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

Recently I have been suffering from an annoying itch in the middle of my left breast. I checked for nodules but can’t find anything unusual except for a white spot on the nipple. Do I have to see my doctor? I am 72 and on low dose HRT.

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

Typical symptoms are itching and a lump or changes in the size and shape of the breast. A difference in the appearance of the skin is also a concern, such as a rash or dimpling of the skin.

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

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

Other cancers can also cause symptoms that affect the nipple. Therefore, in older women, these changes are always taken seriously and usually lead to a referral to a breast clinic.

Assessing potential breast problems involves more than a mammogram. An examination at a breast clinic will also include an ultrasound and perhaps a biopsy. If you opt for a mammogram alone, you risk missing out.

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

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

I suffer from terrible asthma and seem to keep getting chest infections that make it hard for me to breathe. My back has been bothering me for about a week now, so bad that I have to lie down. Could the two things be related?

It’s not uncommon for people with severe asthma to struggle with back pain, especially if they’re prone to respiratory infections, which can cause pain in their own right. This may be due to a complication of the infection itself. An example is pleurisy – when the layers covering the lungs become inflamed.

Anyone who suffers from severe asthma should be under close medical supervision, especially if they have frequent respiratory infections. Pulmonary function tests or a specialist assessment may be required.

Asthma can cause coughing spells, which can often result in muscle strains, aches and pains. It is also possible to develop a bad back from a lack of exercise and movement due to shortness of breath.

However, lower back pain is very common, often caused by an uncomfortable movement or strain, so it cannot be related 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’s common for patients to want to lie down, but doctors don’t recommend bed rest — gentle exercise is key to recovery. Useful moves are listed on the NHS website. Taking painkillers regularly is helpful 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 Ovary Syndrome in her late teens and has suffered terrible hair growth on her face ever since. I was wondering if there were any new treatments for these symptoms? The doctor prescribed a cream and the pill, but neither worked. Would it help if she had her ovaries removed?

Polycystic ovary syndrome, often known as PCOS, is a common condition in which multiple cysts develop on the ovaries. But cysts alone don’t mean you have the condition.

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

Treatment is highly dependent on what a patient wants, as symptoms vary greatly between individuals.

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

PCOS is associated with problems with insulin – the hormone that 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 and balancing hormones.

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

Various types of hormone pills can be used to stabilize the menstrual cycle. These can help with skin and menstrual complaints. An endocrinologist, who specializes in female hormone disorders, would advise on the right type of pill to use.

Have you been left in the mouth without a dentist?

It seems to me that NHS dentistry has not become more accessible since the lockdowns ended.

My clinic is inundated with patients with dental problems who turn to their GP because they can’t get an appointment with their dentist. And I keep coming across horrible stories, like patients gluing their teeth back together with superglue, or sticking gum in a hole.

Unfortunately, GPs can do little in most cases, especially in emergency situations. We lack the expertise and it is quite possible that we are doing something wrong.

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

If this problem affects you, I would like to know. Please write to me at the address below.

Relax, therapy by Zoom works!

I was pleased to see health chiefs giving the green light to digital psychological therapies.

While therapists have been seeing patients on Zoom for a while, digital apps and other online platforms are now officially recommended by the depression and anxiety watchdog NICE. Many of my patients are skeptical when I suggest using an app to improve their mental health.

In fact, there’s a fair amount of high-quality evidence suggesting that this method — which usually involves online exercises and remote therapist appointments — may be just as good as face-to-face therapy. Some patients, such as those with disabilities and social anxiety, often feel more comfortable not seeing someone in person.

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