Bone marrow produces many kinds of blood cells

DEAR DR. ROACH » You have mentioned diseases of the blood marrow in the column before, but what does the bone marrow actually do? DEAR READER » The main job of the bone marrow is to produce the different blood cells: red blood cells to carry oxygen; white blood cells to fight infection and cancers; and platelets to stop bleeding. Diseases of the bone marrow can cause problems by making something abnormal (such as leukemia cells), but also by failing at its job and not making what it is supposed to. Low red cell counts lead to anemia; low white cell counts increase risk of infection; and low platelet counts contribute to abnormal bleeding.

Bone marrow diseases sometimes can be treated directly, but often treatment involves replacing blood products, and possibly using growth factors to make the bone marrow work better.

DEAR DR. ROACH » I know women who have had double mastectomies in order to reduce the risk of cancer. It seems extreme, but I guess it depends on the evaluation of risk. Are prophylactic hysterectomies done for similar reasons? It used to be routinely done when a woman had passed her reproductive years. I’m interested in your take on this. Will health insurance cover these types of surgeries, and if not, how expensive are they? DEAR READER » Prophylactic mastectomies — that is, surgery to remove the breasts in order to avert a breast cancer diagnosis — are a reasonable choice for some women at very high risk of breast cancer, especially those with a family history of breast cancer who have an identifiable genetic predisposition, such as one of the BRCA gene mutations. This decision should be made carefully and in consultation with her doctors, usually an oncologist and a genetic counselor.

Hysterectomy — the removal of a uterus — is not done routinely today, the way it was decades ago. They are removed for disease, either benign or malignant. However, the removal of both ovaries and Fallopian tubes, called a bilateral oophorectomy and salpingectomy, is performed in some women at high risk for ovarian cancer

The cost of surgery in the United States varies dramatically depending on where it is done, but in general it is very expensive.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.