Pharmahealthblog. Health and medical information

I’ll just comment on one thing that may surprise you. You will see from the table that just two tablets of either aspirin or paracetamol, both easily available non-prescription painkillers, is about as strong as 20 milligrams of morphine taken by mouth. Surprising but true and very useful. You don’t need to rely on your doctors for supplies of painkillers as long as one of these drugs works for you and suits you. However, it is very important to know that you must not take aspirin if you are having a chemotherapy drug called methotrexate. Asprin is also not a safe painkiller if you have a stomach ulcer or if you bleed and bruise easily for any reason, but especially if you have a low platelet count. A problem with both aspirin and paracetamol is that it is neither safe nor pleasant to take more than about 4,000 milligrams per day of either one (that is twelve aspirin tablets of 300 milligrams each or eight paracetamol tablets of 500 milligrams each). Higher doses are likely to cause heavy sweating, nausea, vomiting, dizziness, confusion, and in the case of aspirin, ringing in the ears. Too much paracetamol can cause serious liver damage and too much aspirin can seriously disturb the balance of acids and minerals in the blood. This means that, on their own, aspirin and paracetamol are only useful as long as less than 4,000 milligrams per day is enough to control your pain. But don’t worry, there is no such limit for the other painkillers listed.

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Many cancer patients, with or without their knowledge and informed consent, are involved in research into cancer treatment. It is important for you to understand something about this. Basically, there are three different stages of testing for new treatments.

In Phase I studies, researchers test drugs or other treatments that have never before been tried on humans. They have been tested only in the laboratory and on various animals. Phase I studies are designed to find out how the treatment can be used in humans, not whether it is effective against human cancer. It is not expected that there will be any benefit to the individual patients involved in this type of research. The aim is to find out things such as whether it can be taken by mouth or injection, whether it is broken down by the liver or passed out through the kidneys, what doses are safe, how often they should be given and what side effects there are. Because these things are not known, patients who are the human ‘guinea pigs’ in these tests may experience unexpected severe and unpleasant side effects or even die as a result of the treatment. Therefore, only patients for whom there is no known effective anti-cancer treatment available are asked to take part in these studies. You might be happy to participate, knowing that by doing so you could help future patients. However, if you go into it because you hope it will help you personally, it is extremely likely that you will be disappointed.

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First appointment

When you arrive at the clinic, you will be asked a few general questions about your health, and then shown into a cubicle to undress to the waist. It is easier if you wear trousers or a skirt rather than a dress. An X-ray of each of your breasts will then be taken, as described on p. 13. You should tell the radiographer if you are concerned about a lump, as you can be recalled for a clinical examination even if your mammogram does not show any abnormality.

Once both breasts have been X-rayed, you will be able to get dressed again while you wait a few minutes for the films to be developed, and for the radiographer to make sure that they are technically adequate. If you are asked to have a repeat X-ray at this stage, it will be for technical reasons or because a clear picture of the whole area of interest has not been obtained. The radiographer will not have made any medical judgment of your X-rays – only a technical one.

Receiving the results

During the next couple of weeks you and/or your GP should receive one of the following letters.

1    You are likely to receive a letter telling you that the mammogram showed no abnormality and that you will be called again for screening in 3 years time. This may be phrased as ‘no significant abnormality’ to take account of the fact that there is no real ‘normal’ standard as all women’s breasts are different.

2     You may receive a letter asking you to return for another mammogram because your X-rays were technically of poor quality. This may be because you moved slightly while the X-ray was being taken, or the developed film may not show enough of the breast area and armpit.

3     You may receive a letter asking you to return to the clinic for another assessment. This is the case for about 1 woman in 14, and can be because the X-rayed area needs to be examined more closely. Although you are bound to feel concern if this happens, bear in mind that there are numerous changes that occur in the breast tissue with age, some of which are quite normal and some of which may seem abnormal but are harmless.

Of the women who are recalled for further breast screening, 9 out of 10 are found not to have cancer. Most of the breast changes apparent on mammograms are not associated with any form of malignancy. Because of the importance of the early detection of breast cancer for successful treatment, the doctor examining your X-rays will err on the side of caution, and any unusual change in the tissue, or sign of any breast disease, will be examined further.

It may be helpful, while you wait for your second appointment, to make a note of any questions you think of, however trivial they may seem. Any doctor should be happy to explain points which are unclear and to discuss anything you are worried about.

Second appointment

All breast clinics are different, and each will have its own way of doing tests and investigations.

If you are asked to attend a second clinic, more X-rays will probably be taken, possibly from different angles, of one or both breasts. You may then be examined by a doctor, who will feel your breasts for any palpable lump or thickening of the tissue. If the doctor is able to feel anything, you may be given an ultrasound examination, the results of which may be discussed with you by the doctor at this visit or a subsequent one.

A fine needle aspiration biopsy may be done to remove a small sample of cells, or a small piece of tissue may be taken from a suspicious lump in your breast at a separate appointment using a general anesthetic. The cells or tissue sample will have to be examined under a microscope, so another appointment may have to be made for you to receive the results and discuss them with the doctor.

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