Me and my breasts

Absent friends until puberty, breasts thereafter are a source of delight, embarrassment or fear for the rest of a woman's life. The fear is certainly real. One in 12 women in Britain will develop breast cancer, and the probability of death is high. Five years ago, the author Elisa Segrave became one such statistic, only to recover and write a diary of her experiences which somehow found comedy in her plight. In this spirit, she recently returned to the hospital which gave her back her life. Here is he...
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When I enter Charing Cross Hospital, I find that my legs are trembling. I don't want to go to Oncology after all. I have re-visited this hospital many times since I first came in September 1991 with a lump in my breast. I then had two operations - a lumpectomy, then removal of the lymph glands, then six weeks of radiotherapy and six months of chemotherapy, ending in May 1992.

Ever since, I have come here regularly for check-ups and mammograms. My five-year "clear" period - you are supposed to have a better chance if you have survived for five years without a recurrence - is almost up. But despite all my comings and goings, I have never yet returned to the room where I had chemotherapy. I once got as far as the Oncology waiting-room before I turned and ran.

Oddly, I like the hospital. I like the cheerful lobby, which reminds me of a big American hotel, with its flower shop smelling of freesias, its tank of dark orange goldfish, its Lloyds bank, its red post-box, the women in saris, taxis and mini-cabs waiting outside, and its shop selling biscuits, newspapers, soap and sweets. As a writer, I admit that I also like the potential for drama that a hospital provides, the quick, voyeuristic glimpses one has into other peoples' lives. I watch Casualty every Saturday with my daughter, now 15. She was 10 when I got breast cancer.

I am no longer so nervous now when I have my check-ups. Sometimes, I am almost blase. Is this tempting fate? Will I ever experience the same intense terror which I felt when I was first told, here in this hospital, soon after my son's eighth birthday, that I had the illness? Will I feel a similar fear if I get a recurrence?

Today, I have asked my friend Emily, who often accompanied me to the hospital during my treatments, to come with me to the Oncology ward. It's time I went back there. I must face it. Emily was with me when I had my first chemotherapy injection, in November 1991. Her mother Joan had been admitted unexpectedly to the hospital the night before. Joan had collapsed in shock on hearing of Robert Maxwell's death and her pacemaker had gone wrong. In the hospital, in the same wing where I had been after my operations, she had got drunk and cut herself on a broken bottle. She was eventually asked to leave by the nurses.

Emily and I meet in a pizza house for a quick lunch. She arrives looking desperate, a mobile phone clamped to her ear. She has just heard that her mother Joan is now threatening to kill herself. The doctor says that Joan is "parasuicidal", meaning that she won't really do it. But, understandably, Emily is very worried.

Thus, in the hour of my dramatic return to the Oncology ward, I have once again been upstaged by A Mother - this time someone else's. My own mother, who drunkenly fell and broke her hip for the second time, just before I got breast cancer, now has advanced Alzheimer's. The same month, her outsize Basset bit a man so badly that he had to have 40 stitches and the dog was put down. My mother, and Emily's mother, cannot be disposed of so easily.

Emily has finally got through on the mobile. Her mother is weeping in a restaurant in another part of London, escorted by a distant cousin who himself is very unstable. Emily has promised to take over from him at five.

We drive to the hospital.

My first surprise on entering the lobby is that I do not remember where Oncology is. I charge off behind the lifts on the ground floor, but Emily reminds me that it is actually on the first floor, hidden down a passage. Oncology is not indicated on the board with the other departments. It is almost impossible to find on one's first visit. The reason for this reticence, we decide, must be that cancer, and the words associated with it, remind people of death. The word "oncology" is considered almost indecent.

In the Oncology waiting-room, an elegant young black receptionist greets us. I explain that I was here as a patient five years ago and that I would like to see the ward - and the nurses - again. Is Tina still here? The receptionist says certainly she is and, of course, I can go in. As I leave the waiting-room, I glance at an unnaturally thin old lady in a red dressing- gown, escorted by her husband. I feel ashamed of being like a voyeur, of looking at a person who may be dying when I am well.

The ward where they administer the chemotherapy, through injections, drips and tablets, has changed since I was here five years ago. It's much lighter. Instead of six grim, grey beds in a row, there are now only two, near the window, and several low-slung hospital armchairs, which look very comfortable. Patients can now receive their treatment in these chairs. This difference, to me, is subtle but important. If you receive chemotherapy in bed, you feel passive, like an invalid. If you receive it from a chair, you are still part of the outside world, on your way to getting well.

There are also two bright paintings on the wall and two poems, by patients. Everything looks far more cheerful and relaxed.

In the side-room, where the drugs are prepared are the two nurses who treated me five years ago - Tina and Nurse G. Tina, particularly, looks very pleased to see me. I hand over the biscuits I've bought for the patients. I had remembered, just in time, how we were always offered biscuits.

Tina encourages me to go into the ward. I say how much it's improved, and she explains that they were finally able to get some funding. Now there is also a small recovery room where patients can have aromatherapy, something which was very popular but only available once a week in limited hours when I was there.

In the bed nearest the wall is a woman with curly hair. After talking to me for several minutes, she tells me it is a wig. She is completely bald and has lung cancer. She regrets not being able to sing any more. She loved singing, but now she has only one lung. Today, she has to have radiotherapy to her head, in case the cancer has also spread there. We are both amazed to think of this as a possibility. She says calmly that her cancer is incurable. Her doctor said he definitely thought cancer could be induced by stress, and she has undergone a great deal of stress recently. Again, I feel indecently well. Her apparent composure breaks my heart. I can't bear to speak to any more patients and, saying goodbye to Tina who is administering an injection, I signal to Emily to leave.

We take the lift and try to find the ward I was in after my second operation, where I spent 10 days with four extremely pleasant women. Jenny, the one my age, is the only one with whom I have kept in touch. She had a similar treatment to mine (CMF), except for one different drug, and she is now involved in a trial in which she is given small doses of HRT.

Emily and I find ourselves on the wrong floor in an orthopaedic wing. After another trip up a floor and a vain search for the room where a patient changed sex - he went in as a man and came out as a woman - and the one- bedded room where Emily's mother caused a disturbance for over 24 hours, shouting and phoning a tabloid newspaper to complain about its treatment of Maxwell, we go down in the lift and find ourselves outside the ward I was in for one night after I had my first chemotherapy treatment. I do not want to go in here.

I remember my desolation that night and, most of all, my feeling of powerlessness, thinking that if I got worse my children would be left without a mother. It all seems so long ago.

My life has changed enormously since October 1991, when I was told I had cancer. As a result of this, part of my diary, which I had been writing since I was a teenager, was published as a book. I am now what I always wanted to be, a writer, and I have made several new friends as a result, some of whom wrote me fan letters. One young woman, who had also had breast cancer, described how her own mother, on the day of her daughter's operation, had a three-year-old Pekinese put down for no apparent reason, and then, when her daughter was halfway through chemotherapy, went on hunger strike.

In 1995, a surgeon wrote to me. I was very proud to receive this letter. He said that he had bought my book at Heathrow Airport and that it had changed the way he saw his patients; he would show it to the nurses and other doctors in his hospital to make them more aware of what cancer patients go through.

Other readers were surprised that a book which was about cancer made them laugh, and I was also surprised at some of the things they found funny.

My experience has also influenced the way I see other people. Perhaps I have more sympathy than I otherwise would have done. I have just spent two weeks in America. On my last day in New York, I met a French girl, still in her twenties, who had had a recurrence of ovarian cancer. She normally lives on a boat with her fiance, at Long Beach, California, and wants a career photographing children. When I first saw her that afternoon, I had a momentary revulsion because her bald head reminded me of my own chemotherapy. She told me she had deliberately chosen not to buy a wig but to remain bald - in fashion at the moment for her age-group - or to wear a scarf. Her face lit up when she realised I had also had cancer and written about it. She told me she had joined a self-help group in California, for cancer sufferers. Before that, she had felt isolated.

The group-members give each other exercises. "You take a quality for a day," she explained, "such as Courage. I am a photographer, so on that day I go round photographing examples of courage."

If I had not had breast cancer myself, I would probably not have recognised that, without her knowing, she herself was a perfect example.

Most of us have experienced the casualties and sadnesses of cancer. But there are also signs of hope, particularly in the field of research.

Breakthrough, the charity launched in 1991 by Bill Freedman, a businessman whose wife, actress Toby Robins, died of breast cancer, has raised pounds 10 million in five years. The charity was also helped enormously by Lesley Elliott, the young farmer's wife from Somerset with three children, who died in 1994.

In the last few months of her life, Lesley did a tremendous amount to help publicise Breakthrough. No one who saw her on television will forget her as she told, matter-of-factly, how she had prepared three separate books, personal to each of them, to keep after she died.

Last week, I spoke to Professor Gusterson of Cancer Research, who is also director designate of Breakthrough's new research centre. He said that "things had changed" in the last five to 10 years. Because of advances in modern technology, by the year 2003, every gene in the human body will be known and, subsequently, it will be possible to work out how these genes can cause different diseases. The particular diseases will be targeted, and scientists should be able to design drugs specifically to combat each one.

I hope I will be around to see this. I certainly mean to be.

Elisa Segrave's `The Diary of a Breast' (pounds 5.99) is published in paperback by Faber and Faber on 21 April, as is her new novel, `Ten Men' (pounds 10.99)

Fiona Pitt-Kethley, poet When I was about 10, I wanted huge ones. We all did. but once I got into my thirties I realised it was good to have ones that didn't bounce too hard.

At the moment, because I'm breast-feeding, I'm a 40C. I used to be 36B, but they've inflated. I quite enjoy breast-feeding; it makes them feel useful. I envisaged my breasts drooping more, but they're actually sort of silicone-looking, when they fill up with milk. Quite curvy. They kind of go up and down when I feed the baby. I shall probably miss it when I stop.

One interesting thing is now, I'm looking at all the pictures of Madonnas and babies very differently from how I was before. I'm looking at the babies thinking, "Oh, he's just had a bit", or "He's screaming for it". You can tell whether that baby's had his milk or not.

I've got a very good recipe for soreness, a herbal thing. Particularly in the beginning, I used yarrow tea on the nipples, and that makes any soreness OK immediately.

I'm fairly relaxed about my body. I've gone naked. I prefer naked to topless. I did The Naked Chat Show for television. And once, when I interviewed some nudists for radio, I stripped off because I thought they'd feel more relaxed, and it was a better interview because of that.

Sophie Dahl, model I'm 19, and size 12 to 14, one of the biggest girls Storm, my agency, have on their books. My bosoms are size 36DD. Quite serious bosoms.

When I was six, I wanted to be a Page Three girl, I thought that was the most glamorous occupation in the world, the ultimate in beauty and sexiness. I wanted to be like Samantha Fox, and my best friend Emily wanted to be a Buddhist or a taxi driver. You can imagine we came from highly functional families!

I think men's perceptions, especially, are blighted by boobs. For a man, it must be very hard to take someone seriously when he's got these enormous bosoms in his face. But at times you want to have a serious conversation, and you see their eyes slide down. That's completely annoying.

I long to be a mother - I don't mean right away. I think there's nothing more beautiful than the pregnant body. There are some incredible nude pictures of my mother, taken by our nanny in the garden each time she was pregnant. She used to have the same size bosoms as mine. When she was a teenager, they were enormous, but hers got tiny. Boobs can be a pain, they can get in the way, but they are a part of you, and it must be very odd going from having huge bosoms to having nothing.

The first photo shoot I did, about two months ago, was with Nick Knight, and I was completely nude, with bosoms pointing to the sky. It was all very businesslike, not "Come on, get your tits out". I thought that the pictures were only going to be used in New York, and I didn't think any of my friends would see it. Then I learned that the pictures were going to be in ID, which a lot of my friends buy, and which would be seen by people on the train, and walking down the street, so I'd be public property. It was a very odd feeling.

I love my body. I've reached that stage, in the past year, when I've become very accepting of it.

Vanessa Feltz, broadcaster

I started developing breasts at the age of eight, actually only on one side at first. My mother was terrified, she thought I had some ghastly growth. She took me to a paediatrician and he said: "Mrs Feltz, she's developing."

I was thrilled to pieces. It was the most exciting thing that had happened to me in my life. I thought, "Now you're on the road, girl!"

My grandma bought me my first bra, from Pullen's in Temple Fortune. It was called "Littlest Darling" by Berlei. It was just a bit of stretch lace with a pink bow at the front. My friends were envious as hell, and they've remained so ever since.

My father was in the underwear business, so my entire life was influenced by the impact of lingerie on the world. My father's father had actually invented a bra called the "Laura Bra" in the Fifties, which was one of the best-selling British bras of all time. My father was constantly coming back with knickers and girdles and roll-ons, so lingeray, as we called it, was really my heritage.

Then came the anxious wait of how will this bust develop? Will it develop into something worth having, that I can be really proud of? Or will it be two tiny buds that won't be very exciting? But quickly it developed into something of an edifice. By the age of 13, I had a really decent cleavage. I noticed friends of mine walking with drooping shoulders in an attempt to hide their frontage, but I immediately sussed that mine would be a huge asset, socially, sexually and in every other way.

I was never a fat child. I was a perky, wiggly, Lolita-type figure with really big knockers, which was tremendously good fun. I remember once going down the road, and a whole lot of builders shouting: "They're tasty, tasty, very, very tasty." I thought, "Oh, fab!" I never found it too hot to handle.

Then, when I was at Cambridge, I filled up on chocolates, and my breasts grew, which was all to the good. I got married, and got pregnant very quickly, on purpose, and they immediately expanded to double the size of my head. Oh, huge! My bust seemed to fill the entire space from my chin to my stomach. My breasts began to let me down at that point, escalating out of control. It served me right for saying "I must, I must, I must improve my bust".

The next thing that happened, of course, was having the baby and attempting to breast-feed. If your boob is twice the size of the baby's head, it's a very difficult manoeuvre. The fallacy is, the bigger the breast, the better the breastfeeder: that's utterly untrue because you practically suffocate the baby. You need one hand to keep the breast away from its airways, otherwise it can't breathe, and one hand to scrunch your nipple up into a sucking shape. So I had to keep approaching strangers and say, "Could you hold my breast for a moment while I latch my baby on?"

It took me about two weeks to get the hang of it, but I enjoyed it enormously. It was a fantastically dramatic thing. There are these incredible moments when you start to wind down your feeding bra and a huge fountain of milk spurts out and hits the mirror on the other side of the room, or hits your partner in the eye, and life becomes a mountain of sodden breast pads.

Now I'm a 40E. I think I'm OK once I'm cantilevered, but I'm not very good unleashed. As far as the pencil test is concerned, you know, I would fail a suitcase test, which is a bit of a shame.

Every time I allude to my breasts, making jocund quips about them, talking about them, being aware of them and, I suppose, to some extent revelling in them, I have this awful feeling about, God, what if I get cancer in one of them and it has to be chopped off or something? I inspect them for lumps regularly, so does my husband, and once a year I have them checked out. My mother died of endometrium cancer last year, aged 57. It brings home in a particularly terrifying way your own mortality. I almost want, as a kind of superstitious thing, whenever I mention my breasts, to add a kind of codicil: "Yes, I know I'm really lucky to have them, I really appreciate them, I'm grateful. Don't think that I think I'm just going to have them there and undiseased for ever. I don't want to be flippant about them. I'm very pleased to have them, and I don't want anything to go wrong with them." Jenny Eclair, comedian I haven't got any breasts. I've always said it's a good job, because if I had a cleavage it would be full of fag ash in no time. I thought I could think myself into a training bra at one point, and when I was 14 I did buy one of those nylon training bra things from Chelsea Girl. Mine had a picture of a train on it, but it looked like it had been derailed because it was completely crumpled. it was more nipple than breast, really.

I was always jealous of those girls who could customise their blouses, knotting them under their busts. If I knotted mine under my breasts, it would end up under my larynx. On the beach, I wouldn't know whether to lie face down to hide the fact I had no tits, or on my back, to cover up the fact that I had a fat arse, so I'd end up thrashing around.

In later years, their size hasn't bothered me, because they're still quite pert. I wouldn't ever have implants. I think it would be very useful to have different tits for different occasions. I mean, there are tits to be taken seriously, then you want your holiday tits to go to Torremolinos in. Screw-on tits is what we need.

I did manage to breast-feed, but my daughter wasn't very impressed. I could see her giving envious glances to the full, white, milky breasts of other feeding mothers. But my boyfriend knew I was pregnant before I did, because he said there was a shadow of a cleavage.

I'm quite happy to go topless. I'm going to go topless in Nell Dunn's Steaming in the West End at the end of April. I'm doing the lead, so I've got to whack my tits out. Yeah, I'll be flaunting them! Ruth Picardie, journalist

I've never had a very passionate relationship with my breasts. I don't think women are as obsessed with their breasts as men are. Breast size is probably more of an issue if you haven't got them.

After I left school, I was 38C, and I did feel self-conscious about them being big. I would never have worn an under-wired bra to show off my cleavage. But then, with the Wonderbra, post-feminist babe and all that, you could feel good about your breasts, and I think, anyway, as you grow up you get more confident.

My breasts got smaller when I had children, after I finished breastfeeding. I'm now completely happy with my breasts. I think I'm a 36C.

I was worried about breast-feeding being agonising, but it was great. Having twins, the only way to successfully, exclusively breast-feed them is to have one on each tit, and I could never manage that, except in extremis, so they had bottles as well.

Before I had twins, I went to this "lactation workshop" organised by the hospital. There we were, miming with plastic dolls, and I was the only one who was having twins, so I asked the "lactation consultant" - makes you sound like a cow! - if she had any advice, and she said "Oh, it's no different breast-feeding twins". But it's utterly different. All you do is feed.

Yet breast-feeding was great. It's very sensual, your relationship with your children at that age. It's not at all genital, obviously, but it shares many of the things sex has, in the sense that it's very, very sensual.

I always thought you would definitely look twice at someone breast-feeding in public, but I was quite unselfconscious about hoiking them on. When the babies were a few weeks old, some people who I don't know very well came round to see them, and there I was, topless, with one on each tit. They must have been utterly freaked out. But your breasts are not at all sexual when you're feeding; they're functional, they change their status completely.

I stopped breast-feeding at about nine months. Then I noticed the lump. Before I got pregnant, I'd had this lump in my breast - it was my husband who found it. I went to my GP, who told me more-or-less to go away, there was nothing wrong. Matt said, "No, you've definitely got a lump in your breast", so I saw a different doctor, who was really nice. She said, "Well, I'm sure it's fine but you need to see the experts", and sent me to the hospital. They did something called a fine-needle aspiration, and told me that it was benign, though I could have it removed if I wanted. Well, I didn't want to have surgery just for the sake of it.

Then I got pregnant, and your breasts change, they got bigger and lumpier, so I was quite unaware. And the same when you're breast-feeding. But when I stopped breast-feeding, the lump which had been the size of a marble, had grown to the size of a child's fist, but I still didn't panic. I thought, "Oh, well, it's the same lump that's just grown."

It was Matt who encouraged me to go back to the doctor, who referred me back to the specialist. The hospital lost my paperwork, it took two months from going to the doctor to getting the appointment, and suddenly I've got stage three breast cancer.

I am sick of people saying, "Oh, my aunt had breast cancer and she's fine." Stage one and stage two breast cancer are really treatable, they have very good survival rates, you can have surgery, but with stage three cancer, statistically, women who have surgery don't survive any the longer.

Matt feels weird about touching my breast now, and the lump freaks him out, but it doesn't me. I haven't got a very interesting or intimate relationship with my breasts - they're not a very important part of my psyche, quite frankly - but I would rather have them than not. Obviously, if it's a matter of life and death, you'd prefer to have a mastectomy, but it must be horrific.

I still like my breasts. I don't feel they are bad. The cancer seems to be the thing, not the breast. I don't look in the mirror and think "God, I hate you!" I think, "You've got stretch marks".

For me, breast cancer is not really about breasts, it's about life and death. You've got a life-threatening illness, you've got to have horrible treatment, but the breasts are irrelevant. Breast cancer is a very counter- intuitive illness because it doesn't make you feel ill. You feel fine. Then you have chemotherapy, your hair falls out and you think, "Maybe I am going to die."

My breasts are just kind of innocently harbouring this disease. They're not hurting, they don't look weird, I think that's why they feel blameless

The facts about breast cancer

It is every woman's worst nightmare: that heart-stopping moment when she discovers a lump in her breast. Whatever her age, background, or education, logic will desert her. Her immediate conclusion is that it must be cancer - and that, inevitably, she will die.

In calmer moments, she may remember the more comforting statistics - that nine out of 10 women with breast lumps do not have malignant disease - but the fear will not leave her. And the fear is understandable. Britain's mortality rate for breast cancer is one of the highest in the world. Each year, around 32,500 women are diagnosed (1990 figures) and around 14,500 will die. One in 12 women in this country will develop the disease during their lifetime, and more will die from it than from any other cancer.

But in recent years the news has been less gloomy. Breast cancer death rates in Europe and North America are starting to fall, according to the Imperial Cancer Research Fund. Increasing use of the anti-oestrogen drug, tamoxifen, is thought to be a factor, rather than the impact of screening programmes.

There has also been recognition of the value of treatment in specialist units by surgeons and cancer physicians with expertise in management of the disease. Rapid Access Breast Clinics, in which women are seen by specialist medical and nursing staff at a hospital within a week or two of first going with a lump to their GP, are the way forward. Such model clinics already exist in Cardiff and Nottingham, and will undoubtedly save more lives.

Good work has been done by the charity Breakthrough, which in five years has raised pounds 10 million, of a projected pounds 15 million, for the creation of a centre dedicated specifically to breast cancer. Last autumn, Breakthrough contributed pounds 6.5 million to a research development fund jointly developed by The Institute for Cancer Research.

However, a report by the Commons Select Committee on Health concluded that 4,000 lives a year could be saved by a radical overhaul of NHS breast cancer services, and the wider use of consensus guidelines on the most effective treatment. There are still frightening discrepancies between hospitals and health regions in how the disease is tackled. The committee reported that 60 per cent of patients in Hull, Pontefract and Wakefield, for example, undergo radiotherapy compared with only 20 per cent in Bradford.

It is too early to determine the impact of the NHS Breast Screening Programme which offers mammograms to women aged between 50 and 64 every three years. Proponents of the scheme claim that it is already saving a substantial number of lives, but others argue that it has resulted in some women being over-treated for slow-growing tumours that would not have caused them problems in their lifetime. They say that money would be better invested in research into new drug therapies for breast cancer.

A leading breast cancer surgeon warned last October that the cure rate in younger women with breast cancer could be increased by as much as a third if more of them were given chemotherapy in addition to removal of the tumour and radiotherapy. The benefits of adjuvant chemotherapy have been known for several years; just why some women are missing out on it is not clear.

By Liz Hunt, health correspondent

Breakthrough Breast Cancer can be contacted at PO Box LB25, London WC2B 6QW ( 0171-430 2086)

Photograph by Donna Trope

The British fashion designer Alexander McQueen designed this breast plate for one of his fashion shows. Cast from a real body, it is translucent.

Clare Park

Breast-feeding is one piece of the complicated jigsaw of motherhood that can bring physical and mental benefits to both mother and child.

Many medical experts believe that breast-feeding can reduce the risk of breast cancer.

Cindy Palmano

`My eldest daughter was quite frightened - she understood what it meant to have cancer. My youngest thought it was wonderful that I was going to have an operation, and told everyone, even the milkman.

I am outwardly quite positive but inwardly not over-optimistic. My eldest daughter asks me if I'm going to die. I say I don't know, maybe. Do I look like a woman who is going to die?'

(Breakthrough Challenger Heather Clark, who died in 1996)

Peter Robathan

`Some men come to me and say `My wife's had a mastectomy. To me, she's just as beautiful as ever, but I can't convince her of that'.'

(BACUP counsellor on the comments of male partners of women with breast cancer)

Barry Lategan

She was lying on her back and I was massaging her stomach very gently... My head was pillowed on one of Maureen's big round breasts. Very slowly, holding my breath, I moved my hand up to cup the other one, just as I had done all those years ago, in the damp dark basement area of 94 Trenglowan Road.

But it wasn't there.

"I did warn you,' Maureen said.

(From `Therapy' by David Lodge)