A Guide to Breast Cancer - A-Z of the NHS - Dr Gill

okay so we've done blood pressure andy what's the next b you've brought us for the next b i'd like to discuss is breast cancer okay very important it's important because it can be serious and it's important because it's incredibly common and in fact about one in eight women during their life may experience breast cancer so that's a staggering 12 percent of the female population if you look into older age groups it's more common and in fact 80 percent of those patients are over the age of 50 but that doesn't mean that young women don't get breast cancer because 20 percent of patients with breast cancer are under 50 and i expect you've seen a few of those in your general practice absolutely we get all ranges of age and types of people coming in in terms of small people large people people who are smokers every form of lady is potentially at risk of breast cancer and every form of chap is at risk of breast cancer as well because we still have breast tissue but it is very small the point with that is if you have any doubt at all that you may have found a lump somewhere not even necessarily the breast talk to your doctor please you're right james it's important to talk to your doctor i think nonetheless there is reluctance for some women to come forward and they should not be embarrassed this is such an important diagnosis they should make an appointment to see you if they want a female doctor that can be arranged but there's an old phrase that i learned at medical school which you probably learned too which is that no woman should have a lump in the breast absolutely and i've got a story about this a lady that i had and she came into the gp surgery and she was she was worried she was anxious and it was very difficult to work out why she'd actually come to see me that day and i you know i did all the usual gp tricks letting her talk and talking about her fears and things i i couldn't work out why she'd actually come to see me that day eventually we did manage to find out that she was worried about a lump and it turned out that she'd been worried about that lump for about a year when we did have a look at that lump in her breast she left it so long you could physically see the cancer coming through her skin she had what's called a fungating tumor that's a patient that will stay with me for the rest of my life and it's one of those patients that galvanizes me to promote breast cancer awareness and say if you're in doubt even if you're not certain i would more than be i'd be more than happy to see 15 20 people and reassure each and every one and say no i can't find anything don't worry you're safe if that meant we don't miss that one person who's frightened and wasn't sure and i think the general public are sometimes over concerned about us they're over concerned that we're busy and really i would encourage all women out there to come forward if they think they've got a lump in the breast or they're just worried about their breasts in some way yes it's a little bit embarrassing but we're trained to deal with that survival rates in breast cancer fortunately are improving in fact there's been staggering improvements in the last 40 years or so nonetheless it's still not a fantastic diagnosis 90 of women if they're detected early will survive 20 years which is good but that means 10 won't and if the cancer's already spread at diagnosis and about five percent of women have a cancer that's already spread then the outlook is more guarded for those patients but just to repeat the go home message is if you think you've got a problem or you might have a problem or you're just concerned for some reason go and get it checked out and like the blood pressure there are things that people can do to reduce their risk so for example being overweight the same way as blood pressure being overweight does increase your risk of breast cancer because it connects the same reason that women are more susceptible to breast cancer than chaps are breast cancer is driven by estrogen so the things that we that people can do that make more eastern in the body such as being overweight increase the exposure of estrogen and increase the risk of breast cancer some of the things that are protective of breast cancer having a baby because having that baby changes your cycle and means you've got a reduction in exposure breast feeding that said baby is also going to reduce your exposure to estrogen now i'm saying that they're things that are protective i'm not necessarily promoting them as treatments but we need to think about the whole patient and lots of women will go through those things in the course of their life anyway let's talk a bit about what a woman can do to help herself the simple thing a woman can do is breast self-examination now that's quite easy if you don't know how to do it there's lots of videos out there but i think a woman should be doing that every three months or so just checking that there are no lumps and if she's worried some women unfortunately have lumpy breasts so it's quite difficult to tell where they've got a discreet lump i'm actually going to come in there i'm going to disagree slightly i would suggest that a woman checks her breasts twice a month so one different points of their cycle the more that people check everyone how many times do you shower hopefully daily quickly check whilst you're in there the more you know about your body the more confident you're going to be that you've caught something straight away there's no absolute right nor wrong with this but again i go back to the fact that i'm on the interventional side of things i want more checks another thing is if she thinks i got she's got a problem to report that problem now the type of things a woman may feel uh first of all a breast lump but there are other things too um there can be change in the look of the nipple there can be a discharge from the nipple there can be a change in the shape of the breast there can be a change in the skin of the breast so those are five things that a woman may notice and she should report any of those five things and those things also apply to a chap we as chaps we don't check our breasts because we don't have that amount of tissue but we're all very aware of our nipples if you see a change to your nipples male or female get it checked do not sit on this don't think i'll it'll probably be okay any change to the nipple we need to know about it another thing a woman can do is ask her family whether there is a history of breast cancer because breast cancer is to an extent inherited and there are some blood tests now that i expect you're used to ordering on women who have a family history of breast cancer so that's another thing that you can do a final thing and this is for older women is to have a mammogram mammograms are uncomfortable i've never had one but i've got lots of friends who've had one and it involves putting the breast within an x-ray machine so they are uncomfortable but they're very important and in fact the government recommends and in fact invites women between the age of 50 and 70 to have a mammogram every three years now a friend of mine who's in her late 50s admitted to me the other day that she rather naughtily doesn't open the envelope because she thinks it might say come up for a mammogram and because the last one hurt she doesn't want to have a mammogram i don't know how you feel about that james i think that's a shame because it's about again knowing her body and being safe there are some people get worried about having a mammogram because of that radiation the way i view that is i go out to my bike a because i enjoy it and b because i'm trying to keep fit trying to reduce my chance of having high blood pressure but by going out on the bike there is a good chance i'll get knocked off my car and injured it's already happened twice but i still do it anyway because overall i get more benefits from it and that's the same thing with breast screening and breast cancer screening yes it is going to be uncomfortable and there is a theoretical risk from the radiation to it but you are going to have more benefits by going for it then by not so with that lady i would want to do what i could to help her appreciate that she's going to get more benefits than that discomfort she had there if unfortunately the lady does have a lump in her breast and she comes to see you i'd just like to ask you what you would do next about that how would you get that patient to a specialist at your local hospital so as you rightly know and we i'm sure you get plenty of people who you put on two week weights as well in my clinic i have a very low threshold for doing what are called two week weight these are essentially emergency cancer clinic appointments if i've got anybody who even slightly goes on my radar they get this two-week weight referral basically any lady who's coming in with a breast lump is going to be seen by me and is going to be seen then in the breast cancer clinic to make sure that we are safe and i say to an awful lot of patients this is probably nothing and it's probably just you know going to be a waste of an afternoon for you however i absolutely still want you to go along because it's about being safe rather than sorry and i actually thought that when i started training that i was doing a good thing by not referring as many patients as i was and i was trying to save money i've actually been told off with that and told i need to refer more patients and we need to get more patients with normal findings i found that strange initially you definitely shouldn't hold back for referring patients in fact uh before uh this session i had a chat to a breath specialist a breast surgeon in my hospital and i said if you're going to give the general public a single go home message what would it be he said don't ignore a lump in the breast get a two-week weight referral to see me i don't mind he said i don't mind his clinics are very busy in fact they see 90 patients twice a week so for that number of patients you're going to need five or more specialists there to see women to examine their breasts but they are there and they are waiting to see you so that's his message to you all if you come in with a breast lump the chances of you not being sent to the hospital to get extra tests are very very low there are a few patients who i'm able to reassure but that's normally we'll do a couple of things and recheck and then if those changes haven't um gone away you're going to be seen again we take this very very seriously and as with everything if you're not sure i'm not sure that's not good enough we have to get that extra data to make sure everyone is safe and i make no apologies for sending people finally i'll tell you my breath story and this is about my 92 year old mother about 10 years ago i was on sabbatical in boston with my family and this was something i was really looking forward to it taken me two years to organize we had a nice house the work was interesting and one week into the sabbatical my mother rang me and said she had a lump in her breast so i was very distressed she told me not to worry and it's probably not serious dear and i said mum please go to your gp and she did she was referred through the two-week system saw a surgeon who operated about four weeks later and i came home from my sabbatical in boston to look after her that was ten years ago now 10 years later she's fit she's free of breast cancer and cured so that's the go home message you can cure breast cancer well i think that wraps up breast and breast cancer there a subject that i have a great deal of passion for as andy has rightly said one in eight people will be touched by this disease in their lifetime in the case of women slightly less in men but it still affects both parties so take care right with um the breast cancer section out of the way join us for the next video and we'll look at bmi 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