Six weeks of radiotherapy or 30 minutes with the new breast cancer blaster... well, which would YOU choose?

Posted on Feb 02, 2017

A personal article written by Kirsty Lang for the Daily Mail.

I used to think that breast cancer announced its arrival with a lump, a dimple or a rash. But for me, there were no visible signs of anything wrong. So when I got a letter from my local hospital calling me in for a mammogram, just 12 months after my previous breast scan, I almost didn’t go.

The NHS recommends that women over 50 (I’m 54) have a mammogram every three years, so it was probably a clerical error.

What was the point in putting myself through an unnecessary and uncomfortable procedure?

My appointment fell on a hot sunny Tuesday afternoon in April, last year. I wasn’t working and the idea of sitting in the garden with a book was tempting. But then I did the maths.

One in two of us will get cancer at some point in our lives; two of my closest friends had had mastectomies; two other BBC presenters, Sian Williams and Victoria Derbyshire, had recently gone public with their battle against breast cancer. So, I went.

The receptionist in the breast unit looked stressed. ‘Do you want the appointment or not?’ she asked.

There were only two women in front of me, so I decided to stay. Thank God I did.

Just over two weeks later, following another scan, a biopsy and several sleepless nights, I was diagnosed with invasive ductal breast cancer.

The surgeon wanted to operate as soon as possible. The tumour, the size of a one pence piece, was fast growing – a grade three.

‘You mean it’s aggressive?’ I asked.

‘We don’t like to use that term any more,’ he said.

But they had caught it early and I would get to keep my breasts. That was a huge relief, like having a near-miss car accident.

I was to have the standard operation for early stage breast cancer – a lumpectomy.

The surgeon explained how he would cut the tumour out and remove a couple of lymph nodes – glands in the armpit – to make sure it hadn’t spread. Once the wound healed I would have to have six weeks of daily radiotherapy.

As a freelance presenter at the BBC, I don’t get paid if I’m off sick. How was I going to carry on with my job at Radio 4 if I had to go to hospital every day for six weeks?

That night I rang a friend who had had breast cancer five years earlier. ‘I’ve got to have radiotherapy every day for six weeks. Will I be able to work?’

There was a long pause at the other end of the phone. ‘You might. But it won’t be easy.’

I felt my heart sinking. I was frightened. Frightened about dying, and about paying my mortgage.

That’s when she mentioned intraoperative radiotherapy (IORT), a treatment that her mother had been through.

It involves a single 20 to 30 minute dose of radiation administered via a special device while in the operating theatre immediately after the tumour is removed.

In other words, it’s over and done with by the time you come round from your op.

And there are none of the usual unpleasant side effects such as fatigue and sore skin.

All radiotherapy involves using beams of high energy X-rays that destroy hidden cancer cells that may be lurking after surgery. It’s the gold standard treatment for preventing breast cancer recurrence.

But as with so many cancer treatments there is a trade off. The beams also harm healthy tissue.

In a very small number of cases, there can be damage to the heart, and women with left-sided breast cancer, like me, were particularly at risk. Armed with this information I emailed my surgeon. Was I suitable for IORT? The answer was: ‘No.’

My cancer was too fast-growing, my tumour was too large and this was a new treatment, even though the first treatment was done in 1998. The jury is still out, he said, which made it risky.

But 30 years in journalism has taught me not to accept the first answer I get. I decided to seek a second opinion, which all NHS patients are entitled to do.

The medical team who pioneered IORT are based at University College Hospital, London. So I contacted them directly.

A couple of days later I found myself sitting in a consultancy room with two doctors whom I trusted instinctively: Jeffrey Tobias, Professor of Cancer Medicine, and Jayant Vaidya, Professor of Surgery and Oncology at UCL.

Mr Vaidya explained how, working as an oncologist in India and Dundee, he was struck by the long distances many of his patients had to travel every day for their radiotherapy treatment. Some chose a mastectomy instead.

Having reviewed my notes, they said I was eligible. My tumour was small – at an early stage – and oestrogen receptive positive, which means it responds well to hormone medication such as tamoxifen or letrozole, which I was already on.

They were also not convinced my tumour was grade three (tests after it was removed revealed it to be grade two at the time of my operation, which could have been a result of the drug treatment I was put on immediately after diagnosis).

However, I would have to go privately to get IORT as the NHS watchdog, the National Institute for Health and Care Excellence (NICE), has yet to approve IORT due to ‘too much uncertainty in the evidence of its long-term benefit’.

Perhaps this should have put me off. But it didn’t. I like skiing off-piste and I’m a former foreign correspondent. Everything we do in life, and all cancer treatment, involves risk.

Another woman with an identical diagnosis might choose a double mastectomy ‘just to be sure’.

These decisions are down to the individual, having weighed up the evidence.

I went ahead and had the operation on a private ward of an NHS trust.

Luckily I had taken out health insurance years earlier thanks to a BUPA discount scheme for BBC employees. There are six hospitals in the UK equipped with the right machinery, one of them is the Great Western Hospital in Swindon where I went.

My operation went so smoothly that I felt like a bit of a fraud.

I went under the knife at lunchtime and by late afternoon I was told the tumour had been successfully removed and there was no sign of the cancer having spread.

I didn’t even stay overnight and I was back presenting Front Row on Radio 4 six days later.

For the next couple of weeks, I walked around with a spring in my step. And then I went to see my oncologist, Professor Paul Ellis.

I fully expected to be told that I didn’t need any more treatment apart from continuing to take letrozole every day for the next five years. But a minuscule bit of cancer, a micrometastasis, had been found in one of my lymph nodes.

‘There’s a 90 per cent chance your cancer won’t spread elsewhere,’ said Prof Ellis. ‘But if you have chemo that goes up to 95 per cent.’

Again, I was being asked to weigh the risks.

Perhaps it sounds ridiculous, but I really didn’t want to lose my hair. On the other hand five per cent seemed a lot. ‘It’s your decision but, if you were my wife, I’d tell you to have chemo,’ he added.

It was more tolerable than I expected. I had 12 weekly doses and carried on presenting my Radio 4 show until the final two rounds.

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