DR ELLIE CANNON: My breast has not got lumps but it’s itchy, should I be concerned about cancer?

Recently I’ve been suffering an irritating itch in the centre of my left breast. I’ve checked for lumps but can’t find anything unusual apart from a white blob on the nipple. Should I see my GP? I’m 72 and on low-dose HRT.

Changes in the breast of a woman over the age of 70 should always be checked by a GP. It’s unlikely to be anything cancerous, but there’s always a chance it could be.

Typical symptoms include itchiness and a lump or changes in the size and shape of the breast. A difference to the look of the skin is also a worry, such as a rash or dimpling of the skin.

Nipple changes are very important – check for alterations in colour, discharge or when it turns inwards.

One uncommon type of breast cancer is called Paget’s disease, which specifically affects the nipple, causing skin changes that can look a bit like eczema.

Other cancers can also cause symptoms that affect the nipple. This is why these changes in older women are always taken seriously and usually result in a referral to a breast clinic.

Assessing potential problems in the breast involves more than a mammogram. An examination at a breast clinic will also include an ultrasound and perhaps a biopsy. Opting for a mammogram alone risks missing something.

All women are entitled to breast screening every three years between the ages of 50 and 70. Those over 70 can request a mammogram by contacting local breast-screening services, but the GP is the first port of call.

Of course, the breast and nipple can be affected by mild skin problems just like any other part of the body. Itchiness can be caused by dry skin, dermatitis or irritation.

I suffer terrible asthma and seem to keep picking up chest infections, which makes it hard to breathe. In the past week or so I’ve also started to experience problems with my back – so much so that I have to lie down. Could the two things be related?

It isn’t unusual for people with bad asthma to struggle with back pain, especially if they’re prone to chest infections, which in themselves can cause pain. This can be because of a complication of the infection itself. An example is pleurisy – when the layers that cover the lungs become inflamed.

Anyone suffering severe asthma should be under close medical review, especially if they have frequent chest infections. Lung-function testing or a specialist review may be needed.

Asthma can cause bouts of coughing which can often result in pulled muscles, aches and pains. It is also possible to develop a bad back through a lack of exercise and movement due to breathlessness.

However, pain in the lower back is very common, often triggered by an awkward movement or strain, so could be unrelated to asthma. Doctors refer to this as ‘simple’ back pain, to reassure patients that it is not serious.

Back pain generally lasts about six weeks per episode and it is common that patients want to lie down, but doctors do not recommend bed rest – gentle exercise is the key to recovery. Helpful movements are listed on the NHS website. Taking painkillers regularly is useful as it allows you to move more comfortably. Non-medical pain relief, such as heat pads or acupuncture, may also help.

Try visiting an osteopath or physiotherapist for more support.

My 30-year-old daughter developed polycystic ovarian syndrome in her late teens and has suffered terrible hair growth on her face since. I wondered if there were any new treatments for these symptoms? The GP prescribed a cream and the Pill, but neither worked. Would it help if she had her ovaries removed?

Polycystic ovarian syndrome, often known as PCOS, is a very common condition involving multiple cysts that develop on the ovaries. But cysts alone do not mean you have the condition.

Many women have cysts on their ovaries and experience no symptoms. A diagnosis is made only if blood-test results are abnormal and the patient is suffering from irregular periods, excess hair growth and fertility problems. The condition is also linked to weight gain.

Treatment is very much dependent on what a patient wants, as symptoms vary hugely between individuals.

Removing the ovaries would not be an option. This would plunge someone into a sudden and extreme menopause, which is not appropriate for young women who may wish to have a family.

PCOS is associated with insulin problems – the hormone which helps our cells use glucose. A special type of eating plan, called a low-GI diet, can help women with PCOS. It focuses on lowering blood sugar levels and balancing hormones.

The diabetes drug metformin is licensed for use in PCOS and can be prescribed by a GP. Other options focus on specific symptoms. For hair growth, a dermatologist could offer removal treatments, but this isn’t always available on the NHS.

Different types of hormone pills can be used to stabilise the menstrual cycle. These can help with skin and period symptoms. An endocrinologist, who specialises in female hormone conditions, would advise on the right type of pill to use.

Are you left down in the mouth, with no dentist? 

It seems to me that NHS dentistry hasn’t got any more accessible since lockdowns ended (stock photo)

It seems to me that NHS dentistry hasn’t got any more accessible since lockdowns ended.

My clinic is inundated with patients with dental problems who have turned to their GP for help because they can’t get an appointment with their dentist. And I keep coming across awful stories such as patients glueing their teeth back together with superglue, or stuffing chewing gum in a cavity.

Unfortunately, in most cases there is very little that GPs can do – especially in emergency situations. We lack the expertise and it’s very possible we’ll get something wrong.

We are often asked for antibiotics to help infections in the mouth, but this isn’t always the right treatment, not to mention the well-known dangers of prescribing antibiotics unnecessarily.

If this problem is affecting you, I want to know about it. Please write to me at the address below.

Relax, therapy by Zoom works!

Health chiefs have given the green light to digital psychological therapies (stock photo)

I was pleased to see that health chiefs have given the green light to digital psychological therapies.

Although therapists have been seeing patients on Zoom for a while, digital apps and other online platforms are now officially recommended by prescribing watchdog NICE for depression and anxiety. Lots of my patients are sceptical when I suggest using an app to help their mental health health.

In fact, a fair amount of high-quality evidence suggests this method – which usually includes online exercises and remote appointments with therapists – can be as good as face to face therapy. Some patients, such as those with disabilities and social anxiety, often feel more comfortable when they don’t see someone in person.

Personal consultations would be the ideal, but we simply don’t have enough psychologists – NHS or private – to meet the growing demand.