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Q1: I would just like to thank you for your positive article which is indeed a rarity. I am sure I speak for thousands like me who only read the negative every October. I had this seven years ago, and every October I may as well be back then due to the total lack of sensitivity. The only people who write are trying to sell papers with no regard for the devastation they are causing. I fund raise, do what I can speak, to others, but in a positive humorous way. Thanks a million for your common sense writing. Ingrid Morgan, Bushey, Herts.

A: Thank you for your email, it was good of you to write and I so agree that we don't encourage as optimistic an approach to breast cancer as the statistics demand. Having a diagnosis of breast cancer is, of course, a terrible shock for any patient. The breast has connotations of femininity and many women wrongly fear that surgery to the breast is the female equivalent of castration. However, whatever the diagnosis is it is usually not is a death sentence. In my piece (Surviving the hype, October 25) to which you kindly referred, I discussed the amazing results that are now achieved by good treatment in a specialised multi-discipline breast unit following early diagnosis achieved by more stringent screening regime than is currently offered by the NHS in Britain.

In the American private sector, when the woman and her doctors have followed the recommendation of the American Cancer Society assiduously, the fifteen to twenty year recurrence free rate is well over ninety percent. Last year the chairman of the society was visiting England and he corrected me for suggesting it was now over ninety-five percent, it was he said over ninety-six percent.

In Britain, the Cancer Research UK charity predicts that two-thirds of all women with newly-diagnosed breast cancer are now likely to survive for at least twenty years, whereas in the early 1990s only fifty-four percent had a chance of surviving for more than ten years and only fourty-four percent chance of surviving for twenty years. Some of the apparent discrepancy between these figures and those of the American are, of course, because they are measuring different outcomes. The Americans are talking in terms of recurrence of the cancer, whereas the British figures are talking about overall survival. Even so we must not only battle to increase women's understanding of the disease, and the likely good outcome if they have had regular screening, but we should endeavour to ensure that the NHS offers the same standard of screening as the American Cancer Society recommends but can only be obtained privately in Britain.

Q2: I have water cysts in my breasts and I've been told they are not prone to turning cancerous but I'm still concerned they could go that way. What is your opinion? How close a watch should I keep on my breasts to be sure of catching anything cancerous? Name and address withheld.

A: Obviously I can't comment on your particular case but you are certainly right to go and see your doctor and he or she was equally right to take your findings seriously. All breast lumps must always be shown to the doctor and all women should examine their breasts regularly as well as having regular screening. Cysts are most common in the ten years preceding the menopause but can occur at any time. They may be multiple or single but diagnosis should always be confirmed either by ultrasound or by aspiration of the cysts. If the lump doesn't disappear after aspiration or if the fluid is at all blood-stained or if the cyst recurs it is important to have the sections of it examined microscopically by a pathologist.

The problem with cysts, fibro adenomas and other benign breast lumps, especially if they are multiple, is that they may be concealing an early malignant lump that is amongst them. The malignant tumours can be compared to terns' eggs that have been laid amongst pebbles on the beach that are of very similar size and shape to the eggs and for this very reason the eggs are not noticed.

In my own opinion women with so-called lumpy, bumpy breasts, even if they are younger than the age at which breast screening would normally be suggested, should have regular mammography every eighteen months or annually. Not everyone would agree with this but it is a matter of assessing relative risks. Three out of four breasts are soft and of uniform consistency but one in four are lumpy and bumpy. The difference has been compared to the feel of a soft downy pillow at a five star hotel and the lumpy pillow some of us remember from our boarding schools or nights in cheaper hotels.

Q3: I would like to know if masectomy and reconstruction is right for me. In July this year I had my first routine mammogram at the age of 52 and this picked up a very small invasive cancer and an area of DCIS behind the nipple, both in the same breast. Two months later both areas were removed including tissue between the two areas to check for a clear margin. Samples from the lymph nodes were also taken. A week later I returned to receive the results of the surgery to discover that the DCIS area contained an invasive tumour and that the area in between also contained signs of pre-invasive DCIS, the lymph nodes were clear. A mastectomy was recommended along with reconstructive surgery if I chose to follow this path. No radiotherapy or chemotherapy would be necessary.

The surgery will take place at the John Radcliffe Hospital, Oxford where I have met with the plastic surgeon who suggested tissue and skin from my abdomen will be used for the reconstrution in an operation taking six to eight hours. Naturally I often wonder if this is right for me and wonder if such a radical step is the best answer. I have private health cover but felt that the treatment I had been offered and received on the NHS could not be improved upon. Should I go ahead with the proposed surgery in the knowledge that I have been given the best possible advice? Name and address withheld.