A Question Of Health: 'Will tablets stop breast cancer reappearing? And can my unsightly spots be removed?'

I had breast cancer in 1998 and it was successfully treated with a combination of surgery, radiotherapy and chemotherapy. I was lucky not to lose a breast. The first set of treatments lasted for nearly six months. I then started taking tamoxifen tablets every day. I now have yearly check-ups and it seems that I have passed the five-year mark with no sign of cancer coming back. At my last check-up I was told I could stop taking tamoxifen, as it only worked for five years. I protested, and was told to carry on for another six months, when I am due to go back for another check-up. I am very reluctant to stop the tamoxifen as it seems to have prevented the breast cancer from reappearing. Even if it loses its effectiveness, is there any harm in carrying on with tamoxifen for longer than five years?

CANCER CONCERN

I had breast cancer in 1998 and it was successfully treated with a combination of surgery, radiotherapy and chemotherapy. I was lucky not to lose a breast. The first set of treatments lasted for nearly six months. I then started taking tamoxifen tablets every day. I now have yearly check-ups and it seems that I have passed the five-year mark with no sign of cancer coming back. At my last check-up I was told I could stop taking tamoxifen, as it only worked for five years. I protested, and was told to carry on for another six months, when I am due to go back for another check-up. I am very reluctant to stop the tamoxifen as it seems to have prevented the breast cancer from reappearing. Even if it loses its effectiveness, is there any harm in carrying on with tamoxifen for longer than five years?

About one in every 10 British women will develop breast cancer at some time in their lives. It's a relatively common disease. The growth of breast cancer is often fuelled by the female hormone oestrogen. Tamoxifen interferes with oestrogen, by blocking its effects. In this way it helps to prevent breast cancer recurring. Women who take tamoxifen can significantly improve their chances of survival. Tamoxifen also substantially reduces the risk of breast cancer appearing in the other breast. But tamoxifen also has some potentially serious side effects. It makes it more likely that you will develop a blood clot or DVT, and it increases the risk of getting cancer of the lining of the womb. If your original cancer was confined to one breast, and had not spread to any lymph nodes, five years of tamoxifen is probably enough. Taking it for five years is just as effective as taking it for 10 years. If, however, your original breast cancer had already spread to the lymph nodes or other parts of the body, it may be sensible to continue with tamoxifen for more than five years. Discuss these issues with your doctor at the next check-up. Before you go, have a good look at the CancerBACUP website: www.cancerbacup.org.uk.

AFTER CIRCUMCISION

My teenage son was circumcised at the age of three after a urinary tract infection. His foreskin was very tight, and this was causing a blockage of urine flow. I have heard that there is a way of stretching the foreskin after a circumcision, and getting it to grow back over the tip of the penis. Can you explain how this works.

There are various commercial products on the market for stretching the foreskin. Most of these involve attaching weights to the skin of the shaft of the penis. The weights are taped to the penis and gravity pulls down on the skin, encouraging it to stretch. The systems have variable degrees of success. Most require about a year of stretching to achieve the desired results. The weights have to be worn every day for many hours. I have not read any reports of what happens when you stop wearing the weights, but I suspect the length of the foreskin may very slowly return to its circumcised length. There is an American organisation of men who are interested in foreskin restoration. It is called NORM, which stands for National Organization of Restoring Men. They have a comprehensive website at www.norm.org, which your son may want to look at.

SPOT REMOVAL

I have a number of tiny white spots under my lower eyelids and on the side of my nose. Each spot is about the size of a pin head. They have been present for quite a few years and don't seem to change much. They don't itch or cause any real problem, but I feel they are unsightly and wonder if they could be removed. If I did have them removed, would they reappear?

These spots are likely to be tiny skin cysts that are filled with a material called keratin. They can occur at any age and they never lead to serious medical problems, although they can be a cosmetic problem. They could be easily removed by a dermatologist or cosmetic surgeon, but I think it is likely that new ones would appear with time. There is also a small chance that you would end up with small scars where the cysts have been removed. Another possibility is that these spots are a sign of raised blood fats, such as cholesterol. People who have very high cholesterol levels develop spots called xanthelasma around the eyes. They tend to be yellow, rather than white, but they do occur around the eyelids. You should show the spots to a doctor, who may want to check your cholesterol levels. High cholesterol can run in families - a condition known as familial hypercholesterolaemia. Did either of your parents have similar spots or high cholesterol levels? If they did, or if they died from early heart disease, you should also mention this to the doctor. You may be able to cure the spots yourself by gently rubbing them regularly with a soft sponge or brush. Do this when you are in the bath.

HAVE YOUR SAY

READERS WRITE

Thanks to KC, who spotted a mistake in the column of August 18:

I fear that your reply entitled Autoantibody Action was nobbled by gremlins. I am sure that you originally wrote that a low platelet count and white blood cell count indicate that the lady's bone marrow is NOT working well, rather than is NOW working well.

Please send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182 or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions