San Antonio Express-News (Sunday)
Mom worries about husband’s family history of breast cancer
Q: I am concerned that my 33-year-old daughter will have breast cancer. I have no history in my family of breast cancer, but my husband’s grandmother, mother and sister all have had breast cancer with double mastectomies. I have heard that the DNA follows the mother’s side and not the father’s. Is this true or an old wives’ tale? Should she have a BRCA test?
A: Most cases of breast cancer are sporadic, meaning there is no particular identifiable family risk to develop breast cancer. However, there are identified genetic risks, especially including the BRCA1 and BRCA2 genetic variants, which are worth testing for in certain situations.
The guidelines for testing a person for BRCA1/2 are complicated, and I don’t have enough space to even summarize them here. However, the family history you’ve given is probably not enough to recommend gene testing (unless there are other factors, such as an Ashkenazi Jewish background). The types of breast cancer (such as “triple negative” breast cancer) and the ages at which the family members were diagnosed are also important.
The genes for BRCA1/2 are autosomal, not X-linked, meaning that it doesn’t
(much) matter whether they come from the maternal or paternal side. Slight differences due to something called epigenetic changes can mean people who inherit BRCA2 from their father tend to have their breast and ovarian cancers diagnosed at a younger age than if it came from their mother.
Ideally, the person who had the cancer (breast, ovarian, pancreas, and prostate cancers all are affected by BRCA genes) should get tested, not only for BRCA1/2, but other newly identified genetic susceptibility genes.
The best advice on whether testing for your daughter is appropriate would come from a genetic counselor.
Q: Are studies that suggest eating prunes daily might delay or prevent osteoporosis for postmenopausal women valid? Thanks.
M.S.
A: There are several studies that suggested eating prunes may have benefits on the bones. In some studies, women ate 4 ounces of prunes daily (the control group got dried apples), and blood tests suggested less bone turnover. Bone density studies suggested some benefit or at least slowing of decline among women eating prunes compared with the control group. The duration of the studies was in months — quite short, as two years is often needed to see benefits in the bone, which changes slowly.
These sorts of studies would never be acceptable for new medications to treat osteoporosis, which would require significant improvements in bone strength, or better yet, reduction in the risk of fractures. However, prunes have minimal potential for side effects, having been consumed for millennia. Prunes are well known to effectively treat constipation (which can be problematic in people who struggle with loose stools). Both men and women can get osteoporosis, though only women have been included in studies on prunes.
Compared against the currently available osteoporosis treatments, which have the potential, however small, for serious complications, prunes are very safe. They may not keep a person from requiring additional treatment, but they may help.
Q: How do you diagnose bipolar disorder? Do you need a blood test, or can it be diagnosed by a person’s actions?
A.Y.
A: Bipolar affective disorder, formerly called manicdepressive illness, is a psychiatric condition that is frequently misdiagnosed. Over a third of people diagnosed with bipolar disorder waited at least 10 years between seeking treatment for their symptoms and receiving a correct diagnosis.
The diagnosis is made clinically, meaning based on a thorough psychiatric history and exam, but also includes a medical evaluation to be sure there is not a medical condition underlying (or mimicking) the diagnosis.
The major criteria for making the diagnosis of bipolar disorder include depressive symptoms or symptoms of elevated mood. Elevated mood comes in two closely related clinical types: mania and hypomania. With both of these, people have high levels of energy and activity, and an elated or irritable mood. The person must have several of these defining symptoms:
• Inflated self-esteem (grandiosity)
• Decreased need for sleep
• More talkative than usual
• Racing thoughts
• Distractibility
• Increase in activity
(such as work or school; or sexual activity)
• Risky behaviors (buying sprees, foolish business investments, sexual indiscretions)
People with mild or moderate changes are called “hypomanic.” When these changes are severe enough to caused marked impairment in their work or social life, or require hospitalization, or when people have beliefs that are not based in reality at all (psychosis), it is called “mania.” The doctor making the diagnosis must carefully exclude the possibility that these changes are as a result of a different medical condition or related to drug use. For this reason, blood tests are necessary. They do not make the diagnosis (there is no blood test to confirm the diagnosis), but they rule out other causes (thyroid toxicosis may have some similar features, for example).
Many people with bipolar disease have predominantly symptoms of depression, with only one or few relatively mild hypomanic episodes. This is referred to as bipolar 2 disorder. Also, some people will have what looks like major depression and develop manic or hypomanic symptoms during treatment for depression:
This is bipolar disease as well and one important reason that a person being treated for depression needs close follow-up. Depression is occasionally called “unipolar major depression” to distinguish it from bipolar disorder.
Q: I am an 85-year-old female in fair health. I take medication for blood pressure and high cholesterol. My dentist recommended extracting four lower front teeth (two are resorbed), plus a bone graft to prepare for a bridge. I am concerned about medical risks due to my age.
L.H.
A: The medical risk posed by tooth extraction is quite small, even in a person in their 80s. It is not uncommon for the dental surgeon to use a bone graft to help strengthen the area for a bridge or implant. Half a million bone grafts are performed in the U.S. every year.
Infection is the most common serious side effect, and it is not likely. Very rare side effects include blood clots and nerve damage, and these are rarer still. Some discomfort and swelling after the procedure are expected, and your dentist will give you advice (and maybe medication) to treat this.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.