DR ELLIE CANNON: Why isn’t GP concerned about the lump on my breast?

I have a painful lump on my breast, which a doctor told me is nothing to worry about because of where it is. My request for a biopsy was refused. What should I do next? I am 74 and otherwise healthy.

When you first spot a lump on the breast, it is right to be concerned and head straight to the GP – most people know it can be a sign of cancer.

But it is also true that many of the lumps examined in GP surgeries and breast clinics are not cancer. In fact, there is a whole catalogue of lumps that are not sinister. And pain is not commonly a sign of breast cancer.

In a woman of 74, doctors would have to do a very thorough set of investigations before they rule out breast cancer. This is because the risk of the disease increases with age. An examination would be expected, as well as a scan such as a mammogram or ultrasound of the lump.

Today’s reader is a 74-year-old woman who has a painful lump on her breast and was refused a request for a biopsy fearing she may have cancer

Some non-cancerous lumps are within the skin of the breast, whereas primary cancer is in the breast tissue. Doctors can usually make this distinction just by feeling the area.

Normally, patients with a concerning lump will be referred to a breast clinic for a three-pronged assessment: exam, scan and biopsy. But if doctors are confident with the diagnosis based on what they’ve seen in scans, a biopsy may not be necessary. This is not careless – biopsies to remove breast cells are invasive, risking infection and causing pain.

They are important for women with worrying signs, but doctors will always try to avoid doing them unnecessarily.

The question of what to do when you disagree with your doctor is an important one. We all have a right to a second opinion. Ask for this from the same doctor and talk through your concerns. Otherwise, discuss the situation with another GP in the practice, or ask for a second opinion from a specialist – which a GP can usually refer you for.

Two years ago I had a mild mini stroke – or TIA, as I believe it’s called. I was prescribed apixaban, bisoprolol and a statin. I was also given a booklet of procedures I could have instead – but the specialist never offered any of them. Now scans show that my abnormally quick heart rhythm, which doctors think caused the TIA, is still there. Does this mean the drugs aren’t working and I should have been offered a procedure?

Mini strokes do not cause long-term symptoms. In fact, in the majority of cases, patients are back to normal within a day.

Doctors also refer to them as a transient ischaemic attack, or TIA. The focus is therefore to prevent a further attack by prescribing a specific group of medicines. First, statins are recommended to help with lowering cholesterol by at least 40 per cent – this is vital even for patients who have healthy cholesterol levels. High blood pressure must also be treated.

If patients are found to have a fast or irregular heart rhythm – known as atrial fibrillation or AF – they will be given blood-thinning drugs. AF can cause blood clots, and is known as a risk factor for TIAs. It is treated not only with blood-thinning drugs such as apixaban, but also pills to make the heart beat more slowly, such as beta blockers like bisoprolol. These drugs do not stop AF, but slow it down and make it less risky.

So this combination of medicines is most definitely not useless. In fact it is a recognised treatment that is prescribed as standard and shown to reduce the risk of further TIAs.

Anyone who has had a TIA should have ongoing monitoring at the GP or in a hospital clinic.

Doctors will check blood pressure, pulse, side effects from medication and whether any changes are needed in terms of type of drug and dose. It is also important that other risk factors for TIAs and strokes are looked at, such as potential underlying diabetes and smoking.

A few weeks ago I became struck with this constant need to empty my bladder. There is no burning or pain, but I thought it could be a urinary tract infection so I made an appointment to see a doctor, who gave me antibiotics. It made no difference. My urine samples have come back normal. I’m getting worried as the skin around my genitals is becoming red and sore. I just want to feel comfortable again.

Feeling the need to go to the toilet more often than usual is very common – especially in women. Usually this is caused by nothing more serious than a urinary tract infection (UTI). But as women get older, these signs can sometimes indicate something more significant. If symptoms persist despite treatment – and a urine sample is normal – the problem shouldn’t be ignored, especially if the patient is aged 70-plus.

Urinary symptoms like this can occasionally be a sign of ovarian cancer, which is often diagnosed late because the symptoms mimic common problems such as constipation or a UTI.

A doctor should arrange a blood test called a tumour marker, or a pelvic ultrasound scan, or both.

If the vulval area is very red and sore, then the culprit may be a common, harmless condition such as vulval thrush. After the menopause, a drop in levels of oestrogen can leave the vulva and bladder more prone to soreness and discomfort. Thrush cream, which can be bought over the counter, should help.

Take the wild swimming plunge, it’s so relaxing

It took years, but I’ve been bitten by the wild swimming bug. I’ve always been sceptical of claims that taking a dip in freezing water can heal body and mind. After all, I hate the cold. But after much persuasion from my friend Natalie, I decided to take the plunge on Brighton beach last weekend  and was pleasantly surprised.

I’ve written before about my anxiety and feeling as if a million thoughts are racing around my head. I’ve tried mindfulness, breathing exercises and yoga to switch off, but I can’t ever seem to empty my mind.

In the water I was too busy trying not to freeze and keeping afloat to think about anything else. It is honestly the most relaxed I’ve felt in years.

Dr Ellie Cannon, picture right, took the opportunity to go swimming in the sea off Brighton beach

OK, Brighton beach isn’t the wildest of wild swimming spots but there are many ‘proper’ ones across the UK.

Visit outdoorswimmer.com for information on how to get started. One bit of advice, though: never swim alone.

Better be safe with a polio jab

Email [email protected]mailonsunday.co.uk or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT.

Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. If you have a health concern, always consult your own GP.

I’ve heard from a number of parents who are worried about polio, following the Government’s decision to offer all under-nines in London a dose of the polio vaccine.

This doesn’t mean we’re on the brink of an outbreak of the disease which can, in severe cases, cause paralysis.

The polio virus has been spotted in London’s water system, which suggests some people may be infected and are spreading it without symptoms.

But no cases have been identified yet.

So health chiefs have taken an extremely cautious approach by jabbing children – even if they’ve had previous doses.

It is especially important in London, which has some of the lowest uptake rates for vaccination in the country.

So don’t panic, but take the vaccination if it’s offered.

It is better to be safe than sorry.

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