22 OCTOBER 2007
CANCER? WHY HAS MY BODY LET ME DOWN? PART 1
In the first of a two-part series, water-drinking yoga fanatic Christa D'Souza describes the shock of an unexpected diagnosis
Nobody ever thinks it is going to happen to them - least of all me. So when I felt a teeny, tiny lump the size of a large grape seed in the side of my right breast while in the shower back in July, it didn't send me running to the doctor.
Which is not to say I'm not anxious about my health, because I am. But like many a mild hypochondriac, deep down I know that I'm as strong as an ox, and superstitiously believe that as long as I maintain a certain level of worry, I'll stay that way.
Maybe on my next visit to the GP I'll have it checked it out, I thought.
Then again, maybe I won't. This sounds ridiculous when one has gone through the indignity of childbirth - not to mention the palava of having breast implants (more of which later) - but I hate going to doctors and will do almost anything to avoid having to get undressed in front of them.
Who knows, I thought, it might disappear in the next couple of weeks - and besides, there were far more important things to worry about. Such as the enormous amount of writing I had just taken on in order to take three weeks off for our annual summer holiday in Greece.
So off to Mykonos we went, and back we came; the teeny, tiny grape seed still there. The Saturday night we got back, I went to an all-girls' pyjama party and bumped into a friend, Caroline, who was diagnosed with grade III (the most severe form, on a scale of I to III) breast cancer six years ago.
While we sat eating curry in front of The X factor, I found myself telling her about my little grape seed and then discreetly inviting her to the loo, so she could feel it.
Hmm, she said. Not like her lump at all. Meaning what? How did hers feel? More like a wooden shard, she said, but still, I ought to go and get it checked out. Just to give me peace of mind.
Here I am, then, X weeks later in the The London Breast Clinic on Harley Street waiting to see Miss Tena Walters, a consultant surgeon.
I haven't been referred by my GP (I tried to book an appointment, but gave up after getting the busy signal one too many times), but by a private doctor, who also happens to be a friend and who saw me the same morning I called.
As I flick through old copies of Hello!, I recall how tired I'd been the month I'd discovered "it", and I can't help noticing how loose my jeans are. Why have I lost weight when I haven't even been trying, I wonder.
Miss Walters, thank goodness, has the same gut instinct as my private doctor friend: that it is probably something called a fibroid adenoma - a benign cyst that won't develop into anything if it is not removed - but sends me downstairs for a mammogram and an ultrasound.
The man who does my ultrasound seems similarly unbothered. That said, Miss Walters can't just leave it at that; she has to be 100 per cent certain. She is loathe to do a needle biopsy for fear of rupturing one of the implants I had three years ago and wonders if I can come in again for a simple lumpectomy later on that week.
But I'm impatient and I'm curious, and I want to get rid of it right there and then. Would she, could she, so we can have done with it once and for all?
So back down we go to the basement and out it comes - Miss Walters triumphantly holding up a tiny pearl-shaped piece of gristle SHE HAS PULLED OUT OF MY LEFT BREAST WITH a pair of tweezers for me to see before it is popped in a little plastic canister to be biopsied.
Hurrah! Damned Spot is out! I'm clean! So why do I feel a tiny bit deflated when I walk back down Harley Street towards the Tube? Ah, I know.
My boyfriend, the father of my two young children, Nick, had got irritated with me one evening in Mykonos for going on about it (Of course it wasn't anything! Why did I have to be so gloom and doom when we were having such a nice time?) - and here he was being proved right, yet again.
So for the next week, I forget all about it. Miss Walters had told me to make an appointment to see her the following Tuesday, but I don't, believing that if there was something wrong, they will call me.
But, when the Tuesday arrives, for want of something better to do while making my lunch, I call the clinic and ask if the results have come through yet. No, not yet, says the reassuringly distracted voice at the other end; give it an hour. Again, I forget about it.
But then, just as I'm clearing away my lunch, I get a call on my mobile. Could I come in? Miss Walters would like to discuss my results with me in person. Why, I ask? Does that mean bad news? No, says the now not-at-all-distracted voice at the other end, not necessarily, but I need to come in. Today.
I call Caroline and ask her what she thinks of that. She hesitates. Well, she says, maybe it's just protocol, and nurses aren't allowed to give out that sort of information.
I can tell immediately by the angle of Miss Walter's eyebrows, by the tilt of her head, that it's not going to be good news. And I'm right. That tiny little grape seed thingie is not a benign cyst but a malignant tumour. She is awfully sorry to have to tell me this, but yes, it is cancer.
Cancer. It takes a couple of seconds to absorb. Me? Cancer? How could my XX-year-old body have let me down like this? Are they sure the lab hasn't made a mistake? Am I in fact dreaming this? One thing I have no inclination to do, weirdly, is to cry.
I figure if I can keep myself together on the outside, not give too much vent to the fear, panic, worry and disbelief that is roiling inside, I'll be all right. Thank goodness this is happening to me and not one of the kids - now that I couldn't take.
When the fear, worry, panic and disbelief subside a little, the resentment and backtracking kick in. Why me when I'm such a dedicated yoga goer and water drinker? Why me, when a transfat hasn't touched my lips since last Christmas and I don't smoke?
What about all those fag-ash-lil friends of mine who've been taking the Pill for 20 years or more in stark contrast to me, Miss Princess and The Pea, who took the mini-Pill for a total of four days at the age of 20 and felt so strange she's never dared take it since? Or the women I know who are on HRT?
If I've got it, in other words, how come everyone else hasn't? It just doesn't seem fair.
But on the other hand, what about all the rosé I drank in Greece, and all the alcohol I drink generally (two small glasses of wine a day increases your risk of developing breast cancer by 12 per cent).
What about the fact that I had my first child at 37 and my second at 42 (each year one delays having one's first child increases the risk by three per cent)? Oh my goodness, and what about my wretched breast implants?
Could they have anything to do with it? Could this in some way be a message from up above that in the end, vanity always gets punished? If only, as my five-year-old once sobbed after treading on an ant, I could turn back the clock.
Miss Walters smiles sympathetically and tells me I'll drive myself mad if I go down this route; if I start trying to tot up all the alcohol I have drunk, the passive smoke I have inhaled, the dairy and overdone meat I've consumed.
And the implant? It had absolutely nothing to do with it at all, she tells me. In fact, it might even have helped the tumour's early detection because it pushed out the breast tissue.
Here are the facts. One in nine women will get breast cancer in their lifetime and 44,00 people in the UK are diagnosed with it each year.
According to Cancer Research UK, it is now the most common cancer in this country and the rates have increased by more than 50 per cent in the last two decades. Each year more than 12,000 women and around 100 men die from it - 1,400 of whom will be under 50.
Eight of nine breast cancers, meanwhile, occur in women with no history of the disease in the family. Meaning if you think you can only get it if you've had it in the family, forget it.
The point is that, theoretically, you can smoke three packs of cigarettes a day, live on McDonald's, never go to the gym and not get cancer. Similarly, you can be in your twenties, be a tri-athlete and be riddled with it.
The important thing now is not to think about the past, says Miss Walters. It is the present and the future that count. And the future, she says brightly, looks very good for someone who happens to have just been diagnosed with breast cancer.
For a start, we caught it unusually early and the tumour is tiny (0.5mm), so classified as grade I. Furthermore, it is oestrogen positive, and the five-year survival rate for women who get this type of cancer is a very encouraging 90 per cent with the right treatment. As far as cancer goes, in other words, it's "the best, best kind".
But it is still cancer. And there is still a chance it could have spread. The next step, therefore, is to get me into hospital as soon as possible - like tomorrow morning - to perform a sentinel lymph node biopsy, in which a blue dye is injected into the breast to highlight those nodes that are closest to the tumour, and, therefore, most likely to be cancerous.
These dyed lymph nodes are then removed and tested to see if the cancer has spread.
Miss Walters doesn't know how many she will have to take out (we have about 20 under each armpit), but says I'll definitely need a general anaesthetic and, because I'll be sore, I'll need to stay in for the night.
I explain all of this to Nick on the way home. So far, only he, the kids' nanny, my sister Heloise and Caroline know.
Gently he asks me whether I ought to start telling other people. Like my mother. Like his mother. Like our other non-cancer-survivor friends.
I feel myself bristling the way one does when drawing up wedding or christening invitations. It's my cancer, and I'll tell who I want. It's the first "row" we've had in ages.
But he is right and the thought of all the people I am eventually going to have to call, the arrangements I've got to make, the conflicting advice to which I'm going to have to listen (just like when I was pregnant) exhausts me. All I really want to do is crawl into bed with my children and never get out.
I go upstairs to the playroom as if nothing has happened and tell them I've got to go on a very boring work assignment the following day, which means I may be away for the night. I then call my friend Anya, who tells me exactly what I need to hear: that I should think of it as a nasty verruca.
She makes me promise not to google the word "cancer". But I can't stop myself. I have always skipped the cancer stories in the newspaper, but now I can't get enough of them and I go to bed at about two with my head reeling.
The next day, the children's nanny takes me to the hospital after she's done the school run.
She sets exactly the right tone, chatting about the Waitrose shop she's going to do while I'm under, how the children want to know if I'm going away long enough for them to deserve a present, and so forth. We joke about the hospital menu and tell the nurse looking after me why I'm in.
"Ooh," she winces sympathetically, "It was a nasty, was it?"
"Yes but only the size of a grape seed," I say, for my benefit rather than hers.
"Ah well, then, it was just a baby, wasn't it, you'll be fine."