Sun Sentinel Palm Beach Edition

Patient with risk of breast cancer questions safety of yearly MRI

- Dr. Keith Roach Submit letters to ToYour or to 628 Virginia Dr., Orlando, FL 32803.

Dear Dr. Roach: Due to a slight genetic risk of breast cancer (my Tyrer-Cuzick Model score was 20.6%), my doctor wants me to get breast MRIs with contrast annually. I am concerned about long-term exposure to the gadolinium-based contrast dye. I’ve learned that this heavy metal is considered safe, but traces of it can be stored in the brain and other body tissues.

I am 49 and in very good health. I also get mammograms annually. I consulted my doctor about spacing out my MRIs to every two to three years, but he said I should have an MRI every year. So I could be getting these MRIs for the next 35 or so years. Do the benefits of contrast dye outweigh the harm in a person with my health profile? — S.A.

Dear S.A.: I’m afraid I don’t have a good answer for you. It is true that most authoritie­s recommend an intensive breast cancer surveillan­ce program for women at a high risk of breast cancer in the range of a 20% to 25% lifetime risk. (The average risk for developing breast cancer for a woman born today is estimated to be about 13%.)

The Tyrer-Cuzick model of estimating breast cancer risk tends to give higher estimates than the other commonly used models, such as the BRCAPRO. Other models may not put you over the threshold for intensive screening with MRIs, which is usually combined with mammogram.

The question about gadolinium (the chemical element used in the contrast dye for MRIs) is important because some people do store gadolinium in various tissues, including the brain, but the clinical significan­ce of this is unknown. (People with kidney disease can develop a skin disease due to gadolinium, and so they are not recommende­d to have MRIs with gadolinium.)

Although gadolinium can stay in the body for months or years, there has been no evidence of harm from gadolinium in brain tissue, despite these agents having been used for many years. Some agents have less retention than others. The U.S. FDA has mandated patient guides for these contrast agents, which relay the above informatio­n.

Given that there is a probable benefit to intensive screening for breast cancer in your case, due to your high genetic risk, and no more than a theoretica­l risk from gadolinium, I believe that the benefits outweigh the risks, but I can’t say that with complete certainty.

Dear Dr. Roach: A friend gave me a hemp product to try on the quite painful arthritis in my fingers, which affects my ability to enjoy golf. I was reluctant to try it, but for the last two weeks, I’ve used it topically on my fingers and have been pleasantly surprised by a significan­t reduction in pain and an improvemen­t in flexibilit­y.

One of your recent columns mentions Voltaren, which I have also used, but without as much relief. Can you comment on CBD as an alternativ­e treatment for arthritis? — P.H.A.

Dear P.H.A.: There are animal studies suggesting benefit from oral cannabidio­l, a component of cannabis (hemp) that has no psychoacti­ve component (it’s the THC in cannabis that gets people “high”). I found some small studies showing pain relief from topical CBD in people with neuropathy, but not for arthritis. Several people, like you, have written to me with reports of pain relief.

Topical CBD is probably very safe. Even oral CBD should be safe, but studies have found that many products labelled CBD have trace, or more than trace, amounts of THC, enough to make a urine test positive for cannabis.

Until there is some evidence of effectiven­ess, I can’t recommend it, but people can try it based on safety and anecdotal reports.

 ?? ??

Newspapers in English

Newspapers from United States