A breast cancer patient who was spared the ordeal of chemotherapy, thanks to a US test that can determine the need for treatment, is campaigning for the cost to be subsidised for other women in her position.

Charmaine Montesin was faced with the “unaffordable” €3,000 cost of a test to help her decide whether she could avoid debilitating chemotherapy on her road to recovery.

But her father stepped in to pay when she was diagnosed with Stage 2 breast cancer in February.

The test saved the mother-of-two from unnecessary suffering and gave her a quality of life that cannot be measured.

But she finds it “mind-boggling” that the government does not provide the test for free to eligible patients, even though a recent feasibility study commissioned by Action for Breast Cancer Foundation found it could save public money.

Montesin, 51, had already suffered “a big battering” from radiotherapy and surgery when she was faced with the prospect of an eight-week course of chemotherapy.

Shocked because she had hoped chemo would not be necessary, she burst into tears, knowing what to expect as a health professional, and at the first thought that came to mind – losing her hair.

“For someone like me, my hair is everything,” she admitted.

“I do not want to sound too vain, but this was a big consideration.

“As a woman already scarred from surgery, I questioned what would remain of me. For a menopausal woman like me, at my age, the cancer almost takes second place. I know this sounds bad, but it cannot be touched and seen, while you can see yourself in the mirror…

“I never realised how important body image is.”

Fears of a chemo 'carpet bomb'

Montesin’s concern with physical appearance was a blessing in disguise. It was a plastic surgeon she was visiting for a potential cosmetic intervention who first noticed she had a practically undetectable lump in her breast.

“I had cancelled the consultation about three times and was about to do so again… The surgeon insisted I go for a mammogram before he operated on me.”

But hers was not a clear-cut case as to whether chemo would make a difference.

“It fell into a grey area – not too severe, but not nothing either,” she was told.

Chemotherapy could improve her chances by a mere five per cent, and it was up to her whether she wanted to go ahead with the treatment.

“When you have children, you take that five per cent chance… and even less,” she said.

But on the negative side, Montesin knew “chemo is like a carpet bomb that burns the good with the bad and the body takes a massive hit”.

Chemo is like a carpet bomb that burns the good with the bad

She weighed the pros and the cons, wanting to do everything in her power to beat the cancer but fearing the inevitable physical repercussions.

“I also thought of being too ill to care for my children and of not being able to go to work – I had just started a new job.

“I am a health professional and I struggled with the choice, let alone someone elderly or unable to understand.”

Montesin was then informed about the Onctotype-DX test, which predicts how likely breast cancer is to spread within 10 years, giving a score doctors can use to determine if a patient will benefit from chemotherapy.

She was guided through the process by her oncologist, who helped her with the complicated paperwork at a time when everything felt “extra” and hard to cope with.

The upfront payment was made, and specific containers sent to Malta for the sample from Montesin’s breast to be couriered to the US after she signed off on its release from the hospital’s pathology lab.

A push to make test widely available

She shed tears when the results arrived, and she learnt she would not need chemotherapy.

However, along with the relief she felt, Montesin was angry that the government wasted so much money on other things and did not find funding for this.

Montesin was fortunate to find someone to fund the cost of the test, but her “heart goes out” to those who cannot afford it – “and there are many with the current cost of living”. The detailed study on the clinically validated test by EMCS, commissioned by the Action for Breast Cancer Foundation, found that 25 patients between June 2020 and 2021 could have been spared the treatment.

It found it could slash breast cancer chemo rates by 60 per cent if it were made freely available and would save the government almost €100,000 a year, taking into account outpatient and inpatient care costs, as well as loss of productivity due to absence from work.

The scientific study has been presented to the health authorities, to the office of European Parliament President Roberta Metsola and to the Permanent Representation of Malta in the EU.

Montesin said could not understand how it could be shelved as cancer figures surged.

“I think the commitment to cancer in this country is a joke. Yes, we screen and treat, but quality of life also needs attention. It is not just about a pill for an ill.”

While acknowledging that €3,000 was a high additional price if it transpired the patient still needed chemo, she insisted the test could not be considered a luxury.