Dust to Dust

By Peter Martin
The Times (London)

May 16, 2004

http://www.timesonline.co.uk/newspaper/0,,2772-1101365,00.html

Britain is in the grip of a national disaster. A lung-destroying epidemic is killing thousands, and the mortality rate is climbing every year. By 2050 almost 185,000 will have died in agony ï ˜ and that's a best-case scenario. Why is the government doing so little about it? Peter Martin investigates

For years a jobbing carpenter, and more recently a very successful builder, Geoff was ready, with his wife, Bernadette, to ease back and enjoy his retirement. He was 50. But one day at work, while supporting a small steel beam on his shoulder, he ran out of breath, just standing there. That was in September 2002 and, following a bewildering variety of tests at the Wythenshawe hospital, Manchester, the formal diagnosis was delivered in February 2003.

Mesothelioma is a cancer of the pleura, the silky-thin lining of the chest. The disease transforms it into a hard, rubbery substance around the lungs, gradually restricting their function. Breathlessness progresses to extreme pain and respiratory collapse. Time from diagnosis to death is rarely more than a year. There is little we can do, said the specialist, except offer palliative care. But to Bernadette, doing nothing was unthinkable. Well, the specialist said, the UK's first chemotherapy trial for mesothelioma, called MS01, was running. A computer would randomly pick Geoff's treatment: one chemotherapy drug, a new cocktail of three, or just symptom and pain control.

But Bernadette had another possibility in mind: while finding out all she could about mesothelioma on the internet, she'd located one of several American surgeons who remove the lung, plus the pleura and part of the diaphragm, albeit for an impossible $250,000. So what about radical surgery here? The quality of life is so poor afterwards, it's not worth it, said the specialist. And 40% don't survive the operation. But that, as Bernadette knew from her web-surfing, was wrong, old information.

She wanted Geoff to see David Waller at Glenfield hospital in Leicester, one of just 10 UK surgeons who perform the radical option. Wythenshawe responded as if the couple were mad to consider it. But she got her appointment. Waller was blunt: I can't cure you, but some of my patients are alive four years after surgery.

After Geoff had the operation it was back to Manchester, to yet another hospital, Christie's, for mopping-up radiotherapy. But Christie's said, if they were reading Glenfield's pathology report right, the cancer had spread and they couldn't justify radiotherapy: enough damage had already been done. It was a bash in the face. Perhaps the truth was Christie's admitting: "We have no experience of treating people like you."

So, off to hospital number four: Cookridge in Leeds, which specialises in this type of tricky postoperative radiotherapy. And Cookridge said Geoff's cancer had not spread, after all. The couple had to drive from Manchester to Leeds and back, three hours' travelling a day, for 25 sessions.

Asbestos dust is the only known cause of mesothelioma. Geoff's near-fatal exposure came from sawing asbestos roof soffits in the 1970s. Today, with his one good lung and a new Gore-Tex diaphragm, he looks fine, and he feels he's been given the best chance. Still scared and angry, Bernadette says: "There seems to be a breakdown in communication between these hospitals."

The bad old days of maximum asbestos production and its ubiquitous use are gone. But that's not true of asbestos diseases. There is a rising epidemic in every country that once mined it or made asbestos products. Russia, China, Zimbabwe are still hard at it; unbelievably, Canada mines and exports white asbestos to the Third World.

In Britain, asbestosis, the first disease identified, is dying out. But mesothelioma? Specialists are blunt: it's a national disaster. There has been a threefold increase in it since 1990. It now kills 1,800 people a year ï ˜ nearly twice the number that die from cervical cancer, but with no equivalent of the latter's comparatively funding-rich screening programme. Asbestos-triggered lung cancer claims up to twice that many. Worse is to come. Given that these cancers take up to 60 years to appear, the epidemic won't peak until 2015, when up to 6,200 deaths will occur.

The epidemic will not subside until 2050. And that's assuming nobody has any further exposure to asbestos dust. But hundreds of thousands of British homes have asbestos in their fabric, and builders, DIY enthusiasts and maintenance workers aren't always aware of it ï ˜ so it's a vain hope. Unlike asbestosis, usually the result of breathing quantities of asbestos dust over time, these cancers can be seeded by relatively brief exposures. As the World Trade Organization stated in 2001, there is no safe level of exposure, and "controlled risk" is "unachievable". Even on the rosiest predictions, up to 185,000 more deaths are expected here by 2050, another quarter of a million across western Europe and a third of a million in North America. In developing nations, the toll will be colossal.

So what are we doing about it? Not much. The UK's plight takes the breath away in more ways than one. Asbestos is the leading cause of work-related cancer, is the most fatal manufactured carcinogen after tobacco, and accounts for more deaths each year than road accidents (3,450 people died on UK roads in 2001). Yet no government funds have been allocated, that is,"ring-fenced", for tackling the epidemic. Nor is there anything resembling a national medical strategy. Centres of treatment excellence are emerging in London, Leicester, Newcastle and Glasgow, but in between, as Geoff and Bernadette discovered, is a shambles.

There is little hope for cases of asbestos-triggered lung cancer. Closely resembling the smoking-induced variety, it's just as intractable, and no existing treatment has any great impact. But the prognosis for mesothelioma is very different. "There's no good reason why it shouldn't become a chronic, manageable disease," says Dr Kenneth O'Byrne, former head of the British Mesothelioma Interest Group. "And because of how mesothelioma grows and spreads, it's also reasonable to anticipate a cure for some patients."

For the most advanced medical model, look Down Under. Galvanised by the highest asbestos-mortality rate in the world, Australia has a slew of medical world firsts, including emergent preventive treatments and immune therapies. All could be used here. "So we'd not be looking for huge government monies," said O'Byrne.

In the UK we have barely got started. There's the MS01 chemotherapy trial, some pioneering palliative care by Macmillan nurses, the new National Macmillan Mesothelioma Resource Centre in Leicester, and that's about it. Radical surgery is still experimental, with no hard data yet on its efficacy. "Because lab research is almost nonexistent," said Dr Jeremy Steele, consultant specialist in asbestos cancers at St Bartholomew's hospital, London, "nor do we have much of a clue about the mechanisms by which asbestos initiates malignancy, or the genetic aspects of the disease."

Right now, the asbestos subcommittee of the all-party Parliamentary Group on Occupational Safety and Health is creating a UK strategy for tackling mesothelioma, to place before the public health minister, Melanie Johnson. "Better late than never," says John Battle, Labour MP for Leeds West and anti-asbestos campaigner for 20 years.

As it is, a quarter of patients are diagnosed too late for any aggressive treatment. "There isn't the medical expertise out there," Steele explained. "Too many patients never get to see a mesothelioma specialist, and are referred instead to a general cancer specialist or a breast-cancer specialist, who'll say that there isn't any treatment that's effective."

Outrageous as it is, the lack of government funding comes down to the largely unremitting convention that, for cancer research, charities must dig ever deeper. Some government monies have become available for research across a range of thoracic and oncological conditions, but none has been designated specifically for mesothelioma. Prostate cancer gets £4.2m a year.

"The establishment of the National Cancer Research Institute here four years ago seemed like a step in the right direction," said Steele. "The idea was to replicate the US National Cancer Institute. But the UK institute is 'virtual' ï ˜ not much more than an internet network ï ˜ with very little money compared with America's vast research and treatment centre in Maryland and its protected federal budget: $4.7 billion for 2004."

"One reason for the lack of funding," says O'Byrne, "is the profile of the average victim ï ˜ primarily men in the twilight of their working lives who are not 'economically viable'." Compare and contrast with the Ford motor company's sponsorship of Breakthrough Breast Cancer.

Nor does any glamour or kudos attach to mesothelioma within medicine's hierarchies. Says Steele: "You get medical people who say, 'Why on earth are you bothering with that disease?'"

The stock explanation for our medical establishment's slowness sounds plausible: until recently, mesothelioma cases were too few for medical experience to achieve the critical mass essential for mounting a national programme. The big hole in that argument is the superb example set by Australia, which as yet has received no central government funding, although some states have contributed around $8m over the past decade. The shaming fact remains: because of its relatively small population, Australia has far fewer mesothelioma cases annually than the UK. Plainly, will and determination are more important than patient numbers. "We've had a long-term deep denial by the asbestos and insurance companies, by lawyers, scientists and the medical profession, that people were dying," said John Battle.

Consider these two time lines. Asbestosis was first described in 1906, asbestos-triggered lung cancer in 1935, and mesothelioma in 1943. Brown and blue asbestos (blue is the most carcinogenic) weren't banned here until 1985; the ban on white wasn't effected until 1999, two years after new Labour's election promise to do so. Then what? In November, Hartlepool's dock community went ballistic when decaying, asbestos-laden ships arrived from the US for decontamination. The ship deal was a spectral reminder of a 100-year saga, during which the human rights of asbestos workers were never allowed to impinge upon Britain's economic and industrial imperatives.

The start of the epidemic was officially marked in 1906, when a parliamentary commission confirmed the first British asbestos deaths and recommended better factory ventilation. With the number of victims still rising, it took until 1933 before a maximum permitted level of airborne dust was fixed by parliament. It was the level decided by the industry's bosses.

Incredibly, people are still dying as a result of this 1933 dust datum. Set at the density of dust in those factory departments where the lowest incidence of disease had been recorded, it not only established the principle of an acceptable level of industrial deaths, it remained in place for 40 years. But such "protection" applied only to scheduled factory employees; it did not extend to casual or shipyard workers.

Meanwhile, our asbestos industry grew into the biggest in the world. By 1939, just three companies ï ˜ Turner and Newall (T&N), Cape Asbestos and British Belting and Asbestos ï ˜ commanded 40% of the global market. As well as for pipe and boiler lagging, brake shoes, conveyor belts, tiles, roofing, wallboards, cement, ironing boards and oven gloves, asbestos provided fireproof insulation in power stations, ships, railway carriages, cinemas, theatres, offices, civic piles and homes. Lo, the "magic mineral", "white gold", "Lady Asbestos", guardian of the people's safety. But workers' safety remained a black hole of indifference. In 1953, even the shocking discovery that employees in one of the better-ventilated asbestos factories had a tenfold increased risk of lung cancer was ignored. "Nor was the TUC any help," said Nancy Tait. Since her husband died of mesothelioma in 1968, Tait has been Britain's fieriest campaigner; she runs the Occupational and Environmental Diseases Association. Her early negotiating tactic was to dump a bag of white dust on the table: "So, you say this stuff isn't dangerous?"

"Well into the 1970s, the TUC cared less about health and safety than they did about maintaining jobs and arguing for danger money," says Tait. Now in her eighties, she won four important precedents in compensation cases last year.

"The employers knew the dangers all right, but only ever went through the motions of safety," said Tony Lloyd, Labour MP for Manchester Central, who worked for T&N in the late 1960s. "Sometimes you couldn't see the person next to you for dust. We looked like Homepride flour men."

In 1969, after a survey at T&N's Rochdale plant, a new dust limit was incorporated into Asbestos Regulations: two asbestos fibres per cubic centimetre of factory air. "That may not sound much," said Professor Geoffrey Tweedale, occupational historian at Manchester Metropolitan University, "but it's equivalent to 2m fibres per cubic metre of air. Add in the rate of breathing, and you could inhale a billion fibres a day." In setting the new limit, the industry refused to use an electron microscope but chose the bog-standard optical sort, which, at best, can "see" only one fibre in every 100-1,000. And it won several years more to comply. When the government moved to further tighten statutory control in the mid-1970s, concerted lobbying delayed any new dust thresholds until 1982.

Confined to those people who worked directly with asbestos, the first phase of the epidemic barely punctured public consciousness. As with other industrial diseases, it was just something nasty that went on behind factory gates. In October 1965, however, The Sunday Times blew the lid off phase two: the past and future reach of asbestos poisoning outside the workplace. Two intrepid epidemiologists, Muriel Newhouse and Hilda Thompson, had collated the occupational and residential histories of patients who had died of mesothelioma at the London hospital during the previous 30 years. The cancer's high incidence among deceased employees of the Cape Asbestos factory in nearby Barking wasn't surprising. But people living up to half a mile away had also died of mesothelioma. This was the first UK evidence of environmental asbestos pollution, now called "neighbourhood cases". And there was "bystander exposure". Several relatives of asbestos workers had died simply from living in the same house. They included a woman who used to launder her husband's overalls and two men who had been boys of eight and nine when their sisters had worked at the factory.

Today, 1965 is considered the watershed year in compensation cases. After that date, no manufacturer, employer or insurance company can claim not to have known the dangers. T&N saw them immediately. One director, in a memo dictated that Sunday, October 31, 1965, began: "You will have seen the front-page article in the 'Sunday Times', which is highly unfortunate."

But not unfortunate enough. "For compensation for neighbourhood exposure, you had to prove where the dust had come from," said Nancy Tait, "and it took another 30 years to win the first of those cases."

For a snapshot of the difficulties, consider the unfinished Armley saga. In 1988, John Battle called for a public inquiry into a recently discovered cluster of mesothelioma and cancer deaths in Armley, Yorkshire, around the site of the old Roberts asbestos factory, which closed in 1956. The Thatcher government argued that an inquiry would cause needless concern, and that it would be impossible to discover what had happened all those years before.

It hadn't been impossible, of course, for Newhouse and Thompson. And Battle and a volunteer had located the 1920s records of a concerned local GP, including photographs of Roberts' workers and nearby residents, mortally ill and sunken-eyed. They'd also found the employee whose job it had been to clean out Roberts' ventilators. "With no filters on them," said Battle, "they'd blown dust all over Armley for decades."

T&N, which had taken over Roberts' interests, said its records had been destroyed. That was untrue. Eventually located, the records included minutes of Roberts' board members cautioning themselves in 1952 "to keep the lid on" claims that factory dust was harming Armley residents.

Battle's researcher colleague, who recalled as a lad having "snowball" fights with dust snatched from Roberts' window ledges, died in his forties of mesothelioma. Another fatally ill constituent was June Hancock. Before her death in 1997, she was the first in Britain to win compensation for neighbourhood exposure. In the 1950s she had gone to school near the Roberts factory. Her mother also died of mesothelioma. The June Hancock charity now donates what it can to mesothelioma research. "And we're still fighting the neighbourhood cases," said Battle.

There are unfinished tragedies like Armley all over Britain. Other disease black spots where factories once used raw asbestos include Rochdale, Leeds, Manchester, Sunderland, Calderdale, Thurrock, Newham, Tower Hamlets, Barking, Dagenham, Dartford, Bexley and Havering. The shipbuilding and dock localities of West Dunbartonshire, Glasgow, Tyne and Wear, Portsmouth, Southampton, Plymouth and Medway have disease rates of up to six times the norm. Given the time lag and the wild cards of neighbourhood and "bystander" exposure, death will continue to strike these communities, some in their third and fourth generations.

Those now most at risk in Britain are builders, carpenters, electricians, plumbers and DIY enthusiasts ï ˜ anyone who works on, or has done such work on, pre-1985 buildings containing asbestos. "And now we're encountering these diseases in other walks of life," said Jeremy Steele at St Bart's. "Since 2000, our unit has seen office workers, writers, teachers, nurses, clergymen, lawyers and doctors. Sometimes we can pinpoint the critical employment period, but not always."

Nobody has the foggiest how many homes have asbestos in them. An estimated 600,000 business premises do, but it's not known which. In 2002, over 40 years after asbestos building materials became commonplace, the government brought in the Control of Asbestos Work Regulations (CAWR). Those responsible for non-domestic premises are now charged to locate any asbestos, and to assess and manage the risk, which may or may not involve removing the asbestos. The regulations are being tightened this very week. But is containment possible?

The late Alan Dalton, author of Asbestos Killer Dust, warned in 2002: "If the millions of tonnes of asbestos in our homes, schools, hospitals and workplaces is not removed... the 'asbestos cancer epidemic' will continue well into the 22nd century. We must get it right this time, for our children's grandchildren."

How did employers get away with what the TUC Hazards Campaign calls "genocide" for so long? Secrecy. On the rare occasion that a UK asbestos company appeared in court, it was only required to present those documents it chose to. But in 1991, when T&N was obliged to give full disclosure in some US legal actions, over a million previously secret documents ï ˜ including the Armley records ï ˜ hit the public domain. One splendid result, published in 2000, was Magic Mineral to Killer Dust, a centenary history of T&N, by Professor Geoffrey Tweedale.

Take, for example, the activities of the Asbestosis Research Council (ARC) between 1957 and 1990, when it was wound up. Although impartial-sounding, it was an industry artefact. "Modelled on the tobacco industry's example," said Tweedale, "the ARC always argued that the links between asbestos and disease were unproven and that more research was needed." The ARC's very title avoided any acknowledgment of asbestos cancers, and it never once initiated an epidemiological study of asbestosis or any work on its human pathology.

The ARC was the prime UK source of asbestos-research funding and information. Hence the Factory Inspectorate, academics and medical journals reproduced ARC views almost verbatim. Even The Sunday Telegraph has in recent years followed a similar line, via its columnist Christopher Booker, an opponent of the ban-asbestos lobby, whose chief "expert adviser", John Bridle, is the same self-styled "unpaid consultant to the Asbestos Cement Product Producers Association" who briefed the shadow minister John Bercow when he and Iain Duncan Smith fought against CAWR in the October 2002 Commons debate.As it happens, last month Bridle was found guilty on three counts at Barry magistrates' court, in Wales, of making false statements about his professional qualifications and fined £2,700, plus costs.

ARC clones were set up in the US and Australia, and Canada's equivalent still promotes the "controlled use" of asbestos, selectively citing ARC findings to demonstrate that white (chrysotile) asbestos is safe.

What taxes Tweedale most is the decades-long "ambiguous role" of our doctors. "None of them called for an asbestos ban when it might have counted. Only the Admiralty did the right thing when mesothelioma appeared. On the advice of Royal Navy Surgeon Commander Peter Harries, a medical programme was introduced in the mid-1960s at Devonport, and the navy rapidly phased out asbestos in favour of substitutes. Recent studies of Devonport workers suggest that the incidence of mesothelioma may be falling ï ˜ a trend not yet apparent in other UK black spots."

In defence of the medical profession ï ˜ what with government and unions taking so little interest ï ˜ Tweedale says doctors were obliged to work with industry. So much so that they fell in line with the "acceptable risk" argument. "But what you also see is an establishment mentality at work, where top industrialists get on well with top physicians, and there's a kind of entente cordiale."

Australia has a wholly different take. "Faced with the worst industrial disaster in our history, we agreed to throw the best of modern medical research technology at this disease to give us the chance to find something that can help us and the rest of the world." So says the leading figure in Australia's mesothelioma programme, Professor Bruce Robinson of the Queen Elizabeth II Medical Centre, University of Western Australia, Perth. Australia's misfortune was its several asbestos mines, huge international demand for what they dug out of them, and such a cheap alternative to timber that some 30% of houses since 1950 ï ˜ fibro houses ï ˜ were built with asbestos. Today, one in every 230 Australians has a lifetime risk of asbestos disease.

Unique in the world for contamination is Wittenoom, near the north coast of Western Australia. The once-thriving town was built in the 1930s around the country's most productive and lethal blue-asbestos mine and mill. Roads, golf course, racetrack, airport, drive-in cinema, front driveways and playgrounds were all made of blue-asbestos tailings. Eventually emerging as the epicentre of the "blue curse", its ex-workers ï ˜ those that are still alive ï ˜ are now known to have a 16% risk of disease; and time from mesothelioma diagnosis to death is around six months. In 1978, back when asbestos tumbleweed used to bowl round the place, a $2.3m clean-up of Wittenoom started. It was pronounced a failure in 1993. The government officially closed down the town in the 1990s. Now it's a ghost town of just 40 residents who refused to budge, and it still functions, bizarrely, as a tourist beauty spot.

Australian doctors and scientists began to form a national mesothelioma strategy about 10 years ago. It was taken over by the Australian equivalent of our Medical Research Council in 2001. "As well as a small number of centres of excellence," Bruce Robinson said, "we have a national co-operative research group, sending tissue and blood samples between centres for different avenues of research: diagnostic methods, new blood tests, and the mechanisms that initiate this disease. We're pretty well co-ordinated here." Australia is blazing the treatment trail, too. "Like this: step one, surgically remove as much cancer as possible; step two, chemotherapy; step three, administer an immune vaccine for an extra boost."

A gene therapy, the immune vaccine is just one Australian world first. "When the patient has surgery, instead of throwing the tumour into the bucket, you turn it into a vaccine in the lab and inject the patient with that along with some other vaccine and some additional molecules, which stimulates the immune system," explained Robinson. "It hasn't cured the cancer yet, but adds to surgery and chemotherapy. The patients live longer, so it's a good weapon."

Another is the discovery by his team of an early blood test for mesothelioma. The blood marker ï ˜ mesothelin-related proteins secreted by the very first cancer cells ï ˜ can be detected up to three years before the patient would show full enough symptoms for an early, stage-one diagnosis. "That's terrific, because the sooner you catch it in people who are otherwise fit and robust, you have the best possible candidates for treatment," said Robinson. "The marker showed only in 25% of patients, but that's an exciting result for what was our first try."

Another world first, developed by Robinson's colleague Professor Bill Musk, is a preventive treatment. In 1990 his team gave dietary retinol ï ˜ just vitamin A ï ˜ to some ex-Wittenoom workers. By 2002 they showed a significantly lower incidence of mesothelioma than other workers exposed at Wittenoom.

Australia's mesothelioma programme is based on a long-range, radical strategy. "Our government had become aware of the enormous compensation costs," Robinson says. "According to insurance company calculations, mesothelioma is going to cost Australia up to US$10 billion over the next 35 years, America $200 billion, and Europe, including Britain, around $80 billion."

The compensation issue is now approaching stalemate. T&N hasn't paid out a penny since it was put into liquidation by its American parent, Federal Mogul, more than two years ago. But an estimated £20m would settle all British claims against T&N. Meantime, its UK administrators and solicitors ï ˜ although doing a good job ferreting out the liable insurance companies ï ˜ have already absorbed £23m in fees. In litigation-crazy America, 200,000 claims have been filed against T&N, some based only on the fear of getting asbestos disease. "What's driving me crazy," says Battle, "is that these thousands of potential American cases are first in the queue. And while the insurance companies play their long game, our genuine claimants ï ˜ those who haven't died already ï ˜ are only too aware of their mortality."

Introduced by the Manchester-based claimants' solicitor Anthony Coombs, I visited several of his clients. One was Ernest Holt, 73, a mesothelioma victim diagnosed far too late. Although very ill and acutely breathless, he was determined to hang on until the golden anniversary of his marriage to Mavis, and equally determined to talk to me, "in case it might help". But he kept breaking down, once letting loose with: "I'm sorry, I'm sorry, but I'm so jealous of other people."

The Holts won their compensation case against the maintenance firm Ernest used to work for, sawing up asbestos wallboards. It's not much money, but enough for Mavis to get by on, perforce alone. As she explained at the time, "The best thing about the settlement is that Ernest is now able to put his mind to other things in the time we have left." In the event, it was five months: Ernest Holt died on April 29.

The Australians have worked out a bold route through the compensation mess: placing the insurance and the asbestos companies as well as national government at the heart of a large and unprecedented funding pitch. "Since they're looking at liabilities of between $5 billion and $10 billion in Australia," Robinson explained, "it's our intention is to ask for just 10% of that to develop preventive treatments and a cure for mesothelioma. And we won't have to save many lives to make it well worth their while."

As Britain's all-party asbestos subcommittee prepares to make its initial bid for a national mesothelioma strategy, the word is that Tony Blair is "listening". Meanwhile, the breathless shuffle on towards their dusty deaths.

CASE STUDY

George Cahill, 51, is fit-looking, good colour, head shaved in an 'up for it' sort of way and big enough to carry it off. Nothing looks wrong. But he keeps getting flashbacks from years ago: carting his four kids on his shoulders, placing a rugby ball so that they could learn to kick. Two years ago, George and his girlfriend began doing up his little semi in Salford. The front room is a picture; the rest is still a dump. "That's as far as I got before I found out," he says. First, George mistook a sharp left-side pain for a heart attack. When it recurred, and he was sent for a biopsy, the surgeon couldn't get the tube in. The pleura had gone solid: mesothelioma, the result of asbestos exposure.

His fatal contact ï ˜ as an apprentice working on City of Manchester parks-and-gardens vehicles 36 years before ï ˜ had been with asbestos-lined brake shoes. "You'd blow the dust out first and, when you changed the shoes, you'd grind the new ones to give 'em a nice leading edge. End of each shift, we'd squirt the dust off each other with an airline. We had no warning, were given no masks. I'd been carrying this stuff in me like a time bomb."

George is a volunteer in MS01, the UK's first drug trial for mesothelioma, and his ex-wife and kids "have been brilliant". His compensation case against the City of Manchester has been successfully settled. "The Macmillan nurses suss out if you can take it, and they told me it's not a pretty disease." But he is optimistic. "After four chemo sessions I had a CT scan, and they said they'd been shrunk by 50%. What 'they' were, no one told me. They caught me early, and I reckon they wouldn't have bothered with chemo otherwise."

*** POSTED MAY 24, 2004 ***