The first weeks of any cancer diagnosis are a steep learning curve. When I discovered I’d joined the one in eight women with breast cancer, it was the first time I’d even heard of the type of breast cancer I had.
I was bombarded with information about unpronounceable drugs and my diary had to be cleared for a dizzying array of appointments. I quickly learned that the NHS is utterly amazing when you really need it, that life goes on despite cancer, and that having something really serious to worry about puts everything else in perspective.
But I also learned society can horribly trivialise the enormous impact breast cancer can have on how you look. All too often, women are expected to cheerfully wave goodbye to their hair, eyebrows, breasts, even manicures, facials (for fear of infections) and cosmetics to morph into almost nun-like patients.
As a health and beauty writer whose career has included testing products and tweakments, I know just how important appearances can be to a woman’s psyche. Yet I’ve been told, ‘it’s only hair’ by more than one entirely well-meaning person who I know would be devastated to find their own locks on their pillow one morning.
Leah Hardy (pictured) explains her desire to act ‘normal’ after being diagnosed with highly aggressive, grade-3 cancer at age 58
I’ve also been told ‘it will grow back’, which is true for the majority of women, but not all.
My entire approach to cancer has been to try to feel, act and look as ‘normal’ as possible throughout. Yes, first and foremost I want to live, but my appearance is a key part of my identity and I refuse to apologise for wanting to exert some control over all the physical changes that breast cancer brings.
It all started on a sunny September morning when I skipped into my local hospital’s breast clinic. At 58, I was fitter and healthier than I’d been for years. Since February I’d embarked on a midlife makeover. I ate sparingly and exercised almost every day — yoga, Pilates, barre — dropping from a tight 16 to a toned 12. I felt full of energy, my thighs were firmer and my highlighted hair was thick and glossy.
I was so addicted to the gym that when I first noticed a slight tenderness under my right breast, I put it down to the pressure of constantly wearing a tight sports bra, or perhaps a pulled muscle. When I looked in the mirror, however, my right breast appeared an inch or so higher and firmer than the left.
At worst, I reasoned, as I swiftly made a GP appointment, I might have a cyst which would be quickly treated, allowing me to slip back into my busy life as a mother (to two teenagers), wife, friend and writer. I even remember hoping, if something was wrong with either breast, it wouldn’t be the right one — it looked so much perkier than the left.
At the hospital, listening to my symptoms, the consultant agreed they sounded harmless. But during the examination, he asked me to raise my arms above my head and his eyes narrowed and his smile vanished. (I later realised that the underside of my right breast changed shape and sort of tucked inwards when I did this.)
Instantly I realised I was in serious trouble. Shaking, I called my husband: ‘I’m at the breast clinic. I need you to come now.’
I was fast-tracked to a room where I was given an ultrasound and a souped-up mammogram.
Leah (pictured) said the cancer had rapidly moved into her lymph nodes, from where it could sneakily slip into the rest of her body
The technicians were kind, but they couldn’t quite meet my eye. Then I was asked to lie on a couch and another doctor performed four punch biopsies of my right breast and underarm while a nurse held my hand. By now I knew it was highly likely I had cancer.
A few days later I learned that what I thought was an uncomfortable, fast-growing cyst was, in reality, a highly aggressive, grade-3 cancer. My breast cancer cells had an abnormally high level of a protein called HER2 (human epidermal growth factor receptor 2) on their surface, which had stimulated the tumours to grow. This is known as HER2 positive breast cancer.
Nobody knows quite why this happens, but HER2 is responsible for around 20 per cent of breast cancer cases. Kylie Minogue and Jennifer Saunders had this type.
It’s hard to imagine a disease that more effectively strips away our identity as women than breast cancer
Most HER2 positive cancers also have receptors for oestrogen or progesterone. Mine didn’t, and this can make the cancer even more aggressive. The result? I had developed a large mass of cancerous cells throughout my right breast.
The main tumour was six centimetres in diameter and had acted a bit like an implant, giving my breast a fuller, lifted look. The cancer had also rapidly moved into my lymph nodes, from where it could sneakily slip into the rest of my body. As I sat sobbing in his office, my oncologist said, ‘You probably feel this has come out of nowhere, don’t you?’
The initial shock and terror was incredible. At first, despite reassurances from my oncology team, I became convinced my cancer had already spread to my liver and bones and would therefore be treatable but fundamentally incurable.
Doctors told Leah she would need eight sessions of chemotherapy involving five drugs, followed by surgery. Pictured: Leah wearing cold cap
I was swept into a whirlwind of tests and scans. The wait for results was the worst week of my life. I believed every minor ache or pain was a sign of deadly tumours springing up. But the scans were, to my euphoric relief, clear. My doctor told me that, while 20 years ago my type of cancer was a grim diagnosis, improvements to treatment meant he expected to cure me.
However, I’d need eight sessions of chemotherapy involving five drugs, followed by surgery. Whether I’d have a mastectomy or less invasive surgery depended on how well the chemo worked. Then I’d have radiotherapy and a year of targeted therapies such as Herceptin to block HER2’s effects and encourage the immune system to kill the cancer cells. The pace was dizzying. Just 28 days from my first GP appointment, I was sitting, still in shock, on a chemo ward.
I am profoundly grateful for the heroic and tireless care and kindness of the NHS staff at King’s College Hospital in London, but with the focus on the rush to save my life, there have been times when I’ve felt less like a person, and more like a body to be scanned, punctured and filled with chemicals.
How I look is key to my identity. I refuse to apologise for wanting control over the physical changes cancer brings
It’s hard to imagine a disease that more effectively strips away our identity as women than breast cancer. For many, surgery takes away our breasts and chemo can steal every single hair on our body, even our brows and lashes. For a minority of unlucky women on chemo drugs called taxanes — and yes, I’m on one of those — this hair loss can even be permanent.
Some women don’t mind losing their hair, but most very much do. Around half of breast cancer patients cite losing their hair as the most traumatic effect of chemotherapy. Many said it was worse than losing a breast. More than a third of women in one study said they thought about stopping treatment due to hair loss and 8 per cent said they’d reject chemo for that reason. Women said losing their hair made them feel depression, shame, anxiety and lose confidence.
Chemo may also rob young women of their fertility. Around 80 per cent of women also gain weight during treatment, partly due to being pumped full of steroids to prevent chemo side-effects, partly due to brutal hormonal changes as we stop HRT or take oestrogen-suppressing drugs. Even manicures and facials can be off the menu due to infection risk and many salons do not feel confident treating women with cancer.
Leah estimates that she’s lost 50 per cent of her hair after having five of her eight chemo sessions. Pictured: Leah at Future Dreams House
You might think these things are a small price to pay to be alive, and that even to worry about them is foolish vanity. You wouldn’t be alone. While I reeled from the trauma of my diagnosis, I remember thinking I would happily sacrifice everything to live, saying, ‘You can cut off my legs if you like.’
Luckily, my consultant understood me better than I did. He was the first to suggest I wear a ‘cold cap’ — a contraption, free on the NHS, designed to chill the scalp during chemotherapy — to try to preserve my hair.
‘You won’t like looking in the mirror and seeing yourself bald,’ he said, perceptively.
The cap works partly by sending hair follicles into suspended animation, so they’re not as vulnerable to the chemo drugs designed to attack fast-dividing cells. The cold also shrinks blood vessels to cut the amount of drugs reaching my poor hair roots.
The first ten minutes or so of scalp cooling are painful until blissful numbness kicks in. Plus, the first time I wore it, I had a claustrophobic panic attack due to the tightening effect as the cap filled with cold liquid. It doesn’t work for everyone, and it doesn’t prevent hair loss completely.
It might seem like vanity but hair gives you the ability to walk the dog without pitying looks from strangers
After five of my eight chemo sessions, I estimate I’ve lost maybe 50 per cent of my hair, but thanks to scrunch drying and volumising sprays, enough of it remains in a curly bob that I don’t yet feel the need for a wig or scarf.
Caring about hair when you have cancer might seem like vanity, but even more fundamentally, it reflects a longing for privacy and normality. Hair gives you the ability to work, meet a friend for coffee, go to the gym or walk the dog without pitying looks or awkward questions from strangers.
The day before chemo began, between medical appointments I dashed to Tracie Giles, one of London’s best permanent-make-up specialists, for a semi-permanent eyebrow treatment and subtle lash line enhancement. The process, where natural pigments are introduced into superficial layers of the skin via an electrical device with a needle, was a distinct improvement on my own brows.
Knowing that even total hair-loss wouldn’t leave my face bald as an egg allowed me to start chemo with more confidence.
In the next few months, I’m also going to have to deal with surgery and its aftermath. At one point, I searched online for post-surgery bras. I found the products so hideous and confusing and the whole concept so incomprehensible that I shut the pages down in a panic.
Leah (pictured) was invited to new cancer centre Future Dreams House, which sent out 7,000 care packages containing not just food, but beauty products to patients during the pandemic
It wasn’t until I was invited to try out a new cancer centre, called Future Dreams House, that I found the holy grail — lingerie that might make you feel pretty even in the face of cancer.
Future Dreams, the charity, supports awareness and research, focusing on secondary breast cancer. It knows breast cancer affects all aspects of your life, from your relationships to your career and that the impact on body image can be particularly devastating.
In the pandemic, it sent out 7,000 care packages containing not just food, but beauty products to patients and donated more than 1,000 beautiful post-surgery bras.
It’s new centre, a tall, pink building in London’s King’s Cross opened recently by Liz Hurley (thanks to donations including £500,000 from Estee Lauder Co.), houses the only specialised breast cancer support centre in the UK. It feels warm, comforting and luxurious, like a cross between a spa and a boutique hotel.
Here, any woman who has been diagnosed with breast cancer can find tailored packages of emotional, physical and practical support of the kind the NHS simply isn’t designed to provide.
It hosts classes in yoga, exercise, nutrition, physio, life coaching, bra fitting after surgery, make-up, stress management, scarf-tying and wig fitting. In the new year there will be support sessions in employment advice and group sessions for partners, plus there are plans for future beauty services from cancer-trained professionals, including brow and nipple tattoos for women who have lost theirs.
Leah (pictured), who developed blood clots in her left arm from chemo, said yoga and Pilates have been a lifeline throughout her diagnosis and treatment
In an airy studio, I join Marcia Mercier, a specialist Yoga for Cancer teacher and breast cancer survivor. Exercising can be daunting if you are going through treatment. It’s hard to know just how hard to push yourself, especially when dealing with complications.
When I recently developed blood clots in my left arm from chemo, nobody at the hospital seemed quite sure what was OK for me to do in my regular yoga class. Yoga and Pilates have been lifelines for me throughout my diagnosis and treatment, keeping me physically and mentally strong even at my most panic-stricken.
Upstairs, I meet Ryan Riley, founder of Life Kitchen, a cookery school which helps cancer patients rediscover the joy of eating. Exhaustion and illness can destroy appetites, while chemo and radiotherapy can blitz tastebuds. It’s not unusual for everything to taste of soap or metal. Ryan produces easy food full of intense flavours including a delicious miso-infused cream with frozen berries.
For me, however, the most impressive example of the transformative power of Future Dreams House is the time I spend with specialist bra fitter and lingerie consultant Monica Harrington.
A warm, smiley Irish woman from Cork, she is half fashionista half therapist. In her elegant fitting room, she takes women whose sense of self has been shattered by breast cancer and gently helps them find their confidence again.
‘My clients can be emotional,’ she says. ‘For example, women often tell me that intimacy is very difficult for them.’
Alongside me is Penny, a chic, witty woman in her fifties with an immaculate blonde bob. Previously, she’d had a double mastectomy and implants. But when cancer returned to one breast last year, the implants had to be removed permanently, leaving her body confidence in tatters.
Leah said her visit to Future Dreams House (pictured) made her feel a world away from a chemical-filled patient
Gently, Monica shows Penny a range of silky camisoles and satin pyjamas. ‘They are just a little bit sexier, a bit more feminine,’ says Monica. ‘I want to get people out of the breast cancer box and into the kind of things they wore before.’
Penny confesses she is ‘dreading’ an upcoming holiday because she can’t face wearing a swimsuit. But Monica soon coaxes her into a one-piece designed for Future Dreams by Melissa Odabash, whose sister had breast cancer.
There’s something incredibly cheering and bonding about drinking tea around a pile of frothy bras and knickers and we soon start sharing anecdotes and hooting about the various indignities of our breast cancer experiences.
Medical advances mean more and more of us are living ever longer with and after cancer. According to Cancer Research UK, breast cancer survival in the UK has doubled in the last 40 years, from 40 per cent to 78 per cent. It’s estimated fewer than a quarter of the 50,000 women diagnosed with breast cancer each year in the UK will die with it. Most of us will emerge scarred, emotionally traumatised and exhausted but alive. And we don’t just want to survive: we want to live life to the full.
My visit left me with a face aching from laughter, a glamorous Melissa Odabash swimsuit, plus the promise of a bra fitting from Monica and post-surgery yoga advice from Marcia. I felt a world away from a chemical-filled patient and more like, well, me.
- some names have been changed
- To donate to Future Dreams go to futuredreams. org.uk/future-dreams-house/