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

I have a painful lump on my chest, which a doctor says is nothing to worry about because of where it is. My request for a biopsy was declined. What would I do next? I am 74 and otherwise healthy.

When you first notice a breast lump, it’s good to be concerned and see your doctor right away – most people know it could be a sign of cancer.

But it’s also true that many of the lumps examined in primary care and breast clinics are not cancer. In fact, there’s a whole catalog of clumps that aren’t sinister. And pain is not often a sign of breast cancer.

In a 74-year-old woman, doctors would have to do a very thorough battery of tests before ruling out breast cancer. This is because the risk of the disease increases with age. An examination would be expected, as would a scan such as a mammogram or ultrasound of the lump.

Today's reader is a 74-year-old woman with a painful lump on her breast and an application for a biopsy was denied for fear she might have cancer.

Today’s reader is a 74-year-old woman with a painful lump on her breast and an application for a biopsy was denied for fear she might have cancer.

Some noncancerous lumps are in the skin of the breast, while primary cancer is in the breast tissue. Doctors can usually make this distinction by feeling the area.

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

They are important for women with troubling symptoms, but doctors will always try not to do them unnecessarily.

The question of what to do if you disagree with your doctor is an important one. We are all entitled to a second opinion. Ask the same doctor and discuss your concerns. Otherwise, discuss the situation with another GP in the practice, or request a second opinion from a specialist – which a GP can usually refer you for.

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

More from Dr Ellie Cannon for The Mail on Sunday…

Mini strokes don’t cause long-term symptoms. In most cases, patients are even back to normal within a day.

Doctors also refer to them as a transient ischemic attack or TIA. The focus is therefore on preventing a further attack by prescribing a specific group of drugs. First, statins are recommended to lower cholesterol by at least 40 percent — this is vital even for patients with healthy cholesterol levels. High blood pressure should also be treated.

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

This combination of drugs is therefore certainly not useless. In fact, it is a recognized treatment that is prescribed as standard and has been shown to reduce the risk of further TIAs.

Anyone who has had a TIA should have ongoing monitoring with their primary care physician or hospital clinic.

Doctors will monitor blood pressure, pulse, side effects of medication, and whether changes are needed in terms of drug type and dose. It’s also important to look at other risk factors for TIAs and strokes, such as possible underlying diabetes and smoking.

A few weeks ago I was struck by this constant need to empty my bladder. There is no burning or pain, but I thought it could be a urinary tract infection, so I made an appointment with a doctor, who gave me antibiotics. It made no difference. My urine samples have returned to normal. I am concerned because the skin around my genitals becomes red and sore. I just want to feel comfortable again.

Feeling the need to go to the toilet more often than usual is very common, especially in women. Usually this is caused by nothing more serious than a urinary tract infection (UTI). But as women get older, these signs can sometimes point to something more important. If symptoms persist despite treatment – ​​and a urine sample is normal – the problem should not be ignored, especially if the patient is over 70 years of age.

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

A doctor should arrange for a blood test, called a tumor marker, or a pelvic ultrasound, or both.

If the vulval area is very red and sore, the culprit could be a common, harmless condition such as vulval thrush. After menopause, a drop in estrogen levels can make the vulva and bladder more sensitive to pain and discomfort. Thrush cream, which is available without a prescription, should help.

Take the wild dip it’s so relaxing

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

I’ve written before about my anxiety and feeling like a million thoughts are racing through my head. I’ve tried mindfulness, breathing exercises, and yoga to switch off, but I can never clear my mind.

In the water, I was too busy trying not to freeze and float to think of anything else. It’s honestly the most relaxed I’ve felt in years.

dr.  Ellie Cannon, pictured right, took the opportunity to go for a swim in the sea off Brighton beach

dr.  Ellie Cannon, pictured right, took the opportunity to go for a swim in the sea off Brighton beach

dr. Ellie Cannon, pictured right, took the opportunity to go for a swim in the sea off Brighton beach

OK, Brighton beach isn’t the wildest place to swim, but there are many ‘real’ spots in the UK.

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

Better be safe with a polio jab

Do you have a question for Dr. Ellie?

Email DrEllie@mailonsunday.co.uk or write to Health, The Mail on Sunday, 2 Derry Street, London, W8 5TT.

dr. Ellie can only answer in a general context and cannot respond to individual cases or provide personal answers. Always consult your own doctor in case of health problems.

I have heard from a number of parents who are concerned about polio following the government’s decision to offer all children under nine in London a dose of the polio vaccine.

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

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

But no cases have been identified yet.

That’s why health chiefs have taken an extremely cautious approach to jabbing children — even if they’ve had previous doses.

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

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

Better to be safe than sorry.

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