I wear sunblock but what more can I do to avoid skin cancer?
QI am 48 and I’ve already had three basal cell cancers removed from my face. I’m now really careful about wearing sunblock all the time, but is there anything else I can do to try and prevent getting any more?
ABasal cell carcinoma (BCC) is the most common form of skin cancer and usually develops on parts of the body that have been exposed to a lot of UV rays from the sun, such as the scalp and face. Those with fair skin who burn easily are most at risk.
Although sunlight is the main cause, it does seem that some people are genetically more predisposed to getting BCCs than others.
Once you have had one, you are more at risk of having another, and 50 per cent of people with a BCC develop a second within three years.
Unlike melanomas, these very rarely spread to other parts of the body, but if left untreated can cause deep ulceration in the skin.
Depending on their size and position they can be treated in a variety of ways, including cryotherapy, chemotherapy cream or surgical excision.
The best way of preventing further BCCs is to protect the skin from sunlight by wearing high factor sunblock every day (SPF30 or more, with five stars against UVA) and staying out of the sun in the middle of the day.
There is also evidence from Australian research that taking nicotinamide, a form of vitamin B3, has a protective effect. A dose of 500mg twice a day was found, after 12 weeks, to help prevent around a quarter of new skin cancers starting.
It can’t be prescribed by your GP but can be bought from chemists. It only works while you are taking it and it is not yet known how long the preventative effect continues once you stop.
Most medicines can be safely taken with nicotinamide, apart from blood thinners such as warfarin, but if you are on other regular treatments, check with your GP or pharmacist before you start taking it.
Q
I am a 76-year-old male and stoop badly. I had a scan and X-ray, and three doctors gave me different diagnoses. One said it was a crushed vertebrae, one said it was wear and tear. The third said it could be osteoporosis but needed a test they couldn’t do because of Covid, so prescribed tablets. What do you think?
AAlthough a hunched posture or ‘stoop’ can be caused by spasm of the muscles of the back, in older people it is more commonly caused by a change in the shape of one or more of the individual bones (or vertebrae) of the thoracic spine, which is the central section where the ribs are attached.
This can occur when the bones are weakened by osteoporosis and can lead to the inner part of the vertebra being crushed, changing from a cube into a wedge shape. This can happen unknowingly, although sometimes when a vertebra collapses in this way it causes severe pain.
Osteoporosis is a very common condition, and although it is often associated with older women, it can affect men too. One in five men over 50 will break a bone due to the condition. ‘Wear and tear’ is a term doctors usually use for osteoarthritis, where the joints between bones are worn. Although this can cause back pain, it does not usually cause a stoop.
Crushed vertebrae can be seen on an X-ray, but the best way of diagnosing osteoporosis is with a DEXA scan. Now that restrictions have lifted, your GP should be able to arrange this for you. Treatment with bisphosphonate tablets can help reduce further bone loss, and you should also make sure you take a daily vitamin D supplement and have at least 800mg calcium daily.
Q
My periods stopped a couple of years ago and I’ve been on HRT (skin patches) since then. My libido, which used to be good, has totally disappeared – I’ve absolutely no sex drive at all. I’ve been with my partner for 10 years and otherwise our relationship is good. Would it be worth trying testosterone?
A
Although it’s often thought of as a male hormone, testosterone is also an important female hormone, and healthy young women produce three to four times as much testosterone as oestrogen. About half of this comes from the adrenal glands and the other half from the ovaries.
It contributes to libido, sexual arousal and orgasm, and also helps to maintain muscle and bone strength. Testosterone levels naturally decline throughout a woman’s life but, like oestrogen, the loss is particularly marked at the time of menopause, when levels fall by more than 50 per cent. This can affect your sex drive.
Other factors can also play a role in this, such as relationship problems and general low mood, but it sounds as if these do not apply in your case.
Research has shown that in post-menopausal women who have adequate oestrogen replacement, giving testosterone can help to improve sex drive, though it is not known whether this lasts long term, as the follow-up in trials was only six to 12 months.
However, it can cause side effects, including weight gain, acne and hair growth, especially in the beard area, so weigh up the pros and cons.
There is currently no licensed testosterone preparation for women in the UK and that means women have to use a preparation designed for men. Women can choose between testogel sachets, using just one tenth of a sachet a day (so a sachet lasts 10 days) or one pump of tostran gel on alternate days, which provides a slightly higher dose.
Both are available on prescription from your GP, but you will probably have to speak to one with a special interest in the menopause.
If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.