“I’m a bloke,” Dr Peter Ostler, consultant oncologist, says, using the technical terminology, “so I can’t really say, but in my opinion you’re better off without it.” He’s talking, naturally, about my breast.
Dr Ostler is the youngest of the specialists looking after me. Each chemotherapy treatment he appears, in a flurry of nurses and research assistants, and perches on the bed to answer questions, leaving the small medical fry dotted against the walls, clipboards poised, like captured butterflies. He’s ambitious, I think, so if I tell him I’ve heard about someone who has died of this disease, he says, “Not a patient of mine?” with a kind of possessiveness of good outcomes for his patients.
These 10-minute chats pre-chemotherapy (£830.92 worth of drugs) - bill at £380 a time, which doesn’t reflect their value. A friend whose teenage daughter is hospitalised for months says she is still waiting for just one of her daughter’s doctors to sit on the bed, rather than stand at the end, looking down.
I ask if there’s more breast cancer than there used to be in women my age. “It’s still low,” Dr Ostler says, “about 15 per 100, but it does feel like it’s increasing. Although maybe it just didn’t used to be polite to tell someone they had cancer,” he adds, with a little smile for the bad old days before doctors perched on beds.
He doesn’t have pat answers; he thinks while he speaks. So, he continues, “I have a sense that I’m seeing more women my own age,” he says, “but possibly that’s because the over-70s we see once, the treatment is routine, but someone like you I will see much more, because we are concerned to get the effects of the treatment as right as possible for your stage of life.”
What does he think about giving up dairy products?
“Yes,” he sighs, “my colleagues are always sending me the data. But there’s the loss of calcium, and the dangers of osteoporosis. One of my patients stopped having chemotherapy and lives on carrots - she’s orange now. I wouldn’t like to be orange.”
How about weekly chemotherapy, as practised in the US, as opposed to the fortnightly, or three-weekly cycles on this side of the Atlantic? “Ah,” he says, with a you’ve-been-cruising-the-net-again expression: “It’s true that so far the results look very good, but we know that over the course of a study those results can change. So, over here, we tend to wait.
“Also,” he says, “I suppose we in Europe are somewhat cynical, because these drugs are so very expensive, we think American oncologists are just considering how much money they can make.” Then, a little abashed, “of course you always get that kind of talk.”
And so to mastectomy. Oncologically better, he says. But: “Still, if you tell me you really, really want to keep the breast, then ...” and he tails off.
This, as I believe the correct bloke terminology would have it, is called throwing me a googly. Mr al-Dubaisi has never spoken in any terms other than mastectomy - removing the lump alone has not figured. But now the oncologist is looking at me with compassion, and also an urging, it seems to me, to take control of this process. In my mind I can hear the global breast cancer community cheering. Read the books - from Jane Plant’s Your Life in Your Hands to (my personal favourite) Breast Cancer for Dummies - and surf the sites, and it’s all about information, and involving yourself in your healthcare. The assumption is that this very information-gathering is empowering and therefore - somehow - beneficial to the outcome, to saving your life from cancer.
To many, cancer is a medical condition with deeply psychological undertones. Someone is forever passing on that “being positive is really good”. They tell me my frequent smiling is “excellent”. How, I wonder, can my mood - which depends mainly on what I weigh, actually - affect the deadliness with which my cells are dividing?
And then, from the other side, come the mood-gaugers who apparently are not beneficiaries of my beauteous smiles. A mother from school informs me about “expelling anger”. “Someone like me,” she says, “would never get cancer, because I’m always blabbing, but you, you’re very intellectual, terribly controlled, you must let your feelings out.”
Now, having my third chemotherapy - only one more to go before the planned operation - my oncologist, whose opinions I do value, seems to be agreeing with the books: have some influence over the course of your treatment; what is “oncologically best” may not be the whole picture.
This column appears fortnightly.
