Breast Cancer FAQs

Q. How common is breast cancer?

A. There are over 212,000 cases of breast cancer diagnosed in the USA each year. In Canada the figure is 20,500, Australia 13,000 and in the UK the figure is 41,000. Overall, one woman in every nine will get breast cancer at some time in her life.

Q. Who is most at risk?

A. Breast cancer is overwhelmingly a female disease, but about 1% of cases occur in men (around 300 per year in the UK). Amongst women it becomes more common as age increases. More than 80% of cases occur in women over 50. Taking the contraceptive pill slightly increases the risk. Taking hormone replacement therapy significantly increases your risk somewhat more, but the health benefits derived from hormone replacement are better overall. Obesity and heavy drinking also significantly increase the risk.

If one or more relatives have had breast cancer, this also increases your risk of developing it (see below).

Q. Does breast cancer run in families?

A. Having one close relative (mother or sister) with breast cancer doubles your risk of getting breast cancer, when compared to women with no cases in the family. Having two close relatives affected increases your risk further.

There are a very few families in which breast cancer is very common - ie four or more cases. Most of these families carry faulty versions of the 'BRCA' breast cancer genes. Women with a faulty BRCA gene have a 50% to 80% chance of getting breast cancer. Testing for faulty BRCA genes is available on the NHS.

Q. Is the use of deodorants linked to breast cancer?

A. There has been a persistent internet rumour that underarm deodorants cause breast cancer and even one or two newspaper articles that suggested this was backed up by research findings. However, there is no good evidence from cancer research to support this idea. On the contrary: in a large study comparing breast cancer patients and healthy women, there was no difference found at all in their use of underarm deodorants.

What are the symptoms of Breast Cancer?

Screening for breast cancer by mammography (X-raying the breast) is offered every three years in the UK to all women between 50 and 64. The highest number of cases of breast cancer occurs in women between these ages.

Mammography can detect very early breast tumours, when they are too small to be felt. In fact, most of the breast cancers detected by screening are at this very early stage, when they are relatively easy to cure. Studies have shown that women who take part in screening are more likely to have breast cancer diagnosed early and more likely to have it cured and, as a result, are less likely to die from it, than women who do not take part in mammography screening.

Another method of screening available to all women is to feel the breasts for any lumps. A guide on how to do this properly can be obtained at any doctor's surgery. Women should also check for the other main symptoms:

• Change in the size or shape of a breast
• Dimpling of the breast skin
• The nipple becoming inverted
• Swelling or a lump in the armpit

Prostate Cancer FAQs

Q. What is the prostate?

A. The prostate is a small gland located underneath the bladder in men. It is shaped like a doughnut and fits around the tube (called the urethra) which carries urine out of the bladder. The prostate produces the fluid that mixes with sperm when a man ejaculates.

Q. What is prostate cancer?

A. Prostate cancer is now the most common cancer in men in many western countries. However, most prostate tumours are slow-growing and may not need treatment. Others grow quickly and eventually spread to the bones, where they can cause severe pain. Currently there are 30,000 new cases a year in the UK; 215,000 in the USA; 20,000 in Canada and 12,000 new cases a year in Australia.

Q. What are the symptoms of prostate cancer?

A. The main symptoms are: difficulty passing urine, inability to urinate, passing urine often (particularly at night), weak or interrupted urine flow, pain when urinating, blood in the urine and pain in the lower back, hips and upper thighs. However, all of these symptoms can also be caused by other conditions such as benign prostate enlargement. Men with any of these symptoms should consult their doctor.

Risk Factors

Q. What causes prostate cancer?

A. In most cases, we do not yet know the cause of prostate cancer. Exposure to high levels of radiation is one known cause, but this only accounts for a tiny proportion of cases. However, between 5% and 10% of cases run in families, where the patient inherits a high risk of this type of cancer.

Q. Which men are at risk?

A. Prostate Cancer is very rare in men under 50. The risk increases after the age of 50 with half of all cases occurring in men over 75. Men from families with a history of prostate cancer are at higher risk than normal.

Q. Is diet linked to prostate cancer?

A. Some evidence suggests that a low-fat diet can reduce the risk of prostate cancer. Other studies have suggested that a diet high in tomatoes, Vitamin E, cruciform vegetables (such as broccoli, cabbage, cauliflower and brussel sprouts) and selenium can also reduce your risk. However, apart from selenium (see below), these findings have not been confirmed.

Q. Will a vasectomy increase the risk of prostate cancer?

A. It was thought that a vasectomy increased the risk of getting this cancer, but more recent research has suggested that there is no real difference in risk between men who have had a vasectomy and those who have not.

Q. Can prostate cancer be prevented?

A. Although there is no known way of preventing prostate cancer, studies have shown that men who took 200 microgrammes of selenium each day substantially reduced their risk of prostate cancer.

Q. Does prostate cancer run in families?

A. Some families have a higher risk of prostate cancer than others. The normal risk of getting prostate cancer some time in your life is 1 in 13. Having one or more close relatives (father or brother) who got prostate cancer under the age of 70 increases your risk by two or three times (ie your lifetime risk is between 1 in 7 and 1 in 4).

Treatment

Q. What treatments are available for prostate cancer?

A. Sometimes prostate cancers are so slow growing that no treatment is needed. However, when treatment is necessary, there are three main types used:

• Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.
• Radiotherapy - in radiation treatment, high energy rays kill the cancer cells. This will help destroy the original tumour and also reduces the pain caused by tumour cells which have spread to the bones.
• Brachytherapy - this is a newer type of radiotherapy in which small radioactive pellets or wires are inserted directly into the prostate tumour, killing it from the inside. This is at least as effective as the other treatments and sometimes more so. There are also usually fewer side-effects with brachytherapy.
• Hormone therapy - since the growth and division of the prostate cancer cells depends on androgens (the male hormones), drugs can be used to either reduce the level of androgens produced by the body or block the effect of androgens on the cancer cells. These stop the growth of the tumour and sometimes shrink it. However, after about five years, most prostate cancers go on to develop the ability to grow without androgens and the hormone therapy stops working.
• Surgery - in an operation called a prostatectomy, the whole prostate gland is removed.

Cancer Basics

• What is cancer?
  
  
• All living things - ourselves included - are made up of cells. Cells are microscopic packages of living material and we have billions of them. They come in many different types: liver cells, brain cells, blood cells and so on. In the normal adult, cells only grow and divide slowly and under very tight control to make sure that the number of cells in each tissue stays the same. Cancer begins when one cells changes and startys growing and dividing rapidly and out of control. This one cells divides to give two cells, then four, eight and so on until they form growing mass of cancer cells - called a tumour.

• What do malignant and benign mean?

• In some tumours, the cells stay in the same place and as the tumour stops growing before it gets very large - often because it simply runs out space to grow. These are called benign tumours and they are not normally dangerous. We all have benign tumours, such as moles and warts. However, in other tumours the cells are able to invade the surrounding tissue and spread into nearby organs where they can cause serious and, eventually, fatal damage. These are called malignant tumours.

• What is metastasis?

• In many malignant tumours, as the cells spread, they come across blood vessels. If they actually spread into the blood vessel, they get carried around the body and eventually get stuck in a smaller blood vessel in another part of the body. Here they begin to divide and grow again eventually forming a new tumour. These are called secondary tumours or metastases. This process of cancers spreading around the body is called metastasis.

• Do genes cause cancer?

• Every cell carries a set of coded instructions for every activity or function that it can perform. Different genes are active in different cells, which is why a brain cell carries out many different activities from muscle cell. Genes also carry the coded instructions for basic functions of the cell such as the way cells grow and divide. The growth and division of normal cells is tightly controlled by the activity of certain genes. However, when these genes are faulty or when they mechanisms controlling the activity of these genes is damaged, it can cause the growth and division of the cells to go out of control - in other words, the become cancerous. Genes themselves do not cause cancer. When they function normally, genes prevent cancer. However, it is when some genes become damaged that they can malfunction and cause cancer.

• Can you inherit cancer?

• Cancer itself cannot be inherited, but some people do inherit a higher risk of getting cancer. This is because they inherit, from their parents, a slightly damaged version of one of the genes involved in controlling cell division. On its own, this damaged gene is not enough to make cells cancerous. Normally, two or three different genes have to be damaged before a cell will become cancerous. That is why so very few of the billions of cells in our body ever become cancerous. However, if someone starts out with every cell in their body carrying damage in one of these genes, the chance of a cell getting the other types of gene damage and becoming cancerous is much higher. Some of these inherited damaged genes have been identified, such as BRCA1 and BRCA2 which increase the risk of getting breast cancer by five to seven times.

• Do tumours need a blood supply?

• A tumour usually starts with a single cancerous cell that begins growing and dividing. The resulting mass of cancer cells soon gets large enough to need a new blood supply to provide oxygen and nutrients and to remove waste products. Without a blood supply, the cells in the middle of the tumour will die off. In fact, tumours without a blood supply are unable to grow more that about one millimetre across. As soon as they start growing, tumours release small, hormone-like molecules that cause nearby blood vessels to start growing towards the tumour until they actually form a new branch supplying the tumour with blood.