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PRACTICE COMMENT

'A responsibility comes with advising on soap opera stories'

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Victoria Harmer, one of four experts advising the EastEnders team on how to depict breast cancer, explains the responsibilities that come with the role

With the lifetime risk of cancer being one in three, it is now becoming commonplace to see the condition woven into popular television dramas. This was not always the case; BBC Radio 4’s The Archers had been broadcasting for 50 years before any character was diagnosed with the disease. The responsibility was then handed to Ruth Archer to undergo treatment.

Breast cancer - as with other tumour sites - has had a leading role in many soaps. However, the breast cancer storylines do not usually involve most typical presentation. We know that the majority - about 80% - of women are post-menopausal when diagnosed. Peggy Mitchell, who had surgery followed by a delayed breast reconstruction in EastEnders, appears to be the only one to fit this criteria. Ruth Archer was in her early 30s, and Sally Webster in Coronation Street was certainly pre-menopausal when she discovered a cancerous lump in her breast in 2009.

The latest narrative involving breast cancer is in EastEnders; the character of Carol Jackson is receiving neoadjuvant chemotherapy for multi-focal breast cancer. Carol is, however, just post-menopausal at 51 years old. This story is a little more complicated, however, as the character has the mutation of the BRCA2 gene. 

Breast cancer is common, with one in eight women having a lifetime risk, but hereditary breast cancer is far less so; fewer than 1% of women carry one of the two known mutations of this gene, which contributes to about 5% of all breast cancers. Last year, it was well publicised that Angelina Jolie underwent prophylactic breast surgery as a result of discovering she had a mutation of one of these genes. This may have triggered those at EastEnders to decide their drama should have a similar story. Carol Jackson, however, found a lump and was diagnosed with lymph node-positive breast cancer before undergoing the genetic test, as opposed to receiving prophylactic treatment. 

I am one of four advisers to this storyline. I was contacted through Breakthrough Breast Cancer and have a track record in this area, having been part of the team consulted by both The Archers and Coronation Street.

A responsibility accompanies this opportunity - one has to ensure relevant, appropriate information translates to the script. However, there needs to be a balance, as the drama aims to entertain rather than educate. One has a duty to those who have the disease to portray a realistic narrative and to depict unsensationalised fact so as not to scaremonger. The role uses a clinical pool of knowledge as well as drawing upon health promotion messages. 

We have months of the storyline ahead of us and, so far, I am impressed with the team at EastEnders. Hopefully, with their dedication and the input of specialist cancer nurses and other medical advisers, this scenario will play out in a responsible and realistic manner.

Victoria Harmer is team leader/clinical nurse specialist in breast care at Imperial College Healthcare Trust, London. 

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