Huge welcome to everybody, and thank you for joining us for this event. My name is Dr.Zoe Williams, and I'm an NHS GP and a media medic.
So this is the first virtual event from Bupa as part of their Inside Health series, and it's an exclusive event that's just for Bupa customers,and a chance to get insights and valuable advice directly from the expert team at Bupa.
As March represents Ovarian Cancer Awareness Month, we thought that this was the perfect opportunity to talk not only about ovarian cancer, but all things female cancer, exploring the symptoms to look out for,the regular checks and screening options available to you, as well as the impact of age and menopause, etcetera.
We've also received hundreds of questions from yourselves, so thank you again for that, and we'll be sharing some of these questions with our panel,
as many as we possibly can, right at the end of the event, so do stick with us until the end. But first up, we're going to be speaking to Nicola, who’s a Bupa customer, and we're going to hear all
about her personal experience with cancer and what learnings from her journey she can share with us today.
We’re then going to be joined by Dany Bell from Macmillan Cancer Support, who's going to be telling us
about the different avenues of support available to those who are currently dealing with cancer,
either directly or perhaps through a friend or a family member. And then after this, we'll be inviting our Bupa experts, including Dr.
Petra Simić, Dr. Samantha Wild, and Mr. Thomas End to join us in a panel discussion
on the topic of female cancer before answering all of your questions. Okay, so I really want to welcome
Nicola now. Nicola is a Bupa customer who was first diagnosed with breast cancer in October 2019, so that's about 18 months ago, is it, Nicola?
Yeah, it all started in about November 2019, and it's been a very long 18 months but it's come to the end, and I'm very grateful it has done
Excellent news. What I'd love to do is invite you to talk us through your cancer
journey from diagnosis to your current treatment plan.
So in January 2019, I had a clear mammogram, which was great news, what every woman wants to hear.
And then in September, the NHS asked me if they wanted me to join their screening programme.
And I ummed and ahhed, and I thought, “Hm. I don't know, because I've just had a clear mammogram, and do I really need to go ahead and have another mammogram?” But something made me do it, and how lucky was I
that I did it because that mammogram, it identified I did actually have DCIS.
which was precancerous cells, and that I would need further treatment. And I was so happy that I had identified it
really early and I had caught it early, and I was very fortunate. But then I went ahead and had the lumpectomy,
and after that the doctor then said, he explained that it wasn't just DCIS
There was also an invasive element in it. And so I'd gone from precancerous cells to full on cancer,
and that just changed everything in the whole journey that I had ahead of me.
and because he hadn't got wide enough margins, the surgeon said I had to go and have another lumpectomy, so I went ahead and had that.
But still, even after that, they still hadn't got clear enough margins,
but I had to go ahead and have my chemotherapy, so I went off and I had 12 weeks of weekly chemotherapy,
which was pretty gruelling and very tiring, but I got through it.
And at the end of it, I then had to go back and see the surgeon, and we had to talk about should I have a third lumpectomy or should I have a mastectomy,
and it was a big decision. The lumpectomy seemed relatively easy and straightforward, but actually I just wanted to get rid of the cancer.
I wanted everything out, and so I decided, amongst other things other,
I discussed it with a lot of people, and at the end of that, I decided I would have the mastectomy, which is a pretty
brutal, tough operation to go through, but I felt that was the best decision for me in my cancer journey.
And I understand that actually during your cancer journey you had some complications due to the chemotherapy.
Was it due to the Herceptin? Herceptin is an amazing drug, but it can cause problems with the heart,
and so you are given checkups every three months to make sure that everything is going well.
And mine was going really well until after cycle 16 when they found out that I had a left ventricle problem,
so they told me that I had to pause the treatment,
and that would be a psychological blow to me because all I wanted to do was get to the end of my Herceptin and feel like I'd done it.
So they put me on heart drugs and monitored my heart, and finally the heart got strong enough again
so I could go on and complete all 18 cycles, which to me was a victory
16 would’ve been fine, but 18, I just had to get there. I had to tick that box and I had to finish the treatment
Well, there's something psychological as well, isn't it? You are in a fight and you've utilised
whatever you have inside you to give you strength on this battle, on this journey.
And clearly for you, you have that finish line in sight, and in the same way that to run a marathon and then get a sprained ankle
and finish a hundred metres short of the finish line, it must be a similar sort of feeling. You must think, “Oh, I'll do whatever it takes to drag myself all the way to that thing, that goa
that I've been focusing on that's been driving me and giving me strength.” And I wanted to ask a little bit
about your cancer experience has occurred in the midst of a global COVID pandemic
and how has that impacted your treatment, number one, but also your experience of going through this?
One of the things I've been lucky about going through this, my treatment, is that, despite COVID and despite the pandemic,
I actually managed to finish all my treatment pretty much on time and on dose and have all my operations
So that was a big relief, and I know many people haven't
so I was lucky in that respect. But the whole experience did change, because when I started out going to chemo.
I had friends who came along with me and it was all a bit of a laugh. And when I had the cold cap put on, there was somebody doing reflexology for me,
and then I went to doctor's appointments and I had friends or family taking notes, and then I could discuss it with them and I could understand it
And then of course, COVID hit ,and suddenly you weren't allowed anybody in a hospital with you,
which was quite understandable, but it meant you had to do everything on your own. But the staff at the treatment suite were amazing and they become your friends
and it was a day out and it was quite fun, still actually. And the doctor's appointments,
you just have to be more aware and take more notes. And now, Nicola, before I let you go, I'd love to ask you
what would your top three pieces of advice be to give to somebody who's perhaps just received a cancer diagnosis,
or even somebody who has a loved one who's going through this? I think the most important piece of advice is go to your screenings
on a regular basis. Don't miss any. And if you feel anything that's not quite right, go and see your GP, get it tested.
The earlier the diagnosis, the better the prognosis. Then I think
try and talk to other cancer patients and learn about their journey.
They will give you insights and understanding that no one else can give you. The next area is
just try and be positive throughout the whole journey. Find ways to make yourself laugh. And if you feel vulnerable, cry.
There's nothing wrong with crying. And finally, just try and own your journey.
Control it. Understand everything. Do the research,
ask the questions of the doctors, and feel like you are in control of your journey. We welcome it, because actually we might be experts in medicine,
but you are the only expert in you, so it's important that you see yourself as an expert as well.
Nicola, thank you so much for your time and for being so open and sharing your story with us.
We're really grateful. Thank you so much. Bupa Health
Clinics has partnered with the charity Macmillan Cancer Support to provide counselling to people with cancer who are struggling to cope emotionally.
And now, I really want to introduce with a really warm welcome Dany, who’s a strategic advisor for treatment, medicines, and genomics at the Macmillan Cancer Support
So, Dany, thank you so much for joining us here today. To start off with, can you provide us with a bit of an overview
of Macmillan and the role that you have within the charity? Hi, yes.
Hi, Zoe. So Macmillan is one of the largest UK charities,
and we offer people with cancer support ranging from practical, emotional,
social supports, and we do that via a variety of channels. So we have our helpline, which is 24/7.
We fund posts like the famous Macmillan nurses, we have an online community, and we do things like the work that we did with Bupa.
So we have a welfare rights team to help people with financial problems, and the information resources that we have cover
everything really and are really easy accessible to people. So our aim really is to help
everybody to live the best life that they can when they've got cancer. Can you share any interesting facts or figures that would show the landscape
of female cancers and how it's been changing over recent years?
Yeah. So at the moment, 1.6 million women living with cancer,
and we know from looking at statistics that by 2030 that will be 2.2 million women.
We know half of those 1.6 million are living with breast cancer, and we also know, as of 2019,
cancer is the highest cause of death in women. What are the most common reasons that people seek support from Macmillan,
and what are the common types of questions and issues that your members come up with?
I think what I said at the beginning, in terms of people will struggle with a range of things from practical,
emotional, physical, financial at different points, so it's not just all around when they get diagnosed.
And so they will come to us around all of those things. I think we do get a high volume of queries when people are making decisions about treatment or going through treatment.
That is an area where we do get a lot of queries. But we know that people are massively impacted
financially, so we do get a lot of queries and sign posting from our support line through to our welfare rights team.
I think anxiety at different points is another issue, and emotional needs, which is again, through COVID,
why we looked at doing the work with Bupa, because we recognise that ordinarily cancer
has that impact on people, and with COVID on top, people's emotional needs
were increased. Yeah, we've actually seen that reflected. We’ve had a lot of questions coming through from our members for this event talking about the emotional
and the mental side of cancer, so the fear of cancer coming back or the worry of not recovering or panicking about returning to work, everything really.
So what type of help is available for these women? So, I mean, guess
it depends on the individual and how they like to engage in help. I mean, I think in terms of fear of the cancer coming back,
or any concern really, is to talk about it and seek help
in the right place that suits that person. So some people, very comfortable with digital, and we have
a huge amount of information in different formats on our website, so we have podcasts, we have an online community where people can connect
with people going through the same thing, and some people find that support really, really helpful.
And certainly I know through COVID a lot of people have found that a real lifeline.
Some people prefer to talk to someone, so they might pick up our support line
advice that way. So it depends on what the person needs. We have information and support centres that are
based in a lot of hospital trusts across the UK that people can just walk into
where we have trained people,
and some of those are put on virtual services, so we have been able to maintain a lot of our information and support services.
And we've seen a real surge in access to all of those support
channels, really, so we've had a 31% increase
to our support line this lockdown compared to the last one.
Over Christmas, we had 14% more calls than we normally have, and actually we've had a 40%
great hit to our website as well, so we know that people value
our trusted source of information and our specialist advisors. And I think for people out there listening who are potentially struggling,
as a GP, or as Macmillan’s services, Bupa services, we might not be able to fix all those problems,
but we're always here to listen and to guide you and do what we can to help. And nobody should suffer alone in silence.
Always reach out. I guess the final question for you, Dany, is around
we know that cancer doesn't just affect the person living with cancer. It affects everybody else around them.
What advice would you give people who were supporting friends and family members, colleagues through cancer?
I would say exactly the same to them as I would say to someone with cancer is
don't worry in silence. Seek help. Our services are available for people who are affected by cancer
as well as those people that are living with cancer. But equally, I think what a lot of people worry about
is talking to their loved one or their friend or when they've got cancer and they often don't know how to do it.
But I guess the biggest piece of advice I can give is they are still the same person and they need you.
And so just to still communicate with them, still do all the things that you always did.
And I know that some of that's virtual at the moment, but to stay in touch with them and ask them what support they need.
So I think you said it earlier, really, is to talk and talk together and
support them in the way that they need it. And access help and support from services like ours as well
who can give a lot of advice about how you support someone with cancer. Yeah. So those services are not just there for the person who has cancer, they’re there to support
family and friends as well. Davi, thank you so, so much for that lovely insight
into your world, but also for your incredible advice to people out there living with cancer and everybody else as well.
Thank you. Pleasure.
Having heard from our guest speakers, it's
now time to meet our panel of experts and we have three of Bupa's leading medical experts joining us here today
to talk us through female cancers and what we can all do to lower our risk. And we're then going to be putting your questions to our experts in the Q&A at the end of the event.
So please just stick with us. Throughout the panel discussion, we'll be running a few polls as well. So please do get your opinions and your thoughts down on those polls
and we’ll be sharing the answers with you as we go through. So our expert panel, we have Dr.
Petra Simic, who’s previously an NHS GP doctor for 10 years. Petra is now medical director in Bupa Insurance and she's passionate about shifting the stigma
surrounding many female health related subjects and wants to empower women like you with reliable information.
Dr. Samantha Wild, also a GP by background. Sam is the women's health lead for Bupa Health Clinics delivering health assessment and women's health
appointments. She has a vast amount of experience in female health, particularly in issues surrounding the menopause.
And Mr. Thomas Ind. Tom is a skilled gynaecologist. Over the years he's become an expert in complex surgery,
endometriosis, hysterectomy, colonoscopy, and of course cancer.
So welcome everybody. Thank you so much for joining me. We've got so many questions to get through, but to start us off, Petra, I wanted to ask you
about the prevalence of cancer and common symptoms that our viewers should be aware of.
So firstly, can you just provide us with a bit of an overview of the most common female cancers?
Well, thanks Zoe. And so important to be talking about this today. I think when people talk about female cancers, they often
think about cancers which affect women uniquely. And so people often expect that what we'll be talking about is ovarian
cancer, cervical cancer, endometrial cancer. But the truth of the matter is that the top three cancers in women
only figure in one of those cancers which we really think about, which is breast cancer. So breast cancer, lung cancer, and bowel cancer
make up 50% of all cancers that we see in women. So when we talk about female cancers, we need to be thinking about the whole of the female,
not just their reproductive or sexual organs. The top six cancers in women then include things like
melanoma, ovarian, and endometrial carcinoma, and so taken as a whole, those six cancers make up two thirds of the cancers we see in women.
Awareness of breast cancer in the last 20 years since I qualified has really, really increased and women are much more aware of their breast health.
But I would say it's quite interesting how unaware they are of perhaps their bowel health or lung health.
And they don't put it on the same importance level when they're thinking about their health and cancers in particular.
What are the early warning signs that women should be looking out for as an indication that there might be something wrong that needs to be checked?
And in particular, what might be the sort of very subtle or hidden signs that we might not pick up unless we're searching for them?
I mean, it's really hard to give a brief answer to this because there are so many cancers. The six I've just described all have different ways in which they present.
But I think there's a few things that you need to be really aware of. So I think understanding your own personal risk of cancer is quite important.
So I often have quite a lot of young women coming in to see me in surgery concerned about cancer,
but interestingly, the older women who believe their reproductive organs have kind of shut up shop and been mothballed
tend not to be worried actually about things like ovarian cancer because they have in their head,
well their ovaries have stopped working, so therefore they're not a problem. So I think the first thing is to really understand your personal risk.
And broadly the older you are, the higher your risk of cancer in general terms.
If you're a smoker, if you're overweight, if you've got a strong family history of some cancers that may increase your risk of cancer, but often not always.
And if you drink more than the recommended guidelines, these are all things that could increase your risk of cancer. So the first thing I say is know your own risks
and then know your own body. People are aware of their bodies
and knowing when there's a change and that's unusual for you. But importantly, persistent changes.
So if we were to talk about bowels for example, many people's bowels change all the time. It depends on what they've eaten, how stressed they are, how much exercise they've had, how much water they've drunk.
Their bowels can fluctuate and change hugely, but as GPs, what we are interested in is a persistent change in normal for you.
And broadly that applies to most cancers. And probably the most worrying symptom that worries all of us as GPs
if someone has persistent unexplained weight loss, that's one of the things that probably universally I would say, is one of those things
that should not be happening and definitely needs to be checked out.
But then there's the skin lesions that aren't healing or unexpected lumps or bumps
or growths and particularly if they're growing over a short period of time. As we get older, we often gain nice little skin tags
and extra moles and warts and little added bits, but things that grow over a short period of time, it's really important to get those checked out.
Fantastic, brilliant answer Petra. A lot of the viewers have been sending us questions and there's been a real, we've noticed a real focus
on ovarian cancer and we know that ovarian cancer is one that we really worry about
because it tends to present late because the symptoms can be quite vague. So can we dig down a bit deeper into ovarian cancer?
What are the specific symptoms that we should be looking for, we should be looking out for?
What clues might there be that something's wrong? So I mean ovarian cancer is one of those cancers as a GP you most dread
because they're very difficult to find. So importantly with ovarian cancer is if you are young
and of reproductive age, this is unlikely to be a cancer that's going to affect you. Never say never, but really it is, this a cancer of postmenopausal women.
And what we think about is women who have a change in bowel habits. So interestingly, people think about ovarian cancer, they don't think about their bowels,
but actually what's happening to your bowels can be one of the symptoms that are linked with ovarian cancer.
Even to the point of things like indigestion and difficulty eating. So your whole digestive system can be affected.
Abdominal bloating, again, not very specific because as you get older it can be easier to gain weight, particularly in the middle.
But that bloating feeling and women often remember it from when they were say premenstrual, that it feels uncomfortable
perhaps almost like when they were pregnant, that they feel that fullness. So a kind of fullness, sometimes urinary symptoms.
I think the hard thing Zoe, is that so many of those symptoms could be characterised as getting old or having urine infections or irritable bowel syndrome, that it's incredibly difficult.
I think what I would say to women out there is be aware of ovarian cancer
and if you're having symptoms that don't seem right, particularly related to digestion and bowel,
even if your doctor is going along the lines of looking into your bowel, ask them about your ovaries.
Have that conversation because it can be really easy as a GP to get very much down the line of
they have a bowel problem, I must look into their bowel problem to just stop and pause and think that maybe I need to scan their ovaries and check they're okay.
So it's an awareness piece that the ovaries aren't doing their reproductive job but there may be affecting other organs.
And like I said, don't be afraid to say to your GP, could it be my ovaries?
Because I heard that bloating actually can be linked to ovarian cancer. Never be afraid to say what you think it is and never be afraid to use the C word as well.
It's not a dirty word. And as doctors if you say I'm worried it could be ovarian cancer, that might just be the thing
that is required to light that little memory pathway in the GPs brain to do the tests that are available to us.
Tom, what type of abdominal pain might you expect to get with ovarian cancer?
Because there are so many different types of abdominal pain and where would you expect to feel it?
I wouldn't say there's any one particular type of abdominal pain that's more common than others.
I've seen three cases of ovarian cancer this week already
and they were all presented in very, very different ways. Most women have had symptoms for months and months and months.
And the reason general practitioners worry about ovary cancer is the chances of them having had a medical appointment
with someone between when they first developed symptoms and when being diagnosed is quite high.
And a lot of people get gastrointestinal investigations. Irritable bowel syndrome is a very common diagnosis.
But I think one of the points that Petra brought out early on is that this is very rare in young women.
It is something you see in postmenopausal women. It isn't actually one disease, it's actually lots of diseases
and you can actually get ovary cancer with normal ovaries on scan because really the disease is
fallopian tube cancer and ovary cancer and something called peritoneal cancer. It's all the same disease. Great. Thanks Tom.
So yeah, so with ovarian cancer, really important to constantly have it at the back of your mind, particularly in postmenopausal life.
But there are some cancers that we really can make sure we're doing everything we can at home to detect so we can do home checks.
Petra, can you tell us a little bit more about how we can do checks at home to potentially pick up female cancers?
Sure. So the two probably main things are checking for breast cancer and skin cancer would be the two things that you're most able to do because they are kind of looking and touching thing.
And so for breast health, really again, very important to know your own body.
So to get really familiar with what your breasts look like and what they feel like. And the best time for women to do that is often when they're about to jump in the shower or jump in the bath.
So take a moment just to pause and look in the mirror in your bedroom or bathroom just to see if your breasts look or what they look like if you're not really familiar with them.
But to make sure there's been no changes in appearance. And the kind of things we want to know about as GPs is, does it suddenly look uneven?
It's not the same shape as before. Normally that would be on one side more than the other. Is there any dimpling?
Are there any skin changes around the nipples? Sometimes eczema over the nipple can be a sign of something
more worrying going on deeper within the breast. And then what I tend to recommend women do is just get familiar with how their breasts feel often.
So we all wash on a regular basis. That's a really good time to feel your breasts and know how they feel
because especially with the water and the soap, it's a really smooth surface. And I tend to recommend people think about, when they think about examining
breasts, women often worry that they don't know how to do it. And actually breasts can be hard to examine.
They’re glandular tissue, they're not smooth, they're not meant to be smooth. And if you feel them with kind of a poking motion, everyone's breasts will feel very uneven.
So it's about imagining that you've got, I try and tell people to imagine a kind of Ziploc bag of jelly and you've hidden a marble in it and you're trying to find the marble in the jelly.
You wouldn't go like that because you'd keep losing it. What do is you’d press it against a flat surface and run your hand.
So it's the same kind of process with examining your breast, pushing the breast tissue against your chest wall with the flat of your hand.
And what I try and reassure women is that if there is something abnormal there that is very worrying, it's highly likely you might find it because they're not very subtle.
So it might feel like a small hard pea or a cherry or a stone.
The kind of lumps we expect women to find are quite different from normal breast tissue.
But if you find anything that makes you worried, even if it's the same both sides, then come and see the GP.
Let us examine you, let us have a feel. And sometimes it's a case of especially if you're still
having periods, come back after your period and we'll examine you again. But if there is a lump there, then absolutely we should be looking into that
with either a mammogram or an ultrasound scan and your GP should be making that happen for you.
And then mole checks, again, quite simple, looking at your skin, being familiar with your moles.
And when we’re thinking about melanoma, we're thinking about moles that change rapidly over a period of six to eight weeks, growing, crusting, bleeding
and being aware of that. Sometimes even taking pictures of it and then going back a few weeks later and taking another picture maybe with something to reference the size,
that can be a really good way of reassuring yourself it's not growing over that period of time. The same message, if you're worried, go and talk to someone else.
Share the worries and then you can explore whether anything else needs to be done. Okay, so some amazing advice there from Petra on the symptoms
to look out for and simple at home checks that we can all do. So I'd like to introduce the first poll now.
So this is to encourage all of you who are watching to participate so we can make it a live experience.
So we're going to run a quick audience poll and this will appear to the right of your video player.
And what we want to know is, when was the last time that you did an at home cancer check?
Was it in the last month, the last three months, the last six months,
the last year, over a year or never. So take your time, answer that poll, and the results will appear
live as we continue with our panel discussion. Another area of concern for our viewers was cancer risk and age,
and how to identify symptoms as our bodies are naturally changing with age.
So we're going to move on to Sam. And can you talk us through what cancers an older woman would be worried, should be worried about?
I mean we've already mentioned that ovarian cancer is one of them. And if there are any symptoms in particular that they should be looking out for, bearing in mind
there were so many changes that are going on in the body later in life as well?
I'd start by saying, as Petra just said, that all women need to be sort as aware of possible of all the different symptoms that they may experience with respect to different cancers.
So making sure that they’re as educated as possible. And also with regards to the menopause, again, reading up
about that, learning as much as they can, and knowing that there are sort of at least 34 symptoms that we know about and there will be some that overlap with cancers.
And so if they don't feel well, if they feel that things just aren't normal, to go and see their GP.
And as we said, we won't turn them away. We do know that a lot of these cancers do get more common as they get older.
The only one that doesn't is cervical cancer. And so it goes back to what we just said.
You know, don't think that because you are getting older, you're not going to suffer. So please go and see your GP.
Any bleeding after the menopause is not right. It should be checked out. And equally in the perimenopausal period when our bleeding might become a bit erratic, we would still say
if you had any bleeding in between your periods or after intercourse again go and get it checked out.
So I think again it's just reaching out for some help. If you feel that things aren't right go and see your GP.
Not all cancers have detectable symptoms early on. So we're very lucky in this country that we do have a great screening programme.
Sam, could you just give us kind of a brief overview of what the screening programme, what cancer screening we currently have available for women in this country?
When it starts, when it ends, and how frequently people would expect to be offered screening.
Okay. So we have three cancer screening programmes in this country. We have bowel cancer screening, which women may not initially think about.
They’re invited for screening between the ages of 60 to 74 every two years.
And actually I say invited for screening, but a bowel cancer kit is sent to their home. So they have a test that arrives in the post
and they need to take a sample of their stool, and then they send it off as instructed. And then they will get the results through from that.
We also have the cervical cancer screening programme, which starts at the age of 25
and is every three years until the age of 50, but then every five years until the age of 64.
And women are invited to attend to their GP surgery to have a smear test taken.
And then we also have the breast cancer screening programme, which is a mammogram that is done for women over the age of 50 until the age of 70.
And that is done every three years. And is there anything new on the horizon? Any new screening programmes we should be looking out for?
Any plans for screening for ovarian cancer that you are aware of? Yeah, Tom, would you like to elaborate?
Well, I think if everyone’s going to talk about new screening things I think the thing that's most exciting at the moment is the study that's just started a few weeks ago
on women taking their own smears. And there's a lot of data
already in smaller groups on self-sampling. And it's probably as good as, possibly even
better than a nurse or a doctor taking an HPV test. The problem
is that once it's abnormal you do then have to go and be properly examined. So for women who really can't stand
an internal examination, it's not really any good for them. Next, another topic that many of our viewers are interested in
is the genetic links when it comes to cancer. So as a surgeon specialising in gynaecological oncology,
can you talk us through which gynaecological cancers have hereditary links and how our viewers can assess
whether they may be increased risk based on their family history? So there’s a genetic association between ovary cancer
that everyone knows about because of Angelina Jolie, but there's also a genetic association with some uterine cancers.
And as we haven't discussed uterine cancer yet, maybe I should talk a bit about that. Because actually, uterine cancer is the most common female cancer.
I think people forget that. There are actually two main types of ovary cancer.
There's... Sorry. Two main types of uterine cancer. There's one that's definitely associated with diabetes and obesity.
And that's the one that’s sort of doubled in instance in the last 20 years. Now, that isn't associated with a genetic inheritance.
But there is one associated with this syndrome, which we call Lynch syndrome and it's also related to bowel cancer.
And we're beginning to understand that much more now. And everyone who's diagnosed with a uterine or endometrial cancer
will have staining of their tissue to see if they have something called mismatched repair gene staining, abnormal staining.
And if they do, they then go on to get genetic staining for this or genetic testing for this thing called Lynch syndrome.
And it's worthwhile knowing if you've got Lynch syndrome because obviously you can prevent against bowel cancer if you haven't been diagnosed with that,
and it would have implications for other members of your family. So uterine cancer has a very small association with
Lynch syndrome; about 5% to 7%. Then ovary cancer is classically associated with this single BRCA gene,
which Angelina Jolie had.
It's also associated with breast cancer. And your gynaecological oncologists will quite regularly be taking out women's ovaries
from about the age of 40 onwards in order to prevent them from developing ovary cancer in the future.
I think that's really interesting. And I think people who are watching this will be thinking, “If I have a family member who has had cancer, then
should I be undergoing additional screening, additional checks?” What about if I just have one family member versus I have multiple family members?
What's that pattern that you see in families that would make you think that you would be more at risk?
So for ovary cancer, having one first-degree relative,
and the first-degree relative is mother, father, daughter, sibling.
Obviously not father in the case of ovary cancer. But one first-degree relative with over cancer
would probably increase your risk by about 0.8% to 1%. So probably not enough to warrant having your ovaries removed because
that's the intervention that is done. So you've got to have quite a significant risk.
Certainly two first-degree relatives with either ovary cancer
or breast cancer under the age of 50 would probably warrant some kind of genetic consultation.
Now, the specialty of cancer genetics is a hugely expanding specialty at this moment in time.
And really you shouldn't be having any intervention to prophylax against over ovary or breast cancer without having seen a geneticist.
And you can have a series of tests done. Interesting. Thank you, Tom. I'm going to talk a little bit now about prevention and prevention advice.
And Sam, I'm going to come to you to talk about this. So I think looking beyond the checks that we can do, the self-checks and the screening,
what types of things can we all do to minimise our risk of cancer?
So I think there's six ways that I would say that we could tackle this. So the most important is to stop smoking.
That is the most preventable cause of cancer for all types of cancer; is implicated in 70% of lung cancer.
So definitely that would be my number one. Number two, try and reduce the amount of alcohol that you drink.
We know that that is implicated in a lot of cancers too. Try and maintain a healthy weight.
That's really important. Weight is implicated in the endometrial cancer as we've just heard,
but also breast cancer and bowel cancer as well in particular.
Try and have a healthy diet. Try not to stay in the sun too long. That will increase our risk of skin cancers.
So make sure that you wear some protection and you keep covered up, and you wear a hat and you don't go out at the times when the suns at its highest.
So midday. Avoid that midday sun and try and be sensible with regards to that.
And move. Move as much as you can. So exercise. We talk about the importance of exercise, not just to prevent cancers,
but also to reduce our risk of heart disease as well. There's so many benefits to that. So, ensuring that we do get out every day,
particularly at the moment as well when we're not getting out so much, make sure we go out for that walk, go out for that run.
And get some resistance exercise as well and just, yeah, keep moving. And what about diet?
So what are some of the specifics around diet? I mean, I think most people have an idea what an healthy diet is, lots of fruit
and vegetables, the whole grains, not eating too much sugar, too much process or high fatty foods.
But when it comes to minimising our cancer risk, are there any specific foods that we should be
completely avoiding or anything that we should be trying to consume plenty of to protect ourselves?
Yeah. There's no specific evidence to say that we should avoid certain foods or have more of certain foods at the moment in a particular type of food.
And we'd worry maybe that people would become deficient in certain nutrients if they did avoid food groups.
But as you've just said, having a healthy diet, lots of food and vegetables, high fibre,
trying to avoid some processed foods because we do know that that is linked to bowel cancer, and red meat as well.
So keeping that to a minimum, but making sure we get lots of those good proteins. So our white meat, our chicken, our fish, and our pulses
and that sort of thing is a lot better for us. And to dig down a little bit more into alcohol,
how much is too much when it comes to cancer risk?
So I think people would be surprised to hear that alcohol is implicated in seven types of cancer
and actually causes 12,000 cases of cancer a year. And I have a lot of women, and we’ll go onto this,
but are worried about taking HRT because of their breast cancer risk perhaps. But actually, when I point out to them that drinking more than 14
units of alcohol a week is even more risky, they are so surprised by that. So I think it is something that we just don't talk enough about.
So we do say for men and women to try and have less than 14 units of alcohol a week.
It doesn't matter what type of alcohol it is with regards to your cancer risk. And it also doesn't matter whether that's spread out or whether it's
sort of binge drinking as such when we're looking at cancer risk. I mean, it's obviously different in other circumstances, but from that cancer risk point of view,
it's just staying below that 14 units a week. Thank you. Great advice there.
So I'm going to introduce the second poll now and encourage all of you viewing to participate.
And this time we are going to be talking about lifestyle factors. So you should be able to see to the right of your video player where you can participate.
And the question is: What out of the main lifestyle factors
do you want to change to lower your cancer risk? The options are: lose weight, exercise more,
drink less, stop smoking, follow better sun safety, or other.
Sam, a great question for you. We've had lots of people asking questions. Does taking HRT put you at any greater risk of cancer?
And if there is an increased risk, dig down a bit further. Does it depend on the age you are when you start taking HRT or the length of time that you are taking it?
So yes, exactly as you just said. So there is evidence that HRT
can cause endometrial, ovarian, and breast cancer, but we must sort of stress that that risk is very small for most people.
And as you just said, it does depend on the age when you start taking your HRT, how long you take it for, and what type of HRT you take.
So for example, if a lady starts HRT under the age of 51, then when she’s taking that HRT she’s only
replacing the hormones that most women would still have naturally at that age. So her risk from taking HRT at that point is negligible.
It doesn’t increase her risk of developing those cancers. The risk kicks in after she has taken it
for five years over the age of 51. So that's really important and that's something that I have to go through
very regularly with my ladies in clinic. It also depends what type of HRT you take.
So when we take HRT, it's often the progesterone bit that's mixed with the oestrogen that is the worrying hormone that can cause that risk.
So if a woman takes oestrogen-only HRT, that doesn't increase her risk of breast cancer.
Now, it may slightly increase her risk of endometrial cancer if she still a has a uterus.
So in those ladies, we give them the progesterone as well and that will then decrease their risk
of endometrial cancer. And the risk of ovarian cancer is very, very small with any type of HRT.
It is negligible. They say about one in a thousand. It also depends on what type of progesterone that we give.
So the newer progesterones that we give these days, they are more natural, they're not synthetic.
And we have a very safe type of progesterone that we use now. It’s a tablet that can be taken at night.
It's called micronized progesterone, and Utrogestan is a common name for it. And studies so far have not shown that there is an increased risk of breast cancer with that type.
So it really depends what form a lady takes, what age she starts it, and for how long for. I think it's really interesting what you said
something women can really relate to is that this increased risk of cancer in most women is very, very small
and it can be compared to having an extra few glasses of wine per week that you should take.
So I always say to women, “You've got to consider your other lifestyle factors.” And if you're having a bad menopause, you're not feeling very well in yourself,
you don't want to exercise, you're eating rubbish food, you're reaching for that glass of wine, then actually by doing all of those and maybe not getting out and
getting that exercise that you should be, you’re just increasing your risk of cancers in that way rather than taking a tablet of HRT which will enable you to feel better
and therefore take better control of your lifestyle. And then HRTs protective as well.
It's protective against osteoporosis in younger women. Is it protective against heart disease?
I think that's another one that gets a bit confusing because at a certain age it’s protective, then at a certain age, beyond a certain age it's not.
Yeah. Exactly. So we tend these days... The studies show that if you start HRT soon enough, so if you start it within 10 years of your menopause
and under the age of 60, it looks like there is a protective effect on reducing that
risk of heart disease because our risk of heart disease goes up postmenopausally because our oestrogen levels drop.
That affects our blood vessels. It makes our cholesterol rise as well. What about if you have a previous history of cancer or a family
history of cancer, does that affect how safe it is for you to take HRT?
That's a really interesting question. It's quite difficult, again,
with some GPs and some doctors not being as educated as they should be these days.
I see a lot of women that have been told pointblank that, “ You've had cancer before, you can't have any HRT.”
It does depend on what type of cancer they've had. It It depends if they have had a breast cancer
or an endometrial cancer, whether that was one of these hormone receptive-positive cancers that, again, it makes a difference.
It's making sure that we know what type it was. For all those other types of cancers, people that have had leukaemia, for example, or cervical cancer,
bowel cancer, there is no reason why they can't have HRT. It may be that you need to speak to your specialist about that, or see
a menopause specialist, rather than just your normal doctor. We must also remember there's other ways to manage the menopause as well, so you don't
necessarily have to have hormone replacement therapy. There's other medications that we can use.
We can also use topical oestrogen for women that are suffering with what we call the genitourinary
symptoms of the menopause, so women that have dry vaginas, or urinary frequency, recurrent urinary tract infections.
There are other treatments there. One final question on this, Sam, what about women who have had a hysterectomy?
It is really important for these women usually to use HRT.
A lot of hysterectomies are often done in women under the normal age of the menopause. We know it's so important to replace those hormones that they would naturally have had,
as we've already said, to reduce their risk of heart disease, reduce their risk of osteoporosis as well.
Actually, if you've had a hysterectomy, you only need to have oestrogen-only HRT.
It's a lot safer in a way. You haven't got that greater increased risk of breast cancer.
It's negligible, if there is a risk at all. Any medication that you take is always going to have some level of risk.
I think people have developed some fear around HRT, and some people around the contraceptive pill, as well.
I think what's crucial, I guess, the advice that’s out there is make sure you understand
the size of that risk, because usually there's either no risk at all, actually, no increased risk, or that risk is so small.
It is comparative to having those two extra glasses of wine a week. Let's move on to the Q&A section, where we're going to get through as many questions as we can.
Firstly, thank you so much to all of the viewers out there. You submitted hundreds of questions.
Obviously we can't get through them all, but we'll get through as many as we can. Remember, if you have more general questions
about cancer, then do remember you can visit the Bupa Cancer Health Hub, where you'll find out information about different types of cancer and their treatments.
If you’re currently undergoing cancer treatment with Bupa and you have a specific question about your own treatment, contact your own Bupa specialist oncology team.
The details are being shown on your screen now. Panel, Sam, let's come to you first.
Can you inform women of colour of any specific cancers that they might be more prone to, and what signs and symptoms to look out for?
As not necessarily all cancers affect women from different ethnic groups equally.
It might come as a bit of a surprise, but there's actually a lower prevalence of cancers in the BAME groups.
What we find is that there is a poorer survival outcome.
I don't think it comes as a surprise to realise that that's probably due to some taboo, a cultural taboo, shame of talking about it.
Maybe some embarrassment as well. We know, unfortunately, that a lot of women may not be aware
of what symptoms that they should be looking out for. They may not attend for their screening as invited.
They also may not present to the GPs as they should as well. There might be some difficulties accessing GPs and getting listened to.
There may be language barriers there as well. I think studies also show that sometimes,
unfortunately, women of colour may need to present to their GP on more occasions than maybe a white counterpart would, before they actually get listened to and referred as well.
There's a lot of issues there. I think, as well, if you talk to women that have undergone treatment,
they may not necessarily feel that their needs are always catered for. There may be a little bit of lack of understanding about
things that may affect them culturally. They may also not be followed up as well, either.
We do find that women tend to present later with breast cancer, again, than their white counterparts.
We see that they’re twice as likely to present with late-stage breast cancer.
Also, cervical cancer is higher in women as they get older as well.
I think, again, that's related back to not going for their screening test, and maybe not presenting when they have got symptoms.
Thanks, Sam. That was a really comprehensive, and I think really honest answer as well, which brings up some topics that aren't often discussed.
Tom, next question for you. Do some gynaecological conditions such as endometriosis, polycystic ovaries,
fibroids, recurrent UTIs, do they increase your chances of getting cancer?
Let's start with fibroids, because that was the first one I remembered. About one in 500
to 600 fibroids become cancerous. Much more common in an older woman.
A woman with enlarging fibroids in the menopause,
that's the sort of person you have to think about for fibroids becoming cancerous.
Under the age of 40, it's very, very rare. If you have a fibroid, don't worry about it.
One in three women have fibroids. The only time you need to worry about it is when it's growing rapidly in size
and you're over the age of 45 and predominantly over the age of 50. There is an association with a type of cancer
called clear cell cancer and endometriosis. It's normally people who have very severe forms,
the most severe forms of endometriosis. It's quite rare.
I see a few cases, but they tend to all come to me.
It's more common in endometriomas in the menopause.
I wouldn't be worrying hugely about cancer if I had endometriosis. I'd be worrying more about the symptoms of endometriosis.
That's been a topic of great concern in our specialty, especially over the last few weeks.
Why women present less commonly with endometriosis. Why women aren't getting the treatment they should be getting
It's become a bit of a political thing. I think we as a profession really need to up our game in the way we deliver care to women with endometriosis.
I wouldn't be worried about cancer. Polycystic ovaries, yes, because polycystic ovaries is associated with diabetes.
It's an oestrogen-dominant position. If you're someone with polycystic ovaries who is amenorrheic,
that means you do not have periods, then you are someone who is oestrogen-dominant.
You probably should be taking some progesterones to prevent the development of endometrial cancer later on in life.
The easiest way to do that is to go on the pill or to take progesterones, or to have the progesterone coil in.
There is a small association between polycystic ovaries and uterine cancer.
Thank you. Then recurrent UTIs is the last one. I’m not aware of recurrent UTIs being associated with cancer.
They might be associated with bladder cancer, but I'm afraid that's not really my area of expertise.
I would ask one of the general practitioners here who might know.
I think recurrent urine infections, especially if we can’t find a cause for it.
It’s not uncommon in postmenopausal women to get recurrent infections due to low oestrogen levels in the genital area.
If there’s no particular cause for recurrent UTIs, then that can indicate problems with the bladder,
one of which could be bladder cancer. Probably important to say that recurrent urine infections
are incredibly common, and way more common than bladder cancer. It’s one of those things that needs to be investigated.
Tom, is cervical screening still required following a full hysterectomy?
The answer to that isn't a straightforward yes and no.
There are two types of hysterectomy. Well, there are more than two types. You can have a hysterectomy called a subtotal hysterectomy, where the cervix is left behind,
and then cervical screening is absolutely still required. here is a type of hysterectomy where the cervix
is removed, called a total hysterectomy. Normally you don't need to have smear tests after that.
The exception is if when you've had your hysterectomy it is analysed.
If there is any pre-cancer in the cervix when it is analysed,
we normally do a smear of the top of your vagina at six months and eighteen months before discharging you.
Great answer. Anybody, if you still have a cervix, you must have screening.
We all know that when it comes to diagnosing cancer, the earlier the better,
because the earlier a cancer is diagnosed, the easier it is to treat, and the better the chances of survival.
Can you tell us a little bit more about that? How much difference does it make when it comes to the treatment
options for gynaecological cancers? For example, how might you be able to manage a stage one cancer versus a stage three?
You talked about stage one and stage three. I think possibly people wouldn't understand this stage thing.
Generally speaking in most cancers, stage one is a cancer that's confined to the organ that it originated in.
In cervix cancer, it’s when it hasn't spread outside the cervix. In ovary cancer, it's when it's just in the ovary.
In uterine cancer, when it's just in the lining of the womb. When a cancer has spread,
In cervix cancer, it’s when it hasn’t spread outside the cervix. In ovary cancer, it’s when it’s just in the ovary.
In uterine cancer, when it’s just in the lining of the womb. When a cancer has spread, if you remember, I said cancer is a disease of cells.
Cutting out the main cancer isn't going to cut out every cell. Then we're looking at other treatments, other than surgery.
I think that's all the questions that we have time for. Like I say, we had hundreds, but I think there's a lot of information there for everybody to take away.
That just leaves me to say a huge thank you. Thank you so much, Tom, thank you Petra, thank you Sam
for your expertise, for your warmness, and sharing your knowledge with us. I know I've learnt a lot, and I'm sure everybody else has, too, so thank you so much
That concludes the event. That just leaves me to say a huge thank you to all of our speakers and also huge thanks to all of you
for sharing your questions, for taking part in the polls, and for tuning in. I hope you found it informative, and I hope you found it helpful.