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Inside Health:
Gut health
Gut health defined | Symptoms | Food unpacked
Watch in 36 mins
Dr Zoe Williams is joined by Specialist Dietitian Kaitlin Colucci and Iona Bell, a Specialist Dietitian at Bupa’s Cromwell hospital to discuss gut health related issues, including what sort of things are good and bad for your gut, managing gut health symptoms and ways to improve your gut health.
Hello and welcome to Bupa's Inside Health Series.
I'm Dr. Zoe Williams.
And today we're gonna be talking all about gut health.
What do we mean by gut health?
What things are good and bad for our gut and what can we do to look after our gut health?
It's a really interesting topic, but it can be quite confusing and a lot of the science is relatively new.
So I'm gonna be joined by gut health dietitian, Kaitlin Colucci and Iona Bell, who's a specialist dietitian at Bupa's Cromwell Hospital to help us uncover this really interesting topic.
So Kaitlin, let's start with where is the gut and what do we mean by gut health?
So gut health refers to the functioning of our entire gastrointestinal tract.
So that's everything from our mouth all the way through to the exit at the other end.
And its main function is to absorb nutrients from the food that we eat and rid solid waste from the body.
And it also hosts our gut microbiota.
So the community of trillions of bacteria which live inside our large intestine.
Now, for good gut health, there's no real universal definition, but I suppose it could be the absence of any unwanted gut symptoms like abdominal bloating, constipation, or diarrhoea.
And when it comes to our gut health, that also influences other aspects of our health, which will come onto, but what influences our gut health?
So the number one thing which influences our gut health is the food that we eat, in particular, the dietary fibre we consume.
So dietary fibre forms the backbone of all of our plant-based foods.
So our fruits, our vegetables, our whole grains, our beans and lentils and our nuts and our seeds and our gut microbes break down this fibre through a process known as fermentation, which produces all sorts of beneficial molecules, which gets sent all around the body.
And we should be aiming for about 30 grammes of fibre every single day because this has been shown to reduce the risk of certain diseases such as heart disease and type two diabetes.
And we hear more and more now about the gut microbiome.
We also hear that the gut is the second brain and it somehow communicates with our brain and impacts our mental health and it even affects our immune system.
So how is our gut having this huge influence on all these other parts of our health?
So our gut microbiome is not an organ in the conventional sense, but it's a community of trillions of bacteria, fungi, yeasts, and parasites, which live in our large intestine.
And each microbe is capable of producing hundreds of chemicals, which as I was saying, gets sent all around the body to help with our brain health, heart health and skin health.
And 70% of our immune cells are found within the lining of our gut, which is why if we eat a healthy diet, we can help to support a healthy immune system.
Oh, that's fascinating.
I mean that's fascinating to me to think that what we eat can impact all these various aspects.
Tell me a little bit more about the link between food and mood.
So how what we eat can impact our mental health.
So 90% of our serotonin known as our happy hormone, is actually produced within the gut, which is just another reason why it's so important to eat a diet rich in plant-based foods and dietary fibre to help improve our mental health.
And is it true that also the other opposite way is true, you can do things to look after your emotional health and that can give you better gut health?
Absolutely, so there's certain things you can do to help reconnect the gut and the brain, as it were, simple practises such as breathing, because breathing out helps to stimulate that rest and digest nervous system.
Another thing is meditation or mindfulness because that can make you become very present and listen and tune in to what's going on inside the body.
And one of my favourite practises is yoga because as well as including the breathing and the meditation, yoga also involves movement like stretching and compression, which is almost like a little massage for your internal organs and for your guts.
So when it comes to a healthy diet, the guidance seems to change all the time.
The ideas change all the time.
But if we're focusing on looking after our gut health, what suggestions would you have for a healthy diet?
So I suppose my top tips would be to try to eat a diverse range of plant-based foods.
That doesn't mean being 100% plant-based, but aiming for about 30 different plant-based foods per week.
The other thing is to avoid unnecessarily restricted diets.
So avoiding excluding any whole food groups unless you have a medical diagnosis to do so.
So that means not completely cutting out carbs or cutting out fat, for example.
Exactly and actually carbs are super important in our diet because they are so rich in dietary fibre.
The other thing is to try to eat the rainbow when it comes to different fruits and vegetables because they all provide us with different antioxidants and polyphenols, which our gut microbes love and reducing our intake of these ultra processed foods.
So these are foods which contain things like artificial sweeteners, unknown ingredients, and are higher in fat and sugar.
And in addition to all of that, you can experiment with things like fermented foods.
So I'm talking sauerkraut, kimchi, kombucha, kefir, because we know again, these are really beneficial for our our gut microbes.
And we're gonna be covering more of that a little bit later on as well.
So whilst it is natural then to focus on the foods we eat, when we're talking about gut health, there are other parts of our life that are important as well, aren't there?
Like hydration and sleep?
Absolutely, so I always say the most important thing is to chew your food really thoroughly because I think we forget that digestion really does start in the mouth and the more we can chew our food, the easier it is for our body to absorb the nutrients from the food that we eat.
The other thing is to try to avoid wearing high wasted tight fitted clothing because the external abdominal pressure can sometimes worsen digestion and lead to things like abdominal bloating.
Trying to stop smoking and reduce your alcohol intake is really important because smoking can decrease the diversity of the gut microbiome.
It's also important to remember to avoid taking unnecessary medications.
We all need to take medications from time to time, but especially things like the overuse of antibiotics, antibiotics as well as killing off the bad bacteria can often wipe out a lot of the good bacteria.
And the final thing is to really make sure we are drinking enough fluid every day because we've talked about the importance of upping our dietary fibre, but fibre requires fluid to work effectively in the gut.
So we wanna aim for two litres or eight glasses of water every single day.
Wow, so lots to think about, but I think for people, even if you make adjustments to just one or two of those things, then you're gonna make improvements, aren't you?
Absolutely.
Thank you so much Kaitlin, for giving us that insight into the importance of our gut health and especially how it can impact our overall health.
So I'm now with Iona Bell who's a specialist dietitian at Bupa's Cromwell Hospital.
And we're gonna be talking a little bit about gut health issues and touching upon food intolerances.
So Iona as a specialist dietitian, tell me a little bit about your role and your day job.
So I currently work as a specialist dietitian at Cromwell Hospital.
So my mornings consist of ward rounds and also developing nutritional regimes for the patients on the critical care unit.
So this is from IV nutrition to enteral feeding, which is where we insert a tube to feed directly into the gastrointestinal tract.
And my afternoons are spent in the outpatient clinics, with the other specialist dietitians.
And we see a wide variety of patients from IBS, inflammatory bowel disease, coeliac disease, diverticulitis, intolerances and oncology cases as well as many other clinical conditions.
So how might we know when something is potentially wrong with a gut?
What are the telltale signs and symptoms we should look out for?
So if you think that something might be wrong with your gut, you may notice symptoms such as constipation, diarrhoea, flatulence, bloating, abdominal pain and cramps, and a general change in bowel habit.
But it's important to remember that these symptoms can be caused from a wide variety of conditions and you may have one or two of the symptoms or you may experience most, if not all of them.
Okay and I think all those things you mentioned, they're all things that we, I guess we'll get a little bit from time to time.
So when would you recommend is the right time to seek help to go and see your GP for example?
So you should see your GP if you think that anything is wrong with your gut, especially where symptoms are having an impact on your day-to-day life.
And if you're noticing any blood in your stools, a change in stool consistency or a change in stool colour and your GP will then build to help support you and also send you for some further tests.
Okay, so I guess based on that, you might get referred for some tests and you may even get a specific diagnosis and there are many different things that people might get sent to you for, aren't there?
What sort of types of things would you see?
Yeah, so we receive referrals for a variety of reasons through self-referrals or referrals through consultants and GPs.
Some of the most common referrals that we see are those for ulcerative colitis, Crohn's disease, coeliac disease and IBS.
But we also receive referrals for general gut health and also how to manage your intolerances and allergies.
So you mentioned IBS there and I think that's probably one of the commonest conditions people think of when it comes to gut health.
But then there's also IBD which is different.
Can you explain the difference?
Yeah, so inflammatory bowel disease is used to describe two conditions, Crohn's disease and ulcerative colitis, which both cause inflammation in the gut.
Crohn's disease affects any part of the gastrointestinal tract from the mouth all the way to the anus.
Whereas ulcerative colitis only affects large intestine.
If you think that you might have inflammatory bowel disease, you might notice symptoms such as blood in your stool, bloating, lethargy, weight loss, abdominal pain, cramps and discomfort.
Generally the symptoms of IBD will last for a period of time, which is what we call a flareup before going away.
It's really important if you think that you have IBD to speak with your GP as they'll be able to help to offer you some advice as well as send you for some tests and treatment.
Irritable bowel syndrome on the other hand is a condition that affects the digestive tract but there's no inflammation of the gut.
Symptoms can be quite similar to that of IBD.
For example, you might get the bloating and the diarrhoea.
Okay, great, thanks for explaining that.
And if people do get a diagnosis of a specific condition, is this then when they're likely to be referred to somebody like yourself and you can look at diet and other potential causes of their symptoms and help them with a management plan?
Yes, we can help in a variety of ways.
For example, if someone comes to us who has IBS, we generally might ask them when their symptoms first started.
And for some this can be during a really stressful period of time in their lives, for example, in their job or it might be after a loss of a family member or close friend.
We will also take a diet history and also understand the symptoms that they're currently experiencing.
From there we can give them first sign advice, which includes stress management, exercise, dietary advice, and also symptom control.
And if felt appropriate we can give them the low FODMAP diet advice as well.
So you mentioned a low FODMAP diet.
Can you tell me a little bit more about that?
Yeah, so the term FODMAP is an acronym used to describe short chain carbohydrates that are poorly absorbed in our small intestine.
FODMAP stands for fermentable, oligosaccharide, disaccharide, monosaccharide and polyols.
And these short chain carbohydrates are poorly absorbed in everyone, but in those with IBS, will cause them symptoms.
Right?
These FODMAP are found in everyday foods.
For examples in onions and garlic, it's really important if you're going to go and do the low FODMAP map diet that you speak with your dietitian who can help advise you through the three stages.
This consists of complete elimination of these FODMAP foods from your diet before bringing them back in one by one to see which caused symptoms and which you can tolerate.
And now a hotly debated topic in our recent Bupa customer survey was food intolerance.
Over 40% of customers responded said that they wanted to know more about it, so it's really a topic of great interest.
So I wanted to ask you a bit about that.
And firstly, what's the difference between food intolerance and food allergy?
So a food allergy is a reaction that involves the immune system.
It's where the body mistakes a protein that's found in food as a threat and therefore a number of chemicals are released, which cause the symptom of the food allergy.
Almost any food can cause a food allergy, but the most common are nuts, eggs, fish, shellfish, some fruits and vegetables and milk.
A food intolerance on the other hand does not involve the immune system.
And having a food intolerance can cause a wide variety of symptoms and reactions.
But these can be very individual to you with a delayed or immediate onset.
And what are the most common things in the diet that might cause a food intolerance or a food sensitivity?
So one of the most common food intolerances that we see is a lactose intolerance.
And this is where someone might be able to tolerate a little bit of lactose in their diet or no lactose at all.
We also see a non-coeliac gluten sensitivity and this is where despite someone not being diagnosed with coeliac disease or wheat allergies still find that the gluten in food causes them some symptoms such as diarrhoea, bloating, flatulence and abdominal pain.
So would you say that more often than not it tends to be a case of food sensitivity rather than an intolerance?
Yeah, so for example, in someone who has IBS, they might find that having a tables spoon of onions does not cause them any symptoms.
But having three tables spoon of onions causes them quite a lot of gut sensitivity and then brings on those symptoms.
It's the same for example, someone with lactose sensitivity that they can tolerate a lactose containing yogurt.
Having a lactose containing cheese or milk causes them quite severe symptoms.
So what sort of symptoms might somebody get from a food intolerance or sensitivity?
'Cause they can present in all sorts of interesting ways, can't they?
Yeah.
So if you've got a food intolerance or sensitivity, the symptoms of this are very individual to you and they can present in a variety of ways.
However, some of the most common symptoms that we see is bloating, diarrhoea, flatulence and abdominal pain.
Some of the less common symptoms include heartburn, lethargy and tiredness, nausea and acid regurgitation.
So if I suspect that I have an intolerance, should I go ahead and just start cutting things out of my diet and manage that myself or do you think it's better to seek some advice from a healthcare professional?
So you should always see your GP if you think that something might be wrong with your gut and is causing you concern.
However, if you suspect that you have a food intolerance or sensitivity and you can by all means do this on your own and by doing the food elimination and reintroduction method, so this involves taking that food that might be causing you symptoms such as bloating and removing it from the diet.
And then if the symptoms go away, you can then slowly reintroduce it back into the diet and if the symptoms return then you know that this food is causing you problems.
It's important to do this if you can under the supervision of a dietitian as they can help to ensure that your diet doesn't become too restrictive and it stays nutritionally complete.
Okay, so maybe if it's just the one particular type of food, have a go yourself but if there's loads of different things you really need some help with that?
Yeah, definitely.
Yeah, okay.
And what if somebody wants to find out for sure, and a lot of my patients, they want to do a test, they wanna do a quick diagnostic test to find out if they're food intolerances, can they do that?
So unfortunately unlike allergy testing, testing for food intolerances lack some validity.
There's lots of commercially available tests that you might have seen out on the market, but these tests tend to lack quite good evidence to back their claims.
An example of these tests, one is a hair analysis test and this involves taking a strand of your hair and sending it off to the lab to test for food intolerances.
But there's no scientific basis behind this and it lacks that good evidence.
There's also IgG testing, which is where a sample of blood is sent away and it's tested for the IgG antibodies in the blood and it's thought then increasing these antibodies to certain foods shows an intolerance to that food.
However, it's been found that people who are healthy and have no symptoms at all have an increase in these antibodies as well.
And it's thought that the foods that you might commonly eat might show up as an intolerance so you might end up restricting unnecessarily.
There's also kinesiology testing, which is where muscle reactions are looked at when a food is placed near and next to the body.
However, there's no scientific basis behind this and it's thought that the muscle reaction is no better than chance.
Okay, so I guess in summary there's no simple test but if you're having symptoms, if they're persisting, particularly if you're having any symptoms you think could be IBD, it's definitely worth a trip to the GP to get some help and support.
Yeah, definitely always go to your GP if you're are struggling with anything or think that there's anything wrong.
Iona, thank you so much.
That was really interesting and really useful and really good to know that it's the support out there to help people.
Now all of this talk of food has made me think that it's time to unpack what is good and what is bad.
So I'm here in the kitchen with Kaitlin and I think it's probably fair to say that not a week goes by without a new health kick, new fad diet, new supposedly super food of which there is no such thing.
So it's really great to find out what is fact and what is fiction.
And I've got some foods here, some of which we probably tend to think of as good for us and some of us we might think of as not so good for us.
So let's have a look at them.
But before we start with that, I wanted to ask you about probiotics.
So we see lots of probiotic supplements being marketed, but also probiotic drinks in the supermarkets now like kombucha and and kefir.
So are they good for us and should we be investing in them?
So really good question.
So you can find probiotics in food that contain live beneficial bacteria, particularly fermented foods.
So things like kefir, kombucha, kimchi or sauerkraut.
We have limited evidence to show their benefit, but lack of evidence doesn't equate to lack of benefit and we have lots of ancestral evidence to show that these can be really beneficial for our health.
Those aren't to be mistaken with probiotic supplements, which you can buy in capsule form or even some probiotic drinks.
And I just want to make it clear that a normal healthy person does not need to take probiotic to improve their gut's health.
However, if you have a particular gut symptom you're trying to manage, then there might be a particular strain of probiotic bacteria which has been shown in the research to help manage that particular symptom.
Okay, good to know.
And what's the difference between a probiotic and a prebiotic?
So probiotics are the live beneficial bacteria we can take to either maintain or improve our gut health, whereas prebiotics are the food for that gut bacteria and we can get prebiotics from different high fibre foods in our diet.
For example, things like onions and garlics, apples and pears, artichokes, beans and lentils, just to name a few.
Okay, great.
Now one thing I wanted to ask you about and I'm thinking about this plate over here is what are the red flags when you're in a supermarket?
'Cause often packaging and marketing can be quite misleading and have us believe things are good for our health when actually they're may be not so great.
Absolutely.
So it can be really confusing for a consumer to know what's good for our health and what's not and you want to be careful of products that are labelled as natural or even vegan.
That doesn't necessarily mean they're healthy for us.
So for example, if you pick up a packet, it's always good to look at the ingredients list.
You want to be able to understand and read all of the ingredients in the product.
There's about a lot of ingredients on there, some things that I've never heard of before.
Absolutely, so several ingredients, some of which you don't even know what they are.
So although this may look like a healthy choice.
It does.
It may not be the most beneficial thing.
Whereas when you see other products and this is a bar which contains just five ingredients that or whole natural foods and you therefore know this is a little bit better for your health.
So I guess there's no shortcuts.
You kind of have to look at the ingredients list and then make your own decision.
Yeah, absolutely.
One thing I wanted to ask about is caffeine.
So we've got some coffee, tea and colas here.
Is caffeine really that bad for us?
So most people can consume up to 400 milligrammes of caffeine a day.
Pregnant women just 200 milligrammes or so.
How many cups is that?
So that would be about depending on the strength of the tea of coffee, roughly four cups of tea or three cups of coffee.
Okay.
And you can consume that safely without any adverse side effects.
But caffeine is a stimulant and can worsen gut symptoms in those who are sensitive and it's all to do with how caffeine is metabolised in the gut.
And for people who are sensitive impacts can include nervousness, anxiety, and insomnia as caffeine can spike that stress hormone cortisol as well as cause these gut symptoms.
Okay, any any health benefits to these?
Tea and coffee is rich in what we call polyphenols and we know that polyphenols are really good for our gut health.
Any health benefits to to these two and is one worse than the other?
So things like fizzy drinks, they do contain caffeine but they don't contain any other nutrition for our body in that sense.
Okay, so there's no real benefit to having them.
And what about artificial sweeteners?
Are they bad for our gut health?
There is evidence to show that high consumption of artificial sweeteners is detrimental to our gut health.
So it's best to try to avoid them where you can.
Okay, I've got some chillis here.
So spicy foods, some people tend to think of these as as triggers if you do have gut symptoms.
So are they good for us or not?
The active component in chilli is known as capsaicin and some people are affected by spicy foods whereas others are not.
And we tend to see those with increased gut sensitivity such as those with IBS become more sensitive to spicy foods.
Okay, and what about alcohol?
Does that have a negative impact on our gut health?
So alcohol can increase the permeability of our gut.
A term you may have heard be called leaky gut, which can increase the sensitivity of the gut lining, especially in those with IBS.
Now some people may be intolerant to certain components of alcoholic drinks such as the gluten found in beer for people with coeliac disease, whereas others may react to the histamines or the sulphates found in different alcoholic products.
Some alcoholic drinks for example, red wine do contain polyphenols, which we know can be beneficial for our gut health.
However, excess alcohol consumption isn't beneficial for our overall health.
So it's important to try and reduce our intake where we can.
Okay, now this one I'm really interested in chocolate, good or bad?
And are all chocolates equal?
So the higher the percentage of cocoa, the more polyphenols and flavonoids it contains, which again can be really beneficial for our gut microbes.
However, we want to avoid over consumption of any type of chocolate and especially the chocolates with the lower percentage of cocoa, they tend to be higher in fat and sugar, which we know isn't beneficial for our gut health.
OK and I thing with those sort of richer chocolate, you actually need a small amount to feel satisfied.
So it'll be beneficial.
Here I've got some aubergines and tomatoes, although we know fruits and vegetables generally are very good for us, these are part of the nightshade family and some people believe that the nightshade family can cause inflammation in the body.
Is there any truth in that?
So we have no evidence to show that nightshades can cause inflammation in the body.
And in fact, if we avoid all of these fruits and vegetables, we can be unnecessarily restricting the diversity of our diet, which we know is detrimental to our gut health.
When it comes to gut health, is it true that things like garlic, onions and leaks are particularly good as prebiotics?
Absolutely.
They're really rich in these prebiotic fibres as well as things like beans and lentils, artichokes.
So they should definitely form part of a balanced diet.
And what about all the diets and crazes out there?
So juice cleansers, keto, Atkins, where do they stand when it comes to gut health?
So none of these diets have any evidence to show that they can be beneficial for our gut health.
In fact, they're all very low in dietary fibre, which we know is the most important thing when it comes to looking after our gut health.
People may feel temporarily better when they have a complete overhaul of their diet, but often these diets are unsustainable and they're not providing our gut microbes with any goodness that they love.
I also wanted to mention about vegan diets because people adopt a vegan diet assuming it equals a healthy diet, but that's not necessarily the case.
When we look at the premise of a vegan diet, it's to increase your intake of plant-based foods, which are rich in dietary fibre, which can increase the diversity of the gut microbiome.
However, you don't have to go completely vegan to improve your gut health, but focusing on a more plant-based diet, including some animal sources, can still have the same beneficial effect.
Thanks so much Kaitlin.
So I guess to wrap up, for people who don't have any conditions or intolerances, diet diversity really is the way to go alongside being active, looking after our mental health and presumably the occasional treat is okay.
Absolutely.
Thank you so much Kaitlin, that was so interesting.
Kaitlin, I've read that fasting is beneficial for my gut and may ease my symptoms, is that true?
And do the times that we eat affect our gut health?
It is recommended to avoid eating two to three hours before you go to bed because our digestive system does slow down at night.
And this is especially true if you suffer from nocturnal reflux, which is reflux in the evening.
There is some evidence that giving your gut a rest, ideally 12 to 14 hours overnight can be beneficial to allow specific microbes to essentially clean up the lining of your gut, which can keep it really healthy, which is really important to support a healthy immune system.
However, there's no need to skip meals and typically an overnight fast is more than sufficient and it's actually recommended to try and eat a balanced meal every four hours during the day.
So that would include your complex carbohydrates, your protein, and your healthy fats.
Okay.
In some cases it might be recommended to eat little and often especially those who suffer from bad bloating or diarrhoea because smaller meal sizes can sometimes help to ease symptoms.
I think it's become quite popular to extend that fast.
A lot of people are aiming for around 18 hours a day, so there's no evidence that that's beneficial for gut health.
Not necessarily.
The evidence really lies more in people who are aiming to lose weight, but with anything to do with the diet, it's not a one size fits all.
Yeah.
This approach is really effective for some people but not others.
Okay, thank you.
Iona, question for you.
I regularly get heartburn after eating.
How can I make it stop?
So if you regularly get heartburn after eating, it's really important to speak to your GP and they might be able to prescribe you some medications to help with the symptoms.
There are some dietary foods that have been found to aggravate symptoms.
These are spicy foods, fatty foods, caffeinated drinks, tomato products, and also your citrus fruits and juices.
And it might be recommended to try and reduce your consumption of these or eliminate them from the diet it is also advised to try not eat two to three hours before you go to bed and also make sure you're following a healthy balanced diet.
Okey-dokey.
Kaitlin, should I avoid antibiotics?
Will it make my gut health worse?
Now look, we all become ill at times when antibiotics really are a necessity, but avoiding antibiotics unless absolutely necessary leaves the healthy gut bacteria from being wiped out and causing long-term changes to the gut microbiota.
In terms of the evidence for if we do take antibiotics, there is some evidence that actually taking probiotics can help to prevent antibiotic associated diarrhoea.
So it'd be recommended to take them for the duration of the antibiotic course and for two weeks afterwards.
Okay.
And would it be just specific patient groups that that would be recommended for or anyone who's taking antibiotic?
Anyone in particular who's taking an antibiotic could benefit from taking a probiotic.
Okay, all right, that's good to know.
Next question, what causes Crohn's disease?
That's one for you, Iona.
So the prevalence of Crohn's disease is increasing worldwide, but the exact cause of Crohn's disease still remains unknown.
There are some risk factors that have been found to maybe increase your prevalence of Crohn's disease, for example, it's more likely to be diagnosed in your adolescents and younger adults as well as your genetics can play a role.
So someone in your family is diagnosed with Crohn's disease and you also then have an increased chance of getting Crohn's disease.
There's also some other factors, for example, your environment and your ethnicity.
I would like to point out though that food and stress, although they can aggravate symptoms, these have not been found to actually be a cause of Crohn's disease.
Okay.
And Kaitlin, are there genetic links to things like IBS or is it all sort of due to the environment and therefore more controllable?
So it has been shown for IBS to run in families.
So if people haven't discussed their gut symptoms with their family, then I always encourage them to do so because they might not be the only ones suffering alone.
But relatives of an individual with IBS are two to three times more likely to have IBS.
However, studies have shown that individuals may develop IBS sporadically, meaning no one else in the family necessarily suffers from IBS.
And I guess the thing with things running in families is the the genetics that connect the family.
But often people in the same family have similar environmental risks as well, don't they?
It can be difficult to unpick what the reasons are.
Exactly.
Okay, question for you Iona.
What would you recommend to cure repeated constipation?
So if you're struggling with constipation, it is important that you speak with your GP and they might be able to prescribe you some laxatives or there might be another problem that they can help diagnose you with.
But there are some dietary changes that you can make.
One is making sure that you've got enough fibre in your diet, so you're getting the recommended 30 grammes of fibre a day.
So this is found in your fruits and vegetables and also your whole meal products.
It's also important that you're saying hydrated, having the recommended six to eight glasses of water per day and also exercising if you're able to.
And do we have a specific diagnosis of constipation?
When does it become constipation?
I mean I guess I'm asking about frequency of having your bowels moved.
So a normal frequency of bowel movement tends to be between one to three stools a day.
If you find that you're outside of your normal habit and you're not going as regularly as you maybe once were, then that's when you maybe want to start speaking to your GP.
Kaitlin, one for you.
I find that my bowel habit tends to change at different times in my menstrual cycle, is this normal?
Absolutely, so we see differing gut symptoms at different times of the menstrual cycle due to the change in hormones.
So during menstruation, AKA the period, you get an increase in this hormone like chemical called prostaglandin.
The role of prostaglandin is to get the lining of the uterus to contract, but that effect doesn't just stay in the uterus and it can also have an effect on the bowel, which causes an increase of movement of food through the digestive system, which leads to looser and more frequent poops.
Okay.
On the flip side, during the luteal phase of menstruation, we get an increase in the hormone known as progesterone and this can actually slow down the rate of motility through the digestive system leading to things like constipation.
Okay, okay that's really interesting, thank you.
And then my final question is another one for you, Iona.
What causes wind, how much is too much?
Is there a certain point in which we need to be alarmed and does it differ from person to person?
So wind is perfectly normal and it's produced as part of our digestive process when the foods that we eat are fermented in our large intestine in some conditions, for example, IBS, people might find that they produce more wind after eating certain foods than what they normally would.
In terms of wind, how much someone produces is very individual to them.
So if you find that you're producing more than normal, then it's important to go and speak to your GP just in case there's something else going on.
So I think it's kind of like with a lot of things, isn't it?
What's normal is quite a wide variety, but if there's a real significant change for what your normal is, that's when you should seek some help and advice.
Exactly.
Well that's it.
I'm afraid that's all we have time for today.
So thank you both so much for joining me.
If anything we've talked about today has got you thinking about your own gut health, maybe there's an issue you've been having or something you'd like to get checked out, there's much more information on the Bupa website or do make an appointment to see your own GP.
Inside Health:
Breast cancer
Symptoms | Screenings | Lowering your risks
Watch in 47 mins
Dr Zoe Williams and a panel of experts provide essential advice about breast cancer awareness, including how to check for signs and symptoms, breast screening and treatment options. Zoe also talks to breast cancer survivor, Jo Knight about her cancer journey.
I'm Dr. Zoe Williams and welcome back to "Bupa's Inside Health" series.
And today, we're talking about breast cancer.
I'm joined by Dr. Rebecca Rora and Dr. Shiroma De Silva-Minor, and we're gonna be talking about what is breast cancer, what are the common symptoms, How can we check ourselves.
We'll be talking about some of the common myths and also answering some questions that have been submitted by Bupa customers, so we can all be more informed when it comes to breast health.
So Shiroma, let's start off with this term, breast cancer, we hear it all the time, but what does it mean?
What exactly is it?
So breast cancer is cancer that started off in the breast, simply put, but it's actually quite complex because that simple term encompasses a number of different subtypes, depending on where they start off in the breast.
The commonest breast cancers start off in the milk ducts or in the milk globules, so doctoral or lobular cancers.
And when we are thinking of a cancer, it's important to think about the stage or how far it's spread.
So if it's gone to the lymph nodes or further afield, so it can be stage one through till four, and if there is a breast cancer, we also need to think about the grade.
So how aggressive is it on a scale of one to three?
And this is something that's looked at under the microscope and done on the biopsy.
So that term breast cancer is a blanket or an umbrella term that encompasses a lot of different subtypes and it's very complex.
Yeah, it really is.
And that collective term then, breast cancer, we know that it is one of the most common cancers in women in the UK.
Roughly how many people does it affect each year?
So breast cancer is actually the commonest cancer affecting women globally with about 2.
3 million women new cases every year.
Cancer Research UK put the number in the UK at about 56,000 new cases each year in 2020.
So it is incredibly common, with about a lifetime risk of about one in seven or eight.
And that's why, I think realistically, it's likely that we all will know somebody at some point who gets breast cancer because one in seven, that's quite common, isn't it?
And whilst it is a condition that is much more common in women over 50, it's really important to remember that it can affect and it does affect younger women too, and men as well.
Absolutely, so breast cancer, like most cancers, tends to be much commoner as you get older and that's because of defective DNA repair and damage that accumulates over your lifetime.
And so, eight out of 10 breast cancers will be much more common in ladies over 50.
Breast screening in the UK is between 47 and 73, and that's designed to capture that age group that is most at risk.
But the peak instance is at about 65 to 69.
Now, a quarter of all breast cancers will be above that upper age limit, so older ladies in particular need to be much more aware of their breasts, but anyone from 20s upwards really needs to be able to examine themselves and to be aware of any changes, particularly if they fall outside of that screening group and need to keep continuing to monitor.
Yeah.
And of course in men, it does affect men, it's quite rare.
Less than 1% of all breast cancers occur in men and in the UK, there's less than 400 cases annually, but it's much more likely, as men get older, if they're overweight and one in eight will have an underlying genetic cause for their male breast cancers.
I think we always have to be a little bit careful when we talk about lifestyle factors and cancer risk, 'cause we never want people to feel that they cause their cancer through an unhealthy lifestyle 'cause that's not how it works.
But actually, trying to be more healthy can decrease your risk when it comes to breast cancer, can't it?
Absolutely.
And it's anticipated that up to 30% of cancers could be attributable to lifestyle factors, which could be amendable.
And so, diet and lifestyle are very important and one of the big ones is alcohol.
I'm always surprised how many of my patients are not aware that alcohol may have had a causative effect in breast cancers and Cancer Research UK predict that up to 8% of cancers could be attributable to alcohol.
And this is related to DNA damage and oestrogen, the impact on estrogens.
And so alcohol.
It's really about making an informed decision, and for breast cancer survivors, we know that as little as three units a week could increase that risk of recurrence.
So, as long as women are making an informed decision about their lifestyle choices, then that's really important.
Diet is obviously important.
Eating healthily, varied, colourful diet, ideally a Mediterranean type diet, minimising processed food.
We know that exercise is really important and consistently over the last 20 years, various studies have shown that increased activity reduces breast cancer risk.
Okay, and it's always a tricky subject, I think, when we talk about obesity because we know that for a lot of people, it's very, very difficult to manage obesity.
But there is quite a significant link between obesity and breast cancer, isn't there?
Absolutely.
And it's obesity or being overweight in post-menopausal women seems to increase the risk of breast cancers.
We know that fat cells produce estrogens and they can increase your risk of hormonally-driven cancers, not only breast, but also endometrial cancers.
So ideally maintaining weight to a body mass index of under 25 is healthy from a breast cancer viewpoint, but also reduces strokes, heart attacks and risk of dementia.
Okay, and then that's lifestyle, which is obviously really important, but genetic risk is something that is talked about quite a lot in breast cancer and I think most people have heard of the BRCA gene.
But can you tell us a bit more about genetics and the links between breast cancer more generally?
So a gene mutation is a change in the DNA sequencing at DNA level, which can cause a cell to malfunction and possibly become cancerous.
We know that there are certain mutations that can be passed on in families and are considered hereditary or germline.
And one of the commonest ones that we know of is the BRCA One and Two mutation.
But there are about seven other gene mutations which are commonly associated with the risk of breast cancer.
The BRCA genes can increase your lifetime risk of breast and ovarian cancer in women and in men, male prostate cancer and male breast cancer.
So it is important to be aware of it particularly if you have a number of family members with breast cancer or cancers at a young age or male breast cancer, prostate cancer or pancreatic cancer.
And I think whilst having one of those defective genes increases your risk, it's always important to say it's not inevitable then that you will get cancer.
But for people who are worried if cancer does seem to run in their family, can they ask for tests?
Indeed.
So if you are found to be a gene mutation carrier, particularly the BRCA One and Two, then it means that there is a 70% lifetime risk of developing breast cancer before the age of 70.
But it's not inevitable.
And of course, if you know that you are a gene carrier, there are risk reductive strategies in terms of monitoring, screening and risk reductive surgeries.
So we know that Angelina Jolie famously talked about her experience with being a BRCA1 gene carrier because sadly her mother and aunt died of breast cancer and that's how it was identified.
And she was a vocal advocate of risk reductive double mastectomies and having the ovaries removed.
And those surgeries reduce risk factors down to very low levels.
So it's really about being armed with that information and amending your risk through those ways.
But having one of these defective genes doesn't mean it's inevitable you will get breast cancer, though the risk is significantly higher.
If breast cancer does run in a person's family, who would qualify for genetic screening?
So that's a great question.
So if you have a significant family history of breast cancer or multiple different cancers or cancer at a very young age, so under 40 for breast or other cancers, or a prostate cancer under 50, then it may be that you have a genetic mutation that runs through your family.
And so you can talk to your GP and they will be able to do a family history questionnaire and refer you on to a geneticist to assess your particular risk.
Now if you've already had a breast cancer, then your oncologist will be assessing all of those risk factors as part of your family history and your personal history.
And again, they may be able to refer you directly, particularly if you have a particular subtype like triple negative breast cancers under the age of 50 or breast cancer in both breasts or cancer at a very young age, So under 30 or 32.
But if you are concerned, then speak to your GP and genetic testing is now easily done on a saliva or blood test and the results can be available within a month.
Okay, interesting.
We're seeing that survival rates of breast cancer over the past few decades are going up and up and up largely due to new technologies and the treatments are getting better.
What are some of the newer treatments and can we allow ourselves to be quite optimistic because this technology just gets better and better?
Absolutely.
I think that there is room for a great deal of optimism in the treatment of breast cancers.
And certainly we know that breast cancer survival has doubled over the course of the last 40 years.
And even in my 20 years as a breast oncologist, I have seen amazing advances and that's across the board from imaging techniques that identify cancers at a very early stage.
Surgical techniques which are much less disfiguring and just as effective or more effective.
Technical radiotherapy and image guided radiotherapy, intensity modulated and high precision radiotherapy all add to the ways that we can deliver treatment in a way that is as safe as possible because we know that for the majority of our patients, they are going to be long-term survivors and we don't want to have adverse effects as a result of the treatments, but particularly they're being great advances in systemic treatment.
So targeted therapies, immunotherapies, and biological therapies.
So even as recently as 10 years ago, we used to treat breast cancer very much as a one size fits all and now treatments are very much more bespoke to the individual patient and the tumour subtype.
And we are now seeing great advances in breast cancer outcomes.
I think definitely some cause for optimism there.
Dare we be optimistic enough to think that there'll be a cure for breast cancer anytime soon.
So overall about eight outta 10 patients will be cured from early detection and active treatment.
But because we know that some breast cancers can recur even 25 to 30 years later, only time will tell, but we know that breast cancer survival has doubled over the course of the last 40 years.
And so we are definitely seeing an improvement, but the stage is really important.
So the earlier detection and treatment will mean that the higher the likelihood of cure.
So unfortunately, stage four, where the cancer has spread further afield is still not curable, but there have been some great advances and for certain subtypes, they can have very effective treatment that allow the patients to live for very many years.
So we are entering a new era of stage four disease, almost being like a chronic illness.
So yes, lots of room for optimism there too.
Great, thank you, Shiroma, thank you for sharing all that knowledge with us.
I think that gives us all a better understanding of everything when it comes to breast cancer.
So thank you.
Whilst it's powerful to hear about breast cancer from doctors, it's also powerful to hear about it from somebody who's been through it.
Earlier I sat down with Joe Knight, who's a breast cancer survivor and now a campaigner and I want all of you to hear her story too.
Hi, Joe.
Hi, Harry.
So lovely to meet you.
Thank you.
So you are a breast cancer survivor mom, campaigner, absolute inspiration.
Oh, thank you.
What I'd like to do first of all is just ask where are you at the moment on your breast cancer journey?
Okay, I'm five years this year cancer free.
Yeah, I was diagnosed back in 2017.
Okay.
So congratulations.
Thank you.
Yeah, it's a huge kind of milestone to hit within the cancer world.
It's five years free.
So it's amazing.
But I imagine that five years has been.
.
.
Well, I mean you tell me, people describe it as a journey often.
How would you describe that?
Yeah, it's a journey.
It's a real rollercoaster of emotions, physically, mentally, it really is.
It's just a whirlwind, I dunno where the last five years have kind of gone, really.
Yeah, yeah.
They've sort of just whizzed you by.
It really has.
It really has.
From sort of the start to now.
It's like in the distance, where did that five years go?
Well, can we go right back to the start?
So how did you first identify that there was something wrong?
So obviously always checked my breasts regularly, probably not as often as I should, maybe every other month.
And I found a lump that I wasn't sure of.
I'd had a breast reduction six years prior.
So I just assumed it was fatty tissue.
Didn't think anything of it.
Left it for a bit, then I checked again and thought, not quite right, I'll go and get it checked out.
So at that point I then phoned and got a doctor's appointment to see myThank goodness.
Yeah, if I hadn't have done that, I think my story could have been a very different one.
I might not been sat here now you don't know.
Well that's the importance, isn't it?
Of self checking.
And you said maybe you didn't do it every month, but you did it didn't you, which is the main thing.
You were checking.
Exactly, exactly.
That is so, so important.
So how quickly did you see your doctor and how quickly did you.
.
.
How did things progress from there?
I think, 'cause I've mentioned on the phone to the receptionist that I found a lump, I need to see the doctor, I'm not sure what it is.
I was seen within that week.
There was an appointment available and the doctor, she wasn't sure herself, obviously not being a breast expert, she said there is a lump, I'm not sure what it is, but I will refer you.
Don't be alarmed.
I'm gonna put you through on the rapid access, which you'll seen within two weeks.
I was seen within 10 days.
Yeah.
So I wasn't too overly concerned at that point because it was the unknown.
I didn't know what it was.
And that's the message that I always give to my patients.
If you're concerned about something, if there's something there and we're not sure, we need to get you seen within that two week period becauseThat's what you guys are there for.
More often than not, it's not the breast cancer, but if it is, then it's so importantAnd the detection is key.
Absolutely.
So how did things progress?
How quickly?
You said you were seen within 10 days at the specialist breast cancer unit.
Yeah, at my hospital.
Yeah.
And then what happened?
So on that day, I was seen by the consultant.
He did an examination, obviously they must have an inkling there and then, because it was a bit like a one-stop shop for me.
So I saw the consultant, I then had a mammogram from there on, I then had a biopsy on the same day.
And after the biopsy, saw the consultant again.
Again, obviously he'd seen the imaging, couldn't say anything because there had to be a few more tests, the biopsies had to go off.
And then I was seen back with him within.
.
.
Must have been within two weeks at least.
So it was really quick.
So I guess within a month then, is it?
Yeah, for me it was within a month, yeah.
Which was great.
And I think within a month if people aren't checking or sometimes people might delay for more than a month, they're just thinking, oh I'll just see if it goes away.
But it's really important.
I think that's what I hoped.
I delayed it a little bit.
Not a lot, but I think I was hoping, oh, it's nothing, it'll be okay.
But I'm glad I went when I did.
Yeah.
So then your treatment started.
What treatment did you have?
Pretty soon I had to have, because of the nature of the lump where it was, I had to have chemotherapy first.
So six months of chemo, then a mastectomy, then radiotherapy.
And then because my cancer was hormone related, I had to have a full hysterectomy as well.
So been through the mill .
You have, you have.
And tell me a little bit about your family.
I'm a single parent to a 15 year old daughter.
So she was eight at the time when I was diagnosed.
Yeah, I'm a mom and dad, sister, brother.
Breast cancer isn't in the family history.
Prostate cancer.
My dad had prostate cancer but he's in remission now, which is great.
Everything that you've been through, how does that impact you or how did it impact you?
But also how did it impact your daughter?
Yeah, it's hard isn't it?
Because your world just comes.
.
.
You're told, I'm really sorry you have cancer.
You become numb, your world comes crashing around and you just panic.
And for me, I'm an incredibly positive person.
I always have been.
But my fear initially was everybody else, not me.
It was how are my parents gonna cope?
How's my daughter gonna cope?
Am I gonna die?
That's your initial reaction.
Do you think most people think that when they hear the word cancer.
Do you think most peopleWithout a doubt, yeah, I think I'm gonna die and that's what the scary thing is.
And I think until you know exactly what you are dealing with and you get your head round it in the diagnosis and the worst thing that people do is go home and they'll Google it.
Do not Google your diagnosis and it's the hardest thing not to do.
It's hard.
It's really hard because you feel that you need that information.
You get so much negativity and I think exactly until you know what you are dealing with, and your.
.
.
I didn't know there were different types of breast cancer.
I just thought there was breast cancer, that was it.
But there's so many different grades, so many different types of breast cancer that are treated in different ways.
And was yours.
.
.
Were you told that yours was a particularly aggressive form of breast cancer?
Or were you given those statistics that I think sometimes people want, what are the chances of survival, et cetera?
Yeah.
It's hard, isn't it?
Because you want to know, yeah, am I going to die?
What's my lifePersonal questionBut I was scared to kind of ask that.
But because mine was a grade two, if my consultant said if I'd left it any longer, it would've been that next step, next further slightly different treatment.
It wasn't as aggressive as others.
So in that respect, I was lucky, if lucky is a word you use when you've got cancer.
But to me, I was lucky I'd gone early enough andBut you had to, like you say, through the mill with the treatments, chemotherapy, surgery to remove your hysterectomy as well.
Yeah.
So my cancer was hystero-receptive.
Right.
And did you have your ovaries removed as well?
Yeah.
Full hysterectomy.
That's instantly into menopause as well.
Surgical menopause.
Yeah.
So not easy.
Yeah.
No, not easy.
And hence I think that's been.
.
.
My hair hasn't grown back properly, so people may be thinking, why is she still wearing a head scarf?
Why she's not got a lot of hair?
That's probably, my hair hasn't grown back properly.
I kind of expected a full head of hair after five years.
But now you're at this five year point, five years cancer free.
That is a massive milestone.
Because that's like, you can now think about moving on with the rest of your life.
Yeah.
Moving forward.
How do you feel about the rest of your life now?
Positive.
Yeah.
I can't be any other way.
And when you're going through treatment, you're at the hospitals, you're seeing your nurses, you're seeing the specialist.
It's like you've got a comfort blanket.
And you're seeing somebody all the time.
When you finish your treatment and you'll see bye off you go, go your treatment's finished now.
That's when the scary thoughts come in.
You've lost that comfort blanket.
You're not seeing anybody regularly and that's when the kind of fear comes in of recurrence.
Yeah.
Yeah.
And interesting that you decided to not have reconstructive surgery.
Can I ask you about that?
Yeah.
Because when I finished my treatment after radiotherapy, I was left for a year with having had a double mastectomy.
So living with no breast.
I kind of got used to it.
I think I decided not to.
I just didn't want any more surgery.
And for me having had a breast reduction then going to having nothing, I felt comfortable in my own skin, in my body.
And I want other women to understand and to be happy with who they are.
And that boobs don't define you as a woman.
Absolutely not.
I agree.
They don't define.
.
.
They didn't define me and I just want to promote body positivity and it is okay to remain flat and I want that to be an option for other women who are going through, 'cause you automatically think you're gonna have reconstruction.
And do they talk to you about reconstruction as if it's what's gonna happen.
It's not talked about massively at the time of the appointment.
I think it's just initially all your treatment you're gonna have and I just assumed that I would have reconstruction, immediate reconstruction with my surgery, but because I had to have radiotherapy afterwards, They wanted me to heal properly before if I decided to have reconstruction and it's a huge surgery.
Yeah.
Well your positivity is contagious.
It's amazing.
Thank you.
I think the body positivity, your positivity of mind, it's amazing.
What would be the one message you would want to share with other people?
Is just to not be scared of your body.
Check yourselves regularly.
And early detection is key and it's all about educating from the younger generation.
My daughter's 15, so it's so important for me to educate her and the younger generation, not to scare them, but to know their body.
Not to be scared to touch your body, to feel it, to know your normal.
It's so, so important that once a month us women are checking and men too 'cause men get breast cancer too.
And it's important we do it in front of our children, don't we?
We brush our teeth in front of our children.
It's so important.
And this is no different, it's just part of self-care.
So important not to be embarrassed about your body.
We're all different.
It's your body.
It's my body.
It's your body.
Be proud of who you are.
Yeah, exactly.
Well, thank you so much for sharing your radiance and positivity with us.
Oh, thank you for having me.
But also hopefully for inspiring lots of people out there.
I hope so.
To check themselves.
To look after themselves.
And people, you're not alone.
There are hundreds of women, men out there who have been diagnosed.
If you are struggling, get help and just if you find a lump, get it checked.
Joe, thank you so much for sharing.
I think it's so important, as Joe said, that we're checking regularly and if we find anything we're concerned about, we act on it straight away.
When it comes to cancers, breast cancer is one of the types that does not always but often give us clues that it's there.
But in order to pick up those clues, we need to be regularly selfchecking.
We need to know what we're looking out for and also attend any screening mammograms that are offered to us.
So to find out a little bit more in detail what the signs and symptoms are and what to do about it.
I'm gonna have a chat with Rebecca.
So firstly, what are the signs and symptoms of breast cancer?
I think the one that people are most aware of is a lump or swelling in the breast.
Important to remember that that might not be in the breast itself, it might be in the upper chest or even in the armpit.
So important to examine those areas as well.
Also a change in the size or the shape of the breast or a change in the appearance or the consistency of the breast.
So skin changes like dimpling or puckering, really important to speak to your GP about.
In addition, any rashes or redness and inflammation of the breast itself is also a reason to speak to a doctor.
And finally, I think changes to the nipple.
So a pulling in of the nipple, an inversion of the nipple, rash or or crusting around the nipple, and even discharge from the nipple itself are also reasons to seek help.
I think people become very concerned about breast pain.
Actually, that's a really uncommon symptom of breast cancer.
But if it's bothering you and if you've got kind of persistent pain in the breast, in the armpit or in the chest, then that's also a reason to see the doctor.
And as we've mentioned before, also really important to remember these aren't just symptoms for women, they're also symptoms for men as well.
So important to put that in mind.
And I think, on the one hand, it's a positive that breast cancer can give us these clues.
So it's important to know the signs and symptoms, but I think what's really important is that people are just familiar with their own breasts so that they're checking their own breasts regularly.
And then anything that is a change that seems unusual, rather than remembering all of that, if you can remember it, great.
But anything that's unusual, get it checked out.
Yeah, I couldn't agree enough.
This is about women and men understanding what is normal for them, particularly for women at different stages in the breast development, during puberty, in their young life, before and after children, before and after the menopause, at different points in their cycle, really important that they understand what the breasts look like, breasts feel like, and also what's normal in terms of the feel and the appearance of the armpits as well.
So I think it's just about understanding what's normal for you now, checking in regularly about it and knowing that if you do notice something different, to go and ask for help and that there's no such thing as a stupid question.
Absolutely.
And your GP absolutely wants you to go and see them or speak to them at least straight away.
Don't delay.
So being breast aware and checking is our main defence against breast cancer.
But what's also really important is our defence for people who are eligible in the right age bracket is the screening programme.
So that's mammograms.
Yeah, so mammogram is the type of breast X-ray and people might have one of those either as part of the National Screening Programme, as you mentioned, or if they've been referred by their doctor to a specialist appointment.
Now the mammogram itself, important for women to know what to expect during that 'cause it can be a source of anxiety for people.
They'll be invited into the room by the mammographer and you can ask to see a female mammographer if that's important for you.
You'll be asked to undress down to the waist and will be positioned in front of the mammogram machine.
What they'll want to be doing is taking a couple of images of both breasts and to do that, they'll position one of the breasts onto a firm plate, put a clear plate above it and take one image top to bottom and one side to side, including some of the armpit area as well.
Now it's important that people stay still during that.
It can be a bit uncomfortable because the breast is compressed between those two plates, but it only takes a couple of seconds.
I think because it's an X-ray, people can become a bit concerned about the radiation.
Actually in reality, that's a really low dose.
It's about the same as going to Australia and back in terms of radiation dose and the benefits of doing the mammogram tend to out outweigh the risk of doing that.
Also because if it's an X-ray, really important to mention if there's a risk that you could be pregnant or if you are pregnant.
It can be a really worrying time for people if they are referred to be investigated further because they have breast symptoms.
But actually the majority of the time actually turns out to not be breast cancer and be nothing or be something else.
What other things can give breast symptoms that aren't breast cancer?
That's absolutely right.
I mean the majority of women attending for these assessment days will end up being diagnosed with a benign breast condition.
So a non-cancerous breast condition.
In terms of lumps and swellings, one of the really common causes of that might be a fibroadenoma, which is a lump that develops in the breast often during puberty, but it can develop at any age.
In addition, breast cysts can develop.
Those are fluid-filled sacs that often develop in the breast with changes that happen because of age.
So particularly around the menopause, those can start to present themselves.
I think, also really important that people remember that some of those nipple symptoms, so nipple discharge can actually be caused by benign conditions like duct ectasia, which can cause a milky discharge.
Again, something that can happen as a result of age-related changes.
So lots of causes of breast symptoms.
I think the underlying message is to anyone out there, if you notice anything that's unusual, get it checked out sooner rather than later because the chances are it's not breast cancer anyway and you're worrying without any reason.
And if it is breast cancer, the sooner it's diagnosed and the sooner it's treated, the better the outcomes.
And it's really important, Rebecca, that we remind people, even if you're having your mammograms every three years, you still need to self-check in between.
And if people do find something concerning, what should they do?
I think a lot of people's first point of call will be their GP.
Their GP will ask some information about the signs, the symptoms, a bit about the medical history, they might ask about the family history as well.
They'll also want to examine the breasts and the armpit areas.
If they feel that a specialist appointment is necessary, it's important that women know what to expect at that.
So the specialist consultant will also want to examine the breasts and the armpit.
Many women will then go on to have imaging that might be a mammogram, but it might be an ultrasound.
It depends on the age and and the nature of the symptoms.
In addition to that, a small sample of breast tissue might be required to help make that diagnosis.
That can be done under a local anaesthetic very quickly, usually there and then, sometimes with imaging.
When that's all done together.
So the examination, the imaging and the biopsy, that's called a triple assessment or a one-stop shop.
And often that's enough to make a diagnosis on the day.
Where that isn't enough, sometimes women might be referred for something else, for example, some more detailed imaging.
I think it's really important that women remember that everybody who is doing those assessments is aware that this is a really anxiety provoking time.
And Bupa really tries to support people through that.
Firstly through direct access so people can call with symptoms.
There are a couple of straightforward questions with no claims impact that are assessed against national guidance and if that's passed then that's enough for a referral to a consultant.
Also really important that people remember that we have 14 specialist centres for breast cancer care and that allows a very fast, very frictionless access to diagnostics, often within a few days.
And if cancer is diagnosed, then onwards to treatment.
And at the moment, we know that people typically start treatment in about half the time of the national waiting time of about 31 days.
And that all helps to alleviate people's concerns in terms of that period of uncertainty before a diagnosis can be made.
And I think also really important thing to add is that if people detect something that seems unusual for them, don't delay, go and see your doctor.
Usually, it doesn't turn out to be breast cancer, it's fine to monitor it for a couple of weeks, but if it's not going away, really important to get it checked out, because those delays, if you leave it for months and months, it can actually make a really big difference to the outcome.
Yeah, absolutely.
Thank you for sharing all of that.
I think that means we're all much more aware to what to do, what to look out for, and also what will happen if we do go down that path of investigation.
When it comes to being breast aware, the most important thing to do is get to know your normal because this means you are well equipped to identify if anything changes and then you can get it checked out straight away.
And if you're wondering how to check, here's a little something I made earlier.
Here's a quick demo of one way you can self check.
So starting off by looking with your top half, looking from the front, different hand positions, hands behind your head and also pushing onto your hips.
And then do the same from one side and the same from the other side.
And next you're going to feel.
So start with one breast, use the pads of the fingers and use whatever technique works for you.
This is the spiral technique.
So as long as you feel every single area of the breast, it doesn't matter how you do it, some people use the lawnmower technique, some people imagine the breast is in four quarters and fill one quarter at a time.
To complete the examination, you're gonna also feel the front of the chest wall all the way up to the collarbone.
It doesn't matter which hand you use, whatever is easiest.
And then also feel all of the areas in the armpit.
And once you've done one side, the same on the other side and then you're done.
So there you go.
A self check is quick, it's easy and you really can't do it wrong.
The most important thing is just do it.
If you are a mom, do it in front of your daughters.
Talk to your gran about it, your aunties, your sisters, your friends.
And remember that men should be checking too.
This is the best defence we have against breast cancer.
So let's get everybody checking.
There's just so much to talk about in this topic.
And as always, we've asked you to submit some questions for our experts prior to this event.
So we're gonna cover some of the topics and some of the areas that we haven't covered already.
So Rebecca, I'm considering HRT, but I've read it makes my breast cancer risk worse.
Is this true?
HRT is hormone replacement therapy.
It's a treatment used to treat the symptoms of menopause by replacing the hormones that naturally decline with age.
HRT has a fantastic effect on alleviating some of those really concerning symptoms that impact people's quality of life.
But it's important to understand the risks and the benefits of it.
HRT does increase the risk of breast cancer, but it is complicated and it's much related to how long you take the HRT for and the kind of HRT that you take.
There's still lots of research going on in this area and it's been proposed that that increase in risk might be to do with oestrogen and the fact that some breast cancers need oestrogen to grow.
Now we know that the longer you take HRT, the higher the risk of breast cancer, but also the type of HRT.
If you take combined HRT, which has oestrogen and progesterone, then that has a slightly increased risk as well.
What I would say to women is it's really important to balance the impact of those menopause symptoms on the quality of their life together with the other benefits of HRT, such as on bone and heart health and to talk to their doctor, talk to their gynaecologist, talk to their oncologist about any questions they have so that they can make a balanced decision.
Okay, and it's tricky isn't it?
Because actually that that risk benefit equation will be different for different people.
And we've already talked about how things like drinking too much alcohol, not being physically active, having a poor diet, these things can increase your risk and we know that actually the symptoms of menopause can make drinking more likely and so there's a lot of weighing up to do.
Yeah.
Okay then.
The next question is, I have regular breast pain and I'm worried it's cancer, could it be something else?
So breast pain is really common as a symptom, but it's a very uncommon symptom of breast cancer.
I think lots of women have pain around certain times of the month.
We call that cyclical breast pain.
It may not necessarily be pain, it may be a burning sensation, a singing sensation, a sense of heaviness that might include one breast, it might be across both breasts.
But in cyclical breast pain, it does tend to be often before the period so that once a woman's period starts, then that pain will go away.
Often we see that pain stopping around the time of menopause, although of course it can continue afterwards, especially in women who are taking HRT.
I think pain that's there all the time, non-cyclical breast pain can also occur and that that's not at particular times of the month.
What we would say is if you are bothered by a pain, if you are worried about a pain, even if you've been having it for a long time or if it's a new pain, then please ask for help.
So it's not just about minimising and saying, "Oh, it's nothing to worry about.
" If you are worried about it, we'd rather that you spoke to a doctor.
Absolutely.
I completely agree.
Shiroma, a question for you.
I've had cosmetic surgery on my breast, do my implants put me at higher risk?
So implants per se don't increase the risk of breast cancer, but it can be associated with a very rare type of aggressive lymphoma known as anaplastic large cell lymphomas.
Now these are incredibly rare.
And actually I have a question that sometimes I've been asked is if somebody has breast implants, then when it comes to doing self-checks and self examinations, does it change anything?
Does it make it more difficult?
So there are two types of implants.
So they can either be subpectoral, so behind the muscle or in front of the muscle, but at the back of the breast tissue.
So usually the breast tissue is still in front of the implant and so it shouldn't really cause a problem with self-examination and absolutely you should continue to examine and really look for any changes to the norm.
Okay, that's great.
Thank you very much.
Question for you, Rebecca.
I've been on the mini pill for more than 10 years.
Should I change my contraception now and what's best to lower my breast cancer risk?
So the mini pill is the progesterone only pill.
We sometimes call that the POP or the pop.
And there's still lots of research about whether taking a progesterone only pill increases the risk of breast cancer or not.
And that also goes for some of the other progesterone only contraceptives available like coils and implants and injections.
We do know that the combined oral contraceptive does increase the risk of breast cancer, but it doesn't increase it by a lot.
And once you stop taking it, then that risk does reduce down to normal after a couple of years.
However, we also know that breast cancer is rare in younger women and that the combined oral contraceptive is a really safe, really effective form of contraception.
And so again, that goes back to that risk-benefit discussion.
For most women, the benefit of taking the oral contraceptive massively outweighs the slightly increased risk of breast cancer.
But again, if you have questions then please speak to your GP, your nurse, your family planning clinic gynaecologist or oncologist who can help you to kind of understand how your particular circumstances fit.
Yeah, so it comes down to that individualised risk versus benefit and also taking the combined oral contraceptive pill, whilst it does have a slight increased risk of breast cancer, there's an actual slight reduction in risk of some other cancers.
So colorectal cancer and I think endometrial cancer.
So yeah.
Yeah.
Overall I believe there is no increase or decreased risk of cancer across the board.
So the next question is for Shiroma.
My mom has recently been diagnosed with triple negative breast cancer.
Can you explain what this is?
So triple negative breast cancer is one of the four main subtypes of breast cancer.
And the triple negative part refers to the fact that it's oestrogen, progesterone and HER2 receptor negative.
And effectively these are cell surface receptors on the surface of a breast cancer cell.
And where we don't have those receptors to target, it means that chemotherapy and possibly immunotherapy becomes much more important in their management.
They do tend to be more aggressive cancers, but there's still treatable and curable at an early stage and they're much more likely to be associated with an underlying genetic cause.
So a 20% risk of an underlying gene mutation compared to the overall breast cancer risk, which is about 5%.
So would it be fair to say then if it's triple negative, so it's lacking those three different receptors that you spoke of, there'll be certain treatments, breast cancer treatments, that won't be effective.
So perhaps there's less choice of treatments in that particular scenario.
So you're right.
So ordinarily most patients would be treated with endocrine treatment, which are anti oestrogen tablet medication.
Of course that would beLike Tamoxifen is one of, I think people have heard- Exactly.
And that haven't and that would be ineffective in that patient group.
But we've now identified triple negative breast cancer as a very distinct group with different outcomes and different treatments which can be very effective.
So there are specific immunotherapy.
So immunotherapy and breast cancers only works in triple negative breast cancers.
So although there are some treatments that aren't suitable, immunotherapies can only work in triple negatives.
Okay, interesting.
Where are we going to next?
Shiroma I've never had children and was told this makes my risk of breast cancer higher.
Why?
So different hormonal exposures throughout the course of a woman's lifetime can impact on her risk of breast cancer.
And this particularly relates to the total number of lifetime menstrual cycles.
And they can expose the breast tissue to certain hormonal changes which are associated with breast cancer.
And so you have an increased risk if you've got an increased number of total lifetime exposures, whereas your risk is reduced if the total number of menstrual cycles is less.
So for instance, during pregnancy and breastfeeding reduces your menstrual cycles and breastfeeding for 12 months reduces that risk by about 4%.
And pregnancy to term reduces that risk by about 7%.
So overall, if you have a baby and breastfeed for a year, you've had a 11% risk reduction.
And then if you compare that to two or three pregnancies, then you can see that your risk of breast cancer is significantly reduced compared to someone who unfortunately hasn't had a baby or breastfed.
So would it be true to say then if you started your periods at a later age, you'd have less periods over the course of your life and that would also reduce your risk?
Yes, absolutely.
And conversely, we know that starting puberty early and going through menopause late also increase that overall lifetime duration and increases the risk.
Okay.
Interesting.
Shiroma breast cancer can also be confused with an infection of the breast known as mastitis or on the other hand not picked up because the symptoms are very similar.
Can you explain a bit more about this?
Yes, indeed.
So mastitis is when the breast can be swollen, red and painful and maybe related to an infection.
So most commonly this occurs during breastfeeding with a blockage of the milk ducts, but it can occur in in ladies who aren't breastfeeding and also in men.
But it's important to know that these symptoms of a red, swollen, painful breast could also be a sign of a very aggressive type of breast cancer known as inflammatory breast cancer.
And it's important to differentiate between the two.
So if you do have any of those symptoms, really important to see your GP.
And if antibiotics aren't having a significant improvement in symptoms within seven days, then you'd normally be referred up to a specialist breast clinic so that you could have a biopsy of the skin, which could make a definitive diagnosis and differentiate between those two.
Excellent.
And unfortunately that's all we have time for.
So thank you Dr. Rebecca.
Thank you Dr. Shiroma and also thank you to Jo.
I think, hopefully that's really raised your awareness of the importance of self checking, attending screenings and also if you do notice anything that's not quite right don't delay and get it checked out.
Thank you for joining us.
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