I might have avoided ovarian cancer if I lived in England not Wales
Had Heather Morgan lived in England when she was diagnosed with breast cancer 12 years ago, she feels there is a good chance she would never have gone on to develop ovarian cancer.
But her postcode – eight miles (12km) west of the English border, in Monmouthshire – meant she was not eligible for a test which would have revealed that her genetics put her at a much greater risk of developing the secondary cancer.
In 2014, patients in England with triple negative breast cancer who were under 50 – as Heather was – were immediately put forward for genetic testing. But in Wales, they were not.
If Heather had had the test, she said it would have prompted her to have both ovaries removed pre-emptively.
“I am mad annoyed,” said the 59-year old.
“It’s changed everything,” she added, explaining that statistically her 10-year survival chances are 35%.
The Welsh government said a minister for preventative and public health had been appointed to address issues like this and there would be an emphasis on improving early detection in a cancer plan for Wales.
It was not until 2021 that a visible lump in Heather’s abdomen prompted further tests, and she was diagnosed with ovarian cancer.
She then learned that she had the BRCA1 gene mutation, putting her at a greater lifetime risk of both breast and ovarian cancer.
“Had I been tested [in 2014] we would have immediately known I was at high risk for ovarian cancer,” she said.
“I would have immediately had my ovaries removed. It would have been a no-brainer.
“And if they’d have said to have a double mastectomy at that point, I would have.”
Heather was 46 at the time and has kept the letter from the all-Wales genetic testing service telling her why she was not eligible.
In essence, it explained the Welsh government of the day was committed to meeting NICE guidance within the financial year, but at the time work was still being done to increase capacity for testing.
By 2015 the rules in Wales had changed to align with England, but by then Heather had finished her treatment and was not invited for the test.
“If I’m going to the supermarket and I’ve gone a bit over budget I’ll think, why save money? What’s the point, you’ll be dead next week, just buy it,” said Heather.
“Something came through the post about retirement homes – am I going to live that long? Should I be worrying about that? No.”
Heather now supports the National Hereditary Breast Cancer Helpline, a charity which gives advice to people with inherited cancers to make them better aware of the options and rules.
The helpline recently opened an information centre in Flint, north Wales – its first in the country – and is also now branching out to offer support for the cancers associated with BRCA gene mutations.
The helpline’s founder, Wendy Watson, said disparities were not just cross-border but could exist between health boards and trusts across England and Wales.
“We do have postcode lottery healthcare,” she said.
“We shouldn’t have – NICE guidelines should sort that out, but at least we’re here to provide people with access to the information.”
Heather’s family has seen first-hand that discrepancies exist between English health trusts too.
She has two adult daughters and while her youngest has been invited for genetic testing in the north-east of England, her eldest daughter in the north-west, has not.
What are BRCA1 and BRCA2 gene mutations?
BRCA1 and BRCA2 gene mutations greatly increase an individual’s chance of developing certain cancers, including breast and ovarian.
According to the NHS women in the UK have a 12.5% chance, on average, of developing breast cancer in their lifetime and a 2% chance of developing ovarian cancer.
For women with BRCA1 gene alterations, those lifetime risks increase to 72% for breast cancer and 44% for ovarian.
For women with BRCA2 gene alterations, the lifetime risks increase to 69% for breast cancer and 17% for ovarian.
They both come with an increased risk of developing the cancers at a younger age.
NICE guidance recommends annual MRIs to women with BRCA gene mutations from the age of 30-49, with annual mammograms possible from 40 onwards.
While Louise Owen’s experience is different, there is a common theme of conflicting advice and discrepancies which prompted her to lean on the support of the helpline.
The 36-year-old has known for over a decade that she carries the BRCA2 gene mutation, again putting her at an increased lifetime risk of breast and ovarian cancers.
When she turned 30 she had her first MRI as part of the screening available for those with an inherited risk.
But she was told subsequent annual MRIs were not possible as she was breastfeeding, despite her own research suggesting they were safe.
The issues set out by the Breastfeeding Network, Royal College of Radiologists and Society of Radiographers point to questions around the contrast dye that is injected before a breast MRI.
Each conclude that while personal choice is key, it is safe to continue breastfeeding after an MRI “as there is no evidence of risk to the baby/child”.
However Breast Test Wales said: “MRI breast screening is possible while a woman is breastfeeding but the accuracy of the imaging is reduced due to the changes in breast tissue, which can also lead to unnecessary interventions.”
Louise, a mum-of-two, said: “I’m really angry about it, because I feel like why should I have to choose whether I get screening or whether I stop breastfeeding?”
Having seen her own mother go through years of cancer treatment before she passed away in 2016, Louise said her own risk of developing cancer played on her mind a lot and screening would help allay those fears.
However, as a breastfeeding peer support worker, she also feels strongly that she wants to continue feeding her three-year-old until he is ready to stop.
A spokesperson for Breast Test Wales said: “The All-Wales programme for screening this very high risk group of women was rolled out earlier this year across all regions of the country, to provide a consistent service across Wales which is delivered at a hospital in their region.
“MRI breast screening is possible while a woman is breastfeeding but the accuracy of the imaging is reduced due to the changes in breast tissue, which can also lead to unnecessary interventions.
“Breastfeeding for the first six months of a baby’s life provides them with the best nutrition and also helps in reducing the risk of breast cancer in the mother.
“Breast awareness is always important but particularly so for this group of women at higher risk, and we would advise that they continue to carry out self-examination regularly, and seek medical advice if concerned, while pregnant and breastfeeding.”
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A Northern Californian has been confirmed as the fourth-ever person diagnosed with a newly recognized and rare tick-borne disease that causes symptoms similar to Rocky Mountain spotted fever.
The California Department of Public Health confirmed the latest case of Rickettsia lanei bacteria in a patient who was diagnosed in April of this year. Two other California cases were reported in 2004 and 2023.
Public health officials told The Times that the infected person “was seriously ill, hospitalized and has since been discharged and is recovering.”
It is unclear how long the person was in the hospital or what their symptoms were. The state agency said it could not disclose the home county of the person but confirmed the infected person lived and worked in Northern California.
Rickettsia lanei comes from the spotted fever group Rickettsia, bacteria transmitted to humans from the bite of an infected tick.
In California three types of ticks — the American dog tick (Dermacentor similis), the Pacific Coast tick (Dermacentor occidentalis) and the brown dog tick (Rhipicephalus sanguineus) — can transmit the bacteria that cause Rocky Mountain spotted fever in humans and dogs, according to the California Department of Public Health.
Symptoms of Rocky Mountain spotted fever can range from fever and a rash to long-term effects that include damage to internal organs or neurological disorders.
The tick-borne disease has been spreading globally since the early 2000s, most notably in Mexico and Brazil, with reported fatality rates that can exceed 50%, according to a study published by UC Davis.
What is Rickettsia lanei?
Rickettsia lanei bacteria were identified this year in a few Pacific Coast ticks, including a tick in Contra Costa County, according to SFGate, where the latest case was first reported in April.
The new bacterium was added to the list of potentially transmittable pathogens in 2024 by the state public health department after its severe symptoms were studied in two cases of infected men nearly 20 years apart, according to a report published in the Centers for Disease Control and Prevention Emerging and Infectious Diseases journal.
“Sustained investment in public health has enabled development of the advanced molecular tools that detected these infections,” the California Department of Public Health said in a statement to The Times.
According to the report, both men fell ill after spending time outdoors, one playing golf at five courses in Alameda and Contra Costa counties within 14 days of the onset of his symptoms. This first patient had fever, headaches, muscle pain, malaise, loss of appetite, diarrhea and abdominal pain, among other symptoms. His condition worsened on his third day in the hospital, according to the report. The man was ultimately in the hospital for 22 days, including 11 in the intensive care unit with a primary diagnosis of rocky mountain spotted fever and a secondary diagnosis of acute kidney injury.
The other infected person had visited and camped at a county park and state beach in San Mateo and Marin counties. The second man reported a five-day history of headaches, vomiting, light sensitivity, neck pain and confusion, according to the report. On the third day of hospitalization, the man became comatose and was intubated, the report stated. After 13 days, he was discharged with a primary diagnosis of severe Rickettsia.
Researchers have known about Rickettsia lanei since 2018 when it was detected in rabbit ticks in Sonoma County, but they didn’t know its potential harm to humans because the rabbit tick rarely bites people.
“The Pacific Coast tick, which bites humans more frequently, may occasionally acquire the organism from an infected rabbit, which is the most likely route for the rare human infections that have been identified,” the state health agency said.
Should I be worried about contracting Rickettsia lanei?
Human infections are rare but could be underreported because Rickettsia lanei symptoms are very similar to those of rocky mountain spotted fever, said Janet Foley, veterinarian and disease ecologist at UC Davis.
“I think it’s so new that I don’t know if anybody’s really gotten a grant to study it or put it under a microscope,” Foley said.
Rickettsia lanei bacteria cases could also have gone undetected for so long because some cases were not severe, she said.
Foley said Californians should be aware of Rickettsia lanei and take precautions against tick bites.
How to keep disease-carrying ticks at bay
The best way to avoid ticks and tick bites is to be vigilant in your surroundings, Foley said, noting that ticks can transmit other diseases such as Lyme disease.
To keep a disease-carrying tick at bay, Foley recommends:

A Santa Clara County resident who was exposed to measles visited San Francisco International Airport, Trader Joe’s in San Jose on Coleman Avenue and International Halal Market on E. Santa Clara Street on June 8.
The resident was at SFO from 8:30 to 11 a.m. and at Trader Joe’s and International Halal Market between 8 and 10 p.m. The county’s health department is asking people who may have stopped at any of those locations during the mentioned hours to report any symptoms.
“We want members of the public to be aware if you were in those locations at these times to be aware of possible exposure especially if you’re pregnant, an infant or have compromised immunity or are unvaccinated,” said Dr. Sarah Rodman, Santa Clara County’s public health officer.
UCSF Infectious Disease Specialist Dr. Peter Chin-Hong said there is an increase in measles cases across the United States.
“A lot of this is fueled by the increase in exemptions that people are getting for being vaccinated at the kindergarten level,” Chin-Hong said.
Chin-Hong estimates 5-10% of Californians are not vaccinated for measles.
As visitors from all over the world arrive for events such as the World Cup, concerns arise for health professionals and citizens.
“I wish people who could get vaccinated for preventable disease would do so for everybody,” said Teresa Perkins, who shops at the San Jose Trader Joe’s location that was exposed.
According to Chin-Hong, measles is one of the most transmissible infectious diseases. Symptoms include fever, cough, runny nose, red eyes and a rash, which can appear 7 to 21 days after exposure.
Chin-Hong said the risk of getting sick is low if you have received your two-dose measles vaccine.
Santa Clara County Public Health said no new cases of measles have been reported since the June 8 public exposure.

Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) has soared in recent years, but researchers have found it’s still under-recognised and under-diagnosed, especially in adults over the age of 65.
About 2.5million people in the UK have ADHD, according to the NHS. Data published in March 2026, also revealed a further 683,088 had been referred for an ADHD assessment – an increase of more than 130,000 on the previous year.
A study led by researchers at UCL, University of Liverpool and King’s College London revealed rates of new ADHD diagnoses increased after 2020 across most age groups.
The highest rates were observed in boys under 18-years-old, while increases among adults were particularly notable in women. But diagnosis rates among adults aged 65 and over remained consistently low.
Lead author Dr Amber John, who began the research at UCL before moving to the University of Liverpool, said: “The low rates observed in older adults don’t necessarily mean that ADHD is uncommon in older age.
“Instead, they may reflect historical differences in recognition and access to diagnosis, particularly among generations who grew up before ADHD was widely recognised.”
In the study, published in the journal The Lancet Regional Health Europe, researchers found that while 1.19% of people in England had an ADHD diagnosis in their primary care record, recorded diagnosis rates were notably lower across all age groups compared with the international estimates of actual ADHD prevalence, which typically range between 3% and 5%.
This gap was especially large in older adults, with just 0.05% of men and women over the age of 65 diagnosed with ADHD.
The researchers say their findings show that while diagnosis rates for ADHD have increased substantially over the past decade for children and adults, recorded diagnoses of ADHD in England are still lower than the best available estimates of ADHD prevalence.
Data from more than 3.5 million people registered with GP practices in England in 2025 was used to estimate the proportion of people with a recorded ADHD diagnosis at this time.
Researchers then compared this with published estimates of ADHD prevalence in the general population from international studies and used data from more than 42 million patients in England to examine diagnostic trends in ADHD from 2000 to 2024.
“When we compared recorded ADHD diagnoses with published estimates of how common ADHD is in the population, we found a substantial gap across every age group,” Joint first author Dr Gavin Stewart, British Academy Research Fellow at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, said.
“This gap was especially large in older adults, suggesting that many people may have gone unrecognised,” he added.
Dr Angela Hind, Chief Executive of the Medical Research Foundation, commented: “ADHD can profoundly affect many aspects of a person’s life – education, work, relationships – and it often co-exists with other neurodevelopmental conditions.
“When it goes undiagnosed or unsupported, people may spend years not understanding the challenges they face.
“We’re proud to support research that will help strengthen ADHD services and ensure more children and adults can get the recognition and help they need.”

The popular assumption about empathy, repeated across most of contemporary psychology, ethics, education, and public discourse, is that it is one of the unambiguously good human capacities. The empathic person feels what other people feel, understands their suffering, and is for that reason motivated to act in ways that reduce suffering rather than cause it. The assumption is intuitively appealing and, until recently, has been broadly shared across most of the scientific and clinical disciplines that study human behaviour.
The peer-reviewed evidence of the past two decades has substantially complicated the picture.
Empathy, on the strongest current reading of the social neuroscience and personality literature, is selective rather than universal. It is exhaustible rather than inexhaustible. It is exploitable rather than reliable. And in some cases, it can be one of the cognitive resources that the most dangerous personalities in the population use most effectively against the people they are harming.
The Heym 2020 study
In 2020, Nadja Heym and colleagues at Nottingham Trent University published a peer-reviewed study in the journal Personality and Individual Differences that used a statistical technique called latent profile analysis to identify distinct personality patterns within a sample of 991 adults. The participants completed standardised measures of empathy and of the three personality traits collectively known as the Dark Triad: narcissism, Machiavellianism, and psychopathy. The Dark Triad has been studied since the early 2000s as a cluster of socially aversive but non-clinical personality traits that show consistent associations with manipulation, exploitation, and reduced concern for others.
The standard assumption in the personality literature, before the Heym study, was that high empathy and high Dark Triad traits were essentially mutually exclusive. The empathic person was, by definition, not the narcissistic or Machiavellian person. The latent profile analysis tested this assumption.
It did not hold up.
The Heym team identified four distinct profiles in the sample. The Typicals (approximately 34 per cent) had moderate empathy and low Dark Triad traits. The Empaths (approximately 33 per cent) had high empathy and low Dark Triad traits. The Dark Triad group (approximately 13 per cent) had low empathy and high Dark Triad traits, matching the standard assumption in the literature. The fourth group, comprising approximately 19 per cent of the sample, had high empathy combined with high Dark Triad traits. The team called this group the Dark Empaths.
The Dark Empaths were not a hypothesised construct or a clinical category. They were a statistical pattern that emerged from the data, in approximately one in five participants. The proportion has since been broadly replicated in follow-up studies on samples from different countries.
What the dark empath profile actually shows
The follow-up analyses in the Heym study found that Dark Empaths shared some characteristics with each of the other two relevant groups but differed from both in specific ways. Like the standard Dark Triad group, the Dark Empaths showed elevated rates of indirect aggression, including gossip, rumour spreading, social exclusion, and the strategic damage of other people’s reputations. Like the standard Empaths, they showed higher emotional understanding of others and more accurate perception of other people’s mental states.
The combination produced what the team described as an “antagonistic core with empathy.” The Dark Empaths were not simply Dark Triad individuals with a softer surface presentation. The empathy was real, on the measurement instruments used. What distinguished the Dark Empaths from typical empaths was not the absence of empathy but the use to which empathy was put.
Empathy, on this reading, is a cognitive tool. It can be used to identify suffering in others and to reduce that suffering. It can also be used to identify suffering in others and to exploit it. The Heym team’s evidence suggests that approximately a fifth of the adult population is using it for the second purpose at least as often as the first, even while scoring as highly empathic on standard measures.
A short video explains more about the psychology behind dark empaths and why they are so hard to spot – click here to watch it.
Empathy is selective
The Dark Empath finding sits within a broader scientific reassessment of empathy that has been gathering peer-reviewed evidence for approximately two decades.
The most fundamental challenge to the popular framing comes from the social neuroscience research showing that empathy is selective rather than universal. Functional magnetic resonance imaging studies have consistently found that the same neural circuits that activate when a person observes pain in an in-group member fail to activate, or activate substantially less, when the same person observes pain in an out-group member. The effect has been measured across racial, national, religious, political, and team-affiliation categories. People do not, on the neural evidence, feel the same empathy for everyone. They feel substantially more empathy for people who are like them.
The selective activation of empathy is one of the most consistently replicated findings in social neuroscience. It also has direct implications for how empathy operates as a moral guide. A moral system based on empathy is, by the neural evidence, a system that systematically over-weights the suffering of the in-group and under-weights the suffering of the out-group. This is not a bug in the empathy system. It appears to be how the empathy system was designed by evolution to operate.
Empathy is exhaustible
The second major challenge to the popular framing comes from the empathy fatigue research. Tania Singer and Olga Klimecki of the Max Planck Institute for Human Cognitive and Brain Sciences published a foundational paper in Current Biology in 2014 that examined the neural and behavioural consequences of sustained exposure to the suffering of others. The findings, which have since been replicated across multiple populations, indicate that prolonged empathic engagement with suffering activates the same neural pain pathways in the empathiser as in the person being empathised with. Over time, sustained empathic engagement produces measurable distress, anxiety, and depression in the empathiser.
The Singer and Klimecki paper made a further distinction that has become increasingly important in the empathy literature. Empathy, in the technical sense the team used, is the affective sharing of another person’s emotional state. Compassion is different. Compassion involves caring about the suffering of others without sharing it in the same direct affective sense. The two states activate different neural networks. Empathy activates the anterior insula and anterior cingulate cortex, the same regions that process physical pain. Compassion activates the ventral striatum, the medial orbitofrontal cortex, and the ventral tegmental area, the regions that process reward and motivated action.
The practical implication of the distinction is that compassion is sustainable in ways that empathy is not. The healthcare worker who maintains compassion for patients across a thirty-year career does not do so by feeling the patients’ pain on an ongoing basis. The patients’ pain, sustained at that intensity over decades, would damage the worker’s mental health. What the long-career healthcare worker has typically learned to do is to care for patients without sharing their distress, which is a different and more durable cognitive state.
The Bloom case
The most prominent recent popular articulation of these findings is the 2016 book Against Empathy: The Case for Rational Compassion by the Yale psychologist Paul Bloom. The book drew on the social neuroscience and personality research described above to argue that empathy, properly defined, is a poor guide to moral judgment. Bloom argued that the same evidence supporting empathy’s selectivity and exhaustibility also supported a substantial reorientation of how psychology and ethics should treat empathy.
The Bloom argument is not that empathy is bad. The argument is that empathy is a specific cognitive capacity that operates in specific ways and has specific consequences, some of which are good and some of which are not. The popular framing in which empathy is the moral foundation of human goodness does not survive contact with the empirical evidence. What does survive contact with the evidence is a more limited claim: empathy is one of several cognitive resources that humans use in their social and moral lives, with both benefits and costs that depend on how it is deployed.
The Bloom case has been contested by other researchers, including the developmental psychologist Jamil Zaki of Stanford University, who argues that empathy can be trained and refined rather than abandoned. The disagreement is genuine and ongoing in the peer-reviewed literature. What is not in dispute is that the previous consensus, in which empathy was treated as unambiguously good and the only question was how to increase it, is no longer scientifically defensible on the available evidence.
The honest limitations
Several methodological caveats apply to the literature described above.
The Dark Empath construct, while peer-reviewed, is relatively new. The Heym 2020 study has been replicated in some follow-up work but not yet across the breadth of populations and cultures that would establish it as a robust personality category. The 19 per cent proportion identified in the original sample may differ in samples from other cultures, age groups, or socioeconomic contexts. The construct is genuinely supported by the available evidence but should be treated as a current scientific hypothesis rather than as an established personality category.
The neural research on empathy and compassion, while strong, is based largely on laboratory measures of brief emotional responses to specific stimuli. The relationship between laboratory neural patterns and the empathy people actually exercise in their daily lives is plausible but not perfectly direct. The Singer and Klimecki framework has been broadly accepted in social neuroscience but is not the only available model.
The in-group and out-group selectivity of empathy has been measured robustly but is also context-dependent. The same individual can show strong empathy for an out-group member in some circumstances and reduced empathy for the same person in others. The selectivity is not a fixed personality trait but a context-sensitive cognitive bias.
What it means
Several things follow from the differentiated picture of empathy that are worth saying clearly.
The first is that empathy is not, on the strongest current reading of the evidence, a reliable moral compass. It is a cognitive capacity that operates selectively, depletes with use, and can be deployed by people whose intentions are not aligned with the welfare of those they are empathising with. The popular framing in which empathy is the foundation of human goodness underestimates each of these complications.
The second is that the alternative the peer-reviewed literature points to is not the abandonment of empathy but the recognition that compassion is a distinct and more durable mental state. Compassion does not require feeling another person’s pain. It requires caring about another person’s welfare. The distinction has measurable neural correlates and measurable practical consequences for how the two capacities can be sustained across time.
The third is that the existence of the Dark Empath profile, which approximately a fifth of adults appear to display, has practical implications for how individuals navigate their personal and professional relationships. The standard heuristic that emotional understanding equals safety is not, on the available evidence, reliable. Someone can read another person’s emotional state with substantial accuracy and use that reading to manipulate rather than to help. The popular framing that the most dangerous personalities are emotionally cold is, on the Heym evidence, incomplete. Some of them are emotionally warm and using that warmth strategically.
The fourth, on the strongest current reading of fifty years of research that has now substantially shifted in its conclusions, is that empathy is real, important, and useful, but it is not what it has been popularly assumed to be. It is one cognitive tool among several, with specific properties that determine how it operates and what it can and cannot do.
What it cannot do, by the available peer-reviewed evidence, is reliably tell us who is trustworthy and who is not.