Health: `Yes, I can live with my cancer'

Eight years after getting the all-clear, another lump was discovered on Elisa Segrave's breast. This is it, she decided. Then she thought again... . But then

In 1991, I'd had the works, except a mastectomy. I'd had a lumpectomy, all my lymph glands removed, and, after breast cancer was diagnosed, six weeks of radiotherapy and six months of chemotherapy. I'd had a stiff arm and shoulder - still have - probably because of not doing enough arm exercises as taught by the hospital - and, to cap it all, two months after chemotherapy a horse trod on my foot, making me lame.

Like everyone who's had cancer, I'd always dreaded a recurrence. I imagined it would be like the Bergman film The Seventh Seal, in which Death appears in a hood. That would be it.

Last November, after eight years of being "clear" apart from a scare two years ago, a small lump had been detected by a doctor. I'd had a mammogram, then an ultrasound, then a fine needle aspiration (where a needle is inserted into the lump, to draw out fluid or cells), then a core biopsy. Nothing definitive was shown. All these tests, plus the waiting periods in between each, took five months. Finally, since they still couldn't tell whether I had cancer, I was to have the lump removed. I would then know, after eight years, whether I had cancer again. I would rather not use the word "remission", which implies you're going to fall under the axe eventually.

My friend and neighbour in the flat below had offered to look after my dog and me on the day of my general anaesthetic. Ten minutes before I was due to lose consciousness - I had purposely not eaten or drunk anything since midnight - the surgeon who had done the core biopsy two weeks earlier suddenly told me that I could have just another "local" if I liked. He could erect a small sheet in front of my face so I wouldn't be able to see the surgery taking place. (I wondered if he'd made this special offer because I hadn't flinched during his core biopsy a fortnight earlier, though I had been a bit worried when, before stabbing my anaesthetised breast four or five times, the charming Dr D had nonchalantly asked a nurse to "pass the `fork' please".)

I jumped at this unexpected second "local", as I wanted to go to a party that evening. Sure enough, I was home by lunch time. But my dog was alone and instead of the chicken soup my neighbour had promised there was a note pinned to my door: "Have had to go to Yugoslavia. Sorry. Toby has been walked." Nato had started bombing and my neighbour, a journalist, had been sent at short notice to the Balkans.

Twelve days later, I was back at the hospital with my 17-year-old daughter to hear the results. That morning, we had considered placing a bet on whether or not I had cancer again. She'd pointed out that the odds weren't very good - she estimated them at 50-50.

The wait was even longer than usual, because my hospital notes had been left downstairs. My daughter, supposed to be revising for A-levels, read a magazine; I read a piece in an out-of-date newspaper about a young woman who'd had her breast removed by mistake. She hadn't had cancer after all. "She should be so lucky," I thought brutally.

Finally we were in the doctor's room. He wanted to examine my stitches, but I wanted to know at once. "Well, have I got cancer again? I've waited five months to find out."

The answer was neither yes nor no. I had had cancer, before the lump was removed, but now I didn't. Apart from that small lump, which did show cancer (Grade 1, which means the tumour was under 2cm in diameter, the lymph nodes in the arm were not affected and the cancer had not spread elsewhere in the body), there were no other traces.

He said that I should start taking tamoxifen at once and, for ultimate safety, consider having the right breast removed. But I did not have to decide immediately. He took a lot of trouble explaining various details and options to me.

After I returned home, and during the subsequent months, I have noticed how different my reaction was to when I was first told, in autumn 1991, that I had cancer. Partly because of the radiotherapy and chemotherapy, my whole life at that time had been disrupted. My children had been small and I had just got divorced. My mother had incipient Alzheimer's and had broken a limb for the third time. I had not yet published a book and felt frustrated about that.

Now, everything is different. I find I am impatient when a friend, who helped me so much when I had cancer wants me to read pamphlets about tamoxifen and see an American cancer specialist. After consulting a second breast cancer specialist in London, I decided not to have my breast removed. I take extra vitamins and other supplements, but apart from this I have put the episode behind me. Although I am writing this article about cancer, I am not that interested when friends send me e-mails about cancer cures, or when I read about the latest breast cancer survival statistics.

And my mother, who in the past had caused me so much anxiety, now has advanced Alzheimer's and, luckily for me, is looked after by a carer. Instead of witnessing only my mother's deterioration, I have access to the diaries she wrote when she was an intelligent young woman, working during the war in the WAAF.

I have published two books (one on breast cancer) and several stories and articles. And there's something else. At nearly 50, I no longer feel alone in having bad health. Among my friends, one has pericarditis (an inflammation of the sac around the heart), one has had a stroke followed by pancreatitis, two have had hysterectomies, another had a lump pressing on his lung (successfully operated on, but he nearly died), my cousin's eye haemorrhaged and another friend was stabbed outside her front door last year. She later fell into a neighbour's basement area and was badly bruised. In company like this, the sinister phrase "in remission", which I still hate, makes me feel less isolated. Of course, my cancer could be a hundred times worse.

Maybe I am living in a fool's paradise, but I prefer it. Until I had a recurrence, I'd dreaded it. I am relieved to discover that the word "cancer" no longer has the same terrifying power.

The writer's `The Diary of a Breast' is published by Faber & Faber

BREAST CANCER: THE FACTS

n Breast cancer is the most common cancer for women in the

UK, and the biggest killer. It strikes 33,000 women every year, and claims the lives of 13,500. Also, 200 men are diagnosed with it every year - and 90 die.

n Breast cancer is thought to be due to an unknown combination of genetic, environmental, hormonal and lifestyle factors. This week, the charity Breakthrough Breast Cancer opened a pounds 15m centre entirely devoted to breast cancer research.

n It is known that risk factors for women include having a first child at an advanced age, having no children, inheriting genetic faults, starting menstruation at an early age or having a late menopause.

n Almost 90 per cent of cases occur in women aged 45 and over.

n Key symptoms include: a lump in the breast or armpit; discharge from the nipple; changes to the skin of the breast; inversion of the nipple; eczema or swelling of the skin around the nipple; swelling of the upper arm or armpit; discomfort or pain in the breast.

If you are concerned for yourself or a relative, contact Breast Cancer Care's helpline on 0808 800 6000, Mon-Fri 10am-5pm

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