Cancer

Hi, everyone.

Welcome.

Today's topic is cancer, sometimes called the big C.

I think the word cancer itself can create a lot of anxiety, a lot of fear

because for so long we've associated cancer with death.

But today we're gonna talk about cancer,

why it's important to talk about it, and why cancer doesn't necessarily mean death.

It's not all doom and gloom.

So I'm joined by Tim and Rebecca from Bupa.

And if I could come to you, first of all Tim, let's start by explaining the word cancer.

What does it mean?

What is it?

Sure.

I think most people realise our bodies are made up of trillions of different cells,

everything from fingernails, to blood cells, to hair cells.

The thing that always amazes me is these trillions of cells just get on with it.

They're born, they grow, they do their stuff and they die.

They respond to various things from inside the body

and from outside the body, whether it's environment, diet, et cetera.

Sometimes those control mechanisms will go wrong

and those cells will start to either grow out of control or not die when they should die.

And we call those growth tumours.

But a cancer is a tumour that just doesn't know when to stop.

It invades the tissues around it, it can get into the bloodstream and it can spread to other organs

and we call that metastasis.

So cancer's a malignant growth and you may hear them call that

or you may hear them call malignant tumours as well.

And there's probably about 200 different types of cancer that we recognise.

It always amazes me 'cause sometimes people talk about finding a cure for cancer,

but like you say, there are 200 different cancers and is it ever possible to find a single individual cure

for all cancers, do you think?

I think that's not something that is certainly gonna happen

probably not within our lifetimes, but we are getting closer because we understand more and more about what causes cancer,

and we are now looking at treatments that are aimed at those causes rather than just killing off the cancer cells.

So we're definitely moving in the right direction with it.

And what's the picture in the UK at the moment

when it comes to cancer?

Cancer's very common.

There are probably about 3 million people

living with cancer in the UK at any one time.

And there are about 387,000

new cases of cancer every year in the UK.

So that's over a thousand a day.

But every 90 seconds somebody will get that diagnosis of cancer.

And if you were born after 1960,

there's probably about a one in two chance that you're gonna get cancer at some point in your life.

And that sounds scary, doesn't it?

One in two chance.

It used to be one in three not that long ago.

So what's changed?

Has as cancer become more common?

The biggest change is that people are getting older.

Cancer is still a disease of older people primarily because these controlled mechanisms in the cells

gradually fail over time.

So with an ageing population there are gonna be more cancers,

there's more screening programmes, people are becoming more aware of cancer and talks like this I'm sure and I hope will help that.

So we're picking up more cancers as well.

And I think when it comes to cancer,

we've spoken a little bit there about what cancer actually is, which it's really interesting the way you've put it.

What are the causes of cancer?

The causes of cancer, for some cancers we just don't know.

The causes of cancer basically are things that disrupt this control mechanism in yourselves.

So it can be external factors, things like cigarette smoking, exposure to certain chemicals,

obesity we think causes a significant number of cancers.

Hormone changes can cause some cancers

and other lifestyle things can be involved there as well.

But also it is just changes in the genes

that control these cancers.

Now these can be changes that you are born with.

There are changes that can just happen at random

over the course of your life or sometimes they're genetic changes that you've actually inherited.

So can people reduce their risk of cancer?

You can and you can reduce your risk of some cancers

quite significantly.

First thing to do, if you smoke, please stop.

Smoking is the biggest risk factor, not just for lung cancer, which you don't everybody thinks of but mouth cancer,

throat cancer, esophageal cancer, stomach cancer, some skin cancers to a certain extent, even bladder cancer.

So smoking can cause a lot of cancers.

Obesity is a significant risk factor for a lot of cancers.

And again, it's not the obvious things like you'd think, okay, bowel cancer is, I'm overweight, prostate cancer, breast cancer.

So healthy lifestyle, avoiding things like smoking, avoiding excessive alcohol.

You stick to the limits, 14 units three or more days a week, don't binge drink because prolonged liver damage

can cause cancer.

It's really, a lot of it is common sense.

Well, yeah, it always comes back

to those healthy lifestyle measures that we know about, that we talk about all of the time.

But often, life happens as well and it can be really difficult to implement very healthy lifestyle when none of us are perfect.

I think obesity is always an interesting one because we know that more people in this country are above a healthy weight than a healthy weight.

And I think sometimes the individual, it's difficult for individuals to get control of that.

Do you think that there needs to be.

.

.

What changes need to happen I guess at a national level,

government level to help people be a healthier weight?

Because we know that it is a big risk factor for cancer.

We have to look at the information that we provide for people to help them make healthy choices.

But we also have to have to accept some people won't make those healthy choices.

So I think you have to be a little bit paternalistic

and look at cutting down on things like ultra processed foods, because adding artificial substances into natural food,

we were designed to run on certain type of fuel.

If you put diesel in your petrol car, it won't like it.

Put the wrong fuel into your body and things are gonna start going wrong.

And then what about genetics?

Because we know that genetics play a role when it comes to cancer.

How important are our genes

'cause we have no control over those.

We don't have any control over our genes.

We do have some control over things

that might damage our genes as we get older.

So again, I come back to things like smoking and obesity.

We're not quite clear how obesity actually works in increasing cancer risk, but it's causing some kind of genetic damage.

When people talk about genes and genetics, they may be mean different things.

So there's the genetics that you're born with,

the genes that you've got, and any mutations or changes in those genes.

And then there are genetic changes that do run in families.

Now people may say I'm at risk, there's a big history of cancer in my family,

but as I said, one in two of us may get cancer.

We're all going to know a family member who's had cancer.

If you have a large family, you're gonna think I'm at high risk.

There's a lot of people in my family with cancer.

But if you look at things like cancers

at an early age in your family, that's potentially a risk factor for you.

People who have a history of linked cancers,

so women who have had breast cancer and ovarian cancer together, that's a significant risk factor.

There are some different ethnic groups, whether there are different risk factors, people who have had more than one cancer in their lifetime

that suggests they may have a genetic problem which could be inherited.

Again, if you're worried, talk to your doctor,

there are test that can be done.

And if you are at risk, two things.

The fact that you've got a risk factor doesn't mean you're gonna get cancer.

But the fact you haven't got any risk factors

doesn't mean you are not going to get cancer.

So still have to follow all the advice on healthy eating and not smoking, et cetera.

So when it comes to those sort of specific genes, and I think the most common one that people have heard of is the BRCA gene

when it comes to breast cancer, what proportion of cancers are linked to specific gene mutation?

In terms of inherited genes, probably not more than about 10% of all cancers.

Pretty much all cancers, you could probably trace back to a genetic fault somewhere.

But it's something that has appeared entirely at random

that isn't inherited.

But 10% is significant and if you one of those at risk groups, it may mean that your risk

could be a lot higher than 10% of getting cancer.

'Cause it's interesting, isn't it?

'Cause we talk about

how genes are inherited from our parents, but actually those lifestyle behaviours

that you've spoken about are often inherited from our parents as well.

We're more likely to have similar behaviours

to what our parents and what our family do.

And then also the environmental things that,

where we live, if we're exposed to certain chemicals, pollution, they kind of run in families as well.

So I guess when you're thinking about your family history, it's quite complex, isn't it?

Oh, it's very good.

There are so be different factors in play as you said and there's only so much that you can alter.

So it's all about being aware and any worries at all get advice.

You can get advice from your GP, the NHS website, Bupa website, virtual GP consultations with Bupa.

There are so many ways now.

Really don't die of ignorance as they once said about another disease.

Exactly.

Tim, thank you so much.

That was really helpful to sort of set some context and give us some general information about cancer.

Really interesting statistics as well.

So Rebecca, let's have a chat with you.

So you are the medical director in healthcare management at Bupa.

And what I'd love to do is talk about some of the ways

in which we can be proactive with our health to keep ourselves healthy, but more specifically as well to reduce our risk of cancer

but also, what are some of the signs and symptoms we should be looking out for to be vigilant

and to pick up and detect what could be a cancer early?

I think we're all really well aware

of some of the common signs of symptoms.

Checking for breast lumps for example and checking for changes and the appearance

or the texture of your breasts.

But actually there are lots of other things that you should be on the lookout for; lumps in other parts of the body, for example.

And I think something that's been in the media a lot recently has been about changing bowel habit.

So that might mean going to the loo regularly

or becoming more constipated than normal and any change in terms of blood in the poo as well.

I think people are well aware to look for moles and changes in their shape or size, colour of them.

But people should also be on the lookout for new moles.

And I think some of the less spoken about symptoms

that it's really important to be transparent about in women is vaginal bleeding.

So any vaginal bleeding after sex, in between periods

and after the menopause should definitely be a reason to go to the doctor.

I think finally, there are some other symptoms

that it's also important to be aware of.

So persistent heartburn, persistent bloating,

as well as symptoms like a cough or shortness of breath that won't go away.

Those would all be things that we want people to be aware of.

And I think, often the advice that I give to people is,

if there's something unusual that's not quite right for you, whatever it is, however obscure it is,

if you just have that sense that, this doesn't seem quite right, just speak to a doctor about it 'cause at the very best,

we can just put you at ease, and at the very worst, if there is something going on,

we're gonna detect it so much sooner.

What about younger people?

So we do tend to think of cancer

as something that affects older people and it is more prevalent in older people but same people at under the age of 35.

Are there specific signs and symptoms that people who are younger should be looking out for?

Yeah, it's not as straightforward answer,

Zoe, Unfortunately.

Some of the symptoms that happen in younger adults are really generalised and quite vague.

Things like persistent tiredness for example, or loss of appetite, unexpected weight loss

when you're not even trying to.

And that's made more complex because some cancers are actually more common in young adults.

I think it comes down to the point that you just made, which is it's about understanding

what's your version of normal, what's normal for how your body feels and looks,

and becoming an expert in that so that if something doesn't feel quite right then you know that it's time to speak to a professional.

Do you think younger people are less likely to come forward and if so, why?

I mean, I think people can feel embarrassed about symptoms

and they don't want to bother the doctor, and I think we should rest assured

that that's what doctors are here for, it's our job.

We are here to help regardless of whether that's giving you some reassurance

or checking out your symptoms and saying, actually I think this is probably worth something

that we need to investigate.

Maybe one of the, well, I hope anyway, one of the things that might help younger people

is a general, better awareness of our bodies, feeling more comfortable at exploring our bodies,

at looking at our poo, at using a mirror to look at our vulva for example,

which I know with my older patients they can be quite squeamish about things like even looking at their poo.

And I feel like that message hopefully is getting through to younger people.

What would you say to people about that?

Yeah, I completely agree.

I think there used to be lots of advice about the best way to check for things

and even recommending the best time to check for things.

I remember reading something in the media

that women should be checking their breasts in the shower just before their period.

Actually, I think it's probably more generalised than that.

People just need to check in with themselves about exactly what's normal, what their poo looks like,

what the vulva looks like, and do that on a regular basis at different times of the month.

That's particularly important for women on their periods because the body changes a lot so that they can become aware of what changes look like

and if they feel different.

It's really bizarre that we have these bodies, we own them, their ares, we have to look after them.

There are responsibility yet sometimes we feel more comfortable letting somebody else

look at them or touch them in certain places but they're ours so own them people, look after them.

So Rebecca, what about screening?

We're very lucky that in this country we do have great screening programmes for some cancers.

Can you tell us which cancers and a bit more about them?

There are three main national screening programmes

in this country.

The first, which people may not actually be that familiar with is bowel screening.

That happens every two years for people age between 60 and 75 in England.

Starts a bit younger in Wales at 58 and in Scotland at 50.

Breast cancer screening is something

that people might be really familiar with.

That happens every three years for women age between 50 and 70.

And there's actually a trial seeing if we can extend that age period from 47 up to 73.

And cervical cancer screening is something people may already be very familiar with as well.

Again, in England, that's offered every three years.

Starts at 25 up until 49.

And then actually it becomes five yearly up until the age of 64.

In Wales and Scotland, it's a little bit different.

So that's every five years right the way through.

So from 25 up until 64.

What we do know is that screening saves thousands of lives every year.

Not only does it detect cancer early,

but it can also prevent cancer.

And you get your invite

for the national screening programmes automatically, just get sent to your house and that information contains some backgrounds

about what to expect and what's involved, together with the risks versus benefits so that you can make a weighted decision

about participating in it.

Unfortunately, not all of the top five cancers

are included in those national screening programmes and I think the two big exceptions are prostate and lung cancer.

Now for prostate cancer, it doesn't mean that we don't have tests and investigations for it.

It just means that those aren't specific enough

to detect prostate cancer when it's still asymptomatic.

For lung cancer, actually the NHS since 2019

has been offering some early lung cancer checks and so it's worth checking with your GP

to see what's available and where it might be available locally.

Thank you.

And I think sometimes people get a bit confused with screening and what it means.

The purpose of screening is to detect

abnormal changes before there are symptoms.

Sometimes people say to me, well, I don't have any symptoms so I don't need to go.

You do, you do.

And actually if you do have symptoms, then the screening tests aren't the correct test for that anyway.

There are different tests you should be having.

So I think the key message is, if you receive that invitation for screening, do it

because it might just save your life.

Completely.

And it's really important that if people are attending best screening appointments

and they're receiving the all clear, that's fantastic news.

But they should still be really vigilant if something doesn't feel right in between

and still follow those bits of lifestyle advice that we discussed earlier because all of that will reduce

their risk of developing cancer.

Okay, so while screening's great and really important, we know that still a lot of people don't do it.

So we ask Bupa customers why they might not get checked for symptoms if they have them,

but also why they might not attend screening.

And so many people said that they didn't wanna see a Munchahypochondriac

or they didn't wanna bother the doctor.

How would you respond to that?

I mean, I think that's quite sad

that people feel that they can't bother a doctor.

I know that there's lots of publicity at the moment about how doctor's busy, how busy doctors are

and how difficult it is to get an appointment.

But actually, that's our job.

Our role is to be able to help you and that help can come either by reassuring you

that there's nothing to worry about, or by saying actually these symptoms are something that we should investigate further

and helping you to organise that.

Yeah and I can say as well as a GP, I would be so upset if somebody was sat at home worrying,

concerned when it might not be cancer or even worse, letting something get worse and presenting later

when they could get it checked.

No doctor in the land is ever going to be crossed or think you're wasting their time

if you think you have something that could potentially, possibly be cancer.

So pick up the phone.

So the message is, talk to a healthcare professional, talk to your doctor if something doesn't seem right

or even if you just get that feeling something's not right 'cause that can be quite important, can't it?

Trust your gut instinct on this.

Yeah.

Some younger people might be worried that doctors won't take them seriously because of their age,

but equally it's really refreshing to see young people, I think taking more of an interest in their health

than before.

Lots of people wear devices, people are interested in their data, people are engaging with their health more and more.

So what would you say to people who feel maybe that their docs might not take them seriously?

I think it's really important that people feel like that they don't have to be an expert

in order to tell a doctor that they're worried about some of the symptoms.

You wouldn't necessarily expect

that if something went wrong with your car, you'd have to be a mechanic to go to the garage.

So I always try to break it down for people

that they should just be able to explain their symptoms really simply.

So if you've got a new pain for example, when did it start?

When is it happening?

Is it happening when you are eating, walking, sitting, even at rest and how often is it happening?

Is it happening at night or is it just during the day?

You know, those really basic things.

And I think that if people are struggling to pinpoint

when and how their symptoms are coming on, sometimes keeping a diary is really helpful actually,

just writing it down.

That sort of information is really helpful as a doctor

because actually it can prompt a line of questioning that maybe new and it can really help us

to get to the heart of what the problem is.

I always say to people as well, don't be afraid to tell it.

Help us if you because you might have a set of symptoms that the doctor actually doesn't associate with cancer,

which is great 'cause that means it's probably not.

But if you are thinking it, don't be afraid to say to your doctor, I've been really worried about this

because I've been thinking it could be cancer.

Don't be afraid to use that word.

And then at least then as the doctors,

we know that's what you're thinking.

Like you say, it might take you down a line of questioning and hopefully, that will result

and has been able to at least put you ease and reassure you and tell you the reasons why we don't think it is.

Yeah, 100%.

But we know that people under the edge of 35 can absolutely get cancer as well so take it seriously.

The final point, many customers told us that they find it difficult to get an appointment

to see a GP about their concerns at the moment.

And I think we do have to address that.

Again, I would respond to that.

If you're thinking it's cancer, please let us know because that would be prioritised.

But as a Bupa customer, if people are worried, they don't actually need to go to their GP, do they?

They can go directly to Bupa.

Yeah, that's absolutely right.

So patients who are worried about cancer can call our director access team.

And it's a couple of short questions with one of our specialty trained advisors.

There's no claims impact for those questions.

And what we do is compare the symptoms that they're experiencing with national guidance.

And if the threshold of that is met,

then Bupa will refer you directly to a consultant of your choice.

I think, if that's not the right avenue for people,

then there's also the digital GP service, and that will allow you to speak to a GP

and to be able to see the right person first time around.

And I think for people

who really want urgent clinical advice and are really worried,

then anytime healthline nurses are also available 24/7.

So you can call.

If you are waking up in the middle of the night worried about it, we're here to help.

Specifically for skin cancer,

we have a skin cancer remote pathway where we are able to do an assessment and either reassurance

or a referral if we need to or from the comfort of people's own homes.

So, I think with all of those options,

I really don't want people sitting at home worrying about it because there's so much help and advice out there.

We are really here to help.

Rebecca, thank you so much for that.

Absolutely right.

There are so many ways that people can get help.

So hopefully, that's really empowered everyone at home

because nobody should be sat at home on their own worrying about something being cancer that probably isn't.

But if it is, really needs to be addressed as soon as possible.

Okay, so Rebecca and Tim,

we're gonna do one of my favourite activities to do as a doctor now, and that's a bit of a bit of medical myth busting

in the context of cancer.

So first one's for you, Tim.

Supplements and super foods can reduce my risk of cancer.

Okay, I suppose first of all, what do we mean by super food?

We're talking here about a food that has been identified

as having high levels of something, the X factor, whether it's a vitamin, a mineral or whatever.

And yeah, we do know that there are some foods that can prevent you getting some illnesses.

Foods that are high on our end for example,

can help prevent things like anaemia.

But there's no evidence at all that any particular food can protect you

against any kind of cancer at all, unfortunately.

Again, it comes back to being sensible,

eating a healthy, balanced diet, all the main food groups in it.

Nothing too excess.

Be sensible.

If you're worried at all, again, just seek advice.

Rebecca, I'm getting older now

so I don't need to worry about cancer.

Well, unfortunately most types of cancer

do increase as we get older.

And as we previously discussed, about one in two of us will have cancer

during the course of our lifetimes.

And that's because as we age our cells accumulate damage

and sometimes unfortunately, that damage can result in us developing a cancer.

The common cancers as we get older are breast for women, prostate for men, colon, rectum, skin and lung cancer.

I think it's really important for us to remember that just because you're getting older

doesn't mean that you are definitely going to get cancer.

But also those lifestyle factors that we have spoken about before,

actually that's an opportunity.

It means that we can reduce our risk of developing cancer regardless of our age.

So, I find that really heartening.

Perfect.

The next myth for you, Rebecca.

Cancer will always return.

Not necessarily, but it is possible.

And I think that that's why as doctors

we talk in terms of remission, not cure.

I think it's really important for people

who have had a cancer diagnosis or have a family member who have been diagnosed with cancer to remember

that every day in remission reduces that risk of recurrence.

And for most cancers, if they're going to come back, they're going to do so within either the first two years

and even less likely within the first five years.

And after that, literally day by day the risk goes down.

I think after 10 years for some types of cancer, actually, doctors are confident enough to say

that the cancer has been cured.

But just because the risk of recurrence is going down,

that doesn't necessarily mean that the mental burden gets any easier for patients.

And I think we just need to be really sympathetic

about how stressful it is on people.

I think that's something that our nurses are really good at Bupa,

understanding the kind of long term impact of a cancer diagnosis, even years down the line.

Patients need to be listened to and supported and potentially directed to the right information and resources.

So that's something that we're keen to do.

That's really helpful.

The next one again for you Rebecca is,

I don't smoke, can I still get lung cancer?

So firstly, if you've never smoked, that's fantastic news.

Well done.

I think smoking doesn't just increase

your risk of lung cancer, it increases your risk of heart disease, of lung disease and strokes, for example.

I think it's a slightly complicated question firstly because there are some really rare forms of lung cancer

which can occur in people who've never smoked.

And also, people who've been exposed to other people smoke,

so called passive smoking can be increased risk of lung cancer

even if they've never smoked themselves.

And that's really because the chemicals and cigarettes smoke

impair the cells ability to repair themselves.

And so you get this accumulated damage that we've spoken about before

and in certain cases that can lead to cancer.

Smoking overall does increase your risk,

not just of lung cancer but of throat and mouth cancer and actually of all cancers.

But if you've never smoked, that's fantastic.

It reduces your risk of developing all of those.

But it's still really important to attend your screening programmes and to lead a healthy lifestyle,

and to be on the lookout for any of those kind of worrying signs or symptoms that we've already spoken about.

And I think a persistent cough that you don't know why you have it, is unexplained.

Even if you're a non-smoker, even if you've never smoked, still needs to be checked out.

One for you Tim.

Young people don't get to cancer.

It's true to say

that cancer generally is more common in older people, but it's by no means unheard of in younger people.

One of the big concerns for us as doctors at the moment in younger people is melanoma skin cancer.

That's probably the commonest cancer in people under the age of 35.

And that's really down to excessive exposure to the sun,

inadequate protection from the sun.

So that's something that you really have to be careful with.

Younger people, children in particular,

are more prone to some of the blood cancers and things like leukaemia and they can be difficult, again to diagnose and that they can be things

like recurrent infections or tiredness.

And again, if you're concerned about your child,

if you're a young person, you're concerned that things don't feel quite right for you, again, seek advice.

But unfortunately cancer can happen at any age even though it's far more common as you get older.

And there are some cancers that are actually common in young people.

So you spoke about, in children leukaemia

but also testicular cancer is actually rare in older people,

much commoner in younger people and cervical cancer as well.

Yeah, that's true.

And testicular cancer can be a particular problem

because obviously as boys are growing into young men, there are changes there anyway.

And the concern is,

you just think that's part of a normal change with age.

If you find that your testicles are growing unevenly,

don't just assume it's age, get it checked out.

Cervical cancer particularly.

Although we've spoken about the age

that the screening programme kicks in.

As we said, the screening programme is not for people with symptoms of cancer.

So if you're a girl from your teens onwards, if you have symptoms that aren't normal for you,

don't assume it's just your hormone settling down.

Again, get things looked at and get everything checked out.

And I think again it reminds us if you have that, just that gut feeling, something's not right,

whether you are a parent of a child or you're a young person yourself, tell the doctor.

Tell 'em what you're thinking and if you have to be persistent, be persistent because cancers do happen in young people

and they can be quite difficult sometimes to diagnose.

Okay, well thank you both for that.

I love a bit of myth busting.

I always think it's just really interesting and I think hopefully helpful

for the people out there as well.

Which reminds us as well that no question when you're speaking to a doctor is silly, is too small,

it's too out there, just ask it.

And that leads me onto some of the questions that we've had submitted by our viewers before this event.

So question for you, Rebecca.

I know there's a link with genetics and some female cancers.

Is it the same for some men's cancers?

It's the same to a certain extent for male cancers

and particularly for for breast cancer in men and for prostate cancer.

But depending on the gene involved,

actually the risk is a bit lower.

What we'd say is that if you have a close male relative

who's been affected by cancer, then it's definitely worth discussing it with your GP

if you are worried about your own risk.

And I think what people need to be aware of is,

if they feel that they have a genetic risk associated with the family to be aware of the science

and symptoms of that particular cancer just so that they can be on the lookout for them.

Okay.

And when you say a close family member, you mean first degree relative, so that would be a parent, a sibling, or a child?

Exactly.

Okay, next question, Rebecca.

I'm 35 and my dad's recently been diagnosed with prostate cancer.

What can I do to protect myself?

So unfortunately, there's no way of preventing prostate cancer.

I think there are ways that you can reduce the risk.

So there's some recent data that's come out

to show that if you're overweight or if you're obese, you are more likely to be diagnosed

with an advanced stage of the disease, unfortunately.

So it's really important

that you try to maintain as much as possible, nobody's perfect: a healthy diet, maintain really good activity levels,

just so that you can try and stay within that healthy weight range.

I think also really important

to be aware of the science and symptoms of prostate cancer.

And that's particularly true

of a change in the way that you urinate.

So not being able to urinate in the same way that you used to be able to and blood in the semen or urine.

Both reasons to go and see a doctor.

For prostate cancer, if you have a first degree relative

with a history of prostate cancer, and by that we mean a father, a brother,

a child for example, then we know that you are at a slightly increased risk of developing prostate cancer yourself.

And that's definitely worth going to speak to your GP about to get checked.

Okay, next question I have is,

how do I talk to somebody if I'm diagnosed with cancer?

I think that could be a really difficult conversation

to begin with.

I think the main thing is to just start talking.

Doesn't really matter what you say.

I think it's likely that you're gonna have lots of questions

and my advice is to write them down.

I think that's a good place to start

to identify what's important to you, where you might start to find some answers to them

and also might help you to signpost to the best place to answer them.

It might be a family member, it might be a close friend, it might be a health professional or it might be a charity.

There's so much advice out there.

I think one thing that I'm really proud of at Bupa is that our nurses are really good at that.

So we have a specialist support team of nurses who are there to listen,

but also to be able to work through you what might be important for you and support you in the right direction

for where you can get some answers.

That's really helpful.

And how do I talk, support somebody with cancer?

I mean, I think, it's important to remember that not everybody wants to talk about it.

So my recommendation would be that you just start by acknowledging what's happened and then saying that you are free and willing

to listen to whatever they want to talk about, actually.

I think lots of people are really hesitant about

talking to somebody about it directly because they feel like they have to be an expert in it, that they have to know all of the answers.

Actually, it's just about supporting somebody's journey, and they may want to talk about anything other than cancer.

So it's just about being able to join them and hear what they have to say

regardless of what that's about.

I think I'll be afraid to ask as well or let them know.

If you just say to somebody,

I don't wanna overstep the mark here, but you let me know how can I support you?

How can I be there for you?

And just letting them know that that you're there.

It might be that they say, oh, actually I don't wanna talk about it, but I would love to go out for a walk on Sunday

to our favourite spot or whatever, so, yeah, okay.

Tim, couple of questions here for you.

I've been on the contraceptive pill for 20 years since I was 16.

Are there any links to an increased risk of cancer?

This is an interesting one because there were a lot of reports in the media a few years ago, which I think scared a lot of women

about possible cancer risk associated with the pill.

Yes, there is a very slightly increased risk

of breast cancer if you're taking the traditional combined oral contraceptive.

But to put that in context,

maybe one in a hundred cases of breast cancer can be shown to be linked to taking the pill.

Eight in a hundred cases of breast cancer are probably linked to obesity.

So that puts it into context.

The other thing to remember is, even if there's a slightly increased risk of breast cancer,

the pill actually protects you against ovarian cancer and cancer of the womb.

Now breast cancer, as we've discussed,

there are screening programmes.

It's relatively easy to detect early.

Early detection means better treatment,

means better survival.

Ovarian cancer and womb cancer, harder to detect.

There's no screening programme, if they're detected later, survival is worse.

So actually, if you look at the risks and the benefit,

the benefit from being on the pill outweighs the risk.

What I would say is, over the last 20 years, your body might have changed,

the types of contraceptive, the available might have changed, your life circumstances might have changed.

It's probably not a bad time to just have a word with your doctor or your family planning professional and say,

is this still the right thing for me?

Absolutely, brilliant advice.

A close friend recently died of ovarian cancer

and had very few symptoms.

What should I be looking out for?

This is another difficult one because as we've said,

ovarian cancer can be very difficult to diagnose.

The symptoms of ovarian cancer

can mimic lots of other conditions.

But we're looking at things like unexplained abdominal pain, bloating,

feeling full up when you haven't eaten, change is actually in bowel habit and the way you pass urine

can be affected by ovarian cancer, tiredness, unexplained weight loss,

all the things that we've mentioned as rather vague symptoms.

But again, this is all about understanding you

and how you work.

If you hear a funny noise in your car, you go to the garage, if you don't seem to be working properly,

you need to get that checked out and seek advice in it.

And is it, it's partly due to the location

of the ovaries, isn't it?

If you have a breast cancer, your breast on your body, you can examine your breast,

there's a likelihood you might detect a lump, skin cancer if we can see our skin, testicular cancers.

Again, but things like ovarian cancer, pancreatic cancer, cancer with the gallbladder,

those organs that are deep inside the body, we can't access them.

There aren't screening programmes.

So unfortunately, is that one of the reasons

why they do tend to present at a later stage?

Well, absolutely.

And also again, because the symptoms are so vague.

So people are gonna say, oh, it's indigestion.

It's the time of the month, I always retain fluid.

These kinds of things, which that may be perfectly true, but actually you don't necessarily know unless you can get checked out.

And if it's happening all the time and it doesn't seem to be obviously related to food all the time of the month, then please just seek advice.

And then I guess my question from that is, how do we then maintain that balance?

Because

the danger is that every time people get a bit of a funny tummy symptom or feeling a bit tired,

you can start to worry that it's cancer.

Is it more about looking at the pattern that things tend tend to not get worse and better,

worse and better, but gradually get worse?

Or how else can people identify when they should be worried

versus when actually if it's just sort of common things like tiredness, it might not be so worrying?

I think it's important as you said, identify patterns, keep a diary.

When does this happen?

Is it associated with meal times?

Is it associated with sleeping in certain positions?

Is it associated with exercise?

Do things seem to be getting worse under gradual decline?

But again, if you can seek advice and get an explanation for what is going on, then that can actually put your mind at rest

as much as anything else.

And you then have an explanation for those symptoms.

And there are tests, aren't they?

Available as well, which can often be very helpful.

Why might I be offered chemotherapy and not radiotherapy?

There are, as we've said before, 200 or different kinds of cancer.

They're treated in different ways.

I mean, there's a very broad rule.

Radiotherapy because it involves

exposing the cancer to radiation, tends to be confined to cancers, are localised in one part of your body.

Chemotherapy because it gets into your system and can spread right around the body, is more commonly used for cancer

that's spread around the body or things like blood cancers.

However, chemotherapy works very well

for some localised cancers like bowel cancer even in the early stages, breast cancer in the early stages

and sometimes it's used together with radiotherapy and sometimes both are used together with surgery.

So it's very much about what's your cancer type?

Have you had other tests that suggest

that you may not tolerate chemotherapy very well?

Have you had radiotherapy to an area previously?

Which means you can't have radiotherapy twice to that area?

Are there other reasons why you can't have it?

Is your general health so poor that you wouldn't tolerate

a long course of radiotherapy, for example?

So again, talk to your specialist,

write things down, know the questions to ask, talk to the cancer nurses,

people like McMillan Cancer Support, the cancer nurses at Bupa, or all of these people can help you

to answer the questions that you've got.

Yeah, I think sometimes it's just making sense of that, isn't it?

Because these decisions are often not straightforward.

And I dunno if people know, but often we have MDTs or multidisciplinary team meetings where you'll have lots of different experts all in a room

all discussing your case based on things like, the type of cancer, the specimens that they've taken,

the histology, how that looks.

Also, how healthy you are, how fit you are and what your preferences and what your life is like.

And often, that team together will put their heads together and come up what they think is likely to be the best plan

and they'll present that to you.

So specialist nurse will be the perfect person to help you sort of make sense of all that.

And the specialist nurse is also your link into that team because he or she will know what your preferences are

and they can be fed into the team.

Thank you.

And then we have one more question.

I'm due to start chemotherapy next month and considering trying the cold cap.

My hair is shoulder length and very fine.

Is it worth trying?

Should I have it cut before starting?

So what is the cold cap?

And this person wants to know if they should try it.

Right.

Chemotherapy targets cells which are growing and dividing very quickly,

which is what cancer cells do.

Other things that grow and divide very quickly are hair cells.

So I'm sure a lot of people are aware that chemotherapy treatments can make your hair fall out.

Not all chemotherapy, but some.

What has been found is that if you can cool the stout down

to pretty low temperatures, you almost put the hair cells into suspended animation so the chemotherapy has less of an effect on them.

Doesn't work with all kinds of chemotherapy so you need to know whether the chemotherapy is suitable.

It works for any hair type.

It's not a good idea if you suffer from things like recurrent migraine

because basically it gives you an ice cream headache and if you already suffer from migraine, that's not something that you want.

But again, actually, if you're able to tolerate that, then the cold cap maybe a few weeks.

Again, discuss it with your oncologist, discuss it with your specialist nurse.

So I guess that's the thing with the cold cap,

it's about like everything when it comes to cancer, asking the questions, being informed that you can make your decisions.

I think the other thing with the cold cap is, if you do try it and it's too uncomfortable, you can always take it off.

You're not committed to wearing it for every treatment after that.

Thank you, Rebecca.

Thank you, Tim.

Thank you so much for sharing your wealth of knowledge with us.

And I really hope that that's empowered our viewers

to take care of your bodies, be vigilant, attend your screenings.

And if there's anything that you're worried about,

then get it checked out either with your GP or by contacting Bupa.

Hi, everyone.

Welcome.

Today's topic is cancer, sometimes called the big C.

I think the word cancer itself can create a lot of anxiety, a lot of fear

because for so long we've associated cancer with death.

But today we're gonna talk about cancer,

why it's important to talk about it, and why cancer doesn't necessarily mean death.

It's not all doom and gloom.

So I'm joined by Tim and Rebecca from Bupa.

And if I could come to you, first of all Tim, let's start by explaining the word cancer.

What does it mean?

What is it?

Sure.

I think most people realise our bodies are made up of trillions of different cells,

everything from fingernails, to blood cells, to hair cells.

The thing that always amazes me is these trillions of cells just get on with it.

They're born, they grow, they do their stuff and they die.

They respond to various things from inside the body

and from outside the body, whether it's environment, diet, et cetera.

Sometimes those control mechanisms will go wrong

and those cells will start to either grow out of control or not die when they should die.

And we call those growth tumours.

But a cancer is a tumour that just doesn't know when to stop.

It invades the tissues around it, it can get into the bloodstream and it can spread to other organs

and we call that metastasis.

So cancer's a malignant growth and you may hear them call that

or you may hear them call malignant tumours as well.

And there's probably about 200 different types of cancer that we recognise.

It always amazes me 'cause sometimes people talk about finding a cure for cancer,

but like you say, there are 200 different cancers and is it ever possible to find a single individual cure

for all cancers, do you think?

I think that's not something that is certainly gonna happen

probably not within our lifetimes, but we are getting closer because we understand more and more about what causes cancer,

and we are now looking at treatments that are aimed at those causes rather than just killing off the cancer cells.

So we're definitely moving in the right direction with it.

And what's the picture in the UK at the moment

when it comes to cancer?

Cancer's very common.

There are probably about 3 million people

living with cancer in the UK at any one time.

And there are about 387,000

new cases of cancer every year in the UK.

So that's over a thousand a day.

But every 90 seconds somebody will get that diagnosis of cancer.

And if you were born after 1960,

there's probably about a one in two chance that you're gonna get cancer at some point in your life.

And that sounds scary, doesn't it?

One in two chance.

It used to be one in three not that long ago.

So what's changed?

Has as cancer become more common?

The biggest change is that people are getting older.

Cancer is still a disease of older people primarily because these controlled mechanisms in the cells

gradually fail over time.

So with an ageing population there are gonna be more cancers,

there's more screening programmes, people are becoming more aware of cancer and talks like this I'm sure and I hope will help that.

So we're picking up more cancers as well.

And I think when it comes to cancer,

we've spoken a little bit there about what cancer actually is, which it's really interesting the way you've put it.

What are the causes of cancer?

The causes of cancer, for some cancers we just don't know.

The causes of cancer basically are things that disrupt this control mechanism in yourselves.

So it can be external factors, things like cigarette smoking, exposure to certain chemicals,

obesity we think causes a significant number of cancers.

Hormone changes can cause some cancers

and other lifestyle things can be involved there as well.

But also it is just changes in the genes

that control these cancers.

Now these can be changes that you are born with.

There are changes that can just happen at random

over the course of your life or sometimes they're genetic changes that you've actually inherited.

So can people reduce their risk of cancer?

You can and you can reduce your risk of some cancers

quite significantly.

First thing to do, if you smoke, please stop.

Smoking is the biggest risk factor, not just for lung cancer, which you don't everybody thinks of but mouth cancer,

throat cancer, esophageal cancer, stomach cancer, some skin cancers to a certain extent, even bladder cancer.

So smoking can cause a lot of cancers.

Obesity is a significant risk factor for a lot of cancers.

And again, it's not the obvious things like you'd think, okay, bowel cancer is, I'm overweight, prostate cancer, breast cancer.

So healthy lifestyle, avoiding things like smoking, avoiding excessive alcohol.

You stick to the limits, 14 units three or more days a week, don't binge drink because prolonged liver damage

can cause cancer.

It's really, a lot of it is common sense.

Well, yeah, it always comes back

to those healthy lifestyle measures that we know about, that we talk about all of the time.

But often, life happens as well and it can be really difficult to implement very healthy lifestyle when none of us are perfect.

I think obesity is always an interesting one because we know that more people in this country are above a healthy weight than a healthy weight.

And I think sometimes the individual, it's difficult for individuals to get control of that.

Do you think that there needs to be.

.

.

What changes need to happen I guess at a national level,

government level to help people be a healthier weight?

Because we know that it is a big risk factor for cancer.

We have to look at the information that we provide for people to help them make healthy choices.

But we also have to have to accept some people won't make those healthy choices.

So I think you have to be a little bit paternalistic

and look at cutting down on things like ultra processed foods, because adding artificial substances into natural food,

we were designed to run on certain type of fuel.

If you put diesel in your petrol car, it won't like it.

Put the wrong fuel into your body and things are gonna start going wrong.

And then what about genetics?

Because we know that genetics play a role when it comes to cancer.

How important are our genes

'cause we have no control over those.

We don't have any control over our genes.

We do have some control over things

that might damage our genes as we get older.

So again, I come back to things like smoking and obesity.

We're not quite clear how obesity actually works in increasing cancer risk, but it's causing some kind of genetic damage.

When people talk about genes and genetics, they may be mean different things.

So there's the genetics that you're born with,

the genes that you've got, and any mutations or changes in those genes.

And then there are genetic changes that do run in families.

Now people may say I'm at risk, there's a big history of cancer in my family,

but as I said, one in two of us may get cancer.

We're all going to know a family member who's had cancer.

If you have a large family, you're gonna think I'm at high risk.

There's a lot of people in my family with cancer.

But if you look at things like cancers

at an early age in your family, that's potentially a risk factor for you.

People who have a history of linked cancers,

so women who have had breast cancer and ovarian cancer together, that's a significant risk factor.

There are some different ethnic groups, whether there are different risk factors, people who have had more than one cancer in their lifetime

that suggests they may have a genetic problem which could be inherited.

Again, if you're worried, talk to your doctor,

there are test that can be done.

And if you are at risk, two things.

The fact that you've got a risk factor doesn't mean you're gonna get cancer.

But the fact you haven't got any risk factors

doesn't mean you are not going to get cancer.

So still have to follow all the advice on healthy eating and not smoking, et cetera.

So when it comes to those sort of specific genes, and I think the most common one that people have heard of is the BRCA gene

when it comes to breast cancer, what proportion of cancers are linked to specific gene mutation?

In terms of inherited genes, probably not more than about 10% of all cancers.

Pretty much all cancers, you could probably trace back to a genetic fault somewhere.

But it's something that has appeared entirely at random

that isn't inherited.

But 10% is significant and if you one of those at risk groups, it may mean that your risk

could be a lot higher than 10% of getting cancer.

'Cause it's interesting, isn't it?

'Cause we talk about

how genes are inherited from our parents, but actually those lifestyle behaviours

that you've spoken about are often inherited from our parents as well.

We're more likely to have similar behaviours

to what our parents and what our family do.

And then also the environmental things that,

where we live, if we're exposed to certain chemicals, pollution, they kind of run in families as well.

So I guess when you're thinking about your family history, it's quite complex, isn't it?

Oh, it's very good.

There are so be different factors in play as you said and there's only so much that you can alter.

So it's all about being aware and any worries at all get advice.

You can get advice from your GP, the NHS website, Bupa website, virtual GP consultations with Bupa.

There are so many ways now.

Really don't die of ignorance as they once said about another disease.

Exactly.

Tim, thank you so much.

That was really helpful to sort of set some context and give us some general information about cancer.

Really interesting statistics as well.

So Rebecca, let's have a chat with you.

So you are the medical director in healthcare management at Bupa.

And what I'd love to do is talk about some of the ways

in which we can be proactive with our health to keep ourselves healthy, but more specifically as well to reduce our risk of cancer

but also, what are some of the signs and symptoms we should be looking out for to be vigilant

and to pick up and detect what could be a cancer early?

I think we're all really well aware

of some of the common signs of symptoms.

Checking for breast lumps for example and checking for changes and the appearance

or the texture of your breasts.

But actually there are lots of other things that you should be on the lookout for; lumps in other parts of the body, for example.

And I think something that's been in the media a lot recently has been about changing bowel habit.

So that might mean going to the loo regularly

or becoming more constipated than normal and any change in terms of blood in the poo as well.

I think people are well aware to look for moles and changes in their shape or size, colour of them.

But people should also be on the lookout for new moles.

And I think some of the less spoken about symptoms

that it's really important to be transparent about in women is vaginal bleeding.

So any vaginal bleeding after sex, in between periods

and after the menopause should definitely be a reason to go to the doctor.

I think finally, there are some other symptoms

that it's also important to be aware of.

So persistent heartburn, persistent bloating,

as well as symptoms like a cough or shortness of breath that won't go away.

Those would all be things that we want people to be aware of.

And I think, often the advice that I give to people is,

if there's something unusual that's not quite right for you, whatever it is, however obscure it is,

if you just have that sense that, this doesn't seem quite right, just speak to a doctor about it 'cause at the very best,

we can just put you at ease, and at the very worst, if there is something going on,

we're gonna detect it so much sooner.

What about younger people?

So we do tend to think of cancer

as something that affects older people and it is more prevalent in older people but same people at under the age of 35.

Are there specific signs and symptoms that people who are younger should be looking out for?

Yeah, it's not as straightforward answer,

Zoe, Unfortunately.

Some of the symptoms that happen in younger adults are really generalised and quite vague.

Things like persistent tiredness for example, or loss of appetite, unexpected weight loss

when you're not even trying to.

And that's made more complex because some cancers are actually more common in young adults.

I think it comes down to the point that you just made, which is it's about understanding

what's your version of normal, what's normal for how your body feels and looks,

and becoming an expert in that so that if something doesn't feel quite right then you know that it's time to speak to a professional.

Do you think younger people are less likely to come forward and if so, why?

I mean, I think people can feel embarrassed about symptoms

and they don't want to bother the doctor, and I think we should rest assured

that that's what doctors are here for, it's our job.

We are here to help regardless of whether that's giving you some reassurance

or checking out your symptoms and saying, actually I think this is probably worth something

that we need to investigate.

Maybe one of the, well, I hope anyway, one of the things that might help younger people

is a general, better awareness of our bodies, feeling more comfortable at exploring our bodies,

at looking at our poo, at using a mirror to look at our vulva for example,

which I know with my older patients they can be quite squeamish about things like even looking at their poo.

And I feel like that message hopefully is getting through to younger people.

What would you say to people about that?

Yeah, I completely agree.

I think there used to be lots of advice about the best way to check for things

and even recommending the best time to check for things.

I remember reading something in the media

that women should be checking their breasts in the shower just before their period.

Actually, I think it's probably more generalised than that.

People just need to check in with themselves about exactly what's normal, what their poo looks like,

what the vulva looks like, and do that on a regular basis at different times of the month.

That's particularly important for women on their periods because the body changes a lot so that they can become aware of what changes look like

and if they feel different.

It's really bizarre that we have these bodies, we own them, their ares, we have to look after them.

There are responsibility yet sometimes we feel more comfortable letting somebody else

look at them or touch them in certain places but they're ours so own them people, look after them.

So Rebecca, what about screening?

We're very lucky that in this country we do have great screening programmes for some cancers.

Can you tell us which cancers and a bit more about them?

There are three main national screening programmes

in this country.

The first, which people may not actually be that familiar with is bowel screening.

That happens every two years for people age between 60 and 75 in England.

Starts a bit younger in Wales at 58 and in Scotland at 50.

Breast cancer screening is something

that people might be really familiar with.

That happens every three years for women age between 50 and 70.

And there's actually a trial seeing if we can extend that age period from 47 up to 73.

And cervical cancer screening is something people may already be very familiar with as well.

Again, in England, that's offered every three years.

Starts at 25 up until 49.

And then actually it becomes five yearly up until the age of 64.

In Wales and Scotland, it's a little bit different.

So that's every five years right the way through.

So from 25 up until 64.

What we do know is that screening saves thousands of lives every year.

Not only does it detect cancer early,

but it can also prevent cancer.

And you get your invite

for the national screening programmes automatically, just get sent to your house and that information contains some backgrounds

about what to expect and what's involved, together with the risks versus benefits so that you can make a weighted decision

about participating in it.

Unfortunately, not all of the top five cancers

are included in those national screening programmes and I think the two big exceptions are prostate and lung cancer.

Now for prostate cancer, it doesn't mean that we don't have tests and investigations for it.

It just means that those aren't specific enough

to detect prostate cancer when it's still asymptomatic.

For lung cancer, actually the NHS since 2019

has been offering some early lung cancer checks and so it's worth checking with your GP

to see what's available and where it might be available locally.

Thank you.

And I think sometimes people get a bit confused with screening and what it means.

The purpose of screening is to detect

abnormal changes before there are symptoms.

Sometimes people say to me, well, I don't have any symptoms so I don't need to go.

You do, you do.

And actually if you do have symptoms, then the screening tests aren't the correct test for that anyway.

There are different tests you should be having.

So I think the key message is, if you receive that invitation for screening, do it

because it might just save your life.

Completely.

And it's really important that if people are attending best screening appointments

and they're receiving the all clear, that's fantastic news.

But they should still be really vigilant if something doesn't feel right in between

and still follow those bits of lifestyle advice that we discussed earlier because all of that will reduce

their risk of developing cancer.

Okay, so while screening's great and really important, we know that still a lot of people don't do it.

So we ask Bupa customers why they might not get checked for symptoms if they have them,

but also why they might not attend screening.

And so many people said that they didn't wanna see a Munchahypochondriac

or they didn't wanna bother the doctor.

How would you respond to that?

I mean, I think that's quite sad

that people feel that they can't bother a doctor.

I know that there's lots of publicity at the moment about how doctor's busy, how busy doctors are

and how difficult it is to get an appointment.

But actually, that's our job.

Our role is to be able to help you and that help can come either by reassuring you

that there's nothing to worry about, or by saying actually these symptoms are something that we should investigate further

and helping you to organise that.

Yeah and I can say as well as a GP, I would be so upset if somebody was sat at home worrying,

concerned when it might not be cancer or even worse, letting something get worse and presenting later

when they could get it checked.

No doctor in the land is ever going to be crossed or think you're wasting their time

if you think you have something that could potentially, possibly be cancer.

So pick up the phone.

So the message is, talk to a healthcare professional, talk to your doctor if something doesn't seem right

or even if you just get that feeling something's not right 'cause that can be quite important, can't it?

Trust your gut instinct on this.

Yeah.

Some younger people might be worried that doctors won't take them seriously because of their age,

but equally it's really refreshing to see young people, I think taking more of an interest in their health

than before.

Lots of people wear devices, people are interested in their data, people are engaging with their health more and more.

So what would you say to people who feel maybe that their docs might not take them seriously?

I think it's really important that people feel like that they don't have to be an expert

in order to tell a doctor that they're worried about some of the symptoms.

You wouldn't necessarily expect

that if something went wrong with your car, you'd have to be a mechanic to go to the garage.

So I always try to break it down for people

that they should just be able to explain their symptoms really simply.

So if you've got a new pain for example, when did it start?

When is it happening?

Is it happening when you are eating, walking, sitting, even at rest and how often is it happening?

Is it happening at night or is it just during the day?

You know, those really basic things.

And I think that if people are struggling to pinpoint

when and how their symptoms are coming on, sometimes keeping a diary is really helpful actually,

just writing it down.

That sort of information is really helpful as a doctor

because actually it can prompt a line of questioning that maybe new and it can really help us

to get to the heart of what the problem is.

I always say to people as well, don't be afraid to tell it.

Help us if you because you might have a set of symptoms that the doctor actually doesn't associate with cancer,

which is great 'cause that means it's probably not.

But if you are thinking it, don't be afraid to say to your doctor, I've been really worried about this

because I've been thinking it could be cancer.

Don't be afraid to use that word.

And then at least then as the doctors,

we know that's what you're thinking.

Like you say, it might take you down a line of questioning and hopefully, that will result

and has been able to at least put you ease and reassure you and tell you the reasons why we don't think it is.

Yeah, 100%.

But we know that people under the edge of 35 can absolutely get cancer as well so take it seriously.

The final point, many customers told us that they find it difficult to get an appointment

to see a GP about their concerns at the moment.

And I think we do have to address that.

Again, I would respond to that.

If you're thinking it's cancer, please let us know because that would be prioritised.

But as a Bupa customer, if people are worried, they don't actually need to go to their GP, do they?

They can go directly to Bupa.

Yeah, that's absolutely right.

So patients who are worried about cancer can call our director access team.

And it's a couple of short questions with one of our specialty trained advisors.

There's no claims impact for those questions.

And what we do is compare the symptoms that they're experiencing with national guidance.

And if the threshold of that is met,

then Bupa will refer you directly to a consultant of your choice.

I think, if that's not the right avenue for people,

then there's also the digital GP service, and that will allow you to speak to a GP

and to be able to see the right person first time around.

And I think for people

who really want urgent clinical advice and are really worried,

then anytime healthline nurses are also available 24/7.

So you can call.

If you are waking up in the middle of the night worried about it, we're here to help.

Specifically for skin cancer,

we have a skin cancer remote pathway where we are able to do an assessment and either reassurance

or a referral if we need to or from the comfort of people's own homes.

So, I think with all of those options,

I really don't want people sitting at home worrying about it because there's so much help and advice out there.

We are really here to help.

Rebecca, thank you so much for that.

Absolutely right.

There are so many ways that people can get help.

So hopefully, that's really empowered everyone at home

because nobody should be sat at home on their own worrying about something being cancer that probably isn't.

But if it is, really needs to be addressed as soon as possible.

Okay, so Rebecca and Tim,

we're gonna do one of my favourite activities to do as a doctor now, and that's a bit of a bit of medical myth busting

in the context of cancer.

So first one's for you, Tim.

Supplements and super foods can reduce my risk of cancer.

Okay, I suppose first of all, what do we mean by super food?

We're talking here about a food that has been identified

as having high levels of something, the X factor, whether it's a vitamin, a mineral or whatever.

And yeah, we do know that there are some foods that can prevent you getting some illnesses.

Foods that are high on our end for example,

can help prevent things like anaemia.

But there's no evidence at all that any particular food can protect you

against any kind of cancer at all, unfortunately.

Again, it comes back to being sensible,

eating a healthy, balanced diet, all the main food groups in it.

Nothing too excess.

Be sensible.

If you're worried at all, again, just seek advice.

Rebecca, I'm getting older now

so I don't need to worry about cancer.

Well, unfortunately most types of cancer

do increase as we get older.

And as we previously discussed, about one in two of us will have cancer

during the course of our lifetimes.

And that's because as we age our cells accumulate damage

and sometimes unfortunately, that damage can result in us developing a cancer.

The common cancers as we get older are breast for women, prostate for men, colon, rectum, skin and lung cancer.

I think it's really important for us to remember that just because you're getting older

doesn't mean that you are definitely going to get cancer.

But also those lifestyle factors that we have spoken about before,

actually that's an opportunity.

It means that we can reduce our risk of developing cancer regardless of our age.

So, I find that really heartening.

Perfect.

The next myth for you, Rebecca.

Cancer will always return.

Not necessarily, but it is possible.

And I think that that's why as doctors

we talk in terms of remission, not cure.

I think it's really important for people

who have had a cancer diagnosis or have a family member who have been diagnosed with cancer to remember

that every day in remission reduces that risk of recurrence.

And for most cancers, if they're going to come back, they're going to do so within either the first two years

and even less likely within the first five years.

And after that, literally day by day the risk goes down.

I think after 10 years for some types of cancer, actually, doctors are confident enough to say

that the cancer has been cured.

But just because the risk of recurrence is going down,

that doesn't necessarily mean that the mental burden gets any easier for patients.

And I think we just need to be really sympathetic

about how stressful it is on people.

I think that's something that our nurses are really good at Bupa,

understanding the kind of long term impact of a cancer diagnosis, even years down the line.

Patients need to be listened to and supported and potentially directed to the right information and resources.

So that's something that we're keen to do.

That's really helpful.

The next one again for you Rebecca is,

I don't smoke, can I still get lung cancer?

So firstly, if you've never smoked, that's fantastic news.

Well done.

I think smoking doesn't just increase

your risk of lung cancer, it increases your risk of heart disease, of lung disease and strokes, for example.

I think it's a slightly complicated question firstly because there are some really rare forms of lung cancer

which can occur in people who've never smoked.

And also, people who've been exposed to other people smoke,

so called passive smoking can be increased risk of lung cancer

even if they've never smoked themselves.

And that's really because the chemicals and cigarettes smoke

impair the cells ability to repair themselves.

And so you get this accumulated damage that we've spoken about before

and in certain cases that can lead to cancer.

Smoking overall does increase your risk,

not just of lung cancer but of throat and mouth cancer and actually of all cancers.

But if you've never smoked, that's fantastic.

It reduces your risk of developing all of those.

But it's still really important to attend your screening programmes and to lead a healthy lifestyle,

and to be on the lookout for any of those kind of worrying signs or symptoms that we've already spoken about.

And I think a persistent cough that you don't know why you have it, is unexplained.

Even if you're a non-smoker, even if you've never smoked, still needs to be checked out.

One for you Tim.

Young people don't get to cancer.

It's true to say

that cancer generally is more common in older people, but it's by no means unheard of in younger people.

One of the big concerns for us as doctors at the moment in younger people is melanoma skin cancer.

That's probably the commonest cancer in people under the age of 35.

And that's really down to excessive exposure to the sun,

inadequate protection from the sun.

So that's something that you really have to be careful with.

Younger people, children in particular,

are more prone to some of the blood cancers and things like leukaemia and they can be difficult, again to diagnose and that they can be things

like recurrent infections or tiredness.

And again, if you're concerned about your child,

if you're a young person, you're concerned that things don't feel quite right for you, again, seek advice.

But unfortunately cancer can happen at any age even though it's far more common as you get older.

And there are some cancers that are actually common in young people.

So you spoke about, in children leukaemia

but also testicular cancer is actually rare in older people,

much commoner in younger people and cervical cancer as well.

Yeah, that's true.

And testicular cancer can be a particular problem

because obviously as boys are growing into young men, there are changes there anyway.

And the concern is,

you just think that's part of a normal change with age.

If you find that your testicles are growing unevenly,

don't just assume it's age, get it checked out.

Cervical cancer particularly.

Although we've spoken about the age

that the screening programme kicks in.

As we said, the screening programme is not for people with symptoms of cancer.

So if you're a girl from your teens onwards, if you have symptoms that aren't normal for you,

don't assume it's just your hormone settling down.

Again, get things looked at and get everything checked out.

And I think again it reminds us if you have that, just that gut feeling, something's not right,

whether you are a parent of a child or you're a young person yourself, tell the doctor.

Tell 'em what you're thinking and if you have to be persistent, be persistent because cancers do happen in young people

and they can be quite difficult sometimes to diagnose.

Okay, well thank you both for that.

I love a bit of myth busting.

I always think it's just really interesting and I think hopefully helpful

for the people out there as well.

Which reminds us as well that no question when you're speaking to a doctor is silly, is too small,

it's too out there, just ask it.

And that leads me onto some of the questions that we've had submitted by our viewers before this event.

So question for you, Rebecca.

I know there's a link with genetics and some female cancers.

Is it the same for some men's cancers?

It's the same to a certain extent for male cancers

and particularly for for breast cancer in men and for prostate cancer.

But depending on the gene involved,

actually the risk is a bit lower.

What we'd say is that if you have a close male relative

who's been affected by cancer, then it's definitely worth discussing it with your GP

if you are worried about your own risk.

And I think what people need to be aware of is,

if they feel that they have a genetic risk associated with the family to be aware of the science

and symptoms of that particular cancer just so that they can be on the lookout for them.

Okay.

And when you say a close family member, you mean first degree relative, so that would be a parent, a sibling, or a child?

Exactly.

Okay, next question, Rebecca.

I'm 35 and my dad's recently been diagnosed with prostate cancer.

What can I do to protect myself?

So unfortunately, there's no way of preventing prostate cancer.

I think there are ways that you can reduce the risk.

So there's some recent data that's come out

to show that if you're overweight or if you're obese, you are more likely to be diagnosed

with an advanced stage of the disease, unfortunately.

So it's really important

that you try to maintain as much as possible, nobody's perfect: a healthy diet, maintain really good activity levels,

just so that you can try and stay within that healthy weight range.

I think also really important

to be aware of the science and symptoms of prostate cancer.

And that's particularly true

of a change in the way that you urinate.

So not being able to urinate in the same way that you used to be able to and blood in the semen or urine.

Both reasons to go and see a doctor.

For prostate cancer, if you have a first degree relative

with a history of prostate cancer, and by that we mean a father, a brother,

a child for example, then we know that you are at a slightly increased risk of developing prostate cancer yourself.

And that's definitely worth going to speak to your GP about to get checked.

Okay, next question I have is,

how do I talk to somebody if I'm diagnosed with cancer?

I think that could be a really difficult conversation

to begin with.

I think the main thing is to just start talking.

Doesn't really matter what you say.

I think it's likely that you're gonna have lots of questions

and my advice is to write them down.

I think that's a good place to start

to identify what's important to you, where you might start to find some answers to them

and also might help you to signpost to the best place to answer them.

It might be a family member, it might be a close friend, it might be a health professional or it might be a charity.

There's so much advice out there.

I think one thing that I'm really proud of at Bupa is that our nurses are really good at that.

So we have a specialist support team of nurses who are there to listen,

but also to be able to work through you what might be important for you and support you in the right direction

for where you can get some answers.

That's really helpful.

And how do I talk, support somebody with cancer?

I mean, I think, it's important to remember that not everybody wants to talk about it.

So my recommendation would be that you just start by acknowledging what's happened and then saying that you are free and willing

to listen to whatever they want to talk about, actually.

I think lots of people are really hesitant about

talking to somebody about it directly because they feel like they have to be an expert in it, that they have to know all of the answers.

Actually, it's just about supporting somebody's journey, and they may want to talk about anything other than cancer.

So it's just about being able to join them and hear what they have to say

regardless of what that's about.

I think I'll be afraid to ask as well or let them know.

If you just say to somebody,

I don't wanna overstep the mark here, but you let me know how can I support you?

How can I be there for you?

And just letting them know that that you're there.

It might be that they say, oh, actually I don't wanna talk about it, but I would love to go out for a walk on Sunday

to our favourite spot or whatever, so, yeah, okay.

Tim, couple of questions here for you.

I've been on the contraceptive pill for 20 years since I was 16.

Are there any links to an increased risk of cancer?

This is an interesting one because there were a lot of reports in the media a few years ago, which I think scared a lot of women

about possible cancer risk associated with the pill.

Yes, there is a very slightly increased risk

of breast cancer if you're taking the traditional combined oral contraceptive.

But to put that in context,

maybe one in a hundred cases of breast cancer can be shown to be linked to taking the pill.

Eight in a hundred cases of breast cancer are probably linked to obesity.

So that puts it into context.

The other thing to remember is, even if there's a slightly increased risk of breast cancer,

the pill actually protects you against ovarian cancer and cancer of the womb.

Now breast cancer, as we've discussed,

there are screening programmes.

It's relatively easy to detect early.

Early detection means better treatment,

means better survival.

Ovarian cancer and womb cancer, harder to detect.

There's no screening programme, if they're detected later, survival is worse.

So actually, if you look at the risks and the benefit,

the benefit from being on the pill outweighs the risk.

What I would say is, over the last 20 years, your body might have changed,

the types of contraceptive, the available might have changed, your life circumstances might have changed.

It's probably not a bad time to just have a word with your doctor or your family planning professional and say,

is this still the right thing for me?

Absolutely, brilliant advice.

A close friend recently died of ovarian cancer

and had very few symptoms.

What should I be looking out for?

This is another difficult one because as we've said,

ovarian cancer can be very difficult to diagnose.

The symptoms of ovarian cancer

can mimic lots of other conditions.

But we're looking at things like unexplained abdominal pain, bloating,

feeling full up when you haven't eaten, change is actually in bowel habit and the way you pass urine

can be affected by ovarian cancer, tiredness, unexplained weight loss,

all the things that we've mentioned as rather vague symptoms.

But again, this is all about understanding you

and how you work.

If you hear a funny noise in your car, you go to the garage, if you don't seem to be working properly,

you need to get that checked out and seek advice in it.

And is it, it's partly due to the location

of the ovaries, isn't it?

If you have a breast cancer, your breast on your body, you can examine your breast,

there's a likelihood you might detect a lump, skin cancer if we can see our skin, testicular cancers.

Again, but things like ovarian cancer, pancreatic cancer, cancer with the gallbladder,

those organs that are deep inside the body, we can't access them.

There aren't screening programmes.

So unfortunately, is that one of the reasons

why they do tend to present at a later stage?

Well, absolutely.

And also again, because the symptoms are so vague.

So people are gonna say, oh, it's indigestion.

It's the time of the month, I always retain fluid.

These kinds of things, which that may be perfectly true, but actually you don't necessarily know unless you can get checked out.

And if it's happening all the time and it doesn't seem to be obviously related to food all the time of the month, then please just seek advice.

And then I guess my question from that is, how do we then maintain that balance?

Because

the danger is that every time people get a bit of a funny tummy symptom or feeling a bit tired,

you can start to worry that it's cancer.

Is it more about looking at the pattern that things tend tend to not get worse and better,

worse and better, but gradually get worse?

Or how else can people identify when they should be worried

versus when actually if it's just sort of common things like tiredness, it might not be so worrying?

I think it's important as you said, identify patterns, keep a diary.

When does this happen?

Is it associated with meal times?

Is it associated with sleeping in certain positions?

Is it associated with exercise?

Do things seem to be getting worse under gradual decline?

But again, if you can seek advice and get an explanation for what is going on, then that can actually put your mind at rest

as much as anything else.

And you then have an explanation for those symptoms.

And there are tests, aren't they?

Available as well, which can often be very helpful.

Why might I be offered chemotherapy and not radiotherapy?

There are, as we've said before, 200 or different kinds of cancer.

They're treated in different ways.

I mean, there's a very broad rule.

Radiotherapy because it involves

exposing the cancer to radiation, tends to be confined to cancers, are localised in one part of your body.

Chemotherapy because it gets into your system and can spread right around the body, is more commonly used for cancer

that's spread around the body or things like blood cancers.

However, chemotherapy works very well

for some localised cancers like bowel cancer even in the early stages, breast cancer in the early stages

and sometimes it's used together with radiotherapy and sometimes both are used together with surgery.

So it's very much about what's your cancer type?

Have you had other tests that suggest

that you may not tolerate chemotherapy very well?

Have you had radiotherapy to an area previously?

Which means you can't have radiotherapy twice to that area?

Are there other reasons why you can't have it?

Is your general health so poor that you wouldn't tolerate

a long course of radiotherapy, for example?

So again, talk to your specialist,

write things down, know the questions to ask, talk to the cancer nurses,

people like McMillan Cancer Support, the cancer nurses at Bupa, or all of these people can help you

to answer the questions that you've got.

Yeah, I think sometimes it's just making sense of that, isn't it?

Because these decisions are often not straightforward.

And I dunno if people know, but often we have MDTs or multidisciplinary team meetings where you'll have lots of different experts all in a room

all discussing your case based on things like, the type of cancer, the specimens that they've taken,

the histology, how that looks.

Also, how healthy you are, how fit you are and what your preferences and what your life is like.

And often, that team together will put their heads together and come up what they think is likely to be the best plan

and they'll present that to you.

So specialist nurse will be the perfect person to help you sort of make sense of all that.

And the specialist nurse is also your link into that team because he or she will know what your preferences are

and they can be fed into the team.

Thank you.

And then we have one more question.

I'm due to start chemotherapy next month and considering trying the cold cap.

My hair is shoulder length and very fine.

Is it worth trying?

Should I have it cut before starting?

So what is the cold cap?

And this person wants to know if they should try it.

Right.

Chemotherapy targets cells which are growing and dividing very quickly,

which is what cancer cells do.

Other things that grow and divide very quickly are hair cells.

So I'm sure a lot of people are aware that chemotherapy treatments can make your hair fall out.

Not all chemotherapy, but some.

What has been found is that if you can cool the stout down

to pretty low temperatures, you almost put the hair cells into suspended animation so the chemotherapy has less of an effect on them.

Doesn't work with all kinds of chemotherapy so you need to know whether the chemotherapy is suitable.

It works for any hair type.

It's not a good idea if you suffer from things like recurrent migraine

because basically it gives you an ice cream headache and if you already suffer from migraine, that's not something that you want.

But again, actually, if you're able to tolerate that, then the cold cap maybe a few weeks.

Again, discuss it with your oncologist, discuss it with your specialist nurse.

So I guess that's the thing with the cold cap,

it's about like everything when it comes to cancer, asking the questions, being informed that you can make your decisions.

I think the other thing with the cold cap is, if you do try it and it's too uncomfortable, you can always take it off.

You're not committed to wearing it for every treatment after that.

Thank you, Rebecca.

Thank you, Tim.

Thank you so much for sharing your wealth of knowledge with us.

And I really hope that that's empowered our viewers

to take care of your bodies, be vigilant, attend your screenings.

And if there's anything that you're worried about,

then get it checked out either with your GP or by contacting Bupa.