:13:10,555 I want to understand how doctors 223 00:13:10,555 --> 00:13:14,155 decide which patients should have these extra treatments, 224 00:13:14,155 --> 00:13:17,635 especially as they come with side-effects. 225 00:13:18,635 --> 00:13:22,035 Judy King is a medical oncologist in North London. 226 00:13:25,715 --> 00:13:27,675 So we have a range of people in clinic, 227 00:13:27,675 --> 00:13:30,315 but the number of the people that we'll be seeing are having 228 00:13:30,315 --> 00:13:33,555 what's called adjuvant chemotherapy. So they've had their surgery, 229 00:13:33,555 --> 00:13:36,635 they may have had scans. And, as far as we can see, 230 00:13:36,635 --> 00:13:40,635 there is no cancer. However, we know that, untreated, 231 00:13:40,635 --> 00:13:43,195 a number of those patients will have what we call 232 00:13:43,195 --> 00:13:44,835 micro-metastatic disease, 233 00:13:44,835 --> 00:13:47,315 so there will be tiny cells that will have floated off 234 00:13:47,315 --> 00:13:49,435 and ended up in the wrong place, which, 235 00:13:49,435 --> 00:13:53,355 if left unchecked, could come back and cause a cancer recurrence. 236 00:13:53,355 --> 00:13:56,595 And so those are the things that we're trying to treat. 237 00:13:56,595 --> 00:13:59,155 Where do you set that boundary of, "It's worth it for you, 238 00:13:59,155 --> 00:14:01,595 "and it's not worth it for you"? So, in breast cancer, 239 00:14:01,595 --> 00:14:03,755 we would say that what we're looking at is what is, 240 00:14:03,755 --> 00:14:06,995 "What is the chance of you being cancer-free ten years from now?" 241 00:14:06,995 --> 00:14:09,435 And if chemotherapy improves your chance 242 00:14:09,435 --> 00:14:12,035 of being alive by about 5% or more, 243 00:14:12,035 --> 00:14:14,595 then chemotherapy is something that we would usually discuss 244 00:14:14,595 --> 00:14:18,195 with a patient. Let me make sure I understand that, though, 245 00:14:18,195 --> 00:14:20,715 because another way to say the same thing is that, 246 00:14:20,715 --> 00:14:22,955 if you've got 100 women, 247 00:14:22,955 --> 00:14:26,555 all of them have chemo, 248 00:14:26,555 --> 00:14:29,635 and chemo will save the lives of five of them, 249 00:14:29,635 --> 00:14:32,795 that's the threshold? 250 00:14:32,795 --> 00:14:36,435 Yes, so... In a... This would be a relatively low-risk case. 251 00:14:36,435 --> 00:14:39,035 Let's say you have 100 women. 80 of them, 252 00:14:39,035 --> 00:14:42,235 if they do nothing at this point, 253 00:14:42,235 --> 00:14:43,875 would live ten years very happily 254 00:14:43,875 --> 00:14:46,275 with their cancer not coming back. 255 00:14:46,275 --> 00:14:49,555 And maybe 15 of them, the cancer comes back. 256 00:14:49,555 --> 00:14:52,195 Chemotherapy will be the thing that means 257 00:14:52,195 --> 00:14:55,035 the cancer doesn't come back for five out of the 15. 258 00:14:55,035 --> 00:14:58,235 So you have treated 100 women, 259 00:14:58,235 --> 00:15:00,515 and five women have been benefited. 260 00:15:00,515 --> 00:15:04,235 That point is worth repeating. In 100 women, 261 00:15:04,235 --> 00:15:06,395 five of them are going to die of other causes - 262 00:15:06,395 --> 00:15:08,675 perhaps heart attacks or car crashes, 263 00:15:08,675 --> 00:15:10,475 that kind of thing. 264 00:15:10,475 --> 00:15:12,955 Of all of the women that are left, 265 00:15:12,955 --> 00:15:15,755 80 of them, the cancer is not going to come back. 266 00:15:15,755 --> 00:15:18,675 It doesn't matter whether they have chemotherapy or not, 267 00:15:18,675 --> 00:15:20,555 they are already cured. 268 00:15:20,555 --> 00:15:24,835 That leaves 15 women where the cancer is going to return. 269 00:15:24,835 --> 00:15:27,515 However, for five of these women, 270 00:15:27,515 --> 00:15:29,675 if they have chemotherapy now, 271 00:15:29,675 --> 00:15:33,235 they can prevent the cancer from coming back. 272 00:15:33,235 --> 00:15:34,835 But when you start off, 273 00:15:34,835 --> 00:15:37,715 you have no idea who these five women are, 274 00:15:37,715 --> 00:15:41,715 and so every single one of these women 275 00:15:41,715 --> 00:15:45,395 has to go through chemotherapy just to save five lives. 276 00:15:45,395 --> 00:15:47,835 And for everybody else, 277 00:15:47,835 --> 00:15:52,635 chemotherapy made no difference whatsoever. 278 00:15:52,635 --> 00:15:56,115 They had all of the side-effects - hair loss, 279 00:15:56,115 --> 00:15:58,035 vomiting, giving up work, 280 00:15:58,035 --> 00:16:00,235 not being able to see people - 281 00:16:00,235 --> 00:16:02,475 all of that for 95 women, and actually, 282 00:16:02,475 --> 00:16:04,915 it made no difference? 283 00:16:04,915 --> 00:16:07,395 So, yes, that would be the case, 284 00:16:07,395 --> 00:16:09,475 and these are the difficult conversations because 285 00:16:09,475 --> 00:16:11,595 a patient, they could also be thinking, you know, 286 00:16:11,595 --> 00:16:13,115 "Is it really worth it?" 287 00:16:13,115 --> 00:16:15,675 But then I guess on the flip side of that, 288 00:16:15,675 --> 00:16:19,235 you don't know whether you're in the 95 or you're in the five. 289 00:16:19,235 --> 00:16:20,875 And maybe, actually, chemo will be 290 00:16:20,875 --> 00:16:22,955 the thing that saves your life. Exactly. 291 00:16:22,955 --> 00:16:24,275 When all is said and done, 292 00:16:24,275 --> 00:16:27,835 the majority of people would put quite a lot of value 293 00:16:27,835 --> 00:16:30,915 on the concept of, "I don't want this cancer to come back." Mm. 294 00:16:30,915 --> 00:16:34,955 Just because the alternative is so horrible to imagine. 295 00:16:43,155 --> 00:16:46,155 Judy has invited me to observe one of her appointments. 296 00:16:46,155 --> 00:16:48,955 Anne, do you want to come down? Thank you. 297 00:16:48,955 --> 00:16:50,995 Anne is a 67-year-old swimming coach from Barnet. 298 00:16:50,995 --> 00:16:53,875 Hello, come in, my name is Judy King. I am one of the consultants. 299 00:16:53,875 --> 00:16:55,075 She had surgery to remove 300 00:16:55,075 --> 00:16:58,115 a two-centimetre breast tumour, three weeks ago. 301 00:16:58,115 --> 00:17:00,355 ..which is going to wreak havoc with scheduling... 302 00:17:00,355 --> 00:17:02,195 I'm going to talk about what the chemo is, 303 00:17:02,195 --> 00:17:03,835 and why we would recommend it. 304 00:17:03,835 --> 00:17:07,075 And then you can have a think about whether that's something that you 305 00:17:07,075 --> 00:17:09,315 want to do or not. OK. So if we take, 306 00:17:09,315 --> 00:17:11,715 sort of, women in your situation 307 00:17:11,715 --> 00:17:13,795 with this kind of cancer, we're looking at, 308 00:17:13,795 --> 00:17:15,995 "What is the chance of people being alive and well, 309 00:17:15,995 --> 00:17:18,075 "cancer-free ten years down the line?" 310 00:17:18,075 --> 00:17:22,915 Yes. So, this is the chance that everything is fine. 311 00:17:22,915 --> 00:17:28,395 There's a pretty good chance, cancer has been cut out, job done. Mm-hm. 312 00:17:28,395 --> 00:17:33,075 This, here, is the risk of the cancer coming back. 313 00:17:33,075 --> 00:17:36,515 Yeah? So, my job is to reduce that risk. 314 00:17:36,515 --> 00:17:40,635 Right. In terms of absolute numbers, 315 00:17:40,635 --> 00:17:44,035 we reduce the chance of it coming back again by about 4%. 316 00:17:44,035 --> 00:17:47,195 So, the thing is that I don't know if you're one 317 00:17:47,195 --> 00:17:49,315 of these people over here... 318 00:17:49,315 --> 00:17:52,555 No. ..who the surgery is enough, 319 00:17:52,555 --> 00:17:55,755 and I don't know if you're one of these people over here. 320 00:17:55,755 --> 00:17:58,915 So, what I have to say is that I recommend that everybody 321 00:17:58,915 --> 00:18:02,155 has the tablets and the chemo just to reduce 322 00:18:02,155 --> 00:18:04,715 the risk as much as possible. Just to get to that, yeah. So, I'm 323 00:18:04,715 --> 00:18:06,795 going to talk a little bit about how the chemo works 324 00:18:06,795 --> 00:18:09,435 and the side-effects, and then I think we should have 325 00:18:09,435 --> 00:18:12,715 a talk about whether that's something that you want to do. OK. 326 00:18:12,715 --> 00:18:14,115 Is that all right? Yeah. 327 00:18:14,115 --> 00:18:17,755 So, side-effects, common things - feeling tired, 328 00:18:17,755 --> 00:18:21,315 people do feel pretty washed out for a couple of days. Mm-hm. 329 00:18:21,315 --> 00:18:23,435 Chemotherapy can drop your immune system. 330 00:18:23,435 --> 00:18:25,675 That means that, if you get a fever or if you get 331 00:18:25,675 --> 00:18:26,875 an infection, you can't... 332 00:18:26,875 --> 00:18:29,275 Your body can't fight it properly. If you get a fever, 333 00:18:29,275 --> 00:18:31,995 you must phone the emergency numbers. If you can't get through, 334 00:18:31,995 --> 00:18:34,635 you have to go to A&E. All right. 335 00:18:34,635 --> 00:18:36,635 It does affect your hair. 336 00:18:36,635 --> 00:18:38,475 All right? That's probably my... 337 00:18:38,475 --> 00:18:41,115 Out of everything, it's the hair loss that's going to be... 338 00:18:41,115 --> 00:18:43,035 It's actually the thing that most people... 339 00:18:43,035 --> 00:18:45,395 Because I've got such fine hair anyway, so... 340 00:18:45,395 --> 00:18:49,195 Always worth having a scarf or a wig or what have you. Yeah. 341 00:18:49,195 --> 00:18:50,875 Other things, feeling sick or being sick, 342 00:18:50,875 --> 00:18:53,915 acidy, bowels can go either way - can be diarrhoea, 343 00:18:53,915 --> 00:18:55,235 can be constipation. 344 00:18:55,235 --> 00:18:58,155 Aches and pains, those kinds of things. 345 00:18:58,155 --> 00:19:00,035 What are you thinking? 346 00:19:00,035 --> 00:19:01,675 I'm going for it. You're going for it. 347 00:19:01,675 --> 00:19:03,555 Yeah. All right, we're going for it. 348 00:19:03,555 --> 00:19:05,915 Do you want to sign consent now, or do you want some time 349 00:19:05,915 --> 00:19:07,595 to think it over? No, no, I've 350 00:19:07,595 --> 00:19:10,635 made up my mind, that's what I'm going to do. Okey-doke. 351 00:19:28,035 --> 00:19:30,355 How are you feeling? 352 00:19:30,355 --> 00:19:33,315 OK, OK. It's a lot to take in 353 00:19:33,315 --> 00:19:36,555 in one, sort of, short space of time. 354 00:19:36,555 --> 00:19:38,195 Was there a point where you thought, 355 00:19:38,195 --> 00:19:40,235 "Oh, maybe I won't?" 356 00:19:40,235 --> 00:19:43,075 It's always been the case of, 357 00:19:43,075 --> 00:19:46,115 "There's a possibility you might have to have chemo." 358 00:19:46,115 --> 00:19:48,995 So, I think that's been a lead into it, with it. 359 00:19:48,995 --> 00:19:51,835 It's not come as a big shock to say, 360 00:19:51,835 --> 00:19:53,195 "Yeah, you've got to do it." 361 00:19:53,195 --> 00:19:57,635 I think if I don't go along those lines, you know, my... 362 00:19:57,635 --> 00:19:59,715 The chances are it's going to return, 363 00:19:59,715 --> 00:20:02,155 and I don't want that. 364 00:20:02,155 --> 00:20:05,395 I don't know, it's just all so much. It's a lot, isn't it? 365 00:20:05,395 --> 00:20:08,835 It is a lot. It's one of those things, isn't it? 366 00:20:08,835 --> 00:20:11,235 I know. It still sucks, though. 367 00:20:11,235 --> 00:20:13,475 Yeah. It still sucks. ANNE LAUGHS 368 00:20:16,195 --> 00:20:17,795 When I was talking to her outside, 369 00:20:17,795 --> 00:20:20,235 she was sort of saying, "If I don't have the chemo, 370 00:20:20,235 --> 00:20:23,475 "it's overwhelmingly likely that the cancer will come back." 371 00:20:23,475 --> 00:20:25,955 And I didn't, sort of, correct her. 372 00:20:29,275 --> 00:20:32,555 But I think that, like, the difference that the chemo makes, 373 00:20:32,555 --> 00:20:35,955 even if it's not exactly 4%... It's not as big as she thinks. 374 00:20:35,955 --> 00:20:37,475 No, exactly. 375 00:20:37,475 --> 00:20:39,355 It sort of sits slightly more uncomfortably 376 00:20:39,355 --> 00:20:41,355 with you than it does with me. 377 00:20:41,355 --> 00:20:42,795 I'll tell you why. 378 00:20:42,795 --> 00:20:45,915 I've seen the cancers come back. Of course. 379 00:20:45,915 --> 00:20:48,115 And I know that this is a relatively gentle chemo 380 00:20:48,115 --> 00:20:49,475 and I can get her through it. 381 00:20:49,475 --> 00:20:52,115 And I know if that was somebody that I cared about, 382 00:20:52,115 --> 00:20:54,595 I would 100% tell them to have it. 383 00:20:54,595 --> 00:20:55,795 I spend all my life trying 384 00:20:55,795 --> 00:20:58,195 to explain mathematical concepts to people. 385 00:20:58,195 --> 00:20:59,835 And I know how hard it is, right? 386 00:20:59,835 --> 00:21:03,235 And I know how difficult this concept is. 387 00:21:03,235 --> 00:21:05,555 And I'm not saying, even for 388 00:21:05,555 --> 00:21:08,395 a moment, that it would change the path that she's on, 389 00:21:08,395 --> 00:21:10,835 change the decision that she's made. 390 00:21:10,835 --> 00:21:13,795 But I'm just thinking about the patients who are taking chemo 391 00:21:13,795 --> 00:21:16,315 because they think it's their only chance of survival 392 00:21:16,315 --> 00:21:19,555 without realising, actually, it's making a very small difference. 393 00:21:19,555 --> 00:21:21,275 So, the thing is, 394 00:21:21,275 --> 00:21:24,355 I don't think philosophically people can really deal 395 00:21:24,355 --> 00:21:28,715 with that level of complex thinking and decision-making. 396 00:21:28,715 --> 00:21:32,595 I think people need confidence in their decisions, 397 00:21:32,595 --> 00:21:35,675 and sometimes that requires a more simplistic answer. 398 00:21:40,915 --> 00:21:42,915 I'm feeling conflicted. 399 00:21:42,915 --> 00:21:46,835 I'm uneasy that patients might not see how small the benefits are, 400 00:21:46,835 --> 00:21:49,275 but I know what it's like to be frightened, 401 00:21:49,275 --> 00:21:51,875 and just want a doctor to take charge. 402 00:21:53,275 --> 00:21:55,515 Despite my swollen lymph nodes, 403 00:21:55,515 --> 00:21:58,155 I'm still hoping to avoid chemotherapy, 404 00:21:58,155 --> 00:22:01,475 but my mum is urging a more realistic approach. 405 00:22:01,475 --> 00:22:04,155 Mum had cancer when I was in school. 406 00:22:05,475 --> 00:22:07,635 This is why she doesn't give a shit. 407 00:22:07,635 --> 00:22:09,315 SHE LAUGHS 408 00:22:09,315 --> 00:22:12,475 Our family, though, so Mum's got nine brothers and sisters - 409 00:22:12,475 --> 00:22:14,795 how many of them have not had cancer? 410 00:22:14,795 --> 00:22:18,035 THEY LAUGH 411 00:22:18,035 --> 00:22:21,115 You know like how some families play rugby? 412 00:22:21,115 --> 00:22:22,315 Ours gets cancer. 413 00:22:23,515 --> 00:22:26,395 I was very worried about her when I first heard the news. 414 00:22:26,395 --> 00:22:28,875 Yeah. When I first told you, though, 415 00:22:28,875 --> 00:22:31,955 I told it to you in a very positive way. Yes, yeah. 416 00:22:31,955 --> 00:22:33,795 What, and you were still worried about it? 417 00:22:33,795 --> 00:22:38,195 Well, I looked it up online. What did you see when you looked it up? 418 00:22:38,195 --> 00:22:41,835 Well, if it's a hysterectomy and if it's cancer, 419 00:22:41,835 --> 00:22:45,275 then it's chemo. In this country, in the western world, 420 00:22:45,275 --> 00:22:47,515 they decide to do it. 421 00:22:47,515 --> 00:22:50,355 I don't know of anyone who's got away without the chemo 422 00:22:50,355 --> 00:22:53,635 or the radio. You just do your best to fight it. 423 00:22:53,635 --> 00:22:56,555 I've got a chance of it not being, though. Yeah. 424 00:22:58,275 --> 00:22:59,915 So, just wait and see. 425 00:23:04,755 --> 00:23:06,395 Yeah, well done. 426 00:23:06,395 --> 00:23:09,875 They're full of lots of chemicals, you see. What are chemicals? 427 00:23:09,875 --> 00:23:12,115 "What are chemicals?" That's an excellent question, 428 00:23:12,115 --> 00:23:15,755 and probably one for your mum to answer, I'd say, rather than me. 429 00:23:15,755 --> 00:23:17,155 If Hannah has chemotherapy, 430 00:23:17,155 --> 00:23:19,035 that's going to have, you know, 431 00:23:19,035 --> 00:23:22,315 dramatic implications on a number of levels, 432 00:23:22,315 --> 00:23:24,275 from pragmatic levels to emotional levels. 433 00:23:24,275 --> 00:23:28,035 I mean, the kids seeing her going through that's 434 00:23:28,035 --> 00:23:31,315 going to be tough. Me seeing her go through that is going to be tough. 435 00:23:31,315 --> 00:23:34,595 Hannah going through that is going to be tough. What shall we play? 436 00:23:34,595 --> 00:23:37,915 All that really matters is the emotional stability, 437 00:23:37,915 --> 00:23:39,835 which is the most important thing. 438 00:23:43,155 --> 00:23:45,875 I think the thing about cancer, there's this point, 439 00:23:45,875 --> 00:23:48,715 there's this fork in the road, 440 00:23:48,715 --> 00:23:51,355 and it does come down to something as simple 441 00:23:51,355 --> 00:23:53,955 as a few cancer cells in the wrong place. 442 00:23:53,955 --> 00:23:56,155 Where, on one path, we have 443 00:23:56,155 --> 00:24:00,555 a very sick person at home, potentially dying, 444 00:24:00,555 --> 00:24:04,195 and everything changes. 445 00:24:04,195 --> 00:24:06,715 And then the other fork, which is... 446 00:24:08,355 --> 00:24:12,435 I get better, and we get to go on with our lives. 447 00:24:18,275 --> 00:24:22,155 I'm still thinking about my conversations with Judy and Anne, 448 00:24:22,155 --> 00:24:25,835 and how the numbers change as cancer progresses. 449 00:24:25,835 --> 00:24:29,475 I want to understand why patients decide to keep going with treatment, 450 00:24:29,475 --> 00:24:31,915 when the odds are stacked against them. 451 00:24:35,755 --> 00:24:37,995 Online, I came across Nina, 452 00:24:37,995 --> 00:24:40,675 a 39-year-old fashion designer 453 00:24:40,675 --> 00:24:42,715 and mum from South London. 454 00:24:42,715 --> 00:24:46,955 I can't wait to go into chemo tomorrow, 455 00:24:46,955 --> 00:24:49,195 having one more session, 456 00:24:49,195 --> 00:24:50,795 one more cycle. 457 00:24:53,435 --> 00:24:57,515 She's got a particularly aggressive form of breast cancer 458 00:24:57,515 --> 00:24:59,315 that's now considered terminal. 459 00:25:01,355 --> 00:25:03,875 Women with her type and stage of cancer 460 00:25:03,875 --> 00:25:08,595 have only a 12% chance of living five years. 461 00:25:09,955 --> 00:25:11,715 Hi, how are you doing? 462 00:25:11,715 --> 00:25:14,915 Nice to meet you. Lovely to meet you, thank you. 463 00:25:14,915 --> 00:25:16,195 Yeah, well, let's hug! 464 00:25:16,195 --> 00:25:18,475 Her chemo is often exhausting, 465 00:25:18,475 --> 00:25:21,875 and her life's been taken over by medications. 466 00:25:23,915 --> 00:25:26,555 Wow, you weren't joking. Ha, no, 467 00:25:26,555 --> 00:25:30,155 there's... There's quite a lot. 468 00:25:30,155 --> 00:25:32,555 This is for...? This is every day? 469 00:25:32,555 --> 00:25:34,995 So much medication, isn't it? 470 00:25:34,995 --> 00:25:36,355 After chemo, 471 00:25:36,355 --> 00:25:40,555 I take these that help me with anti-sickness. Yep. 472 00:25:40,555 --> 00:25:42,795 Now that I'm on my third cycle, 473 00:25:42,795 --> 00:25:45,435 I'm having to take the pills more often 474 00:25:45,435 --> 00:25:48,435 because I just feel so bad. 475 00:25:48,435 --> 00:25:51,395 Yeah, so blood thinners, 476 00:25:51,395 --> 00:25:53,875 I have to take these. That's an injection? 477 00:25:53,875 --> 00:25:57,635 Yeah, and I have to inject myself every day, 478 00:25:57,635 --> 00:26:01,915 and every day it gets harder. 479 00:26:01,915 --> 00:26:04,555 Do you have to psyche yourself up? 480 00:26:04,555 --> 00:26:07,475 Yeah. Yeah. I feel like my stomach is getting more sensitive 481 00:26:07,475 --> 00:26:10,435 because I've had so many months of it. 482 00:26:10,435 --> 00:26:12,475 And some days I just want to push it in, 483 00:26:12,475 --> 00:26:14,315 but it hurts me. Yeah. 484 00:26:15,835 --> 00:26:17,515 Oh, gosh. 485 00:26:17,515 --> 00:26:23,635 And it's a big reminder that I have cancer. 486 00:26:23,635 --> 00:26:27,755 It's a big reminder, on my good days, that 487 00:26:27,755 --> 00:26:31,155 things are not normal. 488 00:26:31,155 --> 00:26:35,235 I mean, all of this is just such a heavy price that you have to pay. 489 00:26:35,235 --> 00:26:38,875 Yeah, it feels like it. It's the vomiting, 490 00:26:38,875 --> 00:26:40,755 it's the infections, 491 00:26:40,755 --> 00:26:44,155 it's the bleeding gums, it's the nose bleeds. 492 00:26:44,155 --> 00:26:49,435 I've made a choice to have chemo, and, you know, 493 00:26:49,435 --> 00:26:52,755 you can keep throwing anything at me. 494 00:26:52,755 --> 00:26:56,995 As long as I know that I have a percentage in there 495 00:26:56,995 --> 00:27:00,595 of it working, I will do it. You know, 496 00:27:00,595 --> 00:27:02,395 I've committed myself to it. 497 00:27:02,395 --> 00:27:04,235 Do you sort of feel in a way like 498 00:27:04,235 --> 00:27:08,515 you're paying with this three months now and in return, 499 00:27:08,515 --> 00:27:10,235 hopefully, you get a couple of years? 500 00:27:10,235 --> 00:27:13,595 Yeah. It's like a price, a trade. 501 00:27:13,595 --> 00:27:15,435 Yes, it feels like a trade. 502 00:27:15,435 --> 00:27:18,475 Yes, there's just no guarantee. 503 00:27:18,475 --> 00:27:20,915 You have to have the treatment 504 00:27:20,915 --> 00:27:22,755 and hope for the best. 505 00:27:22,755 --> 00:27:25,675 A lot of it is hope, and I'm hopeful. 506 00:27:25,675 --> 00:27:32,715 Do those stories of real miracles where people had stage four cancer, 507 00:27:32,715 --> 00:27:34,115 things look really bad, 508 00:27:34,115 --> 00:27:37,595 and then, somehow or other, their tumours shrank 509 00:27:37,595 --> 00:27:41,275 and they managed to go on and live these very long, 510 00:27:41,275 --> 00:27:43,795 healthy lives, do they play on your mind, those stories? 511 00:27:43,795 --> 00:27:45,875 All the time. Do they? 512 00:27:45,875 --> 00:27:48,115 Yeah, I think I'm going to be one of those stories. 513 00:27:48,115 --> 00:27:49,955 I really believe. 514 00:27:49,955 --> 00:27:56,075 And how do you feel about... thinking about the end? Are you... 515 00:27:56,075 --> 00:27:59,315 Do you think that you've accepted what's going on? 516 00:28:01,075 --> 00:28:04,275 Yes, and no. SHE CHUCKLES 517 00:28:04,275 --> 00:28:06,035 But, yeah, right now, 518 00:28:06,035 --> 00:28:09,475 my heart does not see death. 519 00:28:09,475 --> 00:28:11,715 My heart does not see the end. 520 00:28:11,715 --> 00:28:13,155 Your heart sees those stories. 521 00:28:13,155 --> 00:28:15,875 My heart sees those stories of hope 522 00:28:15,875 --> 00:28:17,995 and I know I'm going to live, 523 00:28:17,995 --> 00:28:21,035 and I'm not going to die. 524 00:28:21,035 --> 00:28:24,315 There's no reason why I can't be one of those people. 525 00:28:24,315 --> 00:28:25,515 So... 526 00:28:28,915 --> 00:28:32,395 Good luck. Thank you. 527 00:28:34,475 --> 00:28:36,915 One thing she said really stood out to me, 528 00:28:36,915 --> 00:28:41,275 where she said that she would have chemo even if it was 1%, 529 00:28:41,275 --> 00:28:45,235 even if there was a 1% chance that chemo would buy her more time, 530 00:28:45,235 --> 00:28:46,435 she would take it. 531 00:28:49,275 --> 00:28:52,515 And that seems pretty incredible to me. 532 00:28:52,515 --> 00:28:57,755 Are you risking, sacrificing, really more than you should? 533 00:28:57,755 --> 00:29:01,515 Rather than just enjoying what you have left? 534 00:29:03,075 --> 00:29:04,715 I think that's what the danger is. 535 00:29:04,715 --> 00:29:07,755 And I don't think she's there yet but I think that there is... 536 00:29:07,755 --> 00:29:11,395 I don't always think that hope is a good thing. 537 00:29:11,395 --> 00:29:14,795 I think there are some times where it can be a bit counterproductive. 538 00:29:15,875 --> 00:29:18,315 Because it's unrealistic? Yeah. 539 00:29:20,355 --> 00:29:22,555 Yeah, or because... Because... 540 00:29:22,555 --> 00:29:24,035 Because you're so focused on 541 00:29:24,035 --> 00:29:26,875 the best possible thing that could happen 542 00:29:26,875 --> 00:29:30,115 that you fail to prepare for what really is happening. 543 00:29:42,915 --> 00:29:45,755 In fact, patients will often go through treatment with 544 00:29:45,755 --> 00:29:48,475 a very low chance of success. 545 00:29:48,475 --> 00:29:52,475 One study showed that over a third of terminal cancer patients 546 00:29:52,475 --> 00:29:54,875 would undergo treatment even if there was only 547 00:29:54,875 --> 00:29:59,155 a 0.1% chance it would prolong their life. 548 00:29:59,155 --> 00:30:01,195 But the doctors who treat them, if they were 549 00:30:01,195 --> 00:30:02,875 to have cancer themselves, 550 00:30:02,875 --> 00:30:05,675 say they would refuse treatment unless it had 551 00:30:05,675 --> 00:30:09,635 at least a 25% chance of working. 552 00:30:09,635 --> 00:30:13,395 Nina is clearly not alone in her dedication to hope, 553 00:30:13,395 --> 00:30:14,995 but I can't help but wonder 554 00:30:14,995 --> 00:30:17,635 what kind of information gap we've created, 555 00:30:17,635 --> 00:30:19,955 where the very people offering a treatment 556 00:30:19,955 --> 00:30:22,315 wouldn't want it for themselves. 557 00:30:24,755 --> 00:30:25,995 Big day. 558 00:30:31,235 --> 00:30:32,875 Got about 20 minutes. 559 00:30:35,915 --> 00:30:37,115 SIGHS 560 00:30:37,115 --> 00:30:40,155 Then I'm getting in the car to go to the hospital to find out... 561 00:30:43,675 --> 00:30:46,235 ..what the situation is, basically, 562 00:30:46,235 --> 00:30:48,835 to find out what they found in the lymph nodes, 563 00:30:48,835 --> 00:30:50,515 to find out... 564 00:30:54,075 --> 00:30:58,875 ..whether I need to have chemo or... 565 00:31:04,155 --> 00:31:08,795 ..whether the surgery did the job of getting everything out. 566 00:31:15,595 --> 00:31:18,195 You just don't have any control or any choice 567 00:31:18,195 --> 00:31:20,035 over what's going to happen. 568 00:31:46,635 --> 00:31:48,235 So how are you, Hannah? 569 00:31:48,235 --> 00:31:49,675 Yeah, all right. Good. 570 00:31:51,795 --> 00:31:54,755 So, you're obviously waiting to hear what the results are. 571 00:31:54,755 --> 00:31:57,315 We're putting you through misery. I know. 572 00:32:03,075 --> 00:32:04,435 I'll tell you in the car. 573 00:32:10,995 --> 00:32:12,275 SHE LAUGHS WITH RELIEF 574 00:32:12,275 --> 00:32:14,035 Yes? 575 00:32:14,035 --> 00:32:16,075 HE LAUGHS Gone? 576 00:32:21,555 --> 00:32:24,195 Oh, my God, really? 577 00:32:24,195 --> 00:32:26,355 Oh, fucking brilliant! 578 00:32:28,875 --> 00:32:30,395 Oh, baby! 579 00:32:32,515 --> 00:32:34,195 Oh, my God. 580 00:32:34,195 --> 00:32:36,475 Oh, God. 581 00:32:38,515 --> 00:32:41,035 Oh, God. Oh, my God. 582 00:32:43,755 --> 00:32:46,635 That's amazing. So go on. Tell me, tell me. Tell me. 583 00:32:46,635 --> 00:32:49,715 It's done. Absolutely done? It's done. 584 00:32:49,715 --> 00:32:51,275 Oh, God. 585 00:32:53,035 --> 00:32:54,635 Jesus Christ. 586 00:32:55,675 --> 00:32:57,075 Oh, thank God. 587 00:32:58,315 --> 00:33:01,555 But they said that all the lymph nodes came back negative. 588 00:33:04,995 --> 00:33:07,435 And he was like, "Can't guarantee." 589 00:33:07,435 --> 00:33:10,915 You know, "This isn't, like, 100% like, you know, this isn't, like, 590 00:33:10,915 --> 00:33:14,355 "a guarantee that it's never come back again, but, like..." 591 00:33:14,355 --> 00:33:15,995 Bloody hell. 592 00:33:15,995 --> 00:33:17,195 Great. 593 00:33:18,235 --> 00:33:20,435 Getting drunk tonight. Fuck, yeah. 594 00:33:22,915 --> 00:33:24,315 Woo! 595 00:33:33,435 --> 00:33:34,675 CHILDREN PLAYING 596 00:33:37,715 --> 00:33:39,115 Pleased with you. 597 00:33:41,595 --> 00:33:44,435 Well done, well done. 598 00:33:45,635 --> 00:33:47,875 It's the best possible news. 599 00:33:49,915 --> 00:33:53,395 But there's still a one in ten chance that my cancer will come back. 600 00:33:54,715 --> 00:33:55,875 Have you had dinner? 601 00:33:55,875 --> 00:33:58,115 Yeah, we did. What did you have? 602 00:33:58,115 --> 00:34:00,875 Daddy? Daddy? 603 00:34:04,875 --> 00:34:07,675 A few months later, there's a problem. 604 00:34:08,995 --> 00:34:12,035 I've started to notice swelling in my legs. 605 00:34:13,235 --> 00:34:14,715 If I'm not careful, 606 00:34:14,715 --> 00:34:18,355 my right leg swells up 607 00:34:18,355 --> 00:34:20,555 to be much bigger than the left-hand side. 608 00:34:20,555 --> 00:34:24,835 It's caused by a side-effect of my surgery called lymphedema, 609 00:34:24,835 --> 00:34:27,995 where excess fluid builds up in your limbs. 610 00:34:27,995 --> 00:34:29,115 It's grim, innit? 611 00:34:30,515 --> 00:34:32,955 You have this system called your lymphatic system, 612 00:34:32,955 --> 00:34:34,795 and it's like little tubes 613 00:34:34,795 --> 00:34:39,315 and channels that are drawing fluid away from all parts of your body, 614 00:34:39,315 --> 00:34:41,995 and then bringing it upwards towards your heart. 615 00:34:41,995 --> 00:34:44,995 Now, along those tubes, 616 00:34:44,995 --> 00:34:47,195 you have these little things called nodes. 617 00:34:47,195 --> 00:34:51,035 When they were doing my surgery, 618 00:34:51,035 --> 00:34:53,435 because they were concerned about cancer being in 619 00:34:53,435 --> 00:34:55,515 the lymph nodes, they chopped them all out. 620 00:34:55,515 --> 00:34:58,155 And so now the fluid just, essentially, leaks out 621 00:34:58,155 --> 00:35:00,195 and collects in my leg. 622 00:35:07,715 --> 00:35:10,555 My devilishly sexy tights! 623 00:35:10,555 --> 00:35:14,995 They're compression garments, so, um, 624 00:35:14,995 --> 00:35:20,915 they just help stop all of the fluid building up, basically. 625 00:35:20,915 --> 00:35:23,115 So, they're really tight down the bottom, 626 00:35:23,115 --> 00:35:27,075 and then they're slightly less tight as you go further up. 627 00:35:27,075 --> 00:35:30,875 But the idea is that they just keep the swelling down. 628 00:35:30,875 --> 00:35:35,435 So, you have to wear them all day, every day. 629 00:35:35,435 --> 00:35:38,195 You really do? Yeah, even on the beach. 630 00:35:39,995 --> 00:35:42,995 It just feels very sensitive to the touch. 631 00:35:42,995 --> 00:35:47,115 It just feels very full and sort of tight. 632 00:35:47,115 --> 00:35:49,155 It's not painful. 633 00:35:51,715 --> 00:35:55,115 It's not, like, excruciating agony. It's just really uncomfortable. 634 00:36:04,755 --> 00:36:06,835 The problem with lymphedema 635 00:36:06,835 --> 00:36:10,075 is that you have no idea how quickly it's going to progress. 636 00:36:10,075 --> 00:36:13,315 It could be that it happens over the course of a few weeks or months. 637 00:36:13,315 --> 00:36:15,155 I mean, it really can be that quick. 638 00:36:16,355 --> 00:36:17,795 Come on. 639 00:36:19,075 --> 00:36:22,195 I have got really upset about it because, you know, 640 00:36:22,195 --> 00:36:25,955 you can't be upright for sustained periods of time. 641 00:36:25,955 --> 00:36:28,355 There was one evening I was like, "Right, I'm 642 00:36:28,355 --> 00:36:30,515 "going to do some baking with my daughter," 643 00:36:30,515 --> 00:36:33,235 and ended up standing up for a while. 644 00:36:33,235 --> 00:36:36,275 And then finally, like, 645 00:36:36,275 --> 00:36:38,515 sat down and put my feet up and like, 646 00:36:38,515 --> 00:36:40,995 literally, my leg, it was like a balloon. 647 00:36:40,995 --> 00:36:43,195 It was, like, incredible. This thing 648 00:36:43,195 --> 00:36:46,435 just, like, basically expanding, like, under your hands. 649 00:36:47,995 --> 00:36:51,515 I just don't have that view of myself in the future. You know? 650 00:36:51,515 --> 00:36:54,475 Like, I don't see myself as, like, in my 50s 651 00:36:54,475 --> 00:36:57,955 with, like, one giant leg, like, 652 00:36:57,955 --> 00:37:01,595 unable to walk 100 metres or, like, 653 00:37:01,595 --> 00:37:03,915 unable to work, even. 654 00:37:10,035 --> 00:37:12,555 When we are facing something that feels like it's 655 00:37:12,555 --> 00:37:15,675 a really terrible enemy, like cancer, 656 00:37:15,675 --> 00:37:21,395 we have this bias towards just trying to get rid of 657 00:37:21,395 --> 00:37:23,995 the overarching concern, 658 00:37:23,995 --> 00:37:25,635 and worry about side-effects later. 659 00:37:25,635 --> 00:37:27,675 Maybe we are too willing 660 00:37:27,675 --> 00:37:30,715 to just do treatment at any cost just 661 00:37:30,715 --> 00:37:33,795 because it feels like we're doing something. 662 00:37:36,835 --> 00:37:39,715 It's estimated up to 400,000 people 663 00:37:39,715 --> 00:37:42,235 in the UK have lymphedema. 664 00:37:42,235 --> 00:37:44,035 After a radical hysterectomy, 665 00:37:44,035 --> 00:37:46,995 there's a one-in-four chance of getting it. 666 00:37:50,035 --> 00:37:54,355 There's limited treatment for lymphedema available on the NHS, 667 00:37:54,355 --> 00:37:58,515 so I'm going to see a private lymphedema surgeon, Alex Ramsden. 668 00:37:58,515 --> 00:38:00,595 They did the radical hysterectomy. 669 00:38:00,595 --> 00:38:06,275 OK. And they took out everything, and then a bit more. 670 00:38:06,275 --> 00:38:09,475 Right. When you say everything, so there was a hysterectomy? 671 00:38:09,475 --> 00:38:13,155 Yeah, and the nodes. And it was... The lymph nodes. 672 00:38:13,155 --> 00:38:14,795 So that's really important. 673 00:38:14,795 --> 00:38:16,875 So, they took out the common lymph nodes, 674 00:38:16,875 --> 00:38:20,435 they took out the interior iliac. 675 00:38:20,435 --> 00:38:23,795 Yep. The exterior iliac. Right. 676 00:38:23,795 --> 00:38:26,995 And they also took out the...obturator? 677 00:38:26,995 --> 00:38:29,835 Obturator, I was just going to say obturator. Is that quite a lot? 678 00:38:33,475 --> 00:38:36,915 Yes. So I'm not a gynaecologist. Of course. OK? 679 00:38:36,915 --> 00:38:39,155 But they are often very aggressive 680 00:38:39,155 --> 00:38:41,155 with this sort of tumour, 681 00:38:41,155 --> 00:38:43,635 and they often take out a lot of nodes, 682 00:38:43,635 --> 00:38:45,715 and it's very difficult to know, 683 00:38:45,715 --> 00:38:49,915 before you start, whether they're going to be positive or negative. 684 00:38:49,915 --> 00:38:52,755 One of the problems with lymphedema, as you will come across, 685 00:38:52,755 --> 00:38:54,875 is not many people know much about it. 686 00:38:54,875 --> 00:38:57,235 People mention the word cancer and everybody hears, 687 00:38:57,235 --> 00:38:59,275 "Cancer, cancer, cancer, cancer, cancer." 688 00:38:59,275 --> 00:39:01,395 Patients have this massive treatment, 689 00:39:01,395 --> 00:39:03,635 and they have all this investment of time and care 690 00:39:03,635 --> 00:39:04,955 and effort, and that's great. 691 00:39:04,955 --> 00:39:07,955 But then you're left with something that is only going to get worse. 692 00:39:07,955 --> 00:39:10,115 You've got it for the rest of your life. 693 00:39:10,115 --> 00:39:12,235 "Here's a stocking." "Here's a stocking." 694 00:39:12,235 --> 00:39:14,515 And everyone goes, "That's really rubbish," 695 00:39:14,515 --> 00:39:18,155 so it's a very common thing that people get very upset 696 00:39:18,155 --> 00:39:21,195 and more traumatised by the lymphedema than they do 697 00:39:21,195 --> 00:39:22,835 by the cancer sometimes. 698 00:39:32,995 --> 00:39:34,395 SNIFFLES 699 00:39:34,395 --> 00:39:36,435 I'm really sorry. 700 00:39:41,795 --> 00:39:44,555 It's just quite hard to hear someone articulate it. 701 00:39:48,195 --> 00:39:49,355 OK. 702 00:39:51,275 --> 00:39:55,595 So, we've kind of got to the nub of it quite quickly. 703 00:39:55,595 --> 00:39:59,195 I don't really know if there was a choice, 704 00:39:59,195 --> 00:40:01,195 and now there's this, like, 705 00:40:01,195 --> 00:40:05,035 lifelong sort of sentence, as it were, 706 00:40:05,035 --> 00:40:10,155 of, like, what could be a genuinely, like, debilitating, 707 00:40:10,155 --> 00:40:12,995 life-changing condition. There might not have been options. 708 00:40:12,995 --> 00:40:15,475 You might have had to do it. Yep. 709 00:40:19,795 --> 00:40:21,795 It will be a little bit stingy, 710 00:40:21,795 --> 00:40:23,355 and I apologise in advance. 711 00:40:23,355 --> 00:40:27,435 Alex is injecting dye into my lymph vessels 712 00:40:27,435 --> 00:40:29,795 and using an infra-red camera to determine 713 00:40:29,795 --> 00:40:32,155 the extent of my lymphedema. 714 00:40:33,635 --> 00:40:35,915 This is the fluid that's trying to get out of your leg. 715 00:40:35,915 --> 00:40:37,755 It can't go through your pelvis. Yeah. 716 00:40:37,755 --> 00:40:39,835 So it's now going onto your tummy wall. 717 00:40:39,835 --> 00:40:42,275 That's why you're getting fullness of your tummy wall. 718 00:40:42,275 --> 00:40:46,235 So, this is the bit that gets really, like, thick, basically. Right. 719 00:40:49,275 --> 00:40:53,315 God, it's, like, a whole galaxy! SHE CHUCKLES 720 00:40:57,275 --> 00:41:00,955 The right leg is really good, 721 00:41:00,955 --> 00:41:03,795 all the way up to where you describe, which is the upper thigh, 722 00:41:03,795 --> 00:41:06,795 when you're starting to get those dermal back flow patterns 723 00:41:06,795 --> 00:41:09,955 overflow onto your abdominal wall, and that is lymphedema, 724 00:41:09,955 --> 00:41:14,555 but it's the very earliest stage of lymphedema that you have. OK. 725 00:41:16,395 --> 00:41:17,755 Because you're really early, 726 00:41:17,755 --> 00:41:20,195 what you're trying to do is stop it getting worse. 727 00:41:20,195 --> 00:41:23,275 If it stays like this forever, that's fine. Right. 728 00:41:23,275 --> 00:41:25,515 It might stay the same for the next 20 years. 729 00:41:25,515 --> 00:41:26,635 I don't know. 730 00:41:27,955 --> 00:41:29,795 Most likely, it's going to get worse. 731 00:41:38,755 --> 00:41:40,715 Am I asking for a bit too much? I don't know, 732 00:41:40,715 --> 00:41:42,355 maybe I am, maybe I'm being a bit greedy. 733 00:41:42,355 --> 00:41:44,635 It's, like, I was in a position where someone had 734 00:41:44,635 --> 00:41:48,075 to take stuff out to save my life, right? I know that. 735 00:41:48,075 --> 00:41:50,515 I just... Maybe I am being a bit greedy to be, like, 736 00:41:50,515 --> 00:41:52,235 "Is it too much to ask that 737 00:41:52,235 --> 00:41:55,995 "I wasn't left with a lifelong chronic condition?" 738 00:41:58,235 --> 00:42:01,675 Only half of cancer patients feel that long-term side-effects 739 00:42:01,675 --> 00:42:06,275 of treatment are fully explained to them. At the moment, 740 00:42:06,275 --> 00:42:09,795 the way that these side-effects and statistics are given, 741 00:42:09,795 --> 00:42:13,395 it's like...reeled off like a list of numbers. 742 00:42:13,395 --> 00:42:15,715 I'm not saying for a second that these treatments 743 00:42:15,715 --> 00:42:17,115 aren't a good thing, 744 00:42:17,115 --> 00:42:20,035 I just think that people should be given... 745 00:42:21,915 --> 00:42:23,195 ..the opportunity 746 00:42:23,195 --> 00:42:26,515 to understand what they're really signing up for. 747 00:42:30,515 --> 00:42:32,395 Life-changing decisions are so hard 748 00:42:32,395 --> 00:42:34,995 to make when you're in the middle of a crisis. 749 00:42:37,835 --> 00:42:41,755 But if you're not part of deciding what risks are worth taking, 750 00:42:41,755 --> 00:42:45,235 cancer care can end up feeling like something that's done TO you. 751 00:42:45,235 --> 00:42:46,595 Not with you. 752 00:42:50,275 --> 00:42:53,675 I keep thinking about how this all started, 753 00:42:53,675 --> 00:42:55,875 the smear test that I put off, 754 00:42:55,875 --> 00:42:58,635 and the one that later found my cancer. 755 00:43:02,075 --> 00:43:03,835 That's the smear test letter, 756 00:43:03,835 --> 00:43:05,635 the one that I missed. 757 00:43:08,315 --> 00:43:11,555 And then there's the one that they sent as the follow-up. 758 00:43:20,075 --> 00:43:22,075 What happened... 759 00:43:23,755 --> 00:43:26,675 ..in my body that I didn't know about between then and then? 760 00:43:28,235 --> 00:43:30,915 And what would they have found if I'd gone to that one? 761 00:43:35,515 --> 00:43:38,995 The cervical screening programme is one of only three screening tests 762 00:43:38,995 --> 00:43:40,595 offered by the NHS, 763 00:43:40,595 --> 00:43:44,035 along with breast and bowel cancer for those over 50. 764 00:43:53,795 --> 00:43:55,675 The NHS estimates that their 765 00:43:55,675 --> 00:44:01,435 cervical screening programme saves around 5,000 lives every year. 766 00:44:01,435 --> 00:44:04,435 But even screening provokes debate. 767 00:44:06,395 --> 00:44:09,035 I'm in Glasgow to meet Dr Margaret McCartney. 768 00:44:09,035 --> 00:44:11,275 She's a GP and an honorary fellow 769 00:44:11,275 --> 00:44:14,955 at the Centre for Evidence-Based Medicine. 770 00:44:14,955 --> 00:44:17,395 She wants to tell me about some research that turns 771 00:44:17,395 --> 00:44:21,635 the tables on what we think we know about cancer. 772 00:44:21,635 --> 00:44:23,275 So, when I was at medical school, 773 00:44:23,275 --> 00:44:26,075 very much you were taught that cancer is a bad thing, 774 00:44:26,075 --> 00:44:28,235 and certainly very often it is a bad thing. 775 00:44:28,235 --> 00:44:30,595 It's something you would want to know about and treat, 776 00:44:30,595 --> 00:44:32,595 but it's more complicated than that as well. 777 00:44:32,595 --> 00:44:35,155 We know that there are many people who've got 778 00:44:35,155 --> 00:44:38,275 a cancer in their bodies that they would not have known about had they 779 00:44:38,275 --> 00:44:39,915 not gone to get tested for it, 780 00:44:39,915 --> 00:44:41,955 and they would never have known about it 781 00:44:41,955 --> 00:44:44,195 because it wasn't a cancer that was destined 782 00:44:44,195 --> 00:44:46,555 to spread or to kill them or to cause problems. 783 00:44:46,555 --> 00:44:48,035 Is this quite a rare thing, though, 784 00:44:48,035 --> 00:44:51,515 that people have cancers that won't go on to kill them? 785 00:44:51,515 --> 00:44:53,515 There's a background that's useful, which is 786 00:44:53,515 --> 00:44:55,955 that there have been a lot of autopsy studies done over 787 00:44:55,955 --> 00:44:58,875 the last few decades, where people have examined 788 00:44:58,875 --> 00:45:03,995 the tissues of individuals who have died suddenly and unexpectedly, 789 00:45:03,995 --> 00:45:06,715 usually road traffic accidents. So, they've had a sudden death, 790 00:45:06,715 --> 00:45:09,075 and these people weren't being treated for cancer. 791 00:45:09,075 --> 00:45:10,995 They weren't being investigated for cancer. 792 00:45:10,995 --> 00:45:14,315 They didn't have symptoms that we knew about that would suggest cancer 793 00:45:14,315 --> 00:45:15,875 and the tissues have been examined 794 00:45:15,875 --> 00:45:21,755 but have found cancer in around about 7% of cases. 7%? 795 00:45:21,755 --> 00:45:22,955 Yeah, yeah. 796 00:45:22,955 --> 00:45:27,435 This does seem like quite an astonishing thing to say. 797 00:45:27,435 --> 00:45:30,075 It's a really weird thing to try and think about 798 00:45:30,075 --> 00:45:32,515 because it runs counter to everything that we're taught 799 00:45:32,515 --> 00:45:34,835 and we're told. If you go and look for cancer, 800 00:45:34,835 --> 00:45:37,195 you will find cancer. There's no question about that, 801 00:45:37,195 --> 00:45:38,475 so if you go and put, you know, 802 00:45:38,475 --> 00:45:41,155 hundreds of people through a CT scanner or an MRI scanner, 803 00:45:41,155 --> 00:45:44,195 you will find cancers that they had no symptoms of, 804 00:45:44,195 --> 00:45:45,715 they didn't have any inkling about. 805 00:45:45,715 --> 00:45:47,515 The big question is whether that cancer was 806 00:45:47,515 --> 00:45:50,635 going to go on and do that person harm. 807 00:45:50,635 --> 00:45:54,275 Some of the studies using MRIs put this number slightly lower, 808 00:45:54,275 --> 00:45:55,675 but we do know that there is 809 00:45:55,675 --> 00:45:59,155 a pool of undiagnosed tumours out there. 810 00:46:00,195 --> 00:46:02,955 But to discover whether those cancers will cause harm, 811 00:46:02,955 --> 00:46:05,555 Margaret wanted to show me something extraordinary 812 00:46:05,555 --> 00:46:10,115 that reveals why hunting for cancer cells isn't always a good thing. 813 00:46:10,115 --> 00:46:14,555 So, this is a graph of what happened in South Korea when they decided 814 00:46:14,555 --> 00:46:18,635 to offer the population screening for thyroid cancer, 815 00:46:18,635 --> 00:46:21,915 and they started to screen people just in 1999. 816 00:46:21,915 --> 00:46:24,715 So, you'll see that, as they started to screen for thyroid cancer, 817 00:46:24,715 --> 00:46:28,595 they found more and more and more and more thyroid cancer. 818 00:46:28,595 --> 00:46:30,315 But what you really need to know is, 819 00:46:30,315 --> 00:46:32,355 does this make a difference to death rates? 820 00:46:32,355 --> 00:46:34,475 Look at the orange line down the bottom, 821 00:46:34,475 --> 00:46:37,115 and you'll see that the mortality is a flatline. 822 00:46:37,115 --> 00:46:39,395 This is a classic graph showing overdiagnosis, 823 00:46:39,395 --> 00:46:41,995 because what you're doing is you're diagnosing more 824 00:46:41,995 --> 00:46:43,875 and more and more thyroid cancer, 825 00:46:43,875 --> 00:46:46,195 but you're not making any difference to death rates. 826 00:46:46,195 --> 00:46:48,595 If you get diagnosed with thyroid cancer, what happens? 827 00:46:48,595 --> 00:46:50,955 What is the treatment for it? It's all in the neck, isn't it? 828 00:46:50,955 --> 00:46:53,355 Yeah, that's right. It's your thyroid gland around here. 829 00:46:53,355 --> 00:46:56,435 You're going to be offered surgery, you might be offered radiotherapy, 830 00:46:56,435 --> 00:46:58,675 you might have to go into long-term treatment after that, 831 00:46:58,675 --> 00:46:59,875 so lots of interventions. 832 00:46:59,875 --> 00:47:02,915 So, there will be some people who've had surgery on their necks 833 00:47:02,915 --> 00:47:05,075 that they didn't need? Totally, absolutely. 834 00:47:05,075 --> 00:47:07,395 If you're not going to benefit from a treatment, 835 00:47:07,395 --> 00:47:09,515 all it can possibly do is give you side-effects. 836 00:47:09,515 --> 00:47:13,075 I guess, in the UK, for something like thyroid cancer, 837 00:47:13,075 --> 00:47:14,395 we don't screen... Yeah. 838 00:47:14,395 --> 00:47:17,395 ..but then there are other types of cancer where we do. 839 00:47:17,395 --> 00:47:19,555 Like breast cancer, for example. 840 00:47:19,555 --> 00:47:22,235 So, in that case, then, is the equation flipped? 841 00:47:22,235 --> 00:47:25,475 Is it very obvious that there's a benefit to do it? 842 00:47:25,475 --> 00:47:28,515 Well, I'd love to say that there was, but it is more complex. 843 00:47:28,515 --> 00:47:31,155 So the government have made a decision that it's cost-effective 844 00:47:31,155 --> 00:47:32,995 to offer it to women. So, the Marmot Review 845 00:47:32,995 --> 00:47:35,235 looked at the evidence around this a few years ago 846 00:47:35,235 --> 00:47:36,435 and they concluded that, 847 00:47:36,435 --> 00:47:39,275 for every 200 women that had breast cancer screening, 848 00:47:39,275 --> 00:47:41,315 you would delay the death of one woman, 849 00:47:41,315 --> 00:47:44,475 but at the cost of three women being over-treated 850 00:47:44,475 --> 00:47:48,235 for breast cancer. And when you say overtreated, 851 00:47:48,235 --> 00:47:52,475 are those the type of women who have cancer, 852 00:47:52,475 --> 00:47:53,915 but don't know about it, 853 00:47:53,915 --> 00:47:57,035 and it's not really going to go on to cause a problem, 854 00:47:57,035 --> 00:47:59,795 and yet they're having things like mastectomies 855 00:47:59,795 --> 00:48:02,315 and biopsies, and all of the concerns around those? 856 00:48:02,315 --> 00:48:04,435 Yeah, that's exactly right. So, these are people 857 00:48:04,435 --> 00:48:07,075 that would never have come to the attention of a doctor 858 00:48:07,075 --> 00:48:09,755 had they not had the tests done. So, what you're saying, 859 00:48:09,755 --> 00:48:11,995 it's good for this group of women overall, 860 00:48:11,995 --> 00:48:13,595 but, sorry, you're the unlucky one, 861 00:48:13,595 --> 00:48:15,595 and you're the unlucky one, and so are you. 862 00:48:15,595 --> 00:48:17,755 But the problem is that those women will never know 863 00:48:17,755 --> 00:48:18,995 that they've been unlucky. 864 00:48:18,995 --> 00:48:21,515 And this is the really big problem because the temptation is, 865 00:48:21,515 --> 00:48:24,155 for every single woman who's been detected as having a problem, 866 00:48:24,155 --> 00:48:26,195 to think that she has been diagnosed early 867 00:48:26,195 --> 00:48:28,715 and that her life has been made better because of that. 868 00:48:28,715 --> 00:48:30,835 But you just don't know that - you don't know which 869 00:48:30,835 --> 00:48:32,155 of those women that you are. 870 00:48:32,155 --> 00:48:34,835 Whether you're the woman that actually did get a benefit, 871 00:48:34,835 --> 00:48:36,995 or whether you're the majority of women that actually 872 00:48:36,995 --> 00:48:38,795 didn't get benefit from treatment. 873 00:48:38,795 --> 00:48:41,875 Do you think it is a big problem that you have 874 00:48:41,875 --> 00:48:45,115 those three women in 200 being overtreated? 875 00:48:45,115 --> 00:48:48,555 Well, I suppose I wouldn't be the person to judge that. 876 00:48:48,555 --> 00:48:50,555 It would be those individual women to judge that. 877 00:48:50,555 --> 00:48:52,275 So, if you have breast cancer screening, 878 00:48:52,275 --> 00:48:54,795 I think you should decide for yourself whether you think 879 00:48:54,795 --> 00:48:56,675 that that risk is worth it or not worth it. 880 00:48:56,675 --> 00:48:58,875 You know, are you happy with that risk yourself? 881 00:49:02,155 --> 00:49:06,155 Cancer screening saves thousands of lives every year, 882 00:49:06,155 --> 00:49:09,595 but it's important to acknowledge that this is not without cost. 883 00:49:11,075 --> 00:49:15,715 There's like this fundamental disconnect, really, 884 00:49:15,715 --> 00:49:17,795 between what the numbers say 885 00:49:17,795 --> 00:49:20,635 and what it actually feels like when you're the number. 886 00:49:22,675 --> 00:49:25,475 Because, of course, you can look at all those statistics and say, 887 00:49:25,475 --> 00:49:27,555 "Oh, that is pretty terrible 888 00:49:27,555 --> 00:49:30,195 "that people are having these life-changing surgeries 889 00:49:30,195 --> 00:49:34,915 "that they don't need, that they never had to go through." 890 00:49:34,915 --> 00:49:37,915 But then, at the same time, 891 00:49:37,915 --> 00:49:39,915 having been diagnosed with cancer, 892 00:49:39,915 --> 00:49:41,635 I know in that moment... 893 00:49:45,035 --> 00:49:48,075 ..I just wanted to get rid of it. 894 00:49:48,075 --> 00:49:50,115 I just wanted to get rid of it. 895 00:49:50,115 --> 00:49:52,755 It wouldn't really have mattered what the numbers said. 896 00:50:01,435 --> 00:50:05,555 There are no easy choices in any of this. 897 00:50:05,555 --> 00:50:08,995 Turning down treatment wasn't right for me, 898 00:50:08,995 --> 00:50:11,595 but that's not the case for everyone. 899 00:50:13,035 --> 00:50:14,075 I'm leaving... 900 00:50:16,195 --> 00:50:18,115 ..St James's. 901 00:50:21,555 --> 00:50:23,715 Three surgeries, 902 00:50:23,715 --> 00:50:26,435 50 sessions of radiotherapy, 903 00:50:26,435 --> 00:50:29,755 six rounds of chemotherapy. 904 00:50:34,755 --> 00:50:36,835 And I've just told them no more treatment. 905 00:50:43,195 --> 00:50:45,195 Rob is a climbing wall inspector 906 00:50:45,195 --> 00:50:47,155 and dad to four-year-old Caleb. 907 00:50:48,275 --> 00:50:52,515 He has a cancer of the soft tissue called synovial sarcoma, 908 00:50:52,515 --> 00:50:54,875 and it's terminal. 909 00:50:54,875 --> 00:50:57,035 I went to Yorkshire to meet him. 910 00:50:58,635 --> 00:51:02,315 If it's OK, I want to take you back to that decision that you made. 911 00:51:02,315 --> 00:51:06,475 Yeah. Tell me a bit about what you were weighing up in your mind at that 912 00:51:06,475 --> 00:51:09,715 point in time. What were the two sides of that argument? 913 00:51:09,715 --> 00:51:13,555 It was quite simply quality or quantity. 914 00:51:13,555 --> 00:51:16,915 I thought, if I had treatment, that I would be spending 915 00:51:16,915 --> 00:51:18,435 a lot of time in hospital, 916 00:51:18,435 --> 00:51:22,315 and I did... That isn't going to be 917 00:51:22,315 --> 00:51:25,355 a very good quality of life. I could have had the treatment, 918 00:51:25,355 --> 00:51:29,195 and it could have, say, given me an extra four or five months. 919 00:51:29,195 --> 00:51:30,835 I could have had the treatment, 920 00:51:30,835 --> 00:51:33,915 and I could have passed away during treatment or just after. 921 00:51:33,915 --> 00:51:36,715 And trying to calculate, work out, 922 00:51:36,715 --> 00:51:40,955 that decision was really, really difficult, to be honest. 923 00:51:40,955 --> 00:51:43,835 But, then, very easy on the flip side of it, 924 00:51:43,835 --> 00:51:47,995 of thinking, "If I want to go to Scotland in my van with Caleb, 925 00:51:47,995 --> 00:51:51,995 "if that's something I want to do before I pass away, 926 00:51:51,995 --> 00:51:54,595 "going through treatment isn't going to get me there." 927 00:51:57,435 --> 00:52:02,115 Well, Caleb, this is Glencoe. 928 00:52:06,555 --> 00:52:07,595 It was only 24 hours, 929 00:52:07,595 --> 00:52:08,995 but I got him to Scotland, 930 00:52:08,995 --> 00:52:10,395 eight hour drive up there, 931 00:52:10,395 --> 00:52:12,435 but we also went to Loch Lomond, 932 00:52:12,435 --> 00:52:15,075 so we had a paddle around Loch Lomond as well. 933 00:52:15,075 --> 00:52:18,555 So, we did lots of things in that 24 hours. 934 00:52:20,315 --> 00:52:22,395 Some people might say 935 00:52:22,395 --> 00:52:24,915 that choosing not to have treatment at 936 00:52:24,915 --> 00:52:27,875 the stage you were at was a bit like giving up. 937 00:52:27,875 --> 00:52:29,835 I don't see it as giving up. 938 00:52:29,835 --> 00:52:35,395 I see it is accepting the inevitable, to be honest. 939 00:52:35,395 --> 00:52:38,355 I know I'm deteriorating, I know things are changing, 940 00:52:38,355 --> 00:52:42,475 but as long as I can come here, ride my bike, I will do. 941 00:52:42,475 --> 00:52:44,875 I've made a lot of memories here, 942 00:52:44,875 --> 00:52:47,715 and that's definitely not what I would have got 943 00:52:47,715 --> 00:52:49,235 had I been in a hospital bed. 944 00:52:58,115 --> 00:53:02,235 So, this, um, is just a memory box for Caleb. 945 00:53:02,235 --> 00:53:05,035 It's got lots of things, all the rocks from different walks 946 00:53:05,035 --> 00:53:07,075 we've been on and painted. Together. 947 00:53:07,075 --> 00:53:10,555 I think that's just so sweet, having stuff like this ready for him. 948 00:53:10,555 --> 00:53:12,235 And then, of course, 949 00:53:12,235 --> 00:53:15,395 letters which... These were written in 2019 when 950 00:53:15,395 --> 00:53:17,235 I was going through treatment. 951 00:53:17,235 --> 00:53:21,915 So, there's, like, one for his 18th birthday and 21st, 952 00:53:21,915 --> 00:53:26,035 wedding day, all these kinds of stuff. Er, first car. 953 00:53:26,035 --> 00:53:28,795 When you realise you're gay, 954 00:53:28,795 --> 00:53:31,475 that's an important one. 955 00:53:31,475 --> 00:53:34,515 You never know! Exactly. 956 00:53:34,515 --> 00:53:36,755 So, first fight with your mum. 957 00:53:36,755 --> 00:53:37,755 SHE LAUGHS 958 00:53:37,755 --> 00:53:39,195 First day at school - 959 00:53:39,195 --> 00:53:42,035 that one can go in the bin, yes! You made it. 960 00:53:42,035 --> 00:53:46,675 I made it, milestone. And how does it feel to have 961 00:53:46,675 --> 00:53:50,155 already, some of them out of date, almost? Well, that's... 962 00:53:50,155 --> 00:53:52,195 Yes, I've surpassed many of the estimations 963 00:53:52,195 --> 00:53:54,955 because that's what it is at the end of the day, isn't it? 964 00:53:54,955 --> 00:53:56,035 They're only estimates. 965 00:53:56,035 --> 00:53:57,995 It takes, I think, quite a lot of strength 966 00:53:57,995 --> 00:54:00,035 to put something like this together. 967 00:54:00,035 --> 00:54:03,355 Yeah. Has it helped you too? Oh, definitely. 968 00:54:03,355 --> 00:54:06,795 I think writing the letters made it feel like I was, 969 00:54:06,795 --> 00:54:10,475 like it was the start of the acceptance, to be honest, 970 00:54:10,475 --> 00:54:12,915 of that this is what's happening. 971 00:54:19,995 --> 00:54:23,675 So, what happens now? Wait, really. 972 00:54:23,675 --> 00:54:25,155 Keep taking my meds, 973 00:54:25,155 --> 00:54:27,515 keep riding my bike. 974 00:54:27,515 --> 00:54:29,755 Go on living, really. 975 00:54:29,755 --> 00:54:32,195 There's nothing else you can do. 976 00:54:37,075 --> 00:54:40,555 There's this incredible amount of strength in what he's doing, 977 00:54:40,555 --> 00:54:46,635 and I think Rob is someone who is just 978 00:54:46,635 --> 00:54:49,475 totally fine with his own mortality. 979 00:54:49,475 --> 00:54:51,355 Like, I know he doesn't want to die, 980 00:54:51,355 --> 00:54:54,995 of course not, but he's... 981 00:54:54,995 --> 00:54:59,715 He's got this calmness of mind. 982 00:54:59,715 --> 00:55:02,475 Like, he's worked out what is important to him, 983 00:55:02,475 --> 00:55:06,915 he knows what his values are, and therefore, 984 00:55:06,915 --> 00:55:09,195 everything else falls into place. 985 00:55:20,155 --> 00:55:22,795 I'll need regular follow-ups for the next five years 986 00:55:22,795 --> 00:55:25,155 to see if the cancer has come back. 987 00:55:27,955 --> 00:55:32,315 Hi, Hannah. Hi, how are you doing? Come through. Thank you. 988 00:55:32,315 --> 00:55:34,635 Come on in, have a seat. Thank you. 989 00:55:34,635 --> 00:55:36,195 How is it otherwise going? 990 00:55:36,195 --> 00:55:40,315 You're fine? Yeah, it's OK, yeah. 991 00:55:40,315 --> 00:55:44,875 I realise now that this is going to be part of my life forever. 992 00:55:48,035 --> 00:55:50,955 It's an anniversary today. 993 00:55:50,955 --> 00:55:54,075 Not the sort of anniversary you traditionally celebrate, 994 00:55:54,075 --> 00:55:56,915 but it was a year ago today that I was in hospital 995 00:55:56,915 --> 00:55:58,915 with my surgery. 996 00:55:58,915 --> 00:56:01,155 I was thinking about it this morning. 997 00:56:01,155 --> 00:56:03,195 It's only until very recently that 998 00:56:03,195 --> 00:56:06,195 I haven't just been completely reeling from it. 999 00:56:06,195 --> 00:56:08,875 I mean, I think it's just impossible to, like, 1000 00:56:08,875 --> 00:56:11,315 get cancer in your mid-thirties 1001 00:56:11,315 --> 00:56:15,395 and not come out of it with 1002 00:56:15,395 --> 00:56:17,555 a really different view of life. Yeah, 1003 00:56:17,555 --> 00:56:19,235 it's left an indelible mark, hasn't it? 1004 00:56:19,235 --> 00:56:21,475 I mean, it's not a simple, you know, 1005 00:56:21,475 --> 00:56:23,915 "Heal, get over it, move on." 1006 00:56:23,915 --> 00:56:26,395 I mean, you do have to move on to a degree, but it's not, 1007 00:56:26,395 --> 00:56:28,075 it's nowhere near that simple. 1008 00:56:30,235 --> 00:56:31,435 I think, for most of us, 1009 00:56:31,435 --> 00:56:33,315 for most of our lives, 1010 00:56:33,315 --> 00:56:37,235 we get to pretend that we are immortal, really. 1011 00:56:37,235 --> 00:56:40,795 We don't have to live with this shadow of death, 1012 00:56:40,795 --> 00:56:42,635 really, hanging over us all the time. 1013 00:56:42,635 --> 00:56:44,915 We have this kind of luxury of that, 1014 00:56:44,915 --> 00:56:49,315 and so I think that whenever you are confronted 1015 00:56:49,315 --> 00:56:51,355 with your own mortality, 1016 00:56:51,355 --> 00:56:54,195 as you are when you receive a cancer diagnosis, 1017 00:56:54,195 --> 00:56:56,395 no matter how serious it is, 1018 00:56:56,395 --> 00:56:59,675 I think that we are so not used to that idea, 1019 00:56:59,675 --> 00:57:02,475 we are so terrified of the idea 1020 00:57:02,475 --> 00:57:05,955 that we are unwilling to tolerate any risk whatsoever. 1021 00:57:08,635 --> 00:57:11,275 I try not to think too hard about the numbers of recurrence, 1022 00:57:11,275 --> 00:57:14,595 because that number of one in ten, 1023 00:57:14,595 --> 00:57:16,715 the chance of recurrence, it is still there, 1024 00:57:16,715 --> 00:57:20,195 and it is still true and it's still a fact. 1025 00:57:22,835 --> 00:57:25,035 I don't know, I just think, over time, 1026 00:57:25,035 --> 00:57:28,595 you have to accept that life comes with risks, and that 1027 00:57:28,595 --> 00:57:32,155 you can't sort of wander around being terrified 1028 00:57:32,155 --> 00:57:34,835 of everything that might happen. Otherwise, 1029 00:57:34,835 --> 00:57:37,755 you're never going to have the chance to properly live it. 1030 00:57:44,195 --> 00:57:47,915 I think that somehow we've decided that the chance of dying 1031 00:57:47,915 --> 00:57:50,475 is the only number that matters, 1032 00:57:50,475 --> 00:57:52,675 and so we've built a one-size-fits-all approach 1033 00:57:52,675 --> 00:57:58,355 to cancer care that takes courage and strength to deviate from. 1034 00:57:58,355 --> 00:58:01,635 Perhaps that's because we're not having honest conversations 1035 00:58:01,635 --> 00:58:05,315 about the true benefits and costs of treatment. 1036 00:58:05,315 --> 00:58:09,355 Only when we do can people work out what they most care about, 1037 00:58:09,355 --> 00:58:11,795 and make the choice that's right for them.