Know your lemons

I am not going to mince my words here. Please read on.

My breast cancer is advanced Stage 3 cancer. It is aggressive in nature. While there is currently no visible spread to other parts of my body, it had spread to numerous lymph nodes increasingly the likelihood of this happening in the future. The risk of recurrence in the coming months and years is significant.

Breast cancer treatment has made huge advances in recent decades and the headline survival rate figures are high. But each person's prognosis will depend on the type of breast cancer they have (breast cancer is not a single disease, but rather a group of different diseases), on a series of individual determining factors and on whether the cancer is detected early.

Two of these factors are clearly outside our control. The other, we can potentially have some bearing on.

We did not catch my cancer early. Had we done so, I would be facing more favourable odds.

I don't write any of this to be sensationalist or to elicit pity. I do not blame myself in any way. I am receiving comprehensive treatment that has been proved to be effective for many women. I have a highly experienced team behind me and am otherwise in good health. I am taking things one step at a time and feel hopeful about my future.

Rather I write this with all of the precious women (and men) in my life front of mind. I write this in the hope that by sharing my experience, I might help prevent even one person ending up in the same situation that I am in.

So many things feel uncertain right now, but these things I do know...

I am 52. I had not yet been invited for routine breast screening or ever had a mammogram before my diagnosis. Routine breast screening on the NHS starts at 50 and should happen every 3 years - ironically I got called for my first routine breast screening the day after my diagnosis, two days before my 52nd birthday.

Covid has massively impacted the breast screening programme, which was entirely suspended during the first lockdown. As a result by September 2020 it was estimated that almost one million women had missed mammograms. Although screening has now restarted, Covid has significantly reduced capacity and there is a backlog to work through. This means that many women are now presenting for screening later, with more advanced cancer and likely poorer outcomes. Self examination is now more important than ever.

For some years I have (fairly) regularly checked my breasts. But my boobs have always been 'lumpy and bumpy' making it hard to know quite what I was looking for or how I would distinguish anything sinister from normal tissue. I am not entirely sure why, but I presumed I was looking for something very specific - a hard, distinct, marble shaped, attached lump in my breast, around 1cm wide.

But this is not necessarily the case, and is perhaps one of the main reasons that I did not catch this cancer earlier.

Looking back, what was perhaps palpable in my breast a little while before diagnosis (but which I didn't really even consciously register as being something to worry about) was something far, far less defined. An area of very subtle tissue change, a few centimetres across, in what I now know is the most common area for tumours, the upper, outer area of the breast. Had I known this I might have paid it more attention.

I perhaps had a vague sense that the tissue felt qualitatively different, somehow 'thicker', but I was not sure it was even something 'new'. As I say, I have naturally lumpy breasts so it did not feel remarkable. It certainly was not what I thought a tumour would feel like. Plus I was perimenopausal - a common feature of which we are always told can be harmless bumps in your breasts.

I eventually discovered a distinct and clear lump in my left armpit just before Christmas. I called my doctor immediately and things moved quickly. Obviously though by this stage the cancer had already spread to my lymph nodes, substantially increasing my risk.

With hindsight (a wonderful thing...), I realise that I had also perhaps been minimising other symptoms for some time that may or may not have been relevant. All indistinct - feeling excessively tired, run down, achey, generally not especially well - and all of which could easily be explained away as a result of the menopause/ having three kids/ a busy job/ the psychological impact of having uprooted and moved our family twice in a year and to a new part of the country/ the toll of lockdown inactivity...the potential reasons that I could offer myself to explain away these symptoms seemed endless.

And so, I want to share some advice. Some things I wish that I had known or done, in the hope it might help just one person take early action...

Almost half of the women in this country do not regularly check their breasts. One in ten never check them. And yet women noticing changes in their breasts is often the first step of diagnosis. Check your boobs often and throughly - at least once a month. If they are naturally bumpy, don't think you won't be able to notice changes. It can take a bit more attention and effort, but the trick is to get familiar with what is normal for you and look for any changes. Check out https://coppafeel.org/your-boobs/boob-check-101/ for a handy video on how to do this and don't forget to check your armpits and the tissue all the way up to your collarbones.

If, like me, you have a notion that you are necessarily looking for a clear 'lump' - then please drop it. Check too for any qualitative changes to the tissue - however indistinct, and get to know the other important signs of breast cancer. As well as checking the feel of your boobs, look for any changes in the way they look - new differences in symmetry, puckering, changes to the nipple, skin rashes. The image at the bottom shows 12 possible signs or for more information check out https://breastcancernow.org/information-support/have-i-got-breast-cancer/signs-symptoms-breast-cancer

Ignore the voice in your head that tells you 'it is probably nothing', that you will be 'wasting your GP's time' or that you will seem like the 'worried well'. Quite frankly, these are a nonsense. Of course, many lumps do turn out to be nothing to worry about - but please let the professionals make this call for you, rather than trying to make it yourself.

Ignore too the voice that tells you that you will see how it progresses over time, and will call the doctor in a month or two if it is still there. We can't be certain how long my cancer has been there, but my oncologist's best guess is months, almost certainly less than a year. Some cancers move fast. Please don't wait.

Around a third of breast cancers in the UK are picked up through the screening programme. If you have not received a routine screening appointment and are due one - please push. Many breast cancers do not present with a lump at all. Others will not be palpable in the early stages and can only be picked up through screening. Early detection means less chance of a mastectomy and chemotherapy and better survival rates.

Err on the side of caution. If you have any concerns at all - however small - please talk to your GP. One friend of mine went to her doctor before being able to feel a lump, because things just 'did not feel right'. She was diagnosed with breast cancer soon after.

Breast cancer does not just happen to middle aged and older women. It also happens to young women and to men. I am encouraged that my 14 year old daughter has been taught the importance of breast examination at school. Please talk to your daughters (and sons) and make them aware of the importance of regular self examination as they get older.

One in seven women in the UK will be diagnosed with breast cancer. Early detection massively increases survival rates. Following the advice above could, quite simply, save your life. Please don't put it off.