Must-know signs you have the deadly gene that almost guarantees cancer - as Kara Tointon announces double mastectomy

Former EastEnders star Kara Tointon has revealed that she has undergone a double mastectomy, following a genetic test which confirmed she carries the deadly BRCA mutation.
While cancer is not usually inherited, some types—including breast, ovarian, pancreatic and prostate cancer—can be strongly influenced by genes.
The majority of hereditary breast cancers are due to mutations in two genes, BRCA1 and BRCA2, which give you between 45-85 per cent chance of developing cancer in your lifetime.
Those with a faulty BRCA gene also have a 50 per cent chance of passing it on to their children, meaning that cancer can sometimes run in families.
So how do you know if you're at risk?
The first sign you may be a BRCA carrier is having a close family member who developed one of three cancers under the age of 50, according to the National Cancer Institute.
This includes breast, ovarian, male breast and pancreatic cancer.
The relative affected must be a first or second degree relation—such as parent, sibling, grandparent, aunt, uncle, niece or nephew.
Similarly, if you have one of these relatives with prostate cancer before the age of 80, it may be a red flag.
About 62 per cent of those with harmful changes in BRCA genes will get prostate cancer by age 80, studies show.
Another risk factor is having jewish ancestry. According to the NHS, one in 40 Ashkenazi jews have a faulty BRCA gene, compared to around 1 in 250 individuals in the UK general population.
Sephardi jews are also at increased risk, with 1 in 140 having a mutated gene.
Ms Tointon, 41, is now urging other women to look out for the signs that they could carry the gene—putting them at a very high risk of cancer.
In a video posted to Instagram that has so far been viewed over 521,000 times, the mother-of-two said: 'You may have heard of the BRCA genes 1 and 2 and as a carrier it means I am at a greater risk of both breast and ovarian cancer.'
'There is a history of both cancers in my family on my mother's side but for various reasons, including generational trauma, we hadn't looked into [genetic testing] until that point.'
In 2018, the soap star was given the option to take a genetic test when her mother Carol, was undergoing treatment for ovarian cancer, which affects up to 58 per cent of women who inherit a faulty BRCA1 gene.
'It was put to us, we took the test and it was confirmed that my mum and I both carried the gene', Ms Tointon explained.
Her mother died just a year later in 2019.
Now, after having her second son in 2021, Ms Tointon has revealed that she underwent two preventative surgeries, including a double a mastectomy and the removal of her fallopian tubes.
'They believe that ovarian cancer begins in the fallopian tubes, so by removing them first, checking them out, you then remove the ovaries later, and closer to menopause', the EastEnders star explained.
Hollywood star Angelina Jolie underwent the same procedure after she discovered she carried the BRCA1 gene, in 2013, raising greater awareness of the defect.
She was told at the time that her risk of developing breast cancer was 87 per cent.
Around one in 1,000 women in the UK are thought to have the BRCA1 variant, but most breast and ovarian cancers occur due to genetic damage that accumulates over time.
This can be caused by too much ultraviolet radiation from the sun, which can damage DNA in your skin cells causing skin cancer.
In some cases, patients with the faulty genes may be offered risk-reducing surgery, which removes tissue such as breasts or ovaries, that could become cancerous.
This is because while having one 'normal' copy of either gene is usually enough to protect cells from becoming cancerous, , this normal gene can change during a person's lifetime—in a process known as somatic alteration—increasing the risk of cancer.
The NHS warns that while genetic testing can help people take steps to manage their risk of developing cancer—including lifestyle changes, regular screening and preventative treatments—a positive result can cause permanent anxiety.
This comes as new research has highlighted a drug that could help women with the so-called Angelina Jolie cancer gene to avoid surgery.
Currently, women who carry a BRCA gene mutation are a much higher risk of breast and ovarian cancer, with many opting for preventative treatments such as a mastectomy.
But new research by the University of Cambridge indicates that giving drugs usually administered in the late stages of breast cancer to healthy people carrying the mutated BRCA genes could prevent them from developing the disease.

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Daily Mail​

24 minutes ago

• Daily Mail​

Fast-track suicide if you pay extra, discount deals for couples and you don't even have to be terminally ill: Inside Germany's morally queasy approach to assisted dying where business is booming for the pedlars of euthanasia

Last week, the UK's highest elected officials ruled on the most existential of questions: how we choose to die. At its third reading, the Assisted Dying Bill passed the Commons by a slim majority of 23 votes, and now its fate lies with the Lords, where it faces a bumpy ride before it becomes law. The upper chamber, for instance, will examine if a three-person panel of professionals (from law, psychiatry and social work) offers greater safety and oversight in approving a patient's application to die than a High Court judge, as was originally proposed. Peers will have at their disposal the grim cost-benefit analysis to the NHS in accelerating the deaths of the terminally ill, released last month under the cover of the local election results. According to the report, as many as 1,300 people are expected to apply to die in the first year, saving as much as £10million in medical bills. But can the health service cope with this demand, especially as NHS staff will be offered an opt-out from the ugly business of state-sponsored suicide? No doubt private health providers are already bending the ears of peers for a slice of the death industry pie. It would be tempting to allow private enterprise to take some of the strain, but I urge the Lords to look at how business seized the opportunity with morally queasy gusto in my native land, Germany, where some firms offer a 'fast track' service for people who can pay more and even special discounts to couples wishing to hasten their demise. Pictured: Pedestrians walk past the posters promoting the Assisted Dying bill at Westminster Underground station In Germany, anyone 18 or over can lawfully commit suicide with the help of a third party. Yes, anyone. There is no requirement for the person to be six months from death, nor is there any specification over having a life-limiting or debilitating illness (as in the UK Bill). A perfectly healthy university student can seek help to kill themselves for no better reason than they are fed up with life. Hannelore Kring, 83, is typical of Germany's liberal approach to assisted suicide. A recording of her death featured in a podcast by news broadcaster WDR and it is a spine-chilling reminder of how relaxed my countrymen are about dying. At an undertaker's, Frau Kring is accompanied by two 'death helpers' – a nurse and retired teacher – and sounds relieved her life will end in a matter of minutes. Dressed in black and with make-up, as if attending a party, she suggests a dance with the nurse. Indeed, she is not ill, she is as healthy as anyone in their 80s. She has run a second-hand men's boutique in Hamburg but feels life's no longer worth living. She's lonely, all her friends have died and the state of the world depresses her. The helpers ask if she really wants to go through with it. 'Absolutely!' she replies enthusiastically. The nurse hooks her up to an infusion of a lethal dose of narcotics – a 'suicide cocktail'. She merely has to turn a valve, letting the toxic chemicals enter her bloodstream, putting her to sleep for ever. It's important she takes the final step herself, otherwise the helpers could be charged with manslaughter. Assisted suicides like this have been fully legal in Germany since 2020, although legislation has been a generation in the making. After the Second World War the subject was largely taboo, in no small part due to revulsion at the Nazis' Aktion T4 programme, which entailed the 'mercy killing' of 300,000 disabled people. By the 1970s and 1980s, a push for more patient autonomy led to court decisions in 1984 and 1990 that ensured suffering, bed-ridden people had the right to stop treatments that prolonged their lives. With the 2009 Patient Directive Law, people could include such instructions in a living will if they became incapacitated. This gave legal protections to doctors offering assisted suicide. But then the public grew uneasy at what seemed a creeping commercialisation of the right to die. Healthcare is not free at the point of use in Germany, so the nation is more comfortable than the UK with private provision within the system. But only up to a point. Many were appalled in 2014 when a Berlin urologist Uwe-Christian Arnold revealed he had helped 'several hundred people' take their lives since the late 1990s for fees of up to €10,000. Christian groups accused him of undermining the sanctity of life. The German Medical Association threatened him with a €50,000 fine, saying doctors should prolong life, not give their patients lethal poisons. Arnold took them to court over the fine and won. Also in 2014, a right-to-die association in Hamburg caused uproar for offering fast-track assisted suicide consultations in exchange for higher membership fees. Its normal rate was €2,000, with a waiting time of a year, but it introduced a jump-the-queue service for €7,000. Other providers offered discounts for couples interested in dying together. These were grisly bargains that lead many to regard Germany as a Las Vegas of suicide, which was anathema to a country that saw itself as otherwise Christian and conservative. Church groups took to Berlin's streets as legislators sought to crack down on the industry. Arnold and others passionately defended their businesses. The 'death helpers' argued the issue was comparable to abortion: a ban would be unfair to the terminally ill, who shouldn't have to travel to places like Switzerland to end their lives with dignity. The debate ended with parliament banning 'commercial' assisted suicide under Chancellor Angela Merkel in 2015. Subsequently, only friends and relatives who received no money for their assistance could help someone end their life. Legal challenges were launched by right-to-die advocates and people suffering terminal illnesses. In a 2020 judgement, the Constitutional Court said the freedoms enshrined in the country's post-war constitution meant 'the decision to take one's own life must be respected by the state as an act of personal autonomy'. Those who had been put out of work by the previous ruling were free to ply their trade once again. Five years after that decision, it feels like we're back to the Wild West of pre-2015. Assisted suicide in Germany is an unregulated free-for-all. A slew of undertakers, lawyers and independent doctors are facilitating a rising toll of assisted deaths. Last year it was about 1,000, though no one is keeping exact figures. Likewise there's no central registry of providers. Nearly anyone can set up shop. The largest player in the business is the German Association for Humane Dying (DGHS), which charges €4,000 a suicide but offers a discounted €6,000 for couples. It says that of the 623 people for whom it arranged suicide last year (it forwards requests to independent teams of doctors and lawyers), 22 per cent were just 'fed up with life'. Two-thirds were female. DGHS spokesperson Wega Wetzel says: 'Women are more likely to be widowed and 'left over' than men. Women are more likely to plan and communicate, while men often choose 'hard' suicide methods such as hanging.' Equally worrying is the fact that nothing prevents young people from choosing the path of assisted suicide. The youngest case I heard of was a 21-year-old man. The only requirement spelled out by the court was that the person be 'freely responsible' for their decision. At least DGHS, to maintain its reputation, has doctors and lawyers screen applicants to ensure they understand what they're getting into, that they're not being coerced and that they do not show symptoms of mental illness or dementia. But nobody knows how many independent providers are making money with assisted suicide. Nobody knows how they are screening clients, particularly in the more affordable services where standards may be lower. A study last month in the British Medical Journal analysed 77 assisted suicides in Munich. It found that one patient's consultation with a clinic lasted 55 minutes and the death was booked for the next day. The assisting physician in another case was a relative of the patient. In a 2022 case, the suicidal person was judged of sound mind based on a five-year-old mental capacity evaluation. But there is still broad support for the right to die: 80 per cent of Germans feel it's appropriate for the critically ill. But just 30 per cent say it should be available to people with a long life ahead of them, and only 3 per cent for young people having a crisis. Ute Lewitzska, professor for suicide studies at Frankfurt University, sees a fundamental change in how we deal with growing old. 'Supply creates demand,' she says. 'The 2020 court decision didn't just open a crack in the door, it flung the door wide open – and we're not going to be able to close that door again.' The fear is a normalisation of assisted suicide. For some it's a humane way to end one's life; for others it's an easy solution to suffering that's being oversold. Dr Lukas Radbruch, director of palliative care at University Clinic Bonn, has worked with end-of-life patients for three decades. He says many more now ask about assisted suicide but 'so many people are not sufficiently informed. Or we have doubts about how voluntary their choice is. Or we realise they still want to live, even if they say they want to die.' Sometimes a suicidal person needs counselling, not the means to kill themselves. Where do you draw the line? Dr Radbruch asks. In 2023 the German parliament tried to hammer out rules to provide clearer guidance, but MPs couldn't reach a consensus. Like many in the West, Germany seems destined to grope its way through this ethical minefield with no transparent way forward that is satisfactory for all. I do not envy the task ahead for Britain's Lords. My country's experience offers a salutary lesson that for the Bill to become law, they must make black and white what is a painfully grey issue.

The Sun

31 minutes ago

• The Sun

Rise in dangerous summer TikTok ‘wellness' trend that puts Gen Z girls at risk of cancer or even death

EVERY morning, Taylor Lyttle heads to a local beauty salon for a 15-minute sunbed session. After topping up her already deep-mahogany tan, at a cost of £13, the 21 year old then scrolls TikTok to check if her skin is darker than all of her sunbed-using friends. 6 'If I see someone online darker than me, I get annoyed. I love how I look with a tan, it boosts my confidence and I feel more attractive,' she says. Taylor, a hairdresser from Belfast, adds that she's aware of the risks of sunbed use, including skin cancer, but isn't too worried. 'I'm very healthy. I eat well, I look after myself. I've never had any issues since I started using sunbeds five years ago. "I think of it as me-time – it's relaxing and reduces my stress,' she says. Like countless other Gen Z girls aged 13-28, Taylor spends hours scrolling posts on TikTok with hashtags like #tanned, #sunnyd and #whatmakesyouhappy, often featuring users bathed in blue UV light. 'It's a problem, but I'd rather die hot than live ugly I guess #yolo #lol #sunbed,' reads one caption. Meanwhile, influencers on the platform claim tanning beds can do everything from boost vitamin D levels to improve your mental health. Not only are many of these claims unproven, some are entirely false, and charities are concerned that marketing tanning as a 'wellness' trend is driving Gen Z girls and women to sunbeds – risking their health, and even death, from skin cancer. It's big money, too, with the UK's largest tanning chain, The Tanning Shop, growing by 40% since 2018. Alarming time-lapse video reveals how tiny 'dark patch' morphs into melanoma 'Social media encourages us – we look at people's tans online and it gets competitive' Taylor has been using sunbeds since she was 16, even though it's illegal under the age of 18. 'No one ever checked my age,' she says. 'I just paid my money and went in. I guess I was self-conscious about my pale skin and I don't have a lot of confidence. "It's something that helps me. My mum knew I was doing it, but she didn't mind.' It's a social thing as well – we'll often meet at the sunbed salon then have coffee or lunch afterwards. Taylor Lyttle She adds: 'Now, I go most days, spending over £200 month to get my fix. I also use nasal tanning sprays [which contain synthetic hormones such as Melanotan II and are sprayed directly into the nostrils to stimulate the production of melanin and darken the skin], before each session, which I get for £25 from a friend.' Last month, Trading Standards issued a warning that tanning nasal sprays could cause 'nausea, vomiting, high blood pressure and even changes in mole shape and size,' and urged users to be cautious about unlicensed sprays bought online. However, Taylor insists she's never suffered any side effects, and plans to continue using them. 'Social media encourages us,' she says. 'I don't post photos of myself, but we all look at people's tans and it gets competitive. "We watch videos about how to boost your tan and most of us use tanners like nasal sprays. "It's a social thing as well – we'll often meet at the sunbed salon then have coffee or lunch afterwards.' Dr Björn Thomas, a consultant dermatologist and lead for melanoma at Guys' and St Thomas' Hospital, London, is seeing a rising number of young patients. 'We're no longer surprised to see someone aged 19 or 20 with melanoma,' he says. 'Often, they've had lots of exposure to sunbeds. It's an increasing trend among younger generations.' Dr Thomas said there is 'minimal' evidence emerging that a small amount of UV light is good for you. 'The reality is, sunbeds are not safe,' he says. 'The carcinogenic, cancer-causing effect could be significantly higher than if you are getting ambient sunlight out and about. Melanoma is a very common cancer – it has the ability to spread and kill patients. It is a very serious diagnosis and the knock-on effect to your life could be devastating.' Risks of sunbeds THE promise of a constant glowing tan is too tempting for some people to deny. But while popping to the sunbed shop may seem harmless, people who use tanning beds should be aware of the risks. Approximately 10 per cent of the population of Northern Europe use sunbeds on a regular basis, the World Health Organization says. Some people use them for years on end, accumulating risk of serious disease. We are here to give you the lowdown on sunbeds and if they are safe to use. According to the World Health Organisation (WHO), sunbeds are as dangerous as smoking. Like the sun, they give out harmful UV rays that damage the DNA in your skin cells. Over time, this may lead to malignant melanoma - the deadliest form of skin cancer - studies have shown. According to the International Agency for Research on Cancer (IARC), there is significant evidence to show that using tanning beds causes melanoma. They report that sunbeds increase the risk of skin cancer by up to 20 per cent, and also state that they have no positive benefits to our health. Cancer Research back this statistic, adding that " there is no such thing as a safe tan from UV radiation". One study found that sunbeds can almost double the risk of cancer compared to never using them - with women 83 per cent more likely to develop the disease. While some people think tanning beds are safer than sitting out in the midday sun, according to Cancer Research, the risk is still twice as high when compared to spending the same amount of time in the Mediterranean sun at lunch time. The Sunbed Association claim there is not enough evidence to link sunbed use with melanoma, adding: "It is over-exposure and burning that will increase a risk of skin cancer, not responsible UV exposure." But the WHO says: "The majority of tanning parlours provide inadequate advice to their customers. "The use of eye protection such as goggles or sunglasses should be mandatory. "However, as sunbed users aim to have an even tan, they often decide against protecting any part of their body." Referring to the link with skin cancer, the world health experts add: "Sunbeds for self-tanning purposes have been available for the last two decades and due to the long latency period for skin cancer and eye damage it has been difficult so far to demonstrate any long-term health effects. "Even though the causes of malignant melanoma are not fully understood, tumour development appears to be linked to occasional exposure to intense sunlight. "Sunbeds subject their users to intermittent high exposures of UVA and UVB radiation – this may provide the ideal setting for the development of malignant skin cancer. "However, the few epidemiological studies that have been carried out to date have not provided any consistent results." Despite the WHO's cautious stance on the skin cancer link, it discourages the use of sunbeds, quoting an expert who said the use of tanning parlours is like "an industrial-scale radiation exposure experiment". Regardless of skin cancer, sunbeds don't just have long-term health risks. Users have reported a range of short-term symptoms including itching, dryness and redness of skin, freckling and photosensitivity. Common outcomes in the longer term, especially in fair-skinned people, may involve blistering of the skin. " Sagging and wrinkling of the skin are an almost certain price to be paid by frequent sunbed users", the WHO says - not quite the outcome you hope for when going to the sunbed shop for a beautiful, youthful look. Georgia Edwards was diagnosed with melanoma when she was just 19, after finding a bloody mole on her thigh. She'd been using sunbeds for three years. 'I was really young and loved having a tan without the faff of getting all messy using fake tan,' recalls Georgia, now 27, from Horley, Surrey. 'My friends and I would go together for 10 minutes and you'd feel like you'd gone to Spain and back. It became addictive.' Even though she was at school when she started, like Taylor, she says she was never asked for ID. I was called back in and there was a consultant and a Macmillan nurse – I knew it wasn't good news and broke down. Georgia Edwards 'I just put my card into the machine and selected how many minutes I wanted. "I was going three or four times a week, but I could have gone twice a day if I'd wanted. No one stopped me.' Georgia showed her GP the affected mole in March 2017, after going to the doctor for a chest infection, and was immediately referred. After a biopsy, she was diagnosed with stage two melanoma that May. 'I was called back in and there was a consultant and a Macmillan nurse – I knew it wasn't good news and broke down.' Georgia, who works in a rehabilitation centre for children with brain injuries, was referred to London's Royal Marsden Hospital for treatment. 6 6 She had two surgeries to remove the cancer. Fortunately, it hadn't spread. 'I had a wide, local incision to cut out the mole and surrounding area as it was quite deep in my skin and close to the lymph nodes,' she says. 'I have a 12cm scar on my leg and, eight years later, I'm still regularly checked as there's a high risk of it returning. 'I was young and naive. I thought it wouldn't happen to me. That was my mindset. Young people simply aren't aware of the dangers, and in years to come there's going to be a mass of people getting diagnosed. "Influencers promoting sunbeds have no idea of the dangers, they don't realise it could cost someone their life.' 'I lost my sister and best friend to sunbed use' Jessica Crowe knows only too well the the pain sunbeds can bring. Her sister Tazmyn spoke to Fabulous in 2021 after being diagnosed with skin cancer in 2014. The mum of three died in March 2023, aged just 31, having used sunbeds up to twice a day when she was younger. 'When we were teenagers, Tazmyn would use them all the time,' recalls Jessica, 31, a healthcare assistant and mum to Poppi, 14, and Memphis-Cub, two. 'I went with her a couple of times, but I'd just burn, so I stopped going. She was the tanned one and she loved it. "But after her diagnosis, she'd often say: 'Why did I do it?' She immediately stopped using them and regretted ever having gone on one.' Five years after her diagnosis, the cancer returned to her lymph nodes – reaching stage three. "Pregnant with her third child at the time, Tazmyn delivered her son 10 weeks prematurely in order to have further cancer treatment, almost losing him to a pulmonary haemorrhage. Tragically, despite further surgery and medication, Tazmyn's cancer spread, progressing to stage four, and in March 2023 she passed away, leaving her children Dillyn-Angel, 14, Saylor-Doll, 11, and Boss, five, to grow up without their mother. Still grieving, Jessica, from Northern Ireland, says she finds social media posts advocating sunbed use and tan-boosting products distressing. 'It makes me so sad and angry. They make it sound like having a sunbed is harmless, when it's not. "As a family, we learned that the hardest way. Everything that Tazmyn went through began with sunbed use. "I was devastated when we lost her. I still am. She wasn't just my sister, but my best friend. 'My daughter would never use a sunbed, as she knows what happened to her aunt, but her friends do – some are only 13. "They are easily influenced by TikTok and Instagram.' This high-intensity UVA radiation can lead to genetic changes and mutations over time, which can build up and increase the risk of skin cancer. Susanna Daniels, CEO of Melanoma Focus The charity Melanoma Focus recently revealed that almost a third of people aged 16 and over in the UK use sunbeds, and that figure rises to 52% among 18-21 year olds. "More worryingly, only 47% of that age group understood that sunbeds increase their risk of skin cancer – and 20% even believed it could decrease the risk. 'These figures are really concerning,' says Susanna Daniels, CEO of Melanoma Focus. 'There is a swathe of misinformation on social media. Rather than being good for your health and increasing levels of vitamin D, as some influencers claim, most sunbeds mainly emit UVA radiation – which damages the DNA in skin cells – rather than UVB, which is required for vitamin D production. 'This high-intensity UVA radiation can lead to genetic changes and mutations over time, which can build up and increase the risk of skin cancer. In 2009, the International Agency for Research on Cancer classified UV radiation from commercial tanning beds as a type 1 carcinogen – putting it in the same category as smoking and asbestos,' explains Susanna. 'As a charity, we are very concerned about this widespread misinformation circulating on social media. "This has been on the rise in recent years and it may be leading people to make harmful choices.' Despite hearing stories like Tazmyn's, Taylor says she has no plans to ditch her TikTok tan any time soon. 'I sometimes worry about the risk and I do check my moles, but I'm young and I put it to the back of my mind,' she confesses. 'People drink, smoke, vape or eat junk food. Lots of things we do are bad, but we do it anyway. For me, a tan is worth the risk.' 'If young people aren't making the right choices, we need to help them' Meanwhile, Jessica has a very different message. 'I'd like to see sunbeds banned like they are in other countries such as Australia, or at least some restrictions so they are not promoted online,' she says. 'When you're young, you don't think about the risks, but if young people aren't making the right choices, we need to help them.' 'Skin cancer took my sister from me and robbed her children of their mother. "My message to young women is: please stop using sunbeds, and ignore these influencers promoting them. Your life is worth more than a tan.' Call the Melanoma helpline on 0808 801 0777, 1-2pm and 7-9pm Monday-Friday, 7-9pm on Sundays ( 6 6

Daily Mail​

32 minutes ago

• Daily Mail​

The Stitch-Up by Emma Szewczak with Dr Andrzej Harris: Help! My vagina has fallen out

The Stitch-Up by Emma Szewczak with Dr Andrzej Harris (Chatto & Windus £22, 288pp) In 2019, Emma Szewczak was being sewn up following the birth of her second child when the midwife paused and said: 'Your vagina's fallen out.' Those words, the author says, were the worst thing anyone had ever said to her. Not even a problematic first experience of childbirth could have prepared her for this. Eventually informed she was suffering a prolapse, she spent three years seeing specialist after specialist, moving from the NHS to private care to the so-called 'wellness' sector, with no one able to offer a solution. Along the course of that journey Szewczak and her husband Dr Andrzej Harris (Associate Professor of Pharmacology at Cambridge) became angrily aware of how many aspects of medicine let women down. Angry and frustrated, they wanted to find out why there's a complete lack of treatment options for conditions (from endometriosis to menopause and everything in between) affecting vast numbers of women across the world. The couple set out to examine 'how medical misogyny harms us all'. The shocking healthcare failures, in medical care and research, may or may not always be the result of institutional 'misogyny' – although most feminists (as I count myself) would level that charge. The problems are acute. In recent years there have been many books on this subject, from Elinor Cleghorn's Unwell Women to Breaking The Taboo by Theo Clarke. The personal stories are bleak, the cold carelessness in female as well as male medical staff often appalling – as Szewczak and Harris make clear. The case for the prosecution mounts: the outrage of vaginal mesh implants, the lack of awareness of potential birth trauma and perinatal psychosis, unnecessary breast surgeries as well as vaginal nips and tucks post-birth, inappropriate intimate examinations, and (of course) the series of maternity hospital scandals, including Shrewsbury and Telford. Endometriosis makes thousands of women suffer but doctors often fail to consider the condition when women seek help for their specific range of symptoms. Why? Underpinning this densely researched book is a simmering rage that women are so often addressed with patronage or indifference. In case you thought the process of birth a doddle, Szewczak provides a frightening litany of possible complications: 'Perinatal tearing… injuries to the pelvic floor… lacerations… episiotomies can become complicated with infection, pain and excessive bleeding… the bladder and urethra can be injured… severe bleeding and shock… damage to the symphysis pubis… postpartum haemorrhage…'. And much more. Who'd be a woman? Which is my problem with the book. For none of the above horrors will be suffered by biological males calling themselves female – or 'trans women', as they would have themselves identified. Yet routinely Szewczak uses the terms 'cis woman' or 'cisgender' for those of us born with the apparatus likely to cause us trouble throughout life, from the first period to the menopause and beyond. How can a book that claims to attack the neglect of women's health dare to belittle the experience of real women by calling it 'cisnormative'? And, astonishingly, just after the dire 'obs-and-gynae' catalogue above, Szewczak, with a degree in gender studies, attacks 'misgendering' (meaning consciously or accidentally calling someone the wrong gender) and 'obscene waiting times for gender-affirming care' for trans people. Is 'misgendering' really as bad as a prolapse or stillbirth? For Szewczak, the answer seems to be yes.