The Big Three

BREAST CANCER

Who gets it: One in 12 women in Britain will develop breast cancer at some time in their life. Every year it is diagnosed in more than 34,000 women. Men can get breast cancer but it is comparatively rare among them - there are only about 200 new cases a year. Very few cases appear in young women but the disease is diagnosed in more than 1,000 women aged 35-39 every year. The incidence increase with age.

Symptoms: It is important to visit the doctor if you find a lump either in the breast or the armpit, discharge from the nipple, nipple eczema, wrinkling of the skin around the nipple or pain in the breast. Nine out of 10 lumps are benign but the rest need immediate treatment

Treatment: Patients with early breast cancer generally have the tumour removed and have radiotherapy to avoid recurrence. For those with advanced breast cancer chemotherapy is a major treatment. Tamoxifen can help by blocking the action of oestrogen in the breast. Surgery and radiotherapy may also be used. Trials are going on to see if tamoxifen reduces the risk in high-risk women.

Risk factors: The strongest is age. In general a greater exposure to oestrogen also increases the risk, so having your first period young or having a late menopause are also risks. Having children late or not at all doubles the risk compared to a woman who had her first child before the age of 20; family history is also significant. Two genes have been identified that account for 85 per cent of families with four or more cases of breast cancer in someone under 60. The contraceptive pill and HRT have been shown in some studies to increase the risk slightly but it is felt the health benefits outweigh the disadvantages. Possible protective factors include high levels of physical activity, breastfeeding, high- fibre diet and high intakes of fresh fruit and vegetables.

Survival rates: 64 per cent of women diagnosed with breast cancer are alive five years later.

Trends: The Macmillan report suggests that breast cancer is set to rise from 9 per cent of women in 1990 to 13.7 per cent in 2018. The CRC and ICRF call that a worst-case scenario and say the opposite is true. Mortality from breast cancer in the UK has fallen dramatically in the past five years, the CRC says. In 1990 15,180 women died from breast cancer compared to 14,080 in 1995. The CRC calls the cloning of two breast cancer genes the "scientific breakthrough of the decade".

Glenda Cooper

PROSTATE CANCER

Who is at risk: With death rates from the disease doubling in the past 20 years, prostate cancer is the second most common cause of cancer deaths among men and is expected to overtake lung cancer as the number one killer by 2010. The disease usually affects men in their 70s. The cause is not known although testosterone is implicated. No one knows why prostate cancer is increasing: an ageing population is probably one factor. Some researchers say more cases are being detected.

Symptoms. An enlarged gland at the base of the penis, difficulty or pain urinating, or passing blood. There are two types: the aggressive form which spreads to other parts of the body, or small, slow growing tumours confined to the prostate.

Treatment: Small tumours which have not spread beyond the prostate are managed by "watchful waiting" (treating symptoms as they appear) - radiation therapy or surgery: the choice is increasingly left to the patient since studies have shown that the outcome of all three treatments is similar. The more aggressive form is usually treated by a combination of hormonal drugs: LHRH inhibitors and an anti-androgen such as flutamide, which reduce the effects of testosterone. Nowadays it is not necessary to remove the testicles although sometimes that is recommended.

Risk factors: not known, although one may be changes in diet over the past 50 years. Dr Jonathan Waxman, of Hammersmith Hospital, London, points out that prostate cancer rates are high in the West where "we eat extraordinary amounts of meat", while in parts of the world where rates are low, diets are vegetarian or fish based. A brother or father with the disease is a minor risk factor. There are no clear answers on how to reduce the risks, but Dr Waxman recommends a balanced diet.

Survival rate: depending on the type of tumour, survival rates range from 15 per cent to 80 per cent over 10-15 years.

Trends: Incidence is projected to triple by 2018, according to the Macmillan report, with one in four men contracting the disease, compared to one in 10 in 1990. A new antibody designed to cling to tumours and stop their growth is entering clinical trials at the Hammersmith Hospital; new molecular therapies are being researched.

For more information, call the Prostate Cancer Charity helpline tel 0181 383 1948

Cheryl Hicks

LUNG CANCER

Who gets it: Smokers. More than 40,000 cases are diagnosed every year. It is rare under the age of 40. It is the commonest cancer in men, but women are fast catching up because they are smoking more - in the 1950s the male/female ratio was 6:1 now it is 2:1.

Symptoms: Starts with a cough or a feeling of breathlessness and then the patient begins to suffer from malaise, lethargy and weight loss. It is a very aggressive cancer and often by the time symptoms appear, it may have spread, making surgery and chemotherapy difficult.

Treatment: At present there is no effective screening test for lung cancer. Surgery can cure, but less than a fifth of non-small cell lung cancers are operable. Palliative radiotherapy can give relief from symptoms for such patients. Chemotherapy is not yet routine outside clinical trials although there is mounting evidence it may help. Trials are being carried out to assess the impact of chemotherapy both on localised disease before radical surgery or radiotherapy.

Risk factors: Smoking accounts for 95 per cent of lung cancer cases. Several hundred are said to die from passive smoking although that is still controversial. Not everyone who smokes will get cancer - experts believe a rogue gene located on chromosome 3 may contribute. Radon gas can be a risk factor as can working with such chemicals such as uranium or asbestos.

How to minimise the risks: Stop smoking.

Survival: Lung cancers accounts for a quarter of all cancer deaths. On average one person dies of lung cancer every 15 minutes. Five year survival rates are 8 per cent for men and 7 per cent for women.

Trends: The Macmillan report says that lung cancer is set to drop sharply in men from 13 per cent to 4.4 per cent while it will double in women reflecting the later stage in which women took up smoking.

The CRC says that important recent developments - the US tobacco companies' admission that their product is addictive and the Government's plans to ban tobacco advertising could mean that smoking-related cancers will fall among women as well as men.