1 00:00:03,200 --> 00:00:07,200 This programme contains some strong language from the start and scenes which some viewers may find upsetting 2 00:00:11,720 --> 00:00:12,280 Fuck. 3 00:00:14,480 --> 00:00:18,560 That means I might be stage three. Cancer. 4 00:00:20,600 --> 00:00:21,800 SHE EXHALES 5 00:00:25,160 --> 00:00:27,680 My name is Hannah Fry. 6 00:00:27,680 --> 00:00:30,760 This equation encapsulates all of 7 00:00:30,760 --> 00:00:34,800 the fundamental properties of the subatomic world. 8 00:00:36,160 --> 00:00:38,880 I'm a professor of mathematics, 9 00:00:38,880 --> 00:00:40,720 and I've spent my life using numbers to try 10 00:00:40,720 --> 00:00:42,960 and understand the world around me. 11 00:00:42,960 --> 00:00:48,040 An airport city, and building it and running it 12 00:00:48,040 --> 00:00:52,120 has tested us to our absolute limits. 13 00:00:52,120 --> 00:00:56,360 In January last year, I was diagnosed with cervical cancer. 14 00:00:57,560 --> 00:01:02,040 I started filming myself as a way to cope with what's happening to me. 15 00:01:02,040 --> 00:01:05,680 Oh, God, oh, my God, it feels like my guts are going to come out. 16 00:01:05,680 --> 00:01:07,960 Again, this is around your knee. 17 00:01:07,960 --> 00:01:11,400 With my doctors, I've had to make some hard decisions about my care, 18 00:01:11,400 --> 00:01:14,320 and I'm not sure we've always got them right. 19 00:01:14,320 --> 00:01:17,880 They are often very aggressive with this sort of tumour, 20 00:01:17,880 --> 00:01:20,280 and they often take out a lot of nodes. 21 00:01:23,680 --> 00:01:25,840 Welcome to my cancer research cave. 22 00:01:25,840 --> 00:01:29,440 I've become obsessed with the statistics behind cancer... 23 00:01:29,440 --> 00:01:31,080 My books. 24 00:01:31,080 --> 00:01:34,200 ..and it's made me question all my assumptions about this disease. 25 00:01:35,560 --> 00:01:37,440 Now I want to find out how doctors 26 00:01:37,440 --> 00:01:40,040 and patients feel about their treatments. 27 00:01:40,040 --> 00:01:44,280 Are we making the right choices in how we deal with cancer? 28 00:01:44,280 --> 00:01:47,360 For 95 of those women, 29 00:01:47,360 --> 00:01:52,280 chemotherapy made no difference to what happened to their cancer? 30 00:01:52,280 --> 00:01:53,640 Yep. 31 00:01:53,640 --> 00:01:56,040 Is searching for cancer always a good idea? 32 00:01:56,040 --> 00:01:58,800 This is a classic graph showing overdiagnosis, 33 00:01:58,800 --> 00:02:00,960 because what you're doing is you're diagnosing more 34 00:02:00,960 --> 00:02:03,040 and more and more thyroid cancer, 35 00:02:03,040 --> 00:02:05,800 but you're not making any difference to death rates. 36 00:02:07,320 --> 00:02:10,480 Have we become so afraid of this disease that we'll do anything 37 00:02:10,480 --> 00:02:13,160 to fight it, no matter the cost? 38 00:02:13,160 --> 00:02:17,560 As long as there's a percentage, there's hope. 39 00:02:17,560 --> 00:02:21,520 It means I might be that 1% that it works for. 40 00:02:21,520 --> 00:02:26,720 And what will I do when faced with my own odds? 41 00:02:26,720 --> 00:02:29,000 I think, whatever happens now, 42 00:02:29,000 --> 00:02:33,360 this has fundamentally changed me, like. 43 00:02:49,640 --> 00:02:52,760 Five! OK, do you want to give that to... 44 00:02:52,760 --> 00:02:55,560 I live in South London with my husband, Phil, 45 00:02:55,560 --> 00:02:57,400 and our two daughters. 46 00:02:57,400 --> 00:02:59,480 Come on, sausage. 47 00:02:59,480 --> 00:03:02,080 They are two and four. 48 00:03:02,080 --> 00:03:05,280 They are absolutely brilliant, 49 00:03:05,280 --> 00:03:10,440 and ridiculously hard work in equal measure. 50 00:03:16,440 --> 00:03:18,520 Phil, my husband, he's a stay-at-home dad. 51 00:03:18,520 --> 00:03:20,480 He takes care of the kids, 52 00:03:20,480 --> 00:03:23,040 he's their primary carer. I like 53 00:03:23,040 --> 00:03:26,280 to describe it that we've got a very traditional 1950s relationship, 54 00:03:26,280 --> 00:03:29,680 just everything's switched around the other way. 55 00:03:29,680 --> 00:03:31,160 There's no way that I would be able 56 00:03:31,160 --> 00:03:33,800 to do my job unless I had that home support. 57 00:03:36,120 --> 00:03:38,440 This particular algorithm, it works a lot like 58 00:03:38,440 --> 00:03:40,320 predictive text does on your phone. 59 00:03:40,320 --> 00:03:43,520 I think the thing about looking at things through numbers is that it 60 00:03:43,520 --> 00:03:46,880 gives you a chance to see yourself 61 00:03:46,880 --> 00:03:50,360 and to see the world from a completely different perspective. 62 00:03:50,360 --> 00:03:52,480 If you imagine you have a corridor 63 00:03:52,480 --> 00:03:55,160 with lots of people moving in opposite directions, 64 00:03:55,160 --> 00:03:59,560 people naturally form these lanes in pedestrian traffic. 65 00:04:01,000 --> 00:04:04,040 I like to imagine it as though you've got these two worlds that are 66 00:04:04,040 --> 00:04:06,160 running in parallel to one another. 67 00:04:06,160 --> 00:04:09,320 So, on the one hand, you've got kind of like the real world, 68 00:04:09,320 --> 00:04:12,600 and then running alongside it, I think it's almost like you have 69 00:04:12,600 --> 00:04:15,000 a mathematical version of that same world. 70 00:04:15,000 --> 00:04:17,280 So, this is the one where you have all of the numbers 71 00:04:17,280 --> 00:04:20,720 and all of the data and all of the equations. 72 00:04:20,720 --> 00:04:24,960 It's a way that you can zoom out and see things as they really are, 73 00:04:24,960 --> 00:04:27,200 rather than how you perceive them to be. 74 00:04:37,000 --> 00:04:41,200 In January 2021, my life changed. 75 00:04:41,200 --> 00:04:43,360 I had a call from my GP telling me 76 00:04:43,360 --> 00:04:46,320 they detected abnormalities on my smear test, 77 00:04:46,320 --> 00:04:49,360 an appointment I'd put off for six months. 78 00:04:52,000 --> 00:04:54,400 So, this one that we're doing here 79 00:04:54,400 --> 00:04:56,480 is for your blood group and type. 80 00:04:56,480 --> 00:04:57,800 I had a number of follow-up 81 00:04:57,800 --> 00:05:01,880 investigations before they could give me the full picture. 82 00:05:01,880 --> 00:05:04,120 He just told me the facts, 83 00:05:04,120 --> 00:05:06,840 which were that they'd found a tumour 84 00:05:06,840 --> 00:05:10,560 and it was about the size of a gobstopper, 85 00:05:10,560 --> 00:05:14,320 and it was all contained within the cervix. 86 00:05:14,320 --> 00:05:17,800 In the moment, you don't really realise what's happening, 87 00:05:17,800 --> 00:05:23,240 and then it's only after that you're reeling from everything. 88 00:05:23,240 --> 00:05:25,000 "What the hell just happened?" 89 00:05:28,360 --> 00:05:30,040 Your hair's really clean. 90 00:05:31,240 --> 00:05:32,960 Did you wash it? 91 00:05:32,960 --> 00:05:34,960 Yeah, all by myself. 92 00:05:34,960 --> 00:05:36,480 I did it myself. 93 00:05:41,240 --> 00:05:44,640 There's no guarantee that this is all going to be OK. 94 00:05:44,640 --> 00:05:47,640 And I've had a pretty good life. 95 00:05:47,640 --> 00:05:50,280 Like, it's one thing for yourself to be like, 96 00:05:50,280 --> 00:05:56,560 "OK, if I only live to 36 or 37, OK, you know, whatever." 97 00:05:56,560 --> 00:05:57,840 Like... 98 00:05:59,640 --> 00:06:01,280 Look at all of the experiences I had, 99 00:06:01,280 --> 00:06:03,840 and that look at all of the brilliant things that I got 100 00:06:03,840 --> 00:06:06,640 to do, and look at all the friends I got to make. 101 00:06:06,640 --> 00:06:10,240 I can't quite deal with the idea of my daughters not having me. 102 00:06:11,920 --> 00:06:13,600 That's the really hard bit, I think. 103 00:06:18,560 --> 00:06:21,280 Hannah's human, so she worries, but at the same time, 104 00:06:21,280 --> 00:06:23,200 she thrives on information. You know, 105 00:06:23,200 --> 00:06:25,680 she's a mathematician and scientist and she, 106 00:06:25,680 --> 00:06:28,200 you know, data is her is, you know, 107 00:06:28,200 --> 00:06:30,600 the thing she lives by. That's who she is. 108 00:06:30,600 --> 00:06:32,240 So, when something like this happens, 109 00:06:32,240 --> 00:06:34,080 she's like, "I need to know everything. 110 00:06:34,080 --> 00:06:36,520 "I don't want to leave any stone unturned." 111 00:06:36,520 --> 00:06:39,120 Like an instinctive reaction, 112 00:06:39,120 --> 00:06:40,800 to just want to read about it. 113 00:06:43,480 --> 00:06:44,840 In the last 40 years, 114 00:06:44,840 --> 00:06:48,360 cancer survival rates have doubled in the UK. 115 00:06:48,360 --> 00:06:52,640 50% of people diagnosed now survive at least ten years, 116 00:06:52,640 --> 00:06:55,520 and that's due to an ever more sophisticated raft 117 00:06:55,520 --> 00:06:57,840 of surgeries and treatments. 118 00:06:59,320 --> 00:07:02,800 The first intervention recommended for me is surgery, 119 00:07:02,800 --> 00:07:06,040 what they call a radical hysterectomy. 120 00:07:07,880 --> 00:07:10,920 They don't just take out the uterus, 121 00:07:10,920 --> 00:07:13,160 they don't just take out the cervix. 122 00:07:13,160 --> 00:07:15,280 They take out the top section of the vagina, 123 00:07:15,280 --> 00:07:16,840 they take out the fallopian tubes, 124 00:07:16,840 --> 00:07:18,880 they take out all the tissue that surrounds it, 125 00:07:18,880 --> 00:07:21,480 so that, in the end, there's nothing between my bladder 126 00:07:21,480 --> 00:07:23,840 and my bowels. It's completely empty. 127 00:07:23,840 --> 00:07:26,680 And all of the pelvic lymph nodes. 128 00:07:30,000 --> 00:07:32,960 I wanted to talk to someone who's been in this position before. 129 00:07:32,960 --> 00:07:37,520 The first person I thought of was my friend David Spiegelhalter. 130 00:07:37,520 --> 00:07:39,160 He's had prostate cancer, 131 00:07:39,160 --> 00:07:42,800 and he's spent a lifetime working in medical statistics. 132 00:07:42,800 --> 00:07:45,560 I'm just like, I don't know, 133 00:07:45,560 --> 00:07:48,120 trying to tackle it in the same way that I do with everything. 134 00:07:48,120 --> 00:07:50,120 I've got, like, this massive stack of books next 135 00:07:50,120 --> 00:07:52,600 to me of things that I'm trying to get through. 136 00:07:52,600 --> 00:07:56,400 Do you think... I don't know. Did the numbers help you? 137 00:07:56,400 --> 00:07:58,000 I think, like everyone else, 138 00:07:58,000 --> 00:08:00,200 it came as a huge emotional hit. 139 00:08:00,200 --> 00:08:04,000 You know, I'm not immune to any of those kind of feelings, 140 00:08:04,000 --> 00:08:06,880 but I suppose I did try to take 141 00:08:06,880 --> 00:08:10,640 a kind of mathematical view to it 142 00:08:10,640 --> 00:08:13,800 and start doing some research on what 143 00:08:13,800 --> 00:08:15,920 the options might be and what the outcomes might be. 144 00:08:15,920 --> 00:08:18,160 And, you know, one aspect of it, of course, 145 00:08:18,160 --> 00:08:21,320 is the feeling that, um, "Oh, you know, I've got cancer, 146 00:08:21,320 --> 00:08:23,240 "let's get it out, you know, just cut it out." 147 00:08:23,240 --> 00:08:24,640 Now I would say to people to 148 00:08:24,640 --> 00:08:26,880 try to keep that under control, just keep calm, 149 00:08:26,880 --> 00:08:29,560 keep calm. That may not be the best policy. 150 00:08:29,560 --> 00:08:32,600 You have to think that these treatments have harms attached 151 00:08:32,600 --> 00:08:35,040 to them, both short-term and long-term, 152 00:08:35,040 --> 00:08:38,000 and the benefits just may not be worth it. 153 00:08:38,000 --> 00:08:42,160 Sometimes you should, what? Fight the urge to want to get rid of it? 154 00:08:42,160 --> 00:08:45,200 I'm talking about the mild case of the disease. 155 00:08:45,200 --> 00:08:49,240 Many more people will be living with cancer in the future. 156 00:08:49,240 --> 00:08:51,480 Is that what happened in your case, then? 157 00:08:51,480 --> 00:08:54,140 Was not having surgery an option? No, 158 00:08:54,140 --> 00:08:56,980 I was quite strongly recommended to have surgery due to 159 00:08:56,980 --> 00:09:01,640 the particular severity of my prostate cancer. 160 00:09:01,640 --> 00:09:03,920 And, so far, I'm clear five years out, 161 00:09:03,920 --> 00:09:05,480 so we'll see, you know... 162 00:09:05,480 --> 00:09:08,560 I... In that sense, I'm not going to complain. 163 00:09:10,440 --> 00:09:13,240 Like David's, my doctors have made it clear that 164 00:09:13,240 --> 00:09:16,320 surgery is the only option for me. 165 00:09:16,320 --> 00:09:20,000 The hysterectomy will mean I can't have another baby, 166 00:09:20,000 --> 00:09:22,360 which is something I'd hoped for, 167 00:09:22,360 --> 00:09:25,320 but I decided it was a price I was willing to pay. 168 00:09:31,120 --> 00:09:35,840 I'm, like, only at the beginning. Hopefully, 169 00:09:35,840 --> 00:09:38,640 this is just a little blip, 170 00:09:38,640 --> 00:09:40,440 a moment of reset 171 00:09:40,440 --> 00:09:42,120 and, kind of, a moment of pause. 172 00:09:44,120 --> 00:09:45,360 The cancer unit or normal? 173 00:09:45,360 --> 00:09:47,560 Yes, please, the cancer unit, yeah, thank you. 174 00:09:51,000 --> 00:09:54,640 My home for the next...week. 175 00:10:00,360 --> 00:10:02,360 What procedure are you having today? 176 00:10:02,360 --> 00:10:04,080 A radical hysterectomy. 177 00:10:07,080 --> 00:10:10,120 Well, this, is quite the thing. 178 00:10:15,400 --> 00:10:18,880 The surgeons are going to remove my pelvic lymph nodes. 179 00:10:18,880 --> 00:10:21,080 They're worried there might be cancer in them, 180 00:10:21,080 --> 00:10:23,000 but they're not sure. 181 00:10:23,000 --> 00:10:24,480 The biggest question 182 00:10:24,480 --> 00:10:29,080 and the most difficult uncertainty is whether or not 183 00:10:29,080 --> 00:10:31,520 the cancer had got into the lymph nodes. 184 00:10:31,520 --> 00:10:34,480 If the cancer hadn't got into the lymph nodes, 185 00:10:34,480 --> 00:10:37,160 then it was stage one cancer. Basically, 186 00:10:37,160 --> 00:10:38,920 your chances of survival are really good. 187 00:10:38,920 --> 00:10:41,800 About 95%. The surgery works. 188 00:10:41,800 --> 00:10:44,360 You're in a really, really good position. 189 00:10:44,360 --> 00:10:48,120 But if it had got into just one lymph node, 190 00:10:48,120 --> 00:10:52,960 you jump from stage one cancer straight to stage three cancer. 191 00:10:52,960 --> 00:10:55,520 It becomes very, very serious. 192 00:11:09,440 --> 00:11:10,600 Hmm. 193 00:11:11,720 --> 00:11:13,520 So the consultant just came in. 194 00:11:15,720 --> 00:11:20,200 And I asked him if he saw anything in the lymph nodes. 195 00:11:22,720 --> 00:11:25,840 And he said that there was four on one side 196 00:11:25,840 --> 00:11:28,520 that were a bit enlarged. 197 00:11:29,960 --> 00:11:32,360 And one on the other side. 198 00:11:34,680 --> 00:11:36,400 Not great news, though, is it? 199 00:11:38,920 --> 00:11:41,120 Four or five of them were enlarged, 200 00:11:41,120 --> 00:11:44,720 and that could be just 201 00:11:44,720 --> 00:11:46,400 your body's fighting infection, 202 00:11:46,400 --> 00:11:49,800 or they could be enlarged because they're cancerous. 203 00:11:49,800 --> 00:11:52,320 I'd read all of this literature before going in 204 00:11:52,320 --> 00:11:54,560 and I knew that if it was in one lymph node, 205 00:11:54,560 --> 00:11:56,800 it was 60% chance of survival, 206 00:11:56,800 --> 00:11:59,320 two lymph nodes it dropped below 50%. 207 00:11:59,320 --> 00:12:02,200 And here he was saying four or five 208 00:12:02,200 --> 00:12:05,440 could potentially be cancerous. 209 00:12:05,440 --> 00:12:07,320 I mean... 210 00:12:07,320 --> 00:12:10,160 Well, then, you're a goner, aren't you, really? 211 00:12:20,120 --> 00:12:23,360 Mummy! Aw! 212 00:12:31,880 --> 00:12:34,040 After six days, I'm home, 213 00:12:34,040 --> 00:12:35,960 but I have to wait for a follow-up appointment 214 00:12:35,960 --> 00:12:39,440 to find out if there's cancer in my lymph nodes. 215 00:12:42,800 --> 00:12:47,840 In the UK, doctors often recommend further treatment after surgery, 216 00:12:47,840 --> 00:12:50,040 called adjuvant therapy. 217 00:12:50,040 --> 00:12:53,840 It's often chemotherapy or radiotherapy. 218 00:12:53,840 --> 00:12:56,280 It's a bit like an insurance policy. 219 00:12:56,280 --> 00:12:58,080 Although the cancer has been removed, 220 00:12:58,080 --> 00:13:00,840 there's a chance it might come back. 221 00:13:00,840 --> 00:13:03,200 The treatment aims to reduce that risk. 222 00:13:08,680 --> 00:13:10,640 I want to understand how doctors 223 00:13:10,640 --> 00:13:14,240 decide which patients should have these extra treatments, 224 00:13:14,240 --> 00:13:17,720 especially as they come with side-effects. 225 00:13:18,720 --> 00:13:22,120 Judy King is a medical oncologist in North London. 226 00:13:25,800 --> 00:13:27,760 So we have a range of people in clinic, 227 00:13:27,760 --> 00:13:30,400 but the number of the people that we'll be seeing are having 228 00:13:30,400 --> 00:13:33,640 what's called adjuvant chemotherapy. So they've had their surgery, 229 00:13:33,640 --> 00:13:36,720 they may have had scans. And, as far as we can see, 230 00:13:36,720 --> 00:13:40,720 there is no cancer. However, we know that, untreated, 231 00:13:40,720 --> 00:13:43,280 a number of those patients will have what we call 232 00:13:43,280 --> 00:13:44,920 micro-metastatic disease, 233 00:13:44,920 --> 00:13:47,400 so there will be tiny cells that will have floated off 234 00:13:47,400 --> 00:13:49,520 and ended up in the wrong place, which, 235 00:13:49,520 --> 00:13:53,440 if left unchecked, could come back and cause a cancer recurrence. 236 00:13:53,440 --> 00:13:56,680 And so those are the things that we're trying to treat. 237 00:13:56,680 --> 00:13:59,240 Where do you set that boundary of, "It's worth it for you, 238 00:13:59,240 --> 00:14:01,680 "and it's not worth it for you"? So, in breast cancer, 239 00:14:01,680 --> 00:14:03,840 we would say that what we're looking at is what is, 240 00:14:03,840 --> 00:14:07,080 "What is the chance of you being cancer-free ten years from now?" 241 00:14:07,080 --> 00:14:09,520 And if chemotherapy improves your chance 242 00:14:09,520 --> 00:14:12,120 of being alive by about 5% or more, 243 00:14:12,120 --> 00:14:14,680 then chemotherapy is something that we would usually discuss 244 00:14:14,680 --> 00:14:18,280 with a patient. Let me make sure I understand that, though, 245 00:14:18,280 --> 00:14:20,800 because another way to say the same thing is that, 246 00:14:20,800 --> 00:14:23,000 if you've got 100 women, 247 00:14:23,000 --> 00:14:26,640 all of them have chemo, 248 00:14:26,640 --> 00:14:29,720 and chemo will save the lives of five of them, 249 00:14:29,720 --> 00:14:32,880 that's the threshold? 250 00:14:32,880 --> 00:14:36,520 Yes, so... In a... This would be a relatively low-risk case. 251 00:14:36,520 --> 00:14:39,080 Let's say you have 100 women. 80 of them, 252 00:14:39,080 --> 00:14:42,320 if they do nothing at this point, 253 00:14:42,320 --> 00:14:43,920 would live ten years very happily 254 00:14:43,920 --> 00:14:46,360 with their cancer not coming back. 255 00:14:46,360 --> 00:14:49,640 And maybe 15 of them, the cancer comes back. 256 00:14:49,640 --> 00:14:52,280 Chemotherapy will be the thing that means 257 00:14:52,280 --> 00:14:55,080 the cancer doesn't come back for five out of the 15. 258 00:14:55,080 --> 00:14:58,280 So you have treated 100 women, 259 00:14:58,280 --> 00:15:00,600 and five women have been benefited. 260 00:15:00,600 --> 00:15:04,320 That point is worth repeating. In 100 women, 261 00:15:04,320 --> 00:15:06,480 five of them are going to die of other causes - 262 00:15:06,480 --> 00:15:08,760 perhaps heart attacks or car crashes, 263 00:15:08,760 --> 00:15:10,560 that kind of thing. 264 00:15:10,560 --> 00:15:13,040 Of all of the women that are left, 265 00:15:13,040 --> 00:15:15,840 80 of them, the cancer is not going to come back. 266 00:15:15,840 --> 00:15:18,720 It doesn't matter whether they have chemotherapy or not, 267 00:15:18,720 --> 00:15:20,640 they are already cured. 268 00:15:20,640 --> 00:15:24,880 That leaves 15 women where the cancer is going to return. 269 00:15:24,880 --> 00:15:27,560 However, for five of these women, 270 00:15:27,560 --> 00:15:29,760 if they have chemotherapy now, 271 00:15:29,760 --> 00:15:33,320 they can prevent the cancer from coming back. 272 00:15:33,320 --> 00:15:34,920 But when you start off, 273 00:15:34,920 --> 00:15:37,800 you have no idea who these five women are, 274 00:15:37,800 --> 00:15:41,800 and so every single one of these women 275 00:15:41,800 --> 00:15:45,440 has to go through chemotherapy just to save five lives. 276 00:15:45,440 --> 00:15:47,920 And for everybody else, 277 00:15:47,920 --> 00:15:52,720 chemotherapy made no difference whatsoever. 278 00:15:52,720 --> 00:15:56,200 They had all of the side-effects - hair loss, 279 00:15:56,200 --> 00:15:58,080 vomiting, giving up work, 280 00:15:58,080 --> 00:16:00,320 not being able to see people - 281 00:16:00,320 --> 00:16:02,520 all of that for 95 women, and actually, 282 00:16:02,520 --> 00:16:04,960 it made no difference? 283 00:16:04,960 --> 00:16:07,480 So, yes, that would be the case, 284 00:16:07,480 --> 00:16:09,560 and these are the difficult conversations because 285 00:16:09,560 --> 00:16:11,680 a patient, they could also be thinking, you know, 286 00:16:11,680 --> 00:16:13,200 "Is it really worth it?" 287 00:16:13,200 --> 00:16:15,760 But then I guess on the flip side of that, 288 00:16:15,760 --> 00:16:19,280 you don't know whether you're in the 95 or you're in the five. 289 00:16:19,280 --> 00:16:20,960 And maybe, actually, chemo will be 290 00:16:20,960 --> 00:16:23,040 the thing that saves your life. Exactly. 291 00:16:23,040 --> 00:16:24,360 When all is said and done, 292 00:16:24,360 --> 00:16:27,920 the majority of people would put quite a lot of value 293 00:16:27,920 --> 00:16:31,000 on the concept of, "I don't want this cancer to come back." Mm. 294 00:16:31,000 --> 00:16:35,040 Just because the alternative is so horrible to imagine. 295 00:16:43,240 --> 00:16:46,240 Judy has invited me to observe one of her appointments. 296 00:16:46,240 --> 00:16:49,040 Anne, do you want to come down? Thank you. 297 00:16:49,040 --> 00:16:51,080 Anne is a 67-year-old swimming coach from Barnet. 298 00:16:51,080 --> 00:16:53,920 Hello, come in, my name is Judy King. I am one of the consultants. 299 00:16:53,920 --> 00:16:55,160 She had surgery to remove 300 00:16:55,160 --> 00:16:58,200 a two-centimetre breast tumour, three weeks ago. 301 00:16:58,200 --> 00:17:00,440 ..which is going to wreak havoc with scheduling... 302 00:17:00,440 --> 00:17:02,240 I'm going to talk about what the chemo is, 303 00:17:02,240 --> 00:17:03,920 and why we would recommend it. 304 00:17:03,920 --> 00:17:07,160 And then you can have a think about whether that's something that you 305 00:17:07,160 --> 00:17:09,360 want to do or not. OK. So if we take, 306 00:17:09,360 --> 00:17:11,800 sort of, women in your situation 307 00:17:11,800 --> 00:17:13,880 with this kind of cancer, we're looking at, 308 00:17:13,880 --> 00:17:16,080 "What is the chance of people being alive and well, 309 00:17:16,080 --> 00:17:18,160 "cancer-free ten years down the line?" 310 00:17:18,160 --> 00:17:23,000 Yes. So, this is the chance that everything is fine. 311 00:17:23,000 --> 00:17:28,480 There's a pretty good chance, cancer has been cut out, job done. Mm-hm. 312 00:17:28,480 --> 00:17:33,160 This, here, is the risk of the cancer coming back. 313 00:17:33,160 --> 00:17:36,560 Yeah? So, my job is to reduce that risk. 314 00:17:36,560 --> 00:17:40,720 Right. In terms of absolute numbers, 315 00:17:40,720 --> 00:17:44,120 we reduce the chance of it coming back again by about 4%. 316 00:17:44,120 --> 00:17:47,240 So, the thing is that I don't know if you're one 317 00:17:47,240 --> 00:17:49,360 of these people over here... 318 00:17:49,360 --> 00:17:52,640 No. ..who the surgery is enough, 319 00:17:52,640 --> 00:17:55,840 and I don't know if you're one of these people over here. 320 00:17:55,840 --> 00:17:59,000 So, what I have to say is that I recommend that everybody 321 00:17:59,000 --> 00:18:02,240 has the tablets and the chemo just to reduce 322 00:18:02,240 --> 00:18:04,800 the risk as much as possible. Just to get to that, yeah. So, I'm 323 00:18:04,800 --> 00:18:06,880 going to talk a little bit about how the chemo works 324 00:18:06,880 --> 00:18:09,520 and the side-effects, and then I think we should have 325 00:18:09,520 --> 00:18:12,760 a talk about whether that's something that you want to do. OK. 326 00:18:12,760 --> 00:18:14,200 Is that all right? Yeah. 327 00:18:14,200 --> 00:18:17,840 So, side-effects, common things - feeling tired, 328 00:18:17,840 --> 00:18:21,400 people do feel pretty washed out for a couple of days. Mm-hm. 329 00:18:21,400 --> 00:18:23,520 Chemotherapy can drop your immune system. 330 00:18:23,520 --> 00:18:25,760 That means that, if you get a fever or if you get 331 00:18:25,760 --> 00:18:26,960 an infection, you can't... 332 00:18:26,960 --> 00:18:29,360 Your body can't fight it properly. If you get a fever, 333 00:18:29,360 --> 00:18:32,040 you must phone the emergency numbers. If you can't get through, 334 00:18:32,040 --> 00:18:34,680 you have to go to A&E. All right. 335 00:18:34,680 --> 00:18:36,680 It does affect your hair. 336 00:18:36,680 --> 00:18:38,560 All right? That's probably my... 337 00:18:38,560 --> 00:18:41,200 Out of everything, it's the hair loss that's going to be... 338 00:18:41,200 --> 00:18:43,120 It's actually the thing that most people... 339 00:18:43,120 --> 00:18:45,480 Because I've got such fine hair anyway, so... 340 00:18:45,480 --> 00:18:49,280 Always worth having a scarf or a wig or what have you. Yeah. 341 00:18:49,280 --> 00:18:50,960 Other things, feeling sick or being sick, 342 00:18:50,960 --> 00:18:53,960 acidy, bowels can go either way - can be diarrhoea, 343 00:18:53,960 --> 00:18:55,320 can be constipation. 344 00:18:55,320 --> 00:18:58,200 Aches and pains, those kinds of things. 345 00:18:58,200 --> 00:19:00,120 What are you thinking? 346 00:19:00,120 --> 00:19:01,720 I'm going for it. You're going for it. 347 00:19:01,720 --> 00:19:03,640 Yeah. All right, we're going for it. 348 00:19:03,640 --> 00:19:05,960 Do you want to sign consent now, or do you want some time 349 00:19:05,960 --> 00:19:07,680 to think it over? No, no, I've 350 00:19:07,680 --> 00:19:10,720 made up my mind, that's what I'm going to do. Okey-doke. 351 00:19:28,080 --> 00:19:30,440 How are you feeling? 352 00:19:30,440 --> 00:19:33,400 OK, OK. It's a lot to take in 353 00:19:33,400 --> 00:19:36,640 in one, sort of, short space of time. 354 00:19:36,640 --> 00:19:38,240 Was there a point where you thought, 355 00:19:38,240 --> 00:19:40,280 "Oh, maybe I won't?" 356 00:19:40,280 --> 00:19:43,160 It's always been the case of, 357 00:19:43,160 --> 00:19:46,200 "There's a possibility you might have to have chemo." 358 00:19:46,200 --> 00:19:49,080 So, I think that's been a lead into it, with it. 359 00:19:49,080 --> 00:19:51,920 It's not come as a big shock to say, 360 00:19:51,920 --> 00:19:53,280 "Yeah, you've got to do it." 361 00:19:53,280 --> 00:19:57,720 I think if I don't go along those lines, you know, my... 362 00:19:57,720 --> 00:19:59,760 The chances are it's going to return, 363 00:19:59,760 --> 00:20:02,240 and I don't want that. 364 00:20:02,240 --> 00:20:05,480 I don't know, it's just all so much. It's a lot, isn't it? 365 00:20:05,480 --> 00:20:08,920 It is a lot. It's one of those things, isn't it? 366 00:20:08,920 --> 00:20:11,320 I know. It still sucks, though. 367 00:20:11,320 --> 00:20:13,560 Yeah. It still sucks. ANNE LAUGHS 368 00:20:16,240 --> 00:20:17,880 When I was talking to her outside, 369 00:20:17,880 --> 00:20:20,320 she was sort of saying, "If I don't have the chemo, 370 00:20:20,320 --> 00:20:23,560 "it's overwhelmingly likely that the cancer will come back." 371 00:20:23,560 --> 00:20:26,000 And I didn't, sort of, correct her. 372 00:20:29,360 --> 00:20:32,640 But I think that, like, the difference that the chemo makes, 373 00:20:32,640 --> 00:20:36,040 even if it's not exactly 4%... It's not as big as she thinks. 374 00:20:36,040 --> 00:20:37,560 No, exactly. 375 00:20:37,560 --> 00:20:39,400 It sort of sits slightly more uncomfortably 376 00:20:39,400 --> 00:20:41,440 with you than it does with me. 377 00:20:41,440 --> 00:20:42,880 I'll tell you why. 378 00:20:42,880 --> 00:20:46,000 I've seen the cancers come back. Of course. 379 00:20:46,000 --> 00:20:48,200 And I know that this is a relatively gentle chemo 380 00:20:48,200 --> 00:20:49,560 and I can get her through it. 381 00:20:49,560 --> 00:20:52,160 And I know if that was somebody that I cared about, 382 00:20:52,160 --> 00:20:54,640 I would 100% tell them to have it. 383 00:20:54,640 --> 00:20:55,880 I spend all my life trying 384 00:20:55,880 --> 00:20:58,240 to explain mathematical concepts to people. 385 00:20:58,240 --> 00:20:59,920 And I know how hard it is, right? 386 00:20:59,920 --> 00:21:03,320 And I know how difficult this concept is. 387 00:21:03,320 --> 00:21:05,640 And I'm not saying, even for 388 00:21:05,640 --> 00:21:08,440 a moment, that it would change the path that she's on, 389 00:21:08,440 --> 00:21:10,920 change the decision that she's made. 390 00:21:10,920 --> 00:21:13,880 But I'm just thinking about the patients who are taking chemo 391 00:21:13,880 --> 00:21:16,400 because they think it's their only chance of survival 392 00:21:16,400 --> 00:21:19,640 without realising, actually, it's making a very small difference. 393 00:21:19,640 --> 00:21:21,360 So, the thing is, 394 00:21:21,360 --> 00:21:24,440 I don't think philosophically people can really deal 395 00:21:24,440 --> 00:21:28,800 with that level of complex thinking and decision-making. 396 00:21:28,800 --> 00:21:32,680 I think people need confidence in their decisions, 397 00:21:32,680 --> 00:21:35,720 and sometimes that requires a more simplistic answer. 398 00:21:40,960 --> 00:21:43,000 I'm feeling conflicted. 399 00:21:43,000 --> 00:21:46,920 I'm uneasy that patients might not see how small the benefits are, 400 00:21:46,920 --> 00:21:49,360 but I know what it's like to be frightened, 401 00:21:49,360 --> 00:21:51,960 and just want a doctor to take charge. 402 00:21:53,360 --> 00:21:55,600 Despite my swollen lymph nodes, 403 00:21:55,600 --> 00:21:58,240 I'm still hoping to avoid chemotherapy, 404 00:21:58,240 --> 00:22:01,560 but my mum is urging a more realistic approach. 405 00:22:01,560 --> 00:22:04,240 Mum had cancer when I was in school. 406 00:22:05,520 --> 00:22:07,720 This is why she doesn't give a shit. 407 00:22:07,720 --> 00:22:09,400 SHE LAUGHS 408 00:22:09,400 --> 00:22:12,560 Our family, though, so Mum's got nine brothers and sisters - 409 00:22:12,560 --> 00:22:14,840 how many of them have not had cancer? 410 00:22:14,840 --> 00:22:18,120 THEY LAUGH 411 00:22:18,120 --> 00:22:21,160 You know like how some families play rugby? 412 00:22:21,160 --> 00:22:22,400 Ours gets cancer. 413 00:22:23,600 --> 00:22:26,440 I was very worried about her when I first heard the news. 414 00:22:26,440 --> 00:22:28,960 Yeah. When I first told you, though, 415 00:22:28,960 --> 00:22:32,040 I told it to you in a very positive way. Yes, yeah. 416 00:22:32,040 --> 00:22:33,880 What, and you were still worried about it? 417 00:22:33,880 --> 00:22:38,280 Well, I looked it up online. What did you see when you looked it up? 418 00:22:38,280 --> 00:22:41,920 Well, if it's a hysterectomy and if it's cancer, 419 00:22:41,920 --> 00:22:45,320 then it's chemo. In this country, in the western world, 420 00:22:45,320 --> 00:22:47,600 they decide to do it. 421 00:22:47,600 --> 00:22:50,440 I don't know of anyone who's got away without the chemo 422 00:22:50,440 --> 00:22:53,720 or the radio. You just do your best to fight it. 423 00:22:53,720 --> 00:22:56,640 I've got a chance of it not being, though. Yeah. 424 00:22:58,360 --> 00:22:59,960 So, just wait and see. 425 00:23:04,840 --> 00:23:06,480 Yeah, well done. 426 00:23:06,480 --> 00:23:09,960 They're full of lots of chemicals, you see. What are chemicals? 427 00:23:09,960 --> 00:23:12,200 "What are chemicals?" That's an excellent question, 428 00:23:12,200 --> 00:23:15,800 and probably one for your mum to answer, I'd say, rather than me. 429 00:23:15,800 --> 00:23:17,240 If Hannah has chemotherapy, 430 00:23:17,240 --> 00:23:19,120 that's going to have, you know, 431 00:23:19,120 --> 00:23:22,400 dramatic implications on a number of levels, 432 00:23:22,400 --> 00:23:24,360 from pragmatic levels to emotional levels. 433 00:23:24,360 --> 00:23:28,120 I mean, the kids seeing her going through that's 434 00:23:28,120 --> 00:23:31,400 going to be tough. Me seeing her go through that is going to be tough. 435 00:23:31,400 --> 00:23:34,680 Hannah going through that is going to be tough. What shall we play? 436 00:23:34,680 --> 00:23:37,960 All that really matters is the emotional stability, 437 00:23:37,960 --> 00:23:39,920 which is the most important thing. 438 00:23:43,240 --> 00:23:45,920 I think the thing about cancer, there's this point, 439 00:23:45,920 --> 00:23:48,800 there's this fork in the road, 440 00:23:48,800 --> 00:23:51,440 and it does come down to something as simple 441 00:23:51,440 --> 00:23:54,040 as a few cancer cells in the wrong place. 442 00:23:54,040 --> 00:23:56,240 Where, on one path, we have 443 00:23:56,240 --> 00:24:00,600 a very sick person at home, potentially dying, 444 00:24:00,600 --> 00:24:04,280 and everything changes. 445 00:24:04,280 --> 00:24:06,800 And then the other fork, which is... 446 00:24:08,440 --> 00:24:12,480 I get better, and we get to go on with our lives. 447 00:24:18,360 --> 00:24:22,240 I'm still thinking about my conversations with Judy and Anne, 448 00:24:22,240 --> 00:24:25,920 and how the numbers change as cancer progresses. 449 00:24:25,920 --> 00:24:29,560 I want to understand why patients decide to keep going with treatment, 450 00:24:29,560 --> 00:24:32,000 when the odds are stacked against them. 451 00:24:35,800 --> 00:24:38,080 Online, I came across Nina, 452 00:24:38,080 --> 00:24:40,720 a 39-year-old fashion designer 453 00:24:40,720 --> 00:24:42,800 and mum from South London. 454 00:24:42,800 --> 00:24:47,000 I can't wait to go into chemo tomorrow, 455 00:24:47,000 --> 00:24:49,240 having one more session, 456 00:24:49,240 --> 00:24:50,840 one more cycle. 457 00:24:53,520 --> 00:24:57,560 She's got a particularly aggressive form of breast cancer 458 00:24:57,560 --> 00:24:59,400 that's now considered terminal. 459 00:25:01,440 --> 00:25:03,960 Women with her type and stage of cancer 460 00:25:03,960 --> 00:25:08,640 have only a 12% chance of living five years. 461 00:25:10,040 --> 00:25:11,800 Hi, how are you doing? 462 00:25:11,800 --> 00:25:15,000 Nice to meet you. Lovely to meet you, thank you. 463 00:25:15,000 --> 00:25:16,240 Yeah, well, let's hug! 464 00:25:16,240 --> 00:25:18,560 Her chemo is often exhausting, 465 00:25:18,560 --> 00:25:21,920 and her life's been taken over by medications. 466 00:25:24,000 --> 00:25:26,640 Wow, you weren't joking. Ha, no, 467 00:25:26,640 --> 00:25:30,240 there's... There's quite a lot. 468 00:25:30,240 --> 00:25:32,600 This is for...? This is every day? 469 00:25:32,600 --> 00:25:35,040 So much medication, isn't it? 470 00:25:35,040 --> 00:25:36,440 After chemo, 471 00:25:36,440 --> 00:25:40,600 I take these that help me with anti-sickness. Yep. 472 00:25:40,600 --> 00:25:42,880 Now that I'm on my third cycle, 473 00:25:42,880 --> 00:25:45,480 I'm having to take the pills more often 474 00:25:45,480 --> 00:25:48,520 because I just feel so bad. 475 00:25:48,520 --> 00:25:51,480 Yeah, so blood thinners, 476 00:25:51,480 --> 00:25:53,960 I have to take these. That's an injection? 477 00:25:53,960 --> 00:25:57,680 Yeah, and I have to inject myself every day, 478 00:25:57,680 --> 00:26:02,000 and every day it gets harder. 479 00:26:02,000 --> 00:26:04,640 Do you have to psyche yourself up? 480 00:26:04,640 --> 00:26:07,560 Yeah. Yeah. I feel like my stomach is getting more sensitive 481 00:26:07,560 --> 00:26:10,520 because I've had so many months of it. 482 00:26:10,520 --> 00:26:12,520 And some days I just want to push it in, 483 00:26:12,520 --> 00:26:14,360 but it hurts me. Yeah. 484 00:26:15,920 --> 00:26:17,600 Oh, gosh. 485 00:26:17,600 --> 00:26:23,720 And it's a big reminder that I have cancer. 486 00:26:23,720 --> 00:26:27,800 It's a big reminder, on my good days, that 487 00:26:27,800 --> 00:26:31,240 things are not normal. 488 00:26:31,240 --> 00:26:35,320 I mean, all of this is just such a heavy price that you have to pay. 489 00:26:35,320 --> 00:26:38,960 Yeah, it feels like it. It's the vomiting, 490 00:26:38,960 --> 00:26:40,840 it's the infections, 491 00:26:40,840 --> 00:26:44,240 it's the bleeding gums, it's the nose bleeds. 492 00:26:44,240 --> 00:26:49,520 I've made a choice to have chemo, and, you know, 493 00:26:49,520 --> 00:26:52,840 you can keep throwing anything at me. 494 00:26:52,840 --> 00:26:57,080 As long as I know that I have a percentage in there 495 00:26:57,080 --> 00:27:00,680 of it working, I will do it. You know, 496 00:27:00,680 --> 00:27:02,480 I've committed myself to it. 497 00:27:02,480 --> 00:27:04,320 Do you sort of feel in a way like 498 00:27:04,320 --> 00:27:08,600 you're paying with this three months now and in return, 499 00:27:08,600 --> 00:27:10,320 hopefully, you get a couple of years? 500 00:27:10,320 --> 00:27:13,640 Yeah. It's like a price, a trade. 501 00:27:13,640 --> 00:27:15,520 Yes, it feels like a trade. 502 00:27:15,520 --> 00:27:18,520 Yes, there's just no guarantee. 503 00:27:18,520 --> 00:27:20,960 You have to have the treatment 504 00:27:20,960 --> 00:27:22,840 and hope for the best. 505 00:27:22,840 --> 00:27:25,760 A lot of it is hope, and I'm hopeful. 506 00:27:25,760 --> 00:27:32,760 Do those stories of real miracles where people had stage four cancer, 507 00:27:32,760 --> 00:27:34,200 things look really bad, 508 00:27:34,200 --> 00:27:37,680 and then, somehow or other, their tumours shrank 509 00:27:37,680 --> 00:27:41,360 and they managed to go on and live these very long, 510 00:27:41,360 --> 00:27:43,840 healthy lives, do they play on your mind, those stories? 511 00:27:43,840 --> 00:27:45,960 All the time. Do they? 512 00:27:45,960 --> 00:27:48,160 Yeah, I think I'm going to be one of those stories. 513 00:27:48,160 --> 00:27:50,040 I really believe. 514 00:27:50,040 --> 00:27:56,160 And how do you feel about... thinking about the end? Are you... 515 00:27:56,160 --> 00:27:59,360 Do you think that you've accepted what's going on? 516 00:28:01,160 --> 00:28:04,320 Yes, and no. SHE CHUCKLES 517 00:28:04,320 --> 00:28:06,080 But, yeah, right now, 518 00:28:06,080 --> 00:28:09,520 my heart does not see death. 519 00:28:09,520 --> 00:28:11,760 My heart does not see the end. 520 00:28:11,760 --> 00:28:13,200 Your heart sees those stories. 521 00:28:13,200 --> 00:28:15,960 My heart sees those stories of hope 522 00:28:15,960 --> 00:28:18,040 and I know I'm going to live, 523 00:28:18,040 --> 00:28:21,120 and I'm not going to die. 524 00:28:21,120 --> 00:28:24,400 There's no reason why I can't be one of those people. 525 00:28:24,400 --> 00:28:25,600 So... 526 00:28:28,960 --> 00:28:32,440 Good luck. Thank you. 527 00:28:34,560 --> 00:28:37,000 One thing she said really stood out to me, 528 00:28:37,000 --> 00:28:41,360 where she said that she would have chemo even if it was 1%, 529 00:28:41,360 --> 00:28:45,280 even if there was a 1% chance that chemo would buy her more time, 530 00:28:45,280 --> 00:28:46,520 she would take it. 531 00:28:49,360 --> 00:28:52,600 And that seems pretty incredible to me. 532 00:28:52,600 --> 00:28:57,840 Are you risking, sacrificing, really more than you should? 533 00:28:57,840 --> 00:29:01,600 Rather than just enjoying what you have left? 534 00:29:03,120 --> 00:29:04,800 I think that's what the danger is. 535 00:29:04,800 --> 00:29:07,840 And I don't think she's there yet but I think that there is... 536 00:29:07,840 --> 00:29:11,480 I don't always think that hope is a good thing. 537 00:29:11,480 --> 00:29:14,880 I think there are some times where it can be a bit counterproductive. 538 00:29:15,920 --> 00:29:18,360 Because it's unrealistic? Yeah. 539 00:29:20,440 --> 00:29:22,600 Yeah, or because... Because... 540 00:29:22,600 --> 00:29:24,120 Because you're so focused on 541 00:29:24,120 --> 00:29:26,960 the best possible thing that could happen 542 00:29:26,960 --> 00:29:30,200 that you fail to prepare for what really is happening. 543 00:29:43,000 --> 00:29:45,840 In fact, patients will often go through treatment with 544 00:29:45,840 --> 00:29:48,560 a very low chance of success. 545 00:29:48,560 --> 00:29:52,560 One study showed that over a third of terminal cancer patients 546 00:29:52,560 --> 00:29:54,960 would undergo treatment even if there was only 547 00:29:54,960 --> 00:29:59,240 a 0.1% chance it would prolong their life. 548 00:29:59,240 --> 00:30:01,240 But the doctors who treat them, if they were 549 00:30:01,240 --> 00:30:02,960 to have cancer themselves, 550 00:30:02,960 --> 00:30:05,720 say they would refuse treatment unless it had 551 00:30:05,720 --> 00:30:09,720 at least a 25% chance of working. 552 00:30:09,720 --> 00:30:13,440 Nina is clearly not alone in her dedication to hope, 553 00:30:13,440 --> 00:30:15,080 but I can't help but wonder 554 00:30:15,080 --> 00:30:17,720 what kind of information gap we've created, 555 00:30:17,720 --> 00:30:20,000 where the very people offering a treatment 556 00:30:20,000 --> 00:30:22,360 wouldn't want it for themselves. 557 00:30:24,800 --> 00:30:26,040 Big day. 558 00:30:31,280 --> 00:30:32,920 Got about 20 minutes. 559 00:30:35,960 --> 00:30:37,200 SIGHS 560 00:30:37,200 --> 00:30:40,200 Then I'm getting in the car to go to the hospital to find out... 561 00:30:43,760 --> 00:30:46,320 ..what the situation is, basically, 562 00:30:46,320 --> 00:30:48,920 to find out what they found in the lymph nodes, 563 00:30:48,920 --> 00:30:50,560 to find out... 564 00:30:54,160 --> 00:30:58,920 ..whether I need to have chemo or... 565 00:31:04,240 --> 00:31:08,880 ..whether the surgery did the job of getting everything out. 566 00:31:15,680 --> 00:31:18,240 You just don't have any control or any choice 567 00:31:18,240 --> 00:31:20,080 over what's going to happen. 568 00:31:46,680 --> 00:31:48,280 So how are you, Hannah? 569 00:31:48,280 --> 00:31:49,720 Yeah, all right. Good. 570 00:31:51,880 --> 00:31:54,840 So, you're obviously waiting to hear what the results are. 571 00:31:54,840 --> 00:31:57,360 We're putting you through misery. I know. 572 00:32:03,120 --> 00:32:04,520 I'll tell you in the car. 573 00:32:11,080 --> 00:32:12,360 SHE LAUGHS WITH RELIEF 574 00:32:12,360 --> 00:32:14,120 Yes? 575 00:32:14,120 --> 00:32:16,120 HE LAUGHS Gone? 576 00:32:21,600 --> 00:32:24,240 Oh, my God, really? 577 00:32:24,240 --> 00:32:26,400 Oh, fucking brilliant! 578 00:32:28,920 --> 00:32:30,440 Oh, baby! 579 00:32:32,560 --> 00:32:34,240 Oh, my God. 580 00:32:34,240 --> 00:32:36,560 Oh, God. 581 00:32:38,600 --> 00:32:41,080 Oh, God. Oh, my God. 582 00:32:43,840 --> 00:32:46,720 That's amazing. So go on. Tell me, tell me. Tell me. 583 00:32:46,720 --> 00:32:49,800 It's done. Absolutely done? It's done. 584 00:32:49,800 --> 00:32:51,360 Oh, God. 585 00:32:53,120 --> 00:32:54,680 Jesus Christ. 586 00:32:55,720 --> 00:32:57,160 Oh, thank God. 587 00:32:58,400 --> 00:33:01,600 But they said that all the lymph nodes came back negative. 588 00:33:05,040 --> 00:33:07,520 And he was like, "Can't guarantee." 589 00:33:07,520 --> 00:33:11,000 You know, "This isn't, like, 100% like, you know, this isn't, like, 590 00:33:11,000 --> 00:33:14,400 "a guarantee that it's never come back again, but, like..." 591 00:33:14,400 --> 00:33:16,040 Bloody hell. 592 00:33:16,040 --> 00:33:17,280 Great. 593 00:33:18,320 --> 00:33:20,480 Getting drunk tonight. Fuck, yeah. 594 00:33:22,960 --> 00:33:24,360 Woo! 595 00:33:33,520 --> 00:33:34,720 CHILDREN PLAYING 596 00:33:37,800 --> 00:33:39,160 Pleased with you. 597 00:33:41,640 --> 00:33:44,480 Well done, well done. 598 00:33:45,680 --> 00:33:47,920 It's the best possible news. 599 00:33:50,040 --> 00:33:53,440 But there's still a one in ten chance that my cancer will come back. 600 00:33:54,800 --> 00:33:55,960 Have you had dinner? 601 00:33:55,960 --> 00:33:58,160 Yeah, we did. What did you have? 602 00:33:58,160 --> 00:34:00,960 Daddy? Daddy? 603 00:34:04,960 --> 00:34:07,720 A few months later, there's a problem. 604 00:34:09,080 --> 00:34:12,120 I've started to notice swelling in my legs. 605 00:34:13,320 --> 00:34:14,760 If I'm not careful, 606 00:34:14,760 --> 00:34:18,440 my right leg swells up 607 00:34:18,440 --> 00:34:20,640 to be much bigger than the left-hand side. 608 00:34:20,640 --> 00:34:24,920 It's caused by a side-effect of my surgery called lymphedema, 609 00:34:24,920 --> 00:34:28,040 where excess fluid builds up in your limbs. 610 00:34:28,040 --> 00:34:29,160 It's grim, innit? 611 00:34:30,600 --> 00:34:33,040 You have this system called your lymphatic system, 612 00:34:33,040 --> 00:34:34,880 and it's like little tubes 613 00:34:34,880 --> 00:34:39,400 and channels that are drawing fluid away from all parts of your body, 614 00:34:39,400 --> 00:34:42,080 and then bringing it upwards towards your heart. 615 00:34:42,080 --> 00:34:45,080 Now, along those tubes, 616 00:34:45,080 --> 00:34:47,240 you have these little things called nodes. 617 00:34:47,240 --> 00:34:51,120 When they were doing my surgery, 618 00:34:51,120 --> 00:34:53,520 because they were concerned about cancer being in 619 00:34:53,520 --> 00:34:55,600 the lymph nodes, they chopped them all out. 620 00:34:55,600 --> 00:34:58,240 And so now the fluid just, essentially, leaks out 621 00:34:58,240 --> 00:35:00,240 and collects in my leg. 622 00:35:07,760 --> 00:35:10,640 My devilishly sexy tights! 623 00:35:10,640 --> 00:35:15,080 They're compression garments, so, um, 624 00:35:15,080 --> 00:35:21,000 they just help stop all of the fluid building up, basically. 625 00:35:21,000 --> 00:35:23,200 So, they're really tight down the bottom, 626 00:35:23,200 --> 00:35:27,160 and then they're slightly less tight as you go further up. 627 00:35:27,160 --> 00:35:30,960 But the idea is that they just keep the swelling down. 628 00:35:30,960 --> 00:35:35,520 So, you have to wear them all day, every day. 629 00:35:35,520 --> 00:35:38,240 You really do? Yeah, even on the beach. 630 00:35:40,080 --> 00:35:43,080 It just feels very sensitive to the touch. 631 00:35:43,080 --> 00:35:47,200 It just feels very full and sort of tight. 632 00:35:47,200 --> 00:35:49,200 It's not painful. 633 00:35:51,800 --> 00:35:55,200 It's not, like, excruciating agony. It's just really uncomfortable. 634 00:36:04,840 --> 00:36:06,920 The problem with lymphedema 635 00:36:06,920 --> 00:36:10,160 is that you have no idea how quickly it's going to progress. 636 00:36:10,160 --> 00:36:13,400 It could be that it happens over the course of a few weeks or months. 637 00:36:13,400 --> 00:36:15,200 I mean, it really can be that quick. 638 00:36:16,440 --> 00:36:17,880 Come on. 639 00:36:19,160 --> 00:36:22,280 I have got really upset about it because, you know, 640 00:36:22,280 --> 00:36:26,040 you can't be upright for sustained periods of time. 641 00:36:26,040 --> 00:36:28,440 There was one evening I was like, "Right, I'm 642 00:36:28,440 --> 00:36:30,600 "going to do some baking with my daughter," 643 00:36:30,600 --> 00:36:33,280 and ended up standing up for a while. 644 00:36:33,280 --> 00:36:36,360 And then finally, like, 645 00:36:36,360 --> 00:36:38,600 sat down and put my feet up and like, 646 00:36:38,600 --> 00:36:41,080 literally, my leg, it was like a balloon. 647 00:36:41,080 --> 00:36:43,280 It was, like, incredible. This thing 648 00:36:43,280 --> 00:36:46,520 just, like, basically expanding, like, under your hands. 649 00:36:48,080 --> 00:36:51,600 I just don't have that view of myself in the future. You know? 650 00:36:51,600 --> 00:36:54,520 Like, I don't see myself as, like, in my 50s 651 00:36:54,520 --> 00:36:58,040 with, like, one giant leg, like, 652 00:36:58,040 --> 00:37:01,640 unable to walk 100 metres or, like, 653 00:37:01,640 --> 00:37:03,960 unable to work, even. 654 00:37:10,120 --> 00:37:12,640 When we are facing something that feels like it's 655 00:37:12,640 --> 00:37:15,760 a really terrible enemy, like cancer, 656 00:37:15,760 --> 00:37:21,480 we have this bias towards just trying to get rid of 657 00:37:21,480 --> 00:37:24,080 the overarching concern, 658 00:37:24,080 --> 00:37:25,720 and worry about side-effects later. 659 00:37:25,720 --> 00:37:27,760 Maybe we are too willing 660 00:37:27,760 --> 00:37:30,800 to just do treatment at any cost just 661 00:37:30,800 --> 00:37:33,840 because it feels like we're doing something. 662 00:37:36,920 --> 00:37:39,760 It's estimated up to 400,000 people 663 00:37:39,760 --> 00:37:42,280 in the UK have lymphedema. 664 00:37:42,280 --> 00:37:44,120 After a radical hysterectomy, 665 00:37:44,120 --> 00:37:47,040 there's a one-in-four chance of getting it. 666 00:37:50,120 --> 00:37:54,440 There's limited treatment for lymphedema available on the NHS, 667 00:37:54,440 --> 00:37:58,600 so I'm going to see a private lymphedema surgeon, Alex Ramsden. 668 00:37:58,600 --> 00:38:00,680 They did the radical hysterectomy. 669 00:38:00,680 --> 00:38:06,360 OK. And they took out everything, and then a bit more. 670 00:38:06,360 --> 00:38:09,560 Right. When you say everything, so there was a hysterectomy? 671 00:38:09,560 --> 00:38:13,240 Yeah, and the nodes. And it was... The lymph nodes. 672 00:38:13,240 --> 00:38:14,880 So that's really important. 673 00:38:14,880 --> 00:38:16,920 So, they took out the common lymph nodes, 674 00:38:16,920 --> 00:38:20,480 they took out the interior iliac. 675 00:38:20,480 --> 00:38:23,880 Yep. The exterior iliac. Right. 676 00:38:23,880 --> 00:38:27,080 And they also took out the...obturator? 677 00:38:27,080 --> 00:38:29,880 Obturator, I was just going to say obturator. Is that quite a lot? 678 00:38:33,560 --> 00:38:37,000 Yes. So I'm not a gynaecologist. Of course. OK? 679 00:38:37,000 --> 00:38:39,240 But they are often very aggressive 680 00:38:39,240 --> 00:38:41,240 with this sort of tumour, 681 00:38:41,240 --> 00:38:43,680 and they often take out a lot of nodes, 682 00:38:43,680 --> 00:38:45,800 and it's very difficult to know, 683 00:38:45,800 --> 00:38:50,000 before you start, whether they're going to be positive or negative. 684 00:38:50,000 --> 00:38:52,840 One of the problems with lymphedema, as you will come across, 685 00:38:52,840 --> 00:38:54,960 is not many people know much about it. 686 00:38:54,960 --> 00:38:57,320 People mention the word cancer and everybody hears, 687 00:38:57,320 --> 00:38:59,360 "Cancer, cancer, cancer, cancer, cancer." 688 00:38:59,360 --> 00:39:01,480 Patients have this massive treatment, 689 00:39:01,480 --> 00:39:03,720 and they have all this investment of time and care 690 00:39:03,720 --> 00:39:05,040 and effort, and that's great. 691 00:39:05,040 --> 00:39:08,040 But then you're left with something that is only going to get worse. 692 00:39:08,040 --> 00:39:10,200 You've got it for the rest of your life. 693 00:39:10,200 --> 00:39:12,320 "Here's a stocking." "Here's a stocking." 694 00:39:12,320 --> 00:39:14,600 And everyone goes, "That's really rubbish," 695 00:39:14,600 --> 00:39:18,240 so it's a very common thing that people get very upset 696 00:39:18,240 --> 00:39:21,240 and more traumatised by the lymphedema than they do 697 00:39:21,240 --> 00:39:22,880 by the cancer sometimes. 698 00:39:33,080 --> 00:39:34,480 SNIFFLES 699 00:39:34,480 --> 00:39:36,480 I'm really sorry. 700 00:39:41,880 --> 00:39:44,600 It's just quite hard to hear someone articulate it. 701 00:39:48,280 --> 00:39:49,400 OK. 702 00:39:51,360 --> 00:39:55,680 So, we've kind of got to the nub of it quite quickly. 703 00:39:55,680 --> 00:39:59,280 I don't really know if there was a choice, 704 00:39:59,280 --> 00:40:01,280 and now there's this, like, 705 00:40:01,280 --> 00:40:05,120 lifelong sort of sentence, as it were, 706 00:40:05,120 --> 00:40:10,240 of, like, what could be a genuinely, like, debilitating, 707 00:40:10,240 --> 00:40:13,080 life-changing condition. There might not have been options. 708 00:40:13,080 --> 00:40:15,520 You might have had to do it. Yep. 709 00:40:19,840 --> 00:40:21,880 It will be a little bit stingy, 710 00:40:21,880 --> 00:40:23,440 and I apologise in advance. 711 00:40:23,440 --> 00:40:27,520 Alex is injecting dye into my lymph vessels 712 00:40:27,520 --> 00:40:29,880 and using an infra-red camera to determine 713 00:40:29,880 --> 00:40:32,240 the extent of my lymphedema. 714 00:40:33,720 --> 00:40:36,000 This is the fluid that's trying to get out of your leg. 715 00:40:36,000 --> 00:40:37,840 It can't go through your pelvis. Yeah. 716 00:40:37,840 --> 00:40:39,920 So it's now going onto your tummy wall. 717 00:40:39,920 --> 00:40:42,360 That's why you're getting fullness of your tummy wall. 718 00:40:42,360 --> 00:40:46,280 So, this is the bit that gets really, like, thick, basically. Right. 719 00:40:49,360 --> 00:40:53,360 God, it's, like, a whole galaxy! SHE CHUCKLES 720 00:40:57,320 --> 00:41:01,040 The right leg is really good, 721 00:41:01,040 --> 00:41:03,880 all the way up to where you describe, which is the upper thigh, 722 00:41:03,880 --> 00:41:06,880 when you're starting to get those dermal back flow patterns 723 00:41:06,880 --> 00:41:10,040 overflow onto your abdominal wall, and that is lymphedema, 724 00:41:10,040 --> 00:41:14,600 but it's the very earliest stage of lymphedema that you have. OK. 725 00:41:16,440 --> 00:41:17,840 Because you're really early, 726 00:41:17,840 --> 00:41:20,280 what you're trying to do is stop it getting worse. 727 00:41:20,280 --> 00:41:23,360 If it stays like this forever, that's fine. Right. 728 00:41:23,360 --> 00:41:25,600 It might stay the same for the next 20 years. 729 00:41:25,600 --> 00:41:26,680 I don't know. 730 00:41:28,040 --> 00:41:29,880 Most likely, it's going to get worse. 731 00:41:38,840 --> 00:41:40,800 Am I asking for a bit too much? I don't know, 732 00:41:40,800 --> 00:41:42,440 maybe I am, maybe I'm being a bit greedy. 733 00:41:42,440 --> 00:41:44,720 It's, like, I was in a position where someone had 734 00:41:44,720 --> 00:41:48,160 to take stuff out to save my life, right? I know that. 735 00:41:48,160 --> 00:41:50,560 I just... Maybe I am being a bit greedy to be, like, 736 00:41:50,560 --> 00:41:52,320 "Is it too much to ask that 737 00:41:52,320 --> 00:41:56,040 "I wasn't left with a lifelong chronic condition?" 738 00:41:58,320 --> 00:42:01,760 Only half of cancer patients feel that long-term side-effects 739 00:42:01,760 --> 00:42:06,360 of treatment are fully explained to them. At the moment, 740 00:42:06,360 --> 00:42:09,880 the way that these side-effects and statistics are given, 741 00:42:09,880 --> 00:42:13,480 it's like...reeled off like a list of numbers. 742 00:42:13,480 --> 00:42:15,760 I'm not saying for a second that these treatments 743 00:42:15,760 --> 00:42:17,200 aren't a good thing, 744 00:42:17,200 --> 00:42:20,080 I just think that people should be given... 745 00:42:21,960 --> 00:42:23,280 ..the opportunity 746 00:42:23,280 --> 00:42:26,600 to understand what they're really signing up for. 747 00:42:30,560 --> 00:42:32,480 Life-changing decisions are so hard 748 00:42:32,480 --> 00:42:35,080 to make when you're in the middle of a crisis. 749 00:42:37,920 --> 00:42:41,840 But if you're not part of deciding what risks are worth taking, 750 00:42:41,840 --> 00:42:45,280 cancer care can end up feeling like something that's done TO you. 751 00:42:45,280 --> 00:42:46,640 Not with you. 752 00:42:50,360 --> 00:42:53,760 I keep thinking about how this all started, 753 00:42:53,760 --> 00:42:55,960 the smear test that I put off, 754 00:42:55,960 --> 00:42:58,720 and the one that later found my cancer. 755 00:43:02,120 --> 00:43:03,880 That's the smear test letter, 756 00:43:03,880 --> 00:43:05,720 the one that I missed. 757 00:43:08,400 --> 00:43:11,600 And then there's the one that they sent as the follow-up. 758 00:43:20,120 --> 00:43:22,160 What happened... 759 00:43:23,840 --> 00:43:26,720 ..in my body that I didn't know about between then and then? 760 00:43:28,320 --> 00:43:31,000 And what would they have found if I'd gone to that one? 761 00:43:35,600 --> 00:43:39,040 The cervical screening programme is one of only three screening tests 762 00:43:39,040 --> 00:43:40,680 offered by the NHS, 763 00:43:40,680 --> 00:43:44,080 along with breast and bowel cancer for those over 50. 764 00:43:53,840 --> 00:43:55,760 The NHS estimates that their 765 00:43:55,760 --> 00:44:01,520 cervical screening programme saves around 5,000 lives every year. 766 00:44:01,520 --> 00:44:04,480 But even screening provokes debate. 767 00:44:06,480 --> 00:44:09,080 I'm in Glasgow to meet Dr Margaret McCartney. 768 00:44:09,080 --> 00:44:11,360 She's a GP and an honorary fellow 769 00:44:11,360 --> 00:44:15,040 at the Centre for Evidence-Based Medicine. 770 00:44:15,040 --> 00:44:17,480 She wants to tell me about some research that turns 771 00:44:17,480 --> 00:44:21,680 the tables on what we think we know about cancer. 772 00:44:21,680 --> 00:44:23,360 So, when I was at medical school, 773 00:44:23,360 --> 00:44:26,160 very much you were taught that cancer is a bad thing, 774 00:44:26,160 --> 00:44:28,320 and certainly very often it is a bad thing. 775 00:44:28,320 --> 00:44:30,680 It's something you would want to know about and treat, 776 00:44:30,680 --> 00:44:32,680 but it's more complicated than that as well. 777 00:44:32,680 --> 00:44:35,240 We know that there are many people who've got 778 00:44:35,240 --> 00:44:38,320 a cancer in their bodies that they would not have known about had they 779 00:44:38,320 --> 00:44:40,000 not gone to get tested for it, 780 00:44:40,000 --> 00:44:42,040 and they would never have known about it 781 00:44:42,040 --> 00:44:44,280 because it wasn't a cancer that was destined 782 00:44:44,280 --> 00:44:46,640 to spread or to kill them or to cause problems. 783 00:44:46,640 --> 00:44:48,120 Is this quite a rare thing, though, 784 00:44:48,120 --> 00:44:51,600 that people have cancers that won't go on to kill them? 785 00:44:51,600 --> 00:44:53,600 There's a background that's useful, which is 786 00:44:53,600 --> 00:44:56,040 that there have been a lot of autopsy studies done over 787 00:44:56,040 --> 00:44:58,960 the last few decades, where people have examined 788 00:44:58,960 --> 00:45:04,080 the tissues of individuals who have died suddenly and unexpectedly, 789 00:45:04,080 --> 00:45:06,800 usually road traffic accidents. So, they've had a sudden death, 790 00:45:06,800 --> 00:45:09,160 and these people weren't being treated for cancer. 791 00:45:09,160 --> 00:45:11,080 They weren't being investigated for cancer. 792 00:45:11,080 --> 00:45:14,400 They didn't have symptoms that we knew about that would suggest cancer 793 00:45:14,400 --> 00:45:15,960 and the tissues have been examined 794 00:45:15,960 --> 00:45:21,800 but have found cancer in around about 7% of cases. 7%? 795 00:45:21,800 --> 00:45:23,040 Yeah, yeah. 796 00:45:23,040 --> 00:45:27,520 This does seem like quite an astonishing thing to say. 797 00:45:27,520 --> 00:45:30,160 It's a really weird thing to try and think about 798 00:45:30,160 --> 00:45:32,600 because it runs counter to everything that we're taught 799 00:45:32,600 --> 00:45:34,920 and we're told. If you go and look for cancer, 800 00:45:34,920 --> 00:45:37,240 you will find cancer. There's no question about that, 801 00:45:37,240 --> 00:45:38,560 so if you go and put, you know, 802 00:45:38,560 --> 00:45:41,240 hundreds of people through a CT scanner or an MRI scanner, 803 00:45:41,240 --> 00:45:44,280 you will find cancers that they had no symptoms of, 804 00:45:44,280 --> 00:45:45,800 they didn't have any inkling about. 805 00:45:45,800 --> 00:45:47,600 The big question is whether that cancer was 806 00:45:47,600 --> 00:45:50,720 going to go on and do that person harm. 807 00:45:50,720 --> 00:45:54,320 Some of the studies using MRIs put this number slightly lower, 808 00:45:54,320 --> 00:45:55,760 but we do know that there is 809 00:45:55,760 --> 00:45:59,200 a pool of undiagnosed tumours out there. 810 00:46:00,280 --> 00:46:03,040 But to discover whether those cancers will cause harm, 811 00:46:03,040 --> 00:46:05,640 Margaret wanted to show me something extraordinary 812 00:46:05,640 --> 00:46:10,200 that reveals why hunting for cancer cells isn't always a good thing. 813 00:46:10,200 --> 00:46:14,640 So, this is a graph of what happened in South Korea when they decided 814 00:46:14,640 --> 00:46:18,720 to offer the population screening for thyroid cancer, 815 00:46:18,720 --> 00:46:22,000 and they started to screen people just in 1999. 816 00:46:22,000 --> 00:46:24,800 So, you'll see that, as they started to screen for thyroid cancer, 817 00:46:24,800 --> 00:46:28,640 they found more and more and more and more thyroid cancer. 818 00:46:28,640 --> 00:46:30,400 But what you really need to know is, 819 00:46:30,400 --> 00:46:32,440 does this make a difference to death rates? 820 00:46:32,440 --> 00:46:34,560 Look at the orange line down the bottom, 821 00:46:34,560 --> 00:46:37,200 and you'll see that the mortality is a flatline. 822 00:46:37,200 --> 00:46:39,480 This is a classic graph showing overdiagnosis, 823 00:46:39,480 --> 00:46:42,040 because what you're doing is you're diagnosing more 824 00:46:42,040 --> 00:46:43,960 and more and more thyroid cancer, 825 00:46:43,960 --> 00:46:46,280 but you're not making any difference to death rates. 826 00:46:46,280 --> 00:46:48,680 If you get diagnosed with thyroid cancer, what happens? 827 00:46:48,680 --> 00:46:51,040 What is the treatment for it? It's all in the neck, isn't it? 828 00:46:51,040 --> 00:46:53,440 Yeah, that's right. It's your thyroid gland around here. 829 00:46:53,440 --> 00:46:56,520 You're going to be offered surgery, you might be offered radiotherapy, 830 00:46:56,520 --> 00:46:58,720 you might have to go into long-term treatment after that, 831 00:46:58,720 --> 00:46:59,960 so lots of interventions. 832 00:46:59,960 --> 00:47:03,000 So, there will be some people who've had surgery on their necks 833 00:47:03,000 --> 00:47:05,160 that they didn't need? Totally, absolutely. 834 00:47:05,160 --> 00:47:07,480 If you're not going to benefit from a treatment, 835 00:47:07,480 --> 00:47:09,600 all it can possibly do is give you side-effects. 836 00:47:09,600 --> 00:47:13,120 I guess, in the UK, for something like thyroid cancer, 837 00:47:13,120 --> 00:47:14,480 we don't screen... Yeah. 838 00:47:14,480 --> 00:47:17,440 ..but then there are other types of cancer where we do. 839 00:47:17,440 --> 00:47:19,640 Like breast cancer, for example. 840 00:47:19,640 --> 00:47:22,320 So, in that case, then, is the equation flipped? 841 00:47:22,320 --> 00:47:25,560 Is it very obvious that there's a benefit to do it? 842 00:47:25,560 --> 00:47:28,600 Well, I'd love to say that there was, but it is more complex. 843 00:47:28,600 --> 00:47:31,240 So the government have made a decision that it's cost-effective 844 00:47:31,240 --> 00:47:33,080 to offer it to women. So, the Marmot Review 845 00:47:33,080 --> 00:47:35,280 looked at the evidence around this a few years ago 846 00:47:35,280 --> 00:47:36,520 and they concluded that, 847 00:47:36,520 --> 00:47:39,360 for every 200 women that had breast cancer screening, 848 00:47:39,360 --> 00:47:41,400 you would delay the death of one woman, 849 00:47:41,400 --> 00:47:44,560 but at the cost of three women being over-treated 850 00:47:44,560 --> 00:47:48,320 for breast cancer. And when you say overtreated, 851 00:47:48,320 --> 00:47:52,520 are those the type of women who have cancer, 852 00:47:52,520 --> 00:47:54,000 but don't know about it, 853 00:47:54,000 --> 00:47:57,120 and it's not really going to go on to cause a problem, 854 00:47:57,120 --> 00:47:59,880 and yet they're having things like mastectomies 855 00:47:59,880 --> 00:48:02,400 and biopsies, and all of the concerns around those? 856 00:48:02,400 --> 00:48:04,520 Yeah, that's exactly right. So, these are people 857 00:48:04,520 --> 00:48:07,160 that would never have come to the attention of a doctor 858 00:48:07,160 --> 00:48:09,840 had they not had the tests done. So, what you're saying, 859 00:48:09,840 --> 00:48:12,040 it's good for this group of women overall, 860 00:48:12,040 --> 00:48:13,680 but, sorry, you're the unlucky one, 861 00:48:13,680 --> 00:48:15,680 and you're the unlucky one, and so are you. 862 00:48:15,680 --> 00:48:17,840 But the problem is that those women will never know 863 00:48:17,840 --> 00:48:19,080 that they've been unlucky. 864 00:48:19,080 --> 00:48:21,600 And this is the really big problem because the temptation is, 865 00:48:21,600 --> 00:48:24,240 for every single woman who's been detected as having a problem, 866 00:48:24,240 --> 00:48:26,280 to think that she has been diagnosed early 867 00:48:26,280 --> 00:48:28,800 and that her life has been made better because of that. 868 00:48:28,800 --> 00:48:30,920 But you just don't know that - you don't know which 869 00:48:30,920 --> 00:48:32,240 of those women that you are. 870 00:48:32,240 --> 00:48:34,920 Whether you're the woman that actually did get a benefit, 871 00:48:34,920 --> 00:48:37,040 or whether you're the majority of women that actually 872 00:48:37,040 --> 00:48:38,880 didn't get benefit from treatment. 873 00:48:38,880 --> 00:48:41,960 Do you think it is a big problem that you have 874 00:48:41,960 --> 00:48:45,200 those three women in 200 being overtreated? 875 00:48:45,200 --> 00:48:48,640 Well, I suppose I wouldn't be the person to judge that. 876 00:48:48,640 --> 00:48:50,640 It would be those individual women to judge that. 877 00:48:50,640 --> 00:48:52,360 So, if you have breast cancer screening, 878 00:48:52,360 --> 00:48:54,880 I think you should decide for yourself whether you think 879 00:48:54,880 --> 00:48:56,760 that that risk is worth it or not worth it. 880 00:48:56,760 --> 00:48:58,960 You know, are you happy with that risk yourself? 881 00:49:02,240 --> 00:49:06,240 Cancer screening saves thousands of lives every year, 882 00:49:06,240 --> 00:49:09,640 but it's important to acknowledge that this is not without cost. 883 00:49:11,160 --> 00:49:15,760 There's like this fundamental disconnect, really, 884 00:49:15,760 --> 00:49:17,880 between what the numbers say 885 00:49:17,880 --> 00:49:20,680 and what it actually feels like when you're the number. 886 00:49:22,760 --> 00:49:25,560 Because, of course, you can look at all those statistics and say, 887 00:49:25,560 --> 00:49:27,640 "Oh, that is pretty terrible 888 00:49:27,640 --> 00:49:30,280 "that people are having these life-changing surgeries 889 00:49:30,280 --> 00:49:34,960 "that they don't need, that they never had to go through." 890 00:49:34,960 --> 00:49:38,000 But then, at the same time, 891 00:49:38,000 --> 00:49:40,000 having been diagnosed with cancer, 892 00:49:40,000 --> 00:49:41,720 I know in that moment... 893 00:49:45,080 --> 00:49:48,120 ..I just wanted to get rid of it. 894 00:49:48,120 --> 00:49:50,200 I just wanted to get rid of it. 895 00:49:50,200 --> 00:49:52,800 It wouldn't really have mattered what the numbers said. 896 00:50:01,520 --> 00:50:05,640 There are no easy choices in any of this. 897 00:50:05,640 --> 00:50:09,080 Turning down treatment wasn't right for me, 898 00:50:09,080 --> 00:50:11,680 but that's not the case for everyone. 899 00:50:13,080 --> 00:50:14,120 I'm leaving... 900 00:50:16,240 --> 00:50:18,160 ..St James's. 901 00:50:21,600 --> 00:50:23,800 Three surgeries, 902 00:50:23,800 --> 00:50:26,520 50 sessions of radiotherapy, 903 00:50:26,520 --> 00:50:29,840 six rounds of chemotherapy. 904 00:50:34,840 --> 00:50:36,920 And I've just told them no more treatment. 905 00:50:43,280 --> 00:50:45,240 Rob is a climbing wall inspector 906 00:50:45,240 --> 00:50:47,200 and dad to four-year-old Caleb. 907 00:50:48,360 --> 00:50:52,560 He has a cancer of the soft tissue called synovial sarcoma, 908 00:50:52,560 --> 00:50:54,920 and it's terminal. 909 00:50:54,920 --> 00:50:57,080 I went to Yorkshire to meet him. 910 00:50:58,720 --> 00:51:02,400 If it's OK, I want to take you back to that decision that you made. 911 00:51:02,400 --> 00:51:06,560 Yeah. Tell me a bit about what you were weighing up in your mind at that 912 00:51:06,560 --> 00:51:09,800 point in time. What were the two sides of that argument? 913 00:51:09,800 --> 00:51:13,640 It was quite simply quality or quantity. 914 00:51:13,640 --> 00:51:17,000 I thought, if I had treatment, that I would be spending 915 00:51:17,000 --> 00:51:18,520 a lot of time in hospital, 916 00:51:18,520 --> 00:51:22,400 and I did... That isn't going to be 917 00:51:22,400 --> 00:51:25,440 a very good quality of life. I could have had the treatment, 918 00:51:25,440 --> 00:51:29,240 and it could have, say, given me an extra four or five months. 919 00:51:29,240 --> 00:51:30,920 I could have had the treatment, 920 00:51:30,920 --> 00:51:33,960 and I could have passed away during treatment or just after. 921 00:51:33,960 --> 00:51:36,800 And trying to calculate, work out, 922 00:51:36,800 --> 00:51:41,040 that decision was really, really difficult, to be honest. 923 00:51:41,040 --> 00:51:43,920 But, then, very easy on the flip side of it, 924 00:51:43,920 --> 00:51:48,080 of thinking, "If I want to go to Scotland in my van with Caleb, 925 00:51:48,080 --> 00:51:52,080 "if that's something I want to do before I pass away, 926 00:51:52,080 --> 00:51:54,640 "going through treatment isn't going to get me there." 927 00:51:57,480 --> 00:52:02,200 Well, Caleb, this is Glencoe. 928 00:52:06,600 --> 00:52:07,640 It was only 24 hours, 929 00:52:07,640 --> 00:52:09,080 but I got him to Scotland, 930 00:52:09,080 --> 00:52:10,480 eight hour drive up there, 931 00:52:10,480 --> 00:52:12,520 but we also went to Loch Lomond, 932 00:52:12,520 --> 00:52:15,160 so we had a paddle around Loch Lomond as well. 933 00:52:15,160 --> 00:52:18,600 So, we did lots of things in that 24 hours. 934 00:52:20,400 --> 00:52:22,480 Some people might say 935 00:52:22,480 --> 00:52:25,000 that choosing not to have treatment at 936 00:52:25,000 --> 00:52:27,920 the stage you were at was a bit like giving up. 937 00:52:27,920 --> 00:52:29,920 I don't see it as giving up. 938 00:52:29,920 --> 00:52:35,480 I see it is accepting the inevitable, to be honest. 939 00:52:35,480 --> 00:52:38,440 I know I'm deteriorating, I know things are changing, 940 00:52:38,440 --> 00:52:42,520 but as long as I can come here, ride my bike, I will do. 941 00:52:42,520 --> 00:52:44,960 I've made a lot of memories here, 942 00:52:44,960 --> 00:52:47,800 and that's definitely not what I would have got 943 00:52:47,800 --> 00:52:49,280 had I been in a hospital bed. 944 00:52:58,200 --> 00:53:02,320 So, this, um, is just a memory box for Caleb. 945 00:53:02,320 --> 00:53:05,120 It's got lots of things, all the rocks from different walks 946 00:53:05,120 --> 00:53:07,160 we've been on and painted. Together. 947 00:53:07,160 --> 00:53:10,600 I think that's just so sweet, having stuff like this ready for him. 948 00:53:10,600 --> 00:53:12,320 And then, of course, 949 00:53:12,320 --> 00:53:15,480 letters which... These were written in 2019 when 950 00:53:15,480 --> 00:53:17,320 I was going through treatment. 951 00:53:17,320 --> 00:53:22,000 So, there's, like, one for his 18th birthday and 21st, 952 00:53:22,000 --> 00:53:26,120 wedding day, all these kinds of stuff. Er, first car. 953 00:53:26,120 --> 00:53:28,880 When you realise you're gay, 954 00:53:28,880 --> 00:53:31,520 that's an important one. 955 00:53:31,520 --> 00:53:34,560 You never know! Exactly. 956 00:53:34,560 --> 00:53:36,800 So, first fight with your mum. 957 00:53:36,800 --> 00:53:37,840 SHE LAUGHS 958 00:53:37,840 --> 00:53:39,280 First day at school - 959 00:53:39,280 --> 00:53:42,120 that one can go in the bin, yes! You made it. 960 00:53:42,120 --> 00:53:46,760 I made it, milestone. And how does it feel to have 961 00:53:46,760 --> 00:53:50,240 already, some of them out of date, almost? Well, that's... 962 00:53:50,240 --> 00:53:52,280 Yes, I've surpassed many of the estimations 963 00:53:52,280 --> 00:53:55,040 because that's what it is at the end of the day, isn't it? 964 00:53:55,040 --> 00:53:56,120 They're only estimates. 965 00:53:56,120 --> 00:53:58,080 It takes, I think, quite a lot of strength 966 00:53:58,080 --> 00:54:00,120 to put something like this together. 967 00:54:00,120 --> 00:54:03,440 Yeah. Has it helped you too? Oh, definitely. 968 00:54:03,440 --> 00:54:06,880 I think writing the letters made it feel like I was, 969 00:54:06,880 --> 00:54:10,520 like it was the start of the acceptance, to be honest, 970 00:54:10,520 --> 00:54:12,960 of that this is what's happening. 971 00:54:20,080 --> 00:54:23,720 So, what happens now? Wait, really. 972 00:54:23,720 --> 00:54:25,200 Keep taking my meds, 973 00:54:25,200 --> 00:54:27,560 keep riding my bike. 974 00:54:27,560 --> 00:54:29,840 Go on living, really. 975 00:54:29,840 --> 00:54:32,280 There's nothing else you can do. 976 00:54:37,160 --> 00:54:40,640 There's this incredible amount of strength in what he's doing, 977 00:54:40,640 --> 00:54:46,720 and I think Rob is someone who is just 978 00:54:46,720 --> 00:54:49,520 totally fine with his own mortality. 979 00:54:49,520 --> 00:54:51,400 Like, I know he doesn't want to die, 980 00:54:51,400 --> 00:54:55,040 of course not, but he's... 981 00:54:55,040 --> 00:54:59,800 He's got this calmness of mind. 982 00:54:59,800 --> 00:55:02,560 Like, he's worked out what is important to him, 983 00:55:02,560 --> 00:55:07,000 he knows what his values are, and therefore, 984 00:55:07,000 --> 00:55:09,240 everything else falls into place. 985 00:55:20,240 --> 00:55:22,840 I'll need regular follow-ups for the next five years 986 00:55:22,840 --> 00:55:25,240 to see if the cancer has come back. 987 00:55:28,040 --> 00:55:32,400 Hi, Hannah. Hi, how are you doing? Come through. Thank you. 988 00:55:32,400 --> 00:55:34,720 Come on in, have a seat. Thank you. 989 00:55:34,720 --> 00:55:36,240 How is it otherwise going? 990 00:55:36,240 --> 00:55:40,400 You're fine? Yeah, it's OK, yeah. 991 00:55:40,400 --> 00:55:44,960 I realise now that this is going to be part of my life forever. 992 00:55:48,120 --> 00:55:51,040 It's an anniversary today. 993 00:55:51,040 --> 00:55:54,160 Not the sort of anniversary you traditionally celebrate, 994 00:55:54,160 --> 00:55:56,960 but it was a year ago today that I was in hospital 995 00:55:56,960 --> 00:55:59,000 with my surgery. 996 00:55:59,000 --> 00:56:01,200 I was thinking about it this morning. 997 00:56:01,200 --> 00:56:03,280 It's only until very recently that 998 00:56:03,280 --> 00:56:06,280 I haven't just been completely reeling from it. 999 00:56:06,280 --> 00:56:08,920 I mean, I think it's just impossible to, like, 1000 00:56:08,920 --> 00:56:11,400 get cancer in your mid-thirties 1001 00:56:11,400 --> 00:56:15,480 and not come out of it with 1002 00:56:15,480 --> 00:56:17,640 a really different view of life. Yeah, 1003 00:56:17,640 --> 00:56:19,280 it's left an indelible mark, hasn't it? 1004 00:56:19,280 --> 00:56:21,520 I mean, it's not a simple, you know, 1005 00:56:21,520 --> 00:56:24,000 "Heal, get over it, move on." 1006 00:56:24,000 --> 00:56:26,440 I mean, you do have to move on to a degree, but it's not, 1007 00:56:26,440 --> 00:56:28,120 it's nowhere near that simple. 1008 00:56:30,320 --> 00:56:31,480 I think, for most of us, 1009 00:56:31,480 --> 00:56:33,400 for most of our lives, 1010 00:56:33,400 --> 00:56:37,320 we get to pretend that we are immortal, really. 1011 00:56:37,320 --> 00:56:40,880 We don't have to live with this shadow of death, 1012 00:56:40,880 --> 00:56:42,680 really, hanging over us all the time. 1013 00:56:42,680 --> 00:56:45,000 We have this kind of luxury of that, 1014 00:56:45,000 --> 00:56:49,360 and so I think that whenever you are confronted 1015 00:56:49,360 --> 00:56:51,440 with your own mortality, 1016 00:56:51,440 --> 00:56:54,240 as you are when you receive a cancer diagnosis, 1017 00:56:54,240 --> 00:56:56,480 no matter how serious it is, 1018 00:56:56,480 --> 00:56:59,720 I think that we are so not used to that idea, 1019 00:56:59,720 --> 00:57:02,560 we are so terrified of the idea 1020 00:57:02,560 --> 00:57:06,040 that we are unwilling to tolerate any risk whatsoever. 1021 00:57:08,720 --> 00:57:11,360 I try not to think too hard about the numbers of recurrence, 1022 00:57:11,360 --> 00:57:14,680 because that number of one in ten, 1023 00:57:14,680 --> 00:57:16,800 the chance of recurrence, it is still there, 1024 00:57:16,800 --> 00:57:20,240 and it is still true and it's still a fact. 1025 00:57:22,920 --> 00:57:25,120 I don't know, I just think, over time, 1026 00:57:25,120 --> 00:57:28,680 you have to accept that life comes with risks, and that 1027 00:57:28,680 --> 00:57:32,240 you can't sort of wander around being terrified 1028 00:57:32,240 --> 00:57:34,920 of everything that might happen. Otherwise, 1029 00:57:34,920 --> 00:57:37,840 you're never going to have the chance to properly live it. 1030 00:57:44,280 --> 00:57:47,960 I think that somehow we've decided that the chance of dying 1031 00:57:47,960 --> 00:57:50,560 is the only number that matters, 1032 00:57:50,560 --> 00:57:52,760 and so we've built a one-size-fits-all approach 1033 00:57:52,760 --> 00:57:58,440 to cancer care that takes courage and strength to deviate from. 1034 00:57:58,440 --> 00:58:01,720 Perhaps that's because we're not having honest conversations 1035 00:58:01,720 --> 00:58:05,400 about the true benefits and costs of treatment. 1036 00:58:05,400 --> 00:58:09,440 Only when we do can people work out what they most care about, 1037 00:58:09,440 --> 00:58:11,840 and make the choice that's right for them.