DEAR DR. ROACH: You have written about screening for breast cancer, but are there any ways to prevent breast cancer in the first place? — T.C.
ANSWER: There are three behaviors that are well-accepted to reduce the risk of breast cancer. Breastfeeding is one, and it’s so good for the baby that we might forget that it has long-term advantages for moms, but add reducing the mother’s breast cancer risk to the list. The second is dietary phytoestrogens, compounds such as soy isoflavones and lignans, which are found in soybeans and other legumes. This data is most clear among Asian women. Finally, regular physical exercise reduces breast cancer risk, especially for women after menopause.
Other dietary factors, such as a diet high in fruits and vegetables and low in meat and saturated fat, may reduce risk of breast cancer, but this isn’t proven. Studies are ongoing to examine whether vitamin D or omega 3 fatty acids may reduce risk, as suggested in previous studies.
For high-risk women, consider chemoprophylaxis with a SERM or aromatase inhibitor, and also a more-intensive screening program.
DEAR DR. ROACH: I went to my ENT doctor in January complaining of muffled hearing and a loud, high-pitched noise in my left ear. He gave me a hearing test, and it showed 50 percent loss. I had an MRI and was told that I have an acoustic neuroma on my left side. This has caused me to go 50 percent deaf in my ear. The ENT doctor wants me to wait six months and see if it grows more, which I don’t want to do because I feel it should be taken out while it is small.
The choices I have are to watch and wait; to have traditional surgery; or to have surgery with gamma knife or cyber knife. I would really like to just get this done and have it taken out before it causes more problems, like affecting my facial nerve, balance nerve or if it gets too close to my brain stem. I also am worried that I may go completely deaf. I am getting a second opinion next month from a neurosurgeon. What are your thoughts on all of this? — B.D.
ANSWER: An acoustic neuroma, also called a vestibular schwannoma, is a type of non-cancerous tumor on the eighth cranial nerve, which is responsible for hearing and balance.
These tumors usually are treated, although some authorities recommend a watch-and-wait approach if they aren’t bothering the patient, if the patient is a poor candidate for surgery or if the patient is otherwise reluctant. None of these seems to apply to you, so I would recommend proceeding with the second opinion, the neurosurgeon, whom I think is likely to recommend treatment. Progressive hearing loss is a clear indication that treatment likely would be beneficial sooner rather than later.
All the treatments you mentioned are reasonable. Cyber knife and gamma knife are ways of delivering radiation to the tumor. Since any of these can achieve the goal of preventing the tumor’s growth and any worsening of symptoms, the choice should be left to the expert.
Dr. Roach regrets that he 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 Good Health, 628 Virginia Drive, Orlando, FL 32803. ©2017 North America Synd.