How To Convince A Friend To Get Genetic Testing

Dear Dr. Bone,
My friend was diagnosed with fallopian tube cancer. I remember reading your column that mentioned it could be hereditary. I want to tell my friend that she should ask her doctor to be tested, but I worry that I am invading her privacy. What do think?

E.R.


Dear E.R.,

I can see how your situation is a sticky one. On one hand you are concerned for your friend’s health and the health of her family members. On the other hand, discussing personal issues like genetic testing can seem too private. There is no one right answer. However, if you put yourself in your friend’s shoes, you might be able to figure out what to do. If she tests and is positive, she will be able to help save her children, siblings, and grandchildren from going through what she is experiencing now. If she tests negative, she will know that she did not pass on a very high risk to develop fallopian tube and other cancers related to it. Since she already has cancer, there is little downside to getting her tested.

So how do you broach the subject? It can be difficult to bring it up in a face-to-face conversation. Perhaps you can include a pamphlet on genetic testing in a greeting card. Your note should explain that you are offering this information because you care so much about her. After that, I would drop the subject and let her decide on her own what to do. To that end, I am sending you some pamphlets and you can decide on your own what to do.

Best of Luck,
Dr. Bone

Self Breast Exam

Dear Dr. Bone,

I am a good patient who goes for annual mammograms, but I do not do breast self exam.I am afraid that I won’t know what I am feeling or that I will find something. I feel guilty about it but have heard various things about how important it is to do regularly. What do you think?

M.M.

Dear M.M.

If only I had a nickel for the number of times that I’ve heard those comments! You are not alone. There are many studies pointing stressing the importance of self exam to find cancers, especially ones that do not show up on mammogram and come up between mammograms (called interval cancers). Other studies show that breast self exam does not necessarily improve survival from breast cancer or long term outcomes. My feeling is that you should try to do them, but not beat yourself up about it if you do not do them regularly. There are now kits available to improve your technique by using silicone or other liquids between to layers to improve your skill. While these may be helpful, if you can just start with soap and water in the shower and try to cover all areas of the breast and armpit it is a good start. Remember, almost every woman has some lumps and bumps. Anything hard, stuck, and painless may be important. Try to examine during the week after your period is over when the breasts tend to be less sensitive. If you are postmenopausal, just pick the first of the month or your birthday number. I liken breast self exam to moving to a new city. In the first few months you don’t know your way around, but eventually, you know the streets well and would notice if there is a traffic detour. Once you make breast self exam a habit, any changes, even small ones, will probably stand out without a conscious effort.

Having said all that, don’t cancel your mammogram! Do them both.

Dr. Bone

Please take advantage of the following videos of Dr. Melanie Bone explaining both a stand up and laying down breast self exam.

Weirdest Cancer Ever

Dear Dr. Bone,

My cousin and I were trying to figure out what type of cancer is the weirdest. Is there really cancer of the fingernail? The hair?

J&J

Cousins

Dear J&J,

Yes, you can get cancer of the fingernail. While it is rare, it does happen. Fungal infections of the nail are very common and cause deformities that have been misdiagnosed as cancer. Traumatic injuries to the nail also cause a discoloration that can be confused with cancer. The most common cancer of the nail is melanoma. It looks like a change in the color of the nail, usually tan to black. Unfortunately it can be misdiagnosed as a nail injury and overlooked. A good rule of thumb (get it!) is to wait until the nail grows. If the lesion does not go away with the nail growth, get it checked out. I suggest seeing a dermatologist.

Hair does not get cancer, but the hair follicle from which the hair grows is susceptible to cancer. Remember, in order to get cancer, there needs to be live cells that divide and a blood supply to the area. Hair has neither of these.

Keep sending more questions.

Dr. Bone

No Scary Hairy: 100% profits donated to Cancer Schmancer

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Paps and Cancer

Dear Dr. Bone,

My gynecologist wants me to have a pap smear. I had a partial hysterectomy 3 years ago and no longer have a cervix. Do I really need a Pap smear to screen for cervical cancer if I don’t have a cervix?

A.M.

Dear  A.M.,

What a smart patient you are! The pap does screen for cervical cancer. If you don’t have a cervix, you probably do not need a pap smear. If your hysterectomy was done for pre-cancer or cancer of the cervix, then I would continue to screen you with pap smears. In my residency many years ago, we were taught to do yearly paps on everyone without a cervix to find vaginal cancer. I have never seen a case. We now know that the HPV virus is the cause of cervix cancer and warts. If you are in a stable, monogamous sexual relationship or are not sexually active, then I would no longer do a pap smear. On the other hand, if you have a new partner or there is a question about your spouse’s fidelity, then I would screen you with a pap and HPV every three years (unless one or the other are abnormal). I refer you to the American College of Obstetricians and Gynecologists website for more information (www.acog.org).

~Dr. Bone.

Plastic Bottles and Cancer

Dear Dr. Bone,

 I drink a lot of water everyday and got nervous when I was sent a message on-line that drinking water out of plastic disposable bottles, especially if they are hot after being left in the car, poses a risk for developing breast cancer. I even read that Sheryl Crowe thinks this might be why she got breast cancer. Is there any truth to this?

Heavy on H20

Delray Beach

Dear Heavy,

First let me remind you that although water is healthy to drink, Americans (and many of my patients!) think that they need to drink large amounts of water each day to cleanse and “detoxify” their systems. The truth is that the human body does not need quite as much water as one would think and those people that drink water only when they are thirsty are no less healthy. I do see women who are depleted of electrolytes because they drink too much water and urinate so much that they lose potassium and sodium along the way, so be careful.

As for the association between plastic water bottles and cancer, the answer is a bit complicated.  There are different plastic bottles. The pliable ones that are designed to be disposable are made of PET (polyethylene teraphthalate), or a #1. This type of plastic is used in many different products and appears to be safe. The hard plastic bottles (like Nalgene or Lexan) are made out of BPA (bisphenol A). There is controversy about this compound. Some scientists believe that BPA acts biologically like estrogen and could promote estrogen-related cancers.

Until more definitive studies are done, it is best not to take any chances. The “green” advice is to use glass, or an old-fashioned thermos (lined with glass). It is better for the earth and, to my knowledge, glass has not been associated with any particular health hazards.

Dr. Bone

Prevention

Dear Dr. Bone,

With all the time, money and effort spent on finding cures and treatments for cancer, why is there not the same done to prevent? If we never got cancer in the first place, we wouldn’t have to cure it! You really don’t need to reply.

Reader

Dear Reader,

That is the million-dollar question. I hope to devote an entire column to it soon. Suffice to say that cancer is not just one disease. The causes are numerous. Each person’s body deals with cancer cells differently so each person would probably require a different prevention strategy. Lastly, there are already a lot of medical and charitable dollars spent on prevention. Open the paper and you will read about the dangers of excess alcohol consumption and cancer. Still, a large percentage of the population drinks too much. I don’t even need to discuss the risks of smoking. Yet we are not a smoke-free nation. The challenge for public health experts is to get America to adopt more healthy lifestyles that would not only decrease cancer, but heart disease, lung disease, diabetes and a host of life-threatening ailments.

Dr. Bone