I’m worried these calcifications are the start of cancer

Q A recent screening mammogram showed I had dots of calcification on one of my breasts. I was told this was not concerning and I just needed another mammogram in three years. However, a friend had this and was then found to have breast cancer. I’m really worried – shouldn’t I be referred for more tests or at least have another mammogram a bit sooner?

A Breast calcifications are small deposits of calcium that can occur anywhere in breast tissue. They are so small you can’t feel them and they don’t cause symptoms. Though they are more commonly found in women, they can also occur in men.

They may develop in the blood vessels inside of the breast or because of other, non-cancerous changes, such as a fibroadenoma (a small lump of fibrous tissue) or a cyst.

They can also occur in scar tissue, which may develop if you’ve had an infection in your breast or have had breast surgery, including implants.

However, they can occasionally be an early sign of cancer.

As in your case, most calcifications are discovered when a routine screening mammogram shows small white dots which can range in size and appearance from very small microcalcifications to larger, macrocalcifications.

The latter occur because of benign, non-cancerous changes and do not need further tests. But microcalcifications can occur because of both benign and cancerous changes, so may need more investigations, such as a biopsy.

All screening mammograms are checked very carefully by trained specialists and if there is any doubt about the findings it is usual to get a second opinion from another doctor.

It sounds as if in your case the calcifications clearly looked benign and therefore you do not need to be concerned.

Having a mammogram exposes your breast tissue to radiation and this in itself can very slightly increase the risk of breast cancer, which is why you have been advised to wait three years for another.

In the interim, stay breast aware, check for changes on a regular basis and if you do find anything unusual, see your GP.

Q I’m 65 and work hard to keep myself healthy. I’m a normal weight, I’ve never smoked, and do a 10k run every week. So I was really horrified when the nurse told me I needed the flu jab for “older people”. Do I have a choice? I feel I’m more suited to the one for younger people.

A The flu vaccine contains four different strains of the virus, which the World Health Authority predicts will hopefully provide cover for the type of virus in circulation each year.

The same vaccine used to be given to all age groups, but from 2015 onwards it became clear that the vaccine did not work as well in those aged over 65 and this difference was particularly marked in the winter of 2017-18, when the vaccine in the older age groups was not effective in more than 75 per cent of older people. This is because the immune system becomes less efficient as we get older. It’s the same reason that shingles, which is caused by a reactivation inside the body of the chickenpox virus, is much more common in older people.

Since 2018 a special substance, known as an adjuvant, has been added to the vaccine for people aged 65 and older. The adjuvant acts to strengthen and lengthen the immune response to the vaccine.

Research has shown that flu vaccines containing this give much higher protection against illness, the chance of being hospitalised and also against dying in those aged 65, compared to the standard vaccine.

Although you have certainly helped yourself to live a longer, healthier life by keeping fit and slim, your immune system is now 65 years old and it won’t react as well to the standard vaccine as when you were younger.

The only downside is the vaccine containing the adjuvant is more likely to cause side effects, such as soreness at the injection site, body ache and mild fever.

You can certainly choose which vaccine to have, but I would strongly recommend that if you want the most effective protection against flu you have the one for the over-65s.

If you do decide to have the one for younger people, it is likely you will need to confirm that you have been fully counselled about the pros and cons of each type of vaccine and that you have had the “younger” version against medical advice.

Q I had some blood tests last month and they showed my cholesterol was normal but said my triglycerides were 0.6, which appears to be lower than the healthy range listed on the results (0.8-2.00). I’m not particularly healthy, so I was surprised. Could the fact I had a black coffee before the test have given me a lower reading?

A Triglycerides are a type of fat, or lipid, found in your blood, and like some types of cholesterol, high levels can lead to thickening and narrowing of the walls of arteries.

Unlike blood levels of cholesterol, which do not alter significantly after eating a meal, eating a fatty meal can increase the level of triglycerides.

Usually there is no need to fast before having a blood cholesterol test, but if it shows that your triglyceride level is very high you may be asked to repeat it first thing in the morning before having breakfast.

There is some evidence that drinking coffee may very marginally increase cholesterol levels, but no evidence that it makes any difference to triglyceride levels.

Generally, low triglyceride levels are regarded as a good thing, though very low levels can occasionally indicate a health problem such as malnutrition, which sounds unlikely in your case.

Your level was only just below the healthy range and just indicates that you hadn’t had any breakfast. I suspect if you had a repeat test done at a different time of day the result would be in the normal range.

● If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard cannot enter into personal correspondence or reply to everyone.