Taxotere, the £2,000-a-shot chemotherapy cocktail, lowers the chance of breast cancer returning to women whose nodes are affected: by 27.5%, to be precise. This disease is cutting a swath through western women - leaving us single-breasted, no-breasted, falsely-breasted - but increasingly, alive. Now, the doctors are refining their use of Taxotere, which is where TAC (I’ll explain in a minute), the trial I’ve blithely agreed to join, comes in.
It’s cold in one of these blue hospital wraps that gape open at the back, so I’m already shivering before I go in to the tiny day operating room. “I’ll be doing the biopsies under local,” Dr Kaplan, consultant radiologist, says.
“What do you mean, biopsies ?” Too late, I’m sharp. On the ball with the questions.
The TAC regime I’m joining is four rounds of chemotherapy before surgery, and four rounds after. Chemotherapy pre-surgery is an attempt to shrink the tumour - the size of my lump would mean the surgeon having to remove so much skin, he’d need to graft flesh in from another part of my body to close the wound. The TAC trial is trying to discover what works better: AC (Adriamycin and cyclophosphamide) before surgery and T (Taxotere) after, or the other way around.
I know this because when Dr Ostler, the oncologist, asked if I’d join an experiment, I said yes immediately, and then Anthony started asking questions. I heard “trial”, and thought, good, anything that turns this into something more than being ill. Anthony is very anxious - what if the trial compromises my treatment? Unlike NHS patients for whom Taxotere, at £2,000, is not yet approved, (though it’s been passed in the US since 1998), as a private patient my doctors can prescribe chemotherapy gold dust if they choose.
Dr Ostler is keen to recruit me to the trial - in another conversation he says, with some irritation, that all patients should be in trials, so answers would be found faster - but he adds that if, at any stage, the team - Muhamed Al Dubaisi, Peter Ostler, and Glenda Kaplan - decide I need a different kind of treatment, they’ll remove me from the regime. (But Anthony is right: months later, the doctors give me a choice, and the decision I make is partly influenced by not wanting to “spoil” the TAC study.)
Now, 48 hours after meeting Dr Ostler, a day after phoning him to say, “I have thought it over, I’m in”, I am lying rigid because I didn’t think to ask the one question that might have made me think twice. To join the trial, the biopsy I’ve already had is not enough. Trial HQ, over in the States, needs more bits of my tumour. Peter Ostler tells me this, but definitely uses the word “biopsy”, singular.
So here I am, flat on Dr Kaplan’s couch. Softly, she chats away, filling cold silences. And, “I’ll be doing the biopsies under local.”
“How many biopsies?” I’m on my back, in a gown that gapes open, and I’m trying to sound assertive.
“Three,” she says.
Dr Ostler’s research nurse is in the room too. “Do you understand about the trial?” she asks me, in a voice that reaches my now hyper-anxious ears as extraordinarily patronising. “Yes,” I say. “Has it been explained to you?” “Yes.” I’m abrupt, and struggling to sit up. “Sorry, you’re disadvantaged lying there,” she says.
Dr Kaplan takes over, her gentle stream of information more frenetic as she sees the pain on my face. “I can’t put local anaesthetic right into the tumour,” she tells me. “I don’t want to know that, I don’t want to know that,” I say. Under her breath she mutters: “Whyever couldn’t they use the original sample?”
To me, a biopsy is so painful, late-night conversation with friends these days is to ask what kind of person they think it takes to plunge a needle into an unanaesthetised part of a woman’s breast. An emerging school of cancer thought opposes screening programmes because the still relative inefficiency of mammograms means that for every tumour discovered, hundreds of women endure false scares and biopsies. When the three test tubes have been placed in a refrigerated box, I sign the trial papers, have a further mammogram and crumple to the floor. The nurse brings tea, and the information that Dr Kaplan will be along. But I stand up and leave the hospital. It feels like the first bit of control I take over this illness, an iota of defiance against these passages of initiation into the Amazons. I don’t, you see, want to be this brave.
This column appears fortnightly.
