This podcast contains the personal stories, opinions and experiences of its speakers, rather than those of Breast Cancer Now.

In this episode, I've just had a brilliant chat with Rosamund Dean, the writer and journalist. And it was fascinating because I've read lots of Rosamund's writing over the years and I've read her thoughts on wellness and her cancer experience, but I've never actually sat down and had a big long chat with her. And today was that chat. I think one of the things that came out of it was how everyone approaches the breast cancer experience differently. Rosamund was not an exerciser. She didn't like exercise and she led quite a sedentary lifestyle before she was diagnosed. And so she is now trying to figure out ways to find exercise that she enjoys so that she will keep it up in order to reduce the risk of her breast cancer returning in future. And I really enjoyed speaking with Rosamund, so I hope you enjoy it too.

Today we're speaking to Rosamund Dean, a journalist and an author who was diagnosed with breast cancer in 2021. Rosamund was diagnosed at the age of 40 and she documented her journey with a column in the Sunday Times Style magazine. She went on to write a book called Reconstruction, How to Rebuild Your Body, Mind and Life After a Breast Cancer Diagnosis. She also writes a newsletter called Well, Well, Well. where she chronicles her efforts to future-proof her body in a way that is both relatable and doable. Rosamund's breast cancer was triple negative, a type of breast cancer that doesn't respond to hormones like estrogen or the growth factor known as HER2. We've talked about triple negative breast cancer on the podcast previously, and we'll be recording an episode focusing on triple negative later in the series, so stay tuned for that. Rosamund. Thank you so much for joining me and welcome to the Breast Cancer Now podcast.

Thank you so much for having me.

So you talked all about your diagnosis on that podcast episode that you recorded with your husband Jonathan back in 2021. But would you be able to give us just a little kind of recap on your diagnosis and your breast cancer treatment?

Yeah, of course. My goodness. 2021 feels like approximately 100 million years ago now. So yeah, I was diagnosed in January 2021. with stage three, grade three, triple negative breast cancer. And my treatment was, it was quite intense. It was five months of chemotherapy before they could do surgery. Then a mastectomy. I had DF flap reconstruction, which is quite major surgery. And then after recovering from that, I had radiotherapy for three weeks. And then a further year of adjuvant chemo to reduce the risk of recurrence. So yeah, they kind of threw the kitchen sink at it, which, you know, I'm very grateful for now that I'm out the other side. I wouldn't say I was very grateful at the time.

You say you're out the other side, which is fantastic news. So where are you out with it now?

So as you know, with triple negative breast cancer, there's nothing that you can take on an ongoing basis. There's no kind of hormone therapy or targeted treatments. So yeah, now. I'm out of active treatment and the only treatment that I still have are Zometa infusions every six months, which are the bones. It has a double benefit. It reduces the risk of recurrence in the bones and strengthens the bones as well. So, that's it's apart from going to see my oncologist every four months, I kind of live my day to day life not feeling like a cancer patient anymore.

And would you be able to explain for anyone who is not familiar what triple negative breast cancer is from your point of view?

Yes, as not a doctor, my very non medical understanding of it is that it's a disease that's kind of defined by what it isn't. So most breast cancers are either estrogen receptor positive, progesterone receptor positive. or her too. And so triple negative is none of those three things. And as I understand it, the latest research is kind of understanding that triple negative breast cancer isn't one thing. It's sort of lots of, there are lots of different variations of it. And I know that work is underway on amazing new targeted treatments for certain types of triple negative breast cancer.

Including by breast cancer now researchers as well, I had the opportunity to tour that lab, which was fantastic last year to see some of the work that they're doing.

yeah.

Wow. It's just, it's incredible the work. There's such clever brains working on this and it's, you know, it's, it's the reason I'm still around today and so many other people. So yeah, it's incredible the work that they do. Now there is immune therapy that is very effective with triple negative breast cancer, that's very, very new. So when I was treated on the NHS, that wasn't available yet. That's only become available since then. But I think that type of immunotherapy can reduce the risk of recurrence by like 40%. So it's amazing. Treatments are coming on every day.

Yeah. And it is amazing to think that, you know, it's only been four years, which is a very short amount of time for you since your diagnosis. And to think that there's already new treatments available is incredibly hopeful.

Yeah, I when I was diagnosed, one oncologist said to me 10 years ago, this would have been a death sentence.

Wow.

Yeah, like, it's just, it really made me realise how lucky I am to, I feel incredibly, incredibly lucky and grateful to all of the doctors and scientists who've produced this amazing treatment that on the NHS here, it's just, it's just incredible.

So you talked there about recurrence and, you know, obviously doing everything possible to stop the breast cancer coming back for you. And that is something you've talked about before, you've written about before the fear of recurrence. What does that mean for your mental health?

Well, it's interesting because when I was diagnosed with breast cancer, didn't... I've heard so many people talk about the fear at that initial diagnosis. But for me, weirdly, the fear came at the end of treatment because when I was diagnosed, this sounds mad, but it didn't even cross my mind that I might die from breast cancer.

I was exactly the same.

Really?

Yep, exactly the same.

Oh, that's good to hear. I thought I was such a weirdo because I thought, you know, breast cancer, you know, that's what Kylie had. Yeah, it's totally treatable. Breast cancer is very survivable. I didn't, I wasn't scared really. I was scared of treatment. I knew that would be really hard, but I didn't actually think that this could be something that killed me. So it was only really, to be honest, it was only at the end of treatment when I really naively expected somebody to say, that's it, treatment's over, you're cancer-free, go forth and live your life being cancer-free and healthy. And instead they said, so with this type of breast cancer, there's about 40 % risk of recurrence and because it's very aggressive. comes back. They basically said you wouldn't have long if it does come back and there's a 40 % chance it might come back. So um, that was the time when it kind of hit me. I think also when you're in the sort of initial phase of really intense active treatment, you're just living day to day and coping with what you have to cope with. So you don't, it kind of doesn't really sink in. What it actually means, know, the reality of it kind of hits you later. So yeah, I definitely found it more difficult at the end of treatment.

Yeah, which I know is true for a lot of people. I think that's completely normal. And I think one of the reasons I mean, I was I was younger, I was 29 when I was diagnosed. And as I said, I I it never crossed my mind that I would die from it. And I think I think that was a naivety because fortunately, I hadn't been I hadn't been in the world of you know, I hadn't been in the cancer community, so I didn't know people who had died from it I didn't know that much about it. And I think that's good. I think it's good to have that naivety and to not know much about it because it's good to educate ourselves, of course, and to know the signs and symptoms. But sometimes we also have survival mechanisms, I think, and maybe that sort of those blinkers on at the beginning.

Yeah, it's such a balance, isn't it? Because I've heard people talk about that. point at the end of treatment and how people should talk to a patient coming to the end of their cancer treatment. And I've heard some people say you shouldn't scare people by telling them their risk of recurrence and talking too much about the fact that it might come back because it can send them into a spiral. I know it sent me into one. But then also on the other side of it, if people are not aware of what they need to look out for in terms of signs and symptoms of secondary breast cancer, which lots of people don't know the symptoms, then, you know, it might not get picked up as quickly as it could do. it's such a difficult situation because I can see both sides of the argument for sure.

Yeah, it's a real balance. And also everyone is so different. Some people prefer to have the knowledge and the knowledge is power. And other people just want to forget all about it and get on with their lives.

Yeah.

So what coping mechanisms have you developed over the years to cope emotionally with living beyond breast cancer?

I found something that really helped me. Well, first of all, I had therapy, which helped me a lot because I was in a total spiral. I was just... I was having panic attacks for the first time in my life. I've always been a very kind of relaxed, easygoing person who doesn't get stressed and can kind of roll with the punches. And that it just really sent me into a spiral. So therapy helped me a lot because it was the thing about therapy is talking through how you feel with somebody who has no emotional connection to you. So if I talk to my husband or my mum or even my friends about how scared I was feeling, it's going to make them scared as well. Like that's a, you can't really be open about how scared you actually are because you're trying to protect that person as well. So I think that's the really powerful thing about therapy. And yeah, if anybody, I know you can be referred by your oncologist to speak to psychologists and Macmillan has access to people as well. And I would really recommend that talking to somebody that's kind of not, doesn't have that personal connection to you. So yeah, that really helped, helped me put it in perspective. And my oncologist told me that if I have a symptom that I fear could be recurrence, if you have, you know, pain in your chest or in your back or headache or a symptom that you feel could be a sign of recurrence, then set a reminder in your phone to check if it's still there in two weeks and then just try and forget about it because setting that reminder gives your brain permission to forget about it because you are going to be reminded and when that reminder goes off, nine times out of ten, it's gone because you've managed to forget about it but if it's still there then you know that it's worth speaking to your oncologist about it. And I have had a couple of times where I've gone in and said, I still have this pain and I've had scans and it's all been fine. But yeah, the further you get away from treatment, the easier it gets. So time really helps. That's been a big thing for me. And another thing that has helped me is taking control in terms of being proactive. about my health because there are things that you can do to reduce your risk of recurrence. Obviously, always have to be very clear that there is no magic bullet and you could do everything right and still get cancer. But you know, it's a it's a kind of scale and there are things that will increase your risk and things that will reduce your risk. So I try and do more of the things that will reduce my risk.

My own technique for that is I have a notes app on my phone where I write down everything. So I'll say, cause it's also, sort of a tracker that helps me to figure out where I am at certain parts of the month. So I'll write things like having lots of hot flushes today or this week, or yeah, just loads of different symptoms. Or for example, if I've last week, I was working out in the gym and lifting weights and I had new pains kind of in my chest area and the immediate thought is could be related to breast cancer. But then I was like, no, I was in the gym yesterday. And so that goes into my notes app. And so then if in a few weeks time or in two months time, there is something that I can see, there's a pattern recurring, then I know how long it's been going on for. But I also like your idea of setting the alarm, because as you say, that allows you to forget about it rather than writing it down every day.

So Yeah, and if you do make notes, then if you do mention something to your oncologist and they say, well, how long has this been going on for? Then you are actually able to tell them.

Exactly.

Without being like, oh, I think, I'm not sure.

Exactly.

So yeah, writing everything down really helps.

Yeah.

So when you're on this podcast before you came on with your husband, Jonathan, and you also wrote a column about your breast cancer in the Sunday Times Style magazine together because you are both journalists and What I loved in the podcast was you talked about how amazingly supportive Jonathan was, particularly with the logistics stuff. So doing cooking and looking after the children. You've got two young children and, um, and that kind of allowed to, allowed you to take some of the weight off yourself so that you could focus on your treatment. But that made me think about Jonathan and what support he was getting. Has he also been able to have, uh, therapy or some other kind of support?

He has not had therapy. No, he's, he's, um, yeah, he decided not to do that, but he's, he's just been brilliant and, he's got good friends that he can talk to. And, um, I, it's, it's funny when we talk about him, uh, helping with cooking and looking after the kids and stuff when I was going through treatment, because it makes it sound like he doesn't do that stuff all the time. And he really, like, he cooks way more than I do anyway. So, um. Yeah, he's just he's brilliant anyway, and he was especially brilliant throughout treatment. And I think because I was diagnosed in lockdown, it was that really, it was that really depressing bit of lockdown where all the schools were closed. So we were homeschooling our two kids. And, it was January and February, and it was just a really, really grim winter. So it was a pretty bleak time and he kind of held all together and he organised this kind of patchwork of childcare within a bubble of people to look after our kids so he could drive me to chemo. And it was all very complicated logistics. And yeah, I mean, I wouldn't like to speak for him. But I think all of that organising maybe helped, you know, gave him an element of control over the whole situation.

Gave a purpose as well, perhaps.

Yeah, exactly.

So we're now four years on from your initial diagnosis and I wondered if you still speak to your kids about cancer and if you still have those conversations and do you still kind of reassure them as you go along or has cancer kind of been forgotten in your household?

Yeah, it's really interesting because then they were three and six and we were just very matter of about it. We didn't overload them with information, but we told them the truth. So they knew that I had breast cancer and I was getting treatment. And, know, it was just it was a very, we were just very matter of fact about it. And I think especially because it was locked down, all four of us were in the house altogether all the time. So there was no if we'd have tried to hide it from them, then it would have been like whispered conversations. And I think actually would have been scarier for them. So we were just very straightforward about it and very honest. And obviously I didn't share my meltdowns with them. We didn't give them too much information, but we gave them the information that they needed to know what was going on. So now they're seven and 10. yeah, they remember I had breast cancer. They will occasionally say something like, remember when you lost your hair? And my daughter, who's at seven now, whenever we walk past cancer research shop in our local town, she always points out and says, cancer research is great. That's what saved you.

Oh!

So yeah, it comes up every now and then, but it seems to just be a very normal part of life and the thing that happened. for them, it's not kind of scary or a traumatic event. And I'm quite proud of that, they seem to have come through it unscathed.

And they're still very young. also you say come through it unscathed, but obviously it was locked down at that time as well. So any issues that they might have afterwards, it's the generation of kids who were in, know, were that age when we're in lockdown. So I think everyone is affected by that in some way, perhaps.

Yeah,

Or not affected if you're a young child, we're probably more affected than them.

Yeah. Yeah, I think if they were older, maybe lockdown would have affected them more when your friends are more important to you. But because they were so young, I think they just loved being at home with us all the time.

Is there anything you would say to other parents who have been diagnosed with breast cancer who are looking to talk to their children about it?

Well, I would say that every body is different and every child is different and every family is different. So you really have to find what works for you. I mean, I would recommend being honest, I did lots of research and the advice I spoke to a child psychologist who advised that if you keep it from them, then because kids aren't stupid, they know when something's going on and they know if they're not getting all the information and then their mind can fill in the blanks and that can often be scarier. So if you... kind of give them the information in a matter of fact way. And, you know, I was lucky to be having curative treatment so I could tell them that I was having treatment that was making me better. So in that instance, I was lucky to be able to frame it in a positive way like that for them. But obviously everyone's different.

Yeah, I love that you went to a child psychologist for advice. That's amazing

Because I'm a journalist, I wrote a feature where I interviewed a child psychologist.

Ahh!

See, that is one thing I love about your job as a journalist is occasionally you can say, oh, I'm really interested in this new clinic that's offering this such and such a thing and can I write a piece about it? And then you can go and experience this really intriguing element of health.

It's the best thing about my job. You know, those moments where you're like, oh, I wonder about blah, blah, blah. I can just write a feature about it and ask an expert and you know look into it

what's the best or the most interesting one of those that you've ever done?

Well, there are so many little things like when I was diagnosed with osteoporosis, I did a deep dive on that and spoke to loads of bone experts and I wrote like several features about that. Same with menopause. When I realised I was going through early menopause, I interviewed loads of experts about that, about different ways to cope with menopausal symptoms if you can't have HRT. And yeah, I think probably one of the biggest ones was when, because I had a family history of breast and ovarian cancer. So they checked me for know, BRCA1 and BRCA2 genetic mutations. And I think maybe PALB. But I had the opportunity to do for a feature one of those genetic tests where they'd test like, you know, 50 genes. And that was really interesting and also reassuring because I didn't have any of the genetic mutations.

Well, all the talk of your being a fantastic journalist and finding out about all the new treatments and gene tests and things brings us onto your brilliant newsletter, Well, Well, Well. which is about future-proofing your health and helping others in the process. So what does the word wellness mean to you?

Ooh, that's so interesting because I think wellness has come to mean something quite annoying.

*Laughing*

You know, sort of sanctimonious, that cliche of drinking a green juice on Instagram and like that. It's quite un relatable. And I feel like that's not how most people live. It's not reality.

Yep.

So yeah, it's, I guess that's not the kind of wellness that has ever appealed to me. But when I, after going through cancer treatment and after being told I had this comparatively higher risk of recurrence, I was so determined to do everything I can to reduce my risk of recurrence. I wanted to be as healthy as possible. That was a really big incentive for me. And I'd never had an incentive like that before or any kind of incentive. mean, this sounds really naive in terms of what we know now about exercise and healthy eating and looking after yourself in general. But I always equated exercise with weight loss, which was You know, I grew up in the nineties. I was a teenager in the nineties and it was very much like, you know, beach body and exercise to lose weight. I think that is a complete misunderstanding of the benefits of exercise. And I just thought if, if you don't, if you don't want or feel that you need to lose weight, then you don't need to do any exercise. I didn't think that I needed to. So I just, I just didn't. I'm not naturally an exercise person. I'm incredibly lazy and if I could get away with it, I would just lie on the sofa all day.

And I think this is why I wanted to do Well, Well, Well, because so much of the advice out there about fitness and exercise and strength training is from people who obviously that they've gone into that line of work because that's their passion. They're really They love it. They love exercise. love working out. They love how it makes them feel. And I know when people talk about runners high and feeling so amazing after exercising and I just don't get that feeling. I know exercise makes me feel good broadly on a day to day basis in terms of, know I feel less lethargic if I exercise and it improves my mood. But I don't love it. I don't love doing it. And when I first decided to seize control of this and do some exercise, I started following all these people on Instagram thinking, oh, they'll really inspire me. But actually, they were just like, just do it, just like do this exercise. And I was like, but how?! If you can't be bothered, how can you actually make yourself do it? So it wasn't so much that I've... you know, lots of the advice is do the this kind of exercise for this number of reps. And I really wanted advice about how psychologically to make yourself exercise when you when you just don't feel like it.

And how do you do that now?

Well, I would say a really key thing is finding a form of exercise that you actually enjoy. Don't force yourself to do something because you've heard it's the best thing to do. Like if you find it bleak and depressing to be in a gym, then don't join a gym like you don't have to. There are so many different ways to move your body and be healthy. And I personally love reformer pilates, which is an expensive habit. So I don't do it as much as I would like to. And I like running in the summer, but I'm very much a fair weather runner. I don't want to run in the cold and dark. And yeah, but I used to think if I'm not doing something consistently or if I stop running because it's cold, then I've like failed. Whereas now I'm a lot more relaxed and adaptable and a bit like if it doesn't feel good for me, then I'm not going to force myself to do it because there will be something that does feel good for me. I do like yoga and Pilates and I like those kind of classes. And I just walking, I love walking and walking with friends. Something I got into during the pandemic. I know lots of people did and lots of people kind of got out of it after the pandemic. But I think it's really worth keeping up with that because I've had some of the best chats with my friends on long walks.

Yeah, I mean, you're covering all the bases there as well of physical health, mental health. you know, emotional recovery and wellbeing and everything else, but also doing gentle exercise, not putting too much strain on your bones, joints, muscles and everything else.

Yeah, yeah, exactly.

So you've written about sleep, stress, spirituality, brain health, menopause, loads, loads more things. Is there a single biggest learning you've had in terms of wellness and health?

The biggest learning is just how different everybody is because everybody has a different approach to health and a different, Some people love exercise, but they just can't eat healthily. They just can't give up their Haribo or whatever it is. And some people like eat perfectly. They love cooking and they love experimenting with different vegetables and they eat amazingly, but they just can't face exercise. And some people do all of that great, but they're just mega stressed and they're not helping themselves in that area of their life. And I think it's so easy to feel so overwhelmed by the world of health and wellness, because there's so much advice out there. So what I try to do is just make it as simple as possible and make it easy and make it fun, because you're not going to stick with it unless it's fun. making something sociable always helps. And with food, there are so many different ways that you can experiment with different things and ideas. And in terms of stress, because stress is a huge, it's a huge one because there's so much evidence to show that being stressed can really impact your skin, your immunity. But it's one of those things that if you tell people stress is bad for them, they're like, great, like another thing to stress about. Now I'm going to stress about being stressed. There are various stages in our lives when we, I remember being very kind of stressed and perfectionist and people pleasing and working all the time in my twenties and getting into my thirties and having kids made me chill out about quite a lot of stuff. But then having had breast cancer, even more. Now I just have such a low level of tolerance for any unnecessary drama or, you know, politics or I'm just, there are very few things in life actually matter and are important to me. And I find it so much easier now to prioritise them. And I do think if you're, if you're feeling very, very stressed and anxious and finding it difficult to cope with, then it's can be helpful to turn your perfectionist tendencies towards this and say, I'm really going to prioritise my stress management and, you know, make a commitment to go to yin yoga every week or listen to some something on the Headspace app or, you know, use those tools because they can be really effective. It's not just namby pamby nonsense. It really has a powerful effect on your whole body, not just your mind.

Yeah. So focusing specifically on mental health, but away from stress, what techniques have you learned through your research?

I would say prioritising sleep is really important because when you're tired, everything is just much more difficult. I definitely prioritise sleep over everything now, so I'm a big fan of an early night. And relationships. are really important. your friends, your family, spending time with people you love, talking things through, that's all there is really. That's just the most important thing, your relationships with other people. And they provide so much benefit in terms of your emotional wellbeing, but also your physical wellbeing. There's so much evidence to show that having good relationships is one of the markers of a long healthy life.

Yeah, one of the things I was actually going to ask you about was social media, because I feel like social media is, we can't really talk about wellness without talking about social media and the impact it has on our mental health. What, how does social media affect you and what's your relationship with it like?

It's kind of a double edged sword, isn't it? Especially when it comes to breast cancer, because When I was diagnosed, I found so much help and support on social media. I found, you know, the doctors are brilliant and I'm definitely not, I wouldn't say a word against my doctors. But there are so many things that you don't get support for because there are so many little things, aren't there, when you're going through cancer treatment. I just remember being on so many drugs because during chemo, give you anti-sickness pills to deal with the nausea and then they give you laxatives because the anti-sickness pills cause constipation and then they give you steroids and then they give you sleeping pills because the steroids keep you awake at night and they, you know, injecting myself in the tummy with the thing that brings your neutrophils.

Oh, the philgrastin was it?

Yes.

Oh, there's another one as well.

No it was that one, philgrastin. yeah, there was never any conversation about, you know, you can improve your white blood cell count in lots of ways, but with what you eat and how you move your body and getting enough sleep and, you know, there are other ways, there are other ways to deal with all these things. And I remember I had such bad math ulcers during chemo, my whole mouth was just like full of them. It's just eating was so painful. my oncologists prescribed, you know, industrial strength painkillers, would sort of dissolve and gargle. But it was actually people on Instagram that messaged me with like other tips that really, really helped in terms of certain foods. And I just feel like I got so much support and advice from the breast cancer community on Instagram. So it was a really, really positive thing for me. But then it is a double-edged sword and once you're in the breast cancer community on Instagram, then obviously inevitably there's really sad news on there far too often, which is obviously just upsetting on a human level, but then also quite triggering if you're living with kind of fear of recurrence anyway. it is a balance. You have to learn to enjoy the good parts of it and then have boundaries when necessary. I would say around breast cancer awareness month, definitely had some social media boundaries.

Yeah. And I think you were talking about friends in the breast cancer community might come to you and suggest a solution to your mouth ulcers, for example. I just wanted to point out that obviously you can only take that advice from people you trust and you you back up that advice with your own research or perhaps checking with your oncologist or medical team because you know there are unfortunately people on social media who will recommend things that aren't you know that aren't legit and we did an episode about that last season in fact with Dr Liz O'Riordan about how to figure out who you can trust on social media and what the most trusted sources are so.

Yes that's a really important point because there is a lot of nonsense out there as well. I like to think I'm quite good at kind of weeding out the weirdness, but there's a lot of it out there.

Yeah, and I think what you said about relationships, which brought me onto social media, made me think that I think sometimes if your mental health takes a dip, sometimes for me that can be because I'm spending too much time either alone or alone and therefore on social media and you can get into that hole or that doom scroll and actually calling a friend or going for a walk with a friend and having that relationship in real life can be the thing that brings your mental health back up, can't it?

Yeah, absolutely. It's almost like social media is like the fast food of socialising. It doesn't nourish you in the same way as having a in-depth conversation with a friend does.

So yeah, it's kind of, you know, convenient sometimes.

Yes. In terms of physical health, you actually wrote a book called Mindful Drinking before your breast cancer diagnosis, which was about reducing alcohol intake. What's the relationship between breast cancer and alcohol?

They are incredibly closely linked. And it's interesting because when I was writing Mindful Drinking, the whole idea behind that book was that there are lots of books out there about sobriety and a lot of people don't want to be completely teetotal. They just want to have a better relationship with alcohol or a bit more control. so mindful drinking was the whole idea was it was very non-judgmental and not scary and not going to be kind of throwing scary stats at you or anything. It was just going to be a very compassionate, useful, practical guide. to drinking less alcohol. But when I started researching it, I couldn't believe the statistics about breast cancer. Like there are over 100 studies really clearly proving the link between drinking alcohol and breast cancer. it was interesting because I had no idea about that before I wrote the book. And then when I was diagnosed, I remember I I signed up for all of the, you know, they give you lots of pamphlets about the kind of holistic things that are offered on the NHS. And I signed up for this nutrition workshop, and it was all on zoom, obviously, because of the pandemic. And I was in this on this video call with all these women who had breast cancer, and the nutritionist started talking about alcohol and going through all of the research and showing the evidence to show how closely linked drinking alcohol is with breast cancer. And all of the other women on this call were like, what? Like they were so shocked. And I kept quiet. I was like, I literally wrote a book on this. But I didn't know it before I wrote the book. And I think now it's a lot more known. People are more aware of the risks. They're more aware of the link between drinking alcohol and breast cancer. And they know, I think in America actually last week, the surgeon general changed the advice around alcohol, sort of say there is no safe amount in terms of breast cancer.

Right

And even now, even now, it's a lot, there's a lot more awareness about that connection. I still think doctors, don't really like to say it because they don't want to feel like they're taking away people's joy. And it's such an ingrained part of life in the UK, maybe especially. You know, we use alcohol for socialising, for celebrating, commiserating. It's just such a part of so many day to day activities. And you've you you've been given this diagnosis, you've got all this bad news and then on top of everything, you're going to tell me I can't have a glass of wine. Like, what? So I can see why people don't want to go there too often. But it's, you know, it's unavoidable. The evidence is really, really strong. And I think it is getting easier to drink less alcohol. There are many, many more alcohol free options now. More people are drinking less. It's as as time goes on, there's been a cultural shift, especially with younger people. It's getting easier. I find it a lot easier now to go to a pub and there's, you know, if it's if it's a fancy pub, it might have a kombucha or, you know, an alcohol free cocktail. Almost always they have a Lucky Saint or an alcohol free beer. So it's much, much easier. You don't have to, you know, have your orange juice and feel like you're at the kids table in the corner of the pub.

So does that mean that your relationship with alcohol has changed completely because of breast cancer or are you sort of everything in moderation now?

Yeah, it's changed a lot. So I would say I drank way too much alcohol between the age of probably 16 and maybe 36. Okay. And then I would say having kids was a turning point because you just can't have hangovers. anymore. You can't, well there are no more lions. And then the breast cancer diagnosis was another turning point. So if there was a graph of my drinking, it probably dropped down at kids and then dropped down further after cancer. So now, I wouldn't say I'm completely sober because I do have the occasional drink, but I am like 99 % sober.

And it's important to say that, you know, if someone listening to this has been diagnosed with breast cancer and they did drink lots of alcohol or do drink lots of alcohol, it's not their fault. There are so many factors that cause breast cancer, many of which are out of our control. But what we're talking about now in this conversation is that there are some things that you can do to reduce the risk of it coming back or to reduce the risk of getting it in the first place. And one of those is drinking less alcohol, one of those is exercising more. What are the other things? Because you referenced doing multiple different things to kind of reduce your risk of occurrence. What are the things you do?

Yeah, I think you've made a really important point there because I would hate to think that anybody would ever feel blamed for their cancer diagnosis. And there's just no room for blame in this at all because every cancer diagnosis is different. Every diagnosis is multifactorial. And I certainly did lots of the things that might increase your risk of breast cancer before my diagnosis. know, I definitely drank too much alcohol. I had a very sedentary life. didn't breastfeed for very long. There was just so many things. I'm really happy to hear advice of things that can reduce my risk. I don't feel like someone saying to me, exercise reduces your risk of breast cancer recurrence. That doesn't make me feel, oh, you're blaming me for not exercising before I got breast cancer. That makes me feel like this is something I can actually do in the future that might reduce my risk of getting cancer again. yeah, everyone is different and I know people take advice in different ways. But for me, any advice I can get along those lines. I'm really, really happy to hear because I've, you know, I want to do everything I can to reduce my risk. So yeah, I'd say number one is drinking less alcohol. That's, there's a really strong connection there. So I, hardly drink at all now. Number two is doing more exercise, which is my least favorite of all the, of all the, all the things. Yeah. Some people find easy to exercise and really hard to drink less alcohol. I would say I found it much easier to drink less alcohol than to do more exercise, but I do it now. And, you know, it does make me feel better. So I am a big proponent of exercise now. And yeah, in terms of eating, there's so much conflicting advice around nutrition for breast cancer, especially. But I think it can just be, you can simplify it down to basically eat more veg. That's the number one advice. It's it's fiber, it's polyphenols, all the nutrients in veg. It's basically veg and plant foods in general.

more variety as well, because it's not anymore, I think, if we go back to the 90s and naughties, it was about... what can we take out of our diets? It was what can we deny ourselves of, which, you know, never ends well. But now it's about what more can we add in?

Exactly,

And it's about adding in spices and herbs and nuts and seeds and pulses and all these different things. And there's so much advice and information out there about that at the moment. So that is fortunate for us.

Yes, exactly. And that's it's a much more joyful way of looking at it, isn't it? What can I add rather than? what must I deprive myself of? And that has definitely changed how I cook now. I'm, whatever I'm cooking, if it's like porridge for the kids in the morning or if it's pasta in the evening, I'm always thinking, what can I add to this to have more, have more of it? Like, can I put seeds in it or can I put more herbs or, you know, another type of veg? I'm always sneaking veg into the kids pasta.

There are many patients who's sexual health has been affected by breast cancer diagnosis. Is that something you've covered in your research and your writing? And is there any way you would send patients for resources on sexual health and wellness?

It's not something your oncologist will bring up. It's just not like it's not their priority is getting rid of the cancer and quite right. you know, they do that very well. But something like that just won't come up. And I remember I remember saying to my oncologist, you know, my periods stopped like as soon as chemo started. Does that mean am I menopausal now? Like, what does that mean? And she said, oh, if you're under 40, then generally your periods will come back. And if you're over 40, generally they won't. And I was like, what about if you're exactly 40? And she was like, you know, we just have to wait and see. And I think it took me a while to realise that I was experiencing menopausal symptoms because so many of them are quite similar to chemo side effects, know, the kind of the impact on your mood and your sleep and brain fog and all those things that are side effects of chemotherapy. I was at the other side of chemo and feeling like I'm just not getting better. I don't understand why I'm still feeling this way. Like, chemo has ended. Why am I still feeling like this? And it took me a while to realise that it was menopause. And I would say it took me about four or five oncologist appointments before I worked up the courage to ask about vaginal dryness. Because it's just really embarrassing to talk to a man in an NHS lanyard about your vagina.

yeah.

And are there any other resources that you've? found or that you've directed people towards in your writing and research around sexual health and wellness?

There's lots of, there are lots of amazing organisations out there doing great work around this. I know the menopause and cancer podcast and Danny Binnington's work is incredible about this because she talks about all the stuff that people find difficult to talk about with their oncologist. So yeah, the vaginal moisturisers are really good. There's one called Yes, which you can actually get prescribed. So I think lots of doctors don't know that or don't mention it. But if you tell them, it actually has the like prescription code on the website. So you can literally give them all the information to prescribe it. And obviously, if you're having cancer treatment, then your NHS prescriptions are free. So you can get this on prescription. So that's really useful for people to know as well.

Yep.

But yeah, basically there's a lot that you can do about it. So don't suffer in silence. Cause I think too many women over too many years have just suffered in silence and it's unnecessary.

Well, that's what we're here for. You know, we like to bring up the difficult topics and have those conversations that people just sometimes don't feel comfortable talking to their doctor about or don't want to waste the doctor's time.

Tell us about your book Reconstruction.

So I wrote the book because I read a lot of breast cancer books after being diagnosed, as lots of people do, and there's lots of kind of science-ey doctor ones and there's lots of kind of memoirs and I felt like I wanted just a really practical book that was like almost like one of those pregnancy books, like what to expect. at every stage and down to what to pack in your hospital bag. So yeah, it was going to be like, if you had a friend who had been through the same thing, you went for a coffee with her, it would just be the stuff that she would tell you basically. And also the reason I wanted it to be called reconstruction, because it's not just about breast reconstruction, it does cover that, but obviously some people don't have or need or want a breast reconstruction. It's about putting yourself back together afterwards because that is such a big part of it. feel like, you know, cancer rates are unfortunately increasing. Fortunately treatments are improving all the time. So there's just a growing number of people living after living life after cancer treatment, often with ongoing effects in terms of perhaps early menopause or perhaps, you know, fear and anxiety. And often it's almost a clean slate opportunity where you can decide who you want to be after cancer treatment because cancer treatment kind of knocks you down to the ground. And it's almost like you've spent your life building a house. And it's just been absolutely flattened and you've got to build it back so you can kind of decide who you want to be. Like what is the post cancer you going to be like? And I really wanted the book to help guide people to do that in a way that's really intentional. So they're so that they can feel, you know, that was an absolutely horrific thing that I went through, but as a result of it, now I'm living the life that I really want to live.

Mm.

And yeah, I thought that was a really important part of it.

Yeah, I mean, I think it's also just a brilliant guidebook for people to pick up when I mean, I've sent it people to people who've been just diagnosed because I think that it helps to dip in and understand the terminology because you can read it from cover to cover like I did. I, you know, I read your story and that was really interesting to me. But you can also dip in and look up what is triple negative and what is her to negative, for example.

Yeah

And it explains those terms, which are often very, very confusing when you first enter this cancer world.

Yes. Yeah.

I mean, I didn't even know there were different types of breast cancer when I was diagnosed. I was so naive. It was ridiculous. And where can we buy the book?

All good book shops and Amazon.

If you could go back and give some words of wisdom from future Rosamund to the Rosamund who'd just been diagnosed in 2021, what do think you would say?

I would say first of all, I wish I had just moved my body a little bit every day because I was very, I was just, as I said, not an exercise person. And I actually asked my oncologist, is there anything that I should be doing during treatment to kind of improve my chances? And she was like, no, no, nothing, just rest. Rest is the most important thing. And I just took that as a license to literally lie on the sofa and watch Netflix for six months. And I think I would have felt a lot better if I'd have just had a walk around the block. I don't mean like, you know, I'm not exactly going to train for a marathon during treatment. I know some people do, they're super fit and that's what they love doing. Great. But I think those of us who don't feel up to much during chemo, shouldn't put any pressure on ourselves, but I do wish I'd just been a little bit more active. And I would say focus on gratitude rather than guilt because when you're going through treatment, obviously you can't do all of the things that you used to. You're like tired, you feel ill. I think you're not the parent that you want to be, or not the friend that you want to be, or not the wife that you want to be ideally. And it's easy to feel like, you know, I'm just being really useless right now. But if you can shift your focus to gratitude, because the people around you want to help you. And, you know, they feel a bit helpless as well seeing you go through it. So accept all of the offers of help that you're given and just be grateful and don't be like, oh my God, you've like... left a meal on my doorstep and I'm not doing anything for you. It's a time when you just have to accept it. So yeah, that's the second thing. And I would say maybe the third thing is don't obsess over food because it's easy to think, oh my God, I shouldn't have this. And I saw on Instagram that I shouldn't have dairy or somebody messaged me and said I should ideally try and have all raw food. it would be so easy and I definitely did at times get caught up in panicking about what I should or shouldn't be eating. But yeah, as we said earlier, it's really very simple. Eat lots of veg, drink lots of water. You can't go wrong.

And gratitude, not guilt. I like that. I'm going to tell myself that. I'd like to finish with the question we're asking everyone on this podcast. Breast Cancer Now's vision is that by 2050, everyone diagnosed with breast cancer will not only live, but be supported to live well. What does it mean to you to live well?

I would say to me, living well means having fun. That is my priority now basically. I make most of my decisions in terms of is this going to be fun? I would say that is not something that I used to do before cancer. I think that's one of the most important things in life now, know, life is short. It might be shorter than we think. And I think we're here to be with people we love and have fun.

Rosamund, thank you so much for joining us.

Thanks so much for having me.

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