Sitting with her hospital consultant, Anita Brown felt overwhelmed by fear. The cancer found in her bladder had spread to her lymph nodes, liver and bones.
Too aggressive to be operated on, the only treatment available was palliative chemotherapy to slow its growth.
Without it, her consultant said gently, Anita was unlikely to survive longer than a few months. ‘I couldn’t stop crying,’ says Anita, 47. ‘I wanted to grow old with my husband, to see my son marry and meet my grandchildren. I was heartbroken.’
Two years on from her terminal diagnosis, chemotherapy has brought her precious time but the married mother of one knows she is lucky to be alive.
‘With every day I feel more scared. Every birthday, and every family gathering, I wonder if it will be the last,’ she says. What makes Anita’s situation even more difficult is that she feels certain she knows what caused the disease.
Anita Brown, 47, (pictured) believes heavy drinking and smoking 20 cigarettes a day for 25 years may have contributed to her terminal cancer diagnoses
Smoking is the biggest cause of bladder cancer, responsible for around half of all cases in the UK — and Anita had been smoking 20 cigarettes a day for 25 years.
Although there’s no proven link, she also worries that her heavy drinking may have contributed to the problem.
Bladder cancer is three times more common in men, who have in the past always been heavier smokers, than women. But a closing of the gap between the number of male and female smokers means that women such as Anita may, in the coming decades, start to redress the balance.
Her story starkly illustrates a recent study by Imperial College London, which found thousands of British woman are dying younger because they have adopted unhealthy habits historically associated with men.
The report, published in medical journal The Lancet, shows that women’s lifestyle choices are increasing their risk of premature death. It reveals that out of 25 wealthy western nations the UK has the fourth-highest premature death rate for women from diabetes, heart disease, cancer and lung disease — conditions largely driven by smoking, drinking and obesity.
For British men, the chance of dying early from one of these diseases is still significantly higher than for women, but men of other nationalities fare even worse, so UK men have only the 13th-highest premature death rate.
Lead author Majid Ezzati, a professor at Imperial College London, said the outcome of the study could be explained in part by social equality, which is advancing faster for British women than elsewhere. Of course, that is a deeply welcome development, hard-won after five decades of feminism.
But it seems that as they have become breadwinners and conquered boardrooms, many of today’s middle-aged women have picked up less desirable traits from men, too.
Viv Charman, 60, (pictured) believes her heavy drinking habit could have contributed to being diagnosed with breast cancer eight years ago
Many of the habits and pastimes traditionally associated with career success and work outside the home — from indulgent business dinners and drinks with colleagues, to spending hours sitting at a desk — are now recognised as terribly unhealthy.
Men have long suffered the ill-effects of this lifestyle, and now researchers say women are starting to feel them too. In short, it is the one element of equality that women never asked for.
‘If women live like men, they will die like men,’ said Prof Ezzati.
Certainly, there has been a profound sociological shift linked to growing equality and more women in the workforce. British women now drink as much alcohol as men, and it was reported this week that a record number of women died from health conditions directly caused by alcohol in 2017 — 40 per cent more than in 2001.
Worldwide, men smoke nearly five times as much as women, but in affluent Western European countries such as Britain there is now nearly no difference between the two groups.
Do women prefer spirits or beer?
More women are choosing pints over wine or spirits. Almost a third say they drink beer at home, compared to just three per cent in 2009.
In fact, lung cancer rates are still peaking among women, while they started falling for men in the Eighties.
This is because women, who took up smoking in large numbers in the Seventies when it became more socially acceptable for them, were slower to give up when the full health impact was realised.
And women are as affected as men — if not more so — by the obesity crisis.
An NHS report released yesterday found one in 20 women are morbidly obese, compared to one in 50 men, and in 2016 and 2017, some 72 per cent of patients admitted to hospital for reasons directly attributed to obesity, were female.
Then there is the impact of sleep deprivation caused by stressful lifestyles — one study found those who slept less than five hours a night doubled their risk of death from cardiovascular disease.
A desk-bound sedentary life, meanwhile, has also been shown to help reduce life expectancy.
By contrast, working in the home as many women did in previous generations, tends to lead to a healthier lifestyle thanks to moderate physical activity and the ability to cook healthy meals.
Jeni Weaver (pictured) who leads a nightclub security team and smokes 40 cigarettes a day has been hospitalised twice in the past two months for a heart condition
In an inevitable consequence of role changes, the gender gap in life expectancy has started to close. In 1971 women could expect to outlive men by 6.3 years; by 2016 that figure was just 3.6 years.
One recent statistical analysis predicted that by 2032 the gap will have closed altogether, with both sexes sharing an average life expectancy of 87.5 years.
‘Unfortunately, advances in social equality have had a deep impact on female health,’ says Dr Elle Boag, social psychologist at Birmingham City University. ‘From the “have-it-all” Eighties when more women started to have careers, we have been increasingly reliant on unhealthy ready meals.
‘The ladette culture of the Nineties encouraged excessive drinking, and the recent trend for “wine o’clock” has made women feel they need a drink to relax.
‘With increasingly hectic lifestyles — women are, after all, still expected to do the majority of household chores and childcare as well as pursue careers — cigarettes also continue to be props that keep women going through stressful days.’
For many women, smoking and especially drinking are still a mark of liberation. It’s an association that has been explicitly promoted by advertisers in the past, who have targeted these products at working women with disposable income.
Yet biological differences between the sexes mean bad lifestyle habits can hit women harder. Higher levels of body fat mean women’s bodies are less able to digest alcohol, while research has shown that a larger waist-to-hip ratio is a bigger heart attack risk factor for women than men.
And, says Dr Agne Zemaite of London Doctors Clinic, ‘some studies have shown that women who have alcohol problems have higher death rates due to suicide, accidents, and other health-related issues — more than twice the rate of men.’
None of which Anita, who lives in Bordon, Hants, with husband Tim, 47, an engineer, had considered before her diagnosis.
Anita (pictured) who started the stressful job of leading a team who deliver valuable cars to auction at age 41, met her husband the same year – she says they smoked and drank together every evening
‘I was brought up to believe my gender was irrelevant,’ she says. ‘If men around me were smoking, why shouldn’t I? Now, I’m appalled and wish more women smokers knew they risk of getting a cancer that’s still known as an “old man’s disease”.’ Anita started smoking aged 19, in 1989, when a cigarette was seen as a stylish accessory.
Later, as a single mother — her son’s father left her in 1991, when she was pregnant — she came to rely on cigarettes as a crutch, ignoring health warnings: ‘I reasoned I could get run over by a bus the next day. Smoking helped me relax.’
A bar manager at the time, she says alcohol also offered ‘relief’ from responsibilities.
‘I could drink most men under the table, and felt I was encouraged to do so during the Nineties,’ she says. ‘I didn’t see why I should have only a half-pint because I was a woman.’ In her 30s, she swapped pubs for drinking at home: ‘My girlfriends and I would enjoy Prosecco, vodka and drinking games including drunken dares. My son, then a teenager, was mortified.’
Aged 41, she started a job in charge of a team tasked with delivering valuable cars to auction. ‘It was stressful,’ says Anita, who met husband Tim, the same year.
‘Tim smoked too, and we shared wine every evening.’
In 2015, Anita discovered blood in her urine and developed pain in her stomach. Initially dismissed as bladder stones and an infection, in March 2016 an ultrasound revealed a cancerous mass in her bladder.
SHE SAYS: ‘At first I was told the tumour could be cut out, but a subsequent CT scan and biopsy revealed the cancer had spread. My doctor said it could hopefully be kept at bay with chemotherapy, but there was still no guarantee I would live to see Christmas.’
She read about the link between smoking and bladder cancer online, learning that chemicals from smoke are filtered out of the blood by the kidneys and end up in urine, which brings them into contact with the bladder lining.
Viv Charman (pictured) says she shared a bottle of red wine with her husband to unwind after a long day at work – overtime they began indulging in up to three bottles of wine per night
‘My urologist had urged me to give up smoking but it was only when I read the evidence myself it really hit home. I felt I deserved to have cancer as it was my choice to smoke,’ says Anita, who has stopped smoking. Though there are no proven links between alcohol and bladder cancer, she has also given up drinking and fears that this could have contributed to the problem.
The hardest part, she says, was telling her clean-living son Ashleigh, 23, who had long disapproved of her drinking and smoking. ‘I felt I was letting him down and said sorry as we cried,’ she says.
Although scans show there is at present no cancer in Anita’s body, ‘doctors have said it will come back’. Meanwhile, chemotherapy has damaged her heart, leaving her reliant on pills to control her blood pressure.
The number of smokers in the UK might be at its lowest recorded level, but more young women are smoking as rates among young men fall.
In 2016, 22 per cent of women aged 25-34 smoked, up from 20 per cent the previous year — and seven per cent higher than the national average of 14.9 per cent.
Whether young women see smoking as a weight-loss tool, or are swayed by celebrity smokers is unclear, but Anita would urge them to stop: ‘They just aren’t thinking about the repercussions in later life.’
Viv Charman no longer has blithe disregard for the consequences of her bad habits. She believes her heavy drinking probably contributed to her own breast cancer eight years ago. Many women, however, still aren’t aware that alcohol is responsible for around six per cent of all breast cancers.
This is thought to be because it increases the production of oestrogen, the female hormone, which breast cells are sensitive to, causing them to become cancerous when exposed to higher than normal amounts.
Viv (pictured) believes people aren’t aware of how alcohol intake can contribute to cancer
Although Viv, 60, a divorced mother of three adult children, enjoyed the odd tipple at weekends in her 20s and 30s it wasn’t until she married her ex-husband in 2006 that she developed a nightly wine habit.
‘My husband and I shared a bottle of red between us after a long day at work,’ says Viv, a cleaner from Selborne, Hants. ‘Work could be difficult. Wine helped me unwind.’
As the years passed, her consumption rose, until she and her husband were drinking up to three bottles of wine between them every night.
‘I knew it wasn’t healthy, but I made excuses, telling myself I wouldn’t have as much the next day. The fact my husband drank too made it easier to justify,’ says Viv.
‘I’d never felt I should drink less because I was a woman. I’d grown up in the Seventies, when alcohol was considered cool.’
Besides, she adds: ‘I was active, ate home-cooked meals and led an otherwise healthy lifestyle. I never felt out of control.’
In May 2010, aged 51, a mammogram revealed a cancerous mass in her right breast. Thankfully, it could be removed with a lumpectomy — an operation to remove the lump.
‘It felt surreal and I was shocked, but felt lucky it had been detected early,’ says Viv. She admits she ‘sidestepped’ the issue of how much she drank at hospital appointments, but then came across the link between breast cancer and alcohol, online.
‘I felt cross. I hadn’t read anything about alcohol causing breast cancer before. This wasn’t something we were told. I decided to stop.’
Since becoming teetotal Viv, who split up with her husband last March, feels more in control of her health. ‘I don’t think people are aware alcohol is a contributory factor to breast cancer,’ she says. ‘I still see women laughing about their wine intake on social media — they don’t realise the impact on their health.’
For Jeni Weaver, there can be little doubt that her lifestyle choices are having a detrimental effect — doctors told her so in no uncertain terms after she was hospitalised twice in the past two months for a heart condition.
Jeni Weaver (pictured) refuses to stop smoking or quit her stressful job as she doesn’t want to be told how to live her life
A single mother of four children aged 15 to 24, who leads an otherwise all-male nightclub security team, she suspects her job isn’t conducive to good health.
‘I love working in a man’s world,’ she says, adding ‘because I am so busy I eat whatever I have time to grab at work — such as crisps — and drink eight coffees a day for energy.’
Jeni also has a 40 cigarettes-a-day habit. Nicotine raises the blood pressure and heart rate, narrows arteries and makes blood clot more easily, meaning that smokers are almost twice as likely to have a heart attack compared with people who have never smoked.
‘The thought of having a heart attack scares me, but I can’t give up,’ says Jeni.
Shortly after arriving at work one evening six weeks ago, Jeni, who started smoking at boarding school aged 15, suddenly felt light-headed. ‘My heart started racing, my legs gave way and I had to sit down,’ she says. ‘I didn’t know what was wrong. It was incredibly frightening.’
She was rushed by ambulance to Scarborough Hospital, where an electrocardiogram (ECG) revealed her heart was beating at 180bpm (a typical heart rate would be 60 to 100 bpm).
Also dehydrated, Jeni was kept in hospital overnight and given fluids intravenously. ‘Doctors weren’t sure what was wrong but said it was stress related and that I had to slow down and cut down on smoking.’
Yet a sense of invincibility meant she was unwilling to do either. ‘I’d been brought up to believe I can do whatever I want,’ says Jeni, who split up with her children’s father when six months pregnant with her youngest and has been financially responsible for bringing up all four.
‘I like the fact I’ve raised the children my own way.’
Four days after being hospitalised, at a follow up GP appointment, another ECG revealed her heart rate was still 150bpm. She was taken back to hospital for more tests, which proved inconclusive, and referred to a cardiologist at Bridlington Hospital in East Yorkshire.
Yet though Jeni has cut down to 20 cigarettes a day, she still refuses to give up smoking, or change her stressful job. ‘I don’t want anyone to tell me how to live my life,’ she says. ‘What will be, will be.’
Perhaps it’s time to admit that women now face a choice, as men long have, between curbing these unhealthy habits — or paying a terrible price.