Breast cancer is the most common cancer in women in the UK, affecting one in nine women at some point in their life.

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Damage to the DNA of these cells results in uncontrolled cell division and growth, and, eventually, sufficient cells accumulate to form a lump.

The cells invade normal surrounding breast tissue and can break off from the primary lump to spread in lymph channels or the blood stream to other organs where secondary lumps (metastases) may form.

The breast is divided into ducts and lobules. The most common form of breast cancer arises from the ducts and is known as invasive ductal carcinoma. Cancers arising from the lobules (invasive lobular carcinomas) are less common.

As with most cancers, the key to successful treatment is early diagnosis before the cancer has had the chance to spread to other organs.

Causes/Risk Factors

The exact causes of breast cancer have not been clearly identified, but certain risk factors have been identified:

• Getting older – 80 per cent of breast cancer cases are in postmenopausal women – it’s relatively unusual in younger women
• Having a significant family history of breast cancer, which may be associated with inherited gene mutations (see below)
• Having no children or children late in life
• Starting your periods early or going through the menopause late
• Taking hormone replacement therapy (HRT) for a prolonged period
• Being overweight
• Drinking alcohol in excess

A genetic link

Fewer than one in 20 cases of breast cancer is inherited. About one person in 1,000 carries the genes responsible, so if a relative has breast cancer it’s most likely to be by chance. However, you should be more wary if you have:

• A relative who was diagnosed under the age of 40
• A close relative with cancer in both breasts
• A male relative with breast cancer
• Two close relatives on the same side of the family diagnosed with breast cancer under 60 or with ovarian cancer
• Three close relatives diagnosed with breast or ovarian cancer at any age

It may be worth writing out a family health history record, to help you work out patterns of disease that run in the family.

If you’re worried, talk to your GP. You may want to think about genetic screening.

SymptomsBreast cancer may be diagnosed before any symptoms occur through screening. The NHS National Breast Screening Programme provides free screening for breast cancer for all women over the age of 50. If you’re between 50 and 70 you should be routinely invited for a mammogram every three years. Women over 70 are encouraged to make their own appointment.

Otherwise, breast cancer may be diagnosed when a woman develops symptoms that alert her to seek medical advice. All women should practise breast awareness. This involves getting to know what’s normal for your breasts in terms of look and texture, so you can spot any changes and get them checked as soon as possible.

In particular you should look for:

• Lumps or thickening of the tissue
• Discharge from the nipple
• ‘Tethering’ of the skin, as if it’s being pulled from the inside
• Any unusual appearance, sensation or pain

 

Remember, most lumps are harmless, especially if you’re young. But you should still get them checked by a doctor as soon as possible.

How’s the diagnosis confirmed?All patients suspected of having breast cancer must be seen by a hospital specialist within two weeks of an urgent referral by their GP.

Some hospitals run ‘one-stop shops’ for rapid assessment of breast lumps where all the examinations can be done on the spot, often with the results available on the same day.

To make an accurate diagnosis, doctors need to carry out a thorough examination. They’ll take a careful look at the lump itself, possibly using an ultrasound and mammogram.

They may take a sample of tissue using needle aspiration and/or needle biopsy. This is then analysed by a pathologist to assess whether malignant cells are present and confirm the diagnosis of cancer.

The cells may be tested to see if they carry certain receptors, which may influence the treatments offered. If they carry hormone receptors, it suggests they’re sensitive to female sex hormones and hormone therapies are likely to be used in their treatment.

Cells carrying the Her2 receptor may respond to the drug trastuzumab (herceptin), which may be used in the treatment of some Her2 positive cancers.

Treatment/RecoveryThere’s no quick cure for breast cancer – if anyone tries to tell you otherwise, be extremely sceptical. However, there are many effective treatments and the death rate from breast cancer in the UK has been falling for a number of years.

Once a diagnosis of breast cancer is confirmed, the exact treatment used, how soon it’s given and how long it takes all depends on several factors, including:

• The stage of the tumour (how far it has spread) and whether there is secondary cancer
• The receptor status of the breast cancer
• The general fitness of the patient
• The menopausal status of the patient
• The woman’s own wishes

Management of breast cancer is a team effort and a number of specialists may be involved including surgeons, oncologists and breast care nurses.

Other investigations, such as blood tests, chest x-rays and CT scans, may also be done.

Cervical cancer is the second most common cancer in women under 35. In 2005, 1,061 women in the UK died from the disease. But precancerous changes in the cervix can be detected, allowing for prompt treatment.

Cancer of the cervix affects the cells lining the entrance to the womb.

About 2,700 women are diagnosed with cervical cancer each year in the UK. Thanks to the cervical cancer screening programme, which checks 4.4 million women every year, the number of women being diagnosed has fallen by more than 40 per cent since 1988.

More then 90 per cent of cervical cancers are a type called squamous cell carcinoma, which start in the surface cells lining the cervix. Between five to ten per cent are a different type, called adenocarcinoma, which form from mucus-producing gland cells (there are also various sub-types of adenocarcinoma). There are also two much more rare types of cervical carcinoma known as small cell carcinoma and cervical sarcoma.

Squamos cell cervical cancer develops in a series of precancerous changes, starting with mild abnormalities in the cells and progressing towards full cancer. Each year, about 24,000 women are found to have the most serious form of precancerous abnormalities (CIN 3 changes) when they have a cervical smear test. Adenocarcinoma is more difficult to spot as it usually starts high up in the cervical canal and may not be picked up by a smear test.

By detecting early changes before cancer has become fully established or spread, cervical screening now saves approximately 4,500 lives a year in England. As a result, the death rate has plummeted by 60 per cent in the past 30 years.

About 70 per cent of women treated for invasive cervical cancer are alive five years later, although survival rates are much higher when the disease is caught in its earlier stages.

What’s the cause?Exactly how cervical cancer develops isn’t known, but it’s most likely to result from a combination of triggers. Risk factors include:

• Infection with certain types of human papilloma virus (HPV), but not the type that causes genital warts. HPV is found in virtually all cases of cervical cancer (both squamous cell carcinoma and adenocarcinoma) and HPV types 16 and 18 carry the highest risk.
• Other sexually transmitted infections in combination with HPV. Women with chlamydia or HIV as well as HPV have a significantly increased risk of cervical cancer.
• Any factor that increases the risk of exposure to HPV, including having many sexual partners, first having sex at a young age and not using barrier contraceptives such as condoms.
• Smokers are twice as likely to develop squamous cell carcinoma of the cervix as non-smokers because chemicals in cigarette smoke damage special cells in the cervix that normally fight the disease.
• The contraceptive pill directly increases the risk by a very small amount.
• Not having a smear test. Almost half of all new cases of cervical cancer occur in women who’ve never had a smear test, which means early, pre-cancerous stages of the disease aren’t detected or treated.

What are the symptoms?

The most common symptoms of cervical cancer include:

• Bleeding between periods or after sex, or new bleeding after the menopause
• Unpleasant smelling vaginal discharge
• Discomfort/pain during intercourse

 

Any of these symptoms may have causes other than cervical cancer, but it is important to get them checked by your GP, even if you’ve attended your routine cervical smear test.

How’s it diagnosed?All women aged 20 to 64 who’ve had sexual intercourse should have a smear test every three to five years. This can be taken by a doctor or nurse at your GP surgery, family planning clinic or well woman clinic.

The NHS Cervical Screening Programme first invites a woman to have a smear test at the age of 25. After that, women are offered screening every three years until the age of 49, and then every five years until 64.

Women over 64 can stop having smear tests if the previous two in the past ten years were negative.

Smear tests detect the early changes of cervical cancer. This is a positive test. Sometimes all that’s needed is to repeat the test a few months later to see if the abnormalities have healed.

Most women will be offered further tests, in particular a colposcopy, where the doctor examines the cervix with a microscope to get a closer look at the cells and take a biopsy (rather like a more intensive smear test).

What’s the treatment?This will depend on the stage of the cancer, but generally aims to destroy or remove abnormal cells. Treatments for precancerous changes include laser, cryotherapy (freezing), cone biopsy (removing a cone-shaped piece of tissue) and hysterectomy.

In invasive cancer, radiotherapyand chemotherapy may be offered.

Sleep is a natural – if still rather mysterious – process we take for granted, until it goes wrong. There are more than 80 recognised sleep problems, with insomnia – the inability to get to sleep or stay asleep once you’ve dropped off – being one of the most common.

How much sleep do we need?

Most adults need between seven and eight hours’ sleep each night, although we’re all different. Some people find they can manage on just three hours. The amount we need reduces as we age. Older women often find their night’s sleep is broken, especially if they’ve taken a nap during the day.

Self-helpThere are many remedies for sleep problems, some more effective than others. The most important thing is to have a good bedtime routine, as this helps to prepare the mind for sleep.

Other things you might like to try include:

• Going to sleep and waking up at the same time every day, whether you’re tired or not.
• Making sure the environment is right for sleep – your bedroom should be the right temperature and not too noisy (don’t have a TV in your bedroom)
• Getting some moderate exercise each day, such as swimming or walking
• Avoiding stimulants such as caffeine before going to bed – try a milky drink instead
• Avoiding too much alcohol – this induces unnatural sleep, so although you may fall asleep easily, you’ll almost certainly wake up during the night
• Not eating or drinking a lot late at night
• Trying relaxation techniques before going to bed, such as yoga, hypnosis or simply listening to music

 

If you can’t sleep, don’t lie there worrying about it. Get up again and do something relaxing such as reading or having a bath.

If your sleep problem persists, see your GP. He or she may be able to refer you to a local sleep disorder clinic, which will investigate your problem in depth, although there may be a long waiting list.