Guide to women's health

Breast cancer

Breast cancer is the most prevalent cancer among women and affects approximately one million women worldwide. It accounts for 30% of all female cancers in the UK and approximately 1 in 9 women in the UK will get breast cancer at some point in their life. Although most cases develop in women over the age of 50, younger women are sometimes affected. It can also develop in men, although this is rare.

What causes breast cancer?

Breast cancer develops from cells in the breast tissue, which is made up of glands for milk production called lobules, as well as the ducts that connect the lobules to the nipples. Cancer cells that remain confined to the lobule and the duct are known as 'in situ' or 'non-invasive', meaning that they have not spread to other parts of the body. Nearly all cancers at this stage can be cured.

An 'invasive' cancer, also known as 'infiltrating', is one in which the cells have moved outside the ducts and lobules and into the surrounding breast tissue. The curability of this type of cancer is strongly influenced by how far the cancer has spread when it is diagnosed.

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is still unknown and continues to challenge scientists. It is thought that something damages or alters certain genes in the cell, making the cell abnormal and causing it to multiply out of control.

What are the symptoms of breast cancer?

For most women the first symptom of breast cancer is a painless lump in the breast. In the vast majority of cases breast lumps prove to be benign and are not cancerous. Most breast lumps are in fact fluid filled cysts or fibroadenomas - a collection of fibrous glandular tissue. If you develop a breast lump or notice any unusual changes in your breasts you should see your doctor straight away in order to rule out cancer.

Other symptoms to look out for include:

• changes in the size or shape of a breast
• a swelling or lump in your armpit
• dimpling or thickening of the skin on the breast
• changes in the shape of a nipple
• discharge from the nipple
• a rash around the nipple
• pain in a breast (although this rarely means cancer).

As with breast lumps, these symptoms don't necessarily mean cancer. However, if any of these symptoms occur you should see your doctor as soon as possible.

The treatment for breast cancer

Treatment for breast cancer will vary from woman to woman depending on a variety of factors such as age, the stage of the cancer, the size of the tumour and whether you have had menopause. Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone therapy. Often a combination of two or more of these treatments is used.

Treatment options should be discussed thoroughly with your doctor.

Cervical cancer and the smear test

Each year in the UK more than 2,800 women are diagnosed with cervical cancer, resulting in around 1,100 deaths. Although most common amongst women over 50 years old, cervical cancer is the second most common cancer in women under the age of 35.

Cervical cancer develops from the cells that line the neck of the womb, known as the cervix. It is usually diagnosed through a biopsy which is performed if abnormal cell changes have been detected following a cervical smear. A biopsy is usually performed at the time of an internal examination called a colposcopy.

In the vast majority of cases there is a period of time when the cells develop abnormal changes but are not yet cancerous. It is by diagnosing and treating these pre-cancerous changes that the development of actual cancer can be prevented.

It is important to remember that it takes many years for the early cell changes that can be detected on a cervical smear to become cancerous and in many cases the changes go away by themselves. In fact, the vast majority of abnormal smear test results do not indicate cancer.

What causes cervical cancer?

There is no definite single cause of cervical cancer. A viral infection of the cervix is present in most cases. Smoking and poor diet appear to increase a woman's risk of developing cervical cancer and there may also be a link to the number of sexual partners a woman has had at a young age.

What are the symptoms of cervical cancer?

Pre-cancerous changes of the cervix that are detected in a cervical smear do not usually cause symptoms. In most cases though, cancer of the cervix does. Possible symptoms include:

• bleeding after sexual intercourse
• bleeding between menstrual periods
• bleeding after the menopause
• an unusual discharge
• discomfort or pain during sex.

If you have experienced any of these symptoms you should visit your doctor. Although, it is most likely that these symptoms are caused by other conditions.

Treatment

If tissue cell changes have occurred, it is normally advised that the tissue is removed. There are several ways of doing this including a diathermy loop or using a laser. Most procedures can be performed with local anaesthetic.

Following these procedures there may be some slight bleeding but the cervix heals quickly. Once removed, the pre-cancerous tissue will be replaced by new, healthier tissue. This form of treatment is highly effective but pre-cancerous changes can return so continued follow-up is essential.

If cervical cancer has been diagnosed, treatment options will depend on the stage of the cancer and include surgery, radiotherapy and chemotherapy.

The menopause

The menopause is defined as the end of the last menstrual period.

The menopause occurs when the ovaries no longer respond to the controlling hormones released by the pituitary gland of the brain. As a result, the ovaries fail to release an egg each month and to produce the sex hormones oestrogen and progesterone. It is the fall in the levels of these hormones in the bloodstream that gives rise to the symptoms of menopause.

How does the menopause start?

Many women experience symptoms of the menopause and irregular periods for several years up to the menopause itself. This is called the climacteric, or 'perimenopause', and represents the gradual decline in the normal function of the ovaries. One of the most common problems during this stage is erratic periods.

What is the menopause like?

Every woman experiences the menopause in their own way. Whilst many hardly notice the change and only suffer from irregular periods, others go through every symptom and find their lives are severely affected.

The transition into the menopause is usually gradual and can be accompanied by a range of symptoms, such as:

• Hot flushes and sweating - this is by far the most common symptom. Episodes can happen at any time, as often as several times an hour, with each hot flush usually lasting between three and six minutes.
• Sleep disturbance – this can be caused by problems falling asleep, restlessness or night-time sweats.
• Psychological changes - depression, mood swings, tiredness and headaches are all possible symptoms.
• Physical changes
  • During the menopause your skin becomes thinner.
  • A lack of oestrogen often means the glands in the vagina don't produce as much lubrication as before and this may cause stinging around the vagina during sex.
  • Some women don't feel like having sex whereas others find their orgasms become less intense.
  • The lack of oestrogen also affects the bladder and you may find you need to pass water more often.
  • There is a gradual rise in the risk of heart disease, stroke and osteoporosis after the menopause.
  • Falling oestrogen levels result in unfavourable changes in cholesterol and fat levels in the blood, causing a predisposition to these problems.

Treatment for the menopause

It's important to remember that the menopause is not an illness. It is a natural phase of life that we have to live with and treatment is not always necessary.

There are, however, a variety of treatments available to combat the symptoms of the menopause. These include:

• Hormone replacement therapy (HRT) – this involves receiving a small daily dose of oestrogen that relieves the symptoms of the menopause by adjusting hormone levels.
• Tibolone - a synthetic steroid hormone that has some oestrogen and some progesterone effects (it also has some testosterone-like effects).
• Clonidine - a drug originally developed for use as a blood pressure lowering treatment but at smaller doses it can relieve hot flushes.
• Oestrogen creams and pessaries - vaginal dryness can be relieved by short courses of oestrogen creams or pessaries that are inserted into the vagina.
• Complementary medicine - a range of ‘complementary’ medical treatments are also widely in use to alleviate menopausal symptoms.

If you have any concerns please do not hesitate in contacting your GP. There are also various other sources that you can refer to or contact for further help and information.