Detective Sarah Cato, who is diagnosed with metastatic breast cancer, talks about the drug funding. / Greg Bowker
She's 31, a mother of two beautiful pre-schoolers, a wife and an accomplished teacher.
And it's likely Emily Stein will be dead before she's 35.
When she was 29, just after the birth of her second daughter, Stein was diagnosed with inflammatory breast cancer.
Aggressive as hell, it had spread to her to her pelvis and was extremely advanced - what they call metastatic or incurable.
When baby Mabel was 4 weeks old Stein started chemotherapy and Herceptin treatment in a bid to shrink the cancer in her breast, by then a 20cm tumour mass.
The Herceptin has ensured the cancer has not spread further through Stein's body, and she's as well as can be expected.
But she knows there will come a time when she needs to look for more treatment options.
One of those options is a drug called Perjeta, approved by Medsafe for women with HER-2 positive cancer - meaning they produce a protein that causes breast cancer cells to grow - in late 2016.
Pharmac started funding Perjeta in January 2017 - but only for patients who have not been treated with chemotherapy and or Herceptin.
The eligibility criteria meant 160 women were blocked from using Perjeta unless they paid themselves for the treatment - costing upwards of $130,000 per patient.
Stein is one of "the 160" - a number that has dwindled in the last year as women succumb to the disease.
Auckland detective Sarah Cato is another.
Cato, 35, hit headlines late last month as she embarked on a mission to raise the money for Perjeta in a bid to stay alive as long as possible for her wife, Keely, and 10-year-old daughter, Emma.
In just 13 days Kiwis rallied together and donated more than $106,000.
Cato was looking at starting Perjeta late in the year, but due to the lightning speed and generosity of her community, her oncologist approved her for treatment this week.
On Tuesday, she had her first round of the drug that could lengthen her life by almost two years - two precious years in which she can see more of Emma growing up and, in her words, lock up more bad guys.
Although Cato hit the jackpot of human kindness and generosity, her fellow "metastatics" have not been as lucky.
Most of them will never be able to get anywhere near Perjeta.
And many of them are angry.
When Pharmac initially announced it would fund Perjeta, Stein was thrilled.
"But because I've already been having Herceptin, it's not funded. I missed out by eight months," she said.
"Down the line when I'm needing to do more treatment it would not even be an option for me."
Like Cato, Stein is desperate to stay alive as long as she can for Mabel, her older daughter Ada, almost 5, and husband, Chris McMurtrie.
"He's going to be a widower by the time he's 35," Stein said.
Emily Stein in hospital. Photo / Supplied
If she was able to get Perjeta when she needed it, it could have an "amazing" impact on her family.
"It will mean my children remember me," she said.
"Ada will have memories of me if I die in the next few years but Mabel is only 2 and she will only remember me from photographs, video and what her family tell her.
"I'd love them to know where they came from and who their mum was."
Pharmac director of operations Lisa Williams said Perjeta was only registered by Medsafe for use in patients who have not received prior treatment with Herceptin or chemotherapy.
In February 2017 it sought "expert clinical advice" from its Pharmacology and Therapeutics Advisory Committee on whether other patients could use the drug.
"PTAC deferred making a recommendation, noting that the available evidence wasn't strong enough, or of a high enough quality, to support the use of pertuzumab for people who had already had treatment," said Williams.
A Pharmac spokesman said there needed to be evidence to show "it works for people who have already been treated".
"And we're open to reviewing any new evidence that supports this sort of use," he said.
This week the New Zealand Breast Cancert Foundation called on Pharmac to review the criteria again after a new trial was presented to the American Society for Clinical Oncology conference showing that the combination of Herceptin and Perjeta considerably lengthened the life of some patients.
The Pherexa trial showed that half of the patients who added Perjeta to their existing Herceptin treatment for metastatic HER2+ breast cancer survived more than three years, compared with an average survival of just two years four months for those continuing on Herceptin alone.
Henderson said in light of the trial results, the NZBCF was preparing a written submission to Pharmac, incorporating the PHEREXA trial results.
Emily Stein spent her 30th birthday in an oncology ward. The mum-of-two is battling incurable breast cancer. Photograph supplied
Stein is also calling on Pharmac to think hard about the women they have left behind in their decision to only effectively fund new cases of metastatic breast cancer.
"The 160 are more than just a number," Stein said.
"We are women who are mothers, wives, daughters, friends, family, contributing members of society and we deserve more.
"We are people with lives and we're women with our own stories and our own journeys.
"I just feel like we've been brushed aside."
Breast Cancer Aotearoa Coalition chairwoman Libby Burgess - herself a survivor of the disease that kills about 650 Kiwi women each year - said it was disappointing the 160 would not be considered for Perjeta.
The BCAC, along with the NZBCF, jointly petitioned Pharmac to fund the 160 in March last year.
At the time Burgess said there was "clearly a growing body of evidence to show that Perjeta is a successful treatment" for women with HER-2 Positive breast cancer and she was hopeful Pharmac would provide access for patients "who desperately need effective new and innovative treatments".
Burgess told the Weekend Herald Perjeta may not be the right option for all of the 160.
"Not all of them want to take up the opportunity," she said.
In her opinion, surely Pharmac could consider funding at least some of them - the ones who want to try it and are healthy enough to withstand the treatment.
"I want to see it funded - I think it's cruel to exclude them from this opportunity.
"It's terrible, it's really sad."
Burgess said every woman fighting cancer deserved the chance for more time - and more quality time.
"These are women with meaningful lives - it's really obvious the value they bring to their community," she said.
What she didn't know, until two years ago, was it had spread to her lung and would ultimately be incurable.
"I was in shock because when I initially had it I did everything," she said.
"I didn't have to have chemo, I didn't have to have radiation but I did those things because it gives you a higher percentage chance of it never coming back.
"But it did."
Lesley did not want her last name published as she is yet to tell some people about her diagnosis.
But she agreed to speak to the Weekend Herald about her life in a bid to educate people on metastatic breast cancer and the people battling it every day.
Lesley is treating her metastatic cancer with a cocktail of drugs including Tamoxifen, which reduced the risk of the disease spreading.
Detective Sarah Cato is battling incurable breast cancer. Photo / Michael Craig
Although the oral chemotherapy was keeping her stable, the time will come when she needs to look at different treatments to lengthen or improve the quality of her life.
She is frustrated Perjeta, if needed, will be out of her reach.
"I've got a new granddaughter who is a week old - I've waited 40 years for this little girl," she said.
"I've got three sons and four grandsons so now I've got a granddaughter and I feel like fate is just not treating me very well.
"I'm just trying to absorb as much of her and the rest of my family as I can. Even though I'm older I still have the same things to live for."
• It's the most common form of cancer to affect women • The cause of the disease is not yet known • There's no way to prevent breast cancer • More than 2600 women and 20 men will be diagnosed each year • More than 650 women die from the disease each year • Kiwi women have a one in nine chance of developing breast cancer • 90-95 per cent of women diagnosed have no family history of the disease • Māori women have a 42.8 per cent higher incidence of breast cancer • Pacific women are 54 per cent more likely to die of breast cancer than other women
WHAT IS METASTATIC BREAST CANCER?
When breast cancer spreads from the breast or armpit to other areas of the body, it is called advanced breast cancer. It's also called metastatic, secondary or Stage 4 breast cancer.
The most common places for breast cancer to spread to are the bones, lungs, liver and sometimes the brain. A secondary tumour in these distant organs is still comprised of breast cancer cells so it is readily identified as a secondary breast cancer rather than a new primary cancer.
Advanced breast cancer can occur months or years after a diagnosis of early or locally advanced breast cancer. Occasionally, it's diagnosed at the same time as the original breast cancer or, on rare occasions, before any tumour can be felt or even imaged in the breast.
(Source: Breast Cancer Foundation NZ)
BE BREAST AWARE - SAVE YOUR OWN LIFE
Changes in the breast that may indicate cancer include:
• A new lump or thickening • A change in the breast shape or size • Pain in the breast that is unusual • Puckering or dimpling of the skin • Any change in one nipple, such as: a turned-in (inverted) nipple or a discharge that occurs without squeezing • A rash or reddening of the skin that appears only on the breast
