Ask the doctor - early mammogram

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I can have a mammogram as part of my new job's health insurance, but I'm only 42. I thought these tests didn't until you were aged 50?
Women have a one in eight chance of being diagnosed with breast cancer during their lifetime. As four out of five cases occur in women over the age of 50, the national breast screening programme concentrates on inviting women aged 50 to 70 for routine mammograms. However, screening is available to women under 50 if they have a strong family history of breast cancer. Recent studies suggest that women in their forties with no close relatives affected are just as likely to develop invasive breast cancer as those with a family history of the disease – and some researchers are calling for all women to be screened annually from age 40. If screening is offered, it is a good idea to accept. However, if you are unsure, talk to your GP.
Dr Sarah Brewer, Prima (May 12)

Although I'm trying to stay positive while I’m going through cancer treatment, sudden bursts of pain that stop me in my tracks are really getting me down. What can I do?

It sounds as if you have breakthrough cancer pain – flare-ups that can be triggered by movement or treatment, or occur for no obvious reason. This pain is different from the background cancer pain that’s experienced by 77% of patients, which can usually be controlled with regular medication. Breakthrough episodes often last for only half an hour or so, but can be very debilitating. Sometimes you won’t need painkillers at all – simply rubbing or massaging the painful area, applying a hot or cold pack, or relaxation techniques, can help. Keeping a pain diary can help your doctor calculate which medications would work best for you, as the options vary depending on the source of your pain. A new website called www.pain-speak.com aims to help cancer sufferers understand more about pain and how they can get the help they need.
Dr Sarah Jarvis, Good Housekeeping (Apr 12)
See all of our advice on coping with pain

My husband is forever getting up in the night to go to the loo. He’s 55, and won’t visit the doctor as he’s terrified of being told he’s got prostate cancer.

While this is the most common male cancer, you can reassure your husband that most men are diagnosed at a much older age – between 70 and 74. Survival rates are also improving. Twenty years ago, fewer than two-thirds of men were alive five years after diagnosis – now it’s nearly 80%. Your husband may well have benign prostatic hyperplasia (BPH), which gets more common with age and affects about 2 million men in the UK. Other symptoms include urgent visits to the loo, a poor stream and dribbling towards the end. However, he should be checked for other causes, such as urine infections and diabetes. His GP may offer a blood test called Prostate Specific Antigen (PSA). It can detect cancer early but the false positive rate is high – two-thirds of men with a raised PSA don’t have prostate cancer, and will need further tests to check.
Dr Sarah Jarvis, Good Housekeeping (Jan 12)

I’ve lost a close friend to bowel cancer and know to look out for warning signs such as loss of appetite, bleeding from the bottom or a change in bowel habits. But by the time my friend was diagnosed the cancer had spread – is any kind of screening available?

The bad news is that bowel cancer kills over 16,000 people a year in the UK – and is the second commonest cause of cancer death. The good news is that picking it up early hugely improves survival rates. In the past five years, a national two-yearly screening programme for 60 to 69-year-olds, using a home-testing kit to detect blood in your stools, has been rolled out by the NHS. If you’re over 70 (or aged between 50 and 74 in Scotland), you can request a test by phoning 0800 707 6060 – worth doing, as regular screening reduces death rates by 16%. And in April 2011, an extra test was launched on the NHS that involves examining the back passage with a small telescope. All men and women in England aged 55 to 59 will be invited for screening within the next few years. The test takes a few minutes and shows promising results.
Dr Sarah Jarvis, Good Housekeeping (Aug 11)

I’ve heard that aluminium and parabens, used in antiperspirants, may cause breast cancer. Should I avoid these?

There has only been indirect evidence of a link between the use of underarm products and risk of breast cancer. Similar links are also found with consumption of animal fat, national income and alcohol intakes, but these may be indicators of wealth and lifestyle. Breast specialists suggest that use of underarm products is unlikely to have any major impact on breast cancer. When going for a mammogram you may be asked not to use underarm products containing aluminium that morning, but this is only because they might obscure the results. According to Cancer Research UK (www.cancerresearchuk.org), the results of 19 studies show no link between parabens or aluminium salts and breast cancer. A study of 1500 women found no difference in the incidence of breast cancer whether the women used deodorant or antiperspirant or not. So it’s down to personal choice – some people choose to avoid synthetic underarm products, some select ‘natural’ organic products, and others prefer to go bare. Dr Sarah Brewer, Prima (Jul 11)

I have been a sun worshipper for years, and have just been diagnosed with basal cell cancer. My doctor seems amazingly blasé about it considering it’s cancer. Should I get a second opinion?

Fortunately you have one of the two ‘non melanoma’ skin cancers, which account for about 90% of cases of skin cancers but only 10% of skin cancer deaths. Basal cell cancer, or BCC, is sometimes known as a ‘rodent ulcer’ – it gradually increases in size if not treated, eating away at the skin, but it virtually never spreads to other parts of the body. That means the outlook in terms of a complete cure is extremely good. Most BCCs are simply treated by cutting them out and regular surveillance, without any need for chemotherapy or radiotherapy. However, you are at risk of getting other skin cancers in the future. You need to make really studious efforts to keep your sun exposure to a minimum for the rest of your life to avoid future problems elsewhere. That means not just covering up with hats and long-sleeved clothes, but wearing a 50 SPF sunscreen on any parts of your body that are exposed to sun.
Dr Sarah Jarvis, Good Housekeeping (Sept 10)

Spotting skin cancer early

My grown-up son spends his life on his mobile phone, and a friend has told me that the radiation can cause brain tumours. He says it's nonsense, but should I be worried?

Many of the health scares that spread like wildfire on the internet are myths, but this story may have some basis in scientific research. We tend to think of scientific studies as providing hard facts, but in this case two analyses of the same studies came to different conclusions. Research found mobile phones do emit a small amount of electromagnetic radiation. The American Food and Drug Administration looked at all the major studies and concluded that even with long-term (over 10 year) use, this doesn't cause any increase in brain tumours. However, a research group in Sweden looked at the same studies - paying particular attention to long-term users - and begs to differ. They found a link with two particular tumours - a benign tumour on the nerve linking the brain and the ear, and a kind of brain cancer called glioma. If your son still isn't convinced, give yourself some peace of mind by buying him a headset to keep the antenna further from his brain.
Dr Sarah Jarvis, Good Housekeeping (Mar 10)

Is this the best treatment?

My 45-year-old husband, who has early stage prostate cancer, has been offered a radical prostatectomy. I've read that non-surgical techniques, such as HIFU, may be just as effective as surgery. Is surgery always the better option?

Prostate cancer is one of the most common cancers in men and 34,000 are diagnosed with it each year in the UK. But it's quite rare in men under 50, with two-thirds of cases in men over 70. A radical prostatectomy aims to provide a complete cure and is suitable when the cancer hasn't spread outside the prostate. The drawback is the side-effects. Erectile dysfunction occurs in 70 per cent of cases, with urinary incontinence in 25 per cent of cases. But if it's your husband's best chance, he'd be ill advised to seek an alternative. HIFU (High Intensity Focused Ultrasound) is only available in trials. A recent study in the British Journal of Cancer found that men treated with HIFU had fewer side-effects than those who had radiotherapy and surgery, but it involved just 172 men whose cancer hadn't spread - though a year after the therapy, 92 per cent of the men were still cancer-free. HIFU is certainly a treatment to watch, but there's no knowing if it offers a better long-term cure than a radical prostatectomy. Dr Louise Selby, SHE (Nov 09)

My husband's worried about his cancer coming back

My partner was diagnosed with testicular cancer, but it was caught early and he's now fine. But he's anxious about it returning. How can I reassure him?

It's great news that your partner has been given the all clear. In fact, testicular cancer is rare, with around 2,100 men diagnosed every year. Most men (about 95 per cent) are fully cured and if there is no relapse within two years after treatment, then there is less than a five per cent chance of it recurring later. A recent study looked at the use of the chemotherapy drug carboplatin on patients with early stage seminoma (one of the most common types of testicular cancer). It found that only five per cent relapsed and, after further successful treatment, none died from testicular cancer. Make sure that he has regular check-ups and ask him if he's interested in seeing a counsellor - visit www.cancerhelp.org.uk for advice on how to find one. Dr Louise Selby, SHE (Feb 09)

I have developed a lump in my mouth and I'm terrified that it is cancerous. Should I get it checked out?

Mouth cancer is more common in men, smokers and women who drink more than 14 units of alcohol a week (the recommended maximum amount). It has also been linked to the HPV virus that is associated with cervical cancer. Mouth cancer may begin as an ulcer that doesn't heal, but it can start as a lump - if it persists for more than four weeks, see your GP or dentist. Other symptoms are red or white patches in the mouth, or teeth that loosen for no reason, though these can all be caused by something harmless. As a general guide, go for a dental check-up every six months and look after your mouth by avoiding tobacco and limiting alcohol. Brush your teeth at least twice a day and follow a healthy diet. For more advice, contact www.mouthcancerfoundation.org. Dr Louise Selby, SHE

Does lip gloss cause cancer?

I've heard that wearing lip gloss may increase the risk of skin cancer. Is this true?

According to US skin specialist Dr Christine Brown, the skin on your lips is very thin and therefore more prone to sun damage. As a result, wearing a lip gloss rather than a sunscreen will not protect against ultraviolet radiation. Having said that, lip cancer is the least common form of oral cancer, and men are twice as likely to be affected as women. Just under 200 cases are diagnosed every year in the UK in males, compared with just under 100 cases in women. It's therefore unlikely that lip gloss itself is harmful. To protect against this form of cancer, wear a sunscreen such as Australian Organic Tea Tree Soothing Lip Balm SPF18 (£2.65). It's available from Holland & Barrett.
Dr Sarah Brewer, Prima

I can’t bear feeling like this I’m taking tamoxifen for breast cancer, but am getting terrible hot flushes. Is there anything I can do to relieve them?

There are several complementary therapies for treating flushes, since it is not appropriate for you to take HRT. One is red clover isoflavone, taken in doses of 60–80mg a day. Studies suggest it doesn’t increase the risk of breast cancer but there is less evidence for women who already have the disease. As it has some oestrogen-like properties, it may be worth avoiding if you have breast cancer that is oestrogen receptive. Other alternatives are dong quoi and black cohosh, but while the latter is usually safe, it has very occasionally caused severe liver problems. Prescription medications effective in treating hot flushes include SSRI tablets. Finally, the group of medicines called the Aromatase Inhibitors work similarly to tamoxifen, but do not cause as many problems with flushes. You could talk to your GP about using these as an alternative to tamoxifen. Dr Sarah Jarvis, Good Housekeeping

Cancer affects my appetite

I have cancer and am finding it difficult to eat. What can I do?

If you experience problems with eating or drinking, or unplanned weight loss, when you have cancer, it’s important to tell your doctor. If the weight loss can be slowed or even stopped, you’re in a better position to fight the illness. Normal healthy eating rules don’t apply, and foods high in calories and protein are needed to help regain lost weight. Visit the website www.nutritionincancer.co.uk – it provides nutritional information for people with cancer. It includes recipes and suggestions for protein-rich, high-calorie snacks, plus an online forum. A free DVD can also be ordered. Dr Sarah Brewer, Prima

Are there any warning signs of ovarian cancer?

My aunt recently died from cancer of the ovary, which wasn’t diagnosed until it had spread. Is there any way of recognising the symptoms early, so it can be picked up sooner?

Cancer of the ovary is the fourth most common cancer in women, affecting about 7,000 a year in the UK. Unfortunately, there are no routine screening tests like those for cervical or breat cancer. However, recognising the early symptoms can make all the difference to the outcome. Until recently, that was difficult as warning signs can be vague and often don’t seem to be gynaecological, but research by the University of Washington has now identified what seems to be a pattern of frequent, persistent symptoms, even in women in the very early stages of the disease. The six symptoms you need to look out for are: persistent bloating; abdominal pain; pelvic pain; increased stomach size; feeling full and difficulty in eating. If you have any of these symptoms for more than 12 days in any month, you should see your GP and explain that you’re concerned ovarian cancer may be the cause. Dr Sarah Jarvis, Good Housekeeping

Breast cancer screening

My 44-year-old cousin has just been diagnosed with breast cancer. Will I need regular screening?

Breast cancer does sometimes run in families, but it's only likely to be a factor if a ‘first degree' relative - your mother, sister or daughter - is affected. Even then, the extra risk is small unless more than one relative is affected. So it's unlikely you need regular mammograms before the standard age of 50, unless other members of your family are affected, too. However, every woman should practice breast awareness, which means paying attention to what your breasts and nipples are normally like, so you can spot changes early. Your practice nurse or GP can give you all the details. Dr Sarah Jarvis, Good Housekeeping

Breast cancer and goseralin

I’m 37 and have just been diagnosed with breast cancer. I’ve been told the tumour is oestrogen sensitive, which means oestrogen makes it grow, and that drug treatment to block this effect could be better than chemotherapy. Instead, I’d have monthly injections of a hormone called goseralin. I’ve been dreading chemotherapy, and this sounds too good to be true – is it?

Let's start with the benefits. If you have oestrogen receptor positive cancer (and over half of women under 50 with breast cancer do) goseralin is a really effective alternative to chemotherapy because it has similar survival rates and less serious side-effects. What's more, while chemotherapy involves repeated hospital visits, you can be given a goseralin injection just once a month by your GP or practice nurse. Of course, as with any drug, there is a downside; the side-effects are similar to menopausal problems, such as hot flushes, sweating, vaginal dryness, loss of libido and possible mood swings. These side-effects disappear after you stop treatment, however, while chemotherapy side-effects can last much longer. The main disadvantage of goseralin is that treatment takes two years - instead of six months of chemotherapy. So really, it's a question of weighing up what's most important to you, and insisting you get a say in deciding your treatment options. Dr Sarah Jarvis, Good Housekeeping

Breast mouse

I’m 29 and have just had a lump in my breast taken out. The surgeon said it was a ‘breast mouse’ and assured me it wasn’t cancerous, but I’m still worried it might increase my risk of breast cancer.

A ‘breast mouse' is a harmless, fibrous lump, named because it ‘scuttles away' under your fingers. Obviously, all breast lumps are worrying until you know what they are. However, with a ‘breast mouse' (officially called a fibroadenoma), you don't need to be concerned. And in the long term it certainly won't increase your risk of breast cancer. Dr Sarah Jarvis, Good Housekeeping

Tamoxifen

I was diagnosed with breast cancer four years ago, and have been taking tamoxifen ever since. I’ve been told I’ll have to stop once I’ve been on it for five years. Is it true, however, that there’s a new drug I can take after that, and does it really help?

I'm delighted to say that it's true. A drug called letrozole (Femara) has recently been licensed for post-menopausal women who have completed their course of tamoxifen. The even better news is that the license was granted after the drug, which is taken as a daily pill, was found to reduce chances of breast cancer returning by almost 40% - and since over half of the recurrences of breast cancer tend to happen after women stop taking tamoxifen, this latest drug should be a life-saving development. Dr Sarah Jarvis, Good Housekeeping

Warning signs for ovarian cancer

Tragically, one of my friends has just been diagnosed with ovarian cancer and is terminally ill because she didn’t go to her doctor until it was too late. Obviously, I’m shaken by what’s happened. Are there are any warning signs to watch out for?

Ovarian cancer can be difficult to recognise until it's quite advanced. However, it has recently been discovered that, unbeknown to them, at least 90% of women with ovarian cancer had had warning signs before they were diagnosed. If these were more widely known, it could make a real difference to survival rates. The sort of persistent signs you should be looking out for include bloating, fullness or swelling in your abdomen; unexplained back or abdominal pain; a change in your bowel habit; excessive and ongoing tiredness; unexplained weight loss or gain or any irregular vaginal bleeding. Dr Sarah Jarvis, Good Housekeeping

Tamoxifen & hot flushes

I was diagnosed with breast cancer two years ago, and take tamoxifen. I know it’s important to keep taking it, but it gives me ghastly hot flushes. Is there an alternative?

There have been huge advances recently in the treatment options for the 80% of postmenopausal women with breast cancer whose tumour is sensitive to oestrogen. Tamoxifen has been the drug of choice for years, and is undoubtedly very effective. However, as you've discovered, the side effects can be hard to live with. In the past couple of years, a new group of drugs, known as aromatase inhibitors, have come on the market. Like tamoxifen, they reduce your production of oestrogen - but by a different mechanism. All of them have proved to be even more effective than tamoxifen and, on the whole, are better tolerated. The first one licensed, anastrazole, can be taken if you suffer side effects and can't tolerate tamoxifen. Now one of the others, exemestane, has been licensed for use as a ‘switch' drug after two to three years on tamoxifen. Talk to your consultant about whether you might be suitable for it. Dr Sarah Jarvis, Good Housekeeping

Breast cancer scare

My lump’s not cancer, but I’m still worried I have a fibroadenoma in my breast. My GP says I don't need it removed, but will leaving it increase my risk of cancer in the future?

A fibroadenoma - a fibrous lump - is thought to occur when certain cells are unusually sensitive to the female hormone oestrogen, causing them to grow more quickly. It's common to just keep a watchful eye, as it may disappear on its own. If it's large or you're worried, you can ask for it to be removed. For most women, having a fibroadenoma does not increase the risk of breast cancer. A few women with a strong family history of breast cancer, and whose fibroadenoma shows complex cell changes, are given regular follow-ups. Talk to your GP about your concerns and, like all women, remain breast aware. You can also call the Breast Cancer Care helpline on 0808 800 6000 or visit www.breastcancercare.org.uk. Dr Sarah Brewer, Prima

Is it worth having the cancer vaccine?

I had pre-cancerous cervical cells in my twenties and mid-forties. Should my teenage daughters have the Gardasil vaccination?

Cervical pre-cancerous abnormalities are not hereditary, as most cases are linked with certain strains of high-risk wart viruses. Condoms offer around 70 per cent protection against these viruses. The Gardasil vaccine protects against the strains associated with 70 per cent of cervical cancers, and those causing 90 per cent of genital warts. Gardasil is licensed for use in girls and boys aged nine to 15 and women aged 16 to 26. I’d strongly advise your daughters to consider having the vaccine – it has the potential to reduce the risk of cervical cancer and abnormal smear results. More information is available from the Jo’s Trust charity; visit www.jotrust.co.uk or call 01327 341965. Dr Sarah Brewer, Prima

Are there any warning signs for lymphoma?

A friend was recently diagnosed with lymphoma, but she wasn’t her usual self for months beforehand. I’d tried to persuade her to see her GP, but she didn’t want to bother him. Are there any warning signs?

Lymphoma is a cancer of your lymph system, which helps fight infection. Early symptoms include painless, rubbery swellings in the neck, groin or armpits; night sweats; fevers; tiredness and unexplained weight loss; all-over itching; irritating cough and shortness of breath. Although symptoms are often mistaken for a cold, you should see your GP if you have more than one that doesn’t go. Catching it early can make a real difference in terms of a positive outcome. Dr Sarah Jarvis, Good Housekeeping

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The answers to specific problems may not apply to everyone. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk