A matter of life and death

Could fertility drugs be linked to ovarian cancer? Debbie Howells aims to find out. She talks to Tobias Jones

Last week, the Cancer Research Campaign announced that it is to investigate the possible links between fertility treatment and ovarian cancer. The study is due to look at the cases of nearly 3,000 women, and will investigate whether fertility treatment effectively prompts the production of cancerous cells as well as eggs.

It's a link that many cancer sufferers have long suspected, though there is so far no clinical evidence to support their suspicions. Debbie Howells, 30, is the wife of the Southampton and former Spurs footballer, David Howells. She underwent fertility treatment, and eight months later was diagnosed with ovarian cancer. She is now a committee member of Ovacome, the support group for sufferers of ovarian cancer, and edits its newsletter.

"I got married in June 1993," she says, "after a relationship of eight and half years. As soon as we got married, we knew we wanted kids. We didn't want to become obsessed with it, but let nature take its course. After eight months I hadn't fallen pregnant, and I was having problems with my periods, so I had a laparoscopy to check my ovaries and my tubes. I was prescribed Clomid [a fertility drug] for three months. The first month it made me very sick, so I stopped for one month, but I started again for the next two months.

"Such was my desperation for a child that anything that gave me the baby I wanted I welcomed. I didn't even have to make a choice. Fertility treatment gets results, and when the need for a child is foremost in your mind nothing else really matters.

"When Clomid hadn't worked, the gynaecologist told me to go away, relax, have a holiday and come and see him again in eight months' time. So I had an appointment for September 1995, but that month - four days before I was due to see the doctor - I collapsed. We were on our way to visit my family, and when I stepped out of the car, I just doubled over in pain. My brother-in-law called a doctor and I was rushed into hospital.

"When I first went in, there were blood and urine tests, but they couldn't diagnose a problem. They kept me in overnight, thinking it was either an ectopic pregnancy or appendicitis. They scanned me in the morning when I was in more pain and they found a something on the right hand side. They told me I needed to be operated on, thinking it was a problem with the ovary: they found a cyst bigger than an orange in the ovary which had ruptured and burst."

In some senses, Debbie was lucky. Ovarian cancer affects almost 6,000 women every year, but because detection is so difficult, it is one of the biggest killers, claiming some 4,000 lives a year. "Looking back now," says Debbie, "I think if that hadn't happened, I probably wouldn't be here now. I went back to see my private gynaecologist, and she told me that the cyst had actually been cancer.

"I had an endoscopy, a gastroscopy, a CT [Computerised Tomography] scan and various blood tests with a cancer specialist at the Marsden Hospital. At that time the prognosis was very good, and to protect my fertility they didn't want to give me chemotherapy. I was seen on a monthly basis for six months, and had blood tests and an internal ultrasound scan. I had a laparoscopy and a D&C [dilatation and curettage].

It was then that I was told the devasting news that I had cancer of the womb and ovaries again, and so I had to have a full hysterectomy, and the left ovary, part of the omentum, and a third of my cervix removed. Then I had to have six months of chemotherapy. That was two years ago, I've been in remission since 4 January 1997. I go back to the doctor every three months for an internal examination. I've been in the clear since.

Obviously now unable to have children between themselves, David and Debbie have embarked on a surrogacy arrangement. But Debbie remains uneasy that the surrogate has been taking the same fertility drug - Clomid - as herself. "It does concern me that she's taking that on my behalf. I wouldn't put a surrogate mother through IVF again: stimulating the ovaries can't actually do them any favours." In 1995, the Committee on Safety of Medicines issued guidelines restricting the use of clomiphene citrate in the UK to a maximum of six months.

"Ovarian cancer always used to affect older, post-menopausal women, but the membership of Ovacome seems to be getting younger and younger. I've asked my doctors if the fertility drugs could cause ovarian cancer, but they've all said there's no evidence. I go to a lot of conferences, and I hear `no evidence' time and time again. But there must be a reason for more people developing ovarian cancer nowadays, and fertility drugs are, after all, more available now.

"After the chemotherapy, I went on holiday and I decided I wanted to help other people. Since then my life has totally changed. I decided not to go back KMPG, the accountants in the city where I was a PA. My work now is very therapeutic, very rewarding: just speaking to someone on the telephone, it's inspiring. I'm now doing the fourth newsletter, and I know it's what I would have liked to read when I was going through it. It's been very hard and it's desperately sad. I feel like a failure because I can't give David children, but we will eventually achieve the family we so want."