"Thank you, we are still trying"

“Our understanding of breast cancer continues to grow; if the pace of advance seems at times bewildering, remember that for some of our patients it will never be fast enough”

Umberto Veronesi

Former Scientific Director and
Minister of Health of Italy

European Institute of Oncology

Milan, Italy

[Forward to Breast Cancer: A Practical Guide; Elsevier Science 2000]

In 1998 I was doing my PhD in breast cancer genetics with Professor Roger Blamey in Nottingham, was a year into my thesis work and pretty much completely all at sea.  The experiments weren’t running, the field seemed to be progressing faster just about everywhere else but in my lab, and everything that I thought would be a good idea to start work on was about to be presented at some upcoming meeting – it seemed that everyone had a jump on me.  It was then that I first met Professor Veronesi who was delivering the keynote opening address at the Annual Breast Meeting that year. 

The Nottingham meeting is not the typical breast cancer symposium and most of us were proud of it.  The lack of the usual six star luxury hotels and convention centres meant that some world leaders in breast cancer research were decking it out like the rest of us in post graduate digs; in those days Nottingham did not have its present monorail system and I think I drove the head of the Netherlands Cancer Institute back to his bed and breakfast in a borrowed Fiat Uno.  the informal setting allowed for a frank exchange of ideas  over beer in jeans and anoraks (it always pays to have raingear in the midlands) and the relaxed air was the perfect antidote to a conference season with too many stuffed shirts and stuffed egos.  In short, I was in clinical research fellow’s heaven. 

I had got to the Nottingham unit on the recommendation of a former colleague of Prof Blamey’s who had told him that “this boy has the irritating habit of asking questions – please see what you can do with him”.  The likes of Blamey and Veronesi were not called clinician – scientists then, but that describes them perfectly.   After my short time with them I came to understand how just doing the clinical service was not ever going to be enough for me.  There were daily encounters with patients who deserved better answers than the ones we could offer.  I would explain the diagnosis of breast cancer, the treatment options and answer the immediate questions – how much would it cost, how would a breast conservation breast look like,  what were the side effects, what the survival likelihood; and then that pause as it all sank in. followed usually in a softer voice as she hopes you’re not going to take this the wrong way, “ So are those the only options?” “Why is it cancer when I’ve been doing my mammograms?” “ Are my daughters safe?”  “How long has the cancer been there?” “Is it something I ate?” And at this clinic when I first tell them their worst fears are now a reality, before the peace that comes with time and friends and caring husbands and excellent nurses, at this first clinic that look they give – “can’t you make it go away?”

In the National University Breast Unit we see patients with different breast issues at different clinics.  The “counselling clinic” is the term for that first clinic when we tell these women their cancer result in the presence of the breast care nurses.   The reason is apparently organisational – so that the partnership of surgeon and nurse comes at regular hours each week.  But in truth I think there is another reason: when Veronesi gave his keynote address in Nottingham he did not quite use the closing words as printed in the forward quoted at the start of this blog. Instead of “patients” he used, “mothers, sisters, wives and daughters”.  That started the change. And makes Counselling Clinics so hard that we find it easier to face at an appointed time each week.  And why we need to challenge convention and ask questions.