Prof Hannah Fry on calculating the risks of cancer treatment: ‘I would have paid any price’
Just as Britain was going into its first lockdown in March 2020, Professor Hannah Fry, now 38, received an NHS letter calling her in for a routine three-yearly smear test. Even by the standards of the most committed workaholic, the demands of her life were – and still are – off-the-scale.
With her flame-red hair, winged eyeliner and diamond nose stud, she has become Britain’s most recognisable mathematician, not only bringing the joy of numbers to the masses through radio and TV documentaries, but also making it cool, with her dry humour and easy style. Her official title might be professor in the mathematics of cities at University College London, where she teaches her students to study the patterns of behaviour in towns and cities, but on her website, alongside her titles ‘mathematician and science presenter’ is another: ‘all-round badass’.
In her role as badass, she tours the country with the hit Radio 4 show The Curious Cases of Rutherford and Fry, a funny, geeky show answering life’s questions. In 2018 she made the prophetic BBC Four documentary Contagion, which looked at the impact of a fictional pandemic on the UK, two years before the real thing occurred. She delivered a TEDx talk on the mathematics of love that went viral (5.5 million views). She has advised on artificial intelligence and algorithms. And when she’s not teaching or being a badass, she is spending time with her husband of nearly nine years, Phil, and her two daughters, aged five and two.
In truth, she says, it wasn’t only her schedule that made her ignore the screening letter. It was also the beginning of the pandemic. ‘The letter just sat on my desk for a while. I think it was partly that we were in lockdown and it was quite difficult to get to the doctors… I think, really, I just didn’t try very hard.’
This month NHS England released figures showing that between March 2020 and March 2021, 326,000 fewer people in England received an urgent referral for suspected cancer; 30,000 people are still waiting for treatment.
Fry ignored her screening invitation until November 2020. She got round to booking an appointment because, she says: ‘We weren’t in lockdown [at that point] and I happened to have a week where I was [around].’
Within two months, by January 2021, she had been diagnosed with potentially very serious cervical cancer. In early February, she was undergoing major surgery. The tumour in her cervix was the size of a gobstopper and, most serious of all, there were multiple enlarged pelvic lymph nodes suggesting it may already be galloping through the rest of her body.
It was these enlarged lymph nodes that indicated a very bad prognosis indeed: ‘Basically, cancer cells in just one would have been serious. In two, I had below a 50 per cent chance of survival. But four? With the four enlarged, I thought “I’m a goner.”’ She was suddenly contemplating death within five years, leaving her two small daughters motherless.
We meet today at Fry’s temporary home in south-east London (the family house nearby is being renovated). Tall and striking, in a black sweatshirt, cobalt trousers and white leather trainers, she shows me into her study, which has a long rail of clothes that she wears for television appearances. It’s full of bright colour – pinks, greens, blues – chosen for the camera to offset her hair.
If a stereotype of a maths professor still exists, she squashes it; but it’s not always been easy, she says. In the past she has worried about what fellow mathematicians think of her media work, ‘But since the cancer,’ she says, ‘I feel like I don’t need anyone’s permission to talk about a subject I really enjoy. All that stuff I got so worked up about has just fallen away.’
It wasn’t sexism, but more the snootiness of the maths world: ‘One mathematician once said to me, “People are quite scared of mathematicians, so let’s keep it that way,” a view I fundamentally disagree with.’ If she hadn’t been a maths professor, she says she would have been a hairdresser. Really? ‘Seriously, seriously,’ she says. ‘I love hair!’
Fry grew up in Ware, on the Essex/Hertfordshire border, the middle daughter of three. Her father worked in a factory and her mother was a stay-at-home mum, but one who placed a high value on education. In the school holidays, she made the girls work through a page a day of a maths textbook. Fry discovered she was good at it, and with this came validation. GCSEs turned to A levels, then a degree in maths at UCL, then a PhD and then, apart from a brief spell working as junior aerodynamicist in Formula 1 (‘I hated it’), it was lecturing: ‘Maths is such a joyous place for me. I couldn’t quite ever give it up. My family were working class. I never knew a lecturer, let alone a professor.’
In February last year, she underwent a radical hysterectomy, which along with the removal of her uterus, included her fallopian tubes, her cervix, part of her vagina and a large selection of pelvic lymph nodes. Her lymph nodes were, as it turns out, clear. Such radical surgery meant she did not need chemo or radiotherapy. She now is cancer free, with three-monthly check-ups, and has only a one in 10 chance of it returning. Screening and surgery saved her life.
But it’s the lifelong effects of her treatment, and the different perspective she gained when she became ‘a number’, as she puts it, that have led her to make a new BBC documentary, Making Sense of Cancer with Hannah Fry. It is full of footage Fry filmed on her phone throughout her cancer journey, and it’s what makes the film so humane and what qualifies her to interrogate survival rates and the statistics related to effective treatments.
‘There are hours and hours of me crying. I wrote a long diary too,’ she says. She is a very private person and initially ‘the diary and footage were so I could have a record of how I was feeling in those moments’.
It was her friend, who runs a TV company, who convinced her to make a documentary: ‘He said, “This is not only footage of somebody with cancer. It is also the story of somebody who has spent their entire life thinking about numbers and trying to rationalise things.”’
This is what makes the documentary unique. As Fry explains, she made the documentary because her blind fear of cancer was at complete odds with her life as a mathematician, analysing numbers and data, unhindered by emotion. In the documentary, she ends by saying: ‘The chance we think we have of dying is the only number that matters… but we are not having honest conversations about the benefits and costs of treatment, and only when we do can people work out what they most care about and what’s right for them.’
It is what the documentary makers call her exploration of ‘almost a medical taboo’, to ask the question: ‘Are there times when a life-changing treatment might not be the right thing to do?’
In the end Fry opted for radical surgery mostly, she says, because once she was referred to Guy’s Hospital, she was presented with only two options: the first was the removal of just her cervix, leaving her womb and lymph nodes intact. This allowed for the possibility of the third child she and her husband wanted, but at the risk of the cancer spreading and also miscarrying her future baby due to the operation on her cervix. There were also those enlarged lymph nodes that seemed to threaten her life. The second option was the removal of everything, to be safe.
‘I didn’t push it,’ she says of the telephone conversation in which she had to decide. ‘I think partly because it was the pandemic and it was a phone call and I think if you are brought up in Britain, well, I am trained to be grateful and not want to waste [doctors’] time. I really didn’t want to ask more questions. It was “we have a slot for you in three weeks to be on the table. It’s a good slot. Do you want it?”’
The fact that her lymph nodes were clear in the end meant she could probably have got away without a hysterectomy. There were two consequences of this treatment: she lost the chance of another child – ‘letting go of that has been part of my acceptance of cancer’ – and she went on to develop lymphedema, a lifelong condition caused by the removal of the lymph nodes. She was not prepared for this. Today her legs swell from undrained fluid and she will have to wear pressure garments, tights or shorts, for the rest of her life. How could she not have known about this? Was it because the pandemic changed cancer care generally? Because she did not ask? Or was not told?
‘There was a time last year when I was just recovering from everything and emotionally bringing myself back to life, and the lymphedema was a real hit, a real blow. I felt very angry about it,’ she says.
‘If I went back in time, I don’t know if I would have made a different decision, but I would really like to have felt like I had more agency, or that I really understood what the calculation of risk was, and that my values and my level of risk were taken into account. I don’t always think that is the case [with cancer care].
‘I was so scared and so scared for my girls, I think I would just have taken any risk that I needed to. I would have paid any price.’
In the last 40 years, cancer survival rates in the UK have doubled. Fifty per cent of people diagnosed now survive 10 years or more due to surgeries and treatments. Thousands of lives are saved every year by screening programmes and by early interventions. In the case of breast cancer, for example, for every 200 women screened, it will delay the death of one woman. Three of those 200 will have been overtreated as a result.
But it is also a world in which, as Fry discovers wearing her mathematician’s hat, treatments such as chemotherapy help only a statistically small number of patients, five out of 100 women in the case of breast cancer. Eighty of the 100 women would live for 10 years without it. But all 100 women have it to ensure they might be helped by it. They will do anything.
‘I don’t think anyone is doing anything wrong but I think a lot of cancer patients feel like they go on a treadmill,’ Fry says, ‘and it’s only when you’re out the other side that you look back and think about all the decisions that were made in that moment and you feel a little bit like a startled rabbit in headlights.
‘Really importantly, all the NHS people I encountered were amazing. They are doing a really difficult job in very difficult circumstances, particularly [during Covid]. But… ’ she pauses. ‘I think if it’s your job to work as an oncologist day in, day out and you see patient after patient, that interaction you have is just part of your 9 to 5. Whereas for you, the patient, in that moment your whole world has fallen apart.’
Fry is very clear that she is not saying that her care was mismanaged, but her message to others like her, and to doctors too, is ‘to take as much care over helping people find their own values and work out their treatments according to that, rather than just saying, “OK, here’s a tumour. Get rid of it.”’
As she asks at the beginning of the documentary: ‘Have we become so afraid of this disease that we will do anything to fight it? What will I do?’
A record 2.7 million people were referred for cancer checks in the last year, 16 per cent higher than pre-pandemic levels. Early referrals are vital. Sajid Javid, Health Secretary, has talked of a 10-year cancer plan that will lead Europe in cancer care, based on record investment to cut waiting times and the introduction of the health care levy to clear Covid backlogs.
Fry’s view of the Government? She chooses her words carefully: ‘I think overall politics is in a worse state than it was five years ago and I would like to get back to respectable debate… I think there was a lack of consistency [during Covid] and I’m also a big believer in intellectual humility. I really believe in the scientific approach of inviting as much scrutiny as you can and being open about your mistakes.’
There are signs of Hannah Fry’s little girls everywhere in the house, from their toys to the star charts on the fridge. She adores them. Recently, she posted on her Instagram that on a romantic weekend away with her husband, she spent the whole time building them a dolls’ house.
They are at school and nursery today, but even so Phil, who used to be a sports writer, runs their house full-time in what she calls a 1950s set-up in reverse. ‘I wouldn’t be able to live my life if I didn’t have Phil who was prepared to be at home.’ He pops back to the house while we talk, bringing Molly the dog back from the groomer’s. In four weeks, they will move back to their renovated house, perhaps not quite as finished as expected – ‘but I don’t stress the small stuff any more,’ she says. ‘Who cares? It’ll be OK.’
The couple met through a blind date set up by friends and married in 2013. As her media career began to take off, ‘it sort of coincided with Phil wanting to write less’. She laughs, ‘People pretend [you can have both] but the secret of almost all the very successful women – and men – I know is that they have a partner at home who does everything… but I think that society isn’t quite comfortable with [men at home] yet. If we are ever out together and people ask him what he does, the reaction he gets – compared to my female friends who are stay-at-home mums – is noticeably different. People still think it’s a bit weird.’
Cancer in the time of Covid meant she was alone in hospital in February 2021. ‘When I was in the hospital room, I couldn’t quite bear to talk to anyone because I was so terrified. I was paralysed with fear. I couldn’t talk to the girls because I didn’t want to upset them, so I would get Phil to call me on FaceTime and then put me in the corner of the room [at home] so I could just watch them, like CCTV. Very creepy!’ she laughs. ‘But it was because I needed to be mentally at home, to escape the hospital room I was in.’
She told her girls that she had a problem with her tummy and would be back in a few days. The eldest, she says, ‘was really struggling’.
She films herself telling Phil in the car after her follow-up appointment in which she learnt that the lymph nodes were clear. That captured moment is extraordinary – and heartbreaking – for its intimacy but also for the relief on Phil’s face.
Fry herself has borne witness to a loved one with cancer. When she was 16 years old, her mother was diagnosed with a sarcoma in her leg, picked up quite by accident while she was undergoing an MRI for something else. A shadow was spotted. The bone was removed and the gap plugged with cement. Her mother was confined to a wheelchair for a while. ‘It was very upsetting for us all,’ Fry says.
‘Who knows if she was overtreated or if it saved her life?’ Fry says. In the film, she explores the theoretical idea of people who live their life unaffected by undetected cancer and the notion of overtreatment.
‘The thing is, nobody ever thinks they have been overtreated. They think the treatment has saved their life. And does it really matter if no one person feels they have really been harmed? Maybe it doesn’t. [But] it feels very uncomfortable to me that people are not being honest about the marginal improvements to life expectancy as well as treatments.’
But, of course, her life was saved. She is not unaware of this.
‘I think if there is one main message from the programme it is that cancer is not straightforward. You are often fighting an invisible enemy that may or may not be there, that may or may not go on to kill you, and you are dealing with treatments that can often do as much harm or make you sicker than the cancer itself.’
It’s been just over a year since her operation. She goes to hospital every three months for a scan – never missing an appointment. So far, everything is clear. Her life has been profoundly changed by her cancer. ‘I give a lot less of a s—t about stuff. I just don’t care any more. Obviously, I care very deeply [about the important stuff]. I feel a lot more concerned about big societal issues, like leaving the place in a better state than when you found it.
‘I used to get so hung up on such little things, like what did I say at this party? Now I feel liberated. I’ve gone from feeling like my life is a problem that needs to be solved to something that is an experience to be enjoyed.
‘And, strangely, I’m not quite as scared of death as I used to be. I am quite accepting of the fact that it will come. I’d like it to be later, sure. But I suppose [cancer] gives you a better focus on what is really important to you.’
Making Sense of Cancer with Hannah Fry airs on BBC Two on 2 June