Should I fear my breasts have been getting greater? DR MARTIN SCURR has the reply…

I’ve always been slim, but a couple of years ago I noticed that the size of my breasts has increased and that I have put weight on. I have not changed my diet. Would a blood test discover the cause? Do I have too much oestrogen? I’m 78.

E. Gahan, by email.

An increase in breast size at your age is unusual. While it’s likely that this has an innocent explanation – and is related to your weight gain – it should be investigated.

Breasts are made up of adipose tissue (i.e. fat) so even a small degree of weight gain may result in an increase in their size.

This explanation is particularly likely if the enlargement has been gradual and if the extra volume is distributed equally between both breasts, and also appears to be consistent with a generalised weight gain.

As you suggest, raised oestrogen may be a factor – excess fat can lead to higher oestrogen levels, which independently might increase breast size.

Raised oestrogen can also be linked to ovarian disease, so I would advise asking your GP for a serum oestradiol test to measure your oestrogen levels – these should be low or undetectable in a healthy woman of your age.

Your GP should also perform a breast examination, and if I were examining you, I would also request a mammogram.

Raised oestrogen may be a factor – excess fat can lead to higher oestrogen levels, which independently might increase breast size (picture posed by model)

I’m on a variety of medicines, including amlodipine, atorvastatin, omeprazole, tamsulosin and finasteride. I’ve also had an enlarged prostate for many years, but it doesn’t seem to be getting better. Do you know why I’m now getting cramps in my legs and feet?

James Glencross, Lochgelly.

Three of the drugs you’re taking – atorvastatin, amlodipine and omeprazole – can cause leg cramps.

But my view is that the statin is the most likely culprit, as it is well recognised, especially in older patients, to cause leg cramps as a side effect – and is more likely to do so if they have low vitamin D levels.

Using omeprazole, a treatment for acid reflux, long term (i.e. over years), can cause lower magnesium levels, which could in turn lead to cramps. Ask your GP for a blood test to check your magnesium levels and, at the same time, ask about stopping the statin for a month – this should cause no harm, and if the cramps reduce it would point to the drug being the culprit (and if so, there are alternatives).

As for your enlarged prostate, this is being treated with tamsulosin and finasteride – these help improve difficulties with urinary flow, the main symptom.

Tamsulosin works by relaxing the smooth muscle cells of the prostate, bladder neck and urethra, while finasteride helps ‘shrink’ the prostate to improve urinary flow.

Neither of these drugs are associated with cramps.

Tamsulosin is the first-line treatment, but if it doesn’t ease the symptoms significantly then finasteride is added to the drug regimen, but it may take some months to see an improvement. If despite both drugs your prostate symptoms are intolerable, then an assessment by a urologist should be the next step, as some patients need surgery to reduce the prostate.

The drugs were a breakthrough when they arrived some 30 years ago, resulting in less surgical intervention for an enlarged prostate, but nevertheless there do remain a proportion of patients who can benefit from surgical treatment.

The options include Turp (transurethral resection of the prostate), which is the gold standard and involves cutting away the excess tissue using a heated loop, or vaporisation.

Other less common treatments, such as water vapour thermal therapy – using a high-pressure water jet to remove the tissue – are available for carefully selected patients.

In my view: The cancer tests I would advise against

Several times each year an anxious patient arrives holding a pathology report – obtained elsewhere – showing a positive result for a tumour marker. Yet scans come back clear, which doesn’t resolve the anxiety.

Typically, the tumour marker is CA125, related to ovarian cancer, although the most recent example I’ve seen was for CA19-9, linked to pancreatic cancer.

There are many markers, but they must not be used for screening otherwise healthy people.

That’s because tumour marker tests are for monitoring the response to cancer treatment and detecting relapse – they’re not meant for screening because of the high numbers of false positives and false negatives they produce.

What should we do when a patient has a raised CA19-9, but normal pancreatic scan results? Should we rescan in 12 months? Or in six months? Or three? What do we offer for the sleepless nights?

And bear in mind that CT scans, which use radiation, are themselves a risk factor for cancer.

This technology is being misused by practitioners who should know better – it causes more trouble and more illness (uncontrollable anxiety) than it solves.

I would avoid such tests unless you have, or have had, cancer.