For the first of our March 29 online live chat sessions we were very pleased to welcome Consultant Clinical Oncologist Dr Martin Hogg to answer your questions on the subject of cancer. Here are the questions you put to Dr Hogg and his answers in full:
AXAPPPhealthcare Morning everyone, just a small note about today's live chat This chat room contains information of general interest about current medical issues, but does not give any specific medical advice.
AXA PPP and BMI Healthcare Limited do not endorse, nor advertise any particular treatments or products for the treatment of cancer. If you are currently receiving treatment, or will shortly undergo treatment, we would strongly recommend that you seek further advice from your GP or consultant in the first instance.
AXAPPPhealthcare Dr Martin Hogg would you mind telling us a little about yourself?
Dr Martin Hogg I currently work at the Rosemere cancer centre which provides cancer care for Lancashire and south Cumbria. I use both radiotherapy and chemotherapy (including the small molecules/biological therapies) to treat breast and gynaecological cancers. I am clinical director there and also work at the BMI Beardwood hospital located just off the M6 by Blackburn.
AXAPPPhealthcare Thanks for that. We see a few people are online - do you have any questions to start us off?
Vogel Morning Dr Hogg - I wanted to ask about the links between taking the contraceptive pill and breast cancer; there seems to be reliable evidence that taking the pill does increase the risk of developing breast cancer... in light of this are any pills considered 'safer' than others?
Dr Martin Hogg Always a tricky question to answer, the older high oestrogen pills are associated with breast cancer, the newer ones less so. It is difficult because taking the pill is a life style choice and we always have to consider the pros and cons of such actions. It is suggested that the higher breast cancer risk in the west is derived from changeable factors such as obesity, alcohol and heart and those which are difficult such as later age of child bearing, fewer children and shorter duration of breast feeding. we would not recommend that a woman does not take the pill because of breast ca risks per se. I would suggest that Vogel speaks with her GP about risks and when she might want a family and takes advantage of any screening offered. in terms of cancer risk and lifestyle the oxford overview group publish their findings about the benefits of treatment and the risk of breast cancer in the lancet and lancet oncology, well worth a look...
Cajgirl: My mother had ovarian cancer about 7 years ago and had a complete hysterectomy, appendectomy and chemo. She has the all clear but my older sister has severe endometriosis which has rendered her infertile and I had polycystic ovaries that meant I had to take Clomid to conceive my twin daughters. Are these conditions at all linked and should me and my sister be concerned about an increased chance of contracting ovarian cancer due to this. We would both be happy to have an elective hysterectomy if this was the case as I have completed my family and she doesn't want one. We are 35 and 37. I have asked mu GP about genetic screening but he says my mother's type of cancer is sporadic and not inherited.
Dr Martin Hogg HI Cajgirl, if your mother had cancer in her 60's or 70's and there isn't a family history we would suggest that the cancer is likely to be sporadic. PCO and endometriosis are not linked with ovarian ca rates per se. I wouldn't recommend an elective risk reducing operation in your setting. Unfortunately there isn't a good screening test for ovarian cancer and I suggest to the daughters of patients that they should take any unusual abdominal symptoms seriously and see their GP, (and not to accept a diagnosis of irritable bowel syndrome until all tests normal)
Girl12 Morning Dr Hogg, how often would you recommend a woman checks her breasts, and from what age?
Dr Martin Hogg HI Girl12, I think she should get into a routine of checking from her early 20's onward, just monthly at the same time each month because we all see a number of young patients. most (9/10) lumps are benign and GP's and surgeons good at sorting things out. when screening comes take up the offer and if there is a family history go to gp to see if you should be referred for earlier screening with MRI.
Girl12 Thanks Dr Hogg, is it common for women to have lumps even if they are just benign?
Dr Martin Hogg Hi yes, common to have lumps and thickenings, the breasts are a glandular structure, especially in younger women, most are benign but not always possible to tell by examination. this is what the gp and surgeons are for, to help and reassure. many lumps change with the monthly cycle, these are just the glands responding to hormones, should go up and down. breast cancer is not usually associated with pain or tenderness
Girl12 Hi Dr Hogg, sorry how do you know if you are checking them correctly?
Dr Martin Hogg There are a number of good guidelines to follow from Macmillan or breast cancer care. in principle, firstly look, see if there is a pulling in the skin or if the breasts are different sizes, move your arms from your hips to above shoulders and look for pulling or unequal movement, then work in a spiral or quarters covering all the breasts, not forgetting to go towards the armpit (axillary tail of breast) do it at same time each month, also check for a nipple discharge too. if your are uncertain, I am sure that your practice nurse will be able to check you are doing it well. the first time is about 'getting to know yourself' too.
Girl 12 Thanks Dr Hogg
Funky Monkey Hello Dr Hogg, my grandma had breast cancer as did hers. Does it run in the family? Thanks
Dr Martin Hogg HI Funky Monkey, it may, how old were your relatives when they had breast cancer? most cancers are sporadic, i.e. not genetic, few are associated with the BRACA gene family or other genetic syndromes (less than 10%). however the family history may lead your local centre to offer screening earlier than age 47.
Funky Monkey My grandma was diagnosed 3 years ago when she was 64 but thank goodness she survived and is in the all clear. My great grandma was unfortunately not so lucky and I think she passed away when she was around 50. I'm really worried that my mum and I might get it. How regularly should we go 4 screening??
Dr Martin Hogg hi funky monkey, I would think about screening 10 years younger than the earliest age, maybe around 40, your mum should go and talk to her gp if she hasn't had a mammogram yet. Mammos good if person over 40, before that MRI better but with MRI we see more lumps and over diagnose things which can increase anxiety too.
Funky Monkey Thank you Dr Hogg!
Cajgirl I have asked mu GP about genetic screening but he says my mother's type of cancer is sporadic and not in inherited.
Dr Martin Hogg I agree with your gp re your genetic risk for ovarian cancer, especially if your mother was in her 60's or 70's when diagnosed. in the absence of family history i wouldn't recommend risk reducing surgery. however, it may be worth checking your family history carefully with your gp to confirm no risk. you may wish to see a gynaecologist to consider surgery for other reason than cancer risk reduction and I ma sure your gp will help. always worth checking breasts etc as normal, unfortunately there isn't any good screening for ovarian ca so any persistent subtle symptoms should be acted upon
Cajgirl Thanks I'll go and visit my GP again.
Billybobs46 Hi Dr Hogg I had a lump removed from my breast in my 30's I am now 54 and have been screened regularly but still have lumpy breasts. On one of my last checkups it was mentioned crystallisation! is this something I should worry about?
Dr Martin Hogg HI Billybob, they are probably referring to calcification in the breast seen on the mammogram, this can develop with time but if there is a new change perhaps a review of the mammogram and maybe a biopsy should be considered. worth checking report with GP carefully...
Billybobs46 Hi Dr Hogg, Yes it was calcification, I am under the NHS screening at present, and I am not due to be screened for another 18 months, I am just a little concerned that when I have exercised there are some little marks in my sports bra, just on the one side, I haven't noticed this before, is this normal or do I need to be checked out. Thank you.
Dr Martin Hogg HI Billybobs, I would go back to GP and ask for repeat mammo as you have a new symptom, (discharge), perhaps in the light of calcification (new) and are not due for another screening form 18 months, worth just getting it all checked out for peace of mind....
Billybobs 46 Thank you
AXAPPPhealthcare Well, we've just got time to say thank you to Dr Hogg, we hope you enjoyed your time with us
Dr Martin Hogg thank you, very different than face to face, easier to talk than type...
AXAPPPhealthcare Thanks Dr Hogg, we'll hand over to Miss Leila Hanna. Maybe next time we'll go for a face to face