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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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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.

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.

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.

Q. I am currently receiving annual chest CT scans to check for hidden lung cancer (I used to be a heavy smoker). Should I be concerned about the cumulative effects of radiation exposure?

A. Radiation from medical scans can cause cancer, but the level of exposure considered potentially dangerous appears to be many times greater than the average CT scan. In addition, cancer from medical scans takes decades to develop, which makes it less of a concern for men being screened for lung cancer, which is currently only recommended for current or former smokers ages 55 and older. Radiation from CT scans is a bigger concern for children and young adults, who have more time to develop cancer after exposure to medical x-rays.

You may drink coffee because it tastes good or helps you wake up. But the popular brew is also associated with health benefits, such as reducing the risk for heart disease, stroke, and type 2 diabetes. Now a study from Harvard-affiliated Dana-Farber Cancer Institute published Aug. 17, 2015, in the Journal of Clinical Oncology suggests that regular consumption of caffeinated coffee may be associated with a reduced recurrence of colon cancer, and even a reduced risk of death. The study included nearly 1,000 people with stage 3 colon cancer. They filled out questionnaires about their dietary patterns during chemotherapy, and then again six months after treatment was completed. People who drank four or more cups of coffee per day were 42% less likely to have cancer return than non-coffee drinkers, and were 34% less likely to die from cancer or any other cause.

This type of study doesn't prove that coffee drinking caused the lower chance of cancer recurrence and death. A randomized trial is needed to show cause and effect. But researchers are encouraged by the results. "Regular coffee intake has been associated with a reduced risk of type 2 diabetes, and it may be that through a similar mechanism, coffee may also improve outcomes for people with advanced colon cancer," says Dr. Charles Fuchs, senior author on the paper.

Treatment decisions are complicated for men with low-risk prostate cancer that grows slowly. These cancers may never become deadly during a man’s expected lifespan. And there is no conclusive evidence showing that treatment in these cases extends survival. So cancer specialists have been leaning toward monitoring low-risk prostate cancer carefully and starting treatment only when it begins to spread. This approach was once used only in academic cancer centers, but new research suggests that this strategy is becoming more common in urology practices throughout the United States and other countries as well.

Can a healthy diet help men with low-risk prostate cancer live longer? The authors of a new study say “yes.” A long-running Physicians’ Health Study, suggests that a diet that is good for the heart, brain, and other parts of the body may also help keep low-risk prostate cancer at bay. On the flip side, a diet rich in red meat and high-fat dairy foods appears to be hazardous for men with this kind of cancer. It isn’t clear why a diet that protects against heart disease would also protect against death from prostate cancer. Dr. Chavarro speculates that it’s because high-fat foods are easily broken down and absorbed by the digestive system, and so they might provide quick energy sources for growing tumors. Nevertheless, the results suggest that by eating healthily, men with prostate cancer can take a proactive step towards living a long life.