Nancy Groce and Nora Groce were identical twins who ‘just knew that’ one day they would be faced with breast cancer.
Their great-grandmother, grandmother and aunt died from the disease. The mother also suffered frequent bouts of illness for close to 30 years before succumbing.
The sisters share the same DNA – and the same genetic risk.
“We are proud of our family’s history. It felt almost inevitable,’ says Nora.
Nancy, who was 42 at the time, was the first to be diagnosed and treated. This was in 1994.
Nora found out she had the disease when it was discovered in 2012. Nancy was also diagnosed in 2015.
They were both undergoing simultaneous treatment for a time.
However, they would each receive a high-quality care in highly respected teaching hospitals. Their experiences however would be vastly different.
Nancy, a native American, lives between New York City and Washington. Nora, however, has lived in London for nearly 14 years.
And so while Nora, a professor in epidemiology at University College London, received free care through the NHS, she could only watch as Nancy, a government adviser, had to balance gruelling treatment with negotiating mounting medical bills with her health insurance provider – which was branded ‘more stressful than the cancer itself’.
The sisters are now both 69 and in remission. However, their stories give a wonderful insight into how it feels to receive cancer treatment in both remarkably different healthcare systems.

While Nora Groce (pictured), a professor in epidemiology at University College London, received free care through the NHS, she could only watch as Nancy, a government adviser, had to balance gruelling treatment with negotiating mounting medical bills with her health insurance provider – which was branded ‘more stressful than the cancer itself’
Nancy recounts, “I was single and had no one to support me.” “Yet, here I was, faced with a life-threatening illness, and had to pay bills from hospitals, doctors and labs.
Nancy, like most Americans, has private health insurance, paying about £3,000 a year for ‘a very good’ package.
However, the plan did not cover her entire treatment.
I ended up spending more than $14,000 [£10,000]”Out of my personal pocket,” she said.
At one point Nancy was ‘mistakenly’ handed a bill for $40,000 – roughly £30,000 – and although she ultimately didn’t have to pay this, she says that the stress it caused at the time was ‘traumatic’.
Meanwhile, Nora says the most she spent was on food from Marks & Spencer, brought in by her husband once when she didn’t fancy the hospital menu – a grand total of £6.95.
The NHS, of course, is not ‘free’ – instead it’s paid for via taxes.
About 20% of tax revenue goes to NHS. An individual earning a professional salary of £50,000 a year would pay £7,486 (20 per cent) in income tax, and £4,852 (12 per cent) in National Insurance, so will be personally contributing about £2,467 a year.
That person’s employer would also pay National Insurance contributions of £5,709, 20 per cent of which – £1,141.80 – would go to the health service.
Nora, who is a mother to two children, said that while a diagnosis of cancer can be devastating, Nancy has so many other things she had to face. It was enough for me to focus on my recovery.
Nora arrived in the UK from Norway in 2008. She enrolled at her local GP office.
“At my first visit they asked me, “Do you have any medical concerns?” “She recalls.
“I told her, “Well, there’s a history of breast cancer in our family,” and she immediately referred me to a genetics clinic so that I could assess my risk.
“I was 55 years old at that time. I was also at an age when women can get mammograms once every three years.
“But due to my past, I was informed that I would have a mammogram every year. I received it at a hospital just 15 minutes away from my home and continued doing so for four years.
Nancy continues: “In the States, we didn’t have this offer to us since it wasn’t part of our health insurance plans.
Nora’s breast cancer was discovered at one of these screenings. After removing the lump from her left breast, Nora had further surgery to remove even more of it. She needed to have a double mastectomy.
“When I was being wheeled in for surgery they had me sign a consent form. This was the only documentation I received regarding my cancer and any other issues with the NHS.
“I had free prescriptions because I was older than 60.”
Nancy has, however, had to endure stressful bureaucratic battles.
There is no NHS in the USA. Health insurance is usually provided by employers. Employers pay a proportion of the monthly premium. The rest is deducted from an employee’s salary.
Patients may be subject to additional costs depending on which type of insurance they have. It is the responsibility of the patient to keep pace with whether treatments are fully or partly covered by insurance – or not covered at all.
Nancy described it as a complicated process. She created an Excel spreadsheet to keep meticulous records of when she was coming in and for whom, and who they were talking to. What their words were and what I paid.
I probably phoned my insurance company at least two dozen times in an effort to get clarifications on the charges or to explain that they weren’t paying me a specific percentage.
“One laboratory assumed that I wasn’t insured and sent me $40,000 bills. It took me weeks to correct this mistake.
Nancy was often required to first pay the services and then claim back afterward. This left her anxious about how she would get reimbursed.
Her explanation is that she worked all the time because of her limited sick days. On days when I was sick, I would go to radiotherapy appointments in the early morning and then go back and work for eight hours.

Nancy (pictured), like most Americans, has private health insurance, paying about £3,000 a year for ‘a very good’ package
“I would come back home and open my mailbox to find yet another bill. Sometimes, I would just lie in my room and shout at the walls. Nancy believes the stress led to her developing high blood pressure – something she didn’t have a problem with before.
Stress was a constant throughout my treatment. It was present not just during the period I was receiving it but also for several months afterward when I had to pay new bills and try to solve old ones. The treatment was not over and I could celebrate. The situation had to be monitored.
She had an MRI done in the summer to confirm that she was not still suffering from cancer.
She said, “It wasn’t very affordable. I thought at first I was going to get a $6,000 bill.” [£4,500].
They decided that it was not $6,000. They resubmitted the application. The process continues back-and forth. Almost everybody I know has had run-ins with their insurance company – strange billings and paperwork.’
The UK Government’s Health and Care Bill currently is in Parliament. This bill could lead to a fundamental restructuring of the delivery of NHS services.
Critics claim that the plans borrow heavily from American systems and open the possibility of further integration of private health care businesses within the NHS.
Despite the growing hospital backlog triggered by Covid – there are 5.8 million people waiting to start hospital treatment in the UK and 300,000 who’ve been waiting more than a year for elective surgery – Nora and Nancy feel their story should serve as a warning against going too far down the road of privatisation.
Nora said: “There are no doubt many problems with NHS. The system is currently under severe strain.
“Comparing the experiences of Nancy and me, I believe that both the NHS (and universal health system) have much to be commended.”
In the US, 66.5 per cent of all bankruptcies were tied to medical issues – either because of high costs for care or time out of work. Recent research revealed that 530,000 households file for bankruptcy annually due to bills or medical problems.
Nancy continues: “When I was first diagnosed I had a joke with a friend from Wales who offered to marry my so I could be treated in the UK. Of course I declined. However, it highlights the inequity in healthcare provision in America.