DEAR DR. ROACH: Two years ago, at age 90, my gynecologist told me that I did not need to see him anymore because of my age. When I mentioned this to my daughter, she became outraged, and said that I need to continue my mammograms and visits to the doctor. What is your opinion? – I.W.
ANSWER: This is actually three questions in one, and none of them is easy. How long do you "need" to continue Pap smears and mammograms, and do you need to keep seeing your gynecologist?
The Pap smear question actually is the easiest, since there is very good evidence that a woman who has had normal Pap smears regularly until age 65 is very unlikely to get cervical cancer. This does not apply to anyone with a history of cancer.
When to stop mammograms is controversial. I feel that they can continue in healthy women indefinitely, but especially in the presence of some other serious disease, a woman over 75 could choose to stop.
I still recommend a regular visit with the gynecologist. Even if a mammogram or Pap smear isn't being done, the gynecologist can discuss other concerns and do an exam.
Questions about breast cancer and its treatment are found in the booklet on that subject. To obtain a copy, write: Dr. Roach – No. 1101W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: Our 48-year-old son has been diagnosed with pityriasis rubra pilaris. He is miserable with the burning, red rash and the loss of skin cells. He now has extremely swollen ankles and feet. We know this is extremely rare. Can you lend any insight into treatment of symptoms? – C.D.
ANSWER: Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease of unknown cause. Generalized redness, sometimes with islands of unaffected skin, is common. Scaly plaques and raised red bumps also occur.
There are several treatments that have been effective for some people, but nothing is effective for everybody. Vitamin A derivatives are the usual first treatment, but more-powerful medicines often are needed. As is so often the case for rare diseases, finding the most experienced local expert (in this case, a dermatologist) can lead to better treatment for your son.
I found a support group at www.prp-support.org.
DEAR DR. ROACH: Americans are infatuated with grilling, barbecuing and charring meat – all forms of high-temperature cooking. Isn't charred food carcinogenic, leading to stomach and colon cancers? – S.B.
ANSWER: Yes, charred meat is carcinogenic, at least according to the preponderance of the data. In fact, increased red meat of any kind probably increases overall cancer risk, but high-temperature cooking creates several kinds of toxic chemicals and increases colon cancer risk specifically. There is some evidence that leaner cuts of red meat aren't as dangerous, and also that marinating, especially in wine, reduces the production of the dangerous chemicals.
I recommend limiting consumption of high-temperature-cooked red meats.
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. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.
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