Dr. Keith Roach

Richmond Times-Dispatch - - COMICS, ETC. -

Dear Dr. Roach: I read that cow’s milk weak­ens the bones. Is that true?  A.H.

Dear A.H.: The pre­pon­der­ance of the ev­i­dence is that dairy in­take — like cow’s milk, yo­gurt and cheese — in­creases bone strength and re­duces frac­ture risk. How­ever, there is not the high­est level of ev­i­dence to sup­port this. In ab­sence of in­ter­ven­tional data (where one group is given cow’s milk and the other given some­thing else), we have to rely on other kinds of ev­i­dence, all of which have some po­ten­tial for bias.

Some of these have shown ben­e­fit from drink­ing cow’s milk; oth­ers have not.

A 2018 study from the U.S. es­ti­mated a 6 to 8 per­cent re­duc­tion in frac­ture risk from con­sum­ing cheese or milk daily. It’s not clear whether it’s the cal­cium, the vi­ta­min D or some­thing else that may be re­duc­ing risk.

Reg­u­lar ex­er­cise is an­other way to re­duce risk of os­teo­poro­sis and frac­tures.

Un­for­tu­nately, some peo­ple will still be at risk for frac­tures de­spite an ex­cel­lent diet and reg­u­lar ex­er­cise, so those at high risk should be screened, and may re­quire med­i­ca­tion.

You can re­duce your chances of need­ing med­i­ca­tion through a good life­style, prefer­ably be­gin­ning in young adult­hood.

Dear Dr. Roach: Do all cer­vi­cal can­cers come from HPV?  B.H.

Dear B.H.: One study es­ti­mated that 99.7 per­cent of all cer­vi­cal can­cers world­wide are due to in­fec­tion from hu­man pa­pil­lo­mavirus, es­pe­cially the high-risk strains that are most likely to cause changes in the cells that can be­come can­cer­ous.

How­ever, most cases of HPV are ef­fec­tively treated by the body, and do not be­come can­cer.

A few can­cers do not have ev­i­dence for HPV when they are looked at. In one re­cent study from the U.S., about 10 per­cent of cer­vi­cal can­cers did not seem to be as­so­ci­ated with HPV, but on care­ful re-eval­u­a­tion, about half of those did have an as­so­ci­a­tion with HPV.

Still, there are some cases of cer­vi­cal can­cer that are not due to HPV, and the risk fac­tors for those may in­clude smok­ing and HIV. This type of cer­vi­cal can­cer has a worse prog­no­sis than HPV-re­lated cer­vi­cal can­cer.

Pop­u­la­tion-level vac­ci­na­tion of HPV is likely to dra­mat­i­cally re­duce cer­vi­cal can­cer, but not elim­i­nate it en­tirely. For this rea­son, the Pap smear, which di­ag­noses can­cer and its pre­cur­sors, is likely to re­main an im­por­tant screen­ing tool.

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