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I had breast cancer 17 years ago. My mother, grandmother and great aunt had all died of this disease. Because the tumour was encapsulated I had a lumpectomy followed by Tamoxifen. During this treatment I was invited to go on the Tamoxifen trial and this lasted for eleven years. At the end, no one discussed with me the implications of this lengthy drug-taking,whether there were there any side effects or longer-lasting consequences. Only recently I read that there was a risk of DVT. Fortunately I had already had a hysterectomy so was not in danger of cancer in the womb. The only side effects that do distress me are my thinning hair and facial hair, which I think must be connected to the supression of oestrogen. I would be very interested to here your thoughts on this for even though it is a long time ago, it is always in the back of my mind. Incidentally, after my last check-up the hospital nurse told me that they were now stopping all follow-up checks after five years which seems far too soon. Annie Croscbie, Berkshire

There is evidence that side effects may outweigh the advantages of taking Tamoxifen if continued for more than five years. If further hormonal adjustment is considered necessary it is usual to switch to an aromatose inhibitor. In many cases this switch takes place after two or three years and in some cases, and with some doctors, aromatose inhibitors are now being used as primary front-line treatment. Patients taking aromatose inhibitors rather than Tamoxifen need to take additional precautions against osteoporosis, and to be always on the lookout for cancer of the uterus.

Watching for both these conditions has now become standard treatment. The incidence of cardiovascular disease is in fact slightly reduced in patients taking Tamoxifen. One of the bisphosphonat drugs is usually prescribed to prevent osteoporosis. The application of Regaine, just as is prescribed for male pattern baldness, is usually recommended for women. It is equally effective in both sexes and helps somewhere around 50 per cent of patients.

The earlier it is used the better and it must be used continuously. I would agree with your opinion that with a family history like yours five years of treatment would have seemed too short. You should now discuss with your own GP and your consultants for pros and cons of going on to an aromatose inhibitor, and should in any case continue to have regular mammographs.

I was diagnosed with breast cancer in 1994 and had both ovaries removed two years later to lessen the chance of recurrence. I was tipped into a sudden menopause at the age of 39. Four ghastly years followed (hot flushes, etc) before my consultant took pity on me and prescribed Tibolone. Things improved drastically and life was worth living again. Four months ago my GP advised that I slowly come off Tibolone because of the risk of stroke, heart problems and breast cancer returning. Reluctantly I am now off the HRT and, predictably, the hot flushes have returned along with many of the other spirit-sapping symptoms of menopause. I lead an active life (tennis, sheep farming and 8-year-old daughter) and would give anything to have my HRT-helped life back. I understand that this would not be without personal risk - have you any suggestions? I have tried every herbal remedy on the market and nothing seems to work. Ally Gregory, Chagford, Devon

The only answer is to come off Tibolone even more gradually than you have already done. You should of course be very assiduous in having regular blood tests to exclude any likely problems that could make cardiovascular disease more likely and you certainly need mammography annually until very old age. Herbal remedies may not help but I am not yet certain that the use of phytoestrogens have yet been fully explored.

Your article on Michael Baum and his expertise in the treatment of breast cancer was very interesting. However, most of the articles I read in the news refer to treatment for hormone receptor positive cancers for which tamoxifen and the aromatase inhibitors are prescribed after surgery. Very little is ever mentioned about women, such as myself, who had hormone receptor negative cancers and who have to rely on surgery, chemotherapy and radiotherapy treatment but for whom no other treatments are available. Are you aware of any research being carried out on this particular cancer and if any drugs are in the pipeline? Judy Woollett

Professor Mike Baum and Professor Jeffrey Tobias of University College London are both working on intra-operative radiotherapy. This will make radiotherapy for breast cancer more efficient, less time-consuming and less destructive to adjacent tissue. There is also continuing research into the best use of chemotherapy for hormone negative breast cancer, even if these patients have at the moment, as you suggest, drawn the short straw in breast cancer as they’re not likely to be helped by hormone therapies.

My daughter aged 45 has recently been diagnosed with breast cancer and is due to see a surgeon next week to discuss surgery and breast reconstruction. Question one: Is there any evidence to show that the incidence of breast cancer in younger women is increasing? Question two: I understand that some tumours are hormonal dependant, in my daughter's case she was on the pill for a number of years and then Depot-Provera. Is there any evidence linking either of these with breast cancer? Question three: Why is breast screening restricted to older women? Michael Page

There is some evidence that more cases of breast cancer are being diagnosed in younger women but it’s not entirely certain if this is an increase in incidents or an improvement in diagnostic methods. There is a greater awareness that some younger women do develop breast cancer and that it is necessary to bear this in mind and to sort out those who have an increased risk. If there is an increased risk they should, despite their age, be examined regularly.

If the incidence is increasing there are various factors that may be responsible. Anything that increases the overall lifetime exposure to estrogens is likely to be responsible. This includes early use of the pill; the later age at which women have pregnancies; the longer gap between pregnancies; the lower likelihood that they will breast feed and that if they do breast feed it will be for weeks rather than months and the use of HRT (now abandoned except for the treatment of severe symptoms for a short period). Good feeding and an increase in weight is also a factor and it seems that alcohol is particularly guilty in this respect.