Making Sense of Cancer with Hannah Fry

[GrandyPandy]

I thought there would be a thread about this, apologies if I've missed one. Would recommend this programme. Hannah looks at over-diagnosis, the underplaying of side-effects and how being aware of the numbers and percentages makes little difference when you actually get a diagnosis - you just want it gone.

Haven't seen this programme & not sure I'll be able to watch as my DM died of cancer and I guess I just find programmes about it too distressing, BUT, I love Dr Hannah Fry. I listen to her Maths of Life slot on Lauren Laverne's radio show on 6Music.

I think she's great, from the glimpses I've seen on various TV; it's very worth watching.

Approaching it as a mathematician she takes a statistical approach r.e. cancer diagnoses (as well as a personal one of course) and looks at people's visceral reaction to get rid of it at all costs.

It's had me musing away since I watched it & got me thinking. Would recommend.

I came across it half way through by accident, and also found it eye-opening. The doctors survey saying they wouldn't opt for preventative treatment without at least a 25% chance of a positive outcome, for one.

Yy and that statistic about -was it 7%? Of people that had died in RTAs, who had cancer they didn't know about or that hadn't metastasised (!)

It was a very good, thought-provoking programme. I hadn't realised she had children at all, let alone such little ones. She is an excellent presenter. Delighted to see she is a Professor at UCL these days.

I thought this was really interesting and thought-provoking and came on MN looking for a thread to see if anyone else did.

That radical hysterectomy Hannah was told was necessary actually wasn't. Her cancer was Stage 1, yet she lost her whole uterus, fallopian tubes, cervix, part of her vagina and all the lymph nodes in her pelvis, which has now left her with lymphodema, which will almost certainly get progressively worse. I was shocked by her findings and the stats behind them.

I totally understand anyone with a cancer diagnosis just wanting it to be removed - I'm sure I'd feel the same - but it's shocking that they removed so much and then discovered that most of it wasn't necessary. Hannah is still only 38 and was presumably plunged straight into full menopause following her surgery. She didn't mention anything about this, but I'd have liked to know whether she is allowed to take HRT or not, given her ovarian cancer diagnosis.

*cervical, not ovarian

I watched this last night, it opened my eyes to cancer treatment statistics and how it is based on odds. The part about screening and detection was thought provoking. Excellent program.

That radical hysterectomy Hannah was told was necessary actually wasn't. Her cancer was Stage 1, yet she lost her whole uterus, fallopian tubes, cervix, part of her vagina and all the lymph nodes in her pelvis, which has now left her with lymphodema, which will almost certainly get progressively worse

The problem is you just don't know. They can stage and grade it from the biopsy and MRI, but they can't be certain until they do the histology on everything that's been removed. I can't remember at what stage they saw swollen lymph nodes, but these could have indicated cancer. Did they remove too many? I'm not sure. Could they remove fewer and test them and then only go back and remove more if they have to? Possibly, but that would also carry risks.

I had previously decided not to go for breast screening because I knew about the false positives and thought I wasn't particularly at risk because I live a healthy lifestyle and there's no cancer in the family, but now having been diagnosed with another form of cancer, it has definitely changed my perception and I will probably take up screening in the future.

Very interesting and I think I need to watch it again to take in all the information and data. Seems it's a numbers game but extremely emotionally charged. There was the guy who had taken a pragmatic decision not to have further treatment which he disliked to gain a possible few more months. Hannah was brave and honest.

I don't think your description is correct. Hannah said they'd found a tumour the size of a gobstopper in her cervix, which presumably was identified by a scan before the surgery. The inflamed lymph nodes were seen during the surgery but on examination in the lab afterwards were found not to be cancerous, so the inflammation (from what she said while waiting for the results) was probably because her immune system was trying to combat the cancer.

Also, unless I missed it, they didn't remove her ovaries. It's the loss of those that precipitates early menopause, isn't it?

With the benefit of hindsight, Hannah may well have been overtreated. The whole point of her programme was that lots of people are, and some of that is the result of screening. It comes from an abundance of caution because if we took a more laissez-faire attitude and just waited to see how the condition progressed instead of treating it at a very early stage, some people would die as a result.

I am over 60 and I know I would go for everything I was advised to have if I was told there was a good chance it would extend my life by a few years without making my life really miserable because of side effects. If I'd been diagnosed with cancer at 38 when my children were tiny I'd have been desperate to have every treatment on offer so I'd see them grow up.

Also, unless I missed it, they didn't remove her ovaries. It's the loss of those that precipitates early menopause, isn't it?

I'm pretty sure she said radical hysterectomy, which does take ovaries. They usually like to get everything out I think to reduce the risk of cancer developing elsewhere.

Also, unless I missed it, they didn't remove her ovaries. It's the loss of those that precipitates early menopause, isn't it?

She listed all the things that were going to be removed in her surgery and she said ovaries as well. I know they were just being cautious - I get it - I really do. But after the fact, to know that they've removed so many things that they didn't need to, is pretty heartbreaking and will have big implications for her quality of life. Treatment for cancer is still such a blunt tool and can be so brutal. I really hope that more accurate tests are soon available so people with cancer don't have to lose so many body parts in radical surgeries that aren't necessary.

I quite liked it. I thought she was very honest & relatable. At the same time I think it’s very easy to make judgements when you have a cancer that can be removed surgically. I know it was touch & go with the lymph nodes but she was very lucky. Also as someone living with stage 4 cancer I positively avoid looking at statistics as they’re so depressing. Although the programme made some good points I felt like by the end I wasn’t really sure what the take home message was.

I'm sorry to hear about your situation Made.
I agree the message was mixed. I think that was partly because there was too much to fit in, and I would definitely watch a short series by Hannah on this. Also, I guess the ambiguity reflected her own views, and the fact it is complicated.

I just listened to her on The Numberphile Podcast, which explored some of the issues in more depth and I think she was clearer in articulating The main issue is around people being fully informed about the risks of more conservative cancer treatments versus the risks of surgery and complications that might come from it, and taking a much more individualised approach to patients. She specifically talks about the risk averse approach to taking lymph nodes as well, and says even with full information she still might not have made a different choice.

Another of the things she was saying was that when you first get diagnosed you get to talk to a nurse for as long as you need to, but then when you see the consultant and they talk about treatment options you've got 15 minutes to make a decision, and she was saying that it would be better if after that appointment with the consultant you to go and you can talk through some of these issues with somebody who would help you to make a much more informed decision.

She thinks that a lot of people are either not hearing or it's not fully been explained to them that actually going through chemo or radiation may have unintended consequences and actually not very significantly improve your survival rate. On the podcast he talks about a conversation she had with David Spiegelhalter who says that most of the stats are around 10 years survival rate, this was possibly around prostate cancer I can't remember, but actually if you look at the 15 year survival rate then it may look very different and actually statistics may look worse for people who have had chemo around the 15 year survival rate than people who haven't because of the effects of chemo.

Of course this entirely depends on what sort of cancer it is and it's very different having something that can be surgically removed with chemo and radiotherapy being a belt and braces approach, from being at stage four and having metastases and so on.

My personal experience is the NHS and also sadly Macmillan have very little interest in looking very specifically at issues around lifestyle, diet beyond something fairly basic, or looking at supplements that you may be able to take that will help your body to fight cancer itself. There is definitely evidence in medical journals around the beneficial (or detrimental) effects of all sorts of things on different types of cancer, but the knowledge (or the ability to share the knowledge) in the staff that I've spoken to seems to be fairly limited.

Thanks op I'd missed this.

Thanks for clarifying about the radical hysterectomy including removal of ovaries, I hadn't understood that. Wow, that's a huge thing to go through at 38 and she did say she had hoped to have another child.

At the risk of trivialising this, I used to watch Star Trek and whenever medical treatment was needed it seemed to be just a case of lying down on the treatment bench, the computer scanned the body and indicated what was wrong and what was needed, and Dr McCoy and a pretty nurse did the necessary. Patient back up and working in minutes. Pretty clear modern medicine, although hugely more useful and effective than it was a couple of generations ago, has a long, long way to go before it can provide genuinely individualised treatments that work.

Thanks Hydro, I think you’re right that a one off programme can’t possibly do this subject justice. It’s a hugely complex area & each different cancer is like a different disease. That’s interesting about the podcast Sierra- I can see that would add more clarity. I think when you get to stage 4 you will try any treatment to give you more time regardless of what the statistics say. I was glad to see the update about the woman with 4 breast cancer to say her cancer was responding to treatment.

Also I am part of a living with bowel cancer group & if most of us had paid attention to the statistics we would have probably have given up ages ago! I’m not sure Hannah’s right that hope can ever be a bad thing. You have to keep going somehow & hope is a big part of that. Maybe some of it is denial but who is to judge?