Fighting back against cancer
Selina John was just 28 years old when she was diagnosed with breast cancer. In the months that followed, she experienced a rollercoaster of emotions, numerous operations and months of treatment.
Now, a year after her initial diagnosis, Selina has the all clear and a truly inspiring story to tell other people.
“Personally, I am very proud to have been part of the Artemis trial and it seems that medically, we are getting closer and closer to better drugs and better outcomes" Selina
In March 2011, 28 year old Selina John, from Hoo in Kent, found a lump in her left breast. Although not particularly concerned, she went to see her doctor to get it checked and was told it was more than likely nothing to worry about.
It was shortly after this that Selina had to travel to Barcelona as part of her work within the insurance industry. Despite having been told by her GP that the lump was probably fine, Selina’s Mum, Pauline and her partner of four months at the time, Colin, were still concerned. While Selina was away, her Mum booked her another GP appointment to see another doctor, for a second opinion.
Selina attended the appointment at the end of May 2011 and was referred, as a precaution, to Maidstone Hospital. She was seen within the two week time frame, which is in place for lumps to be checked, on 9 June, when she had ultrasounds and a biopsy was taken from the lump itself.
“Initially, it looked ok,” Selina said, “and I was asked to come back the following week for the proper results. I wasn’t particularly worried as quite honestly, I didn’t think breast cancer could possibly be an issue given my age of 28.”
A week later, at her follow up appointment, Selina was told she had invasive breast cancer.
“I was listening to what was being said but not hearing,” she said, “It felt like there was so much to take in, so much information and it was all such a shock.”
Selina went on to see Consultant Breast Oncoplastic* Surgeon, Mr Haresh Devalia and Anna Matthews, a breast care nurse to discuss what was to happen next.
“They told me that I needed to have a mammogram, my lymph glands checked and then chemotherapy. We discussed fertility because of my age and the fact that I had no children, which is something that hadn’t ever crossed my mind. It was something I quite simply hadn’t had to think about up until that point. Again, there was so much to take in.
“However, Mr Devalia told me they were treating to cure which is just about the best news you can be given at that point in that situation. He had an amazingly positive attitude and had really thought about me, and the impact all this was having on me as a person and the future ahead of me. He also talked about what would happen once I had got through the treatment – he was absolutely fantastic.”
During the appointment, Selina was asked about her family history in terms of health. As her paternal grandmother had been diagnosed and treated for breast cancer at the age of 37, Selina was referred to Guys Hospital in London for genetics tests to determine the cancer susceptibility in her genes given that her condition could be hereditary.
“It was all a bit of a blur,” said Selina, “There was so much to talk about and so many options to discuss that it was hard to take it all in. It was actually the week after my appointment with Mr Devalia that it really hit me. I was driving on the M25 at the time and I just remember thinking what if it’s spread, what happens now? What about my future? I just wanted the lump out, I felt completely invaded and paranoid.”
Around one week later, Selina returned to Maidstone Hospital to see Consultant radiologist, Dr Ali Sever, to have her lymph glands tested. Thankfully, no cancer was found in her lymph glands and a few days later she went to speak with Dr Russell Burcombe, a Consultant Clinical Oncologist, about starting chemotherapy prior to her operation to have the lump in her breast removed. The reason for having the chemotherapy prior to the operation is to hopefully shrink the size of the lump to minimise the amount of breast tissue removed during surgery.
“It was actually during my conversation with Dr Burcombe that he mentioned the possibility of being part of a clinical trial, called the Artemis trial. I was interested in finding out more about it so I went to speak to Claire Ryan, who is Lead Research Nurse in the Clinical Trials Unit. I spent an hour talking to her about the trial of a drug called Avastin. She was brilliant and gave me a huge amount of information, explained all the ins and outs, risks and benefits, of becoming involved in the trial, then and told me to have a serious think about it.
“The trial itself was a randomised clinical trial which meant that if I fitted the criteria for it, I be would randomly selected either to have the standard treatment of chemotherapy alone, or chemotherapy with the Avastin. So, there was no guarantee that I would receive the new drug at all. Either way though, in my mind, I would be part of the trial and contributing towards the research at the same time as giving myself the best possible chance of getting the most up to date treatment.
“I did, however, make the mistake of searching for information online about Avastin. There was an enormous amount of information on the web, much of it focusing on horrible side effects. The best advice I can give to anyone in the position I was in, is don’t look on the internet for this sort of information – much of it isn’t official and a lot of it is contradictory. The only way you will get a true understanding of what you are putting yourself forward for is by speaking with professionals whose priority is your health and well being.
“After a lot of thinking and many phone calls to Claire Ryan, I decided to put myself forward for the trial. I just thought, why not? Someone has to do these trials, otherwise how do new drugs get out there and properly used? The more I looked into it, the more I realised, people involved in clinical trials can actually make a real difference to the future of things like cancer treatment. Plus, I knew it was safe – it was an NHS led trial and it meant I would get more scans and more blood tests, which I saw as a massive benefit.”
Selina was told she fulfilled the entry criteria for the trial and was randomly assigned to receive the new drug, Avastin, along with her chemotherapy treatment.”
The Avastin was administered concurrently with Selina’s first four courses of chemotherapy and she experienced no particular side effects. In fact, after just two sessions, the lump in her breast had reduced so notably in size that she had to have a coil fitted to it to ensure that it could be easily found at the time of surgery. Selina’s final two courses of treatment were chemotherapy alone.
It was during the time that she was receiving the chemotherapy, that Selina was contacted by Guys Hospital with her genetic test results. She had been found to be positive for BRAC 1, a hereditary gene which made her very susceptible to developing certain forms of cancer. For Selina, this meant an 80% risk of developing breast cancer, a 40% to 50 % chance of developing ovarian cancer and a 65% risk of developing a second breast cancer. She was given the option of preventative surgery – a double mastectomy.
After attending an all day clinic at Guys Hospital shortly after she had received her last chemotherapy treatment, and after speaking to numerous professionals, Selina decided to go ahead with the double mastectomy.
She said: “It was absolutely horrendous to think about a double mastectomy, especially at my age, but Mr Devalia said he could reconstruct at the same time.
“It went ahead on November 18 last year. The operation to remove and reconstruct took nine hours and when I woke up, I felt like I had two solid bricks inside my chest. It was so painful - I had drains attached and I was given morphine.”
Basic recovery from the surgery took Selina around three to four weeks, and during that time, on 23 November, Selina received the news she had been waiting for – results from her treatment showed that no cancer could be found. She had had a ‘complete pathological response’.
However, it was around Christmas time that Selina went through another setback.
“I had pain in my back on the left hand side and I felt really stiff. I had it checked on 2 January this year, and was found to have an infection. I had a small operation to clear it up and we hoped that would be that. But a few weeks later, the wound on the left side where I had had the reconstructive surgery and implant was leaking badly. I went to hospital on January 25 to have it checked again. The day after, I had the implant removed, as my body had rejected it.
“I was told I needed a break from treatment and operations so I decided to go on holiday and take some time out to relax and get back to normal.”
Selina had her second reconstructive surgery on her left breast on 15 June and she is recovering very well.
She said: “Although the problems I had with the left side might be considered a setback, as far as I am concerned they were actually just a bit of a hiccup in all of this. At the end of the day, this part, this surgery, is cosmetic. The other surgery and treatment I had saved my life.
“I have absolutely no doubt at all that, one hundred per cent, I made the right decision to get involved with the clinical trial. I actually feel like I had a personal and moral responsibility to take part because the more drugs that are tested and then made available to fight all forms of cancer, the better.
“I would encourage anyone considering putting their name forward for a clinical trial to get as much information from the professionals around them as possible. You have to be comfortable with the idea of a trial and it has to be your own personal choice. Once you have the facts and the information you need, you can make a decision based on those things, and one that is right for you.
“Personally, I am very proud to have been part of the Artemis trial and it seems that medically, we are getting closer and closer to better drugs and better outcomes. If I have made any difference at all, in the grand scheme of things, by taking part in the trial, then that for me is a huge achievement.”