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
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
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
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
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