When seven-year-old Vicky Forster refused her pills for leukaemia, the nurse told her that if she didn't take them she would die. That, along with the promise of a Game Boy from her parents, was enough to win her round.
Forster had been diagnosed with acute lymphoblastic leukaemia after a bout of pneumonia had refused to shift. Blood tests showed that her white blood cells were dividing uncontrollably and doctors at St Bartholomew's hospital in London gave her a 60/40 chance of survival. An intensive course of treatment followed – including chemotherapy that left her temporarily bald – before she was told she was in remission.
Last week, 18 years after her diagnosis, she learnt that her research into another type of cancer – acute myeloid leukaemia – had achieved the standard for her to be awarded a PhD from Newcastle University's Northern Institute of Cancer Research.
Her remarkable story is encapsulated in the tweet she sent after learning she had passed her viva examination: "Dear Cancer I beat you aged eight, and today I got my PhD in cancer research. Take that." That message has since flown around the world and been re-tweeted more than 4,000 times. She was "completely overwhelmed" by the response – congratulations have come from as far afield as Niger, the Philippines and China, and the tweet has been translated into Spanish and French. The messages that mean most are those from parents whose children are in the position she was. One father tweeted: "Re your tweet about beating leukaemia + getting your PhD in cancer research. Inspirational! My son (6) finishes treatment in 3wks."
Forster wants her experience to offer some hope. "When you're in it, you think about it every day, but then it fades into obscurity and, if you use your experience for strength, then you can do whatever you want. You can be what you want to be. It doesn't have to hold you back in life," she said.
As a child growing up in Chelmsford, Essex, however, it was not medicine that fascinated her: "From about four or five I wanted to be an astronaut. I loved physics and I'd play with my dad with electronic kits and make lights and burglar alarms, and make radios out of spoons and pieces of wire in the garden."
While a patient at Bart's she met one of her heroes: Helen Sharman, the first Briton in space. But she also bombarded the doctors with questions, sparking an interest in cancer treatment that led her to do a degree in biomedical science at Durham University before a local legacy trust, the JGW Patterson Foundation, agreed to fund her doctoral studies.
As part of a team led by Dr James Allan and Professor Olaf Heidenreich, Forster studied a single genetic mutation called AML1-ETO. It is what is known as a fusion, when two bits of DNA that have no business being connected are joined. The team already knew that AML1-ETO alone was not enough to cause leukaemia, but after three years of research they have discovered how other secondary mutations develop that interact with AML1-ETO to give rise to leukaemia.
"Most people who have AML1-ETO will never know and nothing will ever happen to them. But if something presses that extra switch, then they could end up with leukaemia," said Forster.
Her first task was to prepare cells for the research, injecting them with genes and incubating them in a container designed to mimic the conditions of the human body. This painstaking work took nearly nine months. Next, she exposed the cells to radiation to see whether they had developed the secondary DNA mutations that could lead to leukaemia.
The team hope they can keep working on how to exploit their understanding of AML1-ETO and help to reduce relapse rates in patients, but it will be years before there is a treatment.
Forster still has yearly checkups, but her risk of relapse is now extremely small – and with every passing year it becomes lower. Today the only sign of Vicky's experience is a faint scar on her neck from the catheter that dripped her chemotherapy into her bloodstream.
She said: "I remember being in a really darkened room because I had a massive temperature. Leukaemia knocks out your immune system, so I had an infection. The thing I remember most is I had a cannula [tube] in my arm and they were getting fluids into me, but because I was so ill it just hurt and it stung, and it was horrible."
Forster is proof cancer can be beaten. But despite recent advances, particularly in treating childhood leukaemias, she is adamant there is more to be done. Five-year survival rates for childhood leukaemias have risen from 65% to 90% – but that is of little comfort to the other 10%.
In addition to her research, Forster raises money for cancer charities. In September she will run the Great North Run for leukaemia and lymphoma research.
She has fought cancer first as a patient and then as a scientist, but she said: "I always want to be judged not on the fact that I had cancer – I want to be judged on how good I am as a scientist. I am a scientist who happens to have had cancer. It's not about fame and fortune – there are a lot of careers you'd choose before science if you wanted that. I just want to do something that makes a difference."
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