Stella arrives home in Brighton to visit her mum Evelyn after a five year absence. Anxious about the reunion, she stops off at a chicken take-away joint and is served by Noel, who dampens her fears with his wit. Stella meets her mum at an eclectic sea-front flat and learns that mum is recovering from breast cancer.
Stella feels manipulated into staying on in Brighton, but can see Evelyn is in need of support. Noel at The Chicken Shack says he has a brother with sickle cell anaemia so he is familiar with the idea of illness within a family. Together they set about familiarising themselves with Evelyn’s medical condition. They discover that Evelyn has a family history of breast cancer of which she was unaware, Great Great grandfather Douglas died of it in 1920. His two daughters also died from cancer years later. The family history information means Evelyn is now eligible for BRCA testing to see if she is positive for BRCA 1 or 2 genes which increase the risk of breast cancer.
Stella persuades her mum to have the BRCA test but Evelyn is cautious: she has fought most of her life from the standpoint of anarchy - what the state has got on you they can use against you - including your genes. Also, if Evelyn turns out to be BRCA positive, this will have implications for Stella because it indicates that the cancer has a higher chance of being inherited. The implications of having a genetic test for cancer are compared with having a genetic test for sickle cell. Noel has had a genetic test to see if he is a carrier and whether he can be a bone marrow donor to help his brother.
The test results show that Evelyn is indeed BRCA positive. Evelyn’s nurse, Brian, is optimistic, pointing out that Evelyn may benefit from new drugs called PARP inhibitors which are targeted to BRCA positive tumours. This is an example of pharmacogenetics at work. The treatment options for cancer are compared by Noel to the lack of options for sickle cell which has received less than its fair share of funding and is still shrouded in stigma and misunderstanding.
Evelyn does not automatically have access to the PARP inhibitor because it has to undergo clinical trials in order to be shown to be safe, and to work in the way intended. Running such trials is dependent on people being willing to take part and ‘chance’ being randomly given the new drug or the best existing treatment, i.e. some form of chemo. Stella wants Evelyn to join the clinical trial, while Evelyn is reluctant to subject herself to further treatment and side effects in the 50/50 hope of getting the new drug.
Finally agreeing to the trial, Evelyn distracts herself with collating her musical past which is to be a posthumous gift for Stella should she not do well. Stella is between a rock and hard place, with every new bit of information a new challenge emerges – should she now get tested herself? If Stella too is found to be BRCA positive she may be offered regular screening or preventative surgery. Would Noel still be interested in her if she has the “bad” BRCA gene? Noel himself carries the gene for sickle cell but in many ways choosing to have his genetic test was easier for him.
As a carrier, he has not got sickle cell himself and will never get it. The implication of knowinghis genetic status is that if he has a baby with another person who is also a carrier, there is a 1 in 4 chance that his child could inherit sickle cell. If Noel and Stella were to get together, it would be important to know if Stella was also a carrier. Evelyn comes off the trial early having found her health worsening whilst others on the trial appear to be flourishing/dramatically improving. Stella is angry, her mum is giving up and not helping in the advancement of a cure that Stella herself may need one day. Evelyn would rather hire a swanky hall in Brighton Pavilion for a farewell gig. This is what all the information from unearthing dear old Great Great grandfather Douglas has led to - Evelyn’s choice and Stella must accept it. Evelyn hires a room in Brighton Royal Pavilion for a punk party, Stella can’t bring herself to go. Noel pleads for Stella to consider turning up but there’s too much baggage from Stella’s past, it’s Stella’s choice to stay away, she runs to the beach as the gig plays out behind her.
Evelyn finds Stella under the pier at dawn. Reunited in the moment, mother and daughter watch the sun come up together and finally the emotional healing process truly begins.
Abi Bown October 2011