Cancer Archive

Ask the doctor

Q. I'm a 48-year-old woman, and I've never had a mammogram. Different guidelines seem to say different things. What do you recommend?

A. You're right, there are several different guidelines. Probably the two most often consulted by doctors are those of the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS). Recent changes by the ACS bring its recommendations nearer to those of USPSTF. They disagree slightly about you. ACS says you should have a mammogram (because you are over 45), but USPSTF says to begin at age 50. Both expert committees stress that these recommendations apply only to women who are not at extra risk of breast cancer (extra risk includes, for example, having a parent, sibling, or child who's had breast cancer). If a woman is at extra risk, she should start getting mammograms earlier.

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News briefs

The guidelines for routine breast cancer screenings are changing again. The American Cancer Society (ACS) published its new recommendations Oct. 20, 2015, in The Journal of the American Medical Association, suggesting that women at average risk for breast cancer now wait until age 45 to begin getting yearly mammograms (it had been age 40) and then get yearly mammograms until age 54. After that, the ACS now recommends that average-risk women ages 55 to 74 transition to screening every other year (instead of annually). It's a big shift for the ACS, and the recommendations are now more in line with the guidelines that came from the U.S. Preventive Services Task Force (USPSTF) in 2009, which recommended mammograms every two years for average-risk women ages 50 to 74 and advise against routine screening before age 50 in these women. The USPSTF guidelines have been controversial since they came out. But no one is saying that women at increased risk for breast cancer should wait to get a mammogram; it's a decision that must be made by a woman and her doctor, based on her risk factors. One other big change to the ACS guidelines: that women continue screening mammography only if they have a life expectancy of 10 years or longer.

Ask the doctor

Q. I've read news reports that the heartburn drug I take may cause heart attacks. Should I worry about this?

A. Several studies have reported an association between proton-pump inhibitors (PPIs) and heart attacks. PPIs are medications for heartburn, such as omeprazole (Prilosec) and pantoprazole (Protonix). Overall, however, the evidence suggests these medications are not risky for your heart.

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Ask the Doctor

Q. I had a vasectomy many years ago, at age 45. I recently read that this increases my risk of prostate cancer. Should I be concerned?

A. Despite the reports you've heard about the connection between vasectomy and prostate cancer, the evidence is weak for a cause-and-effect relationship. Right now, this hypothetical risk should not cause you undue concern.

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Research we're watching

A preliminary study published Sept. 14, 2015, in JAMA Internal Medicine reported that older women in Spain who ate a traditional Mediterranean diet enhanced with extra-virgin olive oil were less likely to be diagnosed with breast cancer. The study was part of a large Spanish clinical trial, Prevención con Dieta Mediterránea (PREDIMED).

PREDIMED looked at three different groups of women. One followed the Mediterranean diet plus extra servings of olive oil. A second followed the diet plus extra servings of nuts. Those in the third group were ad-vised to reduce their fat intake. The study followed about 4,300 women ages 60 to 80 for five years.

A new study confirms that active surveillance is a safe and reasonable alternative to immediate treatment for prostate cancer. In recently published study that followed 1,300 men, the prostate cancer survival rate after 10-15 years of active surveillance, was 99%. For some men, a strong discomfort with “living with cancer” may steer them away from postponing treatment in favor of careful monitoring.

A new study confirms that active surveillance is a safe and reasonable alternative to immediate treatment for prostate cancer. In recently published study that followed 1,300 men, the prostate cancer survival rate after 10-15 years of active surveillance, was 99%. For some men, a strong discomfort with “living with cancer” may steer them away from postponing treatment in favor of careful monitoring.

Q. I've been having abdominal pain that may be due to gallstones. Is surgery the best solution, or are there other things I can try first?

A. The first thing to determine is whether your abdominal pain is in fact due to gallstones. They typically cause pain on the upper right side or in the center of the abdomen just below the breastbone that radiates to the back or right shoulder. The pain is often brought on by eating—especially fatty foods—or may occur at night. Sometimes gallstone pain is accompanied by sweating, bloating, nausea, or vomiting.

The purpose of treating ductal carcinoma in situ (DCIS)—the earliest, noninvasive form of breast cancer (often called "precancer")—is to prevent those lesions from becoming invasive and thereby greatly reduce the risk of dying from breast cancer. As mammography has become more precise, it has detected more DCIS, and more women get treatment with surgery and often radiation as well. An analysis published online by JAMA Oncology on Aug. 20, 2015, adds to increasing questions about the best way to manage DCIS in most women diagnosed with it.

Canadian researchers analyzed 20 years of data from 108,000 women with DCIS in a database maintained by the National Cancer Institute. Most women were treated with lumpectomy, often followed by radiation, or mastectomy. The researchers found that treatment with radiation or mastectomy did not lower the overall breast cancer death rate in women with DCIS. It remained at 3.3%—the average death rate from all breast cancers. However there were some groups—including African American women and women under 40—in whom the death rate was higher (7% to 8%).

Q. Some of my friends take saw palmetto supplements to reduce urinary problems caused by an overgrown prostate, which I was recently diagnosed with. My friends swear by it, but is there any good evidence this stuff helps? Is saw palmetto safe?

A. The short answer is that we don't have great scientific evidence that taking saw palmetto truly reduces male urinary problems. On the other hand, it doesn't appear to cause major side effects either.